PCOS Review Newsletter #6

Natural Health Ideas for Polycystic Ovary Syndrome
A free monthly newsletter for women with ovarian cysts or PCOS.

Issue #006 January 22, 2003

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TABLE OF CONTENTS

1) Lab Tip: Afternoon Glucose Test Misses Blood Sugar Problems

2) What Do PCOS and Ovarian Cancer Have in Common?

3) "The Thief of Womanhood": Women's Experience of Polycystic Ovarian Syndrome

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1) LAB TIP: AFTERNOON GLUCOSE TEST MISSES BLOOD SUGAR PROBLEMS

Your doctor probably ordered a blood chemistry as part of your PCOS diagnosis. (By the way, if your doctor did NOT order a blood chemistry before prescribing the usual birth control pills and/or metformin, we suggest you find a better doctor.)

Part of the blood chemistry test is your fasting glucose (blood sugar) level. "Fasting glucose" is your blood sugar level after avoiding food or beverages for at least 10 hours. Either a low or a high fasting glucose suggests you have an impaired ability to control your blood sugar. A high fasting glucose would make your doctor suspicious that you are diabetic or pre-diabetic. As you may know, women with PCOS have a much higher risk of developing diabetes than non-PCOS women.

A couple of things can go wrong when testing your fasting blood glucose levels.

First, it's possible you had your blood drawn too soon after eating a meal or consuming a beverage, which has the effect of raising your blood glucose level. Thus, you would have an elevation because you recently ate something, not because you may have a diabetic problem. Hopefully, if your fasting glucose was high, your doctor asked you if you had anything to eat or drink prior to the blood draw.

Second, and more important, is a fact that your doctor may not know about. According to a study in the Journal of the American Medical Association,(1) as many as 50% of people with undiagnosed diabetes may show "normal" results on an afternoon fasting glucose test. In other words, your fasting glucose level in the afternoon is naturally lower than in the morning. So if you had your blood drawn in the afternoon, your blood glucose level might be "normal" whereas a morning test would show your glucose level to be "high".

Researchers discovered that the afternoon test missed twice as many people with diabetes and nearly three times as many people with impaired fasting glucose compared to the morning test. Even a 2-hour shift in testing time may cause an inaccurate "normal" result in a person with blood sugar problems. The implication is this: If you had your blood drawn in the afternoon, and your fasting glucose was "normal" or at the high end of "normal", your blood sugar may actually be higher than you or your doctor think.

OUR RECOMMENDATIONS: We think it's a good idea to get more than one fasting glucose test before making major treatment decisions. And if you can, get your blood drawn in the morning.

Because many women with PCOS have blood sugar abnormalities, you should also get a glycosylated hemoglobin test (HbA1C), which measures the sugar level in your red blood cells. Because red blood cells live about 90 days, the HbA1C test gives you an average for your glucose levels over the past 90 days. If your HbA1C level is high or at the high end of normal, then it's clear you have a problem with chronically elevated blood sugar. We'll talk about other lab tests in future newsletters.

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2) WHAT DO PCOS AND OVARIAN CANCER HAVE IN COMMON?

It now appears that both PCOS and ovarian cancer are driven, in part, by the same dietary habits: eating lots of refined carbohydrates. A study of 2,411 Italian women was just published in the January 2003 issue of Annals of Oncology.(2) This study showed a direct association between the incidence of ovarian cancer, and the total glycemic load of the diet. Simply put, those women who ate the highest amount of carbohydrate, and who ate carbohydrates with the highest glycemic index, were most likely to get ovarian cancer. Similarly, carbohydrate excess contributes to PCOS. (The "glycemic index" is a ranking of foods based on their ability to raise blood sugar levels).

Dietary carbohydrates increase blood sugar and insulin levels, which in turn increases insulin-like growth factors, such as IGF-1. Growth factors are proteins that circulate in your body and tell your cells what to do. Chronically elevated insulin and insulin-like growth factors have been implicated as contributors to a variety of cancers and degenerative conditions.

Another recent study showed a direct and strong association between IGF-1 and ovarian cancer in women who were under 55 years old. This study is relevant to you because earlier studies have indicated that women with PCOS are likely to have elevated levels of IGF-1.(4) Therefore, because most PCOS women are younger than 55 and may have high levels of IGF-1, they have an increased risk of developing ovarian cancer.

For additional information on ovarian cancer, click here.

This article is not intended to scare you. However, ovarian cancer is seldom diagnosed until it's fairly advanced, and your odds of survival are not high. So it's wise to be proactive in reducing your risk.

BOTTOM LINE: PCOS is a serious, generalized metabolic syndrome, a disorder that is driven by multiple factors. We can't afford to compartmentalize PCOS and say it's an ovarian problem and has nothing to do with the rest of your body, or with other diseases and disorders. The PCOS that you see (lack of menses, hirsutism, obesity) is only the tip of the iceberg.

In our view, it's unwise to think you can take birth control pills and everything will somehow turn out all right. It probably won't. So if your doctor diagnoses PCOS, gives you birth control pills, and sends you out the door, you'll need to take responsibility for your own healthcare, in partnership with better-qualified doctor.

YOUR DIET. What diet is best for you is a huge topic that will be presented in our future book. It's too complex to talk about in this article. But you can pick up a few dietary tips in one our past newsletters.

We can also give you a general rule for carbohydrates: "go whole". By "whole", we mean unprocessed. We find that some women with PCOS still rely heavily on processed, fabricated, cooked, or packaged foods. These foods tend to be high in refined carbohydrates and undesirable fats such as trans fatty acids. They are also much lower in fiber and nutritional co-factors required for better blood sugar control.

In other words, do what you can to get closer to nature. For example, when you go to the store, the bulk of your carbohydrate purchases will be made in the produce department. Move on to the meat department, where you purchase fresh fish and poultry. You then go to the part of the store that has raw nuts, seeds and legumes. You may also decide to purchase some eggs and whole grains. Notice that none of these foods are processed or fabricated.

We fully understand the inconvenience involved in purchasing, preparing and eating whole, nutritious foods. But your body wants what is good for it, not what is convenient for you. There is no shortcut for getting PCOS out of your life.

Start your dietary program by switching from refined, processed foods to whole, fresh foods.

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3) "THE THIEF OF WOMANHOOD": WOMEN'S EXPERIENCE OF POLYCYSTIC OVARIAN SYNDROME, Kitzinger C, et al, Soc Sci Med, 2002, 54(3):349-61

ARTICLE SUMMARY: "Previous research on polycystic ovarian syndrome (PCOS) has overwhelmingly been conducted within a medical or psychiatric framework, and has failed to explore women's own experience of the syndrome. Interviews were conducted with 30 women with PCOS recruited through a national self-help organization."

"Thematic analysis of the interviews revealed pervasive reports of feeling 'freakish', 'abnormal', and not 'proper' women. These feelings were related to three symptoms commonly experienced by women with PCOS: 'excess' hair growth; irregular, absent or disrupted periods; and infertility. Smooth hairless bodies and faces, regular menstruation and the capacity to bear children were associated with femininity, and as a result of their symptoms women expressed feeling 'different' from other women and less 'feminine'. The results are discussed within a feminist framework and suggest that polycystic ovarian syndrome is a deeply stigmatizing condition, 'a theft of womanhood', with far reaching implications for all women, whether or not they conform to 'feminine' norms."

OUR COMMENTS: It's no secret to you how emotionally painful PCOS is. It's time for this aspect of PCOS to be recognized in the medical literature for the serious problem it really is.

There's a physical component to your emotional pain. A feeling of being out of control, or carrying negative emotions such as repressed anger leads to a prolonged physiological stress reaction. This reaction creates stress hormones, including cortisol.

Under chronic stress, cortisol levels in your body may remain high for long periods of time. Excessive cortisol interferes with insulin's ability to store blood sugar into tissues. The result is insulin resistance and hyperinsulinism, which many researchers think is the primary driving force behind PCOS. Insulin resistance also contributes to other disorders such as diabetes and heart disease.

How you process your feelings about your body and the reactions of people around you has a lot to do with your eventual outcome with PCOS. Look into various stress management techniques and start using them. They will help you to keep your cortisol hormone under control, and you will have a more optimistic outlook. A few common stress management methods are exercise, meditation, reading poetry, taking a walk, deep yogic breathing, deep relaxation, getting a good night's sleep, resolving emotional issues with others, and sharing your feelings with a good listener or psychotherapist. Stress management is a necessary part of your PCOS healing program.

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