Dana's Low-Carb for Life (Podcast)
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My Encounter With The New Doctor
Submitted by Dana on Wed, 2011-02-09 13:27
As I mentioned in my most recent podcast , I saw a new doctor yesterday. His name is Dr. Andry. I found him by googling "Bioidentical hormones Bloomington IN." I'm 52, and I was concerned about my estrogen levels. About 18 months ago, my primary care physician and I had hormone tests run. They showed I was estrogen deficient, and yet estrogen dominant -- ie, not enough estrogen, but considerably more estrogen than progesterone. They also showed that my testosterone levels were remarkably high. That didn't surprise me. I've long suspected I had high testosterone for a woman. Those of you who have listened to the podcast or my interviews know that I have a very deep voice. I've also always been aggressive -- not mean, just aggressive, willing to to start conversations, willing to take the initiative, willing to speak my mind.
Anyway, I was thinking maybe I needed estrogen, too, and my primary care physician simply felt she wasn't well-versed enough in bioidentical hormone therapy to advise me and prescribe. Hence, my googling.
So I saw Dr. Andry, and was exceedingly impressed. Super-smart guy, very nice. Runs an insurance-free practice, so I had to pay out of pocket for my consultation, but he spent more than an hour with me, really going into my history and current health status in depth. He was very pleased to learn I'm a low carber -- he's been low carbing since 1999, and recommends the diet unreservedly, especially for patients who need to lose weight or have blood sugar problems. He knows a number of the members of what I call The Low Carb Mafia -- Dr. Eric Westman, Dr. Mary Vernon, etc; even knew Dr. Atkins. (I need to take Dr. Andry a cookbook!)
Anyway, he doesn't think my problem is estrogen per se. He thinks it's insulin, and the effects of insulin on estrogen utilization. Indeed, he thinks I have a form of PCOS -- polycystic ovarian syndrome. I have long suspected that I was an undiagosed diabetic, or at least pre-diabetic, by the time I went low carb. I know that I have to keep my carbs very low to keep my weight off; I rarely go above 25 or 30 grams a day these days. I've also had slightly elevated fasting glucose on arising; I've seen it as high as 112. That last worried me, but since my A1C -- the "snapshot" of blood glucose over time -- was healthy, I didn't dwell on it. It had never occurred to me, however, that I might have PCOS. My periods had always been regular, I hadn't had the thinning hair or acne that can accompany PCOS, none of that. But Dr. Andry says that the name is misleading, and it really ought to be called something like "insulin-driven sex hormone derangement syndrome."
Dr. Andry is convinced that my liver is over-producing glucose -- you know, that gluconeogenesis thing that means we don't need to eat carbohydrates to have enough glucose in our blood -- and that glucose is driving elevated insulin levels. I know I'm insulin resistant; that's a given. All of this is skewing my testosterone high, and my estrogen low. It would also explain why I have only been able to get my weight down so far, and no further, you know?
Anyway, Dr. Andry has put me on a modest dose of metformin, an old-school diabetes medication that both improves insulin sensitivity and slows glucose production in the liver. (Interestingly, metformin is the only diabetes medication that Dr. Mary Vernon and Jackie Eberstein recommend in The Atkins Diabetes Revolution.) This should drop my insulin levels, and help straighten out my other hormones. That it may also let me drop a few more pounds is a not-unwelcome possibility.
I will, of course, keep you posted.
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Metformin update?
Hi Dana,
Just discovered your podcast (great job!) and heard about your Metformin adventure.
Do you have any Metformin updates? What dosage are you up to?
Thanks,
Lisa
Have you considered trying
Have you considered trying something like this?
http://www.enzymatictherapy.com/Products/Heart/Blood-Sugar/04906-Blood-Sugar-Manager.aspx
I just found out two things: I'm insulin resistant and I'm not ovulating. I have no (other) pcos symptoms. I'm trying to figure out which one is the chicken and which one is the egg. Doctor wants me on progesterone, but my serum level was normal. I was offered metformin but my fasting and 2hr glucose are normal. Just my fasting insulin is high. I'm going low-carb to see if I can fix this with diet.
Metformin
I was thinking Metformin as I read your post and was going to suggest it when I saw that your doc has prescribed it. Good on him! I've been on it for 6 months now and it really took my appetite away. I lost 20 lbs pretty easily and I can eat a TON of carbs. Now you might not think that is a good thing, LOL. Used to be that I could only lose weight on 20 - 25 carbs per day max!
It can really mess with your stomach unless you start with a small dose (500mg) and gradually increase. I'm taking 2000mg per day now. No hunger, more energy. Gee, this must be what "normal" people feel like.
Met helps your insulin work better, therefore, the energy (sugar & amino acids) that weren't able to get into the cells previously, are now able to. It's like the missing link. I think you will lose weight and feel better. Good Luck!
Local Doctors
I live in your area, Dana. I love that we have such knowledgeable LC advocate in Bloomington! Your description and experience sounds much like my own. Dr. Andry sounds great, but I can't do the "no insurance filing/pay up front" thing. Are there any other doctors you could suggest?
Other doctors?
My primary care physician is Dr. Beth Florini, and I think very well of her. She's at Landmark Family Practice. She's not low carb herself that I know of, but then she's always been slim. (I knew her when she was an undergrad.) She's certainly okay with my low carbing. She also is okay with my strong tendency to self-diagnose; I never get the "Where did you go to medical school?" line. And she's one of those rare doctors who's hip about thyroid.
Bioidentical Hormones
Best of luck and keep us updated on how it goes. I started seeing Dr Jeff Dewester in Greenwood, IN for something similar a couple of years ago. Estrogen and progesterone were fine, but testosterone was almost literally zero. Same diagnosis, but I get testosterone pellets now and have been on Metformin and low carb diets ever since. Feeling much better. I dropped about 30 pounds initially and I think I could drop another 10 or 15 lbs of abdominal fat if I could keep the carbs lower. I have been known to stray into the land of baked goods from time to time before finding my way back. I would like to know how it goes with your doctor because I'd like to know that I have a back-up if needed.
Bio Dentical Hormones
I started the Bio Dentical Hormones last year. I am 53 and was having trouble sleeping at night. I was irritable, night sweats, etc. I had the saliva testing done and all of my estrogen, testosterone, etc. were off. I am taking progesterone cream and took different pills. I have been low carbing since last Feb, but after 45 lb loss, I can't lose anymore. I wonder if I am having the same problem. I still weigh 250. UGH!!!!
Metformin
I'm a 26-year diabetic and, as I was reading your post I thought, "Perhaps some Metformin would help." I've been on it for years - its very safe for almost everyone, though some long time users experience a deficiency in B12. It worth checking your levels annually. Also, the dose they start you on is often not therapeutic - its just to get you started and make sure you have no initial GI problems as beginning users sometimes do. However, since you are not actually diabetic, a smaller dose may accomplish what you are looking for.
Do you ready the Diabetes
Do you ready the Diabetes Update blog? It's written by Jenny Ruhl, and she has a lot of wisdom to share on Metformin for insulin resistance, based on her insightful reading of the diabetes and research literature.
Cinnamon
I read somewhere that cinnamon was supposed to help with insulin resistance. I think I read it on a diabetic's blog at some point. I think they said they were taking a teaspoon or so before meals and it helped their glucose be more normal after they ate. They were doing low carb too. Might be something to look into.
Cinnamon
Yes, cinnamon is a hypoglycemic. It also has some sort of toxic thing in it, if you take a lot regularly (I forget the name and don't feel like looking it up.) Not dangerous if you use it to season stuff here and there, but apparently could be if you gulp the stuff a couple of times a day, every day. The good news is that the medicinal principle is water-soluble, and the toxin is not. So you can get some of the benefit by just putting a cinnamon stick in your tea, that sort of thing. But I don't like cinnamon tea. :-/
You can also buy cinnamon extract capsules specifically for this purpose. For now, I'll stick with what Dr. Andry is suggesting, but I'll bring it up when I see him again.
Best of luck with it!
Best of luck with it! Metformin can cause some stomach upset, even at small doses, so if you have problems tolerating it, ask your doctor for the extended release version. That is a bit easier to tolerate.
Metformin and stomach upset
Not knowing this, I took my Metformin first thing this morning on an empty stomach, along with my thyroid and all. No problems today, at any rate.
Welcome to the Family
Well, may I humbly suggest TuDiabetes for all of the support you can handle? http://tudiabetes.org
There are a LOT of people out there that are in your position that would love to give you the help you need.
Support
But I have support! What do you think you guys are? :-D
Interesting...
Interesting medical stuff, Dana!
I'm a T2 diabetic and control it through diet and exercise - and I also take GTF-Chromium, alpha lioic acid, magnesium, CoQ-10, asian bitten melons, blueberry and prickly pear cactus.
All of those keep my blood sugar under control.
PCOD
Now with this diagnosis - welcome to the true world of diabetes - you might want to start regularly testing BG with a meter watch out for all the hidden "sugars" maltodextine etc (test every 30 minutes for several hours with foods containing these )to see what it does to you -- you may also want to start counting all carbs and not subtract fiber -- diabetics (and insulin resistant is diabetic) react differently -- I would also suggest that you look at Dr. Bernstein's Diabetic solution
And THANK YOU - we had a great dinner last night - caulirice and your Citrus Spice Chicken from the slow cooker recipes -- your books are a life savor for me!
Nancy
Yes, do keep us posted! This
Yes, do keep us posted! This is fascinating information... as I have PCOS myself, and a family full of diabetics. I, too, have found that I must keep my carbs VERY low (no more than 40 grams a day) to keep weight off, and when I am in a nice low-carb groove, even one bite of something sweet will make me literally sick to my stomach.
Good heavens, I love science.
Hormones
This is so interesting, Dana. Glad you were able to find a doc you like (so far) and who's in line with your beliefs and ideas. It makes me think about getting my hormones, etc. checked out. I lost 20 lbs last year from about May to August, and since then, I've lost nothing more, despite eating low carb. I'm also toying with the idea of getting a thingy to check my glucose levels (glucometer?). Thanks for all your interesting info!
Glucometer
Do get a glucometer. They're really oddly fun, for values of "fun" that include sticking holes in your pinkies. I got my first glucometer because I wanted to test various low carb products to see if they were as low carb as they claimed. Really became pretty fascinating, you know? Just wish the strips were cheaper. My best advice to you is to buy mostly based on the price of replacement test strips.
Make sure you're pricking the
Make sure you're pricking the SIDES of your fingers, not the tips where all the nerve endings are. Much, much less painless and easier to do on a regular basis.
I'm type 1 and test 12-15 times a day, so minimizing pain is important to me.