Managing Multiple Disorders in One Body

Managing Multiple Disorders in One Body

Women with PCOS exhibit a very high degree of medical complexity, including dysfunctions of key metabolic and immune mechanisms, affecting a wide range of organ systems. Such dysfunctions can manifest as multiple disorders in one body! Identifying the root causes and common conditions that weave their way through these multiple disorders will facilitate finding a unifying remedy, and eventually a cure, for PCOS and its related conditions.

By understanding how foundational dysfunctions develop and then lead to a myriad of manifestations, we can take those crucial first steps. Conditions found at higher rates in PCOS women than in the general population includeautoimmune thyroid disease (Hashimoto’s Thyroiditis), endometriosis, uterine fibroids (leiomyomata), adenomyosis (uterine lining glands within the muscle of the uterus), and several cancers.

Are women with PCOS simply unlucky to have so many medical maladies in one body, or is there a common theme to explain this? Once you delve beneath the surface, you come to recognize that all of these conditions have similar underlying mechanisms. Uniting all of them are the following: an abnormally functioning immune system, marked by chronic inflammation with elevations of inflammatory signaling agents called inflammatory cytokines, early age exposures to environmental toxicants (chemical endocrine disruptors), nutritional deficiencies, and gut microbiome abnormalities (dysbiosis). The ultimate unifying and underlying cause for all of these maladies in PCOS women is a foundational hormonalproblem: a major dysfunction of estrogen and its receptors, including its production and metabolic degradation. Estrogen is the master hormone, essential for metabolic health,and this requires a properly regulated immune system.  Sadly, PCOS women do not have proper metabolic or immune health.

Let’s begin with a quick overview of the conditions mentioned above. Endometriosis involves a severe localized inflammation in the pelvis, with high levels of inflammatory cytokines within the intra-abdominal (peritoneal) fluid. Interestingly, most menstruating women have some uterine contents flow backwards with each menses, with fluids and tissue passing through and out the Fallopian Tubes. The body’s immune system normally dissolves and gobbles up that tissue, but in women with endometriosis, this process malfunctions, and little holes in the lining of the pelvis (the peritoneum) are created, allowing living cells from the uterine lining to implant and thrive.

This process is controlled by a system of enzymes, called Matrix Metalloproteinases (which remodel tissue) along with immune cells of the body. These cells and processes are under the control of estrogen, which in PCOS women is not functioning correctly. One type of theseimmune cells – the Mast Cell, which isalso controlled by estrogen – accumulates within the pelvis of women with endometriosis, releasingmassive quantities of inflammatory cytokines and chemokines (signaling agents which call other inflammatory white blood cells to the scene.) Thiscreates and sustainslocalized inflammation, promotinglocal estrogen production, and further stimulating growth of the ectopic endometrial cells.

In the case of uterine fibroids, malfunctioning Matrix Metalloproteinases and abnormal local production of estrogen and progesterone cause the muscle cells of the uterus to grow abnormally, creating muscle tumors – fibroids (leiomyomata). Likewise, adenomyosis involves the dysfunction of both the Matrix Metalloproteinases and of estrogen, resulting in the invasion of the endometrial (lining) cells into the muscle of the uterus.

Hashimoto’s Thyroiditis, an autoimmune disease, also involves dysfunction of the immune system, gut dysbiosis,and impaired gut permeability (leaky gut), all related to abnormal estrogen function. Lastly, cancer, the ultimate immune dysfunction, involves uncontrolled inflammation and estrogen malfunction or deficiency. Not surprisingly, the incidence of many cancers is substantially higher in women with estrogen dysfunctions – PCOS, adenomyosis, fibroids, and endometriosis – compared with the rest of the female population.

And what connects PCOS with those other conditions? What is the root cause of PCOS? We now understand that it involves chronic inflammation, gut dysbiosis, and leaky gut;and that estrogen malfunction is at the root of those problems. The cause for this estrogen malfunction involves exposures to endocrine disrupting chemicals at critical points of development – in utero, during infancy, and at puberty, in genetically susceptible women. This inflammatory state is exacerbated by continued chemical exposures and the consumption of a high fat/high sugar diet, filled with processed foods.

Despite all of this, there is substantial reason for hope. A fiber rich diet, stress control, exercise, timed eating and periodic fasting, along with the judicious use of bioidentical hormones, can ameliorate these problems. More on my PCOS protocols for health will be forthcoming in future articles.

References:
Nielsen NM et al. Hum Reprod. 2011;26(6):1555-9
Smarr MM et al. FertilSteril. 2016 Jul 15. Soo15-0282(16)61389-4
Khoufache et al. Minerva Endocrinol. 2012;37(1):75-92
Burney et al. Fert and Steril, 2012;98(3):511-19
Konno et al. Human Cell. 2003;16(3):144-49
Cuevas et al. Reprod Sci.2012;19(8):851-62
Theoharides.ExpDermatol. 2017
Nat Rev Immunol. 2010
Hart, David. 2015. Intern J of Inflam. 2012;452095
Urb et al. PLOS Pathog. 2012;8(4)
Abraham et al. Nat Rev Immunol. 2010;10(6):440-52
Menzies et al. Hum Reprod Update. 2011;17:383-96
Binda et al. ExpOpin on Ther Targets. 2017;21(1)67-75
Vliagoftis et al. Immunol Rev. 2005; 206:190-203
Qiao et al. Blood. 2006;107:610-18
Plos Pathog.2012;8(4):e1002619
Alvarez et al. Neuroscience. 2014;258:111-120
Hart, David. 2015. Intern J of Inflam. 2012;452095
Bulun et al. SmeRepr Med 2004;22(1):45
Sharpe-Timms et al. Ann NY Acad Sci.2002;955:147-56
Smarr MM et al. FertilSteril. 2016 Jul 15. Soo15-0282(16)61389-4
Bayoglu et al. Eur J Ob GynReprod Biol. 2015;184:1-6
Ozcan et al. GyncolEndocrinol. 2015;31(3):219-24
Yavuzetal.J Cancer Res Ther. 2014;10(2):324-9
Cao et al. Evid Based Complement Alternat Med. 2014;781684
Wang et al. Angiogenesis. 2013;16(1):59-69
Ricci et al. Hum Reprod. 2013;28(1):178-88
Xu et al. FertilSteril. 2011;96(4);1021-8
Jackson et al. Hum Reprod. 2005;20:2014-20
Halpam et al. Rev Assoc Med Bras 2015;61(6)519-23
Agostinis et al. Mediators Inflamm. 2015; 918089
Mojzis J et al. Pharmacol Res 2008. 57(4):259-65
Maia et al. Int J of Women’s Health;2012;4:61-65
Kim KA et al. PLOS one. 2012;7(10):47713
Heard ME et al. Endocrinology. 2016 Jul;157(7):2870-82

PCOS and Fatty Liver - The link between grows stronger!

PCOS and Fatty Liver: The Link Between Grows Stronger!

The incredible link of the gut microbiome and overall gut health with the metabolic manifestations of PCOS just keeps growing more clear! A new study was just recently published, the key points shown in the attached below piece, indicating that women with PCOS do indeed carry a higher risk of developing fatty liver.

The intestinal tract links directly with the liver, through a passageway called the enterohepatic circulation. Inflammatory products from the gut head right to the liver. This connecting passage exists to allow the liver, in concert with the brain, to regulate the glucose and fat levels in our blood and to regulate our appetites.

Never did Mother Nature anticipate that humans would eat huge amounts of animal fats and transfats, inordinate quantities of sugar, and high fructose corn syrup in particular, eat nonstop and late into the night, and eat chemicals toxic to our intestinal microbial guests! The outcome of this unfortunate gut environment is gut dysbiosis (the wrong sorts of bacteria living in the gut) and impaired gut barrier function (also called Leaky Gut).

Leaky gut occurs when the wrong gut composition of bacteria develops and toxic particles are produced by them, called Lipopolysaccharides (LPS) – also called endotoxin – which pass through the gut lining and into the adjacent immune cells, called the Gut Associated Lyphoid Tissue (the GALT). These immune cells feel that they must defend the body against these toxins, as they are assuming the body is undergoing a serious infection, and a severe inflammatory reaction develops in the liver and a chronic state of inflammation develops throughout the body.

This occurs as the immune cells release their own inflammatory products, designed to protect us from invading bacteria, fungus, parasites, and such, but in this case, these “helpful” immune cells are actually furthering the damage being done by creating an unremitting state of chronic inflammation in the liver and throughout the body. This also manifests are severe inflammatory acne!

The occurrence of this inflammation in the liver worsens insulin resistance, causing more testosterone to be made and further interfering with the natural hormonal functions of the ovary.

The first thing all women with PCOS must do is to change the diet to help heal and restore a healthy gut. Food can and indeed should, be thy medicine!!

And that will be the topic of my next PCOS blog!

The Two Flavors Of PCOS

The Two Flavors Of PCOS

Until relatively recently, I was of the understanding that Polycystic ovary syndrome (PCOS) was simply one condition, with many different degrees of severity. Some women had very irregular cycles, while others were fairly normal. Some had terrible facial hair, some cystic acne, some thinning hair, some were obese while some couldn’t put on a pound. Variety abounded!

While all of that remains true, it turns out that there really are two quite different conditions, with many similarities, yet with foundational differences. The two distinct types of PCOS are the type with high levels of testosterone, and the other type, characterized by high levels of DHEA-S. This is not “new” news. We’ve known for a long time that different androgens can be elevated in different women with PCOS. But all were still lumped together under the single umbrella of PCOS.

Here are my observations. Please understand that these are generalizations. Women with high testosterone PCOS are easier to treat regarding their acne and weight issues compared with the elevated DHEA-S group. The women I see with very high DHEA-S tend to have recalcitrant cystic acne, often very severe. And their excessive fat tissue is very difficult to burn. Though I am opposed to the use of oral contraceptives in general, I’ve had women with high DHEA-S go on oral contraceptives and in general they do poorly. Their skin doesn’t improve and they gain more weight. Similarly with Spironolactone, it simply doesn’t help.

I’ve treated the high DHEA-S women group in the same ways I treated the high testosterone group, and I now think that may not be the best approach. They are indeed different.

I believe that the women with the high DHEA-S need to work on reducing stress and improving sleep more than the high testosterone group. Getting to bed by 10:30 PM, getting some sun most days, and controlling stress should be very beneficial and high priorities.

The DHEA-S comes from the adrenal glands, not the ovaries, and it’s the adrenal glands which respond so dramatically to stress. It’s so essential for those women to keep stress levels low. Exercise would be even more important for the women with high DHEA-S, in part to lower stress and also to increase metabolism. Getting on a diet with low amounts of animal meats and high amounts of varied vegetables, should be a mainstay of treatment as well. I’ve also found a high percentage of women with elevated DHEA-S levels to be poor detoxifiers. Emphasizing cruciferous vegetables and taking a great B vitamin complex, with methylated B’s, should be tried. And be sure the levels of Vitamin D are around 50. Getting genetics checked is also reasonable.

I’d like to end by saying that much more needs to be learned about these two quite different types of PCOS. But one thing which has been found out is that women with high DHEA-S have no higher risk for diabetes and heart disease than does the general population. This is amazing and encouraging news! The unpleasantness of today will be the anti aging foundation of the future. There is indeed much to celebrate and to look towards. There is, to put it simply, much hope and much happiness ahead.

How Much Exercise is Needed to Maintain Weight Loss?

I have some bad news and some good news. But, as always, the bad news comes first.

If you have lost a significant amount of weight, it will undoubtedly be harder for you to maintain your new weight than it is for someone of the exact same weight and body composition who was never overweight.

What do I mean by this? Let’s assume that you’ve just lost 50 pounds and now weigh 150 pounds with 30% body fat – a reasonably “good” percentage for someone your age. Your friend, who may or may not have PCOS, also weighs 150 pounds with the same percent body fat. For ease of comparison, we will assume that you also do the same amount of daily physical activity – you sit, you walk, you sit some more – pretty typical for the twenty-first century.

Let’s guesstimate that your resting metabolic rate (the number of calories you burn, if you’re sitting at rest all day) is around 1500 – we multiply your bodyweight in pounds by 10 for a rough estimate. Then we multiply that by 1.6 to account for the additional calories you burn from a day’s worth of average physical activity for a total of 2400 calories per day.

Here’s the problem. Your friend can eat her 2400 calories per day and her weight bounces up and down the normal 2-3 pounds, but long term it stays the same. You, on the other hand, for reasons we don’t fully understand, can only eat 1900 calories per day to keep from gaining weight. If you eat the same diet as your friend, you’ll gain an extra pound every week (500 calories per day x 7 days = 3500 calories, which is the energy content of a pound of fat) and within a year will have regained every pound you lost.

You didn’t overeat; your body has simply become super-efficient and now under-burns calories. This is exactly what the Persistent metabolic adaptation 6 years after “The Biggest Loser” competition study showed us. Contestant metabolic rates averaged 500 calories per day lower than similar sized people who had never lost weight.

It doesn’t seem fair, but that’s the way it is. This problem is further compounded by the fact that when you’re only eating 1900 calories per day, you will most likely be hungry almost all the time. Except in rare cases, your appetite center doesn’t adjust well to this fact and still expects to consume 2400 calories to maintain your 150-pound body. This is absolutely, unequivocally unfair, right?

So, what can you do? What’s the “good” news promised at the beginning?

It turns out that you can exercise the 500-calorie daily deficit away, rather than starving for the rest of your life. How much? Roughly an hour per day at moderate intensity – oh, come on, it’s not that bad! And the only side effect is that you’ll be even healthier than you ever imagined. In a future post, I’ll show you just how easy this can be.

Risks of Conventional Hormone Replacement Therapy

This is data from rats but shows that periodic, as opposed to continuous, treatment with estradiol, is protective for the brain from ischemic damage. This article urges research be done in human females to investigate a more physiological approach to estrogen therapy than what is currently being done.

This is what I absolutely believe – hormones must be replaced in a physiological manner for there to be maximum benefit and minimal negatives.

The conventional manner in which female hormones are given to menopausal women simply makes no sense, as it is not consistent with physiology. Women are cyclic, beautifully rhythmic creatures … not static ones … and must receive hormones consist with how they were designed for them.

I know I’m an outlier now, but time will bear me out. The functions of estrogen are well known and highly protective … and after menopause women suffer in varying degrees from hormonal deprivation. Yes … It is natural … but it is so very negative to a woman’s very being.

After menopause … women simply dry up! They can get dry eyes, dry bladders, dry vaginas, dry skin, dry arteries, dry brains, dry muscles, dry hearts, dry mouths, dry guts, dry bones, and on and on … And yes … I use the word dry a bit loosely … but it’s really quite close to the truth!!

Women must demand that proper research be done for them! Women are wondrous and rhythmic and should live their lives in harmony with nature!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625208/

What’s for Dinner?

When you sit down at the table to eat, what do you think makes for a great meal?

My first rule of thumb is quite simple – all food must taste good and be good for you! Those rules simply cannot be broken. Next, once it meets those qualifications, it is really important that it is truly scrumptious. If given a choice, why go for food you don’t really love, and who doesn’t love to eat? Eating is one of the true joys of life, and it makes me, and actually everyone, happy and satisfied when eating wonderful food.

Second, we should think about nutrition – is the food we’re eating supporting our long-term health. If it isn’t, then we’re setting ourselves up for all the dangerous health consequences that plague PCOS women: obesity, pre-diabetes and type-2 diabetes, cardiovascular disease, inflammatory bowel disease, and more.

And of course we will think about the toxin content of the food. Is it organic or not? What chemicals are contained in it or is it a processed food, which, by the way, I never will eat! And is it fresh and full of nutrients, or old and wilted.

Rarely, however, do we think about the food we eat in terms of feeding the 30-40 trillion (that’s right, trillion!) bacteria that inhabit our GI tract, call the gut microbiome. This is a lot more important than you might think, because the latest scientific research is telling us that these little fellows – who have been part and parcel of who we are for the past several million years – have an incredibly powerful impact on virtually every organ system in our bodies.

They help digest and process our food and create a vast range of metabolites that we absorb and use all over our bodies. They also produce neurotransmitters that control our feelings of anxiety and depression and also help regulate our blood glucose levels through several mechanisms – and that’s just scratching the surface.

So, the bottom line is: when you sit down to eat, remember that you’re not just eating for yourself, the 20-30 trillion (yup, there we go with the trillion again) human cells that make up your body, but also for the gazillion microbial guests, who are also seated at the table.

And exactly what, you may ask, would they like to eat?

Fortunately, the answer to this is relatively straightforward and not at all discouraging. They like to eat high-quality, whole foods, and they like variety. They love lots of vegetables, both above ground and root vegetables, and a slightly lesser amount of fruit, especially when they are organic and not tainted by residues of herbicides and pesticides. They prefer plant-based sources of protein (beans, lentils, quinoa, and amaranth) over animal-based sources and do well with good doses of the fatty acid, Omega 3. And please avoid simple sugars and sugar substitutes, as they are quite toxic to the microbiome. It is simply much better to be focusing on carbohydrates containing lots of fiber. Fiber is the foundational food for the microbiota which dwells within our gut.

If you give these single-cell companions what they want, they will reward you in spectacular ways. Your weight, blood pressure, body fat percentage, cholesterol levels, and fasting glucose level will drop, all of which will lead to substantial reductions in inflammation and oxidative stress. And, if you stay tuned to this blog, we’ll give you wonderful recipes and cooking advice that will make your new diet every bit as delicious as it is good for your health!

PCOS and Inflammation

There is a common thread which ties all women with PCOS together, whether they are over- or underweight, young or old. That link is INFLAMMATION – the driving force behind the ills afflicting all PCOS women.

Let me explain a bit about inflammation, how it develops, and how it can create havoc for women with PCOS. The inflammatory process begins during pregnancy as the fetus’ developing estrogen receptors are misprogrammed by the presence of toxic chemicals, such as bisphenol A, a powerful endocrine disrupting chemical found in plastics and thermal printing papers.Since estrogen receptors are present in virtually every cell of the female body, this bodes poorly for the development of proper metabolic functions, as it is estrogen which is the master of metabolism in the female body.

What does inflammation actually mean for the female body and why it is so bad?

Acute inflammation is a normal response to a trauma or an infection. This type of inflammation involves the activation of the innate immune system,which protects the body from invading organisms. This acute, short term inflammation is a normal and very important part of our immune defense system.

Unfortunately, there are times when inflammation becomes chronic, due to a malfunction and misdirection of the immune system. When this develops, bad things follow right behind. A key component of an acute inflammatory response is the activation of white blood cells, called macrophages. They then secrete substances called inflammatory cytokines and enzymes which act something like a natural acid.

The inflammatory cytokines include substances like tumor necrosis factor alpha, which, if produced in an uncontrolled fashion, leads to insulin resistance, elevated levels of glucose and insulin-like growth factor 1, and high production of testosterone. Also produced by macrophages are special enzymes, called matrix metalloproteinases, which are substances designed to kill invading bacteria and aid in the removal of dead tissue. Chronic production of these matrix metalloproteinases causes damage to body structures, such as the interior lining of arteries, which in turn leads to severe acne.

Estrogen is the ultimate controlling force behind the function of macrophages, and receptors for estrogen reside on these cells. When estrogen receptors are not properly developed, estrogen can no longer control the actions of macrophages. With control reduced in women with PCOS, macrophages run amok through the female body, doing much damage. They are perpetually in a state of high alert, ready to release inflammatory cytokines and myeloperoxidase, and they are more easily stimulated compared with immune cells in women without PCOS.

Much of the stimulation to the macrophages originates in the gastrointestinal tract, also known as the gut. Studies now show for the first time that women with PCOS have a more “leaky gut,” meaning that the single-cell barrier between the internal contents of the colon and the rest of the body is compromised. This allows inflammation-inducing particles within the colon, derived from the overgrowth of predominantly gram-negative bacteria called lipopolysaccharides (LPS), to pass through the colon wall and enter into the surrounding immune system, known as the gut-associated lymphatic system (GALT). Within the GALT reside those key cells – the macrophages – which are triggered by the LPS to release their inflammatory substances.

This is a short introduction to a very complex subject. In upcoming articles, I’ll explain more about what is happening within the gut, and I’ll also dive further into the story of inflammation as the driving force behind the suffering of women with PCOS and how to “tame the flames of PCOS!”

How PCOS affects Depression and Anxiety

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 times to discard quite 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%, and 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, including the impact of infertility, hirsutism, and acne on mood. The fact that many women with PCOS experience menstrual dysfunction, 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, they found that in comparing hirsutism and obesity, the most 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 the population of women with PCOS.

The reasons for the increased vulnerability of depression and anxiety in women with PCOS as well as for PCOS women 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 several pathways independent of the visible symptoms of PCOS, such as obesity, acne, and hirsutism. 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 wellbeing. 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.

*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: Depression and Anxiety in Women with PCOS http://pcosdiva.com/2015/12/depression-and-anxiety-in-women-with-pcos/

What is the condition known as PCOS (Polycystic Ovary Syndrome)?

PCOS incorporates the word, SYNDROME! When that word is linked with a condition, it basically means that no one really knows why someone would develop it, and, as well, it has a great variety of ways it can manifest itself.  PCOS is therefore, a highly individualized condition, resulting from each woman’s unique genetic make-up, along with her mode of delivery at birth, whether or not she was breastfed, her exposures to a variety of chemicals which can act as endocrine disruptors, her nutritional status, her sleep patterns, her exposure to antibiotics and vaccines, her stress levels, and more. Essentially, it is a very complex and variable condition!

Many choices you make can affect how you experience PCOS, which symptoms you get, and how severe they may be. Some women struggle with irregular or no periods at all; some have acne; most struggle with excessive weight gain, while others easily maintain very slim figures. Infertility is a common complaint while thinning scalp hair and excessive growth of facial hair plague other women. And women with PCOS all have elevated risks for developing various cancers, diabetes, irritable bowel syndrome, cardiovascular disease, anxiety and depression, and problems with sleep. PCOS is, at its very heart, a condition characterized by universal insulin resistance and systemic inflammation, regardless of whether the woman is obese or thin. Inflammation is a driving force of the condition.

In fact, since PCOS was first described by Drs. Stein and Leventhal in 1935, physicians throughout the world have debated with defining the syndrome. Today, there are three closely related sets of criteria (NIH, Rotterdam, and AE-PCOS Society) and all revolve around the following issues: infrequent or no menstrual periods, polycystic ovaries (many very small cysts surrounding the core of the ovaries), excessive production of androgens (hormones found in males such as DHEAS and testosterone), and the elimination of other known causes for these symptoms. PCOS is by far the most common endocrine disorder suffered by women around the world, affecting up to 25% of all reproductive-aged women.

Lest you become too distraught over all of these realities, there is a brighter side.  There are things you can and should do, along with choices you can make, all of which will ameliorate your symptoms and transform your life for the better.

And that will be the focus and driving force for this blog – transforming lives such as yours, and creating happiness. The dialogue we will have together will focus on concrete ways to make your life as wonderful and rewarding as it should be, despite your PCOS!

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 or with young adulthood, following the advent of puberty and the onset of periods. In reality, shocking as it may seem, PCOS begins with birth!!

Now how, you may ask, can that happen? Doesn’t puberty herald the onset of the 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 treating it BEFORE all the misery that you know all too well ensues, following the completion of puberty.

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. What happens is that these chemicals enter the pregnant woman’s body through various means and then cross the placenta, thereby entering  the baby’s body, where it actually concentrates 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. And estrogen has three different kinds of receptors, so the end result can be hormone chaos and the various organs of the developing baby’s body simply do not get the right exposure to hormones, particularly estrogen.  The baby is born with a “confused” hormonal system, unable to respond properly to the hormones due to the abnormal function of their receptors, as well as the inability to manufacture them 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. What that means is 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, yet she eats quite well… that 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 which can be administered as early as age 6 to make a likely diagnosis! 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, called an Adipokine. Adiponectin is an extremely important and vital hormone to prevent 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 the girl is at high risk to develop PCOS. The potential for Adiponectin to be used as an early screening tool means that girls at high risk to develop PCOS can be identified as young as age 6! Once identified, 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 blow to health which occurs 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.

*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at:  http://pcosdiva.com/2015/11/diagnosis-and-treatment-of-pcos/

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