PCOS Review Newsletter #1
Natural Health Ideas for Polycystic Ovary Syndrome
A free monthly newsletter for women with ovarian cysts or PCOS.
Issue #001 June 21, 2002
Nancy Dunne, Naturopathic Physician
Bill Slater, Research Associate
2) What is a Naturopathic Doctor?
3) Polycystic Ovarian Association Conference
4) The PCOS - Metformin - Heart Disease Connection
5) Vitamin E, PCOS, and Heart Disease
6 "Taking Charge of Your Fertility"
1) INSPIRED FROM THE HEART.
I am happy to launch this new resource for women with PCOS. Over the past twelve years, I've been a practicing physician and have worked with women with polycystic ovary syndrome (PCOS) and related health problems.
Working with these women has awakened me to the fact that some of my own health issues are related to insulin resistance and abundant androgens (male hormones). Since my teens, I've personally struggled with my weight, with acne and with being decidedly hairy. I sought solutions in all the ways that are familiar to each of you - with the same disappointing results.
However, like a lot of women, it took a threat to a loved one to really grab my attention. My 20-year-old daughter's menstrual difficulties and persistent acne have recently been diagnosed as aspects of PCOS. I've found myself focusing all of my resources on providing her with the best information about treatments and practices to address the experience of living with PCOS. My goal is to share this knowledge with you.
2) WHAT IS A NATUROPATHIC DOCTOR?
I'm a licensed naturopathic physician. Naturopathic physicians are general practitioners trained as specialists in natural medicine. We treat disease and restore health by using clinical nutrition, herbal medicine, homeopathy, physical medicine, exercise therapy, counseling, acupuncture and other modalities.
Naturopathic physicians perform physical exams, like your annual GYN exam or your kid's soccer physical. We order standard laboratory tests to check your blood sugar, cholesterol and hormone levels, as well as specialty tests like nutritional and dietary assessments, metabolic analysis and allergy tests. We are the only primary care physicians clinically trained in the use of a wide variety of natural therapies.
3) POLYCYSTIC OVARIAN ASSOCIATION CONFERENCE
We attended the Polycystic Ovarian Association (PCOSA) annual conference a few weeks ago. It was a wonderful conference. The PCOSA is a non-profit organization created by women who have PCOS. Its purpose is to serve and support women with PCOS. It's an excellent resource for you.
If you're not a member of PCOSA and you have PCOS or any of its symptoms, we urge you to join this outstanding group of women. Their website is:
At the conference, we had an opportunity to meet many women with PCOS and hear their stories. We also heard MDs and other health professionals share their knowledge about PCOS and how to deal with it. We'll share some of that information in future newsletters.
4) THE PCOS - METFORMIN - HEART DISEASE CONNECTION
Every year cardiovascular problems claim more women's lives than the next fourteen causes of death combined. One in five develop some type of heart or blood vessel disease, including high cholesterol, atherosclerosis, high blood pressure, stroke, congestive heart failure and heart attack.
Women with PCOS are at greater risk than the general female population for developing cardiovascular disease (1, 2). There are several ways the increased risk can occur. We'll just explore one of them in this article.
One of the features of PCOS is *insulin resistance*, where excessive amounts of insulin hormone are required to store blood sugar into cells. Doctors commonly prescribe the insulin- sensitizing drug metformin for women with PCOS or diabetes. Metformin helps PCOS women to normalize insulin and glucose, and may even play a role in inducing ovulation and reducing male hormone levels (3).
But there is at least one major problem with metformin. It may interfere with absorption of essential nutrients in your GI tract. Medical studies spanning the last twenty years have shown that metformin causes malabsorption of vitamin B12 (4).
Metformin interferes with the calcium-dependent cell membranes in your gut that absorb vitamin B12. A recent study has shown that taking a calcium supplement reverses this problem, thus improving your B12 absorption (4). Many studies have shown that B12, B6 and folic acid supplementation will help correct problems created by poor diet and malabsorption problems.
Vitamin B12 is essential to the proper growth and function of all the cells in your body. It's required for synthesis of DNA and for many crucial biochemical functions. A long-term B12 deficiency can show up as a neurological problem with the spinal cord, brain, and peripheral nerves. However, neurological symptoms are by no means the only health problem associated with B12 deficiency. There is also a link between B12 deficiency and cardiovascular disease.
Vitamin B12, along with vitamin B6 and folic acid (another B vitamin), is responsible for metabolizing homocysteine into less potentially harmful substances (5). Homocysteine is an amino acid found in the blood. A normal amount is OK.
But over eighty medical studies have shown that elevated homocysteine greatly increases the risks of developing clogged arteries in the heart or brain, as well as the vessels of the legs and arms. Elevated homocysteine has been found in diabetics (6) and in women with PCOS (7, 8).
If you are taking metformin on a long-term basis, if you have PCOS, and if you are at risk for developing diabetes, you should be taking supplemental vitamin B12, B6, and folic acid. These B vitamins are a natural way for you to metabolize homocysteine and help reduce your risk for developing cardiovascular disease.
In summary, here's what we recommend:
First, take a high quality multiple vitamin-mineral. The calcium in it should help with B12 absorption. The B vitamin levels in your multi should be in the 50-100 milligram (mg) range for a daily total. The exceptions are B12 and folic acid, which are measured in micrograms (mcg). A reasonable amount of B12 is 500-1,200 mcg, and 400 mcg of folic acid. One study has indicated that taking as little as 250 mcg of folic acid daily should reduce homocystiene levels to safe ranges in women taking metformin (9).
Second, consumption of whole foods will increase your levels of all the B vitamins needed to reduce homocysteine and to generally improve your health. Eat fresh vegetables and fresh fruit daily. Try for 3-4 servings of fish per week. Legumes (beans and peas), and moderate amounts of raw nuts and seeds will also contribute to your better health.
Third, reduce your intake of all refined, manufactured foods. We'll have a lot more to say about a healthy diet in future newsletters, and in our forthcoming book, *Natural Solutions for PCOS*.
5) VITAMIN E, PCOS, AND HEART DISEASE
Vitamin E is a key nutrient for PCOS women to take - in addition to a multiple vitamin-mineral.
Vitamin E is a generally safe and potent supplement that ameliorates problems associated with PCOS, diabetes and heart disease. Women at high risk for stroke or bleeding problems should be aware that high amounts of Vitamin E can worsen their problems.
A reasonable amount of vitamin E is 400-800 IU daily. There are various forms of vitamin E, called *alpha*, *beta*, *delta* and *gamma* tocopherols. Most supplements have only the *alpha* form because that is the least expensive. The *alpha* form is beneficial, but not nearly as beneficial as all the forms together. All the forms together are called *mixed tocopherols*. They have more health benefits but are also more expensive. As with most products, *you get what you pay for* when you buy supplements. So don't buy the cheapest vitamin E you can find; it may not be as effective for you.
Women with PCOS have a higher risk of developing diabetes. Diabetics suffer damage to blood vessels, especially in the eyes and kidneys. Long-term use of vitamin E has been shown to strengthen major blood vessels in diabetics (10). Vitamin E also improves insulin action in non-insulin-dependent diabetics (11).
Recent studies suggest long-term vitamin E supplementation in men reduces androgens (male hormones) (12, 13). Women with PCOS generally have excessive levels of male hormones, which cause hirsutism and other problems. While we should be cautious about applying male data to females, we might speculate that vitamin E could have an ameliorating effect on male hormones in PCOS women.
Vitamin E supplementation has also been useful in correcting estrogen deficiency states such as hot flashes. Hot flashes are associated with high levels of luetinizing hormone (LH). High LH is also a feature of polycystic ovary development.
We need more research to clarify the relationship between vitamin E and hormones. Meanwhile, don't wait. Regular, long-term use of supplemental vitamin E clearly benefits your health.
6) TAKING CHARGE OF YOUR FERTILITY: THE DEFINITIVE GUIDE TO NATURAL BIRTH CONTROL AND PREGNANCY ACHIEVEMENT
by Toni Weschler, MPH, HarperCollins Books New York, 2002 $23.95
"How wonderful to know that control can be returned to where it belongs", said another reviewer of Weschler's detailed and easily-understood book about your reproductive life. We agree!
This comprehensive book explains how to practice the fertility awareness method (FAM). By using simple fertility signs, including peaks in morning body temperature and changes in cervical position and cervical mucus, you can determine when ovulation is occurring. FAM is a valuable tool for those who are trying to conceive.
Infertile women who used the FAM technique have reported to Ms. Weschler that by filling in the detailed charts in the book, they realized they were chronically miscarrying, even when their doctors told them they were not conceiving at all. The book explains how to chart body temperature so that it's easy to tell when a pregnancy has occurred - and when there's danger of miscarriage.
This must-have book answers most questions you would have about your reproductive life. It provides you with information and vocabulary that will help you to more effectively interact with your doctor. The book is also a valuable resource for teens.
FOOTNOTES
1. Talbott, E et al, Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study, J Clin Epidemiol, 1998; 51:415-422.
2. Wild, R.A., Metabolic aspects of polycystic ovary syndrome, Semin Reprod Endocrinol, 1997 May;15(2):105-10 3. Bloomgarden, ZT et al, Use of insulin-sensitizing agents in patients with polycystic ovary syndrome, Endocr Practt, 2001, 7(4):279-86
4. Bauman, WA et al, Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin, Diabetes Care, 2000, 23(9):1227-31
5. Selhub, J, Folate, vitamin B12 and vitamin B6 and one carbon metabolism, J Nutr Health Aging, 2002, 6(1):39-42
6. Yeromenko, Y et al, Homocysteine and cardiovascular risk in patient with diabetes mellitus, Nutr Metab Cardiovasc Dis, 2001, 11(2):108-16
7. Loverro, G et al, The plasma homocystein levels are increased in polycystic ovary syndrome, Gynecol Obstet Invest, 2002, 53(3):157-62
8. Vrbikova, J et al, Homocysteine and steroids levels in metformin treated women with polycystic ovary syndrome, Exp Clin Endocrinol Diabetes, 2002, 10(2):74-6
9. Aarsand, AK et al, Folate administration reduces circulating homocysteine levels in NIDDM patients on long-term metformin treatment. J Intern Med 1998 Aug;244(2):169-74
10. Paolisso, G et al, Chronic vitamin E administration improves brachial reactivity and increases intracellular magnesium concentration in type II diabetic patients, J Clin Endocrinol Metab, 2000, 85(1):109-15
11. Ceriello A, Oxidative stress and glycemic regulation, Metabolism, 2000, 49(2 Suppl 1):27-9
12. Hartman, TJ et al, Effects of long-term alpha-tocopherol supplementation on serum hormones in older men, Prostate, 2001, 46(1):33-8
13. Zhang, Y et al, Vitamin E succinate inhibits the function of
androgen receptor and the expression of prostate-specific antigen
in prostate cancer cells, Proc Natl Acad Sci USA, 2002,
99(11):7408-13
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