tolerate it, then I’ll switch you to the slightly more expensive Two months later
sustained release version of the drug. I really think that this is Ursula weighed in having lost 30 pounds, down from 222
going to get control of your insulin, the excess androgens, and to 192.
help bring your cholesterol down," I said. "Your face looks great," I commented. "Your acne looks
"So, this is all I have to do to bring down my cholesterol?" like it is clearing up."
asked Ursula. "It's gotten better just in the past week or two. I thought
"No. I also want you to take some Inositol hexanicotinate. it would take forever," Ursula reported. "When am I going to
This is a non-flush version of niacin. It is only two-thirds as ef- be able to get rid of this beard and this mustache? Should I do
fective as niacin in treating lipid disorders, but it has fewer side electrolysis? I hate to keep shaving, although my husband and
effects. I think you will tolerate it better. It can raise another I joke about it."
chemical in your blood called homocysteine, which will ac- "It’s hard to predict how much of the facial hair will clear
celerate the rate at which you get heart disease through a com- up quite honestly. I can put you on a diuretic called Aldactone
pletely different mechanism, so I want you to be on a good B or spironolactone, but if you want to get pregnant, I wouldn't
complex 100 while you are taking the non flush niacin. Lastly, use it because it is contraindicated in pregnancy. You may
I want you on fish oil, flax seed, and walnuts. Increase your want to go ahead and have electrolysis done or laser removal
soluble fiber either in the form of psyllium, apples or oat bran of the hair. As your androgens come down, you shouldn't get
to 30 grams a day. All of this will help bring your cholesterol any more hair, but the hair that you have may not go away," I
down and rev up your liver detoxification process," I said. explained.
"Will I have to stay on all of this stuff for the rest of my "I may try waxing before I go that route," Ursula sighed.
life?" asked Ursula. I repeated blood work on Ursula and her lipid profile
"Hopefully not. If you do what I tell you to do, you will showed that her total cholesterol came down to 250, LDL 150,
have a different body three months from now, and an even HDL up to 40, and triglycerides down to 200. Fasting blood
healthier body six to nine months from now. Then, you won't sugar was still in the mid 90s. Fasting insulin down to 18.
need a lot of these supplements and the severe dietary restric- "How is your PMS and your periods?" I asked.
tions. For right now, we have to turn your metabolism around "I am still irritable and short-tempered and have the hard-
pretty dramatically to enable you to avoid the complications est time controlling my carbohydrate cravings just before my
of diabetes, heart disease, and stroke. Are you willing to do period," Ursula complained.
this?" I asked. "Do your breasts still get tender? Do you retain fluid?" I
Ursula took a deep breath, paused, and said, "You fixed asked.
my muscles; I can do this." "Yes, all of that," said Ursula.
I smiled, shook her hand, and said, "I’ll talk with you in “Didn’t I start you on progesterone?” I asked.
a month."

Telephone Consult
I called Ursula to see how she was doing. She was doing
remarkably well. She had indulged on her birthday and her
wedding anniversary. Other than that, she had stuck with the
diet and exercise program and had taken most of her supple-
ments most of the time.
"How much metformin are you up to now?" I asked.
"I am getting pretty bad diarrhea and I’m only on 500 mg
twice a day," Ursula reported.
"Then let's switch over to the sustained release metformin
500 mg and start out with one pill each day for this next week.
Take it at night, and then try reintroducing the higher dose,
taking it twice a day in a week to ten days," I suggested. "Are
you still taking your B complex 100?" I asked.
"No, I stopped that when my bottle was empty," asked
Ursula.
"Well, metformin can reduce your B vitamins, so take at
least one of those a day," I instructed. "What is your weight
doing?"
"That's the best part. I am down 12 pounds," Ursula
beamed over the phone.
"Well, remember, this is the month that you will lose the
weight the fastest. Stick with it and you will continue to lose
the weight at a slower rate. Give me a call back if the diarrhea
doesn't resolve,” I asked.

FEBRUARY 2010
11
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