PCOS Review Newsletter #17
Natural Health Ideas for Polycystic Ovary Syndrome
A free monthly newsletter for women with ovarian cysts or PCOS.
Issue #017 November 4, 2004
Nancy Dunne, N.D., Naturopathic Physician
Bill Slater, Research Associate
1) To Eat Less, Start a Meal with a Low-Calorie Salad
3) Chromium for Insulin Resistance and PCOS
4) Phthalates - A Wild Card in Infertility?
1) To Eat Less, Start a Meal with a Low-Calorie Salad
Here's a way to not worry about portion control at a meal. Eating a salad at the beginning of a meal may cause you to eat less food and thus cut calories without feeling deprived.
In a recent study, women were given different salads as a first course to a meal. The salads came in two sizes, 3 cups and 1-1/2 cups. Each size salad had 3 different amounts of cheese and salad dressing, so that each size salad had a low, medium, and high calorie version.
As compared to women who had no salad at all before a meal, the women who first had a "low calorie" large salad ended up consuming 12% fewer calories for the whole meal. Women who first ate a small low calorie salad consumed 7% fewer calories for the entire meal.
In contrast, those women who had a large high-calorie salad (lots of cheese and salad dressing) actually ended up eating 17% more calories in the meal than the women who ate no salad at all.
This study suggests that if you have a good-sized low-calorie garden salad before a meal, you will consume substantially fewer calories for the total meal.
If you find yourself eating more at a meal than you like, we recommend that you have a sizeable mixed garden salad first. Use only a small amount of dressing, or a dressing that is low in calories. Also, don't add cheese, ham, luncheon meats or other fatty animal foods. Some avocado is OK. Eat at least 2-3 cups of garden salad before starting the rest of your meal.
You may be pleasantly surprised to find that even though it feels like you're eating a lot of food, you'll actually be reducing your total calorie intake. The study suggests a 12% reduction in calories is possible, which is quite significant. Calorie reduction is a proven way to improve symptoms of PCOS.
Source: Rolls, BJ et al, Salad and satiety: Energy density and portion size of a first-course salad affect energy intake at lunch", J Am Dietetic Assoc, October 2004, 104(10):1570-1576
2) Hair Loss and PCOS
About 15% of American women have hair loss, also known as alopecia. Loss of hair or baldness occurs when hair falls out but new hair does not grow in its place. Loss usually develops gradually and may be patchy or diffuse (all over).
Loss of hair is more than a minor cosmetic problem. It has to potential to make you feel vulnerable (naked), and can cause unfavorable changes in how you feel about yourself.
The cause of the failure to grow new hair is not well understood, but in the case of women with PCOS (polycystic ovarian syndrome), excessively high levels of androgens (male hormones) are thought to be primarily responsible.
A male hormone called dihydrotestosterone (DHT), which is converted from testosterone, binds to sites on hair follicles and appears to make the follicles go into their "resting" phase sooner, which in turn starts to cause the hairs produced by those follicles to become thinner and thinner with each growth cycle.
For more information about the causes and treatment of hair loss, please visit our Hair Loss page.
3) Chromium for Insulin Resistance and PCOS
A small study of six women with PCOS (polycystic ovarian syndrome) and insulin resistance showed encouraging results with chromium supplementation. These women took 1000 mcg of chromium picolinate for two months, at which time their glucose disposal (insulin sensitivity) had improved by an average of 35%, and their baseline insulin levels fell by 22%. This is the only study we've found that deals specifically with PCOS.
We don't necessarily recommend that much chromium. The dosage depends on your needs and your dietary intake of chromium.
Learn more at our Chromium page.
Source: Lydic ML et al, Effects of chromium supplementation on insulin sensitivity and reproductive function in polycystic ovarian syndrome: A pilot study, Fertility and Sterility, 2003, 80(2):45-46
4) Phthalates - A Wild Card in Infertility?
Phthalates ("thal-ates") are high-production-volume synthetic chemicals found in innumerable plastics and other common consumer products. Recent epidemiologic evidence suggests that women have a unique exposure profile to phthalates, which raises concern about the potential health hazards posed by such exposures.
Globally, more than 18 billion pounds of phthalates are used each year, primarily as plasticizers in flexible polyvinyl chloride (PVC) products. Phthalates are found in most PVC products including vinyl upholstery, tablecloths, shower curtains, raincoats, and soft-squeeze children's toys. Phthalates are used as inert ingredients in many sprays including pesticides and many consumer products such as cosmetics and wood finishes. Phthalates are also used as adhesives, defoaming agents, solvents, and lubricants.
Phthalates are approved for use in medical devices such as tubing, blood bags, and dialysis equipment and is also used to manufacture the 500 million pairs of disposable medical exam and sterile surgical vinyl gloves produced annually. Phthalates are used to impart flexibility to plastics, but they leach from plastic products into the environment over time. Given their high production volume, common use, and widespread environmental contamination, humans are exposed to these compounds through ingestion, inhalation, and skin exposure on a daily basis.
The Agency for Toxic Substances and Disease Registry estimates that the maximum daily exposure to one of the phthalates, DEHP, is about 2 mg per day for the general population. However, occupational and medical exposures can reach much higher level.
A recent study by the Centers for Disease Control and Prevention found phthalate metabolites in the urine of more than 75% of subjects tested. The CDC study also found that women of reproductive age had significantly higher urinary levels of one of the phthalates than other sex/age groups. These higher levels may be due to the fact that phthalates are used in many beauty products including perfume, lotion, and nail polish. Thus, women have a unique exposure profile, which raises a concern about the potential health hazards posed by such exposures.
Limited studies in human populations suggest an association between phthalate exposure and adverse reproductive health outcomes. For example, chronic occupational exposure to high levels of phthalates is associated with decreased rates of pregnancy and higher rates of miscarriage in female factory workers. Higher urinary phthalate levels correlated with pregnancy complications such as anemia, toxemia, and preeclampsia in women living near a plastics manufacturer.
Although occupational exposure is limited to a select population, women have exposures to phthalates in beauty and consumer products on a daily basis. During pregnancy and delivery, both the mother and fetus may be exposed to phthalates through medical devices. Exposure to the fetus in utero is a concern because some phthalates are developmental toxicants. Puerto Rican girls with premature breast development had higher levels of blood phthalates compared to other girls, suggesting an association between phthalate exposure and abnormal reproductive development.
Research with lab animals has shown that phthalates interfere with the ovary's ability to produce estrogen and thus prevent ovulation. Some animals also developed polycystic ovaries. What exactly phthalates do in the ovaries isn't entirely clear, but they may disrupt the timing of the growth and differentiation of the follicle so that it "skips" the ovulatory phase and goes into the post-ovulatory phase without ovulation actually occurring.
In addition, your liver has to work hard to detoxify phthalates. In this process, oxidant stress (production of damaging free radicals) can result. The risk of potential liver cancer is also increased. There is also some concern that phthalates could lead to defects in the developing fetus.
Is there a "safe" level of phthalates? No one really knows. But all the news so far is bad and none of it good. One common phthalate (DEHP) has been removed from children's products intended for mouthing, such as pacifiers. In our view, the less exposure you have, the better -- especially if you are trying to get pregnant or are pregnant now.
You can reduce your exposure by being observant. Notice what plastic or synthetic products you come in contact with. Do you know what is in the cosmetics you are using? When you open a sealed consumer product, do you detect a slight plastic or chemical smell? Do you use vinyl gloves in your job? Did you let that new plastic raincoat air out in the sun before putting it into the closet?
There's no need to be paranoid about plastics and petrochemical pollution. On the other hand, total inaction is clearly not a good option. Chemical pollution of our environment is a developing threat to your reproductive and overall health. Therefore, you should take some steps to minimize your exposure. You can also help your liver to metabolize and detoxify some of these chemicals by taking vitamin/mineral supplements that help your liver do this important job (more on this in a future newsletter).
Source: Lovekamp-Swan T et al, Mechanisms of phthalate ester toxicity in the female reproductive system, Environ Health Perspect. 2003 Feb;111(2):139-45
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