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Ask Amy: Wife’s extreme weight loss tilts the marriage

Apr 12th, 2019
Comments Off on Ask Amy: Wife’s extreme weight loss tilts the marriage

DEAR AMY: I have been married for 16 years, and have been with my wife for 18 years.

She is 5 feet, 4 inches tall and has always weighed around 200 to 230 pounds. Eight months ago she had gastric bypass and now weighs 135 pounds.

I know she is healthier and she is happier, but I am miserable, as I feel I lost the person I fell in love with.

She makes me feel like I am a bad person for not liking a skinnier wife, but I dont find her sexually attractive anymore.

I am not sure what to do at this point. How can I save my marriage and find her more attractive? Do I have to settle? I am 6 feet, 4 inches tall and 320 pounds and have been heavy my entire life.

Hefty and Confused

DEAR HEFTY: Extreme weight loss is a major stressor on relationships, for some of the reasons you are citing. When a person literally transforms into another person, they move through the world differently, with different interests, needs, habits and perceptions. (Its not just about how your jeans fit.)

Spouses often assume designated roles, and now your wifes role has changed. But what about you?

I imagine she is also receiving a lot of positive attention, which might make your alienation and disorientation worse. Her new body might also make you feel self-conscious about yours.

Because this change is so extreme, and so rapid, I hope you will be patient as you both adjust. Please seek professional help, as you transition through this marital disruption.

The hospital that performed her surgery should offer a referral for a counselor specializing in this common relationship response.

DEAR AMY: Am I being heartless for wanting to cut off my 24-year-old daughter? She is engaged to be married in the fall of 2020, but she is a full-time student who does pet-sitting as a part-time job. She lives with her boyfriend, and he has a full-time job.

She and her boyfriend moved away to her college city almost three years ago and we see them when they visit once or twice a year.

We have younger children and feel that although she is still a full-time student, we have to set a cut-off age and stop paying for her cellphone bill. This is the only expense we pay for her. We arent in the financial position to help any of our children with college tuition.

My daughter got extremely angry when I brought up the subject of her taking over her phone bill, saying she doesnt have the money, yet I know she pays for video-streaming subscriptions, and is going to a concert for a performer she has seen a couple times already.

She finishes her very demanding semester in May and says that she might take one class during the summer. How can I make her realize that she is being unreasonable? Or am I being heartless?

I want to tell her to get another job during the summer and stop acting like an entitled brat!

Mad Mom Lisa

DEAR MAD MOM: The cellphone bill seems to have emerged as a major marker of emerging adulthood. (I was inordinately proud of my own daughter when she suddenly suggested that she would take over the cost of her own phone and yes, she was 24.)

You are not being heartless. But your daughter and her younger siblings will not know what your boundaries are unless you establish them.

She finishes her demanding semester in May. This would be the perfect time to transition away from your cellphone plan, and onto her own (or with her fiance).

Her pet-sitting business should pick up during the summer. She could work it around another part-time job, and the class she plans to take.

I dont think it is necessary or even useful to try to convince a young person that her expectations are unreasonable. You simply say, This is whats going to happen. And if she grumbles about it so what? Your message to her should always be, You can handle it. We have confidence in you. Youll be fine. (Please, dont call her a brat.)

DEAR AMY: Dont Knock My Stuff was upset that her husband seems to find and share negative information about things she enjoys.

I too have the same curiosity as her husband and have ruined things for my wife.

I think the writer was being oversensitive but that the husband clearly had taken it too far.

Been There

DEAR BEEN THERE: Thank you.

You can contact Amy Dickinson via email: ASKAMY@amydickinson.com. Readers may send postal mail to Ask Amy, P.O. Box 194, Freeville, NY 13068. You can also follow her on Twitter @askingamy or like her on Facebook.

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Ask Amy: Wife's extreme weight loss tilts the marriage

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Human growth hormone Drug Information, Professional

Apr 7th, 2019
Comments Off on Human growth hormone Drug Information, Professional

Generic Name: Growth HormoneThis monograph includes information on the following:

1) Somatrem2) Somatropin, Recombinant

JAN:SomatropinHuman growth hormone{10}5VA CLASSIFICATIONPrimary: HS701

Commonly used brand name(s): Genotropin2; Genotropin Miniquick2; Humatrope2; Norditropin2; Norditropin cartridges2; Nutropin2; Nutropin AQ2; Protropin1; Saizen2; Serostim2.

Note:For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

Category:

Growth hormone

IndicationsAccepted

Growth failureGrowth hormone deficiencyassociated (treatment)Somatrem and recombinant somatropin are indicated in children for long-term treatment of growth failure caused by pituitary growth hormone (GH) deficiency (pituitary dwarfism), including GH deficiency caused by cranial irradiation. {10}4 {10}3 {10}2 {10}1 {10}0 {20}9 {20}8 {20}7 {20}6 {20}5 {20}4 {20}3 {20}2 {20}1 {20}0{22}9 Failure to grow must be documented by a subnormal growth rate, and GH deficiency is usually identified by a lack of response to two standard pharmacologic stimuli that would normally provoke the release of somatropin or evidence of impaired spontaneous secretion or bioactivity of endogenous GH. {22}8 {22}7 {22}6 {22}5Recombinant somatropin ( Genotropin, Humatrope, Nutropin, Nutropin AQ) is also indicated in adults for treatment of growth failure caused by GH deficiency1 when both of the following criteria are present: {22}4 {22}3 {22}2 {22}1• GH deficiency of adult onset, alone or with multiple hormone deficiencies, such as hypopituitarism, as a result of hypothalamic or pituitary disease, radiation therapy, surgery, or trauma. Or GH deficiency of childhood onset that was not confirmed until adulthood; and#149; Negative response to a standard growth hormone stimulation test, i.e., maximum peak of less than 5 nanograms per mL when measured by polyclonal antibody (RIA) or less than 2.5 nanograms per mL when measured by monoclonal antibody (IRMA).

Chronic renal insufficiencyassociated (treatment)Recombinant somatropin ( Nutropin, Nutropin AQ) is indicated in children for treatment of growth failure caused by chronic renal insufficiency. It has been shown to improve growth rate and correct the acquired height deficit seen in these patients. Somatropin may be used until the time of renal transplantation. However, there are insufficient data to establish benefit of therapy beyond 3 years. {22}0 {23}9 {23}8

Prader-Willi syndrome (PWS)-associated (treatment)1Somatropin is indicated for long-term treatment of pediatric patients who have growth failure due to PWS. The diagnosis of PWS should be confirmed by appropriate genetic testing{23}7Turner's syndromeassociated (treatment) 1Recombinant somatropin ( Humatrope, Nutropin, Nutropin AQ) is indicated for long-term treatment of short stature associated with Turner"s syndrome. {23}6 {23}5 {23}4Cachexia, acquired immunodeficiency syndrome (AIDS)associated (treatment) orWeight loss, AIDS-associated (treatment)Recombinant somatropin ( Serostim), in conjunction with the appropriate antiretroviral therapy, is indicated for treatment of AIDS-associated cachexia or weight loss. {23}3 {23}2UnacceptedThere are currently insufficient data to establish the efficacy and the long-term safety of the use of growth hormone in treating idiopathic short stature. {23}1 {23}0 {25}9

Growth hormone is not recommended for growth promotion in pediatric patients with closed epiphyses. {25}8 {25}7 {25}6 {25}5 {25}4 {25}3 {25}2 {25}1 {25}0 {27}9 {27}8{27}7

The use of human growth hormone in older males to change body composition (e.g., to decrease adiposity and to prevent decline in muscle mass) is not recommended. {27}6 {27}5 {27}4 {27}3 {27}2

Growth hormone is not indicated in patients with functioning renal allografts. {27}1 {27}0

1Not included in Canadian product labeling.

Pharmacology/Pharmacokinetics

Physicochemical characteristics:SourceSomatrem: Biosynthetic. A single polypeptide chain of 192 amino acids, one more (methionine) than naturally occurring human growth hormone, produced by a recombinant DNA process in Escherichia coli . {28}9 {28}8 {28}7Somatropin, recombinant: Biosynthetic, produced by a recombinant DNA process in E. coli ; {28}6 {28}5 {28}4 {28}3 same amino acid sequence as naturally occurring human growth hormone. {28}2 {28}1 {28}0 {10}9 {10}8 {10}7 {10}6 {10}5 A single polypeptide chain of 191 amino acids. {10}4 {10}3 {10}2 {10}1 {10}0 {20}9 {20}8 {20}7 {20}6 {20}5 {20}4 {20}3 {20}2Molecular weightSomatrem: 22,256.39 {20}1Somatropin: 22,125.19 {20}0

pHGenotropin (reconstituted solution): 6.7. {22}9Humatrope (reconstituted solution): 7.5. {22}8Norditropin (reconstituted solution): 7.3. {22}7Nutropin (reconstituted solution): 7.4. {22}6 {22}5Nutropin AQ: 6. {22}4 {22}3Protropin (reconstituted solution): 7.8. {22}2Saizen (reconstituted solution): 6.5 to 8.5. {22}1Serostim (reconstituted solution): 7.4 to 8.5. {22}0Mechanism of action/Effect:

Human growth hormone is an anterior pituitary hormone. Most anabolic actions are thought to be mediated by insulin-like growth factor-I (IGF-I, which has also been known as somatomedin C), synthesized in the liver and other tissues in response to growth hormone stimulation. {25}9 {25}8 {25}7 {25}6 {25}5 {25}4 IGF-I concentrations are low in children with growth hormone deficiency but normalize in response to administration of exogenous growth hormone. {25}3 {25}2 {25}1 {25}0 {27}9 {27}8 {27}7 {27}6 {27}5 {27}4 {27}3

Growth hormone stimulates linear growth by affecting cartilaginous growth areas of long bones. {27}2 {27}1 {27}0 {28}9 {28}8 {28}7 {28}6 {28}5 {28}4 {28}3 {28}2 It also stimulates growth by increasing the number and size of skeletal muscle cells, {28}1 {28}0 {21}9 {21}8 {21}7 {21}6 {21}5 {21}4 {21}3 {21}2 {21}1 influencing the size of organs, and increasing red cell mass {21}0 {21}9 {21}8 {21}7 {21}6 {21}5 {21}4 {21}3 through erythropoietin stimulation. {21}2

Growth hormone influences metabolism of carbohydrates by decreasing insulin sensitivity and possibly by affecting glucose transport; {21}1 {21}0 {10}9 {10}8 of fats by causing mobilization of fatty acids; {10}7 {10}6 {10}5 {10}4 {10}3 {10}2 of minerals by causing the retention of phosphorus, sodium, and potassium through promotion of cellular growth; {10}1 {10}0 {20}9 {20}8 {20}7 {20}6 {20}5 {20}4 {20}3 {20}2 {20}1 {20}0 {22}9 of proteins by increasing protein synthesis, which results in nitrogen retention; {22}8 {22}7 {22}6 {22}5 {22}4 {22}3 {22}2 {22}1 {22}0 {25}9 {25}8 {25}7 {25}6 {25}5 and of connective tissue by stimulating synthesis of chondroitin sulfate and collagen, and by increasing urinary excretion of hydroxyproline. {25}4 {25}3 {25}2 {25}1 {25}0 {28}9 {28}8 {28}7

Other actions/effects:

In adults, increases in lean body mass, total body water, and physical performance, and decreases in body fat and waist circumference, are seen with growth hormone therapy. {28}6 {28}5 {28}4 {28}3Absorption:

Bioavailability:

Genotropin: Approximately 80% following subcutaneous administration of a 0.03-mg-per-kg of body weight dose in the thigh. {28}2

Humatrope: 63% and 75% following intramuscular and subcutaneous administration, respectively. {28}1

Nutropin, Nutropin AQ: 81 20%. {28}0 {29}9

Saizen: 70 to 80%. {29}8

Distribution:

Localizes to highly perfused organs, especially the kidneys and liver. {29}7 {29}6 {29}5

Vol D:

Genotropin: 1.3 0.81 L per kg following administration to adults with growth hormone deficiency. {29}4

Humatrope: 0.07 L per kg following intravenous injection. {29}3

Nutropin, Nutropin AQ: At steady-state, 50 mL per kg of body weight in healthy adult males. {29}2 {29}1

Saizen, Serostim: 12 1.08 L following intravenous injection to healthy volunteers. {29}0 {10}9

Biotransformation:

Primarily renal, also hepatic. In renal cells, growth hormone is cleaved into its constituent amino acids, which are returned to the systemic circulation. {10}8 {10}7 {10}6 {10}5 {10}4 {10}3 {10}2Half-life:

Intravenous injectionApproximately 20 to 30 minutes (elimination). {10}1 {10}0 {27}9 {27}8 {27}7 {27}6 {27}5 {27}4 {27}3 {27}2

Intramuscular or subcutaneous injectionSerum concentrations decline with a half-life of approximately 3 to 5 hours, {27}1 {27}0 {26}9 {26}8 {26}7 {26}6 {26}5 reflecting continued release of the hormone from the injection site. {26}4 {26}3Duration of action:

Approximately 12 to 48 hours. {26}2 {26}1Elimination:Biliary (approximately 0.1% of a dose as unchanged drug). {26}0 {75}9

Precautions to ConsiderCarcinogenicity/Mutagenicity

Carcinogenicity and mutagenicity testing have not been performed in animals or humans. {75}8 {75}7 {75}6 {75}5 {75}4 {75}3 {75}2 {75}1 {75}0 {28} {29} {30} Mutagenicity testing in vitro with recombinant somatropin did not reveal any mutagenic effects. {21} {29}

Anecdotal cases of acute and chronic leukemia have been reported in patients treated with human growth hormone, at an incidence slightly higher than that expected in the overall population. {20} {21} {65} {66} However, the exact relationship to human growth hormone therapy is unknown. {01} {10} {20} {21} {22} {23} {25} {27} {28} {29} {30} {65} {66} Leukemia has also been reported in hypopituitary patients who have not been treated with growth hormone. {44} {45} {46} {47} {48} {57}Pregnancy/ReproductionFertilityStudies in rats and rabbits administered doses of up to 31 and 62 times, respectively, the recommended human pediatric dose on a body surface area basis have not shown that somatropin causes impaired fertility. {25}

PregnancyStudies have not been done in humans. {10} {20} {21} {23} {25} {26} {27} {28} {29} {30} {75}

Studies in rats and rabbits administered doses of up to 31 and 62 times, respectively, the recommended human pediatric dose on a body surface area basis have not shown that somatropin causes adverse effects in the fetus. {25}

FDA Pregnancy Category B ( Genotropin, Saizen, Serostim). {21} {25} {26} {75}

FDA Pregnancy Category C ( Humatrope, Norditropin, Nutropin, Nutropin AQ, Protropin). {01} {10} {20} {22} {23}Breast-feeding

It is not known whether growth hormone is distributed into breast milk. {01} {10} {20} {21} {22} {23} {25} {26} {27} {28} {29} {30} {75}Pediatrics

Safety and efficacy in pediatric patients with acquired immunodeficiency syndrome (AIDS) have not been established. {26} {75}

Geriatrics

Appropriate studies on the relationship of age to the effects of growth hormone have not been performed in the geriatric population. However, geriatrics-specific problems that would limit the usefulness of this medication in the elderly are not expected.Drug interactions and/or related problemsThe following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)not necessarily inclusive (=major clinical significance):

Note:Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.

Anabolic steroids{59}{66} orAndrogens orEstrogens orThyroid hormones(concurrent use of excessive doses of these hormones may accelerate epiphyseal closure, although hormone supplement therapy may be necessary in patients with deficiencies of these hormones to maintain the growth response to human growth hormone {05} {16} {59} {66} {72} {73})

Corticosteroids, glucocorticoid{01}{10}{20}{21}{22}{23}{25}{27}{28}{29}{30} or Corticotropin (ACTH),{20}{21}{22}{28} especially with chronic therapeutic use(inhibition of the growth response to human growth hormone may occur {01} {10} {20} {21} {23} {25} {27} {28} {29} {30} with chronic therapeutic use of corticotropin or with daily oral corticosteroid doses [per square meter of body surface area] in excess of:

Betamethasone: 300 to 450 mcg

Cortisone: 12.5 to 18.8 mg

Dexamethasone: {68} 250 to 500 mcg

Hydrocortisone: 10 to 15 mg {29}

Methylprednisolone: 2 to 3 mg

Prednisolone: 2.5 to 3.75 mg

Prednisone: 2.5 to 3.75 mg

Triamcinolone: 2 to 3 mg

Maximum parenteral corticosteroid doses are approximately one half maximum oral doses. In general, it is recommended that these doses not be exceeded during human growth hormone therapy and if larger doses are required, administration of human growth hormone should be postponed, except for brief administration of stress dosages during acute febrile illness or other acute stress; {37} however, there is great interindividual variation. {37} Also, concurrent use with corticotropin is not recommended; of the others, hydrocortisone or cortisone is usually preferred, except in extenuating circumstances {37})

Laboratory value alterationsThe following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)not necessarily inclusive (=major clinical significance):

With physiology/laboratory test valuesAlkaline phosphatase{01}{10}{21}{22}{23}{25}{27}{28}{29}{30}(values may be increased {01} {10} {21} {22} {23} {25} {27} {28} {29} {30})

Glucose tolerance{01}{10}{20}{21}{26}{27}{28}{30}{31}{35}{56}{59}{66}(may be reduced by high doses {10} {11} {20} {21} {26} {27} {28} {30} {35} {56} {66})

Inorganic phosphate{01}{10}{21}{22}{23}{25}{27}{28}{29}{30}{56}(serum concentrations may be increased to normal during treatment with growth hormone as a result of metabolic activity associated with bone growth as well as increased tubular reabsorption of phosphate by the kidneys {22} {23} {28} {30} {56})

Nonesterified fatty acids{01}{10}{21}{22}{23}{25}{27}{28}{29}{30}{56}(plasma concentrations may be increased as a result of lipid mobilization from body fat stores {01} {10} {21} {22} {25} {27} {28} {30} {56})

Parathyroid hormone{01}{22}{23}{28}{30}(concentrations may be increased {01} {22} {23} {28} {30})

Thyroid function{27}{28}{30}{59}(serum thyroxine [T 4] concentration, radioactive iodine uptake [RAIU], and thyroxine-binding capacity may be slightly decreased; {11} {14} {15} {16} {59} asymptomatic hypothyroidism usually occurs in less than 5%, but possibly up to 10 to 20%, {37} of patients with hypopituitarism {06} {07} {09} {11} {12} {13} {14} {16} {17} {59})

Medical considerations/ContraindicationsThe medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate) not necessarily inclusive (=major clinical significance).

Risk-benefit should be considered when the following medical problems existDiabetes mellitus{10}{21}{25}{29}(growth hormone may cause insulin resistance; adjustment of insulin dosage may be needed {10} {21})

Hypothyroidism, untreated{01}{10}{20}{22}{23}{27}{28}{29}{30}(interferes with growth response to human growth hormone; {01} {10} {20} {21} {22} {23} {25} {27} {28} {29} {30} prior and/or concurrent thyroid hormone replacement therapy is recommended {01} {08} {16} {20} {21} {22} {23} {27} {28} {29} {30})

Malignancy,{03} especially intracranial tumor, actively growing{01}{10}{20}{21}{22}{23}{25}{27}{28}{29}{30} within the previous 12 months(human growth hormone should not be used if there is evidence of progression or recurrent growth of an underlying tumor; {01} {20} {21} {27} {28} {29} {30} antitumor therapy and a reasonable period of observation should be complete before initiating growth hormone therapy {10} {21} {27} {65})

Sensitivity to any component of the growth hormone product prescribed{20}{26}Patient monitoringThe following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; =major clinical significance):

Antibodies to growth hormone, serologic evaluation for{01}{10}{20}{22}{23}{25}{27}{28}{29}{30}{37}(in some cases, where growth rate falls during therapy and all other causes of growth inhibition have been ruled out, serologic evaluation for the presence of antibodies to growth hormone may be performed, with emphasis on binding capacity; {01} {20} {22} {23} {25} {27} {28} {29} {30} {37} antibodies to somatrem may be formed in the first 3 to 6 months of treatment {11} {14} but only rarely cause failure to respond to therapy; {27} {30} antibodies to recombinant somatropin have been detected in patients treated for 6 months or more; relative incidence of antibody formation is difficult to compare because different assays have been used; {37} {51} however, growth inhibition appears to be correlated more with high antibody binding capacity [exceeding 2 mg per L] {01} {20} {21} {22} {23} {25} {28} {30} than with growth hormone titer, {37} {67} and differences in antibody formation have demonstrated minimal clinical significance to date {49} {51})

Bone age determinations{25}{29}(recommended annually during therapy, especially in pubertal patients on concurrent androgen, estrogen, {03} or thyroid replacement {29} therapy since concurrent use may accelerate epiphyseal maturation {25} {29} {73})

Calcium concentrations, serum{24} andParathyroid hormone concentrations, serum{24} andPhosphorus concentrations, serum{24} andRenal function determinations{22}{24}(recommended periodically in patients with growth failure secondary to chronic renal insufficiency to detect progression of renal osteodystrophy {22} {23} {28})

Examinations to monitor intracranial lesion{01}{10}{20}{21}{22}{23}{27}{28}{29}{30}(recommended at frequent intervals in patients with growth hormone deficiency secondary to an intracranial lesion {01} {10} {20} {22} {27} {28} {29} {30})

Examinations to monitor progression of scoliosis{01}{10}{22}{23}{27}{28}{30}(although growth hormone has not been shown to increase the incidence of scoliosis, rapid growth can lead to progression of scoliosis; close monitoring is recommended {01} {10} {22} {23} {27} {28} {30})

Funduscopic examinations{01}{10}{20}{21}{22}{23}{25}{26}{27}{28}{29}{30}{75}(recommended upon initiation and periodically during the course of growth hormone therapy, to detect intracranial hypertension {01} {10} {20} {21} {22} {23} {25} {26} {27} {28} {29} {30} {75})

Glucose concentrations{01}{10}{20}{21}{22}{23}{26}{27}{28}{29}{30}{75}(recommended periodically because growth hormone can cause insulin resistance {10} {20} {21} {27} {28} {29} {30} {75})

Growth rate determinations from stadiometer measurements(recommended every 3 to 6 months during therapy; {37} if the growth rate does not exceed the pretreatment growth rate by at least 2 cm per year, the patient should be checked for noncompliance or the presence of antibodies or other medical problems such as hypothyroidism or malnutrition {03} {36} {39} {55} {72})

Radiograph, hip{22}{23}{28}(recommended prior to growth hormone therapy in patients with chronic renal insufficiency because risk of slipped capital femoral epiphysis and avascular necrosis of the femoral head are increased in patients with advanced renal osteodystrophy {22} {28})

Thyroid function determinations{01}{10}{20}{21}{22}{23}{25}{27}{29}{30}{59}(recommended at regular intervals during therapy to detect hypothyroidism that develops during treatment; {01} {21} {22} {23} {27} {29} {30} untreated hypothyroidism interferes with response to human growth hormone {01} {16} {22} {23} {27} {29} {30} {59})

Side/Adverse Effects

Note:Prolonged use of excessive doses of human growth hormone in patients who are not growth hormone deficient may theoretically cause acromegalic features (face, hands, feet) and other problems associated with acromegaly, including organ enlargement, diabetes mellitus, atherosclerosis, hypertension, and nerve entrapment syndrome (carpal tunnel syndrome). {04} {06} {08} {09} {11} {13} {19} {31} {35} {52} {56} {66}Development of antibodies to growth hormone may occur in a small number of patients. Interference with growth response has been seen only when antibody binding capacity exceeded 2 mg per L. {01} {20} {21} {22} {23} {25} {28} {29} {30} For patients receiving somatrem who exhibit attenuation of growth response as a result of an increased production of antibodies, consideration should be given to transferring to somatropin. It has been suggested, although not proven, that methionine on the N-terminus of somatrem causes development of antibodies. {30}

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)not necessarily inclusive:Those indicating need for medical attentionIncidence more frequentOtitis media or other ear disorders in patients with Turner's syndrome{10}{22}{23}

Incidence rareAllergic reaction (skin rash or itching){01}{22}{23}{25}{26}{28}{30}{41}{75}intracranial hypertension (changes in vision; headache; nausea and vomiting; papilledema)in children{01}{10}{20}{21}{22}{23}{25}{27}{28}{29}{30}lipodystrophy at site of injection (depression of the skin){21}{25}{26}{27}{29}pain and swelling at site of injection {01}{03}{10}{11}{21}{22}{23}{25}{28}{29}{30}pancreatitis (abdominal pain or distension; nausea; vomiting){01}{10}{22}{23}{26}{28}{30}{75}slipped capital femoral epiphysis (limp; pain in hip or knee)in children{01}{10}{20}{21}{22}{25}{28}{29}{30}{42}{43}{53}{54}

Note:Symptoms of intracranial hypertension usually occur within the first 8 weeks of therapy and resolve with a reduction in growth hormone dose or discontinuation of therapy. {01} {10} {20} {21} {22} {23} {25} {27} {28} {30}The risk of lipodystrophy may be decreased by rotating injection sites. {25} {26} {27} {29}Slipped capital femoral epiphyses may also occur in growth hormonedeficient children not treated with growth hormone. {42} {54}

Those indicating need for medical attention only if they continue or are bothersomeIncidence less frequent or rareCarpal tunnel syndrome mild and transient{01}{10}{21}{22}{23}{26}{28}{30}{75}gynecomastia (enlargement of breasts){01}{10}{22}{23}{28}{30}headache {10}{20}{21}{27}{29}increased growth of nevi {01}{10}{22}{23}{28}{30}joint pain {10}{21}{22}{23}muscle pain {10}{20}{21}{26}{27}{75}peripheral edema (swelling of hands, feet, or lower legs){01}{10}{21}{22}{23}{26}{27}{28}{30}{75}unusual tiredness or weakness {20}{21}{27}

OverdoseFor more information on the management of overdose or unintentional ingestion, contact a Poison Control Center (see Poison Control Center Listing ).Clinical effects of overdoseThe following effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)not necessarily inclusive:AcuteHypoglycemia (anxiety; behavior change similar to drunkenness; blurred vision; cold sweats; confusion; cool, pale skin; difficulty in concentrating; drowsiness; excessive hunger; fast heartbeat; headache; nausea; nervousness; nightmares; restless sleep; shakiness; slurred speech; unusual tiredness or weakness)initially{10}{21}{27}{29}hyperglycemia (blurred vision; drowsiness; dry mouth; flushed, dry skin; fruit-like breath odor; increased frequency and volume of urination; ketones in urine; loss of appetite; nausea or vomiting; stomachache; tiredness; troubled breathing [rapid and deep]; unconsciousness; unusual thirst)subsequently{10}{21}{22}{23}{27}{29}

ChronicAcromegaly (amenorrhea; backache; changes in vision; excessive sweating; extreme weakness; headache; increase in hat, glove, or shoe size; joint pain; pain in extremities; polydipsia; polyuria){10}{21}{22}{23}{25}{26}{27}{28}{29}{30}{75}

Patient ConsultationAs an aid to patient consultation, refer to Advice for the Patient, Growth Hormone (Systemic) .

In providing consultation, consider emphasizing the following selected information ( = major clinical significance):Before using this medication Conditions affecting use, especially:Sensitivity to any component of the growth hormone product prescribedOther medications, especially corticosteroids or corticotropin (ACTH)Other medical problems, especially untreated hypothyroidismProper use of this medication Proper preparation and administration of medication

Carefully selecting and rotating injection sites {18} {21} {26} {27} {28} {29} {30} {75}

Safe handling and disposal of needles and syringes; {01} {10} {22} {23} {25} {26} {28} {30} {75} not reusing needles and syringes {75}

Proper dosing

Proper storagePrecautions while using this medication Importance of regular visits to physician

Side/adverse effectsSigns of potential side effects, especially otitis media or other ear disorders (in patients with Turner's syndrome), allergic reaction, intracranial hypertension (in children), lipodystrophy at site of injection, pain and swelling at site of injection, pancreatitis, and slipped capital femoral epiphysis (in children)

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Human growth hormone Drug Information, Professional

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Use Of Human Growth Hormone HGH Injections? Studtropin

Apr 7th, 2019
Comments Off on Use Of Human Growth Hormone HGH Injections? Studtropin

Measuring achilds growth

HGH medication can facilitate youngsters and adults World Health Organization have a somatotrophic hormone deficiency.HGH is important to growth, particularly in youngsters, however, its also concerned in several different processes within the body, together with bone density, muscle mass, and mood.

Different hormones control varied body functions and processes, together with growth and development, metabolism, sexual operate and replica and mood. It helps process protein and will increase fat breakdown to assist give the energy required for tissue growth.Growth hormone levels will change through the day, and physical activity plays a section.

Exercise and similar activities will cause the amount to rise naturally. Sleep, stress, and low blood glucose levels conjointly increase somatotrophic hormone levels. Even little changes in HGH levels have an effect on the body. Too little or an excessive amount of somatotrophic hormone will cause significant growth issues. deficient HGH is one in every of the most causes of short stature and conditions like a genetic abnormality.

Someindividuals use HGH as a result of they believe itll build muscle, improveperformance, or slow aging. However, the present proof doesnt support theutilization of HGH for these functions.

Children with low levels of lack of somatotrophic hormone might or might not be smaller at birth. Growth issues might seem in time, for instance, if theyre smaller than their classmates and growing but a pair of inches a year. Some youngsters ar unable to provide somatotrophic hormone once they ar born and still have low levels throughout their life.

In someyoungsters, an absence of somatotrophic hormone is an element of a geneticcondition, however, sometimes the reason for the deficiency is unknown.

In adults,an absence of somatotrophic hormone is usually due to harm to the pituitarybody, which can be permanent. The harm might have occurred in childhood oradulthood.

Problems within the pituitary with manufacturing somatotrophic hormone ar usually thanks to a pituitary tumour. The pituitary are often broken by the tumour itself or by treatment like surgery and radiation.

Growth endocrine deficiency also can be a mix of 1 or additional hormone deficiencies. Buy HGH Online For Some medical conditions Which will be very beneficial For human Body.

Turners syndrome: ladies with this condition typically have underdeveloped feminine sexual characteristics.

Prader-Willi syndrome: A inherited disease causes weak tonicity, feeding difficulties, poor growth, and delayed development.

Noonan syndrome: This inherited disease interferes with the correct development of varied a part of the body.

Chronic uropathy

A person will administer HGH injections reception or receive the endocrine at the doctors workplace.Buy Pure HGH Injection Online At Studtropin Which is Launched by Biostuds

The mostcommon treatment in each adults and kids is somatotrophic hormone medical carevictimisation lab-developed HGH injections.

Doses occurmany times per week or on a routine betting on however severe the deficiencyis.Manufacturers designed the expansion endocrine to mimic the behavior ofnatural somatotrophic hormone within the body. itll be prescribed by a doctor.

HGHtreatments are often self-administered or given by a doctor. Treatments arusually given for many years. Patients can see their doctor each month more orless to see their condition.

Blood testsare dole out to visualize if further somatotrophic hormone is required and iftreatments ought to be inflated, decreased, or stopped. steroid alcohol levels,blood glucose levels, and bone density also will be checked to visualize iftheyre healthy.

Takingsomatotrophic hormone will have an effect on the bodys response tohypoglycemic agent, that controls blood glucose levels. somatotrophic hormonedeficiency also can result in high steroid alcohol and brittle bones if itsnot treated.

Specifictreatment for somatotrophic hormone deficiency depends on the person.

Doctors basethis treatment on sure factors, such as:

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Published by Studtropin

At Studtropin You Can easily get Growth Hormone Supplements at affordable Prices. We Provide range of HGH for sale which are healthy and beneficial to maintain Fitness. Benefits of Taking hormone Growth are Muscles Growth, Anti-Aging, Increase exercise capacity, Increase bone density, Increase muscle mass, Decrease body fat and many more. Buy HGH Online from Stud tropin to maintain your healthy lifestyle.For More Details your can contact on +1 732 708 2292 and Mail us at Studtropins@gmail.com.View all posts by Studtropin

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Use Of Human Growth Hormone HGH Injections? Studtropin

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Ipamorelin vs Sermorelin – Ipamorelin

Apr 6th, 2019
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Whilst ipamorelin is regarded as being a GHRP product, sermorelin is regarded as being a GHRH product; this means that it doesnt instigate a massive spike in growth hormone release, but rather sustains and optimises access to growth hormone whilst it is present.

As such, these two products can be effectively combined together.

Its worth noting that these two items actually share a similar list of benefits, though sermorelin is reportedly beneficial for boosting the immune system and supporting more restful sleep in a manner that is surplus to many other secretagogue varieties.

On balance, it does present an extended list of potential side effects when compared to ipamorelin. These products should not be compared, rather the user should consider how their unique benefits can be combined.

Youll often hear different peptide names being mentioned alongside each other, each with their own individual classification depending on how many amino acids they contain as part of their activation sequence.

Two of the most common classifications are pentapeptides (peptides featuring a chain of five or more amino acids as previously discussed) and hexapeptides.

Just like pentapeptides, hexapeptides too are a common feature of many skin care / anti aging products and medications / pharmaceutical applications.

Unlike anabolic steroids, a peptides functionality is not determined merely by its name alone instead, its all about what lies within.

The name hexapeptide merely means that the peptide type in question contains a chain of 6 amino acids. It does not dictate by default which six or what effect they will manifest.

This is only the same with pentapeptides, whereas their name merely dictates that a five amino acid chain is present. In either scenario, the products natures could be completely different to one another.

The below image showcases what a hexapeptide structure looks like.With the above information in mind, it is largely irrelevant to try and determine a peptide by its numerical value alone. Instead, treat them as you would steroids and look into the individual character traits on offer with each named peptide variety in order to understand more about them.

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Independence | 2019’s Best Rated Hcg Diet – Best HCG Drops …

Apr 6th, 2019
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HCG Diet: Independence (KS)

In the past trying to get rid of excess body fat in Independence Kansas was never easy. Sure, if you were just trying to lose a couple pounds in Independence it may be a little bit easier, but for most in Independence, it is not about losing a couple of pounds. For most in Independence Kansas, it is about losing 10 pounds or more in Independence. And that used to be a difficult thing to do in Independence. Those days are now a thing of the past thanks to a fantastic Independence product called HCG Triumph weight-reduction plan drops.

Triumph HCG drops are not just another weight reducing fad product. It is an entire weight reducing program that has been many years in the making in Independence and that is utilizing not only some of the most advanced weight reducing solutions and ingredients in the world of natural weight reducing, but Triumph HCG drops also use the most advanced solutions in Independence KS in nutrition and proper maintenance of weight management. Together, it makes for a Kansas weight reducing program that is very effective and that is also incredibly quick in Independence. With the Triumph HCG Drops, you will lose fat more quickly and efficiently than with anything else in Independence KS, period!

The Independence secret behind these Triumph hcg drops is in the unique formula. Independence KS HCG is a natural hormone that lets your body in Independence know that it needs to burn down your stored fats in Independence in order to make up for the lower intake of calories. What this means for you in Independence KS, is that by sticking to the Triumph HCG diet weight reduction plan program, you will be on a reduced calorie hcg diet weight reduction plan that may seem like a strict one to people in Independence KS not using the Triumph hcg diet, but which is actually quite an easy one to follow with the Triumph hcg drops in Independence.

Recent Independence advances have made it possible to make hcg drops in Independence that accomplishes two things:

It's the purest formula possible -- 100% pure for Fantastic results in Independence!It's now very affordable for the Independence Kansas dieter to use Triumph hcg drops for weight reducing

Now with the Triumph hcg diet formula, you can lose fat in a safe, natural way that is now affordable for anyone in Independence.

The Four Benefits of the Triumph Hcg Diet.

Triumph HCG drops combine a revolutionary diet protocol with advanced science in Independence KS. This allows for a natural way for your body in Independence to burn an incredible amount of your stored fat and lose fat fast. Now, by working with your body and not against it, you will lose fat safely and quickly. Plus, you'll keep the extra weight off in Independence once you have lost it.

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HCG Diet | HCG Diet Information | Your HCG Diet

Apr 6th, 2019
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Weve all tried diets in the past and know how difficult it can be to lose weight and keep it off. The HCG diet isnt the newest fad, miracle cure, or food delivery service. In fact, the HCG diet has been around since the 1950s when the protocol was created by Dr. A.T.W. Simeons.

Simply put, the HCG hormone allows you to maintain a very low calorie diet (VLCD), while eliminating hunger pangs.The easy-to-take drops allow your body to unlock stored fat around the midsection (hips, belly, bottom, and thighs) as well as the upper arms. We provide you with not only the hormone-includedHCG drops, but the step-by-step specifics of the diet. You will know when to start, what to eat, how to track your progress, and all the information you need to safely transition off of the diet once you have reached your goal.

Dr. A.T.W. Simeons formally published the HCG Diet in the 1950s. Since then it has gained popularity at a very fast pace. The original HCG diet was published in Italy, where Dr. Simeons was practicing as an endocrinologist. Having worked with the endocrine system and being very familiar with its function, Dr. Simeons knew that there was something out there that could help, if not cure, obesity. At the time, Dr. Simeons had no way of predicting the need for products like HCG. Currently, more than one-third of US adults are considered obese. Obese affects anyone that has a BMI of 30 or higher. BMI can be calculated using the following formula:

Weight (lb) / [Height (in)]2 x 703

The HCG diet plan is a diet where you take the hormone HCG, also know as Human Chorionic Gonadotropin, either sublingually or through injections. The diet is accompanied by a low calorie diet. When following Dr. Simeons protocol, you will follow a 500-calorie diet. With the HCG diet, its not just the HCG that works and its not just the diet that works. Its a combination of the two. A lot of people wonder if they will go into starvation mode while on the HCG diet. The answer is no. With the diet protocol, your body doesnt just exist on 500 calories. The HCG forces your body to unlock the fat that is stored in the mid-section (hips, thighs, belly, and butt) as well as in the upper arms. Your body then consumes between 1500-4000 calories from the stored fat being released into your body IN ADDITION to the 500 calories that are being eaten. A lot of times this stored fat is referred to as abnormal fat. Its fat that our body does not need to survive. It was stored there by our body because we werent able to burn all that we consumed, or sometimes there are other factors that play into obesity like thyroid issues, hereditary, etc.

The objective of the HCG diet is to help a person lose weight quickly, but also to maintain the weight loss long term. Long term weight stabilization will happen through the use of HCG because it helps reset your hypothalamus, the maintenance phase teaches you how to eat whole & natural foods, and by the end of the full program, your body should no longer be craving the sugars and carbohydrates that your body once craved.

The HCG diet was made public to help people struggling with obesity lose weight. A lot of times, these people may be too overweight to exercise, so dieting is the first step in losing weight. After the weight goes down, they can start to introduce exercise into their daily routine. While on the HCG diet, exercise should be kept to a minimum to ensure your body doesnt burn more than it should, which in turn could cause your body to either go into starvation mode or start burning muscle. Exercise that is allowed while on the diet would be walking, swimming, or yoga. These can be done 3-5 times per week, for up to 1 hour at a time. Although this diet was designed to help obese customers lose weight quickly, it can also be used for people that only have 5 pounds to lose. The protocol is the same, but there are some variations that can be made to ensure you dont lose too much weight.

The foods that are allowed on the HCG diet are lean proteins, fruits, and vegetables. Sugars, starches, and oils are not allowed. By getting rid of these 3 items, your body will start to lose weight. The foods allowed on the HCG diet help your body metabolize them quickly, allowing for a greater weight loss. Anytime that something is eaten or used that is not allowed on the diet, people can experience a stall in their weight loss or even possibly a gain. When doing the HCG diet, its always best to be completely committed to the diet and your health. The best thing for your body is the food listed on the protocol. Even once you enter maintenance, and of course after the diet is all done, its best to stick with a similar way of eating. You dont have to starve yourself, and we would never recommend that you eat only 500 calories per day without HCG in your system. To maintain your weight loss long term, we would recommend a diet rich in lean proteins, raw fruits, and raw vegetables. Even when using diet products such as diet sodas, our body can still gain weight, so its best to steer clear of diet products after the diet is over. It also would be a good idea to introduce a workout routine into your daily life. It doesnt need to be a strenuous workout daily, but a nice 30-60 minute work out 3-5 times per week would be ideal.

When on the HCG diet, you can take the HCG for a minimum of 23 days up to 45 days. The minimum of 23 days is how long it takes for your hypothalamus to be reset. By resetting your hypothalamus, your body will continue to burn calories at your new lower rate, which is typically faster than what it was when a person was overweight. Its not recommended to go over the 45 day mark with the injections, but you can go up to 60 days with the drops. The reason for this is because the body can become immune to HCG. If a body is immune to HCG, the body can go into starvation mode, which will make a person weak and very tired. Its always best to take a break, following the outlined maintenance guidelines, to ensure that you dont become immune. This also ensures that your weight loss will continue at a good pace if you choose to the HCG diet again. If you have more than 40-60lbs to lose, you may have to do multiple rounds of HCG, which is very common. However, make sure you are following maintenance for best results.

When looking to do the HCG diet, make sure you plan ahead. Try doing the diet when you dont have any vacations or parties coming up in the near future. The more you can dedicate yourself to the diet itself, the better off you will be long term.

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Free DIY HCG Diet Menus – Do-It-Yourself HCG

Apr 6th, 2019
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These HCG Diet Menus were created by us, the owners of DIY HCG, because we lost weight fast following this plan and now we want to help you lose weight fast too! These recipes are also excellent while you are on the ketogenic diet and other related healthy eating diet plans.

Diets work with good planning... Start your week off right by planning your meals. The more you plan,the less likely you are to deviate from the HCG Diet. Actually, diet like ketogenic diets and others require planning too.

We have created several sample menus for all parts and phases of the HCG Diet (an other related plans, like the ketogenic diet plan) to give you some ideas of how to incorporate foods together while on the HCG Diet. Click below to get your creative juices flowing andstart planning your meals today.

The gorge days are also known as 'load days.You will see high-fat foods such as pizza, milk-shakes, ranch, cheese, cookies, etc. on these HCG Diet gorge day sample menus. Bonus - We have the top 6 tips for the gorge days here too. Now you'll be able to complete your gorge days with confidence... and antacids.

Gorge Day Menus

Phase 2 is also known VLCD and P2. You'll see very low calorie foods such as lean meats, veggies, fruits. Plus, some HCG Diet safe products thrown in to give you ideas of how to make food taste better while on the HCG Diet, like ourSimple Girl Carolina Kick BBQ sauce,Simple Girl Hot Sauce,Simple Girl salad dressings,Simple Girl seasonings,flavored stevia,and more!

Phase 2/Low Calorie Menus

Phase 3 is also known as maintenance and P3. You'll see larger, healthier meals to help establish your new-found freedom. Most of the HCG Phase 3 meals, and other diet plans like the ketogenic diet, are also centered around protein, which is a very important part of this phase. Meals and snacks high in protein have been established to help dieters maintain weight loss easier and keep the weight off long-term, when compared to participants who do not eat high-protein foods duringPhase 3 of the HCG Diet.

Phase 3/High Protein Sample Menus

Thanks for visiting the sample menu portion of our website... we hope it helped you better understand what to eat while on the HCG Diet and how to incorporate the food together into great meals and other diet plans.

Looking for ways to make your meals better?We have some great products (that were going to brag about for a bit) that can really help you on your HCG Diet weight loss journey!

Pre-Portioned Lean Meats:Take the mess out of the HCG Diet weve done all the work for you. These meats are pre-trimmed to remove any visible fat, pre-measured to exactly 100 grams portions, frozen, and shipped to your door! See more about these productshere.

Dressings and Sauces:We have several different salad dressings and sauces that are life savers while on the HCGDiet. Such as ourPhase 2 safeSimple Girl Sweet Vinaigrette salad dressing,which is perfect on anything. Or our top-sellingSimple Girl Carolina Kick BBQ Saucethat is perfect for all phases of the HCG Diet. See more about these productshere.

Grissini Breadsticks:Depending on where you live, the correct brand of grissini breadstick for the HCG Diet is hard to find. So, for the ultimate convenience of our customers, we started selling them. See more about these productshere.

Simple Girl Spices and Seasonings:Store-bought spices are filled with sugars and additives that can mess you up on Phase 2 or Phase 3 of the HCG Diet and other diet plans like the ketogenic diet plan. We have a line of stevia sweetened, zero-calories spices that are perfect for all phases of the HCG Diet. See more about these productshere.

Flavored Stevia:Life should be sweet, sometimes your food should be sweet too. While on all phases of the HCG Diet and other diet plans like the ketogenic diet plan, use diet-safe stevia. We carry SweetLeafstevia which is an all-natural, zero calorie sweetener. Its available in plain (clear) or flavors. See more about these productshere.

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HCG Diet – About Face Anti-Aging Institute

Apr 6th, 2019
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The average person loses up to 2 lbs per day while using the Rx HCG Diet Protocol under our medical provider guidance.

About Face is located in Harker Heights, Texas and serves Waco, Killeen, Temple, Belton, and the Central Texas Region. Contact us today to schedule a consultation with our clinic and find out how the HCG Diet can help you achieve your weight loss goals.

HCG is a hormone that occurs naturally in the human body, which causes the release of fat stores into the bloodstream. In conjunction with a specific meal plan customized for your metabolic needs, HCG will allow you to see rapid loss of fat while retaining your muscle. HCG does not make you lose weight the diet makes you lose weight. However, the HCG injections changehowyou lose weight.

Each client comes in to our clinic for an initial consultation with Mr. Garberich to discuss medical history, weight loss clinic goals and expectations to understand if the HCG Diet if right for them.

Next, the client will be asked to obtain any required lab work from their primary care physician (which may be covered by insurance) or directly from Mr. Garberich (which is not covered by insurance). Please note that the cost of the labs is not included in About Faces price for the HCG Diet.

After Mr. Garberich reviews the results of the lab work, and the client is cleared to participate in the diet, Mr. Garberich will call in the prescription for HCG. Please note that the cost of the prescription is not included in About Faces price for the HCG Diet. The price of the prescription may vary based on your insurance policy.

Next, the first appointment is scheduled to establish a physical baseline for each client. At this time, our medical team conducts a physical exam, and the clients body composition and resting metabolic rate are measured using our Bod Pod and Metabolic Analyzer. Mr. Garberich will go over a customized meal plan and instruct the patient how to administer the hormone treatment at home.

Our 65-year old female client was desperate to lose weight and decided to try the HCG Diet

I have tried so many diet plans over the years, and always had the same result lose a few pounds and then stop. Id get depressed and just start eating whatever I could get my hands on. BUT with the help of Mr. Garberich and his staff, the HCG diet plan has helped me to stay on the plan. As of today I have lost 18 lbs in 34 days. It has allowed my body to become adjusted to eating a balanced diet. Between About Face and my husband I have had so much support to keep me strong and focused on my weight loss. Many thanks to About Face. I would recommend anyone interested in losing weight to make an appointment with Mr. Garberich. He can explain in detail what is involved and is very patient with helping you to understand.

The first phase of the diet is 26 days long with the HCG Medical Weight Loss Clinic treatment. However, it is About Faces mission to teach each client sustainable and healthy habits that will last a lifetime. During the 26-day diet, you will have full access to Mr. Garberich for questions and advice on nutrition, administering the HCG Medical Weight Loss treatments and any other questions you may have.

We offer a financing solution through Advance Care and Care Credit. We will be happy to review the requirements and help you with the application process either over the phone or during your consultation. You can also apply online or call Advance Care or Care Credit at your own convenience.

Contact About Face Anti-Aging Institute / Weight Loss Clinic today to schedule a consultation with Mr. Garberich and find out the HCG Diet can optimize your weight loss journey.

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ANRED: What causes eating disorders?

Apr 5th, 2019
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Temperament seems to be, at least in part,genetically determined. Some personality types (obsessive-compulsiveand sensitive-avoidant, for example) are more vulnerable to eatingdisorders than others. New research suggests that genetic factorspredispose some people to anxiety, perfectionism, and obsessive-compulsivethoughts and behaviors. These people seem to have more than theirshare of eating disorders. In fact, people with a mother or sisterwho has had anorexia nervosa are 12 times more likely than otherswith no family history of that disorder to develop it themselves.They are four times more likely to develop bulimia. (Eating DisordersReview. Nov/Dec 2002)

Studies reported in the New England Journalof Medicine (3/03) indicate that for some, but not all, peopleheredity is an important factor in the development of obesityand binge eating.

Also, once a person begins to starve, stuff,or purge, those behaviors in and of themselves can alter brainchemistry and prolong the disorder. For example, both undereatingand overeating can activate brain chemicals that produce feelingsof peace and euphoria, thus temporarily dispelling anxiety anddepression. In fact some researchers believe that eating disorderedfolks may be using food to self-medicate painful feelings anddistressing moods.

A note about stress and overeating: New research suggests that there is a biologicallink between stress and the drive to eat. Comfort foods highin sugar, fat, and calories seem to calm the bodys responseto chronic stress. In addition, hormones produced when one isunder stress encourage the formation of fat cells. In Westernizedcountries life tends to be competitive, fast paced, demanding,and stressful. There may be a link between so-called modern lifeand increasing rates of overeating, overweight, and obesity.(Study to be published in Proceedings of the National Academyof Sciences. Author is Mary Dallman, professor of physiology,University of California at San Francisco [2003].)

People with eating disorders tend to beperfectionistic. They have unrealistic expectations of themselvesand others. In spite of their many achievements, they feel inadequate,defective, and worthless. In addition, they see the world asblack and white, no shades of gray. Everything is either goodor bad, a success or a failure, fat or thin. If fat is bad andthin is good, then thinner is better, and thinnest is best even if thinnest is sixty-eight pounds in a hospital bed on lifesupport.

Some people with eating disorders use thebehaviors to avoid sexuality. Others use them to try to takecontrol of themselves and their lives. They are strong, usuallywinning the power struggles they find themselves in, but insidethey feel weak, powerless, victimized, defeated, and resentful.

People with eating disorders often lacka sense of identity. They try to define themselves by manufacturinga socially approved and admired exterior. They have answeredthe existential question, Who am I? by symbolicallysaying I am, or I am trying to be, thin. Therefore, I matter.

People with eating disorders often arelegitimately angry, but because they seek approval and fear criticism,they do not know how to express their anger in healthy ways.They turn it against themselves by starving or stuffing.

Some people with eating disorders say theyfeel smothered in overprotective families. Others feel abandoned,misunderstood, and alone. Parents who overvalue physical appearancecan unwittingly contribute to an eating disorder. So can thosewho make critical comments, even in jest, about their childrensbodies.

These families tend to be overprotective,rigid, and ineffective at resolving conflict. Sometimes mothersare emotionally cool while fathers are physically or emotionallyabsent. At the same time, there are high expectations of achievementand success. Children learn not to disclose doubts, fears, anxieties,and imperfections. Instead they try to solve their problems bymanipulating weight and food.

In addition, research suggests that daughtersof mothers with histories of eating disorders may be at higherrisk of eating disorders themselves than are children of motherswith few food and weight issues.

According to a report published in theApril 1999 issue of the International Journal of Eating Disorders,mothers who have anorexia, bulimia, or binge eating disorderhandle food issues and weight concerns differently than motherswho have never had eating disorders.

Patterns are observable even in infancy.They include odd feeding schedules, using food for rewards, punishments,comfort, or other non-nutritive purposes, and concerns abouttheir daughters weight.

Still to be determined is whether or notdaughters of mothers with eating disorders will themselves becomeeating disordered when they reach adolescence.

Also, if mothers and fathers preach andnag about junk food and try to limit their childrens accessto treats, the children will desire and overeat these very items.A recent study (Am J Clin Nutr 2003;78:215) indicates that whenparents restrict eating, children are more likely to eat whenthey are not hungry. The more severe the restriction, the strongerthe desire to eat prohibited foods. These behaviors may set thestage for a full blown eating disorder in the future.

Sometimes appearance-obsessed friends orromantic partners create pressure that encourages eating disorders.Ditto for sorority houses, theatre troupes, dance companies,school cliques, and other situations where peers influence oneanother in unhealthy ways.

People vulnerable to eating disorders also,in most cases, are experiencing relationship problems, lonelinessin particular. Some may be withdrawn with only superficial orconflicted connections to other people. Others may seem to beliving exciting lives filled with friends and social activities,but later they will confess that they did not feel they reallyfit in, that no one seemed to really understand them, and thatthey had no true friends or confidants with whom they could sharethoughts, feelings, doubts, insecurities, fears, hopes, ambitions,and so forth. Often they desperately want healthy connectionsto others but fear criticism and rejection if their perceivedflaws and shortcomings become known.

In Westernized countries characterizedby various forms of competition, and in pockets of affluencein developing countries, women often experience unrealistic culturaldemands for thinness. They respond by linking their self-exteem,or self-disgust, to their weight.

Cultural expectations can be cruel andunrelenting. In order for a woman to consider herself happy,she has to be in a good relationship, be happy with her kids,her friends have to like her, her job has to be going well, herhouse has to look really good and she has to be thin.(Professor Alice Domar, Harvard Medical School. Parade Magazine,October 11, 2003)

People in western countries are flooded by media words and images. An average U.S. child, for example, sees more than 30,000 TV commercial each year (TV-Turnoff Network, 2005). That child watches more than 21 hours of TV each week plus dozens of magazines and many movies every year. In those media, happy and successful people are almost always portrayed by actors and models who are young, toned, and thin. The vast majority are stylishly dressed and have spent much time on hair styles and makeup.

Factoid: According to Health magazine, April 2002, 32% of female TV network characters are underweight, while only 5% of females in the U.S. audience are underweight.

In contrast, evil, stupid, or buffoonish people are portrayed by actors who are older, frumpier, unkempt, perhaps physically challenged. Many are fat.

Factoid: Again according to Health magazine, only 3% of female TV network characters are obese, while 25% of U.S. women fall into that category.

Most people want to be happy and successful, states that require thought, personal development, and usually hard work. The media, especially ads and commercials for appearance-related items, suggest that we can avoid the hard character work by making our bodies into copies of the icons of success.

Reading between the lines of many ads reveals a not-so-subtle message You are not acceptable the way you are. The only way you can become acceptable is to buy our product and try to look like our model (who is six feet tall and wears size four jeans and is probably anorexic). If you cant quite manage it, better keep buying our product. Its your only hope.

The differences between media images of happy, successful men and women are interesting. The women, with few exceptions, are young and thin. Thin is desirable. The men are young or older, but the heroes and good guys are strong and powerful in all the areas that matter physically, in the business world, and socially. For men in the media, thin is not desirable; power is desirable. Thin men are seen as skinny, and skinny men are often depicted as sick, weak, frail, or deviant.

These differences are reflected in male and female approaches to self-help. When a man wants to improve himself, he often begins by lifting weights to become bigger, stronger, and more powerful. When a woman want to improve herself, she usually begins with a diet, which will leave her smaller, weaker, and less powerful. Yet females have just as strong needs for power and control as do males.

Many people believe this media stereotyping helps explain why about ninety percent of people with eating disorders are women and only ten percent are men.

In recent years it has become politically correct for the media to make some effort to combat eating disorders. We have seen magazine articles and TV shows featuring the perils and heartbreak of anorexia and bulimia, but these efforts seem weak and ineffective when they are presented in the usual context. For example, how can one believe that a fashion magazine is truly motivated to combat anorexia when their articles about that subject are surrounded by advertisements featuring anorexic-looking models? How can one believe that the talk show hostess is truly in favor of strong, healthy female bodies when she frequently prods her stick-like thighs and talks about how much she wants to lose weight from her already scrawny body?

In May 1999, research was published that demonstrated the medias unhealthy affect on womens self-esteem and body awareness. In 1995, before television came to their island, the people of Fiji thought the ideal body was round, plump, and soft. Then, after 38 months of Melrose Place, Beverly Hills 90210, and similar western shows, Fijian teenage girls showed serious signs of eating disorders.

In another study, females who regularly watch TV three or more nights per week are fifty percent more likely than non-watchers to feel too big or too fat. About two-thirds of the TV-watching female teens dieted in the month preceding the survey. Fifteen percent admitted vomiting to control their weight. TV shows like the two mentioned above are fantasies, but all over the world young women, and some not so young, accept them as instructions on how to look and act. Thats really a shame.

An important question for people who watch TV, read magazines, and go to movies do these media present images that open a window on the real world, or do they hold up a fun house mirror in which the reflections of real people are distorted into impossibly tall, thin sticks (or impossibly muscular, steroid-dependent male action figures)? Media consumers need to be wise consumers of visual images.

And wise consumers of verbal images too. The impact on vulnerable, insecure people cannot be calculated when they hear celebrities say things like Whenever I watch TV and see those poor starving kids all over the world, I cant help but cry. I mean Id love to be skinny like that, but not with all those flies and death and stuff. Mariah Carey

For more information on this topic, we recommend Remote Control Childhood? Combatting the Hazards of Media Culture, a book by Diane Levin. In addition, parents can help their children learn to think critically by teaching them to ask the following questions about material presented through the media:

For an online interactive exercise in media analysis, visit the childrens section of the Public Broadcast Systems website. The exercise is aimed at younger children, but everyone can learn from it, and parents are encouraged to work through it too.

If people are vulnerable to eating disorders,sometimes all it takes to put the ball in motion is a triggerevent that they do not know how to handle. A trigger could besomething as seemingly innocuous as teasing or as devastatingas rape or incest.

Triggers often happen at times of transition,shock, or loss where increased demands are made on people whoalready are unsure of their ability to meet expectations. Suchtriggers might include puberty starting a new school, beginninga new job, death, divorce, marriage, family problems, breakupof an important relationship, critical comments from someoneimportant, graduation into a chaotic, competitive world, andso forth.

There is some evidence to suggest thatgirls who achieve sexual maturity ahead of peers, with the associateddevelopment of breasts, hips, and other physical signs of womanhood,are at increased risk of becoming eating disordered. They maywrongly interpret their new curves as being fat andfeel uncomfortable because they no longer look like peers whostill have childish bodies.

Wanting to take control and fix things,but not really knowing how, and under the influence of a culturethat equates success and happiness with thinness, the persontackles her/his body instead of the problem at hand. Dieting,bingeing, purging, exercising, and other strange behaviors arenot random craziness. They are heroic, but misguided and ineffective,attempts to take charge in a world that seems overwhelming.

Sometimes people such as diabetics whomust pay meticulous attention to what they eat become vulnerableto eating disorders. A certain amount of obsessiveness is necessaryfor health, but when the fine line is crossed, healthy obsessivenesscan quickly become pathological.

Perhaps the most common trigger of disorderedeating is dieting. It is a bit simplistic, but nonetheless true,to say that if there were no dieting, there would be no anorexianervosa. Neither would there be the bulimia that people createwhen they diet, make themselves chronically hungry, overeat inresponse to that hunger, and then, panicky about weight gain,vomit or otherwise purge to get rid of the calories.

Feeling guilty and perhaps horrified atwhat they have done, they swear to be good. Thatusually means more dieting, which leads to more hunger, and sothe cycle repeats again and again. It is axiomatic in eatingdisorders treatment programs that the best way to avoid a bingeis to never, never allow oneself to become ravenously hungry.It is far wiser to be aware of internal signals and respond tohunger cues early on by eating appropriate amounts of nourishing,healthy food.

For an excellent and detailed discussion of the dangers and disappointments of dieting, visit NEDA, our sister organization.

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Guide to FODMAP Dieting | IBS Diets

Apr 5th, 2019
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Some Helpful Tips

When starting the low FODMAP diet it is first helpful to understand what FODMAPs actually are, the page What are FODMAPs? gives a rundown of the technical aspects of the diet. Once you have digested that page have a look at the FODMAP safe food list and either bookmark the page or print the page and familiarize yourself with the list so you have a good idea of what to consume as well as which ingredients you need to look out for.

Many people find it helpful to start a food diary when undertaking this diet, as well as other diets that can help with IBS. To do so simply write down each food item you consume for each meal on a daily basis noting down the quantity of food and any possible symptoms you may have got from eating a particular food item. I find it best to also give a rating out of 10 how you feel each day with 1 being terrible and 10 being awesome! You can go to the IBS and Food Symptom Diary page to find a premade PDF and a spreadsheet to use.

Please note that I recommend you talk to your GP/Doctor and ask for a referral to see a dietitian as it is recommended to undertake this diet under the guidance of a registered dietitian.

After reading the FODMAP food list and looking at FODMAP friendly recipes it is helpful to follow the recommended FODMAP diet plan and then go shopping for the right foods needed on the diet.

It is recommended by Monash University that you follow the typical FODMAP diet plan. The plan is to eliminate or reduce all sources of FODMAPs as best you can for 6 8 weeks and then slowly add high FODMAP foods one at a time to help you identify any food that triggers your symptoms. Be sure to use a food and symptom diary to help you keep track of what foods may be causing any symptoms.

When you go to the supermarket you will need to be constantly checking the ingredients on food items. Any items with onion or garlic products you will need to leave behind as they can be big contributors to feeling unwell. Another easy thing to check is any items with wheat often companies list allergy advice and specify if there is any gluten present. Head for the free from food aisle if your supermarket has one as that helps a great deal and buy lots of gluten free bread and other gluten free items. A favourite of mine is genius bread as they have changed the recipe recently and it actually tastes nice. In the free from aisle be sure to avoid any foods with soya in them as they are quite a common dairy free product. Be wary of seemingly safe items such as chicken stock cubes as they often have gluten and/or onion and/or garlic.

After you have returned from the supermarket it may help to get rid of any items you had before that contain any of the bad foods in your cupboards and fridge/freezer. You may find it helpful to work out your meals in advance as often repeating meals or making big batches and freezing helps ease the planning stage.

Breakfasts can be gluten free porridge, gluten free bread toasted with a serving of low FODMAP fruit. Or perhaps rice crispies with chocolate oat milk which makes a very tasty cocopops substitute.

For lunches I tend to make gluten free bread sandwiches with sandwich meat (be sure theres no gluten or onion!), lettuce, mayo (check the label, some mayonnaise is not suitable) and sometimes I put tortilla chips in them. Yum.

Dinners can be a variety of things from stir-frys to rice dishes like risotto. Jacket potatoes with butter served with a nice steak goes down lovely. Drinks dont just have to be water, you are allowed the odd beer or wine and also any of the full fat soda drinks like coca-cola and pepsi are OK (assuming they do not contain HFCS like they do not here in the UK) in small dosages.

Hopefully this guide helps you to get a grasp on how to undertake the FODMAP diet. If things are still not clear please contact me and I will try my best to help you.

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