I'm 29, female and weigh 155kg. I've been following a 1200 calorie per day diet for 8 weeks (1400-1500 per day off and on for 18 months previously - in approx 6 weeks bursts after which I get fed up and stop calorie counting but rarely would have exceeded 2500 cals - special occasions and most days would have been 1500-1800) plus 1000mg Metformin (prescribed for PCOS - 500mg the first 4 weeks) with minimal weight loss - around 6lbs, most in weeks 2 and 3. I paid for a evening cortisol saliva test (11pm) which came back with a result of 1.2 ng/mlI then paid for a 24 hour cortisol + DHEA saliva test with the following resultsCortisol:30 minutes post awakening - 23.6 nmol/L+ 4-5 hours - 5.7 nmol/L+ 4-5 hours - 5.5 nmol/Lbedtime - 4.5 nmol/LTotal: 39.4Reference ranges:12 - 225.0 - 9.03.0 - 7.01.0 - 3.0DHEA:am: 0.44pm 0.47Reference range: 0.4-1.7DHEA : Cortisol Ratio 1.15 (range 2-6)The tests were performed by Genova Diagnostics (ZRT for the first evening cortisol test) who I believe to be reputable but the practitioner I purchased the test kit from seems to not be an MD and is interested in selling diet plans (fourweekfatloss.com) and nutritional supplements. Are these tests results indicative of any medical problems and worth mentioning to my GP? Could they explain my difficulties in losing weight? I also suffer from hirituism, hair loss, menstrual irregularities (2-3 per year from age 12 to 23, none since taking cerazette, ceased cerazette 4 months ago and no period yet), (GP says all due to PCOS and obesity), poor wound healing, facial redness (GP said seb derm+ maybe rosacea based on a very quick visual examination and prescribed metrogel but it had no effect). Sex hormones were all within normal range but sex hormone binding globulin was low-normal.I'm open to any suggestions, my GP wants me to have surgery but I don't want it because I don't think it will work - she says it definitely would but if I'm not losing weight on 1200 calories a day I don't see how it would be any different after surgery. She also wanted me to try orlistat before metformin but there were supply problems but to me it seems like she doesn't believe me about my diet if she wanted me to try orlistat for 3 months first.A typical day would be 271g Grilled lean chicken for breakfast or 136g chicken with a courgette + cheese muffin or a 90g bagel.Lunch would be 2-3 slices of ham + lettuce and cucumber with a teaspoon of salad cream or vegetable soupDinner is more varied - casserole, cottage pie, chilli, spinach curry, ravioli, pasta bolegnese, stir fry with an average of 450-550 calories
HelloWelcome to Ja and thanks for the very interesting question.Your labs do not indicate any serious medical problemBefore we go further I need to know what your TSH level is.
2.9 (reference range 0.3 - 5.5)
OKI think this is where your problem is more than cortisol, but let's take it step by step.A 24 hour urine free cortisol is definitive for correct quantitative amounts and to make sure you do not have hyper secretion.Then, new guidelines indicate that TSH should fall in between .3 and 3.So you are borderline high which means you are near hypothyroid.Many experts given your symptoms, might use armour thyroid in low dose to help with weight loss at this point.yes PCOS can account for a lot, but, diet and exercise, and weight loss are needed to fix this, and you are going to have a hard time losing weight with a TSH of 2.9.Frankly, functional medicine trained MDs are interested in your cortisol the way it is, which indicated a stress pattern, and in correcting your thyroid right now, far more than MDs that are not trained in functional medicine.Diet is extremely important here for the cortisol /DHEA ration and a nutrient dense diet should be used along with other interventions...this can be found in the book Eat to Live, by Dr. Joel Fuhrman. The diet will stop inflammation in the system and help with the cortisol balance, and with the PCOS, even the thyroid and should be implemented now.To find a doc like this, go here.www.functionalmedicine.org
Let me know if you have further questions.
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I've had my inflammation levels checked and they are fine. I looked at the website you suggested and there are no doctors in my area. I came via the UK website, I was expecting to get a UK based expert. The nhs guidelines do not recommend treatment other than regular checkups below 10mU/L and I don't think armour its available here
OKWe just trained our first group of UK docs in London this year...if you call IFM they can help you.Armour can be shipped everywhere.Regular medicine is not going to recommend any intervention based on your diet.The anti-inflammatory diet is also nutrient dense, and is needed regardless, and it also helps stabIllize the cortisol cycle, regardless of your inflammAtory load.I would find a more enlightened doc.I know they are there.What you can do on your own is the diet, exercise, cut out all endocrine disruptors...processed food, food from plastic, pesticide food, etc.You can also help this with magnesium, 500 mg a day preferably magnesium taurate, fish oil, cinnamon, a B-100 sustained release complex, ginger, and turmeric.
Relist: Other."expert" is pushing his own 'alternative medicine' agenda and a highly questionable organization that has already been fined several times for making unsubstantiated claims.
HiI was following your question.I do agree with Dr. Thomas- your thyroid is borderline elevated (they recently changed the TSH criteria) and you may benefit from low dose of thyroxine +/- T3 for subclinical hypothyroidism.In terms of the surgery- the advantage of the surgery is that it not only helps you feel full, but it affects the amout of calories that you can absorb, since the food is transiting through the gut faster. The issue is- you have a very efficient metabolism. Everything that you eat is being absorbed. If you disrupt this with bypass surgery, it will make you more inefficient and so you will absorb less calories than before, therefore helping you lose weight. I also noted your diet. It is not the total amount of calories in, but the type. Processed food like cheese muffins, bagels, pasta should be eliminated entirely. Your carbs should be obtained from fruits and veggies with scant portions of grains such as oats, flaxseed. I did not see any mention of you exercising, you need to exercise every day for at least 30 minutes. brisk walking is a great place to start..
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