PCOS - Annovulation-Infertility and obesity

I enjoyed participating in the PCOS  talk with endocrinologist an UBC professor Dr Jerilynn Prior we had in March 2009. Dr. Prior and I will be co-presenting again on Monday October 19, 2009 on managing the sympstoms associated with menopause.  For details click here. 


Next talk on PCOS is with Dr. Beth Taylor, Reproductive Endocronolgist from Gensis Fertility Centre.  Dr. Taylor and I will be co-presenting on strategies to reverse and treat PCOS. Click here for details on the September 29, 2009 talk.

Below is a recap of the PCOS evening I presented in March 2009.  I hope it is helpful.

PCOS affects many of the women that I see in my practice every day. Some of them had no idea they had PCOS until they found they couldn’t get pregnant. Many of you reading this may not have even realized that you have PCOS until now. This is because, even though PCOS affects up to 10 percent of women in North America and is the leading cause of infertility, it is not well understood, diagnosed or treated by western medicine.


In this post I want to talk about the most effective strategies you can take to balance your hormones and optimize your fertility based on information I have learned from years of study and clinical experience, as well as knowledge gleaned from my mentors in the field.

What is PCOS?

PCOS, also known as annovulation androgen excess (AAE) , is a
condition in which women have high levels of male hormones (androgens).
These hormones play a role in blocking the release of the egg from the
follicle and in the overproduction of the female hormone estrogen. As a
result your ovaries fill with cysts or create immature follicles that
are unable to generate eggs.


Insulin seems to be a key factor in PCOS. Many women with PCOS have
increased insulin resistance. High levels of insulin in the blood lead
to the ovaries producing too much androgen. As well, excess insulin
leads to excess glucose in the blood, and sets the conditions for
prediabetes, weight gain and diabesity. If untreated, PCOS can lead to
overweight, obesity, heart disease, diabetes and some cancers.


Clinically, if you have two out of three of the following symptoms you will most likely be diagnosed with PCOS.


1. Irregular, few, or absent menstrual periods.
2. Androgen
excess – clinical or biochemical (excessive body hair, acne, loss of
head hair, increases t testosterone in the blood)
3. Poly cystic ovaries


How Does Insulin Affect Fertility?


Insulin is a hormone that regulates the change of sugar, starches, and
other food into energy for the body’s use or for storage. Excess
insulin causes a rise in male hormones, which can lead to acne,
excessive hair growth, weight gain, and ovulation problems.


As well, insulin blocks the liver from producing sex hormone
binding globulin --a hormone that restricts which cells are affected by
testosterone. So high insulin levels increase the amount of male
hormones circulating in the blood and also amplify the effects on these
hormones on all the cells. In turn high levels of insulin stimulate the
ovaries to overproduce androgens. Excess androgens cause the follicles
to develop too quickly & then to shut down prematurely before they
produce an egg.


To further complicate matters insulin insensitivity contributes to
gain weight, especially in the belly area and makes it harder to lose
the weight. If that wasn't bad enough this excess fat sets up a
negative feed back system where high blood levels of the fat derived
hormone leptin (increases your appetite), inhibits the production of
female fertility hormones.



How Can You Treat PCOS

The first thing to understand about PCOS is that there is no magic
bullet or pill you can take to cure it. The good news is that I have
found that a combination of weight loss, diet, exercise, acupuncture,
herbal treatment and mind-body techniques can be extremely effective in
eliminating PCOS symptoms, getting ovulation on track, and reversing
the negative effects of stress.


1. Weight loss


Just losing 5 to 10% of your body weight can be enough to bring on
monthly ovulatory cycles. Also, losing just a few pounds, regardless of
the type of diet, has been shown to reduce inflammatory markers. This
is worthy of mention because certain inflammatory markers (High TNF
alpha) have been associated with IVF failure--another reason to find a
healthy weight.


However, if you are insulin resistant you probably find it very
difficult to lose weight. If your doctor has told you that you have
PCOS because you are overweight that is not really the full truth. If
you exercise regularly and eat fairly well and continue to gain weight
then you are probably over weight because you have PCOS or insulin
resistance and not the other way around. Below we will discuss ways to
make it easier for you to lose weight.


2. Diet


The Acubalance Fertile Diet
is a whole food, low glycemic approach to eating. This diet is based on
the best research and practice experience available, including Chinese
medicine dietary therapy and information from the Harvard Nurses Health
Study (check out our website for the full Acubalance Fertile Diet
This study found, over eight years of follow up, that women who had the
lowest risk of ovulation problem-related infertility (or the highest
fertility) ate a plant based, low GI, whole foods diet focusing more on
vegetable protein and monounsaturated fats. They exercised more and
took a multivitamin mineral supplement.


We know that changing your habits can be tough to do alone so we
are creating an online Acubalalnce Fertile Diet community where we are
inviting you to contribute your tips and recipes for eating a whole
food, low GI diet.


Our Fertile Diet
currently has loads of information and recipes for you to review and
choose from including a three week menu plan designed to get you
started. There are also lots of tips and information on everything from
detoxing your food cupboard, best places to shop for whole, locally
gown food, to how to eat mindfully.


The key here is to eat foods in as natural and whole a state as
possible so they take time to be digested and are converted to sugar
(glucose) slowly. This keeps your blood sugar at an even level and
prevents your insulin from spiking.


Carbs are allowed to eat as long as they are slow carbs (see details on line).
And you can lower the glycemic index of a food by mixing a protein and
a good fat with a carb to slow down the rate it is absorbed it into
your bloodstream. This diet alone should help with weight loss.


3. Exercise


Exercise has been shown to be extremely effective in increasing
insulin sensitively. And it doesn’t need to be super strenuous. Just
moving your body for 30 minutes a day so that you break a little sweat
is enough to help reset your insulin sensitivity.


Walking is a great way to start --it doesn’t take any equipment,
its free and its good for the planet! Or find something else you enjoy.
If you like swimming and tennis but hate the gym then swim and play
tennis. Just commit to doing some form of exercise for at least 30
minutes a day. Mix it up with some resistance training twice a week.


Exercise is good for you for a whole lot of reasons including:
• Burning calories
• Building muscle, which in turn increases insulin sensitivity (reduces insulin resistant)
• Reducing insulin levels in the blood
• Making weight loss easier as less glucose is converted to fat
• Reducing cortisol and visceral fat (abdominal fat)
• Reducing stress and promotes deep relaxation

4. Acupuncture


Some recent studies have shown that electro acupuncture (EA) given regularly and frequently (sometimes daily) can help:

• Increase blood flow to the ovaries (many women with PCOS ovaries are nutrient deprived)
• Regulate the hypothalamus pituitary Ovarian axis HPOA (a fancy way of saying it regulates the menstrual cycle)
• Reduce the ovarian volume and number of ovarian cyst
• With weight loss and reduce appetite
• Reduce cortisol levels
• Increase insulin sensitivity and decreases blood glucose and lipid levels

To effectively treat PCOS it appears that the usual once a week
treatment is not enough. I recommend two to four EA treatments per
week, with two being a minimum

5. Herbal Therapy and Supplements


Please see your Chinese herbalist for a custom made formula.
There is no one size fits all when using Chinese herbs. However, there
are some western herbs and supplements that appear to help stabilize
blood sugar and balance hormones


Here are list of some of these supplements:

 

  • B vitamins, magnesium, alpha lipoic acid and omega 3 fatty acids
  • N-Acetyl Cystein
  • Bitter Melon and fenugreek
  • Saw Plamento – blocks the production of DHT (dihydrtestosterone)
  • Cinnamon

 

It is actually distress and not stress that is the problem. Distress
is how your body reacts to stress. Chronic stress leads to high levels
of cortisol in your body which in turn lead to increased abdominal fat
deposits (elevating your risk of diabetes, cardiovascular disease and
PCOS) and increased appetite. This is why exercise is important as it
lowers your cortisol levels and so, indirectly, helps reduce your
appetite and lose abdominal fat. Yoga, meditation, mindfulness, walks
in nature, massage and acupuncture or acupressure can all help reduce
distress and bring on deep relaxation.


There may be no simple treatment for PCOS but combining weight
loss, diet, exercise, acupuncture, herbal treatment and mind-body
techniques can make a big difference to your health, well being and
fertility.


I want to thank my mentors for providing guidance in treating
complex metabolic disorders like PCOS. I am indebted to my following
mentors for the information and clinical experience they share with me
on a regular basis. I am truly blessed to have such great teachers.

 

• Randine Lewis – Author of The Infertility Cure
• Jane Lyttleton – Author Treatment of Infertility with Chinese Medicine
• Sharon Weizenbaum – Graduate Mentorship Program
• Daoshing NI – Author of the Tao of Wellness


Lorne Brown, DR TCM, FABORM
Founder, Clinical Director

 

 


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