Kufunsa ndi Kent Holtorf, MD
Kent Holtorf, MD akhala akugwira ntchito nthawi yaitali ndi odwala omwe ali ndi kusiyana kwa mahomoni - kuphatikizapo chithokomiro, adrenal, ndi mahomoni obereka. Amathamanga ku Holtorf Medical Group ku California, komwe amadziwika bwino kwambiri ndi matenda a endocrine, kuphatikizapo hypothyroidism , kuthamanga kwa adrenal, ndi insulin kukana.
Dr. Holtorf wakhala akugwira ntchito ndi odwala ake ambiri - ambiri mwa iwo omwe ali ndi chithokomiro chopanda mphamvu - omwe awona kuti n'zovuta kapena zowoneka zosatheka kuchepetsa kulemera.
Zimene adazipeza ndikuti ngakhale pali zifukwa zambiri zomwe zimatheka chifukwa cholephera kuchepetsa thupi, pafupifupi odwala onse olemera kwambiri komanso ovuta kwambiri omwe amachitira amakhala ndi zovuta zowonongeka zamagetsi komanso zamaganizo zomwe zimapangitsa kuti odwalawa azivutika kwambiri. Makamaka, Dr. Holtorf, chifukwa cha kafukufuku wina wam'tsogolo, adayang'anitsitsa kufufuza mahomoni awiri ofunika - leptin ndi kutembenukira ku T3 (r3) - ndikuchiza zosaoneka kuti zithandize odwala kulemera.
Ndine wokondwa kuti ndikubweretsereni kuyankhulana ndi Dr. Kent Holtorf, ndikukambirana njira zake zothandizira odwala chithokomiro kuti apeze kulemera kwanthawi yaitali .
Mary Shomon: Wanena kuti iwe umamva kuti mahomoni awiri ofunika - leptin ndi kutsutsana ndi T3 - akuthandizira kwambiri pakuletsa kulemera ndi kuchepa kwa thupi. Kodi mungatiuze pang'ono za leptin, choyamba, ndipo chikukhudzana bwanji ndi zovuta zowonongeka?
Kent Holtorf, MD: Mankhwala a leptin amapezeka kuti ndiwo amachititsa kuti thupi likhale lolemera kwambiri. Leptin imadziwika ndi maselo olemera ndipo maulendo a leptin amakula ndi kuwonjezeka kwa mafuta. Kuchulukitsidwa kwa leptin komwe kumachitika ndi kulemera kwowonjezera kumadyetsa-kubwerera ku hypothalamus monga chizindikiro chakuti pali mafuta okwanira (malo).
Izi zimapangitsa thupi kuwotcha mafuta m'malo mopitirira kusunga mafuta owonjezera, ndipo zimayambitsa kutulutsa timadzi timene timatulutsa timadzi timene timatulutsa timadzi timene timatulutsa timadzi timene timatulutsa timadzi timene timatulutsa timadzi timene timatulutsa timadzi timene timatulutsa kachilombo.
Komabe, kafukufuku akupeza kuti anthu ambiri olemera kwambiri omwe akuvutika ndi kutaya thupi amakhala ndi leptin yosiyana, komwe leptin imatha kuchepetsa hypothalamus ndikuyambitsa kagayidwe ka shuga. Kukanika kwa leptin kumabweretsa hypothalamus kuwona njala, kotero njira zambiri zimagwiritsidwa ntchito kuti zowonjezera malo ogulitsa mafuta, pamene thupi limayesa kusinthira chidziwitso cha njala.
Njira zomwe zimagwiritsidwa ntchito zimaphatikizapo kuchepa kwa TSH, kutembenuza T4 mpaka T3 kutembenuka, kuwonjezeka kwa T3, kuwonjezeka kwa chilakolako, kuwonjezeka kwa kusakanikirana ndi insulini komanso kulepheretsa kutulutsa mafuta.
Njirazi zingakhale mbali imodzi chifukwa cha kuchepetsa malamulo a leptin receptors omwe amapezeka ndi kuwonjezeka kwa leptin nthawi yaitali.
Chotsatira? Mukakhala olemera kwambiri kwa nthawi yaitali, zimakhala zovuta kulemera.
Mary Shomon: Iwe wanena kuti umamva kuti ma sefa a leptin pamwamba pa 10 akhoza kulandira chithandizo.
Kodi mungathe kufotokozera pang'ono za magulu a leptin?
Kent Holtorf, MD: Ambiri olemera kwambiri kapena olemera kwambiri amakhala ndi leptin m'munsimu khumi, ngakhale kuti mabungwe akuluakulu amagwiritsira ntchito tsamba 1 mpaka 9.5 kwa amuna ndi 4 mpaka 25 kwa akazi. (Ziyenera kukumbukiridwa kuti izi zikuphatikizapo 95% omwe amatchedwa anthu ozolowereka ndipo akuphatikizapo ambiri omwe ali olemera kwambiri.) Odwala onse omwe ali ndi kulemera kwabwino adzakhala ndi leptin zosakwana 10.
Mary Shomon: Kodi mumachiza bwanji leptin mukuchita?
Kent Holtorf, MD: Chithandizo chingathe kugwiritsidwa ntchito pochiza leptin - leptin kukana. Leptin yokweza ikuwonetsanso, kuti TSH ndi chizindikiro chosavomerezeka cha chithokomiro cha tizilombo , monga momwe TSH imayambidwira, komanso kuchepa kwa T4-to-T3 kutembenuka.
Mwachidule, ngati leptin yanu imakwezeka, mwakhala mukuchepetse chithokomiro cha tizilombo. Komanso, pafupifupi anthu onse omwe ali ndi matenda a shuga ndi ofanana ndi leptin, omwe awonetsedwa kuchepetsa kutembenuka kwa T4-to-T3 kwa odwala shuga ndi pafupifupi 50% popanda kuwonjezeka kwa TSH, zomwe zimapangitsa kuti zikhale zovuta kwambiri kwa anthu a mtundu wa II omwe ali ndi matenda a shuga kuti adzichepetse.
Chifukwa chakuti kutembenuka kwa T4-to-T3 kosauka, T3 yomasulidwa nthawi yake ndi mankhwala abwino - ngakhale mankhwala ophatikiza T4 / T3 monga chilengedwe chochitidwa ndi chithokomiro (NDT) angagwiritsidwe ntchito.
Timayang'anitsitsa odwala athu mlingo wokwanira (RMR), ndipo mwachidwi, omwe ali ndi makina a leptin okwera omwe amasonyeza kuti leptin amatsutsa ali ndi RMRs omwe nthawi zonse amakhala ochepa. Odwalawa nthawi zambiri amawotcha mafuta osakwana 500 mpaka 600 tsiku lililonse kuposa munthu wina wofanana ndi thupi.
Choncho, kuti akhale ndi mwayi wokhala wolemera, odwalawa akhoza kuyesa ndi kuchepetsa makilogalamu 500 mpaka 600 pa tsiku (kungosiya kulemera), kuchita masewera olimbitsa thupi kwa ora limodzi kapena awiri pa tsiku (kungoti musapitirize kulemera ) kapena kuonetsetsa kuti chithokomiro ndi kagayidwe kake kamayambitsa.
Anthu ndi zamoyo zabwino kwambiri chifukwa timatha kusunga mafuta (mafuta) bwino. Pali njira zambiri zowonjezera ndi kuteteza leptin ndi chimodzi mwa izo, kotero timagwiritsa ntchito njira zambiri; palibe mankhwala amatsenga, ngakhale mankhwala amodzi angakhudze kwambiri wodwalayo.
Kuwonjezera pa kukonzetsa chithokomiro (kumbukirani, kupereka hormone ya chithokomiro kuti muchepetse kulemera si koyenera, koma si zomwe tikuchita, apa tikukonza kusowa kwabwino), Symlin (pramlintide) ndi / kapena Byetta (exenatide) akhoza kukhala ogwira mtima kwambiri kwa ambiri. Mankhwala a Choononic Gonadrotropin (HCG) ndi chinthu china chimene chingathandize ena. Ngakhale ndapeza kuti Wellbutin (antipropressant Wellbutin) (bupropion) sagwira bwino ntchito yolemetsa, kuphatikizapo Wellbutrin ndi mlingo wotsika naltrexone (LDN) ali ndi zotsatira zabwino zodabwitsa. Topamax (topiramate) ndi mwayi kwa ena koma nthawizonse sizimalekerera. Kufuna kudya zakudya zofunikira, zomwe zimapangitsa kuti thupi likhale ndi mphamvu, lingagwiritsidwe ntchito, makamaka ngati RMR ili yochepa.
Mary Shomon: Symlin ndi Byetta amafunikira majekesiti ambiri patsiku, zomwe zingawononge anthu ena kuti asatenge. Mankhwalawa akhoza kukhala ndi zotsatira zovuta kwa odwala ena - kuphatikizapo kunyoza, kusanza ndi kutopa. Ndi odwala angati omwe apeza kuti mankhwalawa ndi ovuta kwambiri kupitiliza kumwa? Kodi muli ndi malangizo omwe athandiza odwala kuthana ndi mankhwalawa?
Kent Holtorf, MD: Kutenga kansalu kakang'ono kamodzi patsiku kungakhale kovuta, koma pamene odwala ali ndi zotsatira zabwino ndizofunikira kwambiri. Zochita zingapo: Choyamba, anthu ena amadandaula kuti mankhwalawa amafunikira firiji, koma kawirikawiri sikoyenera, chifukwa mankhwalawa amakhala otetezeka pa kutentha kwa masana. Kotero si vuto kuti muzisungire mu thumba lanu kapena mu tebulo la desiki.
Chowopsa kwambiri ndi zotsatira zowonongeka, zomwe zimapezeka pafupifupi 25% mwa odwala. Nthawi zambiri imakhala yofatsa komanso imachepetsabe ndikugwiritsabe ntchito, koma odwala angapo sangalekerere. Kwa Byetta, ndikupempha kuyamba ndi injection 5 mcg musanadye. Odwala ena amayamba kuwombera mfuti kwa masiku angapo oyambirira (kumangokhalira kukankhira pang'onopang'ono). Kuwopsya kwa anthu ena kungakhale chifukwa cha kuchuluka kwa mimba ya asidi, kotero Zantac (ranitidine) kapena proton pump inhibitor mankhwala - monga Prilosec (omeprazole), Prevacid (lansoprazole), kapena Nexium (esomeprazole) mwachitsanzo - akhoza khalani othandiza. Pali kuwombera kamodzi pa sabata mu njira yovomerezeka ya FDA, yomwe yawonetsedwa kukhala ndi zotsatira zochepa komanso kuwonjezeka kwabwino.
Mary Shomon: Mudatchula kuti kwa odwala ena, mumakhala nawo jekeseni wa 10 mg wa Byetta katatu tsiku ndi tsiku, ndi chakudya. Kodi ndiyeso yeniyeni yotani ya Symlin?
Kent Holtorf, MD: Nausea sichimakhala ndi zotsatira zochepa za Symlin, poyerekeza ndi Byetta, kotero ndizotheka kwa odwala ena. Kwa Symlin, mlingo woyenera ndi 120 mcg, katatu patsiku. Byetta ndi Symlin ali ndi chiopsezo chochepa cha hypoglycemia kupatula ngati muli ndi insulini kapena mankhwala a sulfonylurea a shuga .
Mary Shomon: Mumamvanso kuti kusintha kwa T3 ndi nkhani. Kodi mungatiuze pang'ono za kusintha T3?
Kent Holtorf, MD: T4 ikhoza kutembenuzidwa kukhala T3, hormoni yogwira ntchito yomwe imakhala ndi mphamvu yamagetsi, kapena kuti iwononge T3, yomwe imakhala yosavomerezeka ya T3, ndipo imachepetsa zotsatira za T3. Madokotala - kuphatikizapo otchedwa endocrinologists - amaphunzitsidwa kuti kutsogolo kwa T3 ndi chabe metabolite yosatetezeka, koma kafukufuku amasonyeza kuti ali ndi zotsatira zamphamvu za antithyroid. Ndipotu, zakhala zikuwonetseratu kuti ndizoopsa kwambiri muchitetezo cha chithokomiro kusiyana ndi PTU, mankhwala omwe amagwiritsidwa ntchito kuti awononge matenda a hyperthyroidism. Kutembenuza T3 kumagwirizanitsa ndi ma T3 amphamvu, kotero imakhalanso chizindikiro cha minofu hypothyroidism, ndi chiwerengero chapamwamba (kapena pansi pa T3 / RT3 chiŵerengero) chosonyeza kusowa kwakukulu.
Mary Shomon: Ndichifukwa chiyani mukuganiza kuti kachiwiri T3 imathandiza bwanji kuti odwala chithokomiro akhale ovuta kulemera?
Kent Holtorf, MD: Zotsatira za T3 zimapangidwa panthawi yachisokonezo kapena njala kuchepetsa kuchepa kwa thupi, komanso kukhala ndi nkhawa nthawi zambiri, RT3 ikhoza kukhala yowonjezereka, kuthetsa chithokomiro cha chithokomiro ndi shuga. Anthu omwe amadya zakudya zambiri - kapena omwe amatayika kwambiri - amakhala ndi kuchepa kwa thupi kusiyana ndi munthu wolemera ndi wolemera minofu omwe anali asanasiye kutaya thupi kapena kudya kwakukulu m'mbuyomo. Izi zinawonetsedwa mu phunziro la Leibel lofalitsidwa m'magazini ya Metabolism , yotchedwa "Kufooketsa Mphamvu za Mphamvu ku Odwala Ochepetsedwa-Ochepa." Kafukufukuyu anayerekezera chiwerengero cha kuchepetsa thupi kwa anthu omwe anataya kulemera kwakukulu kwa iwo ofunitsitsa womwewo omwe sanatayike kulemera kwakukulu m'mbuyomo. Olembawo adapeza kuti, omwe adadya ndi kutaya thupi m'mbuyomo, anali ndi 25% ya kuchepa kwa thupi kusiyana ndi odwala omwe sanatayike.
Ophunzitsa onsewo ndi a zaumoyo omwe sanagwidwe ndi vuto lomwe akukuuzani kuti muchite monga momwe amachitira sakudziwa kuti kulibe vuto kwa anthu omwe ali ndi vuto lalitali lalitali. Inde, ngakhale ophunzitsira awa sangathe ngakhale kulemera kwake ndi kagayidwe ka shuga kamene kakakhala 20 mpaka 40% pansi pa zachibadwa.
Timayesa kuchuluka kwa maselo a chithokomiro omwe timakhala nawo ndikupeza kuti akugwirizanitsa ndi T3. Kutalika kwa T3, kumunsi kwa metabolism, ndi anthu ambiri omwe ali ndi kagayidwe ka shuga kamene kali ndi 20 mpaka 40% poyerekeza ndi kuyembekezera kwa mndandanda wa thupi lawo (BMI). Palibe amene amakhulupirira kuti amadya pang'ono, ndipo amadzimva kuti ndi olephera - ngakhale akuchita zonse bwino. Mpaka kuchepetsa kuchepa kwa thupi lawo, zakudya ndi masewera olimbitsa thupi sizilephera kukwaniritsa nthawi yayitali.
Mary Shomon: Ndi nthawi yanji yomwe mumaganiza kuti T3 ndi yaikulu kwambiri ndipo mukufuna chithandizo?
Kent Holtorf, MD: Monga china chirichonse mu mankhwala ndi kupitiriza, koma anthu odwala nthawi zambiri amakhala pansi pa 250 pg / ml ndipo ayenera kukhala ndi chiwerengero chaulere T3 / chiwerengero cha T3 chachikulu kuposa 1.8 ngati T3 mfulu ali mu ng / dl kapena 0.018 ngati mfulu T3 ili mu pg / ml.
Mary Shomon: Kodi mumachita bwanji kuti mukhale ndi ma t3 akuluakulu?
Kent Holtorf, MD: Kutsika kwakukulu T3, ndikovuta kwambiri T4 kukonzekera kokha. Kuphatikizidwa kwa T4 / T3 kuli bwino kwambiri kusiyana ndi kukonzekera T4-kokha, monga Levoxyl ndi Synthroid , koma pa maulendo apamwamba omwe amatha kutulutsidwa T3 ndi abwino.
Mary Shomon: Kodi ndi zakudya ziti zomwe mumasintha zomwe mumalimbikitsa ndi njira zachipatala?
Kent Holtorf, MD: Odwala ambiri omwe abwera nawo akhala akudya zakudya zambiri komanso kusintha kwa moyo wawo ndipo ambiri amadziwa bwino dera limenelo. Zakudya zochepa zotchedwa carbohydrate zidzathetsa chithokomiro ndikuwonjezereka kutsogolo kwa T3 kusiyana ndi kuchepetsa kuchepetsa kalori ndi chakudya chokwanira, kotero pamene zakudya zotsika kwambiri za m'magazi zingayambitse kulemera koyambirira, odwala amatha kulemera pokhapokha ngati atayambanso kuyankha nkhani ya T3.
Mary Shomon: Kodi mungatipatse ife kuzindikira kulemera kwa zomwe mukukumana nazo ndi odwala chithokomiro omwe, atayesedwa, akuwonetsa leptin kukana, ndi kutsika kwambiri T3, ndi kuyamba mankhwala anu pazifukwa izi?
Kent Holtorf, MD: Timayesa ndikufufuza ndikusamalira zinthu zambiri zomwe zingatheke. Takhala tikupambana ndi anthu ambiri, kuchokera kwa iwo omwe amafunikira kutaya mapaundi pang'ono kwa iwo omwe ali oposa mapaundi oposa oposa. Okhutiritsa kwambiri ndi anthu omwe amataya mapaundi 50 kapena 100 kapena kuposa. Zimasintha miyoyo yawo.
Tikuwonanso odwala ambiri amene amabwera pambuyo poti mimba imadutsa - omwe mwina sanateteze thupi kapena atapindula kwambiri. Ambiri amakhala ndi tizilombo toyambitsa matenda komanso tizilombo toyambitsa matenda. Angakhalenso ndi kuchepa kwa hormone yochepa.
Tinali ndi munthu mmodzi yemwe anali kudya makilogalamu 800 patsiku atatha kudya mimba ndipo adakali wolemera. Palibe amene anakhulupirira kuti zonsezi anali kudya mpaka atamuika kuchipatala ndikuyang'anira chakudya chake. Anamukakamiza kuti chithokomiro chake chikhale chabwino, popeza anali ndi TSH , T4 ndi T3. Tikayang'ananso T3, tinali ndi zaka zoposa 800 ndipo leptin yake inali 75. Tinayang'ana kuchuluka kwake kwa thupi komanso 45% pansipa. Kudya yekha kungakhale kosagwira ntchito ndi wodwala woteroyo.
Komanso, poizoni monga biphenyl-A amalepheretsa kulandira chithokomiro kulikonse m'thupi kupatulapo pituitary, yomwe ili ndi mapulogalamu osiyanasiyana. Choncho chifukwa cha chikhalidwe cha poizoni izi, ndimakhulupirira kuti aliyense ali ndi vuto lachithokomiro chomwe sichipezeka ndi TSH. Anthu amadana ndi kudya ndi kusowa kochita masewera olimbitsa thupi m'dzikoli, koma ndikuganiza kuti vuto lalikulu ndi chithokomiro chomwe chimasokoneza poizoni komanso mavuto.
Kuwonjezera pamenepo, kudya zakudya kumasonyeza kuti sikuti kungachepetse kutembenuka kwa T4-to-T3 ndi kuwonjezereka kutsogolo kwa T3, koma kumasonyezanso kuchepetsa chiwerengero cha zithokomiro zapakati pazithokomiro - koma kachiwiri, osati pituitary - kotero kuchuluka komweko kwa Chithokomiro chili ndi zotsatira zochepa, koma TSH sichitha. Izi zikuwonetsera kufunika kwa majekesi ndi majekeseni pamagulu a chithokomiro payekha. Komanso, amayi ali ndi zowonjezera zowonongeka kuposa amuna, zomwe zimapangitsa kuti zikhale zovuta kwambiri kuti zichepe zichepetse mu ma seroni a ma chithokomiro.
Mary Shomon: Kodi mumayang'anitsitsa kuchepetsa shuga ndi insulini, komanso / kapena mukuyezetsa magazi ndi odwala anu omwe ali olemera kwambiri komanso ovutika kulemera?
Kent Holtorf, MD: Timadya kudya kwa shuga ndi kusala kudya, komanso ma Hemaglobin A1C (HA1C) mayesero, kuyang'ana kuteteza kusakanikirana , osati kungoyang'ana "normals". (SHBG). Zimayambitsa chiwindi chifukwa cha mahomoni a chithokomiro ndi estrogen, choncho ikhoza kukhala chithandizo chofunika kwambiri cha chithokomiro.
Mzimayi wam'malamulo, mlingo ukhale pamwamba pa 70. Ngati sichoncho, ndizisonyezero zabwino kuti pali chithokomiro chochepa cha minofu. Izi ndizowona makamaka ngati mayiyo ali ndi chithokomiro pamlomo, chifukwa - chifukwa choyamba kudutsa thupi - chiwindi chake chidzakhala ndi ma chithokomiro chokwanira kwambiri kusiyana ndi ziwalo zina zonse. Choncho, ngati SHBG ili yotsika, thupi lonse liri ndi chithokomiro chochepa.
(Zindikirani: Mayesowa si othandiza ngati mkazi ali pamwambowo m'malo mwake, chifukwa izi zidzakweza kwambiri SHBG chifukwa cha msinkhu waukulu wa estrogen pachiwindi. Mayesowa ndi olondola kwa amayi omwe akugwiritsa ntchito transdermal estrogen kukonzekera, komabe.)
Matenda a shuga ndi ma polycystic ovary syndrome (PCOS) amatsutsanso SHBG, chifukwa cha ma T3 omwe amachititsa kuti mavitaminiwa asapitirire. Komanso, ngati mutayang'ana SHBG musanayambe kusinthira chithokomiro ndikuwona kusintha pang'ono ndi chithandizo, ndizisonyezero kuti muli ndi vuto la chithokomiro. Mufunanso kufufuza zotsatirazi:
- (1) (IGF-1)
- insulini-kukula kukula komwe kumakhudza mapuloteni 3 (IGFBP3)
- dehydroepiandrosterone (DHEA)
- testosterone
- mchere wokhala ndi luteinizing (LH)
- hormone yochititsa chidwi yotchedwa hormone (FSH)
- iodine yamakina
- cortisol
- adrenocorticotropic hormone (ACTH)
- Puloteni wothandizira kwambiri (CRP) - kutupa kumachepetsa TSH ndipo kumawonjezera rT3
- homocysteine - chizindikiro cha mavitamini otsika a chithokomiro ndi otsika
- lipids - mkulu wa cholesterol ndi chizindikiro cha chithokomiro chotsika komanso triglycerides yapamwamba ndi chizindikiro cha insulini kukana
- chitsulo ndi ferritin - ferritin amafunika kuti atsegulire chithokomiro, zizindikiro zambiri zomwe anthu amakhulupirira kuti zimakhala ndi kuchepa kwa magazi m'thupi la pansi ndi chifukwa cha kutsekemera kwa chithokomiro chochepa
- Vitamini D - ayenera kukhala wamkulu kuposa 80
- Matenda a koriyosi (peroxidase antibodies) (TPO) ndi antithyroglobulin antibodies - chidwi chochititsa chidwi cha chithokomiro mwa anthu omwe anali otopa ndipo anapeza kuti, ngakhale kuti alibe umboni wa antibodies ya TPO kapena antithyroglobulin, ambiri anali ndi kutupa kwa chithokomiro ndipo anayankha mozizwitsa m'malo mwa chithokomiro ngakhale kudzera mu chithokomiro Mipingo inali muyeso yeniyeni
- serotonin mlingo - nthawi zambiri amakhala otsika kapena otsika kwambiri pa serotonin ndi nthenda yozizira chifukwa serotonin yopangidwira ikucheperachedwa ndi chithokomiro chochepetsetsa komanso kuchepetsa kupweteka nthawi zambiri sizingagwire ntchito ngati ma T3 ali osakwanira
Odwala ovutika maganizo nthawi zambiri amakhala ndi TSH yochepa kwambiri komanso yapamwamba kwambiri ya T4, yapamwamba kapena yodabwitsa kwambiri ya T3 komanso ya T3 yochepa. Madokotala ambiri adzayang'ana TSH ndi T4 ndipo adzalongosola kuti wodwala ali ndi chithokomiro chokwanira (kuchokera kumapeto otsika TSH ndi mapeto otsiriza T4) koma ali ndi ma t3 omwe ali otsika kwambiri (monga momwe amasonyezera ndi ma T3 / rT3 ochepa) . Odwalawa nthawi zambiri amayankha bwino T3 supplementation. Kupereka mankhwala otchedwa serotonin mwachibadwa kapena mwa jekeseni kungakhalenso kothandiza kwambiri odwala omwe amalephera kulandira mankhwala (omwe sanayankhe kapena osayesetsa kumwa mankhwala) popanda zotsatira zowononga za odwala matenda opatsirana.
Mary Shomon: Ngati wina wakweza shuga ya magazi ya insulini kukana - koma osati matenda a shuga - kodi mumawaika pa glucophage (metformin) popewera?
Kent Holtorf, MD: Inde, sikungakhale kwanzeru kuyembekezera kuti wina ali ndi shuga kuti agwiritse ntchito metformin kapena njira zina. Timagwiritsanso ntchito mavitamini, zomwe timakonda ndi GlucoSX. Ngakhale kuti metformin inali yaikulu ya insulin kukana, ife kawirikawiri anadutsa metformin ndipo anapita kwa Byetta ndi Symlin, chifukwa choposa kwambiri kulemera.
Mary Shomon: Odwala ambiri a chithokomiro akhala akundifunsa ine za mankhwala a HCG (human chorionic gonadotropin) kuti awonongeke, kuphatikizapo jekeseni wa mankhwala ndi zilembo zazing'ono, ndi mawonekedwe osiyana a homeopathic of HCG. Ine ndakumanapo ndi amayi ambiri omwe anali hypothyroid, wolemera maola 200, ndipo anapita ku mankhwala a HCG, ndipo anataya mapaundi 25 kapena kuposerapo pa mankhwala a HCG masiku 40. Ndikudziwa madokotala ambiri omwe akuyamba kugwiritsa ntchito. Kodi mumaganiza zotani pazimenezi monga chithandizo cha mankhwala olemera?
Tapeza kuti HCG imathandiza amayi ambiri. Tapeza injection ya HCG yapamwamba kuti ikhale yogwira mtima kwambiri kuposa ma HCG kapena HCG zopangira zina. Komanso, chifukwa choti mumapereka mlingo wapamwamba kwambiri pamagulu ndi ma transdermally - chifukwa cha kuchepetsa kuyamwa - ndizovuta kwambiri kuchita ngati katemera kakang'ono kakang'ono.
Kent Holtorf, MD ndiye adayambitsa bungwe la Holtorf Medical Group ku California.
> Zotsatira:
> Holtorf, MD, Kent. Kucheza ndi Mary Shomon. October 2009.
> Leibel RL, Hirsch J. "Kuwonjezera mphamvu zofunikira zowonjezera kwa odwala ochepa-ochepa." Metabolism. 1984 Feb; 33 (2): 164-70. Online.