Tuesday, June 13, 2006

Androgens and Antagonists

I have an unfortunate medical condition, called Ulcerative Colitis (non-Crohns) . Doctors dont understand the causes of the disease (other then there seems to be a genetic risk for it), there are no real effective treatments; and though some therapies work on some people, nothing has really worked on me.

The most common treatment is a combination of steroids (mostly prednizone), H2 receptor antagonists (Tagamet, Zantac, Pepcid), antacids, and sometimes proton pump inhibitors (Prilosec, Nexium, Prevacid).

Well I went on prilosec years ago when it first came out, and it was moderately effective, but even under insurance it was ridiculously expensive, all out of proportion to its effect (about $14 a day). Priolsec is supposed to be taken as a 14 day course of treatment, then it is suppsoed to remain effective for up to 4 months.

In my case, a 14 day course of treatment is effective for... about 14 days. My body juat seems to be very resistant to drugs.

Because of my body mass, my natural resistance, the degree of acid production, and aggravating factors, none of these treatements have all that much effect, but they all at least help.

For me, the most effective was very large doses of Cimetidine (tagamet), and by very large I mean 8 times the standard over the counter doses (the max prescription dose). With enough cimetidine, I can stay free of reflux and other acid issues, cramping etc... for about 8 hours at a time. I can get the same effect by taking about as much famotidine and ranitidine each as I do cimetidine (i.e. 8 times the OTC dose for each, COMBINED - effectively taking twice as much drugs total when not using Cimetidine).

I've been to every internist, and gastroenterologist I could find; al they could really do for me wa ssuggest the treatments already taken, and charge me more money for useless advice. Now there's supposed to be a new way of controlling it that was developed out of research into MS, but its still unproven (it treats the disease on an auto-immune basis) so I'mna keep a close watch and see what happens.

Anyway, for a long time I pretty much just suffered through, because all of the above were rather expensive to take all the time, but in the last three years, my illness has become more severe, and just living with it has become very painful.

At the same time the H2 Antagonists have come down in price significantly, and Prilosec has been made available in an over the counter formulation. Over the past 10 years, Cimetidine went from $2 a pill, down to $8 for 120; with corresponding reductions in the other H2As; and Prilosec went from $14 a pill down to $1-2 a pill.

Anyway, for the last three years I've been taking a LOT of Cimetidine.

At the same time, I've been trying to lose weight.

Apparently, and unknown to me, these two things are mutually exclusive. The doctors never told me of that particular side effect of cimetidine, and I hadn't really noted it in any side effect sheets either. Its not that it wasnt there, it's just it wasn't noted as significant.

I've been wondering why, even when I am excercising and eating right, I cant seem to drop any bodyfat, I'm just gaining muscle; and not much muscle tone at that, mostly jsut mass (which I already have more than enough of). Well it turns out the reason is that cimetidine causes the normal mechanisms in Males that burn off estrogen to shut down.

I was reading an article last night about it, and the effect is especially pronounced among those with gynocomastia already; as well as those of higher body mass, and higher body fat. Larger doeses of course make for a larger effect, and I'm taking a very large dose, almost every day. This one set of side effect is apparently what prompted the major switch from Tagamet to Zantac and Pepcid in the late 80s and early 90s.

The effects of this excessive estrogen include excessive water retention, bodyfat gain, difficulty in weight loss and muscle toning, lack of energy, lack of endurance, feelings of dehydration or constant thirst, and gynocomastia. Additinally there is a highly elevated risk of cancer.

Yeah, I've got all of that going on. Thing is, those are also (in a milder form) side effects of the disease itself; I just thought they were getting worse on their own. Plus, since I'm already gynocomastic genetically, this simply aggravates the problem.

Anyway, as of today, I'm dropping the cimetidine completely from my regimen.

My plan as of now is to take Prilosec, and if I have breakthrough reflux or other acid effects, I'll treat them with Ranitidine and Famotidine; as well as conventional antacids. Heres hoping this will help in the weight loss, but even if it doesnt the reduction of side effects, and especially cancer risk is well worth it.