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Clinical Use of Anabolics and Hormones
Clinical Use of Anabolics and Hormones
Any suggestions on how to get rid of gut after starting meds
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<blockquote data-quote="Nelson Vergel" data-source="post: 9662" data-attributes="member: 3"><p>Several treatments and approaches have been and are being studied to decrease visceral fat in HIV positive people:</p><p></p><p></p><p></p><p><strong>Human growth hormone</strong> can lower belly fat, but not without side effects. Serostim (a brand of HGH) is approved to treat HIV wasting, but its side effects led the FDA to deny its approval for lipodystrophy. These included joint pain, edema (water retention), increased lipoatrophy and blood sugar increases. Its high cost and lack of insurance reimbursement (due to its lack of FDA approval) are also barriers to use. It requires daily or every other day injections under the skin. But it has been shown to decrease visceral fat by 30% in 6 months.</p><p></p><p></p><p><strong>Tesamorelin</strong> (Egrifta) is a copy of a hormone that causes the pituitary gland to produce growth hormone. This is the only product approver by the FDA for the treatment of abdominal fat in HIV. Like Serostim, it requires daily injections under the skin but it seems to have milder side effects: mild edema, some joint pain, and a hypersensitivity reaction in 10% of people (sweating and rash). But it does not increase blood sugar or cause lipoatrophy, and it may lower triglycerides, a problem caused by some HIV meds. It has been shown to decrease visceral fat by 15% in 6 months.</p><p>Activists are concerned that its price will be high. This could cause insurance companies and Medicare to deny payment since it may be perceived as a cosmetic product. Also, it will be sold in the U.S. by Serono, the same company that sells Serostim. Serono has had poor relations with activists in the past, and was also fined over $700 million by Medicare for using fraudulent practices to induce some physicians to prescribe Serostim.</p><p></p><p></p><p><strong>Leptin</strong> is another new contender in the search to decrease visceral fat. This hormone, discovered in 1994, is produced by fat cells. Leptin levels in the blood are generally proportional to the level of body fat. In the hypothalamus (the part of the brain that controls appetite), high levels of leptin suppress the appetite and stimulate fat-burning. Like Serostim, it is taken as an injection under the skin, but it requires two injections a day, though other doses may be studied in the future. In a study of eight men with HIV and lipodystrophy, visceral fat decreased by 32% after 6 months, with no change in subcutaneous fat. Bad (LDL) cholesterol decreased by 16% and good (HDL) cholesterol increased by 19%, with a significant decrease of triglycerides. Leptin was well tolerated but it decreased lean mass. Early, small studies have not shown leptin to have negative effects on blood sugar, as Serostim can. But activists are asking its manufacturer to do larger studies in people with HIV to determine if leptin is useful and if it will be cost-effective.</p><p></p><p></p><p><strong>Metformin</strong> is a diabetes drug that at first showed promise in reducing abdominal fat. But later studies have not confirmed this, and have in fact shown that it may worsen lipoatrophy. However, in people without lipoatrophy who have glucose intolerance, metformin may reduce the risk of diabetes and therefore, abdominal fat. Its effects may be enhanced by exercise. Metformin improves insulin sensitivity, triglycerides, and fatty liver, but can cause <a href="http://www.thebody.com/content/art6030.html?ic=4001" target="_blank">diarrhea</a> and weight loss (which may itself lead to a decrease in visceral fat). Some people have reported low blood sugar and dizzy spells, so users of this drug should have snacks at hand to increase blood sugar if needed.</p><p></p><p></p><p></p><p><strong>Testosterone gels</strong> (Androgel, Testim) can reduce waist size in men, but only by lowering subcutaneous fat. In studies, no visceral fat decreases were seen. Testosterone is usually prescribed for people with HIV who have low blood levels of natural testosterone. Data in women are lacking, but one study of 23 women found that those with HIV-related lipodystrophy had higher testosterone levels than HIV-positive women without lipodystrophy. Gels, injections, and a new subcutaneous pellet delivery system are becoming more commonly accepted by physicians.</p><p></p><p></p><p><strong>Oxandrin (oxandrolone, or Anavar in foreign countries) </strong>, an oral anabolic steroid, showed encouraging results for decreasing visceral fat in a small pilot study. But LDL cholesterol increased and HDL cholesterol decreased, along with a small decrease in subcutaneous fat. No body fat studies have been done with the other commonly used anabolic steroid, nandrolone decanoate.</p><p></p><p></p><p><strong>Nutrition</strong> studies are lacking. A study at Tufts showed a trend toward less lipodystrophy in those who exercised and increased their soluble fiber (fruits and vegetables). More research is needed on low-carbohydrate diets, which have been shown to improve insulin resistance and visceral fat in HIV-negative people. One observational cohort found that people with HIV eat more saturated fats, which could lead to fat problems. A study of <a href="http://www.thebody.com/content/art6083.html?ic=4001" target="_blank">nutrition</a> and lifestyle modifications resulted in decreased belly fat in people with HIV, so there is a clear need for more care providers and organizations to include nutrition and exercise information in their educational efforts.</p><p></p><p></p><p>Sticking to an exercise program can be a challenge for many people who lead busy lives or can't afford to join a gym. But effective home exercise programs are available and could be part of the health counseling given by health care providers and organizations.</p><p></p><p>Aerobic exercise and weight training decreased triglycerides and visceral fat in a small pilot study. Another study showed that strength training increased lean body mass and decreased fat mass more than aerobic exercise, while improving cholesterol and triglycerides. A regimen of an hour of strength training combined with 20 minutes of aerobic exercise three to four times a week has been shown to work for most people (results take at least eight weeks to be noticeable). But exercise research in HIV remains in its infancy. Sticking to an exercise program can be a challenge for many people who lead busy lives or can't afford to join a gym. But effective home exercise programs are available and could be part of the health counseling given by health care providers and organizations.Liposuction, assisted by ultrasound, seems to be effective at removing fat from the hump that can occur at the back of the neck. Breaking the fat fibers with ultrasound can loosen them up for easier removal. But this can not be used for removing the visceral fat that surrounds organs in the belly, since removing that is too risky. Some insurance plans and Medicare pay for liposuction when the fat gain is associated with pain or sleep disorders.</p><p></p><p>Fat gain can also occur in the upper part of the body, especially in the breasts. Some studies show increases in estradiol, a female hormone, in men taking Sustiva. This may cause gynecomastia (increased breast size) in a few people. Drugs like Arimidex, an estrogen blocker, or switching from Sustiva can help those who are in early stages of this problem.</p><p></p><p>Fat burners are being promoted by some TV commercials. But they have not been shown to work and can increase blood pressure and anxiety. Also, beware of nutritional growth hormone supplements -- there are no data indicating that they work.</p></blockquote><p></p>
[QUOTE="Nelson Vergel, post: 9662, member: 3"] Several treatments and approaches have been and are being studied to decrease visceral fat in HIV positive people: [B]Human growth hormone[/B] can lower belly fat, but not without side effects. Serostim (a brand of HGH) is approved to treat HIV wasting, but its side effects led the FDA to deny its approval for lipodystrophy. These included joint pain, edema (water retention), increased lipoatrophy and blood sugar increases. Its high cost and lack of insurance reimbursement (due to its lack of FDA approval) are also barriers to use. It requires daily or every other day injections under the skin. But it has been shown to decrease visceral fat by 30% in 6 months. [B]Tesamorelin[/B] (Egrifta) is a copy of a hormone that causes the pituitary gland to produce growth hormone. This is the only product approver by the FDA for the treatment of abdominal fat in HIV. Like Serostim, it requires daily injections under the skin but it seems to have milder side effects: mild edema, some joint pain, and a hypersensitivity reaction in 10% of people (sweating and rash). But it does not increase blood sugar or cause lipoatrophy, and it may lower triglycerides, a problem caused by some HIV meds. It has been shown to decrease visceral fat by 15% in 6 months. Activists are concerned that its price will be high. This could cause insurance companies and Medicare to deny payment since it may be perceived as a cosmetic product. Also, it will be sold in the U.S. by Serono, the same company that sells Serostim. Serono has had poor relations with activists in the past, and was also fined over $700 million by Medicare for using fraudulent practices to induce some physicians to prescribe Serostim. [B]Leptin[/B] is another new contender in the search to decrease visceral fat. This hormone, discovered in 1994, is produced by fat cells. Leptin levels in the blood are generally proportional to the level of body fat. In the hypothalamus (the part of the brain that controls appetite), high levels of leptin suppress the appetite and stimulate fat-burning. Like Serostim, it is taken as an injection under the skin, but it requires two injections a day, though other doses may be studied in the future. In a study of eight men with HIV and lipodystrophy, visceral fat decreased by 32% after 6 months, with no change in subcutaneous fat. Bad (LDL) cholesterol decreased by 16% and good (HDL) cholesterol increased by 19%, with a significant decrease of triglycerides. Leptin was well tolerated but it decreased lean mass. Early, small studies have not shown leptin to have negative effects on blood sugar, as Serostim can. But activists are asking its manufacturer to do larger studies in people with HIV to determine if leptin is useful and if it will be cost-effective. [B]Metformin[/B] is a diabetes drug that at first showed promise in reducing abdominal fat. But later studies have not confirmed this, and have in fact shown that it may worsen lipoatrophy. However, in people without lipoatrophy who have glucose intolerance, metformin may reduce the risk of diabetes and therefore, abdominal fat. Its effects may be enhanced by exercise. Metformin improves insulin sensitivity, triglycerides, and fatty liver, but can cause [URL='http://www.thebody.com/content/art6030.html?ic=4001']diarrhea[/URL] and weight loss (which may itself lead to a decrease in visceral fat). Some people have reported low blood sugar and dizzy spells, so users of this drug should have snacks at hand to increase blood sugar if needed. [B]Testosterone gels[/B] (Androgel, Testim) can reduce waist size in men, but only by lowering subcutaneous fat. In studies, no visceral fat decreases were seen. Testosterone is usually prescribed for people with HIV who have low blood levels of natural testosterone. Data in women are lacking, but one study of 23 women found that those with HIV-related lipodystrophy had higher testosterone levels than HIV-positive women without lipodystrophy. Gels, injections, and a new subcutaneous pellet delivery system are becoming more commonly accepted by physicians. [B]Oxandrin (oxandrolone, or Anavar in foreign countries) [/B], an oral anabolic steroid, showed encouraging results for decreasing visceral fat in a small pilot study. But LDL cholesterol increased and HDL cholesterol decreased, along with a small decrease in subcutaneous fat. No body fat studies have been done with the other commonly used anabolic steroid, nandrolone decanoate. [B]Nutrition[/B] studies are lacking. A study at Tufts showed a trend toward less lipodystrophy in those who exercised and increased their soluble fiber (fruits and vegetables). More research is needed on low-carbohydrate diets, which have been shown to improve insulin resistance and visceral fat in HIV-negative people. One observational cohort found that people with HIV eat more saturated fats, which could lead to fat problems. A study of [URL='http://www.thebody.com/content/art6083.html?ic=4001']nutrition[/URL] and lifestyle modifications resulted in decreased belly fat in people with HIV, so there is a clear need for more care providers and organizations to include nutrition and exercise information in their educational efforts. Sticking to an exercise program can be a challenge for many people who lead busy lives or can't afford to join a gym. But effective home exercise programs are available and could be part of the health counseling given by health care providers and organizations. Aerobic exercise and weight training decreased triglycerides and visceral fat in a small pilot study. Another study showed that strength training increased lean body mass and decreased fat mass more than aerobic exercise, while improving cholesterol and triglycerides. A regimen of an hour of strength training combined with 20 minutes of aerobic exercise three to four times a week has been shown to work for most people (results take at least eight weeks to be noticeable). But exercise research in HIV remains in its infancy. Sticking to an exercise program can be a challenge for many people who lead busy lives or can't afford to join a gym. But effective home exercise programs are available and could be part of the health counseling given by health care providers and organizations.Liposuction, assisted by ultrasound, seems to be effective at removing fat from the hump that can occur at the back of the neck. Breaking the fat fibers with ultrasound can loosen them up for easier removal. But this can not be used for removing the visceral fat that surrounds organs in the belly, since removing that is too risky. Some insurance plans and Medicare pay for liposuction when the fat gain is associated with pain or sleep disorders. Fat gain can also occur in the upper part of the body, especially in the breasts. Some studies show increases in estradiol, a female hormone, in men taking Sustiva. This may cause gynecomastia (increased breast size) in a few people. Drugs like Arimidex, an estrogen blocker, or switching from Sustiva can help those who are in early stages of this problem. Fat burners are being promoted by some TV commercials. But they have not been shown to work and can increase blood pressure and anxiety. Also, beware of nutritional growth hormone supplements -- there are no data indicating that they work. [/QUOTE]
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Clinical Use of Anabolics and Hormones
Clinical Use of Anabolics and Hormones
Any suggestions on how to get rid of gut after starting meds
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