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  • Treating Hypothalamic Pituitary Dysfunction (HPD): By William Wilson, M.D.


    Posted by .(JavaScript must be enabled to view this email address)
    Tuesday, June 01, 2004 8:30 am Email this article
    In his interview, William Wilson, M.D., discussed a condition he has named Hypothalamic Pituitary Dysfunction, or HPD for short. In this article he provides an outline for diagnosis, treatment and examples of patients he has treated.

    Treatment Goals

    1. Improve or eliminate HPD symptoms.
    2. Normalize CNS neurotransmitter levels.
    3. Improve metabolic (Syndrome X) parameters (Body composition, glucose intolerance, lipids, blood pressure).

    HPD: The Unifying Theory

    1. If, we consider diseases of HPD to have the same cause, then the same general treatment can be used for all the diseases.
    2. When confronting one HPD syndrome, look for:
      • Other HPD symptoms
      • Depleted neurotransmitters
      • Metabolic changes
    3. Make the diagnosis of HPD!

    Examples

    1. Fibromyalgia: Patients with this condition have excessive body fat.
    2. Type II diabetes: Most patients with this condition have carbohydrate cravings and mood swings.
    3. Anorexia: Patients with this condition have excessive body fat.

    PATIENT EXAMPLES

    Patient #1: 52-year-old Female

    Her neurotransmitter levels were as follows:

    Patient #2: 31-year-old Female

    Her neurotransmitter levels were as follows:

    Patient #3: 20-year-old Female

    Her neurotransmitter levels were as follows:

    Four Pillars of Effective Treatment for HPD

    1. Dietary changes
    2. Targeted medications
    3. Precursor supplements
    4. Exercise

    Dietary Changes

    1. Eliminate or dramatically reduce High-glycemic-index carbohydrates.
    2. Consider the serving size when it comes to glycemic load.
    3. Too many high glycemic carbohydrates equals failure regardless of treatment.

    The Danger of High-Glycemic Index Carbohydrates

    They are dangerous, not because they cause weight gain, but because they:

    1. Deplete neurotransmitters.
    2. Trigger famine protective metabolic mode.
    3. Result in inappropriate fat storage & other metabolic changes.

    Diet Composition

    The diet should consist of:

    The type of carbohydrate is most critical.

    Dietary Considerations

    A patient should:

    1. Consume small amounts throughout day.
    2. Avoid skipping meals.
    3. Eat a good breakfast.
    4. Don???t count calorie, instead focus on diet composition.

    Traditional Dieting

    Traditional dieting consists of under-eating, however, this:

    1. Almost always makes HPD worse.
    2. Causes loss of lean body mass, not fat.
    3. Accelerates HPD.
    4. Worsens famine protective metabolic mode.

    Precursor Supplements: Unlocking the Mystery

    The Key to treating patients with HPD is restoration of neurotransmitters to optimal or therapeutic ranges.

    This is the only way to reach and maintain long term clinical stability.

    The Key???s Composition

    The essential components are:

    1. Precursor amino acids including:
      • 5-HTP which is converted to serotonin.
      • Glutamate which is converted to GABA.
      • Tyrosine and phenylalanine which is converted to epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine.
    2. Essential vitamins.
    3. Essential mineral cofactors.

    The Lock

    Catecholamine (adrenaline, noradrenaline and dopamine) and serotonin systems are intimately intertwined, so both must be addressed.

    Trying the Key

    Phase 1: The primary focus should be on serotonin.

    Phase 2: Treatment should address both the catecholamine and serotonin systems.

    Turning the Key

    Dopamine and serotonin are restored within months, however, it may take a year of continuous treatment to restore epinephrine and norepinephrine (adrenaline and noradrenaline).

    People with HPD stages II and III may require life-long use of supplements.

    Testing the Door

    Symptoms are the guide to effective clinical outcomes.

    The first goal of treatment is to eliminate symptoms.

    The success or failure of treatment should be evaluated by its ability to eliminate symptoms.

    False Keys

    Short-term relief can be obtained with low dose medication, however, this is not a long-term solution.

    Long-term relief results when neurotransmitter levels are restored.

    Long-term effective treatment cannot be obtained without amino acid supplementation.

    Targeted Medications: The Primary Purpose of Medications is to:

    1. Manage stage II & III HPD.
    2. Control symptoms.
    3. Improve compliance.
    4. Buy time to change:
      • Lifestyle
      • Restore neurotransmitters with supplements

    It is Difficult to Treat Some Patients with HPD Because:

    1. They find it difficult or impossible to comply with lifestyle changes.
    2. Their symptoms are too severe.
    3. Quick symptom resolution is needed.

    Improving Compliance

    Certain things can be done to improve compliance, including:

    Guidelines for Using Medications when Treating a Patient with HPD

    Baseline testing is a must before adding medications.

    You should:

    1. Use the lowest possible dose that:
      • Doesn???t cause side-effects.
      • Gives satisfactory therapeutic effect.
    2. Target medications at neurotransmitters, not the clinical label.

    Masking the Problem: How Medications Mask the Condition.

    Medications provide temporary symptom relief, however, the problem is that they:

    1. Do not restore neurotransmitter levels.
    2. Worsens depletion of neurotransmitters.
    3. Symptom relief lessens with time.
    4. Improper use of medications accelerates HPD.

    Removing the Mask: Tapering

    It is important to:

    1. Wait a minimum of 6 months.
    2. Wait until neurotransmitters are in their therapeutic range.
    3. Constantly monitor neurotransmitter levels.
    4. Consider increasing the dose if symptoms break through.

    Catecholamine-Enhancing Medications

    Catecholamine-enhancing medications include:

    85% of patients respond well to Phentermine or Adderall.

    When using Addreral, extended-release Adderall XR is preferred.

    Abuse potential of Phentermine and Adderall

    Phentermine is rarely abused.

    Adderall has minimal abuse potential. Abuse of this drug usually occurs in teenagers.

    Serotonin-Enhancing Medications

    The following serotonin-enhancing medications and dosage ranges are useful in some patients with HPD:

    Avoid These Drugs
    The following drugs should be avoided in patients with HPD:

    Watch Out For:

    The Benefits of Exercise Include:

    The Problem with Diet and Exercise Alone
    Eating “right” and exercise alone may result in weight loss, but the problem for patients with HPD is that:

    When is Exercise Effective?

    Exercise is effective when neurotransmitters are balanced. When they are balanced, exercise can:

    Making Therapeutic Decisions

    Use the presence or absence of HPD symptoms; they precede metabolic changes.

    Measure neurotransmitter levels.

    Do not be influenced by BMI, size, or weight, look at body composition instead.

    Treatment Considerations

    Initial treatment is trial and error; watch symptoms to determine effectiveness of the treatment.

    It is necessary that treatment, including the use of medications, be individualized for each patient.

    Medical Evaluation for HPD: The First Appointment Should Include:

    Key Parameters to Look For Include:

    When Diagnosis Is Confirmed, Initiate the 4 Pillars

    First Follow-up Visit Should Include:

    Continuing On

    Follow-up visits should be scheduled monthly.

    Retest neurotransmitters every 4-6 weeks until therapeutic levels have been achieved or if there is a change in clinical presentation.

    Maintenance Begins When The Following Have Been Achieved:

    Then you can:

    Keys to Maintenance Include:

    Key to Long-Term Management Include:

    How Can Patients Prevent HPD?

    1. Avoid high glycemic carbohydrates!
    2. Avoid other triggers.
    3. Regular exercise.
    4. Low dose supplements to help avoid depletion.

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