Revisiting: PCOS and metabolic overlap: what is and is not studied posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Everything in post #32 holds. The case it does not cover is the one I have.
Marking my uncertainty on PCOS and metabolic overlap explicitly. I am confident about the direction, much less confident about the size, and not confident at all that it generalises past the case in the first post.
Post #34 is the version of this I will quote in future. One addition.
Nobody has said the unglamorous part of PCOS and metabolic overlap yet, so: most of the variation is explained by things that are boring to write about and easy to check.
Where I part company with post #32, and it is a narrow parting.
Bariatric surgery history: altered anatomy after surgery affects absorption. That matters for oral medications and for reconstituted solutions. Discussing specific medications and doses with a clinician familiar with bariatric surgery is prudent.
Post-authorisation safety studies are the place where under-studied populations eventually appear, and they are public.
The short version is the first sentence; the rest is why.
Where two conditions pull in opposite directions, that is a clinical judgement rather than a lookup, and it is the kind of question a forum answers worst.
I would want to see it done twice before believing it once.
PCOS and metabolic overlap: polycystic ovary syndrome has metabolic overlap with obesity and insulin resistance. Data on compounds in this class in PCOS specifically is thin; most discussion is by mechanism.
A partial answer, offered because a partial answer beats none.
Worth stating the null on PCOS and metabolic overlap before we explain it: the observation may be nothing. That possibility deserves a sentence and usually does not get one.
PCOS and metabolic overlap came up in a thread eighteen months ago and was answered well. I cannot find it, which is itself the problem, so here is the reconstruction.
Taking post #41 at face value and following it one step further.
My position on PCOS and metabolic overlap is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly.
Gastrointestinal conditions interact with a mechanism that slows gastric emptying in ways that are plausible and largely unstudied.
I would put a moderate confidence on that and no more.
Building on post #45 rather than restating it.
If you are new and reading this thread for the answer to PCOS and metabolic overlap: the answer is conditional, the conditions are in the third reply, and the rest of the thread is worth skipping.
Post #45 describes the usual case. This is about the unusual one.
The practical value of this subcategory is helping somebody frame the question they take to an appointment, and that is worth being explicit about.
That is one dataset and I would not build a rule on it.
A condition that affects nutrition or absorption changes the calculus around a treatment that reduces intake, and that interaction is mostly unstudied.
The answer changed when I changed how I was measuring, which was informative.
Adding a small correction to the PCOS and metabolic overlap summary above rather than a disagreement with it. The substance holds; one of the figures is out by a factor that matters.
What I want from this PCOS and metabolic overlap thread is the list of things that would need to be true for the claim to hold. If we can write that list, we can check it.
Worth separating two things that post #50 runs together.
PCOS and metabolic overlap is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.
The version of PCOS and metabolic overlap that I was taught turned out to be a teaching simplification. Useful, and not true in the way I had assumed it was.
Taking post #55 at face value and following it one step further.
Where the honest answer is "nobody knows", giving it plainly is more useful than a confident synthesis of mechanism and anecdote.
Noting that I have skin in this question and have tried to discount for it.
Post #54 and I disagree about the size of the effect, not about the direction.
Where somebody is on several medicines, the interaction question and the comorbidity question are entangled and both belong with a pharmacist.
Multiple comorbidities: a person with diabetes, kidney disease, and cardiovascular disease is outside the studied populations in most trials. Extrapolating to that person requires reasoning from the individual component trials and mechanisms.
The general answer and the answer for your case may diverge here.
Everything in post #58 holds. The case it does not cover is the one I have.
I would keep PCOS and metabolic overlap and the decision it usually gets used for separate in this thread. They are related and they are not the same question, and merging them is why the last one went badly.
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- Osteoarthritis and mechanical versus metabolic improvementClinical › Comorbidities · 6 replies
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