Natural Approaches to PCOS

1.     Causes of PCOS

a.     Genetic link

b.     Insulin resistance

  •   Leads to elevated levels of insulin
  •  Elevated levels of insulin lead to testosterone production in the ovary
  •  Inhibits the production of SHBG (sex hormone binding globulin) in the liver

c.     Low grade inflammation

  •   Many women with PCOS may have a low grade level of inflammation

d.     Adrenal origins and stress

2.     Traditional approaches

a.     Oral contraceptives

b.     Spirinolactone

c.     Metformin

d.     Progestins

e.     Tests that should be performed: pelvic ulstrasound, LH FSH, Estradiol Progesterone, Prolactin, Free Testosterone, 17 hydroxy progesterone, SHBG, FAI (free androgen index), DHEA, DHEAS, 24 hour urine for free cortisol, Hemoglobin AIC, Lipid profile, Thyroid profile

3.     Natural lifestyle approaches

a.     Address stress and support adrenals

  • Stress elevates DHEA, DHEAS, androstenedione production
  •  Support adrenals with: restorative exercise, mindfulness, calorie appropriate diet, proper sleep, supplements

b.     Address insulin resistance

  • Elevated insulin levels stimulate ovarian cytochrome P450 in ovary which leads to androgen production in the ovary
  • Lowered insulin levels lead to improved ovulation
  • Caloric strategies
    •  Consume majority of calories in the am hours
      • Leads to lowered insulin levels and thus lowered testosterone levels
      • Example 1800 kcal diet: 980 kcal breakfast, 640 kcal lunch, 190 kcal dinner
      • Add snacks to consume 5 meals per day to limit spikes of glucose Increase whole grains, vegetables and fruits, and fiber
  • Balance protein and carbohydrates
  • Consume: whole grains, sprouted grains, fiber (helps to stabilize glucose by slowing the digestion of carbohydrates
  • Avoid: white flour, processed foods, rice, potatoes
  • Consume: low glycemic index foods (these breakdown slowly)
  • Limit carbohydrates per day to 100 grams if overweight
  • Decrease AGEs (advanced glycation end products) in diet
    • Leads to decreased insulin and therefore decreased testosterone
    • AGEs are pro oxidant and inflammation
  •  Increase Calcium and Vitamin D
    • Calcium 1000 mg per da
    • Vitamin D3 5,000 IU per day
  • Add magnesium
    • Magnesium 300 mg per day
    • Leads to increase insulin sensitivity
  •  Increase chromium
    • Chromium 200 mcg per day
    • Leads to lower insulin levels
  • Add a probiotic
    • Decreases inflammation
  •  Increase Omega 3 fatty acid
    • May decrease testosterone levels
    • An increase in fish oil to 3 grams per day can lead to lowered levels of testosterone
    •  Add Omega 3s in the form of
      • Fish oil
      •  Cod liver oil
      • EPO (evening primrose oil) 1500 mg per day

c.     Restorative exercise

  • Exercise of 30 minutes per day can increase insulin sensitivity
  • Avoid stressful exercise “weekend warrior” as this will stress the adrenals

d.     Limit toxic exposure

  • Eat as organic as possible
    • Avoid organopesticides
    • Avoid glycophosphates
  • Avoid plastic exposure
    •  Glass bottled water
    • Glass storage
    • Never cook, microwave or heat plastics
  • Other sources of toxic exposures
    • Cosmetics
    • Avoid parabens
      • Preservatives used in a wide variety of personal care products  Shampoos, conditioners, lotions, facial and shower cleansers and scrubs
      • HEALTH CONCERNS: Endocrine disruption, cancer, developmental and reproductive toxicity
      • Some forms of parabens are banned in other countries
      • FOUND IN: Color cosmetics, fragranced lotions, body washes and hair care products, nail polish and treatment
    • Avoid phthalates
      •  WHAT TO LOOK FOR ON THE LABEL:  phthalate, DEP, DBP, DEHP and fragrance
      • HEALTH CONCERNS: Endocrine disruption, developmental and reproductive toxicity, cancer
      • FOUND IN: A wide variety of personal care products
    • Drugs
      •  Avoid misuse of antibiotics
      • Alter the gut microbes
      • Avoid misuse of protein pump inhibitors
      •  Alter the gut microbes
    • Clothing
    • Architecture

e.  Add inositol

  • Inositol is a dietary supplement that has shown some benefit for PCOS (polycystic ovarian syndrome). There are 9 forms (stereoisomers) of inositol, however the commonly used term inositol generally refers to the most common form, myo-inositol. Inositols are naturally found in the highest concentrations in whole grains, beans, nuts and citrus fruits. IIt is also naturally  made in the body. Studies have shown that inositol improves the way the body uses insulin, promotes normal hormone levels, resulting in more regular menstrual cycles and normal ovarian function, normalizing lipid levels and helps with egg quality. It may also help with weight loss. In women with PCOS, a high percentage of women taking myo-inositol will establish regular periods and show evidence of ovulation
  • Myo- inositol may help some women with PCOS and can help with restoration of more normal blood sugar levels, testosterone levels, and lipid levels. It can therefore help with excess hair growth, acne, and also improve ovulation. It also may help with fertility, anxiety, and depression. It may also be beneficial for PMS. Women with PCOS appear to benefit more from a combination of isomers of inositol, in a ration of 40:1 of myo-inositol to D-chiro-inositol. Other ratios of inositol isomers are undergoing clinical investigation currently.
  • A recent study published in February 2015 again demonstrated the effectiveness of myo-inositol in patents with PCOS. Fifty women with PCOS, insulin resistance and lack of ovulation were given myo-inositol. Twenty-nine of the 50 women showed evidence of ovulation and 11 (37.9%) became pregnant. In the patients who did not ovulate on myo-inositol alone, 13 of the 18 showed an ovulatory response when clomiphene was added and six (42.6%) conceived.
  • Extensive research supports the use of myo-inositol in PCOS. Its effects may be additive to metformin.
  • In addition to PCOS, myo-inositol has been used in the treatment of diabetic neuropathy, depression, Alzheimer’s disease, and panic disorder. myo-inositiol is well tolerated and appears safe when used at doses up to 12 grams per day.Common side effects may include nausea fatigue, dizziness and insomnia.
  • Resources:
    • Ovasitol
      • Ovasitol is a supplement formulated specifically for women with PCOS. It contains myo and d-chiro inositol in the ratio 40:1. Ovasitol also contains maltodextrin. This is a carbohydrate, made from starch that is used for thickening. The addition of maltodextrin means that some people are more likely to experience side effects, such as diarrhea, nausea and constipation. If this happens to you, you might want to try another inositol product before giving up on inositol altogether.
    • Sensitol
      • Sensitol™ is a formulation comprised of myo-inositol (MI) and D-chiro-inositol (DCI) - along with alpha lipoic acid.

f.      Alter and improve estrogen metabolism

g.     Address inflammation

h.     Other beneficial supplements

  • B6 and other B vitamins

4.     Expectations and incremental steps

a.     Changes may take 6 to 12 months to outcome

b.     Goal is to stabilize blood sugar levels and decrease insulin resistance; maintain hormone balance; promote healthy digestion

c.     Lifestyle: manage stress, restorative exercise

d.     Diet: whole food, low glycemic anti-inflammatory diet

e.     Supplements: promote hormone balance and insulin levels

5.     Resources

a.     Dietary Guidelines

  • Low glycemic index, anti-inflammatory diet
  • Mediterranean Diet

b.     Supplements

  • Calcium
  •  Vitamin D3
  • Cod liver oil
  •  Fish oil
  •  B vitamins
    •  B6 50mg per day
  • Inositol
    • Decreases insulin production
  • Licorce
  • Maca
  • Vitex
    •  Increases progesterone production
  • Tribulus
  •  Royal Jelly
    • May help to decrease inflammation
  • Gymnema
    • Supports blood sugar levels
  • Cinnamon
    • Lowers insulin resistance
  • DIM
    • Helps with estrogen metabolism
  •  White peony
    • When combined with licorice may help with painful menses
  • Saw Palmetto
    • May help with hirsuitism
    • Inhibits DHEA production
  •  Adrenal Support
    • Ashwaganda
    • Magnesium
    •  Licorice
    • Rhodiola