Nutritional Insights for Polycystic Ovarian Syndrome

In honor of PCOS awareness month, I’d like to continue the conversation that Christine started last week in her informative article, Addressing Polycystic Ovarian Syndrome. (Check out her post for a clear overview of what PCOS is and how it is most effectively diagnosed and treated). As Christine mentioned, PCOS is one of the most common endocrine disorders facing American women today and sadly it often goes undiagnosed. The silver lining?  With natural interventions that address the root causes of PCOS, it’s possible to successfully manage and/or reverse the condition entirely.

 If you are struggling with the symptoms of PCOS (including insulin resistance, cystic acne, unwanted facial hair, trouble losing weight, long menstrual cycles or infertility), it’s best to work with a qualified heath practitioner to establish a clear diagnosis and treatment plan.

 Here at Double Happiness Health, we take a multifaceted approach when treating PCOS. Aside from acupuncture, herbal medicine and supplements, we rely on the wisdom of functional medicine to evaluate and address the root causes of the condition. This includes improving nutrition and overall gut health, stress management, sleep and healthy detoxification. In today’s post, I’ll walk you through some of the nutritional insights we most often recommend to those struggling with PCOS.

 Healthy nutrition is of paramount importance in women with PCOS as diet is one of the most effective ways to increase insulin sensitivity, balance blood sugar and reduce excess testosterone. The main medication used to achieve these goals is Metformin – but it’s entirely possible to do this naturally with the steps listed here. 

  • Focus on fresh, whole foods and ditch what’s packaged and processed.

  • Balance your energy throughout each day with hormone healthy proteins, good fats and slow carbs with a pound of vibrantly colored vegetables and low glycemic fruit. Including fat and protein with each meal improves glycemic control and weight loss, lowers androgen levels and reduces PCOS symptoms.

  • Hormone healthy proteins include organic poultry, low mercury fish like salmon, sardines and halibut, and plant-based options like legumes, nuts and seeds.

  • High quality fats like olive oil and avocados help reduce sugar cravings, support the nervous system and aid in the assimilation of fat-soluble vitamins like A, D, K and E. Other great sources include coconut oil, organic ghee, nuts like almonds and walnuts and seeds like pumpkin and sesame seeds.

  •  Slow carbs are rich in fiber, vitamins, minerals and phytochemicals. Include a heaping dose of green veggies (focusing on cruciferous foods like broccoli and cabbage) and low to moderate amounts of low glycemic fruits, starchy energy vegetables like sweet potatoes, parsnips and winter squash, and gluten free grains like quinoa and millet. You may have been told to avoid carbs altogether but such extreme restriction can activate the stress response which makes it harder to lose weight and maintain healthy glucose levels.

  • Kick to the curb all sugar and white flour products, soda, fruit juice and alcohol. If you can eat small amounts of natural sweeteners like honey and maple syrup without increasing your sugar cravings, stick to 1 tablespoon per day.

  • Timing is everything! When and how you eat throughout the day is almost as important as what you eat. Insulin sensitivity is often highest in the morning so you should consider eating your biggest meal of the day for breakfast. Lunch should be slightly more moderate and it’s best if dinner is rather light. If you struggle with sleep, try including some slow carbohydrates like sweet potatoes or a half a cup of cooked gluten free grain with dinner. And be sure to eat at least 2-3 hours before bed so your body has adequate time to digest before sleep.

 Aim for foods especially high in these 3 nutrients

Vitamin D

Research has shown that Vitamin D is an especially important nutrient for women with PCOS as it helps to balance blood sugar, improve ovarian follicular development and increase progesterone. As many as 85% of women with PCOS have been found to have low serum concentrations of Vitamin D (less than 20ng/ml) so it’s a good idea to have your levels checked and supplement accordingly. The best food sources are cod liver oil, salmon and sardines.

Quercetin

Quercetin is a type of flavonoid antioxidant that has been shown to improve the metabolic features of those with PCOS. (For more details, see the resources below for a couple of interesting studies on the potential therapeutic benefits). Foods high in quercetin include apples, grapes, dark cherries and berries, cruciferous vegetables, dark leafy greens, olive oil, red onions and citrus fruits.  Inositol

Inositol

Inositol has been shown to improve insulin sensitivity, reduce serum testosterone levels, increase ovulation and conception rates in women with PCOS. Often, supplementation is recommended (especially in a combined form with myo-inositol and d-chiro inositol) but you can increase your intake through consuming myo-inositol rich legumes like garbanzo beans, kidney beans and lentils. In a recent meta-analysis of randomized clinical trials included below, myo-inositol was as effective as the pharmaceutical Metformin in improving the metabolic profile in women with PCOS and was considered a safer option without risks of side effects!

 

 A quick note about stress…

The HPAO (Hypothalamic, Pituitary, Adrenal, Ovarian) Axis is a complicated system that governs your stress response. The long and short of it is this: more stress has the potential to reduce insulin sensitivity, increase testosterone, and trigger a cascade of other metabolic and hormonal symptoms that make it harder for your body to heal. Most of us are spending the majority of each day in our sympathetic “fight or flight” nervous system and this takes quite a toll on our bodies over time – especially in women with PCOS. My favorite practices for calming the nervous system include acupuncture, deep breathing exercises, restorative yoga, walking in nature and meditation.

 If you’d like to learn more about the other strategies we use to effectively treat PCOS (like improving gut health, sleep and healthy detoxification) we’d love to connect with you. Feel free to reach out via phone or schedule an appointment online. 

 Wishing you well on your path to better health!

 

References:

 Centers for Disease Control and Prevention: PCOS (Polycystic Ovary Syndrome) and Diabetes

https://www.cdc.gov/diabetes/basics/pcos.html

 National Institute of Health Vitamin D Fact Sheet for health professionals

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

 Oral Quercetin Supplementation Enhances Adiponectin Receptor Transcript Expression in Polycystic Ovary Syndrome Patients: A Randomized Placebo-Controlled Double-Blind Clinical Trial.

https://www.ncbi.nlm.nih.gov/pubmed/29105398

 Slow Carbs, not Low Carbs. The truth about low carb diets.

https://drhyman.com/blog/2015/08/20/slow-carbs-not-low-carbs-the-truth-about-low-carb-diets/

 Short-term effects of metformin and myo-inositol in women with polycystic ovarian syndrome (PCOS): a meta-analysis of randomized clinic trials.

https://www.ncbi.nlm.nih.gov/pubmed/30614282

 The Role of Vitamin D in Polycystic Ovarian Syndrome.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669857/

 Therapeutic potentials of Quercetin in management of polycystic ovarian syndrome using Letrozole induced rat model: a histological and a biochemical study.

https://www.ncbi.nlm.nih.gov/pubmed/29615083

 

 

Addressing PCOS- Polycystic Ovarian Syndrome

September is PCOS awareness month. Because we do so much work with women and fertility, we see patients with PCOS almost daily in our clinic. These are some of our most rewarding cases, as we often meet these women after they have been trying unsuccessfully to conceive and without ever being told they had PCOS. We find a natural approach works wonders for many of these women.

What is PCOS?

Polycystic Ovarian Syndrome is one of the most common endocrine and reproductive disorders in the US. It is estimated that up to 12% of women have PCOS and yet 50% of patients do not know they have it. PCOS affects fertility because it can delay ovulation but it also can cause diabetes and cardiovascular disease, so early detection is crucial. PCOS is challenging to diagnose because it can present very differently among patients. Common symptoms may include weight gain, acne, hirsutism or excess hair growth on the face or lower belly and loss of scalp hair. Delayed ovulation occurs as a result of high testosterone due to multiple follicles or “cysts” in the ovaries which is what gives PCOS its name. Consequently, women may experience long cycles of 35-60 days or more between periods.

According to the Rotterdam Consensus, two of three criteria must be met to make a positive diagnosis of PCOS.

  1. Delayed ovulation.

  2. Presence of multiple small follicles seen with ultrasound.

  3. Either clinical or biochemical signs of androgen excess.

Comprehensive testing for PCOS

Because PCOS elevates the risk of chronic disease, screening for PCOS is important beyond promoting timely ovulation and optimized fertility.

Besides an ultrasound of your ovaries, I would recommend having serum testosterone tested as well as AMH (anti-mullerian hormone) on any day of your cycle. On cycle day 3, test FSH (follicular stimulating hormone) and LH (luteinizing hormone) ratio; an elevated LH is seen in women with irregular cycles and points to PCOS.. Rule out insulin resistance with high homeostatic model assessment insulin resistance (HOMA-IR), which is a calculation involving the ratio of insulin to basal (fasting) glucose.

Treatment of PCOS

Most MD’s will put women on birth control to address irregular cycles. When experiencing fertility challenges, women with PCOS are commonly offered the drug Clomid (often without a trigger shot) to assist in inducing ovulation. The drug Metformin is offered to help with insulin resistance. These medications do come with side effects and do not always work. More importantly, they do not help address the underlying cause of the disease, nor do they diminish the associated health risks that come with PCOS . An effective natural approach to PCOS that addresses root causes would include a lower-carb, plant-based diet, regular exercise and acupuncture.

How does acupuncture help PCOS? Glad you asked;-)

Acupuncture:

  • May decrease hyperinsulinemia and increase insulin clearance- YES PLEASE.

  • May decrease testosterone-

  • May induce ovulation in PCOS.

  • Increase skeletal muscle glucose uptake- YAY.

  • Increase release of your feel-good chemical messengers; neuropeptides, serotonin, dopamine, endogenous opioids, and oxytocin.

  • Inhibit central sympathetic nerve activity

If you suspect that you have PCOS, ask your GYN or MD to do appropriate testing to rule it out. To read the latest on PCOS, check out FIona McCulloch’s brilliant book called 8 Steps to Reverse Your PCOS. Fiona breaks down the subtypes of PCOS and how to work with each one. Come in to Double Happiness Health for an evaluation, customized treatment plan and some wonderful acupuncture to help get you balanced and feeling great.

REFERENCES:

Acupuncture and exercise for PCOS

https://www.sciencedaily.com/releases/2009/06/090629081135.htm

Acupuncture helps insulin sensitivity

http://www.diabetesincontrol.com/acupuncture-helps-to-increase-insulin-sensitivity/

Acupuncture treatment for insulin sensitivity of women with polycystic ovary syndrome and insulin resistance:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343367/

Acupuncture and women’s health: an overview of the role of acupuncture and its clinical management in women’s reproductive health

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962314/

Intermittent Fasting: The Chinese Medical View

If you’re into health, nutrition, and fitness, you’ve likely heard the buzz around intermittent fasting. But is this dietary trend right for everyone?  What does traditional Chinese medical wisdom have to say about it?  And what impact does it have on fertility?

What is intermittent fasting?

 Intermittent fasting (IF) is an eating pattern that includes regular, short-term fasts. There are several models, one being Time-Restricted Eating.  For this type of IF, you extend your regular overnight fast to between 12 to 16 hours by skipping either breakfast or dinner every day.  One popular version of this approach is the 16:8 diet which involves fasting for 16 hours and condensing your eating into an eight-hour time slot.

 Another form of IF includes Whole-Day Fasting, which, like it sounds, consists of fasting for 24 hours anywhere from once or twice a week to once or twice a month.

 Some describe intermittent fasting as a lifestyle rather than a diet, since it doesn’t dictate what food you eat or avoid, but rather a pattern of eating.  Proponents of IF point out that our hunter-gatherer ancestors would not have had three square meals a day, but rather times of feast and famine, depending on how well the hunt went. 

 While most research on IF has been done using lab animals, human trials have also been conducted and make up a growing body of work that shows its benefits.  If done correctly, IF may help regulate blood glucose, improve blood lipids, reduce the risk of coronary disease, manage body weight, and reduce the risk of cancer and other chronic diseases.  Ketogenesis — when your cells switch from burning glucose to burning fats — is one of the mechanisms behind the improved health seen with short-term fasting.  Also, as you fast, your insulin levels drop and your levels of human growth hormone and norepinephrine increase, which has a positive impact on metabolism and longevity.

 What does traditional Chinese medicine have to say about this lifestyle? 

 Chinese medical wisdom has long recommended eating during daylight and resting at night (including resting the digestive organs).  This is part of living in harmony with the circadian cycles. 

Traditional Chinese medical (TCM) wisdom around diet concurs with the adage “Eat breakfast like a king, lunch like a prince and dinner like a pauper.”  According to the TCM meridian clock (a chronological map of the strength of the organs at different times of the day), the digestive organs of the Spleen and Stomach are most active in the morning (Stomach time being 7-9am and Spleen time 9-11am).  So it makes sense to load up your calories earlier in the day, when the digestive fires are strongest.

Also in accordance with the meridian clock, Chinese medicine practitioners often recommend abstaining from eating for at least 2 hours before bedtime.  This allows your food to begin to digest before you sleep, giving an important break to the digestive organs overnight.  The Gallbladder and Liver have the most qi and blood from 11pm-1am (Gallbladder) and from 1-3am (Liver).  During these hours, it is important for your body to be in a deep sleep state and not distracted by digestive tasks, otherwise the Liver will fail to get nourishment from the blood and will not be able to perform its many functions.

So TCM does support restricting eating to daylight hours, but rather than skipping breakfast, it would encourage skipping or going light on dinner.  However, I don’t believe there is much support in TCM for whole-day fasting.  In Chinese medical school, we learn that long fasts can weaken the Spleen Qi and lead to deficiencies.  Instead, we should eat at regular intervals as the earth element (Spleen and Stomach) loves a routine.  Eating at about the same times every day can help the gastrointestinal tract to perform optimally.

 

What is IF’s impact on fertility?

As a practitioner, I see many patients who are trying intermittent fasting and loving it.  They see benefits like loss of fat, increase in lean body mass, and curbing unhealthy cravings.  A few things to note about my patients who love IF, though — most of them are doing the Time-Restricted Eating variety and all of them are male.  

 I did some research on intermittent fasting in women and it seems that it may not always go down as well with us ladies.  A small study found that blood sugar control worsened for women after 22 days of alternate-day fasting, while there was no adverse effect on blood sugar for men (Source).  And while some women love IF, others report serious side effects like binge eating, metabolic disruption, lost menstrual periods, and early-onset menopause.

It’s important to understand that intermittent fasting is a stressor on the body.  And just like other stressors such as lack of sleep, emotional stress, too much exercise, and illness, too little food can suppress our fertility.  It happens through a tipping of the scales — energy gets taken away from the production of sex hormones and directed toward the production of stress hormones.  The stress hormone cortisol inhibits GnRH (the precursor of our sex hormones) and suppresses the ovaries’ production of estrogen and progesterone, which plays havoc with our fertility.  This makes sense from a biological perspective — during times of food shortage, our body needs to conserve resources, not make a huge expenditure on reproduction.  Learn more about cortisol in Janice’s post Cortisol: The Goldilocks Hormone.

 On the other hand, there are certain women- especially some with PCOS or with insulin resistance who find intermittent fasting helpful in conceiving. As a woman, you may be thinking, well, I’m not trying to get pregnant anyway.  But it’s important to remember that estrogen and progesterone play many important roles in our body, from regulating our body temperature to protecting our cardiovascular health to balancing our mood.

For anyone considering intermittent fasting:

it is best to check with your doctor to know if it is a diet that is appropriate for you. Double Happiness Health- based Internal Medical doctor and Obesity specialist Dr. Priyanka Wali explains that anyone starting an IF protocol should first have labs checked such as iron, omega’s, B12 and Vit D. If you have an underlying nutritional deficiency and start IF, you may make things worse. Also, she points out that eating nutrient dense food during your eating window is of paramount importance. Don’t eat junk food when it’s time to eat.

With this knowledge in hand, I don’t discourage all my female patients from intermittent fasting, but I do recommend a gentler version, more in line with the Chinese medicine view.  A 12-14 hour overnight fast seems a more reasonable length of fasting, giving time for the digestive organs to rest without pushing us into stressful territory.  And I don’t recommend the whole-day fasting approach to my female patients.

If you are curious to try intermittent fasting, we highly recommend you get some lab testing first to rule out underlying nutritional deficiencies. When you practice intermittent fasting, be especially careful to eat nutrient dense food during your eating window and pay close attention to how you feel, both during the fast and during your eating hours.  If you feel very “hangry” before your first meal of the day, you may want to shorten your fasting hours.  And if you feel bloated, overly-full, and sluggish during your eating hours, your Spleen may be too deficient to effectively digest so much food at once.  It’s always a good idea to check in with your Double Happiness practitioner before making any major dietary or lifestyle change.

REFERENCES:

CHINESE MEDICINE DIET RECOMMENDATIONS

https://www.wildearthacupuncture.com/blog/2018/9/6/chinese-medicine-diet-recommendations

Fasting, circadian rhythms, and time restricted feeding in healthy lifespan

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388543/

Glucose tolerance and skeletal muscle gene expression in response to alternate day fasting

https://www.ncbi.nlm.nih.gov/pubmed/15833943

INTERMITTENT FASTING FOR WOMEN: A BEGINNER’S GUIDE https://www.healthline.com/nutrition/intermittent-fasting-for-women

INTERMITTENT FASTING FOR WOMEN: IMPORTANT INFORMATION YOU NEED TO KNOW

https://www.precisionnutrition.com/intermittent-fasting-women

INTERMITTENT FASTING: SURPRISING UPDATE https://health.harvard.edu/blog/intermittent-fasting-surprising-update-2018062914156

Intermittent Fasting: The Science Behind the Trend https://chriskresser.com/intermittent-fasting-the-science-behind-the-trend/

IS TIME-RESTRICTED EATING EFFECTIVE FOR WEIGHT LOSS?

https://www.medicalnewstoday.com/articles/322365.php

LIVER IN CHINESE MEDICINE

https://www.karger.com/Article/FullText/466694

 16/8 INTERMITTENT FASTING: A BEGINNER’S GUIDE

https://www.healthline.com/nutrition/16-8-intermittent-fasting#getting-started

 

 

Holistic Approach to IBS

Holistic Approach to IBS

Irritable bowel syndrome (IBS) is on the rise. It has a worldwide prevalence of 10-20% and has become one of the most common disorders seen by gastroenterologists and primary care physicians alike. I myself have noticed an increase in the number of patients with digestive health disorders in our clinic. I thought it would be helpful to write this blog post because many patients ask, “What is IBS, and how do I know if I have it?”

Favorite Summer Soup Recipe

Favorite Summer Soup Recipe

This delicious (and oh-so-easy!) summer soup comes from the wonderful Mickey Trescott of the Autoimmune Wellness Blog. It’s one of the many mouth-watering recipes in her book, The Autoimmune Paleo Cookbook, An Allergen-Free Approach to Managing Chronic Illness. If you are struggling with an autoimmune condition or are simply seeking to nourish yourself well, this cookbook is a fantastic resource.

The Benefits of Forest Bathing

The Benefits of Forest Bathing

I did some communing with nature deep in the Sinkyone Wilderness State Park this weekend. As my boyfriend and I slowly walked into the park, winding our way along a rustic elk path that paralleled the majestic pacific coast, I could feel myself dropping into a level of presence and relaxation that allowed me to let go of future concerns or worries of the past and to just be.The Japanese coined the term shinrin-yoku, or “forest bathing” in the early 80’s. Since that time, forest bathing has become a popular ritual of preventative health care in Japan. In the decades that have followed, several robust studies have proven the health benefits of simply spending time in under the canopy of a living forest or in a natural area. Once again, science backs up this practice we intuitively know is great for us.