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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 56822
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I have been told in the past I have PCOS, I exercise almost

Customer Question

Hi, I have been told in the past I have PCOS, I exercise almost daily, mostly stick within 1800-2000 calories and have done so for years but I struggle to lose weight at all now!
JA: Have you used any medication for PCOS?
Customer: No
JA: Got it. Have you seen a doctor about PCOS?
Customer: A while ago
JA: Thank you so much for your time. Finally, is there anything else in your medical history you think the Doctor should know?
Customer: I have lost a lot of weight prior to now around 85lbs
Submitted: 19 days ago.
Category: Medical
Expert:  Dr. Arun Phophalia replied 19 days ago.

What are your age, height, and weight?

What did your hormonal tests show?

Customer: replied 19 days ago.
35 5ft6 80kgI have had hormonal tests for thyroid etc recently but not recently for pcos
Expert:  Dr. Arun Phophalia replied 19 days ago.

Thanks for the further information.

I am writing the answer for you and will get back to you in 5 minutes.

Unless you wish to speak in person, you can ignore the request for a phone call automatically generated by the website, not by me.

Thank you.

Expert:  Dr. Arun Phophalia replied 19 days ago.

The first step would be to get the following investigations for PCOS, if not done;

1) androgen,

2) luteinizing hormone (LH), and

3) insulin

4) Ultrasound of ovaries.

The treatment is;

a) The drug of choice for inducing ovulation in PCOS is clomiphene citrate.

b) Metformin

c) Coming to optimum weight.

d) Laparoscopic ovarian drilling.

e) Spironolactone, flutamide and finasteride are antiandrogens that work in PCOS by decreasing androgen levels, thereby reducing the signs of hirsutism, hair loss, and acne. These antiandrogens may also improve lipid levels, which can be elevated in patients with PCOS.

The following measures can help you with weight loss;

1) Drinking 500 ml of water before every meal. This is achieved primarily through a water-induced increase in resting energy expenditure.

2) A sufficient amount of sleep and a healthy sleep pattern is important to harness weight loss.

3) Fat substitutes;

a) Olestra (Olean) has been approved for use as a dietary supplement and additive in various foods, such as potato chips and crackers. Olestra has a calorie value of 0 kcal/g, whereas fat has a value of approximately 9.1 kcal/g.

b) Two portions of margarine, Benecol and Take Control, block cholesterol absorption in the intestine and can lower total and LDL-cholesterol levels.

4) Other possibly beneficial agents, which may help in some individuals;

a) St. John's Wort

b) Psyllium

c) Chromium

d) Ginseng

e) Axokine.

Also, consider whether there are any underlying medical causes that are preventing you from losing weight as follows:

1 Low thyroid or Hypothyroidism is notorious for causing unnecessary weight gain and it will not respond to simple dietary adjustments. A thyroid function test would be necessary to diagnose the problem.

2) Another cause can be excess cortisol Cortisol levels, ACTH, and suppression tests would be diagnostic.

The following measure would be recommended:

1) Avoid sugar-containing products or products which contain artificial sweeteners.

2) Increase protein intake which has been shown to reduce cravings and help with weight loss such as

  • Egg whites,

  • fish, seafood,

  • legumes, nuts,

  • Meat,

  • dairy products and some whole grains.

3) Cut carbohydrates from the diet as much as you can.

4) Dietary fiber is another excellent way to reduce belly fat. However, the important thing is to use soluble viscous fiber, such as the fiber present in legumes, cereals like oats. Dietary supplements like glucomannan will also help here.

5) Following food products can be helpful here as well,

  • Oatmeal, the unsweetened kind

  • Almonds and other nuts

  • Olive oil (use this or coconut oil for cooking)

  • Berries that contain a lot of fiber

  • Beans and legumes

  • Whole grains

  • Peanut butter (limit yourself to two tablespoons a day)

  • Avocados

  • Tea

  • Cannellini beans

  • Broccoli

  • Flaxseeds

  • Green tea

  • Curd

The dietary adjustment should be combined with moderate exercise. A good exercise regimen is very important in order to lose weight.

Following over the counter medications are supposed to be effective for weight loss with the measures you are already doing (exercises and dietary cautions);

1) Alli; decreases fat absorption in the body.

2) Conjugated linoleic acid; decreases body fat.

Weight loss pills usually work in the following ways;

1) boosting the body's basal metabolic rate,

2) blocking the absorption of dietary fat,

3) suppressing appetite.

These are the other over the counter herbs/supplements which have some evidence of efficacy;

1) Green tea extract

2) Guar gum

3) Chitosan

4) Hoodia

5) Chromium

6) Bitter orange

There are prescription medications too which your doctor may recommend;

a) Phentermine is the US Food and Drug Administration (FDA)-approved for short-term (up to 12 weeks) treatment of obesity and is the most widely prescribed weight-loss drug.

b) Diethylpropion

c) Benzphetamine and Phendimetrazine

d) Orlistat is currently available as a prescription drug (Xenical 120 mg) or an over-the-counter weight loss supplement (Alli 60 mg).

The weight loss pills can have some significant side effects in individuals and they can best be used as;

1) Adjunct to the other measures like diet and exercise.

2) They should be used as short-term measures.

Weight loss management is long-term management like diabetes and high blood pressure so one needs to take continuous precautions to continue weight loss and prevent weight gain (as you know). The treatment of obesity is built on the core pyramid of diet, exercise, and lifestyle change. Diet has always been central to the study of nutrition. So you should also consult a nutritional specialist and endocrinologist (if not yet done). Here is an article written by a doctor for treating his own obesity;

http://www.medscape.com/viewarticle/749483_4

I wish your symptoms resolve soon.

I would be happy to assist you further if you need any more information.
Thanks for using Just Answer.

Customer: replied 18 days ago.
Hellothanks for the above, I really don't need the help with weight loss, I am doing all the right things in that regard and have been doing so for the last 12+ years
Is it easy for me to ask for these tests (androgen, LH etc) via the NHS? or is it best to go to a specialist private endocrinologist?
Expert:  Dr. Arun Phophalia replied 18 days ago.

NHS may be extremely slow as you understand so getting privately may help.