Mar, 2018

4 Drivers of PCOS

THE 4 DRIVERS OF PCOS

Polycystic Ovarian Syndrome (PCOS) affects 1 in 10 women of reproductive age. Before reading this article make sure you check out “What is PCOS? (and Why It Needs a New Name)” to learn about what qualifies as PCOS and how to get an appropriate diagnosis.

When it comes to treating PCOS you need to look deeper than the irregular periods, acne and androgen excess. You need to look for the underlying cause. Why is your cycle irregular? Where did the acne come from? Why are your hormones unbalanced in the first place? The answer can typically be boiled down to one (or more) of these four main drivers of PCOS. Once you know your driver(s) you can address the cause of your PCOS– not just the symptoms.

INSULIN RESISTANT PCOS

This is the most common driver, affecting up to 70% of women with PCOS. Insulin resistance impairs ovulation (a key feature in PCOS) by affecting androgen levels, LH levels, and proteins that bind to hormones in your blood.

[INSULIN RESISTANCE – Insulin’s job is to help move glucose (fuel from food) from your blood into your cells. Insulin resistance occurs when your cells, for various reasons, become resistant to the signalling power of insulin.]

Insulin resistance occur due to smoking, stress, sleep deprivation, alcohol, trans-fat, unhealthy gut bacteria, magnesium deficiency, and environmental toxins. All of which are very prevalent in North America.

Simple blood tests can be run to determine if you have insulin resistance. We can then target the causes of insulin resistance in your life. Lifestyle and dietary changes coupled with strategic supplementation can help reduce your body’s resistance to insulin and therefore improve your PCOS.

POST-PILL PCOS

The second driver of PCOS is the hormonal birth control pill. Studies show a link between the pill and androgen levels, insulin resistance, and (by design) an inhibition of ovulation.

After coming off the hormonal birth control pill your body is adapting to the removal of this hormonal ‘control’. Not everyone will experience unwanted changes when stopping the pill. However, if you’ve had menstrual issues or hormonal imbalances before starting the pill, you will likely experience some when stopping. These may include acne, unwanted hair growth, irregular periods, dysmenorrhea (painful periods), PMS (premenstrual syndrome), and/or a rise in androgens (especially if on an anti-androgen pill – commonly chosen if acne was a concern). Due to these changes you may fit the diagnostic criteria for PCOS. For many, post-pill PCOS is temporary and may resolve on its own with time. Strategically addressing hormonal imbalances and other minor/co- drivers can help resolve your PCOS and regulate your cycle sooner, helping you get back on track.

Talk to your health care provider about what to expect when coming off the pill so you know what is normal and what requires further investigation. Be sure to track your cycle while coming off the pill so you know if your body is adapting appropriately. To help reduce unwanted changes talk to your Naturopathic Doctor about how to prepare your body for this hormonal shift before you stop the pill.

INFLAMMATORY PCOS

Inflammation and environmental toxins are the third driver of PCOS.

Studies show endocrine disrupting chemicals (EDCs) such as bisphenol A (BPA) and phthalates may cause reproductive health problems such as infertility, premature ovarian failure, abnormal hormone levels (ie. excess androgens), and reduced ovulation. Studies also show that women with PCOS have higher levels of BPA in their bodies.

How do you combat this driver? You reduce your exposure. Removing many EDCs can be quite easy.

First: identify your exposures to ECDs.

Second: remove or replace these exposures with less harmful alternatives.

There are 3 easy places to start:

Simply switching from plastic to glass – water bottles, kitchen containers, and choosing foods sold in glass containers.
What you put on your body (shampoo, conditioner, body wash, face wash, moisturizer, make-up, hand soap, laundry detergent, etc).
What you use to clean your house (kitchen cleaner, sprays, deodorizers).

For #2 and #3 visit ewg.org/SkinDeep and download the app “Think Dirty” on your phone. Type in the name and brand of the products you use. Each database will rank the products as Low-Hazard/Neutral (0-2), Moderate-Hazard/Half-and-Half (3-6), or High-Hazard/Dirty (7-10). Aim to replace your moderate/high-hazard products with low-hazard products to help reduce your exposure to harmful chemicals. You can do this all right away or over time – even one small change helps!

ADRENAL PCOS

If you have PCOS the main driver is likely one of the three mentioned above. In rare cases your adrenal glands may be the sole driver of your PCOS.

Your adrenal glands sit on top of your kidneys. You probably know them as the producers of cortisol (the stress hormone). But cortisol isn’t all these glands produce. DHEA-S (an androgen) also comes from the adrenal glands. Excess DHEA-S is linked to the presentation of PCOS and may be the only elevated androgen in up to 10% of PCOS patients.

To reduce this driver of PCOS first take a look at where your stress comes from. Is it family? Friends? Your relationship? Job-related? Finances? It’s likely a combination of a few, and at least one daily. So, what are you doing daily to reduce this stress?

Pick one of these stress-reduction techniques to try this week!

Mindful meditation. Download the app “Headspace.” This app contains guided mediations to help you master the skill of meditation.

Journaling. Use a regular notebook or one designed for mindfulness, such as “The Five Minute Journal.” Get your emotions and thoughts down on paper to help keep your mind clear.

Talk it out. Perceived social support is a strong protective factor for both depression and anxiety and helps foster coping strategies.

Nature Walks. Studies show spending time in nature can help reduce stress levels. This is also a great option for anyone who has difficulty with stationary meditation.

Working to reduce your stressors and your perception of these stressors can help ease the pressure on your adrenal glands. This can be done on your own or with the help of a professional (such as a psychotherapist). Nutraceuticals and botanical medicine can also be used to support your adrenal glands and modulate your stress levels. By improving adrenal function we can improve adrenal-driven PCOS.

That sums up the four main drivers of PCOS, but it is important to note there are other factors that may also be contributing to your PCOS. These include thyroid dysfunction, nutrient deficiencies, dietary restrictions, and elevated prolactin. Be sure to consult healthcare professional to ensure you are getting the appropriate testing and that all of your drivers of PCOS are being addressed.

To learn more book an appointment or a free 15-minute consultation here, or send me a private message here and get to know your options.

Resources:

INSULIN RESIATNCE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872139/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018970/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334071/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680959/; Briden, Lara. Period Repair Manual. Lexington: 2015. OCP: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135453/, https://www.ncbi.nlm.nih.gov/pubmed/22811306/, https://www.webmd.com/sex/birth-control/stopping-pill-10-ways-body-changes#1; ENVIRONMENTAL: https://www.ncbi.nlm.nih.gov/pubmed/27559705, https://www.ncbi.nlm.nih.gov/pubmed/21193545, https://www.ncbi.nlm.nih.gov/pubmed/26063868; INFLAMMATORY: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245829/; ADRENALS: https://www.ncbi.nlm.nih.gov/pubmed/17932770, https://www.ncbi.nlm.nih.gov/pubmed/18950759. https://www.ncbi.nlm.nih.gov/pubmed/27336356, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772979/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709294/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/, image: http://www.thevitpro.com/uploads/8/4/1/7/8417615/303034.jpg

adrenal glands, birth control pill, endocrine disrupting chemicals, environmental toxins, inflammation, insulin resiatance, ovulation, PCOS, polycystic ovarian syndrome, post-pill, thyroid

Feb, 2018

By Dr. McKenzie Nisbet, ND

Why is PMS so Common?

WHY IS PMS SO COMMON?

Premenstrual syndrome (PMS) is a catch-all diagnosis for countless symptoms occurring around the luteal phase of your cycle. Symptoms may last days or weeks; typically worsening 6 days before and peaking 2 days before the start of menses.

Most women have some degree of PMS and about 20-40% of women report severe symptoms that cause disability. Though PMS is clearly very common, it is not normal.

It is not normal to have disabling symptoms for days to weeks each and every month.

As women, our hormonal regulation is highly complex. This complexity is why we are able to support another being – through pregnancy and into infancy. When this regulation becomes disrupted we experience an array of symptoms based on our unique hormonal balance and lifestyle.

The most common symptoms are breast tenderness, abdominal pain, headaches, back pain, joint or muscles aches, water retention, difficulty with sleep, digestive concerns, skin blemishes, food cravings, exhaustion, irritability, anger, and feeling down.

WHY DO WE HAVE PMS?

The actual cause of PMS is “unknown”. However, it is likely a complex combination of hormonal imbalances, neurotransmitter interactions, and lifestyle factors.

Many factors associated with PMS are extremely prevalent in the typical North American lifestyle. By being aware of these risks and making small changes you can reduce your symptoms of PMS.

YOUR DIET

Research shows that diet plays a significant role in determining who is more likely to experience PMS symptoms. Diets with less sugar, fewer refined grains/carbohydrates, and more fruits, vegetables, whole grains and fibre experience less PMS symptoms.

One study compared three different diets and concluded that PMS is more common in women consuming a “Western” dietary pattern, and is less likely in women consuming “traditional” or “healthy” dietary patterns. Though the “traditional” and “healthy” diets used in this study (below) are not perfect, this paper showed how diet alone can have a huge impact on your PMS symptoms.

WESTERN DIETARY PATTERN: high in red and visceral meats, fast foods, vegetable oil and mayonnaise, sweets and desserts, salty snacks, refined grains, sugar and soft drinks, high-fat dairy products, spices and fried potato.
TRADITIONAL DIETARY PATTERN: high in eggs, cooked potatoes, legumes and nuts, poultry, hydrogenated oil, cabbage, sweets and desserts
HEALTHY DIETARY PATTERN: high in vegetables, fruits, natural juice, olive, tea and coffee, fish, low-fat dairy products, legumes and nuts.

NUTRIENT DEFICIENCIES

Certain nutrient deficiencies have been linked to PMS symptom frequency and severity. Two of the most common deficiencies are Magnesium and Vitamin B6.

MAGNEISUM

Magnesium deficiency is very common in Canadian women, with the highest level of deficiency occurring in girls 12-19 years of age. The classic North American lifestyle – filled with high levels of sodium, fat, and soda intake, coupled with high levels of stress – encourages this deficiency. Magnesium supplementation has been shown to reduce premenstrual fluid retention as well as improve muscle aches, headaches, insomnia, anxiety and low mood.

VITAMIN B6

B6 is an important cofactor in our bodies. Cofactors help enzymes complete biological transformations. For example,Vitamin B6 is a cofactor in the production of serotonin (your ‘happy hormone’). It has been shown that women who experience PMS have lower levels of serotonin during the second half of their cycle. By ensuring adequate B6 intake you can support serotonin production.

B6 is also one of the nutrients needed for the proper absorption of magnesium. It has been studied alongside magnesium and is shown to be more effective than supplementing with magnesium alone.

The dose and form of these vitamins and minerals will affect their efficacy so be sure to check with your healthcare provider before choosing your supplements.

INFLAMMATION

The North American lifestyle is pro-inflammatory; due to our poor diet, lack of activity, and our chronic internal and external stressors. Higher levels of general inflammation within the body are significantly associated with PMS symptoms – specifically mood symptoms, abdominal cramps and back pain, appetite cravings, weight gain, bloating, and breast pain. The best place to start reducing inflammation is through your diet.

STRESS LEVEL

Our life is filled with constant daily stressors. Everything from rushed mornings, long commutes, lack of job security, unsatisfying careers, financial stressors, family responsibilities, unhealthy relationships, rising costs, and the addiction to technology has put us in a chronic state of stress. This chronic stress actually has a greater impact on PMS than acute stressors.

To combat this chronic stress, mindfulness has been shown to be help reduce stress reactivity, improve coping measures, and reduce anxiety. The best stress reduction technique is the one that works for you.

Give one of these a try:

Mindful meditation. Download the app “Headspace.” This app contains guided mediations to help you master the skill of meditation.

Journaling. Use a regular notebook or one designed for mindfulness, such as “The Five Minute Journal.” Get your emotions and thoughts down on paper to help keep your mind clear.

Talk it out. Perceived social support is a strong protective factor for both depression and anxiety and helps foster coping strategies.

Nature Walks. Studies show spending time in nature can help reduce stress levels. This is also a great option for anyone who has difficulty with stationary meditation.

DIAGNOSING & TRACKING YOUR PMS

How do you know for sure that you have PMS? Technically, you can’t. There is no simple definitive blood test for diagnosing PMS. PMS is determined based on your history, the timing of your symptoms, daily rating of symptoms over multiple cycles, and ruling out other causes of your symptoms.

The best thing you can start doing today for your PMS is to track your cycle. Get to know your symptoms – when do they start and end, what makes you feel better (or worse), and how does their severity and frequency change as your cycle progresses? Everyone’s experience is unique to them. By understanding your symptom picture, we can make specific recommendations for your PMS and monitor changes between your cycles. When it comes to PMS; the more information, the better.

To take tracking one step further and really understand the hormonal component of your symptoms we can do functional lab testing. These are not your average blood tests. One of the most comprehensive functional test for cycle irregularities is the “DUTCH Complete” by Precision Analytical. This test shows us your estrogens and their metabolites, your liver’s ability to remove excess hormones from the body, progesterone marks, androgens (such as testosterone), cortisol and cortisone curves, DHEA, as well as organic acids and nutritional markers (such as Vitamin B6). This knowledge allows us to create a more focused treatment plan for your unique presentation.

To start tracking your symptoms use a free fertility tracker app such as “Kindara” or download this free “PMS Symptom Tracker.”

Remember, it is not normal to have disabling symptoms for days to weeks each and every month. To learn about why you have PMS and what we can do about it, book an appointment here and reclaim your cycle.

Resources:

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072449/; DIET: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/F2C1436021136BDA3A9CC0968C351E46/S0007114515003943a.pdf/western_dietary_pattern_is_related_to_premenstrual_syndrome_a_casecontrol_study.pdf; NUTRIENTS: https://www.ncbi.nlm.nih.gov/pubmed/9861593, http://pubmedcentralcanada.ca/pmcc/articles/PMC5372959/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455825/, https://www.ncbi.nlm.nih.gov/pubmed/11425281, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586582/, https://www.ncbi.nlm.nih.gov/pubmed/23853635, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5452159/, https://www.ncbi.nlm.nih.gov/pubmed/11425281; INFLAMAMTION: https://www.ncbi.nlm.nih.gov/pubmed/27135720; STRESS: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772979/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709294/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/

chronic stress, diet, DUTCH, hormonal imbalances, inflammation, lifestyle factors, magnesium, meditation, mindfulness, neurotransmitter interactions, PMS, premenstrual syndrome, vitamin B6