Acne and PCOS

Just thinking about “acne” makes my stomach churn, since it is one of the most hated of all the PCOS symptoms. Acne affects a large percentage of women with PCOS and is something you simply cannot ignore. It stares at you with every glance at your reflection. I am fully aware of the pain experienced by those with acne; I suffered for much of my adult life with it. I want to up-front tell you that I cannot give you a magic pill to clear your acne, but I will share my most effective approaches, and let you know of some exciting up-coming research.

The sad thing is that there are many dermatologists who believe they have the magic pill in the form of Isotretinoin (Accutane), a drug originally formulated as a chemotherapeutic agent. I must issue a serious warning concerning this medication for PCOS women. The success rate in this group is much lower than for others; only about one in three has long term benefit. Some see short-term improvement, followed by the acne’s return with a vengeance a short time later. Isotretinoin also has many side-effects such as headaches, dry eyes, cracked lips, bleeding gums, and fatigue. Among the more serious ones are birth defects, increased suicidal feelings and suicides, liver injury, elevation of blood lipids (fats), and permanent irritable bowel syndrome.

The other issue I want to address immediately is the use of oral contraceptives for PCOS acne. Oral contraceptives do sometimes help reduce acne in PCOS women, though often it does not. Oral contraceptives are chemical hormone mimics and are not good for the gut health. They deplete the body of B vitamins as well. They increase blood clot formation, which can be life-threatening. Long term use can increase breast cancer risk. They also can increase headaches and depression. These effects make me hesitant to prescribe them, though I will at times.

Spironolactone is another conventional drug often prescribed for acne, with mixed results. Although technically approved as a diuretic, it seems to work by blocking the action of testosterone in the skin. My patients have had less than stellar results with this treatment, but it can be tried.

I’d like you to understand why you have such stubborn acne. Your acne is the outward manifestation of inner inflammation combined with an elevated level of androgens (male type hormones)! Those of you who have read my previous article on PCOS and inflammation understand that a cardinal issue with PCOS is systemic (generalized) inflammation. This inflammation is also occurring in your skin, and so you must tackle this problem for what it truly is – a terrible SYMPTOM of an underlying inflammatory situation. The high levels of inflammation trigger still higher systemic levels of testosterone and DHEA (adrenal androgen), further aggravating the acne in an emotionally aggravating feed-forward scenario.

In PCOS women, the bacteria on the skin have been demonstrated to be different from that of “normal” women. Additionally, the sebum, or oily material which protects our skin, is also unique in PCOS women; its constituent fatty acid components are not the same and have reduced capability to fight off infection, hence the development of cystic, recalcitrant acne.

So what shall we do? We must douse those fires! We first must measure your inflammatory status and then must lower it. Your acne will dramatically improve once the flames are out. Start by getting your inflammatory lab tests performed. Contact me if you need help on this. Over the past few months, I’ve worked out a system to help all get these important tests performed at a network of draw sites. Next, we must get that inflammation down. As this is a short article on a very complex problem, I can only provide an overview of my program. If desired, I am happy to help you individually, simply contact me.

The treatment of PCOS related acne starts with your food choices. You must eat an anti-inflammatory diet. Avoid all dairy, in all forms! Dairy increases levels of IGF-1, which increases testosterone, increasing acne! Also, avoid all wheat and gluten, all sugars and sweeteners, alcohol, white rice and corn, and all chemical and processed foods.

There is no diet which is perfect for all PCOS women, so please feel free to do some experimentation to discover what works best for you. We are all unique in our immune systems, our toxic load, and genetics. The unifying theme must, however, be a diet to reduce inflammation! For those who enjoy it and can handle it, I suggest trying initially, for three to six months only, an organic vegan diet consisting of 10 servings (1/2 cup each) of vegetables, including at least 4 servings of a variety of root vegetables such as beet roots, turnips, rutabagas, parsnips, and carrots. Add in 2 fruits, particularly tart apples and berries. The other vegetables should consist of many different varieties of vegetables – all the colors of the rainbow! The phytonutrients and anti-oxidants in these foods fight inflammation and the resistant starch fibers in the vegetables, particularly in the root vegetables, provide nourishment to those critically important bacteria living in your intestinal tract. Add in organic beans, lentils, a handful of organic raw seeds and nuts, small amounts of whole grains such as millet, buckwheat, quinoa, and brown rice, along with lots of green and spearmint tea. This diet is high in nutrients, anti-oxidants, and gut-nourishing fiber. A healthy gut lowers generalized inflammation, which in turn lowers circulating testosterone and DHEA levels, which then reduces inflammation in the skin and improves acne! But if not eating animal products is more than you can handle, go ahead and add in some organic eggs, chicken, red meat, and fish.

Another option exists for women without disordered eating. Published data has revealed that testosterone and inflammation can be reduced by eating most of the day’s calories at breakfast, a third at lunch and fewer than a hundred calories at dinner. In one study, testosterone and insulin levels were reduced quickly by 50%! Although this was an incredible achievement, please recognize that this regimen was only tested in one study, and this way of eating is definitely neither suitable nor feasible for everyone!

You also must control stress! High stress causes increased output of cortisol, and that causes more acne! I hope to write an article on stress and PCOS in the upcoming months, but for now I would recommend buying guided imagery CDs for stress, take a course in meditation, learn progressive relaxation or tapping, get massages, or all of the above! There are studies showing that hypnosis can actually improve acne. The mind controls your stress level and your immune system’s responses, and YOU can control your mind with practice!

Sleep is a critical element related to inflammation. Just one night of sleep deprivation results in elevated markers of inflammation. Maintaining your Circadian Rhythm is a key element of health and the management of your acne. Wake and sleep consistently and get 7-8 hours of sleep nightly.

There are a few key supplements I recommend to reduce acne. They work by improving detoxification functions in the liver and by improving the metabolic functions of the body. In turn, generalized inflammation is reduced. Myo-Inositol, resveratrol, N-Acetyl Cysteine, and berberine are all very helpful. Taking a high potency B complex, containing methylated B vitamins is important. There are also published studies showing benefit from taking Vitamin B5, at a dose of 2 grams, 3 times daily, along with CoQ10, and L-Carnitine at a dose of 1 gram twice daily. Spearmint tea has been shown to lower testosterone levels and reduce acne.

Healing acne is slow going, so expect it to take 6 months to see very significant improvement.

In terms of topicals, several are helpful. Organic essential oils can help to control the skin bacteria. Blends with Thyme and Tea Tree are great. We use an excellent blend called Clear Skin by Simplers Botanicals. I recommend an organic acne line from Sophyto. In a study pitting ProActiv against Sophyto, Sophyto won! It incorporates antioxidants from organic fruits and vegetables grown on a farm on the British Isles. There are also several prescription topicals I have made up at my local compound pharmacy which I utilize. I have also found that acne peels can be very beneficial by exfoliating the skin. I have had success with a peel called ViPeel, designed specifically for acne skin.

I also want to emphasize that I am vehemently against the use of antibiotics for the treatment of acne. Actually, they rarely work for PCOS patients anyway, and from a long-term view, they are incredibly harmful to the GUT microbiome. Remember, there are supposed to be bacteria all over our bodies and within our bodies. The “right” bacteria in our guts reduce inflammation, and hence, reduce acne. Bacteria also typically grow resistant in time to the antibiotics and cease working at all, and so the antibiotics can create more harm by killing off our GOOD bacteria, those which are actually protective!

In terms of future hope, I am currently working to begin a study of the effects of a five-day diet which mimics the effects of fasting on the state of acne in PCOS women. It has been shown that this program reduces markers of inflammation, IGF-1, and insulin levels, all of which are associated with acne. The hope is that this dietary program will substantially reduce acne.

In summary, as you have seen, there clearly is no magic bullet for the treatment of PCOS acne, whether cystic or not. As my imperative is always to do no harm, I avoid Accutane and antibiotics, and prescribe oral contraceptives judiciously. My ultimate hope is to reduce the underlying generalized inflammation and lower androgen levels (testosterone and DHEA levels), while also healing the gut of PCOS women. Then the fire in the skin will be calmed, and the acne will finally fade away.

 

PCOS and Gallbladder Issues

PCOS and Gallbladder Issues

As if women with PCOS don’t have enough on their plates to deal with already, add another to the list-gallbladder dysfunction and gallstones! Yes… it’s true… many women with PCOS also have problems with the workings of their gallbladders. But please…don’t despair as there are many options to help your gallbladders function better…and when they work better…all of you will work and feel better!

Let’s begin with some gallbladder basics. Do you even know why you have one? And is it even important, as many women have their gallbladders removed and no one seems to bat an eye! There reality is that, like all organs we were are born with, the gallbladder serves a very important purpose. Should yours have been removed already or truly must be removed in the future, please don’t think that it doesn’t matter and then make no accommodations for its loss.

The gallbladder is a very important part of digestion … don’t part with it lightly or readily. The gallbladder is a storage vehicle. It holds cholesterol and bile, secreted by the liver. Bile is truly a fascinating creature. It, like many things in the human body, is an amazing multitasker! Bile is vile! Well… just sort of. Bile is the toxic waste material created by the liver in the process of detoxification, also known as biotransformation, of your body’s own old hormones and neurotransmitters, and of environmental toxins and pharmaceuticals. It really is toxic waste!! But it’s amazing stuff. It is also an emulsifier.

When you eat fat, you need to break it down into its little component pieces and then digest and absorb it. Please don’t think fat is evil. Actually it is essential to life, which is why fats are called essential fatty acids. You truly cannot live without fats in your diet. You need a proper balance of the different types of fats, and many are deficient in the type called Omega 3, which is primarily obtained from fish and somewhat from plants like flax seeds and walnuts. And many of you have probably heard that olive oil and coconut oil are healthful fats. And so is the fat in the yolk of organic eggs. We will talk more about fat another time…for now take me at my word that fat is essential to life and you need bile to help you digest it.

Back to bile… it is a natural emulsifier. That means it can take a fat and turn it into being water soluble, so it can mix with water! This is truly like a miracle. You probably know that if you have greasy hands and simply run them under the water faucet, the hands stay oily. If, however, you rub in soap, the grease will be able to be washed off your hands without a problem! Soap is an emulsifier-it makes fat able to be washed off with water.

Without bile, you simply can’t digest fats, and with the fats come the fat soluble vitamins… like Vitamin E, A, K, and D! These vitamins are essential to proper functioning! If you don’t have a gallbladder or the one you have doesn’t work well, you will naturally have difficulty with your digestion of fats and of fat soluble vitamins!! If that’s the case, you need to actually take bile at the beginning of each meal. This bile comes from an ox! It’s the closest we have to human and it works well. You also need to take digestive enzymes as well as that nearly always becomes a problem when the gallbladder is gone or malfunctioning. The gallbladder triggers the pancreas to release it digestive enzymes. It is very important that you do this or you’re quite simply not going to digest your food properly! Women with PCOS have enough issues…malnutrition shouldn’t be one of them!

So why do women with PCOS have problems so often with their gallbladders? It’s related to gastrointestinal problems in general, and women with PCOS are renowned for what we term “gut problems.”  Many have irritable bowel syndrome (IBS) with constipation or diarrhea and general gut issues, acid reflux (GERD), dysbiosis (the wrong gut bacteria), and sometimes even more serious inflammatory bowel disease. There are quite a few theories as to why PCOS women how so many gastrointestinal problems, but it is known for sure that many have what is called “leaky gut” and  small intestinal bowel overgrowth, along with many food allergies, sensitivities, and autoimmune states as well. Because of these issues, the proper signals to the gallbladder don’t occur and it becomes sluggish, and can actually get sludge in it, and it can even progress to gallstones. Just because you have sludge or stones does not mean the gallbladder must go! Only if you’ve had recurrent pain, pancreatitis, or infection, is it then absolutely necessary to have it removed… but remember you’ll absolutely need a bile and digestive enzyme supplement.

Some PCOS women get gallstones or sludge because she goes on a low fat diet for a long time. I don’t recommend a woman go on such a diet!! That is not the way to get healthy! You already know that fat is essential to life!!

I believe strongly that all women with PCOS should have their GI tracts checked out for overgrowth of bad bacteria, small intestinal bowel overgrowth (SIBO), issues with low levels of stomach acid and digestive enzymes, constipation or diarrhea, stomachaches, and the like. And please…do not go on a low fat diet…nor go on a prolonged very low calorie diet…as that too will make you more prone to gallstones.

If you do have gallstones and you haven’t had severe pain, infection or pancreatitis, get another opinion before having your gallbladder removed. Often women can live a long and normal life with gallstones. With gallstones, you’ll want to do a liver detox regularly, eat a healthy amount of good fats, work on stress as that is so unhealthy for the gut, and you can even consider medication to try to dissolve your gallstones, if you meet the criteria. In general though, my first choice, as always, is to try to work with you simply with a lifestyle approach.

The key take-home points are that we should try hard to maintain good gallbladder health by eating healthy fats and getting the GI tract checked out by a good doctor who understands what is needed for PCOS women, and if you have gallbladder issues already or have had yours removed, get on bile and digestive enzymes right away!! And remember, stay positive and focused on doing the right things to maintain your health, at most of the time!!! Good luck and give your gallbladder a virtual hug today!!

 

Flagship Project on Precision Medicine

March 1, 2016
Flagship Project on Precision Medicine for Underserved Women Will Advance Learning Health System

Washington, D.C. – On February 25th , President Obama participated in a panel discussion at the White House Precision Medicine Summit Initiative (PMI), marking the one year anniversary. The panel featured remarks from inspiring patients, researchers and others working in the PMI field.

More than 40 private-sector organizations and a variety of federal agencies are making commitments to new actions and principles that are spearheading the Precision Medicine Initiative. One such flagship project, “Precision Medicine for Underserved Women with Polycystic Ovary Syndrome (PCOS),” aims to align precision medicine with the vision embodied by the Learning Health System (LHS) Core Values. The PCOS genetic disorder causes infertility that eventually ends up in a disease state of diabetes, heart disease or cancer creating an enormous cost to the healthcare system.

The Learning Health Community, a grassroots, multi-stakeholder movement aimed at transforming our nation’s health system into one that is capable of engendering learning from every experience of every consenting patient, and rapidly feeding back lessons learned to empower better decisions that improve people’s health.

President Obama said, “The (PMI) goal is to create a common database of ultimately a million people that is diverse. Ultimately we can take a disease that may be rare and start seeing patterns we may not have seen before.”

Marc Wine, a supporter of the LHS – Precision Medicine PCOS Project and participant in Learning Health Community initiatives, who attended the summit hosted by the president said, “One goal is to seek collaboration with underserved communities in genomics, open data and integrative medicine. This will result in engaging individual patients in ways that will move them from dependency on fragmented healthcare to the point where patients can use their own evidence-based genetic information to make the very best health decisions.”

The Precision Medicine PCOS Project is aimed at developing a protocol for women with PCOS while employing an integrative medicine approach to treatment based on the participant’s molecular makeup, clinical data and available scientific knowledge.

The PMI includes ongoing efforts through the Department of Veterans Affairs (VA), the Department of Defense (DOD), the Food and Drug Administration (FDA), the Office of the National Coordinator for Health IT and the Office for Civil Rights, all in line with Vice President Biden’s Cancer Moon-shot initiative.

“The LHS is the fabric that weaves together and enables various use cases aimed at improving health including precision medicine, Patient-Centered Outcomes Research (PCOR), public health surveillance, patient engagement, quality improvement, patient safety, and further uses not yet envisioned,” said Joshua C. Rubin, JD, MBA, MPH, MPP, a leader in the LHS movement.

The LHS vision has been the subject of over 16 reports of the Institute of Medicine since 2007, and now represents the pinnacle goal of federal health IT strategic planning for the coming decade.

Through aligning the LHS – Precision Medicine PCOS project with this larger vision, the project team is working to ensure that infrastructure and key components created to advance this flagship project will support future use cases.

The Precision Medicine PCOS Project was recently launched in Atlanta at Medici Medical Arts Clinic, with Chief Medical Officer, Dr. Sonny Dosanjh and a group of 37 women who have PCOS, a complex and chronic syndrome that affects 7 million women in America. Ten of these initial women will form the Patient Advisory Team resulting in ongoing involvement in systems design, learning and education systems and participating in the use of their molecular data. This provides unique involvement so women with PCOS will have access to not only their data, but also how the clinical support and care is delivered individually.

By building such efforts upon a sturdy foundation of Learning Health Systems “Core Values,” this Precision Medicine PCOS Project will collaboratively build the big data, Artificial Intelligence infrastructure large enough to include all individuals and populations through open knowledge sharing.

The Precision Medicine PCOS Project with LHS, aligning with the president’s PMI and the underserved, has taken the initiative to launch its innovation in Atlanta, phasing-in a large cohort of women with PCOS which is the number one cause of infertility in women. As a complicated endocrine and metabolic disease, PCOS has received limited attention by the medical community.

Of the estimated 7 million women with PCOS, less than 0.1% of the NIH budget is focused on research to help these women. This Precision Medicine PCOS Project was started in December 2015 and may be the largest ever project to use state of the art genetic and molecular research, science, evidence-based integrative medicine and technology to help this growing underserved community of women.

The Precision Medicine PCOS Project is acting to build a nationwide collaborative to empower women with PCOS to manage this complex genetic disease throughout their lifetime.

The project’s leader and Founder of Open Source Health, Inc., Sonya Satveit, said, “As women, we have been underserved in healthcare for too long, if I can make a difference, I have accomplished my life-long dream. To have such an incredible team, that shares my passion, come together around this critically underserved area of women’s health, gives me confidence that we will make a difference and give hope to women with genetically caused infertility. “ The project expects to see the first results in late 2016.

For more information see:
Open Source Health, Inc.: http://opensourcehealth.com/
Learning Health Community: http://www.learninghealth.org
The White House Precision Medicine Summit: https://www.whitehouse.gov/blog/2016/02/25/precision-medicine-health-care-tailored-you

Depression and Anxiety in women with PCOS

Depression and Anxiety in women with PCOS
December 25, 2015

January is a month when many feel the effects of the holiday season coming to a sudden end. The decorations must all be put away; there is often a big mess of discarded wrappings to deal with, thank you notes calling to be written, and health resolutions to write – and often to discard just as quickly. For many, unfortunately, January is a “down-mood” month, one with long, cold days and long, dark nights; when we are often faced with a stark reality, without the joyous festivities to hide behind!

And for those with PCOS, to add to the general “down-ness of January,” is the fact that mood disorders are increased in women with PCOS compared to women without this condition. In fact, all women with PCOS, at all times of the year, should have an initial evaluation to include assessment of mental health disorders. The prevalence of depression in women with PCOS is high and varies from 28 to 64%, while the prevalence of anxiety in women with PCOS ranges from 34-57%.

In recent years, the complex relationship between PCOS and psychosocial issues has come to the forefront, with a prominent link found between specific features of PCOS and mental well-being. The fact that many women with PCOS experience menstrual dysfunction and infertility, hirsutism and obesity, along with cystic acne, creates a situation which can clearly result in profound psychosocial distress. In one interesting study from South Asia, researchers found that in comparing hirsutism and obesity, more depression was related to the presence of hirsutism. The scientific literature now shows clearly that anxiety levels, psychological distress, depressive feelings, and social fears are all markedly higher in women with PCOS.

The reasons for this increased vulnerability to depression and anxiety and for women with PCOS to develop psychiatric disorders are still unclear. But in addition to the negative mood reactions to the visible symptoms of PCOS, there are others which likely involve pathways independent of these visible symptoms. In one study of 300 women, nearly a third had anxiety, and quality of life was lowest in those with a combination of stress and depression.

Stress is one of the common mechanisms that induce psychological disorders. This occurs via the hypothalamic-pituitary-adrenal (HPA) axis and involves circadian rhythms. With significant stress, there is alteration of the HPA axis and disruption of the circadian rhythm, altering the functional relationship of the brain with the endocrine systems, resulting in adverse impacts on health. Women with PCOS have a higher level of sympathetic output from their adrenal glands. They tend to have higher outputs of cortisol and adrenaline, and to have dysfunctional melatonin, and therefore more inflammation and poorer sleep.  The higher levels of cortisol and adrenaline make those women more prone to anxiety and sleep dysfunction, adversely affecting mood.

Women with PCOS have an exaggerated response by the sympathetic nervous system, with a heightened response to negative stimuli compared with non-PCOS women. They have an abnormally increased cortisol response to physical and psychological stressors which cannot be explained by their BMI, increased percent of body fat, fasting insulin, or elevated androgen levels. Indeed, there is an independent and inherent mechanism exaggerating the stress response, in a negative way, for PCOS women. Additionally, there is evidence of an increased incidence of eating disorders and suicidal behavior among PCOS women. Sadly, they are at an increased risk of social phobia and suicide attempts.

But none of this means that women with PCOS can’t have full and wonderful lives. All this means is that it must be recognized that PCOS women have an added risk for adverse reactions to normal stressors and are more prone to anxiety and depression. Therefore, more active and proactive management is necessary. Women with PCOS need to cultivate coping mechanisms, and there are many to choose from. The maintenance of the emotional well-being of women with PCOS needs more nurturing than what is needed for the average woman. But with such support, every woman with PCOS can achieve mental, emotional, and spiritual health.

The ways to achieve emotional happiness are many, and all can be combined to satisfy each individual woman’s unique needs. Some of the effective methods are the varying forms of meditation, hypnosis, the Emotional Freedom Techniques, including tapping, Tai Chi, Chi Gong, yoga, massage, baths, acupuncture, cognitive behavioral therapy, essential oils, and my own personal favorite, guided imagery. I utilize several techniques for my own stress therapy, emphasizing baths, essential oils, and guided imagery, but all can be amazingly effective! Each woman must try out several and discover what works particularly well for her.

If you feel especially down or stressed, be sure to seek assistance and find your personal path to emotional, spiritual, and mental well-being. Do not delay even a minute getting help if you have any tendencies towards self-harm! Please contact me if you are seeking PCOS medical care and do not know where to turn.

 

Attention PCOS Moms : Diagnosis and Treatment of PCOS in Young Girls

Most doctors and patients alike believe that PCOS is a condition which appears in the teen years, following the advent of puberty and the onset of periods. In reality, shocking as it may seem, PCOS begins at birth! Now how, you may ask, can that happen? Doesn’t puberty herald the onset of all the medical challenges faced by young women with PCOS? The answer to that question is: mostly so, but there are signs and symptoms early on, and there can be early detection!

Here is the story of the beginnings of PCOS, and with this knowledge comes the capability to predict with reasonable, if not perfect, accuracy whether or not your daughter will develop PCOS. With that knowledge comes the power to begin treatment BEFORE all the misery that you know all too well ensues.

While in utero, because of the ubiquitous toxins surrounding us all, everyone becomes exposed to numerous chemicals, including ones which act as endocrine disruptors, particularly Bisphenol A (BPA). Such exposures alter the very foundational development and function of hormone receptors. Here’s what happens: endocrine disrupting chemicals enter the pregnant woman’s body through various means and then cross the placenta. They thereby gain entry to the baby’s body, where they actually concentrate in greater quantity than in the mom’s body! This sad fact has only been recently realized. Researchers, measuring the chemical levels in the moms, often found low levels and concluded they were below the threshold to cause problems, while being unaware that the levels of that chemical were actually much higher within the baby.

Chemical endocrine disruptors are like cheap knock-off imitations of real hormones. They can attach to receptors and act in one of many ways – mimicking the real hormone, blocking the action of the hormone, or something in between. Since estrogen has three different kinds of receptors, the end result can be hormonal chaos, as the various organs of the developing baby’s body simply do not get the right exposure to hormones, particularly to estrogen. The baby is born with a “confused” hormonal system, unable to respond properly to certain hormones due to the abnormal function of their receptors. This is in addition to the endocrine glands’ inability to manufacture these hormones properly.

When there is a problem with the functioning of the estrogen receptors, systemic inflammation occurs. This occurs because estrogen functions as the master of metabolic homeostasis. This means that estrogen controls a female’s appetite, energy usage, metabolic rate, location of fat deposits, and how fat functions. Estrogen is truly the mastermind of all that is female and metabolic!

Young girls born to PCOS moms have about a 50% chance of developing PCOS themselves. Given those odds, it is really imperative for us to diagnose, with some reasonable probability, which of those daughters will and which won’t have to deal with PCOS. And there are ways to reasonably identify young girls as having a high predilection to develop PCOS.

From a physical point of view, here are the suspicious symptoms. If a very young girl, from approximately age 4 to 12 years of age, has an unusual amount of waist and belly fat, in spite of eating quite well, this is a powerful clue. Estrogen regulates where fat is deposited and how it functions, so young girls destined to get PCOS may be showing signs of abnormal fat deposition and already have difficulty maintaining a healthy weight, well before puberty sets in.

There is also a blood test which has good predictability for detecting PCOS prone girls and that can be administered as early as age 6. This test is called Adiponectin. I order it through the Cleveland HeartLab, a very prestigious cardiovascular laboratory, affiliated with the renowned Cleveland Clinic. Adiponectin is a type of hormone made by adipose (fat) tissue and is extremely important in preventing inflammation, insulin resistance, and obesity. It is involved in managing how fat tissue functions, the level of inflammation in the body, how energy is produced and stored, and the transport of glucose from the blood into cells, impacting insulin resistance. Estrogen controls the production of Adiponectin. In girls prone to develop PCOS, the Adiponectin levels will be unusually low.

The finding of low Adiponectin levels raises a big red flag that a girl is at high risk to develop PCOS. The potential for Adiponectin to be used as an early screening tool means that for these girls proactive therapies can be initiated to lower the chance of PCOS becoming severe. Lifestyle changes involving diet, sleep, stress, exercise, and nutrition can all be implemented to greatly soften the blows which occur with the passage through puberty.

I would be happy to assist any who have daughters they would like evaluated for PCOS risk status. I can see and examine them and order Adiponectin, as well as all indicated inflammation testing. I strongly advocate for a proactive approach to all diseases in order to prevent the devastating effects of an advanced disease state. This philosophy is particularly applicable to PCOS to ameliorate the suffering so many with the condition must endure.

Progesterone Cream for PCOS: Is it Right for You?

Many women with PCOS realize that they have significant hormonal dysfunctions, manifesting in many ways, including menstrual irregularities, thyroid problems, insulin resistance and glucose dysregulation, weight loss resistance, sleep problems, and infertility.

Among the many hormones which can be dysfunctional is progesterone. Of particular concern are an increased risk for miscarriages, pregnancy complications and preterm delivery, irregular cycles, PMS and mood swings, and significantly elevated risk for uterine lining (endometrial) overgrowth (hyperplasia) and uterine cancer!

The elevated uterine (endometrial) cancer risk arises from infrequent and irregular ovulation and from progesterone receptor resistance. The continuous estrogen production characteristic of PCOS results in an imbalanced situation in which there is chronic, unopposed exposure of the uterine lining (endometrium) to estrogen, without the balancing effects of progesterone. The progesterone receptor resistance issue compounds the problem by not allowing the progesterone which is produced to have the desired effects upon progesterone receptors throughout the body. And of course, by not properly impacting the receptors on the uterine lining, the effects of estrogen dominate; increase the cancer risk, with the result being frank endometrial cancer developing, in some cases. Shockingly, such cancers can occur at surprisingly young ages!

Progesterone receptors reside throughout the female body. Among the other progesterone receptors which have received much attention are those in the breasts. In fact, there is now much written that in the event of radiation exposure, both large and small, progesterone can possibly affect certain breast stem cells, now known as cancer stem cells, stimulating them to develop into florid cancer cells.

Of great interest in our evolving understanding of progesterone as a critical regulator has been research into the functioning of the progesterone receptor. As inferred above, several studies in humans have indicated that, in women with PCOS, there is receptor resistance to progesterone in the cell nucleus within those organs which possess progesterone receptors. Progesterone resistance means there is a reduced responsiveness in target tissues to the available progesterone. Gene expression analysis of PCOS endometrium reveals progesterone resistance, but the mechanisms and sensitivity are not yet completely understood.

It is clear, though, that PCOS women with endometrial hyperplasia are more likely than non-PCOS women to proceed further into trouble and have a higher likelihood of developing endometrial carcinoma. There are two forms of the progesterone receptor, A and B, and they are not functionally equivalent. Some animal studies suggest that the A receptor may be key to normal uterine function. Most likely, however, both the A and B forms contribute to the diverse and indispensable actions of progesterone involving cellular events in humans. Progesterone in human females also acts through another set of receptors; these are different from the nuclear receptors. They are membrane-bound progesterone receptors, and these receptors appear to be regulated in normal human endometrium in a cycle-dependent manner, but the precise mechanisms of each membrane progesterone receptor also has yet to be determined.

With the widespread dissemination of information now available, affording a degree of understanding by many women with PCOS that they have significant issues with their progesterone, some have wondered if adding progesterone cream into their PCOS treatment regimen makes sense. Perhaps this could reduce their risk for endometrial (uterine) cancer? Perhaps such hormone use would aid proper sleep, and improve mood and fertility? Perhaps so! There are progesterone products which can be readily purchased over the counter (OTC), without any medical supervision. Does it make sense for a woman with PCOS to buy and use them?

These are excellent questions, and the answer is: maybe “yes” to the use of progesterone as a therapeutic modality, but a resounding “no” to the use of any OTC versions of progesterone.

The biological effects of progesterone depend on the dose, the duration of the stimulus, and the presence, levels, and function of other hormones such as 17 Beta Estradiol, testosterone, thyroid, melatonin, DHEA-S, cortisol, and oxytocin. The woman’s age can also play a role. The application of progesterone as a therapeutic modality is complex and is absolutely not one which should be undertaken without medical supervision. The prescription should be individualized as far as its dose, and absolutely should be formulated by a quality pharmacy. Additionally, the goals involved with its use should be clearly delineated, and the woman using the progesterone must be closely followed and monitored. Depending on the specific needs and situation of the patient, other hormones may be indicated to be prescribed as well.

We live in a world filled with toxins, and some behave as endocrine mimics or so-called endocrine disruptors. Such ubiquitous chemicals play additional havoc with our endocrine systems, creating individualized needs and responses. This adds another layer of complexity which must be considered as therapies are planned. Often a several week detox program prior to the start of progesterone therapy is warranted.

It should always be acknowledged that progesterone is an important and powerful hormone with many effects throughout the body. An over-the-counter product is not able to provide a consistent and therapeutic dose of progesterone, as the actual dosing is truly unknown when such products are utilized and reproducibility does not exist.

I would urge all of you who read this who suffer from PCOS to locate a qualified and caring doctor to work with you, one who will carefully measure your hormone levels and your inflammation markers, and truly look at your total medical picture. If I can personally help any of you on your quest for health, please let me know, as I have created special programs for women who live a distance from my practice in Southern California.

Happily, through lifestyle changes, detoxification, and nutraceutical use, one’s intrinsic hormones can often be improved and this may happily negate the need for prescription hormones. Should that goal not be attainable, it truly is essential that you use only quality, commercially prescribed or compounded progesterone, and not an OTC product, containing unknown ingredients and dosage, and without the critical supervision of a caring and knowledgeable physician.

Microbiome and PCOS

Until fairly recently, you could look at yourself in a mirror and believe that the reflection was the real “you.” No longer is that the case! It is now recognized that more DNA exists within us, derived from our Microbiome, than from our own genetic tissues. The Microbiome consists of the trillions of bacteria which live both on and in us. And what is now understood is that those little critters are not freeloaders! To the contrary, they are key players in all aspects of our health, and unfortunately for those of us suffering from PCOS, the bacteria comprising our Microbiome are unlikely to be the right ones, nor to be present in the correct amounts, for our maximal well-being.

The particular areas of the Microbiome I’ll touch on in this article will include the mouth, along with the rest of the gastrointestinal system, and the female reproductive system. Next month, I will deal with acne, so I’ll touch on the skin Microbiome at that time. The topic of the Microbiome is truly “hot!” New information is coming out about the enormous significance of these bacterial colonies on a weekly basis. In fact, along with a colleague of mine, I am currently preparing a study of the Microbiome of PCOS women.

Let’s start our review of the Microbiome by beginning at the top, with the mouth. I would say that virtually no one has been thinking of the mouth bacteria as important except as an annoyance, as something to wipe out as much as possible with mouthwash. Let’s kill all those germs on contact! Well, unfortunately, it turns out that the bacteria in our mouths are actually critical to making nitric oxide, a necessary ingredient for the proper function of our cardiovascular system. It is now realized that when we eat certain vegetables which contain nitrates, the bacteria in our mouths, after being swallowed with our saliva, work with our stomach acid to create nitric oxide.

Without the right bacteria, nitric oxide quite simply will not be made. Nitric oxide is an essential part of our health. Unfortunately, we have done a great job of killing off the essential bacteria within our mouths through the use of mouthwash, antibiotics, toothpastes, and numerous bacteria-killing chemicals in foods. Also, drugs such as Nexium and Prilosec, which block stomach acid production, prevent proper nitric oxide production in the stomach.

Even without the things we do to kill off our bacteria, it seems from several small studies, that women with PCOS have different bacteria in their mouths than do “normal” woman. What that means is still unclear, but most probably, PCOS women do not, as a group, produce nitric oxide properly. One thing that is clear is that women with low nitric oxide have higher pregnancy complications, which we know is true of PCOS women, and more cardiovascular conditions.

Moving down the GI tract, we come to the Microbiome of the Gut. These bacteria are critical to every function of our bodies and the wrong Microbiome results in increased risk of cardiovascular disease, autoimmune disease, depression and anxiety, cognition issues, and cancer. It is beyond the scope of this small article to go into great detail on all aspects of the Microbiome, but it is important that you at least know it exists and is critically important to your health.

The analogy I like to use is the following: there is a complex society – an advanced civilization of microscopic people living in our intestinal tract, and they perform many critical functions necessary for our well-being. By not realizing their importance, we’ve systematically gone about trying, inadvertently, to destroy them. We’ve dropped bombs on them (antibiotics), starved them (inadequate fiber in our diets), and tortured and killed them (additives and chemicals in foods). Most of us weren’t even given the best start to the formation of our Microbiomes, since we weren’t breast fed for at least a year. For all of these reasons and more, our Microbiomes have reduced diversity and absolute numbers and may include many wrong players as well. When the conditions within our Gut are not right and the Microbiome is “wrong,” there is typically inflammation of a low grade in the Gut, resulting in inflammation throughout our bodies. Systemic (body-wide) inflammation leads to increased insulin levels, insulin resistance, weight loss resistance, elevated levels of IGF-1, and higher levels of testosterone. Now, with this new knowledge, evaluating my patients’ Microbiome has become commonplace for me and healing the inflamed Gut and remediating the Microbiome is an essential part of my treatment plan.

Lastly, I want to mention the Microbiome of the female genital tract. The bacteria in the vagina are essential to the health of the organs which lie above – the uterus, fallopian tubes, and ovaries. We’ve known that there are bacteria within the vagina, but the essential functions they perform for the health of the reproductive tract and their role in fertility was minimally comprehended. What is now coming to light is that the vaginal Microbiome is related to the proper function of the sperm, facilitating proper motility and ultimate fertilization of the egg. Additionally, in the past we believed that the environments within the uterus and fallopian tubes were sterile, but in fact, that is not true. The bacteria within those spaces are critical to having normal fertility. Even the ovary can contain some bacteria, and they must be of the right sort for all to work properly.

So what can you do today? Do not use mouthwash or chemical toothpaste-use a natural one. Do not take a drug to lower stomach acid production. If you are on one, work with a doctor who knows how to wean you off. I can help, if necessary. Do not take antibiotics unless it is absolutely essential – and I mean that! Don’t put chemicals in or near your vagina. Use organic aloe vera gel or coconut oil as a lubricant. Use Vitamin E suppositories or oil for irritations. In general, use natural products for all treatments of the vulva and vagina.

Recognize that oral contraceptives are bad for nitric oxide production and the Microbiome. If you use them, there are risks and benefits which must be considered. This is, unfortunately, one of the risks. Eat lots of root vegetables (all vegetables from below the surface), as well as beans and lentils, buckwheat and millet. Those items contain resistant starch – hard for you to digest but great for the bacteria to ferment! Eat above ground vegetables, too. Avoid all sweeteners, soft drinks, bread, processed foods, dry and instant cereal, alcohol, and please try to eat all organic. Eat fermented foods. Work with a doctor who can test your Microbiome and treat it. Also work with a doctor who understands nitric oxide. These are all really important items. Treat your Microbiome like the important complex civilization it is. You need them as much as they need you! It is the ultimate symbiotic relationship!

Three Little Letters That Put You and Your Baby at Risk

The world we live in is quite different from the one inhabited by our grandmothers. Our world is filled with well over 85,000 different chemicals, most of which have no safety data whatsoever. Others are recognized as dangerous by leading scientists, yet no alterations are recommended by our government for their continued and widespread use.

One chemical found widely in our world is Bisphenol A (BPA). It is produced in huge quantities and is used in the production of plastics intended to have a direct contact with food, including plastic packaging and plastic kitchenware, and it is also present in the inside linings of cans and jar lids.

Humans can get exposed to BPA by ingesting it through the mouth, breathing it in, and absorbing  it through the skin. The main sources of BPA include food packaging, dust, dental materials (including dental sealants), healthcare equipment, thermal paper (receipts and boarding passes), and children’s toys and other articles.

BPA has a chemical structure with some similarities to real estrogen, and therefore, it can interact with estrogen receptors in strange and various ways; acting in some cases as if it were a powerful estrogen (agonist) and on other organs acting as an estrogen blocker (antagonist).

BPA is one of many chemicals now known to be endocrine disruptors. It basically creates hormonal chaos throughout the body. Strangely, its initial existence was as a “synthetic estrogen,” proposed for use as a drug.

BPA has been shown to play a role in the development of several endocrine disorders of women (and men). These include precocious (early onset) puberty, breast tumors, and, of course, our very own Polycystic Ovary Syndrome! We all experience continual exposure to BPA on a daily basis, and it bio-accumulates – meaning its amount in the body grows steadily, and during pregnancy, BPA accumulates in the fetus more so than in the mother! In rodents, levels of BPA which are comparable to the levels many women are actually exposed to, affect the brain, liver, gut, adipose tissue, insulin producing pancreas tissue, breast tissue, and the reproductive tract structurally and functionally. High levels are associated with obesity, diabetes, and cardiovascular disease, in addition to PCOS.

Exposure to BPA while in the womb, can alter the very structure of the ovary, increasing the number of cysts and can actually disrupt the development of those critical eggs within the ovaries! Exposure can alter how the genes actually work, allowing them to be reprogrammed and resulting in reduced fertility and alteration of the very development of the baby.

BPA has been shown to directly cause higher levels of testosterone to be produced, higher rates of implantation failure, reduced ovarian response to hormonal signals, altered development of the embryo, defective uterine response to hormones, alterations in the function and production of hormones by the pituitary gland, recurrent miscarriage, decreased estrogen response to fertility drug treatments, and premature births!

Given this knowledge of the enormous effects which BPA and the likely effects of many other endocrine-disrupting chemicals in the development of PCOS, what is one to do? First off, avoid plastic like the plague! Don’t store food in it, use plastic utensils, or microwave in it. Remember that the chemicals are most likely to leach out and into the food when the food is warm, so if you must use plastic, only use it with cold food. Try not to touch receipts, don’t buy food from cans (unless they are BPA-, BPF- and BPS-free), and place water in glass or stainless steel containers as much as possible!

Get your BPA levels checked. There are labs which do that testing. And eat a high-fiber diet, low in protein and with moderate amounts of healthy fats. Keep stress under control and use supplements to control inflammation and assist proper metabolic functioning. Consider supplementation with bio-identical hormones. Though we cannot change your in-utero and childhood exposures to BPA and other endocrine disruptors, there is so much we can do to ameliorate the damage which they did and continue to inflict. Stay optimistic and true to your cause – stay on the path towards optimal wellness!

Chronic Inflammation and PCOS

PCOS is the most common endocrine dysfunction of women, now affecting, in varying degrees, up to 20% of all women across the world! There is now no area of the globe in which women are not impacted by this condition. It is widely recognized that women affected by PCOS have many medical troubles – obesity with weight loss resistance, pre-diabetes and diabetes, increased risk for strokes and heart attacks, menstrual dysfunctions, infertility, pregnancy complications, recalcitrant cystic acne and excessive facial hair, sleep problems, irritable bowel syndrome, arthritis, mood swings, and thyroid problems.

There is a powerful concept at the very core of PCOS, which is often neglected, and that is the essential fact that inflammation is the driver of ALL of these problems! Amazingly, the majority of scientific and medical researchers in this field remain unaware of this powerful connection, yet the recognition of the relationship between PCOS and inflammation is critical to the proper approach to managing and treating it! It goes beyond the scope of this article to explain the entire array of factors underlying the chronic and unremitting inflammation present in all PCOS women, including the 20% who are lean, but I want you to understand the very basics of this issue and why it is so critical that YOUR level of inflammation get measured, monitored, and as best it can be…..remediated!

So here is a brief overview of inflammation and PCOS. Women with PCOS live in a chronic state of physical stress (and often emotional stress) with an up-regulated adrenal system, giving rise to elevated levels of the hormone cortisol. Chronic over-production of cortisol results in a lowered level of metabolic activity, with reduced thyroid functioning, elevated levels of blood glucose, and intestinal abnormalities.

This creates a state of inflammation in the intestines and insulin resistance throughout the body. This chronic, low level intestinal inflammation damages the intestinal lining, impairing the function of a critical barrier, a barrier designed to prevent transport of toxins and bacteria across the intestinal wall. When this barrier no longer functions properly, the result is “leaky gut.” Intestinal contents actually cross into the body proper, inappropriately stimulating the immune system, and further inciting inflammation!!

As well, women with PCOS have adipose tissues (fat) which function abnormally, with low production of a hormone made by fat tissue called Adiponectin. This hormone is very anti-inflammatory and promotes fat burning, along with the transport of glucose across cell membranes. When the levels of Adiponectin are too low, insulin resistance grows and the body cannot burn fat properly!

The combined effects of low Adiponectin and elevated cortisol levels, result in abnormal fat accumulation and distribution, and high levels of circulating glucose. This then leads to a “snow ball” effect. High blood sugar induces more inflammation; excessive fat tissue elevates levels of inflammation; low Adiponectin further increases inflammation; leaky gut augments inflammation, and high cortisol levels perpetually fuel the fires of PCOS inflammation. So, what is the sum result of all of this? This results in the perfect storm of inflammation producing factors!

These factors create a persistent and constant up regulation of macrophages – the white blood cells of the body which produce what are called inflammatory cytokines, chemical messengers of the body designed to enable us to fight and fend off invaders, like bacteria. But in women with PCOS, this defensive mechanism is being activated inappropriately and persistently with the potential for dire results. Inflammation is now universally recognized as a factor contributing to the development of cancers, dementia, cardiovascular disease, depression, arthritis, tendinitis, autoimmune disease, and more! Unattended, PCOS women have a lifetime elevated risk of all of those outcomes.

Now comes the good news! Although all PCOS women are impacted, we can dramatically lower this state of chronic inflammation, promote weight loss, reduce insulin resistance, improve acne and facial hair, as well as improve the large array of additional maladies suffered by PCOS women around the world! The journey to health begins by measuring your personal level of inflammation, evaluating your initial inflammatory state and monitoring its subsequent improvement following the institution of appropriate therapies.

To provide my patients with the ultimate in excellent healthcare, I utilize the services of a specialty cardiovascular laboratory. By utilizing a unique panel of inflammatory biomarkers, in addition to other cardiovascular and hormone tests, the progress towards restitution of health can be measured and monitored. If you would like to learn more about the special inflammatory lab panel I utilize and how you can get these tests drawn on yourself, no matter where you live, please email me at mail@integrativemgi.com. My team will contact you, so you can get your needs met!

1 2