Hormonal Barriers Obesity

7/29/2019 Hormonal Barriers Obesity

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. Matthew Andr MDIU Health Bloomington

MDWeightWoRxBeWell Grant-Centerstone



2. Physical Activity

.

4. Medical Treatment

.

2. Endocrine/Hormone management

3. Ps chiatric treatment



’

Com liance

Readiness

Medications

Saboteurs

Discipline

Evolution???







We have the SAME genetics as those whose geneswere selected for in a “calorie poor” environment.

It believes there will be a famine tomorrow

No “Weight Set Point.” The heavier the better

Energy “Savings Account”



-

Not about Body Building

’

Not about maximizing hormone levels

’ -approximating “normal”/optimal function indisordered bod s stems

“Too much” can be just as bad as “not enough”





$$$

CALORIES

SocialTIME!!

IN

Ps chMetabolic

(Hormones)



Insulin Leptin

NPY

Ghrelin Glucagon

Amylin

c…



10%

20 PHYSICAL

70%

ACTIVITY

RATE

CALORIES

OUT



Obesit is a result of ener imbalance. Loss of

Homeostasis. Hormones are substances released from

speci ic p aces in t e o y to cause speci iceffects in different tissues

“ ”

Innumerable hormones involved with weightmana ement.

Improper hormone balance can be a majorcause of weight gain and hinder weight loss.Pro ems arise rom too muc an too itt e.



Thyroid

Testosterone



Require high levels of insulin to controllucose.

This causes a reflexive hypoglycemia and leads

to overeatin , es eciall of carboh drates



Glucose & Insulin Levels in Insulin Resistance

Glucose Insulin



Hypoglycemia Hyperphagia/carbohydrate cravings

Cortisol release

Increased Fat Storage (incr. lipoprotein lipase) Fatigue

Disrupts other hormone systems



Delayed rise in glucose due to prolonged digestion Gives insulin more time to work at lower levels

Exercise

Pushes glucose into cells Increased muscle mass improves Insulin Sensitivity

Medications

Metformin, Januvia, Vytorin, Byetta



Bi uanide. Used for over 50 ears

Can treat AND prevent Diabetes Decreases diabetes risk by one third!!!

Mechanism: Drives glucose into cells and

inhibits glucagon conversion on glycogen to.

Have to have healthy kidneys

Treatment of choice in Insulin ResistanceS ndromes



anuvia On l za Trad enta et al.

DPP4 inhibitors DPP4 is an enzyme that breaks down GLP-1

They increase GLP-1 Activity

GLP-1: an incretin: released from the gut afteroo n a e o ass s appropr a e nsu nrelease, inhibits glucagon, and SLOWSGASTRIC EMPTYING.

Low risk for hypoglycemia

Safe but subtle and ex ensive!



“ ”

These are ANALOGUES of GLP-1. , ,

loss, Expensive

Can cause lots of Nausea and vomitting ifclient overeats

Low risk for hypoglycemia



Energy/Glucose Utilization, Body Temperature,Catecholamine sensitivity, Heart Rate, Fatutilization, Growth, Memory and Concentration

Produces T4 (which the body converts to T3) Production controlled by the pituitary gland

and its release of Thyroid Stimulating



Low Th roid can be a ma or barrier to wei ht

loss. Low Thyroid Symptoms:

Cold Intolerance, Low BBT

Goiter (from TSH overstimulation)

Menorrhagia

Edema

“Brain Fog” Heart arrythmias

epress on



Hashimoto’s is Most Common Assessed b levels of TSH lon er half-life than

T4 and T3)

Problem: What is a “normal TSH??” Major debate in Endocrinology currently

Normal values 0.34 mIU L to 5.6 mIU L

What is an Optimal TSH?

Probabl less than 2.0 Some sa less than 1.0



Iodine Supplementation Synthetic T4 (Synthroid)

Synthetic T3 (Cytomel)

Natural Thyroid (Armour) Compounded Formulations (specific ratios,

individualized per patient)



Osteoporosis and Osteopenia Dexa Scans, NTx Ratio

Cardiac problems, arrhythmias, cardiomyopathy

Wasting of lean tissue Anxiety

Tremors



Imbalances in E and P are common during thiseriod.

Estrogen Dominance very common



New Name?

Insulin Related Sex Hormone Dysfunction Extremel common 4-12% of the o ulation.

(much higher for sub-acute forms)

Leading hormonal cause of infertility High insulin increases GnRH pulse frequency,

raising LH, lowering FSH.

Waldstreicher et al. 1988 Morales et al. 1996

MacArthur et al. 1958, Yen et al. 1970



Weight Gain Anovulation

Acne

Hirsutism Insulin Resistance/Hyperinsulinemia

Edema

rregu ar pa n u per o s Infertility





PMS-type symptoms

Edema

Insomnia



approach menopause. Often P falls farther faster than E. Es eciall if

excess adipose tissue, which produces E)

Occurs des ite monthl c clin .



Women’s Health Initiative

At least safe, at best, effective for breast cancer



Think PMS More Serious Risks

Headaches (migraine) Fluid Retention

Endometrial/BreastHyper plasia

Breast Tenderness

Weight Gain (hips)

varian ysts

Insulin Resistance

a gue

Anxiety Endometriosis

Fibroc stic Breasts

Dysmenorrhea

Decreased Libido

Infertility Blood Clots



Weight Loss High Fiber Diet

Reduce insulin resistance

Avoid extrinsic Estrogens: soy, chemicals, pesticides

Replace/Augment Progesterone itself

Can use progestins (but have significant risks) Natural progesterone



Males lose about 3% Free T er ear after 40.1

Functions pertaining to weight: Increase lean mass, decrease body fat

Increases insulin sensitivity

Deficiencies lead to fat accumulation, insulin

Can increase appetite

Debate on what are “normal” levels

–. , , – .



WHI: 2002. Stopped early due to 0.3%/yr riskincrease in breast cancer for women takinPremarin and Provera.

Millions of women told to sto hormones Instructed “smallest dose for shortest time”

Results were extra olated to all hormones

Why??? Not evidence based to do so.



April 2011 JAMA2011;305(13):1305-1314.

Health Outcomes After Stopping Conjugated

Women With Prior HysterectomyAndrea Z. LaCroix, PhD; Rowan T. Chlebowski, MD, PhD; JoAnn E. Manson, MD, DrPH; Aaron K. Aragaki, MS; Karen C.

ohnson,MD,MPH; Lisa Martin, MD; Karen L. Mar olis, MD, MPH; Marcia L. Stefanick,

PhD; Robert Brzyski, MD, PhD; J. David Curb, MD, MPH; Barbara V. Howard, PhD; CoraE. Lewis, MD, MSPH; Jean Wactawski-Wende, PhD for the WHI Investigators



HRT is it safe?

April 2011 JAMA2011;305(13):1305-1314.

Estrogens Among Postmenopausal Women WithPrior Hysterectomy

Andrea Z. LaCroix, PhD; Rowan T. Chlebowski, MD, PhD; JoAnn E. Manson, MD, DrPH; Aaron K. Aragaki, MS; Karen C.ohnson MD MPH Lisa Martin MD Karen L. Mar olis MD MPH Marcia L. Stefanick PhDRobert Brzyski, MD, PhD; J. David Curb, MD, MPH; Barbara V. Howard, PhD; Cora E. Lewis, MD, MSPH; Jean Wactawski-Wende, PhD for the WHI Investigators

Premarin only over placebo

ew u e nes



Multiple New Agents ,

Risks: irritability, erythrocytosis, elevated

No evidence it causes Prostate Cancer. Somethat it decreases it. Can make an active cancer

grow faster Will raise E2 levels as well, close monitorin



In oun er males <45-50 , can use a ents toincrease endogenous Testosterone production

omi rima ex Clomid – a SERM. Raises LH and FSH

Arimadex – Aromatase inhibitor raises LH

HCG (Human Chorionic Gonadotropin)

Functions like LH in the male Increases T production, partial estrogen reducer

Tends to cause wei ht loss h othalamic moa??



C closet.

New medication for diabetes. Increases DA activity in the hypothalamus Moves lucose into cells Improves pp glucose w/o increasing insulin! Seems to increase glucose utilization

particularly helpful in circadian misalignment (night shiftworkers).

Scranton, et al, BMC endocrine disorders 2007 Jun 25;7:3

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Hormonal Barriers Obesity