Polycystic Ovarian Syndrome

by Claudette WadsworthPolycystic ovarian syndromeis one of the most commonhormonal problems forwomen and a risk factorfor type-2 diabetes -although it is one of theleast publicised risk factors.Many women have PCOSfor 20 or 30 years beforethey develop diabetes,and most don't realisethat their daughters andgranddaughters are at highrisk too.

WHAT IS IT?PCOS is a group of conditions thataffects 5 - 10% of women. Usually itbegins in puberty and worsens withtime, although fortunately it is abenign disorder. PCOS is complexbecause it is so much affected by awoman's emotions, thoughts, diet andpersonal history.

Instead of producing eggs in the ovaryand releasing them once a month -called 'ovulation' - women with PCO/Sproduce eggs that do not matureproperly but develop into multiplecysts on the ovaries. The woman's bodyproduces too many male hormones,known as androgens.

20 - 25% of women will have multipleovarian cysts on the ovaries - PCO - butonly half of these or fewer (5 - 10% ofwomen) will actually have PCOS.

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WHAT IS THEDIFFERENCE BETWEENPOLYCYSTIC OVARIESAND PCO SYNDROME?Polycystic ovaries (PCO) is a conditionaffecting only the ovaries, whereasPCOS involves other bodily systems andorgans apart from the femalereproductive system, such as bloodsugars and insulin.

40% of women in families that havePCOS or type-2 diabetes have PCOSthemselves, indicating a possibleinheritable tendency or underlyingcause.

Between 50% and 70% of women withPCOS have high insulin levels.

SIGNS AND SYMPTOMSIrregular or absent menstrualperiods: usually the first warningsign

• Infertility: 75% of women with PCOS

• Hirsutism: excess body hair 60%Obesity: 40%

• Acne

• Irregular and profuse menstrualbleeding: 30%Deeper voice and masculine bodyshape: 20%

Alopecia (hair loss/thinning on scalpand pubic hair)Craving sugars and starchycarbohydrates such as white flourproducts

Hypoglycemia: imbalanced bloodsugar levels

•" Acanthosis nigricans: dark velvetypatches on the skin

Increased abdominal fat: theapple/android shape

DIAGNOSISDiagnosis of PCO must include at least2 of the following:

1. Anovulation (no ovulation): follicleson the ovaries fail to release the eggswithin. This results in irregular orinfrequent occurrence of menstrualperiods - although in some women, itis possible to have periods and still notbe ovulating.

2. Abnormal hormone blood testsindicating raised male hormoneproduction:

lutenizing hormone (LH) is elevated,while follicle stimulating hormone(FSH) is usually low at a ratio of 2:1 ormore.

Oestrogen levels are high as a result ofconversion in the periphery of thebody, such as fat stores, of androgens(male hormones) into oestrogens(female hormones), as well as anunopposed oestrogen production bythe ovaries.

Progesterone and SHBG levels are lowas ovulation does not occur, whileandrogens such as testosterone, FAIand DHEAS are abnormally high.

3. Internal ultrasound examinationillustrating 10 or more cysts on anovary. Typically the ovary containsmany 2 - 5 mm follicular cysts.

According to Dr Warren Kidson, theleading endocrinologist on PCOS at thePrince of Wales and Sydney Children'sHospitals, all women diagnosed withPCO should be screened for insulinresistance and consequent diagnosis ofPCOS by a 1 + 2 hour oral glucosetolerance test (GTT) with insulin.Measuring only fasting blood sugarand fasting insulin are not sufficient.The GTT will determine whether it issystemic and whether the woman hasalready developed type-2 diabetes.

WHAT CAUSES PCOS?There are four primary underlyingcauses that all interact and contributeto varying degrees in different women,and all of which must be addressed.These include hormonal imbalance,insulin resistance, obesity and stress.

1. HormonesOur hormones are controlled by thepituitary gland in the brain whereiutenizing hormone (LH) and folliclestimulating hormone (FSH) areproduced. These hormones stimulatethe ovaries to produce oestrogen andprogesterone. Directly above thepituitary is the brain's fertility centre orclock that regulates the production ofLH and FSH. In a woman, this centreworks in a cyclic fashion, once everymonth, while in a man it works in acontinuous fashion. In PCOS, there hasbeen a functional derangement of thiscentre and thus also of thesehypothalamic-pituitary hormones.

Excess LH production causes excessandrogen production in the folliclesinside the ovaries. This prevents

50 New Vegetarian and Natural Health Summer 2005/06

ovulation and normal folliculardevelopment, resulting in theformation of small cystic folliclesinstead of mature follicles. Theseimmature follicles are unable to releaseeggs for ovulation. Therefore,ovulation does not take place, soprogesterone is virtually nonexistentbecause this is only produced for thesecond half of a menstrual cycle afterovulation.

These abnormally high levels ofandrogens, primarily testosterone andandrostenedione, are responsible forthe development of acne, male-patternhair loss, excessive facial and body hair,and acanthosis nigricans (dark velvetypatches on the skin).

The lack of progesterone alsostimulates the continued release of LHthat remains elevated abnormally dueto anovulation.

The relatively high oestrogen levelsthat are unopposed by progesteronestimulate growth of the lining of theuterus, the endometrium. This is aconcern of the long-term complicationsof PCOS as there is very little sheddingof it because there are few periodsoccurring.

Previous eating disorders, for examplebulimia and anorexia, have beenshown to upset the pituitary fertilityclock and thus upset hormonalregulation even years after eating isnormalised.

In a few women, the fertility clock maynot fully mature, with periods startinglater than usual, between 14 and 18years of age, and the menstrual cyclesbeing irregular from the first periodonwards.

2. Insulin ResistanceInsulin is a hormone secreted by thepancreas to control blood sugar levelsby allowing the body's cells to take upand use sugar (glucose) for energy.Many women with PCOS have elevatedlevels of insulin in their blood, causinginsulin resistance in which the cells nolonger respond to insulin so theyrequire larger amounts of insulin toremove the same amount of sugarfrom the blood.

Excessive dietary sugars, high-glycaemic-index carbohydrates,Candida infections, mineraldeficiencies, stress or excess body fat,particularly abdominal weight, allcontribute to excessive insulin secretionby the pancreas. The extra insulin istrying to normalise blood sugar levelsby getting the sugar into the body'scells and out of the bloodstream.

Insulin inhibits sex-hormone-bindingglobulin (SHBG) that normally removescirculating androgens and oestrogensso that they can be detoxified andbroken down by the liver. The result iselevated androgens and oestrogensremaining in the blood stream.

Insulin also increases androgenproduction in the ovaries and theadrenals, as well as increasing LHproduction by the pituitary gland.

Smoking, alcohol and caffeineexacerbate insulin resistance and PCOS.Previous eating disorders, such asbulimia and anorexia, can program thebody into insulin resistance even yearsafterwards because of the priorextreme blood sugar imbalances.

3. ObesityPCOS women have a lifelong tendencyto increased abdominal weight - theandroid or apple shape, particularlyafter 30 years of age or afterpregnancy. Many women with PCOSwill gain weight easily and find thatlosing weight is difficult, despite dietand exercise.

Excess body fat activates aromatase inperipheral tissues and fat cellsconverting androgens into oestrogens.This has a negative feedback via thehypothalamus to increase LH, creatinga vicious cycle of excess androgenproduction.

Androgens are also converted inperipheral tissues into more potentforms by the enzyme 5-a-reductase, forexample, testosterone converted todihydrotestosterone.

Enlarged fat cells also secrete TNF-alpha and a newly discoveredhormone, resistin, that make themuscles more resistant to insulin.

However, there is light at the end ofthe tunnel! A 5% reduaion in bodyweight has been shown to normalizehormones. This amounts to only about5 kg for most women, which is realisticand achievable.

4. Stress Hormonesstress stimulates adrenaline secretionby the adrenal glands that in turnstimulates insulin secretion to providean immediate energy source for thebody cells for 'fight/flight'.

Under chronic stress, excess cortisol isreleased from the adrenals producingexcessive prolactin secretion, which inturn further decreases FSH andincreases LH (via decreasing GnRH).

Stress also causes elevated androgenproduction from the adrenalsthemselves. Stress affects your bloodsugar levels as you have to raise themin order to have something to run off,which in turn raises insulin.

These stressors may be current lifestressors, emotional and psychologicalstress or repressed pain from the past.Also, very low body weight activatesthe release of adrenaline from theadrenals as the body is not providedwith enough energy. This stimulatesmore insulin release. GnRH production- that controls the pituitary gland - isstopped at less than 16% body weight.

causing a cessation of menstruationand decreased conversion of androgensinto oestrogens in the periphery,resulting in androgen accumulation. SoPCOS is not just confined to womenwho are overweight as previouslythought.

LONG-TERMCOMPLICATIONS OF PCOSImplementing prevention strategies iscrucial to any treatment of PCOS andhas also been shown to be veryeffective at reducing the increased risksof:

• Hirsutism (excess body and facialhair, acne, balding, deepening ofvoice, masculine body shape) due tohigh androgen levels.

• Infertility: decreased fertilisation dueto lack of ovulation.

Miscarriage which has 30 ~ 50%higher risk in first trimester, andthere is a higher risk of pre-eclampsia in third trimester due tohigh LH levels adversely affectingegg quality.

Endometrial hyperplasia and uterinecancer: increased cell proliferation orthickening of the uterus lining iscaused by the unopposed oestrogensthat are a precursor to endometrialcancer. A woman must have aminimum of 5 - 6 menstrual periodsper year, or, if she is over 35 years ofage, a period almost monthly. (Papsmears do not detect this, theyinvestigate the cervix only).

Hormonal and menstrualdisturbances, ovarian cancer, breastcancer.

• Type-2 diabetes mellltus andgestational diabetes due to insulinresistance and obesity. The recentDiabetes Prevention Programme hasshown that diet and exercise canprevent diabetes and is moreeffective than drug therapy(Metformin) in trials.

• Heart disease: increased risks ofcardiovascular disease, hypertension(high blood pressure), heart attackand atherosclerosis.

Osteoporosis: especially for womenwho are thin or adrenally exhaustedfrom chronic stress.

Obesity

The best indicator for the risk ofthese long-term complications is CRP(a chronic inflammatory marker), ablood test performed by a GP. It ispreferable that the CRP count is lessthan three, although the ideal is lessthan one. . ^ >

Summer 2005/06 New Vegetarian and Natural Health 51

WHAT ABOUT SIMPLYTAKING THE PILL?In the past, doctors simply prescribedthe oral contraceptive plil (OCP) as thestandard treatment for PCOS, but thedangers of this are now being realised.The Pill masks the underlying conditionand actually aggravates insulinresistance, hastening the onset ofdiabetes. A 1997 study of 98,590 nursesin the USA over a long period of timerevealed that type-2 diabetes was 60%more prevalent in women taking oralcontraceptives. According to Dr Kidson,if a woman is insulin resistant withPCOS, the Pill could be expected toincrease the risk of diabetes by at least100% and possibly by 200%.

NATUROPATHICTREATMENTSFOR PCOSSelf-HealingDietary and lifestyle changes areessential for successful treatment ofPCOS and for maintenance of thecondition long term to preventcomplications.

Diet''• Eat regularly. Have three main meals

and two snacks daily that stimulateyour metabolism. If you skip meals, itslows your metabolism down andyour blood sugar levels drop so thatyou crave sugar or a stimulant tobring them back up again quickly.

Have protein in all your meals. Thiscontrols your blood sugars by slowingdown the absorption of sugars,stimulating your metabolism,decreasing hunger and sugarcravings, as well as being importantfor liver detoxification of hormones.Protein foods are dairy products,eggs, legumes (dried beans and peas),nuts and seeds (and flesh foods).

^Eliminate all sugar-rich foods -sweets, chocolate, soft drinks, fruitjuices (eat fruit maximum of threepieces/day), cordials, alcohol, driedfruit, anything with added sugar,honey and the artificial sweeteners -Splenda, Nutrasweet and aspartame.

® Decrease all refined carbohydrates-white flour products including whitebread, noodles, pasta, packet biscuitsand pastry. Also limit white rice andpotatoes because they have highglycaemic indices. Dense, seededbreads and wholemeal pastaoccasionally are fine.

• Low-glycaemic-index foods are best,for example, whole-grain breads,rolled oats, Basmati, Doongara orbrown rice (not white or jasminerice), temperate climate fruits, forexample, apples (but not bananas).

• Avoid all junk foods, processed foodsand deep-fried foods - anything

battered, hot chips, packet chips,doughnuts, packet cereals, packetbiscuits.

*- What can I eat for breakfast? Plainrolled-oat porridge or natural muesliwith plain natural cultured yoghurt,fruit, nuts and seeds, or eggs orbaked beans with whole-grain toast.

• Avoid coffee, alcohol, cigarettes orother stimulants as these increaselevels of the stress hormone,adrenaline, which raises your bloodsugars and insulin. As well, thesestimulants provide numerous toxicchemicals.

• Include foods that containphytoestrogens that help bufferagainst the stronger oestrogens inthe body. Examples are 2 table-spoons of ground flaxseeds/linseedsdaily; 1/4 cup of alfalfa sprouts;beans and legumes instead of grains;sunflower seeds; non-genetically-modified soy products such as tofu,tempeh and miso. However, I do notadvocate other Western-invented soyproducts such as soy sausages, soyprotein powders, soy cheeses, etc.

• Omega-3 oils are anti-inflammatoryand should be consumed daily.Sources are flaxseeds, avocado,walnuts and cold-water oily fish (ifyou eat fish).

^ Herbal teas - roasted dandelion rootis an excellent coffee alternative; orhave green tea, nettle leaf, redclover and calendula.

Lifestyle^ Regular moderate exercise. A

minimum of 45 minutes 4 times aweek (ideally daily) of exercise withstretching or yoga is essential tocontrol insulin levels, increasecirculation through the pelvis and forstress management. Even just doinghip circling, pelvic thrusts and hipstretches is very beneficial if done for10 minutes every day.

• Castor oil applied to the lowerabdomen with a hot water bottle ontop is very anti-inflammatory. Applyfor half an hour, three times a week,and pay attention to all thoughts,feelings and emotions that arise. Tryto source an organic or pesticide-freecastor oil.

Adopt a lifestyle that balances workand relaxation, allowing some timeto have fun, relax and have a goodlaugh! Consider a massagefortnightly, meditation, breathingtechniques, aromatherapy,acupuncture, yoga and relaxing hotEpsom-salts baths with rose andlavender oils!

Make time for some creative outletfor yourself - even if it's only anhour on a weekend. It can besomething you love doing or arepassionate about, into which you putall your stresses and emotions and

start to move the energies in thebody - for example, singing,dancing, gardening, art, woodwork,cooking. Our internal lives are verymuch reflected by our external livesand vice versa. Certainly, the femalereproductive system is the Utopia ofcreativity through fertility, whetheror not it is being used for that.Therefore, it is important to look atwhere in your life you are being orexpressing your creativity.

Reconnect with other natural cyclessuch as the moon, sea or beach tides.Go out into natural light as much aspossible (this does not necessarilymean direct sunlight). Natural lightaffects the pituitary gland andtherefore ovulation. Even considersleeping with the light on for threedays in the middle of every month.

According to Christiane Northrup, agynaecologist in the USA who wrotethe book. Women's Bodies, Women'sWisdom, stresses that have beenfound to suppress ovarian andmenstrual cycle functioning includenegative feelings about beingfemale. Women who have suchfeelings often repress this side ofthemselves, so it may mean perhapssimply allowing themselves toreconnect with their feminine,creative, nurturing, gentler side,rather than the masculine, analytical,productive, goal-oriented side.

Northrup writes that women who donot ovulate are often tense, anxious,more dependent and may also havesuppressed rage against theirmothers. This indicates howimportant it is to deal withchildhood/parent dynamics and alsoto simply allow a full range ofemotional responses to life's events.Commonly, anger is viewed as anegative emotion, but it is often veryappropriate for the circumstance,and when expressed correctly is avery powerful force. It is interestingto note that road rage in Australia ishighest among young female drivers.Perhaps this is because women aretaught, albeit unconsciously, thatanger is not an appropriate emotionfor women and thus we have veryfew legitimate outlets for itcompared to men. Perhaps trykickboxing or a free-form art class asan emotional outlet.

It has also been noted that womenwith PCOS often have a need forouter or external approval, and placeenormous pressure on themselvestrying to live up to these societal orparental expectations. So perhapstake the pressure off yourself andstart putting your own needs anddesires first every now and then.

52 New Vegetarian and Natural Health Summer 2005/06

Supplements: Nutrients, HerbsFor insulin resistance and obesity: chromium, alpha-lipoicacid, gymnema, magnesium and goat's rue have all beenfound to be effective.For acne: zinc, chromium and lots of liver support arenecessary, with herbs such as dandelion root, calendula,burdock and echinacea.

Facial and body hair requires 6 - 1 2 months' treatment asit is more stubborn to treat. Try fennel cream at aconcentration of 25 ml in 100 gm vitamin E base creamapplied 3 times daily, zinc, pumpkin seeds 1 - 2tabiespoons per day, peony and iicorice, saw palmetto.

i>* Treatment of infertility depends on whether the woman is" currently on assisted reproductive techniques, such as iVF,

because the naturopathic remedies need to be adjusted soas not to interfere with IVF drugs, although naturopathictreatment is possibie concomitant with IVF treatment. In

fact, naturopathic remedies have been shown to increasethe chances of successful IVF conception.

There is no single remedy that will improve PCOS, and forany remedies the dosages wiil vary according to thepotency and quality of the product and the severity of thesymptoms, it is recommended to see a practitionerexperienced in treating PCOS to prescribe herbalmedicines and nutritionai supplements.

Professor Robert Norman and Dr Ann Clarke of Adelaidewere worid pioneers when they showed that diet, regularexercise and weight reduction in women with PCOS, whohad faiied to conceive with IVF, brought about conception in75% of cases without IVF!Peony and iicorice are a common herbal combination forPCO, together with lady's mantle, chaste tree and shatavari,ali of which help regulate the hormones. However, licoriceshould not be taken by anyone with high blood pressure.

NVNH

THE AUTHORClaudette Wadsworth, BHithSc, BA, AdvDNat, NutD, DRiVI. AdvNFM, iVlATiViS.Claudette practises as a naturopath, herbaiist, nutritionist and naturai fertility management practitioner,speciaiising in women's hormonai heaith and fertiiity.She is located in Bondi Junction, Sydney, phone 02 9369 1081; website www.ciaudettewad5worth.com.au.

"Great spirits have aiways encountered opposition from mediocre minds." - Albert Einstein

News from Near and Far continued from page 11

CHEAPER MEAT DOESN'T EQUAL HAPPIER MEALSThe giant feedlots and factory farmsthat have brought us cheaper meatalso are fanning the spread of bird fluand mad cow disease, says a newreport from a prominentenvironmental think tank.

"Factory farms are breaking the cyclebetween small farmers, their animais,and the environment, with coiiateraidamage to human health and localcommunities," says the Washington,D.C.-based Worldwatch Institute.According to the report, 'HappieriVieals: Rethinking the Global MeatIndustry,' consumers can help bybuying meat that is organic or fromgrass-fed livestock or that comes fromsmaller producers and by embracingvegetarianism.

Research Associate, DanielleNierenberg, salutes the World Bank forbacking away from funding large-scalelivestock projects in the developingworid and adds that in June, 167governments beionging to the WorldOrganization for Animal Health agreedon new voluntary standards for thehumane transportation and slaughterof animals. Even so, industrial systemsgenerate 74% of the world's poultryproducts, 50% of all pork, 43% ofbeef, and 68% of eggs. Feedlotsaccount for more than 40% of worldmeat production, up from 30% in1990. industrial countries dominateproduction but factory farming isexpanding rapidly near the major citiesof Asia, Africa and Latin America. Here,"high population densities and weakpublic health, occupational and

environmental standards areexacerbating the impacts of thesefarms."

Crowded, inhumane and unhygienicconditions on factory farms can sickenanimals and create "the perfectenvironment for the spread of diseasesincluding avian flu, bovine spongiformencephalopathy (BSE) and foot-and-mouth disease," according toNierenberg. Additionally, factory-farmed meat and fish contain "anarsenai of unnaturai ingredients"including chemical and otherpollutants, arsenic and hormones. Fromthe early 1970s to the mid-90s, meatconsumption in developing countries

grew by 70 million tons, nearly triplethe rise In industrial nations.Nierenberg adds, "The true costs offactory farming are not reflected in thelow price consumers currentiy pay formeat.

"Environmental and health effects -such as rising antibiotic resistance andcardiovascular disease - are absentfrom most assessments of the costs andbenefits of this growing trend ...Overuse of antibiotics and otherantimicrobials in livestock and poultryoperations, meanwhiie, is underminingthe toolbox of effective medicines forhuman use."

continued on page 59

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Summer 2005/06 New Vegetarian and Naturai Heaith 53