Managing PCOS - A Naturopathic Perspective

Last time we looked at the most common endocrine condition for reproductive aged women - PCOS, here we focus on its naturopathic management. Lifestyle This is the first line of treatment for those with PCOS, by addressing high risk weight gain through prevention and assisting with weight loss where needed. For those who are overweight/obese it is realistic to look at a 5-10% reduction of body weight, which can often help regulate menstrual cycles and improve fertility prospects. By creating good eating habits and focusing on sustainable weight loss is vital, plus regular weigh-ins and measurement will help keep you on track.   Limiting sugary and refined carbohydrate foods is key. As well as maintaining good glycaemic control by eating regularly, choosing low GI foods and eating a diet rich in vegetables and whole foods. Exercise 30 minutes of moderate to vigorous intensity exercise per day is recommended, in addition to diet changes and increasing your incidental exercise. For instance, take the stairs rather than lift, park your car further away and if taking public transport get off the stop before. Also, consider a pedometer and aim to reach 2000 steps a day.  Minerals  Women with PCOS have been found to be more magnesium deficient than the average population. Therefore by ensuring adequate dietary levels of magnesium is important as it helps with insulin control. Foods high in magnesium include cocoa powder, rice bran, brazil nuts, tahini, almonds, oat bran, untoasted museli, English spinach and bananas.  Chromium is another useful mineral in PCOS as it helps to regulate serum glucose and insulin control, as well as helping fat metabolism. Food sources of chromium include brewer’s yeast, molassess, raw parsley, olives, spinach, cottage cheese, raw apple. Omega 3 fatty acids - Foods rich in omega 3 fatty acids (fish and flaxseed oil, walnuts) may be protective in reducing the progression of insulin resistance to glucose intolerance.  An appropriate fish oil supplement might be recommended. Your naturopathic practitioner will be able to recommend mineral supplements in appropriate ranges to treat deficiencies. Herbal medicine Herbal medicines can be useful to address many aspects of PCOS including blood sugar dysregulation, menstrual irregularities and stress, which can all exasperate the condition.   If you think you might have PCOS and would like more detail or a naturopathic approach, call us on 02 9976 5466 for a consultation.

What is PCOS?

Are you one of the 12-18% of women with PCOS?  Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in reproductive aged women – it is estimated 12-18% of Australian women have PCOS.  You might experience one or more of these symptoms if you have PCOS:-  Excessive hair growth in areas which are unusual for women and common for men such as the face or chest, the medical name for this is hirsutism.  Acne – like hair growth this can be a sign of excess levels of hormonal androgens.  Overweight / obesity – around 40% of women with PCOS are overweight.  Menstrual irregularities – a history of irregular periods where the length of a menstrual cycle can be short, e.g. less than 21 days (sometimes with periods of no ovulation) or long cycles, e.g. more than 35 days. It is estimated that menstrual irregularities effects 90% of women   Abnormal bleeding patterns – a third of PCOS women have abnormal menstrual bleeding patterns.  Fertility issues – a failure to ovulate regularly, 70% of women with PCOS develop infertility.  Prediabetes – 50-70% of women with PCOS have insulin resistance and metabolic syndrome.  PCOS symptoms often start in teenage years with menstrual irregularities, and change over time with infertility and signs of androgen excess (male pattern hair growth and acne) and weight issue. This can then lead to insulin resistance and the progression into type 2 diabetes, which can lead to cardiovascular health issues.  Your health care practitioner is likely to investigate further with the following tests:-  Blood test – measure free testosterone and also likely to check the function of your thyroid and pituitary by looking at TSH, prolactin and FSH levels. A check of blood glucose, insulin and blood lipids would be likely also, as these can elevate in PCOS.  Vaginal ultrasound – in women over 18 years to check for polycystic ovaries, however this alone is not enough for a diagnosis as it is a common presentation especially in young women.      So why does it happen?  It’s thought to be a mix of hormonal and metabolic dysfunction causing a dysregulation in ovarian function. Certain factors like lack of exercise, poor diet, obesity, genetic predisposition, smoking, steroid drug use can heighten insulin resistance and the likelihood of PCOS. Also, stress can exasperate it, as it effects hormonal dysregulation, cortisol and blood regulation.  One interesting theory is that PCOS is a result of a ‘thrifty gene’, which in times of food shortage would provide an advantage (increasing muscle strength, moderate abdominal fatness and decreased insulin sensitivity), the trouble is in times of unlimited food supplies and a sedentary lifestyle (a norm for many) a negative response is the result leading to the modern presentation of PCOS.     Management of PCOS  The presentation of PCOS can vary greatly from woman to woman; therefore the management of PCOS will vary greatly too. There are advantages in an integrated approach - involving both your GP and naturopath, specialist referral might also be necessary e.g. endocrinologist or fertility specialist.    Further resources  Jean Hailes for Women’s Health –  www.jeanhailes.org.au  If you think you might have PCOS and would like a naturopathic approach, call us on 02 9976 5466 for a consultation.    Next SeedPod News:  A Naturopathic perspective on treating PCOS.

Nutritional Support for IVF

The preconception period continues to gain recognition as an ideal opportunity to optimise the health of the prospective parents. It is well understood that a healthy lifestyle and good nutrition influences the quality of egg and sperm and thereby increases the chances of a successful pregnancy. Likewise nutritional support is essential during IVF cycles to ensure healthy embryonic development.

Recent data from national health surveys indicate that the general population’s nutritional intake is suboptimal and virtually everyone suffers to some extent from deficiencies of essential vitamins, minerals and trace elements.

A preconception Mediterranean-type diet has been associated with increased success of achieving pregnancy among couples undergoing IVF. This diet is characterised by a high intake of vegetables and good quality vegetable oils, fish, nuts, legumes and low intake of dairy and snacks. A Dutch study showed couples with a high adherence to this diet had a 40% increased chance of pregnancy after embryo transfer.
In comparison, the Western dietary pattern is characterized by a high intake of red and processed meats, high-fat foods, refined grains, and high-sugar drinks and desserts, and is relatively low in fruits, vegetables, whole-grain foods, poultry, and fish. This diet has been shown in animal studies to be detrimental to fertility.

Some important nutrients in the Mediterranean-type diet that may mediate the benefits during IVF include:

B vitamins

• Poor B-vitamin status is associated with early pregnancy loss. The early embryo requires folate to reduce risk of neural tube defects. Availability of B vitamins during the period immediately preceding egg recovery may affect embryo viability after IVF. There is also a positive association between folate intake and sperm quality.
• Food sources: Avocado, Brewer’s yeast, rice bran, oatbran, dark leafy greens (collard greens, mustard greens, romaine lettuce, spinach and turnip greens), sunflower seeds, legumes, lentils, mushrooms, wholegrains

Vitamin D

• Higher levels of vitamin D in body are directly related to vitamin D levels in follicular fluid of egg which are associated with improved ovarian response to ovarian hyperstimulation, high quality embryos, improved implantation and pregnancy rates.
• Food sources: Eggs, fatty fish, butter and cod liver oil. You can also get vitamin D from sitting out in the sun for 10 to 50 minutes per day 4-6 times per week. But absorption is impacted by the darkness of your skin.

Essential Fatty Acids:

• Omega-3 acids have shown benefit on fertility outcome by improving egg quality and their subsequent development into competent embryos. They also help to regulate hormones in the body, increase cervical mucous, decrease miscarriage risk and regulate anti-inflammatory action in the ovulatory cycle and implantation process during IVF.
• Food sources: Flax seeds, walnuts, salmon, sardines, snapper, trout, whiting.

Antioxidants: (vitamin C, vitamin E, zinc, selenium, CoQ10, alpha lipoic acid)
Anti-oxidants have many roles to play during IVF. They manage oxidative stress and reduce impact of reactive oxygen species (ROS), provide gentle detoxification and support gonadal DNA integrity.

• IVF procedures such as sperm preparation and embryo medium may increase ROS and oxidative stress
• Oxidative stress impacts sperm-egg interaction and implantation
• ROS may affect egg maturation, development of the embryo, and implantation
• Zinc is important for ovulation and a recent animal study has shown a positive association with high zinc levels and the increased development of blastocyst in IVF
• High antioxidant dietary intake has been associated with higher sperm numbers, motility and quality
• Food Sources: Colourful fruits and vegetables. Some of the fruits highest in antioxidants are plums, pomegranates, blueberries and strawberries. Eat a rainbow of foods everyday.

For more information see our Diet for Conceiving Well on our website www.fertilityhealth.com.au and for information & support with IVF call the clinic on 9976 5466.

Are we over using IVF?

Originally IVF was developed for women with tubal disease. It was then expanded for use in men with poor semen quality. Now IVF is being applied to other types of subfertility such as mild male subfertility, endometriosis and unexplained subfertility.
Are we over-treating couples who had a reasonable chance of conceiving naturally? Is it equally effective in these conditions? What are the consequences of using IVF? Do the risks outweigh the benefits?

What is meant by IVF?
IVF is commonly used term for Assisted Reproductive Technology (ART) which includes:

• Assisted insemination (AI) or Intrauterine insemination (IUI) – sperm introduced in uterus around ovulation for fertilisation
• In Vitro Fertilistation (IVF) – when egg and sperm are put together in test tube to fertilise prior to transplantation into the uterus
• Intracytoplasmic Sperm Injection (ICSI) – sperm is injected into egg for fertilisation prior to transplantation into the uterus
• Gamete & Zygote Intrafallopian Transfer (GIFT) – gamete (egg & sperm) are introduced into the fallopian tube; less often used

Rising Rates of IVF

• One million babies were born in first 25 years of IVF (1978 – 2003)
• An estimated 5 million babies will have been born to IVF by end 2013.
• 2-3% of all births occurs via IVF in developed countries

Unexplained Fertility and IVF

• More than 90% of fertile couples are expected to achieve conception within 12 months of contraception-free sexual intercourse
• Sub-fertile couples are considered to have a good prognosis for natural conception in 2-3 year timeframe of trying to conceive
• Unexplained fertility accounts for 25-30% couples presenting for IVF, and many of these conceive before treatment. A Dutch study of 500 sub-fertile couples showed 60% conceived naturally after their initial assessment at the fertility clinic.

 

Emerging Risks of IVF

• Multiple pregnancies are associated with maternal and perinatal complications; this is not such an issue in Australia where single embryo transfers are the norm
• Some studies show 50-70% additional risk of preterm birth and congenital anomalies
• Healthy children born through IVF may have higher blood pressure, glucose levels and vascular dysfunction than children conceived naturally. Epigenetic and developmental abnormalities after ART have been shown in animal studies.

Emotional Adjustment to IVF

• IVF is a multidimensional stressor; many couples seeking fertility help, especially IVF are not prepared for the challenges ahead
• The treatment (doctor visits, hormonal changes, daily injections) constitutes the primary stressor and is most likely to evoke anxiety
• The unpredictable outcome of the treatment is another major stressor and more likely to evoke feelings of depression
• Other considerations are the financial burden and the impact on the couple’s marriage

IVF or not IVF?

• IVF has allowed many infertile couples to have a family
• IVF procedures are improving and having increasing success. Although IVF success rates fall away with increasing maternal age
• Some couples will be clinically defined as infertile, that is, unable to achieve spontaneous conception within 12 months of contraception-free sexual intercourse
• However, many of these may indeed be sub-fertile, and just need more time to try for spontaneous conception

Next week: Nutritional Support for IVF
If you would like more information on IVF procedures and support, please call the clinic on 9976 5466.

A Mother Centred C Section

Are you needing to plan a scheduled Caesarean? Do you know someone who is? Are there ways to improve the experience for the physical and emotional wellbeing of mother and baby? Did you know you should have immediate skin-skin time with your baby after a C section? Watch these two excellent videos before you begin reading (and forward this to a friend):

• Mother Centre C- Section by Jentle ChildBirth Foundation:  https://www.youtube.com/watch?v=m5RIcaK98Yg
• Skin to Skin immediately after C Section: https://www.youtube.com/watch?v=0jCjk73Xpn8
    

With preparation and an open discussion with your doctor, you can prepare yourself for a planned or unplanned cesarean section. These more supportive procedures can help make you feel more involved in the birthing process, as well as improving breastfeeding and bonding with your newborn. Identify the following elements of a mother-friendly caesarean which most appeal to you, and ask your medical team about which of these are possible in your hospital.

Atmosphere

• Ask if room lights can be dimmed and theatre warmed a little to help mother and baby feel more relaxed, comfortable and allow a feeling of intimacy during the skin-on-skin time.
• Request theatre ‘chatter’ and noise be minimised to allow the focus on the special moment of birth and first contact for the family. You may, however, wish for the doctors to explain the process as it is happening.

 
Preparation & Practicalities

• Prior to delivery, practice breathing and relaxation techniques that you can use during the procedure.
• Decide what photos you would like taken and who will take them
• Ask the anesthetist to ensure you have at least one arm free to envelope the baby for easier skin-to-skin contact after delivery.
• Ensure your ‘theatre gown’ is removed or moved in preparation for complete skin-to-skin contact.

• Have your support people in with you. While policy prevents a crowd of bystanders in the theatre, the partner and a Doula are welcomed in a mother-friendly caesarean. A doula is valued as a support to both parents, especially the mother if the dad needs to go with the baby for extra attention.

• Request that the surgery be performed more slowly. (see Video 1.) The extra time taken to ‘walk the baby’s body out’ allows the uterus to squeeze excess fluid out of the lungs. (This process occurs during a vaginal birth and is important for healthy breathing after birth.) Once the baby’s head is out, the doctor may wait a couple of minutes before lifting the baby’s body out for this purpose.

• Request the screen to be lowered at the point of delivery, so you can watch your baby being born. The abdominal incision will remain hidden from view, but you will be able to see your baby being gently lifted out from your uterus. In a mother-friendly caesarean, time and care is taken to allow mothers to feel more involved in the birth process.

• Request a delay in cord clamping until it stops pulsing. The health benefits to baby are well documented and will be supported by your doctor if all is travelling well with the birth. 

• Ensure immediate skin-to-skin contact, as long as you and the baby are healthy. At a mother/family-friendly caesarean, skin-to-skin is a priority. As well as aiding with bonding, skin to skin immediately after birth has been found to regulate the baby’s body temperature & breathing and increase the likelihood of breastfeeding.

• Request the opportunity to breastfeed within the first half to one hour and have baby stay with you throughout your time in theatre and recovery. Breastfeeding within that first half to one hour increases your chances of successful breastfeeding, and is considered to be an important part of postnatal care. You are able to breastfeed whilst still on the operating table.

• The immediate minutes and hours post-birth are very important for mother-baby bonding. In a mother-friendly caesarean, the amount of time you spent separated from your baby will be limited. 

If you would like more information on C Section support or natural birthing preparation, call the clinic on 9976 5466.

Natural Skin Care

Skin care is a multimillion dollar industry but with so many products available it is hard to know what is best for you. Often the simplest products are the best for us to use. Have you ever taken the time to read over the ingredients list of your beauty products? Chances are that they will be filled with hundreds of chemicals.
Just imagine the collection of chemicals you are exposed to every day that come in beauty products- soaps, shampoo, conditioner, body wash, face wash, deodorant, moisturizers, perfumes, make up, hair spray. This is literally hundreds of chemicals each day! I encourage you to read each and every ingredient next time you have a shower and get ready for your day and just think about the magnitude of this chemical exposure if on a daily basis!
 
The Environment Working Group has set up a website called ‘Skin deep’ which allows you to search any product and find detailed information about the safety of the chemicals used. You can simply type in the product name and it will bring up information about the various health effects that the product may have. It grades your product, so you know if it contains low, moderate and high risk ingredients. It then lists all the ingredients found in the product with information about those chemicals and your health. I strongly urge you to use the website yourself and learn more about the products and chemicals you are using on your skin -http://www.ewg.org/skindeep/
 
The problem for many of us is that we don’t understand what the chemicals used actually are - you need to be a chemist to decipher the list! This in itself should be a pretty big warning sign that the ingredients are not safe.
Below lists the top 12 most toxic ingredients used in skin care - these ingredients may be cancer causing, neurotoxic, endocrine or hormone disrupting, toxic to organs or skin irritants. I suggest you scan your ingredients list of these products and ensure you’re not exposing yourself and your family to these highly toxic substances on a daily basis.

Luckily there are plenty of natural and chemical free beauty products available to use. The following lists some of my favourite brands, products and natural remedies that have been tried and tested both on myself and patients. Next time you are replacing a skin care product, take the time to find a cleaner alternative that will dramatically lower your chemical exposure.
 
Moogoo skincare products

This is one of my favourite natural skin care brands. For those of you with dermatitis, eczema, psoriasis or dry skin the ‘eczema and psoriasis cream’ is one of the best on the market and I have seen fantastic improvements in my patient’s skin health with this product. They have a huge range of products (including shampoo and conditioners and natural skin tanning products). They also make a good range of products for acne free skin. They don’t use any harmful chemicals and instead fill their products with ingredients that literally feed your skin with nutrients and herbs.
www.moogoo.com.au
 
Miessence deodorant range


It has taken me a long time to find a natural deodorant that actually works but this one is the best I have come across so far- and my patient’s agree. The deodorant contains just essential oils along with baking soda so it is completely natural. There are no nasty antiperspirant ingredients and no aluminium. The deodorant comes in a range of flavours but even the fragrance free works a treat.
www.miessence.com
 
Tea tree oil

Tea tree oil is an antimicrobial, antibacterial, antifungal and antiseptic. For this reason it can be used for a range of skin issues. Don’t use it directly on the skin as it is too irritating- it needs to be diluted. Use it on acne prone skin to reduce bacterial involvement after washing your face. The tea tree oil can either be diluted in some water splashed on the face or add a few drops onto a warm wet cloth or make-up wipe and wipe over the face. You can use it to reduce the risk of infection following a cut or scrape.
 
Lavender oil


Lavender oil is great to have on hand if you have any blemishes or redness as it takes the red colour out of the skin. This one can be used directly onto the skin and does also have antimicrobial activity. Use it for acne, breakouts, blemishes or rosacea.
 

Coconut oil 

This is a great alternative to moisturizer and is of course a completely natural product. Coconut oil is full of healthy fats that help to moisturize and soften the skin. It has some antimicrobial activity which also makes it great for skin prone to breakouts. It can soothe inflamed skin, reduce flaky skin, reduces wrinkles by plumping up the skin and is also high in antioxidants which mean it has anti-ageing effects. While coconut oil is solid at room temperature, it will melt with only a small amount of heat therefore the heat on your skin will be enough to allow it to spread nicely. Coconut oil can be used as a hair treatment for dry hair too. I always suggest using the coconut oil on the skin at the end of the day (before bed) with a shower in the morning to wash it off. This is because the smell of the oil can change once it has been exposed to the air for too long. It can also get onto your clothing so best to wear something comfortable to bed that you don’t mind ending up with a coconut smell.
 

If you would like more information on skin care products or what might be useful for your skin type, call the clinic on 9976 5466

Eczema

This months blog is all about eczema. This is because in the last 18 months I have seen a huge influx of patients with eczema in my clinic. All skin conditions are notoriously difficult to treat naturally, primarily because results can take a few months to become visible. However with the only medical treatment being long term use of steroid based anti-inflammatory cream, tackling eczema from a Naturopathic perspective is a much better long term strategy.
The steroid creams will temporarily mask the eczema, but as soon as you stop using the cream the rash will come back. They also thin the skin when used long term. However, I have seen some amazing improvements in my eczema patients and wanted to share with you a different perspective on treatment of all skin conditions. Below lists some of the things I have found work best when tackling eczema.
 
What is eczema?
Eczema is an irritating skin disease that ranges from chronic, itchy minor rashes to raging acute eczema flare-ups with open, oozing sores that require bandaging. It typically presents on the skin folds in places such as the elbows or behind the knees as well as the face and hands. However, some of my patients have eczema over their entire body. Besides being upset about how the skin looks, they are often itchy and uncomfortable and skin flaking is a problem.
 
Medically, eczema is viewed as an atopic (allergic) skin condition where the skin barrier defense is defective and damage. The skin becomes dry, scaly and irritated as both water and oil are lost through the skin. Infections are common as the exposed skin cracks and bacteria thrice, leading to further information and itch.

 

Eczema considerations and causes
Eczema causes and triggers are often much for complicated and diverse than the medical view of atopy.  There are a huge host of factors that can cause an outbreak with each patient having a different set of imbalances that need to be addresses. The key is investigating the complicating factors for each person, and working on these. As most Naturopaths know, the key to health lies in the gut and you will see this is a big focus of treatment.

Below lists some of the factors I investigate when treating eczema:

1- Food intolerances/food allergies- I find food intolerances to be the most important part of diagnosis or treatment of eczema.  Common food based triggers include dairy products, soy, seafood, nuts and seeds, eggs, and wheat. I test every eczema patient for food intolerances and find this to be the best way to manage eczema in the long term.

2- Inhaled environmental allergens- Inhaled substances such as mould, yeasts, dust, dust mites or pollen can also be an issue. Treatment involves limiting exposure where possible, but our prime work involves balancing the allergic/atopic parts of the immune system to reduce reactions.
 
3- Gut flora- Our digestive tracts contain somewhere between 2-5kgs of bacteria that have very important roles in immune balance (among other uses such as absorption of nutrients). Correcting gut flora levels and replenishing specific strains that reduce atopic tendencies works well for controlling eczema.
 
4- ‘Leaky gut’- The name may not sound great, however leaky gut syndrome refers to poor health of the small intestines. Because 70% of our immune system lies in the gut, a healthy digestive system is paramount for immune balance. On top of this, our gut flora live on the mucous membranes lining the digestive tract therefore a healthy digestive environment is paramount.
 
5- Low stomach acids- Low levels of hydrochloric acid in the stomach have been found to be common in eczema suffers and it is believed that this will further impact their gut flora, digestive health and immune system. Simple strategies for stimulating digestion are great for controlling eczema long term.
 
7- Stress- Stress and the associated cortisol and adrenaline levels are a major trigger for eczema. They disrupt the immune system, cause inflammation and switch off digestion.
 
9- Nutritional deficiencies- Nutritional deficiencies are also common in eczema and need to be address. The most common include zinc and Omega-3 fatty acid deficiencies. Omega-3 is essential for keeping the waterproof barrier function of the skin healthy as well as control inflammation. Zinc improves skin healing and balances the immune system.
 
For most, it is not one thing but a combination of factors that need to be addressed to improve skin health and eczema. Our goal for treatment is thorough investigation and assessment to decide what is important for you.
 

Want help with your eczema? Send Hayley an email tome@hayleystockbridge.com.au for more information or to book an appointment