Wani hira da Kent Holtorf, MD
Kent Holtorf, MD yana da tarihin yin aiki tare da marasa lafiya wadanda ke da halayen hormone - ciki har da thyroid, adrenal, da kuma hormones. Ya rungumar Holtorf Medical Group a California, inda ya kwarewa a cikin rikice-rikice na endocrine, ciki har da hypothyroidism , adrenal insufficiency, da kuma insulin juriya.
Dr. Holtorf yana aiki tare da wasu marasa lafiya - da yawa daga cikinsu suna da maganin ciwon daji - waɗanda suka ga ya wuya ko ba zai yiwu su rasa nauyi ba.
Abin da ya gano shi ne cewa yayin da akwai wasu dalilai masu yawa a cikin rashin yiwuwar rasa nauyi, kusan dukkanin nauyin kisa da marasa lafiya wanda ya biyo baya sun nuna alamun maganganu na rayuwa da kuma endocrinological waɗanda suke manyan masu bayar da gudummawa ga matsalolin kalubale na waɗannan marasa lafiya. Musamman, Dr. Holtorf yana da, bisa ga wasu bincike na karshe, ya mayar da hankalin akan kimantawa na biyu mabudai - leptin da baya T3 (rT3) - da kuma magance duk wani rashin daidaituwa da aka gano don taimakawa marasa lafiya suyi nauyi.
Ina farin cikin iya kawo maka wannan hira tare da Dokta Kent Holtorf, yana tattauna hanyoyin da zai taimaka wa marasa lafiya na thyroid su sami asarar dogon lokaci .
Maryamu Shomon: Kayi magana da cewa kun ji cewa biyu mabambanta guda biyu - leptin da baya T3 - suna taka muhimmiyar rawa wajen tsara nauyin nauyi da metabolism. Za a iya fada mana game da leptin, na farko, da kuma abin da ya yi da ƙalubalen asarar nauyi?
Kent Holtorf, MD: An gano hormone leptin a matsayin babban mai kula da nauyin jiki da metabolism. Leptin yana ɓoye ta jiki mai kima da kuma matakan karuwa mai yawa tare da tarawar mai. Ƙara yawan kyawawan kwayoyin da ke faruwa tare da karuwar nauyin yau da kullum yana ciyarwa-baya ga hypothalamus a matsayin alamar cewa akwai isasshen makamashi (mai).
Wannan yana motsa jiki don ƙona kitshin maimakon ci gaba da adana kaya mai yawa, kuma yana taimakawa thyroid sakewa hormone (TRH) don ƙarfafa thyroid stimulating hormone (TSH) da kuma thyroid samar.
Binciken bincike yana gano cewa, yawancin mutanen da suka kamu da ƙananan da suke fama da wahalar rasa nauyi suna da nauyin nau'i nau'i na juriya marasa ƙarfi, inda leptin yana da ikon ragewa ya shafi hypothalamus da kuma daidaita metabolism. Wannan sakamakon juriya marasa tsinkaye a cikin hypothalamus yana jin yunwa, saboda haka ana amfani da hanyoyi masu yawa don ƙara yawan kayan ajiya, kamar yadda jiki yake kokarin warware abin da ake ji dadin yunwa.
Ayyukan da aka kunna sun hada da ragowar TSH, ƙwanƙwasa T4 zuwa tuba T3, karuwa a baya T3, karuwa a ci, ci karuwa a cikin insulin da kuma dakatar da lipolysis
Wadannan sifofi na iya zama a cikin sashi saboda tsarin ƙaddamar da masu sauraron leptin da ke faruwa tare da karuwa mai tsawo a leptin.
Sakamakon? Da zarar kayi nauyi don tsawon lokaci, zai zama da wuya a rasa nauyi.
Maryamu: Ya ce ka ji cewa matakan leptin a sama da 10 na iya samun magani.
Za a iya bayyana wani bayani game da matakan leptin?
Kent Holtorf, MD: Yawancin nauyin nauyin nauyin nau'i ko nauyin al'ada na da matakan leptin a kasa da 10, kodayake mafi yawan shafuka masu mahimmanci zasuyi amfani da layi na 1 zuwa 9.5 na maza da 4 zuwa 25 ga mata. (Dole ne a tuna cewa wannan rukuni ya ƙunshi 95% na waɗanda ake kira al'ada al'ada kuma ya haɗa da yawancin masu karba.) Kusan dukkan marasa lafiya da suke da nauyin lafiya suna da leptin kasa da 10.
Maryamu: Yaya kake bi da juriya a cikin aikinka?
Kent Holtorf, MD: Jiyya za a iya mayar da hankali akan magance leptin - leptin juriya. Wani leptin mai mahimmanci ya nuna cewa, TSH wani alamar da ba za a iya dogara ba don nauyin maganin thyroid , kamar yadda TSH ya shafe sau da yawa, tare da rage ƙin T4-to-T3.
A takaice, idan an ɗauke leptin dinku, kun rage yawan matakan thyroid. Har ila yau, kusan dukkanin masu ciwon sukari ne mai maganin leptin, wanda aka nuna don rage tubar T4-to-T3 a cikin masu ciwon sukari ta hanyar 50% ba tare da karuwa ba a TSH, yana mai da wuya ga nau'in masu ciwon sukari na II su rasa nauyi.
Saboda akwai talaucin T4-to-T3 maras kyau, T3-lokaci-da-da-da-wane wanda aka fitar T3 shi ne mafi kyau magani - ko da yake T4 / T3 hade magunguna irin su halitta na da ciwon thyroid (NDT) za a iya amfani.
Muna duba kudaden ƙwayar ƙarancin jiki (RMR) a cikin marasa lafiya, kuma mai sha'awa, waɗanda suke da matakan leptin da aka haɓaka da ke nuna juriya na leptin suna da RMR da suke cikin ƙasa a al'ada. Wadannan marasa lafiya suna cinye calories 500 zuwa 600 kadan a kowace rana fiye da wanda yake daidai da masallacin jiki.
Sabili da haka, don samun damar da za a rasa nauyi, waɗannan marasa lafiya zasu iya yin ƙoƙari su rage yawan adadin kuzari ta 500 zuwa 600 da adadin kuzari a rana (kawai don ci gaba da samun nauyi), motsa jiki don sa'a ko biyu a rana (kawai don kiyayewa daga samun karfin ) ko normalize thyroid da metabolism.
Mutane su ne jinsin nasara sosai domin muna iya adana makamashi (mai) sosai. Akwai hanyoyi masu yawa don samun nauyi da kuma juriya na leptin ɗaya ne daga gare su, saboda haka muna amfani da tsarin tsarin multisystem; babu wani magungunan sihiri, ko da yake duk wani magani zai iya yin tasiri a kan wani mai haƙuri.
Bugu da ƙari, yin gyaran maganin thyroid (tuna, bada hormone thyroid don rasa nauyi ba daidai ba ne, amma ba haka ba ne abin da muke yi ba, a nan muna gyara wani rashi), Symlin (pramlintide) da / ko Byetta (exenatide) na iya zama tasiri saboda mutane da yawa. Ƙungiyar Chorionic Gortadors (HCG) wani zaɓi ne mai yiwuwa wanda ke aiki ga wasu. Duk da yake na gano cewa mai maganin antitpressing Wellbutin (bupropion) ba ya aiki sosai don asarar nauyi, haɗin Wellbutrin da ƙananan naltrexone (LDN) yana da wasu sakamako mai ban mamaki. Topamax (topiramate) wani zaɓi ne ga wasu amma ba a koyaushe ya dace ba. Ana iya amfani da masu ƙarancin ci abinci mai mahimmanci, wanda ya inganta ƙarfafa metabolism, za'a iya amfani da su, musamman idan RMR ta ƙasaita.
Maryamu Shomon: Symlin da Byetta suna buƙatar yawan injections a kowace rana, wanda zai iya katse wasu mutane daga karbar su. Magunguna na iya samun wasu cututtukan sakamako masu wuya ga wasu marasa lafiya - ciki har da tashin hankali, vomiting da gajiya. Da yawa daga cikin marasa lafiya sun gano waɗannan magungunan mawuyacin ci gaba da shan? Kuna da wasu matakai da suka taimaka wa marasa lafiya magance waɗannan magunguna?
Kent Holtorf, MD: Yin amfani da wani abu mai sauƙi a sau ɗaya a rana yana iya zama matsala, amma idan marasa lafiya sun sami sakamako mai kyau ya fi dacewa ga mafi yawan. Wasu ƙwararrun: Na farko, wasu suna damuwa cewa magunguna suna buƙatar gwaninta, amma yawanci ba dole ba ne, don waɗannan magunguna suna da ƙarfi a yanayin zafi na yau. Don haka ba matsala ba ne don ajiye shi a cikin jakar ku ko a cikin aljihun tebur.
Babban sakamako mafi girma shine maganin, wanda ya faru a kimanin kashi 25% na marasa lafiya. Yawancin lokaci yana da sauki kuma ya rage tare da ci gaba da amfani, amma kaɗan marasa lafiya ba zasu iya jurewa ba. Don Byetta, ina bayar da shawarar farawa tare da inganci 5 mcg kafin cin abinci. Wasu marasa lafiya farawa tare da rabi harbi na 'yan kwanakin farko (kawai suna turawa cikin rami). Mawuyacin hali a wasu mutane zai iya zama saboda yawan ƙwayar ciki na ciki, don haka Zantac (ranitidine) ko magungunan kwantar da hanzarin proton - kamar Prilosec (omeprazole), Prevacid (lansoprazole), ko Nexium (esomeprazole) misali - iya zama taimako. Akwai fasalin sa'a guda daya a cikin tsari na FDA, wanda aka nuna cewa yana da ragowar sakamako mai mahimmanci da kuma karuwar saukakawa.
Maryamu Shomon: Kunyi bayanin cewa ga wasu marasa lafiya, kuna da su har zuwa Byetta sau 10 a kullum, tare da abinci. Mene ne mafi kyawun magani ga Symlin?
Kent Holtorf, MD: Jigilar jiki ba ta da wani sakamako na Symlin, idan aka kwatanta da Byetta, saboda haka yana da kyau ga wasu marasa lafiya. Ga Symlin, kashi mafi kyau shine 120 mcg, sau uku a kowace rana. Dukansu Byetta da Symlin suna da mummunar haɗari ga hypoglycemia sai dai idan kana kan insulin ko a sulfonylurea magani ga ciwon sukari .
Maryamu Shomon: Kuna jin cewa canjin T3 shine batun. Kuna iya gaya mana kadan game da sake juya T3?
Kent Holtorf, MD: T4 zai iya zama ko dai ya tuba zuwa T3, hormone mai aiki wanda ke da tasiri, ko kuma ya juya T3, wanda shine nau'i na T3, kuma a hakika yana ɗaukar tasirin T3. Doctors - ciki har da endocrinologists - an koya cewa baya T3 ne kawai m aiki, amma karatu nuna cewa yana da m antithyroid effects. A gaskiya ma, an nuna cewa ya zama mai karfin ikon maganin thyroid fiye da PTU, magani wanda ake amfani dashi ga hyperthyroidism. Gyara T3 ya haɗa daidai da matakan T3 na kwayoyin halitta, don haka shi ma alama ne ga hypothyroidism, tare da matakan da suka fi girma (ko raƙuman ƙananan T3 / RT3) wanda ke nuna ƙananan rashi.
Maryamu Shomon: Me yasa kake ji baya T3 taka rawar a yin wuya ga wasu thyroid marasa lafiya don rasa nauyi?
Kent Holtorf, MD: An cire T3 a lokutan damuwa ko yunwa don rage ƙarfin hali, kuma tare da damuwa na yau da kullum ko rushewa, RT3 na iya zama haɓaka, yana kawar da maganin thyroid aiki da metabolism. Mutane a kan abincin na yau da kullum - ko waɗanda suka rasa muhimmancin nauyin nauyi - zasu kasance da ƙananan ƙarfin hali fiye da mutum wanda yake da nauyin nauyin da ƙwayar tsoka wadda ba ta rasa nauyi mai nauyi ba ko kuma ta mutu a cikin baya. Wannan ya nuna a cikin wani binciken da Leibel ya wallafa a cikin mujallar Metabolism , wanda ake kira "Ƙaddamar da Bukatar Harkokin Kayan Lantarki a Raunin marasa lafiya." Wannan nazarin ya kwatanta basal a cikin mutanen da suka rasa nauyi ga wadanda nauyin nauyin da basu rasa ba. muhimmancin nauyi a baya. Masu marubuta sun gano cewa wadanda suka mutu kuma sun rasa nauyi a baya suna da, a matsakaicin, kashi 25% na ƙaƙƙarfan ƙwayar cuta fiye da marasa lafiya marasa lafiya.
Duk wa] anda suka horar da su da kuma lafiyar lafiyar jiki, wanda ba su da matsala mai nauyi, wanda ya gaya maka ka yi kamar yadda ba su san abin da ya zama mummunan ga mutanen da suka yi matsala mai tsawo ba. Hakika, ko da waɗannan masu horarwa ba za su iya kula da nauyin da suke da su ba tare da matakan da ke da kashi 20 zuwa 40 cikin ƙasa.
Muna jarrabawar ƙwayar ƙarancin maganin da ke cikin maganin marasa lafiya da kawancin ka kuma gano shi inversely correled tare da baya T3. Mafi girma da baya T3, da ƙananan metabolism, tare da mutane da yawa wadanda ke da metabolism wanda yake da kashi 20 zuwa 40% fiye da yadda aka sa ran su ne (BMI). Babu wanda ya yi imani da irin abincin da suke ci, kuma an yi su kamar rashin lafiya - duk da yin duk abin da ke daidai. Har sai an magance matsalolin da suke ciki, abinci da motsa jiki ba zasu kasa cimma nasara ba.
Maryamu: A wane lokaci kake la'akari da baya T3 da yawa kuma yana buƙatar magani?
Kent Holtorf, MD: Kamar duk abin da yake a magani shi ne ci gaba, amma mutane masu lafiya suna da yawa a ƙarƙashin 250 pg / ml kuma ya kamata a sami rabo mai t3 / baya T3 mafi girma fiye da 1.8 idan T3 kyauta ta kasance a cikin / dl ko 0.018 idan kyauta T3 yana cikin pg / ml.
Maryamu: Yaya za ka yi la'akari da matakan T3?
Kent Holtorf, MD: Mafi girma daga T3, ƙaddarar shirin T4 mafi mahimmanci zai kasance. T4 / T3 haɗuwa sun fi dacewa da shirye-shiryen T4-kawai, kamar Levoxyl da Synthroid , amma ga matakan da aka ƙaddamar da sauri wanda aka ƙaddamar da T3 shine mafi kyau.
Maryamu: Abin da za a iya ba da abinci da kuma salon rayuwa za ku bayar da shawarar tare da waɗannan maganin likita?
Kent Holtorf, MD: Yawancin marasa lafiya da suka shiga sun kasance suna cin abinci mai yawa da salon rayuwarsu kuma suna da masaniya a wannan yanki. Sauran ƙwayoyin carbohydrate za su shafe aikin gyaran ka da kuma ƙara ƙwanƙwasa T3 fiye da adadin calories masu dacewa tare da isasshen carbohydrates, saboda haka yayin da mai rageccen carbohydrate zai iya haifar da asarar asarar farko, marasa lafiya ba zai yiwu ba a sake samun nauyi sai dai idan an magance matsalar T3.
Maryamu Shomon: Shin zaka iya ba mu tunanin yadda za ku sami asarar kuɗin da kuka samu tare da masu maganin thyroid wadanda, bayan gwaji, sun nuna juriya na leptin, da kuma babban t3 na T3, da kuma fara magunguna don wadannan yanayi?
Kent Holtorf, MD: Muna ƙoƙari mu bincika da kuma bi da yawancin dysfunctions da suboptimal yanayin rayuwa wanda za mu iya. Mun sami nasara tare da mutane masu yawa, daga wadanda suke bukatar rasa 'yan fam zuwa ga wadanda suke da nauyin dari dari ko fiye. Mafi yawan gamsuwa shine mutanen da suka rasa 50 zuwa 100 fam ko fiye. Yana canzawa rayuwarsu.
Har ila yau, muna ganin karin marasa lafiya da suka shigo bayan ƙetare - waɗanda ba su rasa nauyi ba ko kuma sun sami yawa ko duk nauyin da suke da shi. Yawancin suna da ƙananan ƙwayoyin thyroid da matakan leptin juriya. Hakanan kuma suna iya samun raunin hormone mai girma.
Muna da mutum guda wanda ke cin calories 800 a rana daya bayan ya wuce tazara kuma tana ci gaba da yin nauyi. Babu wanda ya yi imani cewa wannan ita ce ta ci har sai sun saka ta a asibitin da kuma kula da abincinsa. Suka nace ta herroid ya lafiya, kamar yadda ta na da al'ada TSH , T4 da T3. A lokacin da muka duba ta baya T3, duk da haka, kuma ya kai 800 kuma leptin ya kasance 75. Mun duba ta da kima da kuma 45% a kasa al'ada. Abin da ya mutu shine, ba shakka ba zai yi aiki tare da irin wannan mai haƙuri ba.
Har ila yau, toxins irin su biphenyl-A na iya toshe masu karɓa na thyroid a ko'ina cikin jiki sai dai ga pituitary, wanda ke da masu karɓa daban. Saboda haka saboda yanayin yanayi na wadannan gubobi, Na yi imani cewa kowa yana da dangi na karoid aiki wanda TSH ba ta gano ba. Mutane sun zargi cin abinci da rashin aikin motsa jiki a cikin wannan kasa, amma ina ganin matsala mai girma shine maganin maganin ciwon hawan gwiwarka, da kuma danniya.
Bugu da ƙari, ana nuna alamar ba kawai rage ƙwayar T4-to-T3 ba kuma ƙara ƙaddamar T3, amma an nuna shi don rage yawan lambobin masu karɓar maganin thyroid - amma kuma, ba a cikin pituitary ba - don haka adadi na thyroid yana da ƙasa da sakamako, amma TSH ba canzawa. Wannan ya nuna muhimmancin maganin asibiti da kuma ƙaddamar da ƙwayar nama a cikin ƙaddamar da aikin ciwon thyroid a cikin mutum. Har ila yau, mata suna da masu karba da karancin kawanci fiye da maza, suna sa su kara da hankali ga ƙananan raguwa a cikin kwayoyin magani na hormones.
Maryamu Shomon: Kuna duba glucose azumi da matakan insulin, kuma / ko kuma gwada glucose na juriya tare da marasa lafiya wadanda suke da karba kuma suna fama da rashin nauyi?
Kent Holtorf, MD: Muna azumi glucose da azumi mai insulin, da kuma Hemaglobin A1C (HA1C) gwajin, don neman danniya na insulin , ba kawai kallon "al'ada" ba. Wani muhimmin labaran da za a samu shi ne hormone jima'i mai ɗaukar globulin (SHBG). An motsa shi a cikin hanta a mayar da martani ga hormone thyroid da estrogen, don haka zai iya zama mai amfani alama don nama matakin thyroid.
A cikin mace mai tsaurin mata, matakin zai kasance a sama da 70. In ba haka ba, yana da kyau a nuna cewa akwai nauyin nau'i na thyroid. Wannan shi ne ainihin gaskiya idan mace tana kan saurin maganin karoid, saboda - saboda haɗuwa ta farko da ake ciki - hanta zai sami matakan ƙwayar jikinka fiye da sauran kyallen takalma. Saboda haka, idan SHBG bashi, sauran jiki yana da ƙananan ƙwayar ka.
(Lura: Wannan jarabawar ba ta da amfani idan mace tana cikin sauyin yaduwar jijiyar, saboda wannan zai haifar da SHBG saboda girman isrogen a cikin hanta. Wannan jarrabawar daidai ne ga matan da suke amfani da shirye-shiryen estrogen na transdermal.)
Ciwon sukari da polycystic ovary syndrome (PCOS) kuma suna kashe SHBG, saboda matakan T3 da aka ƙwaƙashe ciki wanda aka gani a cikin waɗannan yanayi. Har ila yau, idan ka duba ka SHBG kafin ka fara maye gurbin karo kuma ka ga kadan canji tare da magani, yana nuna cewa kana da juriya thyroid. Har ila yau kuna son duba waɗannan abubuwa masu zuwa:
- insulin-like girma factor 1 (IGF-1)
- insulin-kamar girma factor daura furotin 3 (IGFBP3)
- dehydroepiandrosterone (DHEA)
- testosterone
- luteinizing hormone (LH)
- follicle stimulating hormone (FSH)
- urinary aidin
- cortisol
- adonocorticotropic hormone (ACTH)
- C-reactive gina jiki (CRP) - ƙonewa rage ƙananan TSH kuma ƙara rT3
- homocysteine - alama ce don low thyroid da low B bitamin
- lipids - high cholesterol ne alama don low thyroid kuma high triglycerides ne alama don insulin juriya
- baƙin ƙarfe da ferritin - ferritin ake bukata don kunna thyroid, da yawa bayyanar cututtuka da cewa mutane siffanta zuwa anemia tare da low ferritin ne ainihin saboda low nama thyroid kunnawa
- bitamin D - ya kamata ya fi 80
- thyroid peroxidase antibodies (TPO) da kuma antithyroglobulin antibodies - mai ban sha'awa bincike ya thyroid biopsies a cikin mutanen da suka kasance fatigued kuma gano cewa, duk da ciwon ba shaida TPO ko antithyroglobulin antibodies, mafi ya yi thyroid ƙonewa da kuma amsa symptomatically to thyroid sauyawa ko da ta thyroid matakan sun kasance a cikin al'ada
- matakin serotonin - sau da yawa wani ƙananan ƙwayar maganin serotonin tare da ƙananan ƙwayar ƙanƙara saboda yawancin ciwon serotonin yana cike da ƙananan ƙwayar ka da kuma antidepressants ba zai yi aiki ba idan matakan T3 su ne suboptimal
Masu fama da matsananciyar hali za su sami TSH da al'amuran al'ada T4, masu mahimmanci na al'ada T3 da T3 marasa ƙarfi. Yawancin likitoci zasu duba TSH da T4 da cewa likitan yana da ƙwayar thyroid (bisa ƙananan TSH da ƙananan T4) amma suna da ƙananan matakan T3 (kamar yadda ƙananan T3 / rT3 suka nuna) . Wadannan marasa lafiya sau da yawa suna karɓa sosai ga ƙarin T3. Yin amfani da maganin maganin maganin kwayoyin halitta ko dai ta hanyar magana ko ta hanyar allura zai iya zama tasiri sosai wajen maganin marasa lafiya marasa lafiya (wadanda ba su amsa ko amsa mummunar maganin magunguna ba) ba tare da maganin maganin antidepressants ba.
Maryamu: Idan wani yayi girman jini yana nuna alamar insulin - amma ba cike da ciwon sukari ba - shin kuna sanya su a kan Glucophage (metformin) akan hana?
Kent Holtorf, MD: Haka ne, ba sa hankalta a jira har sai wani yana da ciwon sukari don amfani da metformin ko wasu magance. Har ila yau muna amfani da kari, wanda muke so shine GlucoSX. Yayin da metformin ya kasance babban mahimmancin juriya na insulin, mun haɗu da metformin kuma muka ci gaba da yin amfani da Byetta da Symlin, saboda yawancin hasara na asara.
Maryamu Shomon: Mutane da yawa masu shan magani sunyi tambayar ni game da cututtuka na HCG (human chorionic gonadotropin) saboda asarar hasara, ciki har da injections da takalma, da kuma nauyin HCG na gida. Na sadu da kaina da wasu matan da suka kasance hypothyroid, sun kai kimanin 200, kuma sun ci gaba da maganin HCG, kuma sun rasa fam 25 ko fiye a cikin kwanaki 40 na HCG magani. Na san ƙarin likitoci da suka fara amfani da shi. Menene tunaninku game da wannan a matsayin zaɓi na asarar asarar nauyi?
Mun sami HCG tasiri ga mata da yawa. Mun sami takardar maganin HCG maganin ƙwayoyi don zama mafi tasiri fiye da HCG ko kuma HCG creams. Har ila yau, saboda dole ne ka bayar da kashi mafi girma a hankali kuma a cikin ƙuƙwalwa - saboda raƙuman ragewa - yana da tsada sosai a matsayin ƙananan allurar subcutaneous.
Kent Holtorf, MD ne ya kafa kamfanin Holtorf Medical a California.
> Sources:
> Holtorf, MD, Kent. Yi hira da Maryamu Maryamu. Oktoba 2009.
> Leibel RL, Hirsch J. "Ya rage yawan buƙatun makamashi a marasa lafiya marasa karuwa." Metabolism. 1984 Feb, 33 (2): 164-70. Online.