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.