PCOS Review Newsletter #15
Natural Health Ideas for Polycystic Ovary Syndrome
A free monthly newsletter for women with ovarian cysts or PCOS.
Issue #015 August 31, 2004
Nancy Dunne, N.D., Naturopathic Physician
Bill Slater, Research Associate
2) Bread & Refined Carbs May Lead to PCOS Acne
4) Is Liposuction an Option for PCOS Weight Problems?
1) Vitamin D for PCOS
Women with PCOS (polycystic ovarian syndrome) may also have varying degrees of insulin resistance and an increased incidence of diabetes.
Over the past 30 years, numerous studies have established a role for calcium in egg maturation and normal follicular development. PCOS is characterized by hyperandrogenic chronic anovulation (lack of ovulation) due to excess androgens (masculinizing hormones), ovarian theca cell overgrowth, and arrested follicular development.
Vitamin D plays a crucial role in calcium absorption and regulation. A study conducted at Columbia University investigated whether vitamin D and calcium dysregulation contribute to the development of follicular arrest in women with PCOS, resulting in reproductive and menstrual dysfunction.
They studied 13 women who had chronic anovulation, hyperandrogenism and vitamin D insufficiency. Nine had abnormal pelvic sonograms with multiple ovarian follicular cysts. All were hirsute, two had hair loss, and five had acanthosis nigricans.
Vitamin D combined with calcium supplementation resulted in normalized menstrual cycles within 2 months for seven women. Two became pregnant and the others maintained normal menstrual cycles. These data suggest that abnormalities in calcium balance may be responsible, in part, for the arrested follicular development in women with PCOS and may contribute to the pathogenesis of PCOS.
Two other recent studies have shown that vitamin D deficiency may be a contributing factor to insulin resistance and diabetes, both of which are problems for women with PCOS. These and other studies suggest that vitamin D plays a role in the secretion, and possibly the action, of insulin. People with diabetes tend to have lower vitamin D levels. See our July 2004 issue for more details about one of theses studies.
You can increase your vitamin D levels by exposing your skin to more sunlight. You can also take a vitamin D supplement. However, since vitamin D is toxic in high doses, it's wise to get your vitamin D level measured with a blood test, or consult with a licensed naturopathic physician.
Sources:
Thys-Jacobs S, et al, Vitamin D and calcium dysregulation in the
polycystic ovarian syndrome, Steroids. 1999 Jun;64(6):430-5.
2) Bread & Refined Carbs May Lead to PCOS Acne
There is a link between acne and what you eat.
Eating highly processed, easily digestible foods such as refined breads and cereals causes an undesirable chain reaction in your body. First, there is an increased amount of sugar. In turn, this excess sugar forces your body to produce high levels of insulin and insulin-like growth factor (IGF-1).
Elevated insulin levels lead to an excess of masculinizing hormones, which cause pores in your skin to secrete sebum, a greasy substance that attracts acne-promoting bacteria. In addition, IGF-1 promotes the multiplication of skin cells known as keratinocytes, a process associated with acne.
Previous evidence has shown a link between insulin or IGF-1 and acne. It has been found that when IGF-1 is used to treat certain illnesses, masculinizing hormones increase, followed by acne. On the other hand, when women with PCOS were treated with the insulin-reducing drug metformin, acne was improved. Moreover, many women with acne problems overproduce insulin and IGF-1, researchers say.
If you have acne, a low-carbohydrate, low-glycemic diet may be appropriate. Modern food processing methods may alter the protein structures in the grains, leading to faster digestion followed by excess releases of insulin.
Source: Cordain L et al, Acne vulgaris: a disease of Western civilization., Arch Dermatol.,2002;138(12):1584-90
3) Milk-Acne-PCOS Connection
In addition to avoiding refined carbohydrates and highly processed foods, a recent report suggests that you may also think about how much milk you are consuming.
Acne may be caused in large part by the male hormone 5alpha-dihydrotestosterone, which turns on oil-making cells in the skin of both men and women. Cow’s milk contains 5 alpha-reduced steroids and other hormones that can be broken down to dihydrotestosterone. The enzymes necessary to convert the hormones to dihydrotestosterone are present in your oil glands.
These hormones in cow’s milk are particularly high in pregnant cows, which make up 75%-90% of the dairy milk market. High milk intake has been shown to increase blood levels of insulin-like growth factor-1 (IGF-1). High IGF-1 levels are believed to promote acne through hyperkeratinization, a multiplication of skin cells associated with acne.
In a study of 6,500 adolescent offspring from the Nurses’ Health Study II, results showed a significant positive association between milk consumption and acne. The relationship was independent of the fat content of the milk.
Other foods with a positive association included milk-based instant breakfast drinks, sherbet, cottage cheese and cream cheese, but not other dairy foods or foods such as french fries, chocolate candy or pizza.
According to Dr. William Danby, a dermatologist who spoke at the Atlantic Dermatological Conference, “Milk is designed to make things grow. Human beings are the only animal to continue to drink milk beyond infancy, and it is not even the milk of our own species. Young growing humans need milk from pregnant cows just as much as young growing cows need milk from pregnant humans - not at all.”
Many women attempt to minimize PCOS symptoms by reducing the carbohydrate content of their diet and by increasing dairy consumption, since dairy is high in protein and has no carbs. This article suggests that milk products may not give you the results you're looking for. We suggest you increase consumption of fresh vegetables and get some of your animal protein from fish, poultry and egg whites. Refined grain and dairy products are ubiquitous and convenient. But they are not necessarily healthy.
Source: Mahoney D, Got Milk? Got Acne? New Research Suggests Link, Family Practice News, June 1, 2004:54.
4) Is Liposuction an Option for PCOS Weight Problems?
If you're quite overweight and haven't been able to lose weight, you may have considered liposuction as a last resort. Liposuction is the surgical removal of abdominal fat.
If you could just get rid of a lot of fat cells, perhaps you think you could get back to normal. However, a recent study published in the New England Journal of Medicine indicates that liposuction may not be a good idea.
The study evaluated women with abdominal obesity and varying degrees of insulin resistance. Liposuction decreased the volume of subcutaneous abdominal adipose (fat) tissue by 28%-44%.
However, liposuction did not significantly affect the insulin sensitivity of muscle, liver, or fat tissue. Nor did it favorably alter coronary heart disease risk factors, including blood pressure and plasma glucose, insulin and blood fat concentrations.
This study showed that abdominal liposuction did not significantly improve obesity-associated metabolic abnormalities. PCOS is a fundamental metabolic disorder that cannot be cured by liposuction. Reducing adipose tissue mass by itself does not achieve the same metabolic benefits as weight loss does.
When we say "weight loss", we mean loss of fat while retaining or increasing muscle mass. Regular exercise and a healthy diet is the best approach to healthy weight loss. Keep in mind that muscle is heavier than fat. So your total weight may not go down much, but so long as you are losing fat and building muscle, you're on the right track for reducing insulin resistance, normalizing your hormones and reducing some of your PCOS symptoms. To know how much body fat you are carrying (or losing), you can get a "body fat percentage" test from your doctor or possibly at your local gym.
Source: Klein S, Fontana L, et al, Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease, N Engl J Med, June 17, 2004;350(25):2549-2557
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