Kubvunzurudza naKent Holtorf, MD
Kent Holtorf, MD ane nhoroondo refu yekushanda nevarwere vane uwandu hwemhomoni - kusanganisira utachiona, adrenal, uye mahomoni ekubereka. Anomhanya kuHoltorf Medical Group muCalifornia, kwaanonyanya kugadzirisa zvakanyanya endocrine kudzvinyirira, kusanganisira hypothyroidism , adrenal insufficiency, uye insulin kudzivisa.
Dr. Holtorf ave achishanda nevarwere vake vakawanda - vakawanda vavo vane utachiona husingagadziriswi - avo vakaona zvakaoma kana kuti zvinoita sevasingagoni kuderedza uremu.
Zvaakawana ndezvokuti kunyange zvazvo pane zvinhu zvakawanda zvinobatanidzwa mukushaya kukwanisa kuora muviri, zvinenge zvese kuwandisa kwepamusoro uye varwere vanopfurikidza avo vanobata vane zviratidzo zvemagetsi uye endocrinological dysfunction izvo zvinokonzera kukura kwezvinetso zvevarwere ava. Kunyanya, Dr. Holtorf, akatevedzera zvimwe zvekutsvaga, akatsunga kuongorora maviri mahomoni makuru - leptin uye kushandura T3 (r3) - uye kurapa chero zvikanganiso zvakarongeka kubatsira varwere vake kushaya uremu.
Ndiri kufara kuti ndikwanise kukuunzai mubvunzurudzo iyi naDkt. Kent Holtorf, muchikurukura nzira dzake dzekubatsira varwere vehutano kuti vawane nguva yakareba yekurema kwemairi .
Mary Shomon: Wati iwe unonzwa kuti maviri mahomoni makuru - leptin uye anoshandura T3 - vari kutamba basa rinokosha pakuronga uremu uye metabolism. Unogona kutiudza zvishoma nezve leptin, kutanga, uye chii chine chokuita nekurema kwekutapedza matambudziko?
Kent Holtorf, MD: The hormone leptin yakatorwa kuva mutungamiriri mukuru wehutano hwemuviri uye metabolism. Leptin yakavanzwa nemasero ane mafuta uye mazinga eLeptin kuwedzera nekuunganidza kwemafuta. Iyo yakawedzera kuvhara reptin iyo inoitika nekuwedzera kuwanda zvinowanzopa zvokudya-kudzokera ku hypothalamus sechiratidzo chokuti kune simba rakakwana (mafuta) zvivako.
Izvi zvinokurudzira muviri kupisa mafuta pane kuramba uchichengetedza mafuta akawanda, uye inoita kuti utachiona ubudise hormone (TRH) kuwedzera utachiona hunokurudzira hormone (TSH) uye utachiona hunogadzirwa.
Zvidzidzo zviri kuwanikwa, zvisinei, kuti vazhinji vevanhu vanorema kudarika vari kuomerwa nekuderedza ureve vane maitiro akasiyana-siyana e-leptin resistance, apo leptin ine simba rakapera rekukanganisa hypothalamus uye rinodzora kushandiswa kwemagetsi. Izvi zvinokonzerwa neptin inokonzerwa ne hypothalamus inonzwa nzara, saka nzira dzakawanda dzinoshandiswa kuwedzera mafuta emafuta, sezvo muviri unoyedza kuchinja kuonekwa kwekushaya nzara.
Nzira dzinoshandiswa dzinosanganisira kuderedzwa kweTSH kuvhara, kubviswa kweT4 kusvika kuT3 kutendeuka, kuwedzera mumharaunda yeT3, kuwedzera kwechido, kuwedzera kwekuchengetedzwa kwe insulin uye kuvharwa kwemapolysis (mafuta kuputsika).
Aya maitiro angave ari chikamu pamusana pokuderedza-mutemo weeptin receptors inoitika nekuwedzera kwenguva refu muLeptin.
Mugumisiro? Kana uchinge wakanyanyisa kudarika nguva yakareba, zvinowedzera kuoma kurasika.
Mary Shomon: Wati iwe unonzwa kuti maruva eptin kumusoro kwe10 anogona kupa chirongwa.
Iwe unogona kutsanangura zvishoma nezvemaji eptin?
Kent Holtorf, MD: Vazhinji vanoremekedzwa kana vanowanzorema vane vanhu vane leptin mazasi pasi pe10, kunyange zvazvo mabhii makuru mazita akawanda achashandisa rondedzero ye1 kusvika ku55 yevarume uye 4 kusvika ku25 kuvakadzi. (Inofanirwa kurangarirwa kuti urongwa huno hunosanganisira 95% yevanhu vanonzi vanhu vanowanzogara uye inosanganisira vazhinji vane uwandu hwepamusoro.) Vanenge vose varwere vane hutano hwakanaka vachange vane leptin pasi pe10.
Mary Shomon: Iwe unobata sei kupomerwa kweLeptin muitiro wako?
Kent Holtorf, MD: Kurapa kunogona kuisa pfungwa pakurapa yakakwirira yeLeptin - leptin resistance. Imwe leinin yakakwirira inoratidzawo, zvakadaro, kuti TSH ndiyo chiratidzo chisingavimbiki chetachiona hwehutachiona , sezvo TSH inowanzodzingwa, pamwe chete nekuderedzwa zvikuru T4-kusvika-T3 kutendeuka.
Muchidimbu, kana leptin yako ichikwiridzirwa, wakaderedza utachiona hwehutachiona. Uyewo, vanenge vose vane chirwere cheshuga vanorwara neptin, iyo yakaratidzwa kuderedza T4-kusvika-T3 kutendeuka muvanhu vane chirwere cheshuga nekusvika 50% pasina kuwedzera kweTSH, zvichiita kuti zvive zvakaoma kurudzi rwechipiri diabhesi kuti rurege kuwanda.
Nemhaka yokuti kune varombo T4-kusvika-T3 kutendeuka, nguva-yakabudiswa T3 ndiyo yakanakisisa kurapwa - kunyange T4 / T3 mishonga pamwe chete yakadai seyakasikwa yakasikirwa nehutachiona (NDT) inogona kushandiswa.
Isu tinotarisa kusara kwemaitiro emagetsi (RMR) muvarwere vedu, uye zvinonakidza, avo vane marefu eptin anoratidzira anoratidza kumira kweeptin vane RMRs inogara iri pasi pemazuva ose. Varwere ava vanowanzopisa 500 kusvika ku 600 makoriki pasi zuva rimwe nerimwe kupfuura mumwe munhu akaenzana mumuviri.
Nokudaro, kuva nemukana unonzwisisika wekurasikirwa, varwere ava vanogona kuedza nekuderedza makorikori nemazana mashanu kusvika 600 pazuva (kungozvidzivirira kubva pakuwana uremu), kurovedza kweawa kana maviri pazuva (kungoita kuti urege kubva kuwedzera kukura ) kana kuti kuisa utachiona hwetachiona uye metabolism.
Vanhu vanhu vanobudirira chaizvo nokuti tinogona kuchengeta simba (mafuta) zvakanaka. Kune nzira dzakawanda dzekudzivirira uye retainin kukanganisa ingo imwe chete yadzo, saka tinoshandisa nzira ye multisystem; hapana mumwe magetsi bullet, kunyange zvazvo chero kurapwa kumwe kunogona kuita zvinoshamisa kune mumwe murwere.
Kuwedzera pakugadzirisa utachiona (yeuka, kupa utachiona hweHormon kuti uremerwe uremu hahusi kukodzera, asi handizvo zvatiri kuita, apa tiri kugadzirisa kukanganisa), Symlin (pramlintide) uye / kana Byetta (exenatide) inogona kuva yakabudirira kune vakawanda. Munhu Chorionic Gonadrotropin (HCG) ndeimwe nzira inogona kushandiswa iyo inoshanda kune vamwe. Kunyange zvazvo ndaona kuti Wellbutin inopesana nemanzwiro (bupropion) isingashande zvakanaka pakurasikirwa nekurema, kusanganiswa kweWelbutrin uye pasi-dose naltrexone (LDN) kune zvimwe zvinogutsa zvakanaka. Topamax (topiramate) isarudzo kune vamwe asi haisi nguva dzose inoregererwa. Chirwere chekudya chinokonzera kudya, icho chinokurudzira kushandiswa kwemagetsi, chinogona kushandiswa, kunyanya kana RMR iri pasi.
Mary Shomon: Symlin na Byetta vanowanzodikanwa majekiseni akawanda pazuva, izvo zvinogona kuvhiringidza vamwe vanhu kuti vasazvitora. Mishonga iyi inogona kuva nedambudziko rakaoma kune vamwe varwere - kusanganisira kuora mwoyo, kurutsa uye kuneta. Vangani vevarwere venyu vakawana mishonga iyi yakaoma zvakare kuramba ichitora? Iwe une mazano anobatsira varwere kubata nemishonga iyi here?
Kent Holtorf, MD: Kutora mutsvuku mutsvuku kakawanda pazuva kunogona kuva dambudziko, asi kana varwere vane migumisiro yakanaka inokosha kune vakawanda. Nzira shoma shoma: Kutanga, vamwe vanhu vane hanya kuti mishonga inoda refrigeration, asi kazhinji haifaniri kukosha, sezvo mishonga iyi yakanyatsogadzikana pamasikati masikati. Saka hazvisi dambudziko kuzvichengetedza muhomwe yako kana mudheketi redeskiti.
Chikuru chinokonzera chikamu ndeyeusea, inowanikwa munenge 25% yevarwere. Nenguva yakawanda iyo inononoka uye inopera nekushandiswa zvakapfurikidza, asi vashoma vashoma havazokwanisi kuvhiringidza. Ne Byetta, ndinokurudzira kutanga ne 5 mcg injection vasati vadya. Vamwe varwere vanotanga nehafu yepfuti kwemazuva mashomanana okutanga (kungoita kuti pfunger iite hafu). Kuvhiringidzika kune vamwe vanhu kunogona kuitika nekuda kwekuwedzera kwemaitiro emudumbu, saka Zantac (ranitidine) kana proton pump inhibitor zvinodhaka - sa Prilosec (omeprazole), Premecid (lansoprazole), kana Nexium (esomeprazole) somuenzaniso - inogona ivai anobatsira. Pane imwe nguva-ye-sabhota muitiro weDAA yekubvumidza, iyo yakaratidzwa kuva nemigumisiro yakaderera pamwe nekuwedzera kuri nyore.
Mary Shomon: Wakareva izvi kune vamwe varwere, iwe unazvo kutora kusvika ku 10 mcg injection yeByetta katatu zuva nezuva, pamwe nekudya. Ndeipi iyo yakanakisisa yekurapa kwaSylin?
Kent Holtorf, MD: Nausea inowanzosvibisa chikamu cheSylin, ichienzaniswa neByetta, saka zvinoshandiswa kune vamwe varwere. KuSylin, chirwere chakakwana 120 mcg, katatu pazuva. Zvose Byetta uye Symlin vane ngozi shoma kwazvo ye hypoglycemia kunze kwekuti iwe uri pane insulini kana pane sulfonylurea mishonga yechirwere cheshuga .
Mary Shomon: Iwe unonzwa zvakare kuti kutsauka T3 inyaya. Unogona here kutiudza zvishoma nezvitsotsi T3?
Kent Holtorf, MD: T4 inogona kuchinjwa kuT3, iyo inoshandiswa hormone inobata tsvina, kana kuti inoshandura T3, iyo inenge isingashandisi T3, uye inodzivisa matambudziko eT3. Vanachiremba - kusanganisira endocrinologists - vanodzidziswa kuti kuchinja kweT3 kunongova kusina simba kwemasabolite, asi zvidzidzo zvinoratidza kuti ine simba rinoshandiswa nevhitithyroid. Zvechokwadi, yakaratidzwa kuva yakanyanya inhibitor yehutano yakanyanya kupfuura PTU, mushonga unoshandiswa hyperthyroidism. Kudzorera T3 inversely inopindirana ne-intracellular T3 mazinga, saka iyo inoratidzawo kuti inonzi tissue hypothyroidism, ine nheyo dzakakwirira (kana kuti dzisingabatsiri muT3 / RT3 chirongwa) zvinoratidza kushayikwa kwakanyanya.
Mary Shomon: Sei uchinzwa uchidzoka T3 inobatsira mukuita kuti zvive zvakaoma kune vamwe varwere vane chirwere chetachiona kuti vashande?
Kent Holtorf, MD: Mutsara weT3 unobudiswa munguva dzekutambudzika kana nzara yekuderedza metabolism, uye nekusingaperi kushungurudzika kana kudya, RT3 inogona kuramba ichikwirira, ichidzivirira utachiona hwehutachiona uye metabolism. Vanhu vane zvipembenene zvisingagumi - kana avo vanorasikirwa nehuwandu hwehuwandu hwemutoro - vachava nechepasi chemetabolism kupfuura munhu ane uremu hwakafanana uye musimba mashoma uyo akanga asina kurasikirwa nehukuru hunorema kana kudyiwa zvakanyanya munguva yakapfuura. Izvi zvakaratidzwa mukudzidza kwakaitwa naLeibel yakabudiswa mumagazini yeMetabolism , iyo inonzi "Kurasikirwa Kwemagetsi Ezvokudya Mukuderedza-Vose Varwere." Ichi chidzidzo chakafananidza nheyo yemagetsi yevanhu mumashure avo vakanga varasikirwa nehuwandu hunokosha kune avo ehumwe uremu hwavakanga vasina kurasikirwa chiremera chakakura kare. Vanyori vakaona kuti avo vakange vadya uye vakarasikirwa nehupfumi munguva yakapfuura, pavhareji, 25% yepamusoro metabolism kupfuura varwere vane simba vakanga vasina kurasikirwa nehukuru hunorema.
Vose vadzidzisi uye utano hwehutano husina kumbobvira huine dambudziko rekuremera vanokuudza kuti uite sezvavanenge vasingazivi kuti chii chakaipa kune vanhu vane dambudziko rekureba kwemarefu. Zvechokwadi, kunyange vadzidzisi ava vaisagona kunyange kutokwanisa kuisa uremu hwavo ne metabolism iyo 20 kusvika ku40% pasi pezvakanaka.
Tinoedza kuwedzera kwehuwandu hwemagetsi mumakirini edu ehutachiona uye tinoiona ichinyatsopindirana nechekare T3. Iyo yakasimudza tsananguro T3, iyo yakaderera metabolism, nevanhu vakawanda vakadaro vane metabolism iyo 20 kusvika ku40% yakaderera pane inotarisirwa kuti miviri yavo mizhinji index (BMI). Hapana anotenda kuti vaduku vanodya sei, uye vanoitwa kuti vanzwe sekundikundi-pasinei nekuita zvose zvakanaka. Kusvikira simba ravo risina kugadziriswa rinotaurirwa, kudya uye kuita zvepabonde zvichange zvisingakwanisi kubudirira kubudirira kwenguva refu.
Mary Shomon: Panguva ipi iwe unofunga nezvekudzokera shure T3 yakakwirira uye unoda kurapwa?
Kent Holtorf, MD: Sezvimwe zvinhu zvose mukurapa ndezvekuenderera mberi, asi vanhu vane hutano vanowanzosvika pasi pe 250 pg / ml uye vanofanira kuva nehurukuro yeT3 / reverse T3 yakawanda kupfuura 1.8 kana pasina T3 iri mu ng / dl kana 0.018 kana isina T3 iri mupg / ml.
Mary Shomon: Iwe unowanzobata sei zvakasvibiswa zvekare T3 mazinga?
Kent Holtorf, MD: Iyo yakasimudza tsananguro T3, iyo inenge isingabatsiri T4 chete yekugadzirira ichave. T4 / T3 kusanganiswa zviri nani kupfuura T4-chete kugadzirira, saLevoxyl uye Synthroid , asi kune mazinga akakwirira akakonzerwa nguva yakasunungurwa T3 yakanakisisa.
Mary Shomon: Ndezvipi zvekudya uye mararamiro anochinja iwe unokurudzira pamwe chete nemaitiro aya ekurapa?
Kent Holtorf, MD: Vazhinji varwere vanopinda vakapinda muzvokudya zvakawanda uye mararamiro ehupenyu uye ivo kazhinji vanoziva kwazvo munharaunda iyoyo. Low-carbohydrate diets ichadzivirira utachiona hunoita kuti uwedzere kuchinja kweT3 kupfuura kuenzaniswa kwekoriori ekuderedza neakakodhaidhi yakakwana, naizvozvo apo kudya kwema-carbohydrate kunogona kukonzera kushama kwekutanga, varwere vanogona kutorazve uremu kunze kwekuti shanduko yeT3 inotaridzirwa.
Mary Shomon: Ungatipa here pfungwa yekurasikirwa kwezviremera zvinowanikwa iwe nevarwere vehutachiona uyo, mushure mekuedzwa, kuratidza kuti leptin isaramba, uye yakasimudza t3 T3, uye utange marapirwo ako kune izvi?
Kent Holtorf, MD: Tinoedza uye tinoongorora uye tinoshandisa zvirwere zvakawanda uye zvinokonzerwa nemagetsi zvatinogona. Takabudirira nehuwandu hwevanhu, kubva kune avo vanoda kurasikirwa mapaundi mashoma kune avo vanopfuura zana kana kupfuura mapaundi ekurema. Iyo inonyanya kugutsa ndeyevanhu vanorasikirwa ne50 kusvika ku100 pounds kana kupfuura. Icho chachinja zvachose hupenyu hwavo.
Tiri kuonawo vamwe varwere vanopinda mushure mekudya kwechikafu -avo avo vanga vasina kuora muviri kana kuti vakawana zvakawanda kana kurema kwavo kwose shure. Vakawanda vane maitiro ehutachiona ehutachiona uyewo zvakakosha septin resistance. Vanogonawo kuva nekukura kwehomoni inowedzerawo.
Tine munhu mumwe chete akanga achidya makori mazana 800 pazuva mushure mekunge gastric inpass uye iye achiri kuwedzera kuwanda. Hapana aidavira kuti ndiyo yose yaaidya kusvikira vamuisa muchipatara uye achicherechedza kudya kwake kudya. Vakasimudza utachiona hwake hwakanaka, sezvo aive ane TSH , T4 uye T3. Apo patakaongorora chechi yake T3, zvisinei, uye yakanga inopfuura 800 uye leptin yake yaive nemakore 75. Takatarisa dhiyabhorosi yake uye yaiva 45% pasi pezvakanaka. Kudya ndoga, zvechokwadi, kusamboshanda nemurwere akadaro.
Uyewo, zvinodhaka zvakadai seBiphenyl-A zvinogona kudzivirira utachiona hwemaestropi kwose kwose mumuviri kunze kwepituitary, iyo ine mhando dzakasiyana-siyana. Saka nekuda kwehuwandu hwehuwandu hwezvinokonzera izvi, ndinotenda kuti munhu wese ane uwandu hwehutachiona husingawaniki neTSH. Vanhu vanokanganisa kudya kwekudya nekushayikwa kwekurovedza muviri kwehutano hwakanyanya munyika muno, asi ndinofunga dambudziko guru ndiro utachiona-huvhiringidza chepfu, pamwe nekudzvinyirira.
Uyezve, kudya kunoratidzirwa kuti kwete kungoita kuderedza T4-kusvika-T3 kutendeuka uye kuwedzera kuchinja kweT3, asi kunoratidzwawo kuderedza nhamba dzepachiviri chetachiona zvinogamuchirwa - asi zvakare, kwete mupituitary - saka zvakaenzana utachiona hune zvishoma, asi TSH haina kuchinja. Izvi zvinoratidza kukosha kwechipatara uye kuongororwa maitiro ekugadziriswa mukugadzirisa kwehutano hwehutachiona huri mune mumwe munhu. Uyezve, vakadzi vane zvishoma zvinotapira zvehutori kupfuura varume, zvichiita kuti zvive nyore kunzwisisa kune zviduku zvishoma zvishoma nezvishoma mumashonga ehomoni.
Mary Shomon: Unotarisawo kutsanya glucose uye insulin mazinga, uye / kana kuita glucose kuvhiringidzika kuongororwa nevarwere vako vari kuwandisa uye vane kuoma kurasika?
Kent Holtorf, MD: Tinotsanya glucose nekutsanya insulini, pamwe neHemaglobin A1C (HA1C) miedzo, kutarisa kushandiswa kwekuchengetedza insulin , kwete kungotarisa zvinowanzoitwa "normals." Imwe yebasa rinokosha kuti uwane humoni inosunga globulin (SHBG). Iyo inokurudzirwa muchiropa ichienderana nehroroid hormone uye estrogen, saka inogona kuva chinhu chinokosha chemavara ehutachiona.
Mumukadzi wekutanga, chiyero chinofanira kuva pamusoro pe70. Kana zvisingaiti, chiratidzo chakanaka chokuti kune madiki mashoma ehutachiona. Izvi zvinonyanya kuitika kana mukadzi ari pamuromo wehutachiwana panzvimbo, nokuti - nemhaka yekutanga kudarika metabolism - chiropa chake chichava nehuwandu hwehutori hwepamusoro kupfuura humwe huse hwemashupu. Nokudaro, kana SHBG iri pasi, muviri wose uri pasi utachiona.
(Cherechedza: Uyu muedzo haubatsiri kana mukadzi ari pamuromo wesrogen kushandurwa, nokuti izvozvo zvichasimudza SHBG nenzira yakakwirira yeestrogen muropa.Uye kuongorora kwakarurama kune vakadzi vari kushandisa transdermal estrogen maitiro, zvisinei.)
Chirwere cheshuga uye polycystic ovary syndrome (PCOS) chinodzvinyirira SHBG, nokuda kwekudzivirirwa kwemazinga eT3 ekuonekwa mumamiriro aya. Uyewo, kana iwe uchitarisa SHBG yako usati waenda kunzvimbo yehutori uye uone kuchinja kuduku nokurapa, chiratidzo chekuti iwe unorwisa utachiona. Iwewo unoda kutarisa zvinotevera:
- insulini-kufanana nekukura 1 (IGF-1)
- insulini-kufanana nekukura kunobatanidza protein 3 (IGFBP3)
- dehydroepiandrosterone (DHEA)
- testosterone
- luteinizing hormone (LH)
- follicle stimulating hormone (FSH)
- urin iodine
- cortisol
- adrenocorticotropic hormone (ACTH)
- C-reactive protein (CRP) - kuputira kunopera TSH uye kuwedzera rT3
- homocysteine - mucherechedzo wepamusoro wehutachiona uye yakadzika mavitamini B
- lipids - high cholesterol inoratidza chiratidzo chetachiona uye yakanyanya triglycerides chiratidzo chekuchengetedza insulin
- simbi uye ferritin - ferritin inofanirwa kubudiswa nehutachiona, zviratidzo zvizhinji zvokuti vanhu vanoti chirwere chemahyamu nechokudzivirira ferritin chaizvoizvo chikonzero nokuda kwechikafu chemashuga chinotanga kushandiswa
- vitamini D - inofanira kuva yakakura kudarika 80
- thyroid peroxidase antibodies (TPO) uye antithyroglobulin antibodies - chiitiko chinonakidza chakaitwa nehutano hwehutachiona mune vanhu vakanga vakaneta uye vakawana kuti, pasinei nokuti pasina uchapupu hwe TPO kana antithyroglobulin antibodies, vazhinji vaiva nehutachiona hwekurohwa uye vakapindura zviratidzo nenzira yekurovedza utachiona kunyange nehutachiona mazinga aive akaenzana
- serotonin level - pane kazhinji yakaderera kana yakaderera serotonin yezinga nehutachiona hwepamusoro nokuti shanduro ye serotonin inodzingwa nechechi yehutachiona uye inodzvinyirira kazhinji haiwanzoshanda kana T3 mazinga ari oga
Vagari vaora mwoyo vanowanzova ne-TSH yakasara-yakakwana uye yepamusoro-yakakwana T4, yakakwirira kana yakakwirira-inoshandura T3 uye yakaderera-yakakwana T3. Vanachiremba vakawanda vanoongorora TSH naT4 uye vanofungidzira kuti murwere ane utachiona hwepamusoro-huno (hunobva pamucheto wokupedzisira TSH uye kumapeto ekupedzisira T4) asi chaizvoizvo vane madiki masero ema3 T3 (sezvakaratidzwa neavo pasi peT3 / rT3 ratios) . Varwere ava vanowanzopindura zvakanaka T3 supplementation. Kupa mishonga yemishonga serotonin yemumuromo kana kujowa kunogonawo kuva yakakosha muvatachiona vasingagoni kurapwa (avo vasina kupindura kana kupindura zvisina kunaka mishonga) pasina maitiro emagumisiro evanhu vanodzvinyirira.
Mary Shomon: Kana mumwe munhu akakwira shuga yeropa inoratidza insulin kudzivisa - asi kwete chirwere chakakwana cheshuga - unozviisa paGlucophage (metformin) kudzivirira here?
Kent Holtorf, MD: Hungu, hazvina musoro kutarisira kusvikira mumwe munhu ane chirwere cheshuga kuti ashandise metformin kana mamwe mazano. Isu tinoshandisawo zvidimbu, zvatinoda ndiGlucoSX. Kunyange zvazvo metformin yaiva yepamusoro ye insulin yokurwisana, isu kazhinji takapfuura metformin uye takaenderera kuByetta uye Symlin, nekuda kwehuwandu hwakawanda hwekurasikirwa kwekurema.
Mary Shomon: Varwere vazhinji vane chirwere chetachiona vakandikumbira nezveHCG (chirongwa chevanhu chinonzi chorionic gonadotropin) chekureruka kwemazivi, kusanganisira majekiseni emishonga uye zvinyorwa zvinyorwa, uye kupfuura-the-counter-homopopotome forms maHCG. Ini ndakasangana nevakadzi vanoverengeka vaive hypothyroid, vakaremerwa kupfuura 200 lbs, uye vakapfuurira maHCG mishonga, uye vakarashika mapepa makumi maviri nemashanu kana kupfuura mukati mezana remazuva makumi mana ehutano hweHCG. Ndinoziva vanachiremba vakawanda uye varikutanga kushandisa. Ndezvipi zvaunofunga pamusoro peizvi sekurasikirwa kwekutakura kurapa?
Takawana HCG inoshanda kuvakadzi vazhinji. Takawana mishonga yeHCG injection inonyanya kushanda kupfuura zvinyorwa zvinyorwa HCG kana HCG creams. Uyewo, nokuti iwe unofanirwa kupa chiremba chakanyanya kudarika uye kuchinja-shanduka - nekuda kwekuderera kunononoka - zvakanyanya kudhura kuita sechidiki chiduku chinopinza.
Kent Holtorf, MD muvambi weHoltorf Medical Group muCalifornia.
> Sources:
> Holtorf, MD, Kent. Kubvunzurudza naMary Shomon. October 2009.
> Leibel RL, Hirsch J. "Kupera simba kwezvinhu zvinodiwa mune zvishoma-kune vanorwara." Metabolism. 1984 Feb; 33 (2): 164-70. Online.