PCOS Messages for February, 2002: Re: argument

Re: argument

From: Belle (anonymous@obgyn.net)
Mon, 25 Feb 2002 00:40:25 -0600 (CST)

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I would like to answer some of your concerns.

There have been multiple posts on exercise and low carbing. Nearly every day, I see and/or answer posts on these aspects of PCOS management. No one here is belittling the benefit from these avenues. I believe that you will find that I stated that I would not recommend Glucophage for some people in the post that you mentioned from Feb 4, 2002. I have linked it below. I would like to remind you however that the study you have brought up indicating that diet and exercise are better than metformin was not done only on women with PCOS. The diet and exercise would work better on people who are having problems due to lifestyle more than people who are geneticlally predisposed to having insulin resistance.

As far as brand goes, metformin was not available in the states until two weeks ago. Glucophage was our only source of metformin hydrochloride. There is the possibility that the brand name Glucophage has been used more frequently because of that, it is all we had. I do not recall anyone being asked to leave if they did not use metformin. I do recall asking people to do research on PCOS, mainly because some of the questions have very long answers and it takes so long to type them out.

This board was designed specifically for the purpose of discussing PCOS. The rules are posted at http://forums.obgyn.net/pcos/rules.html . Even given that, I am not aware of any diabetes related question that has been ignored here. I am aware that not everyone here has experience with diabetes and therefore may not be comfortable with answering these questions. I also do not read every post. If the title does not strike me, I skip it. Perhaps I have missed some diabetes questions in that way. I can only assume that other women are in the same position.

I have not seen reliable research in a number of years that indicate that there is another cause of PCOS. Perhaps you are thinking of the two different sources of androgens.

This post that you refered to from Feb. 4 is linked here: http://forums.obgyn.net/pcos/PCOS.0202/0050.html . In that post you will see that I stated that I would probably not read those articles because I had other things on my plate and since I was not interested in preventing pregancy, I would not be likely to take the time to look these articles up. You did not give links and those articles were from 1995 and 1997. Both of those issues were in the stacks in the back of the research center where the librarians had to retreive them. I did end up looking at these articles, but it took away alot of time from my family. In the end, both of these articles support the fact that women with PCOS should not use oral contraceptives.

In the Journal of Clinical Endocrinology & Metabolism, Vol 80, 3327 - 3334 Copyright 1995 by MT Korytkowski, M Mokan, MJ Horwitz and SL Berga, from the Division of Endocrinology, University of Pittsburgh School of Medicine, Pennsylvania 15213, it does *not* say that insulin resistance decreased, it says that ISI (insulin sensitivity index) decreased. We need insulin sensitivity to *increase* that is what metformin does for us. The actual abstract for this article states that "In women with PCOS, an increase in insulin concentrations during hyperglycemia accounted for the decline in ISI (P = 0.026), whereas in control women the decrease in ISI was attributable to a decrease in glucose disposal (P= 0.004). In conclusion, PCOS is characterized by insulin resistance in the untreated state. Short-term therapy with a triphasic OC results in a further decline in ISI in women with PCOS, without inducing additional adverse effects on lipids." This means that our insulin problems became worse. This study was done specifically on triphasics. This also shows the different ways that women with PCOS react from women without PCOS. Our bodies are different and we need to recognize that.

The other article that you listed: The Journal of Clinical Endocrinology & Metabolism Vol. 82, No. 9 3074-3077 Copyright 1997 by Shahla Nader, Maggy G. Riad-Gabriel and Mohammed F. Saad (A multi-team study with reprint requests to be sent to Shahla Nader, M.D., Dividion of Reproductive Endocrinology, University of Texas medical School, 6431 Fannin, Suite 3.036, Houston, Texas 77030) states specifically that "Glucose tolerance deteriorated significantly, and two women developed diabetes."

Perhaps there is some confusion about the terms used in these research articles. We want our insulin sensitivity to be high. Our cells do not accept the insulin as well as they should. This means that insulin sensitivity is low. We need our glucose to be used readily. We need our glucose tolerance to be optimal. Sometimes research articles can be difficult to understand.

You are correct that I can only give information based on what I have been told and I may not get the whole story. This is the reason that I try to give thorough responses to all of the questions that I answer. I do not think anyone here will accuse me of having answers that are too brief.

I hope this answers some of the questions that you brought up.

PCOS is not fun for anyone and everyone needs help in their own way. Researching and learning about this disorder is really the only hope that we have to determine if we are getting adequate health care. Once we have the information, we must act in order to reap the benefits of that information.

-- Belle

At Sun, 24 Feb 2002, Victoria wrote: > >I also have been quite honest in the bias on the pushing Metformin here. >Metformin is an excellent choice for PCOS. However, I didn't see anywhere that >said when I joined this list, that this is a 'you must believe that PCOS = IR you must take Metformin or you aren't making the right/correct choice for your >health' list. That is the impression I'm getting. Maybe obgyn.net should make a >public statement about the direction of the list, whether only one brand/belief >or type of treatment for PCOS is welcome or not. If not, then it is fair to ask >that all attitudes and treatment methods be accepted here. That means that just >because someone else has a different treatment or method, they aren't told to >leave, are told don't know what they are talking about, or are wrong because it >doesn't match up with some elses'. > >Other lists do present questions that are off topic and they get answered. The >diabetic and PCO newsgroups have had NIIDM/PCOS questions posted and answered >before, no problem. If this isn't a list for diabetic experts, then why are we >putting so much emphasis on Metformin and prevention of Type II diabetes? Surely >some ladies on here are NIDDM and have ties in both areas. Kristy could have >been told up front that that was a question best answered elsewhere. Why not? > >In a head to head battle, in a resource I have put across before, diet and >exercise beat Metformin from 58% to 31% in the prevention of Type II Diabetes. >So if we all want the best for each person, shouldn't we also include more low >carb diet information, more support for those trying to manage diet and >exercise, not just taking a pill? If diet and exercise beat Metformin, then that >does indicate that there are possibly other factors at work that affect our >ability to get NIDDM, or that Metformin is not what we originally thought it >was. > >It is correct in that we are not sure what the direct cause of PCOS is. Although >an insulin problem is the most likely explanation at this point, there was >discussion on another list about the possibilities of two different causes of >PCOS. > >As for the comment on people unwilling to read research papers, please check the >Mon, 4 Feb 2002 00:40:12 -0600 (CST) posting on Re: BCP (changed subject line). >Belle wouldn't read my references that did offer a different viewpoint on BCP. >We all complain about medical healthcare professionals that won't read our >literature to give us Metformin, however its ok when Belle won't read other >literature on the safety of BCP, but Kristy got negative comments for not >reading the articles here. In speaking with some of my health professional >friends, >

She >probably has not gone over everything in her medical history to really give >Belle enough info to make a judgement on her situation. In fairness to both >Kristy and Belle, if Belle doesn't know the history, Belle can't make a >recommendation, anymore than a doctor can only getting part of the story. > >-- >Victoria >

-- Hope this helps,

Belle

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