PCOS Review Newsletter #5
Natural Health Ideas for Polycystic Ovary Syndrome
A free monthly newsletter for women with ovarian cysts or PCOS.
Issue #005 October 25, 2002
Nancy Dunne, N.D., Naturopathic Physician
Bill Slater, Research Associate
1) All About Metformin (Glucophage)
4) What is Insulin Resistance?
5) How Do I Know if I Have Insulin Resistance?
6) Is Insulin Resistance Genetic?
7) How to Lessen Insulin Resistance
7-B) Don't Obsess About Losing Weight
7-D) Use Carefully Selected Supplements
8) Long-term "Pill" Users Are Just as Fertile as Others
1) ALL ABOUT METFORMIN (GLUCOPHAGE)
Hello!
Many of you have contacted us about the use of metformin (Glucophage) to help you with insulin resistance, infertility and other PCOS problems. We've put up a web page that outlines the benefits and risks of metformin. If you go to this web page, you will get a lot of your questions answered.
www.ovarian-cysts-pcos.com/glucophage-metformin-pcos.html
In this issue of PCOS Health Review, we offer some suggestions for improving insulin resistance. Insulin resistance is one of the root causes of polycystic ovary syndrome and contributes to infertility.
3) THE CAUSES OF INFERTILITY
Infertility is a very distressing disorder. It is also very complex to deal with.
In general, infertility falls into one of five categories:
- Ovarian disorders: 20-25% of infertility - disturbances in the production and release of eggs.
- Male factor: 40-50% of infertility - inadequate sperm quality, function or motility; this category also includes couples who are unable to have intercourse due to injuries or for other reasons).
- Pelvic factor: 20-25% of infertility - including uterine abnormalities, fibroid tumors, blocked fallopian tubes, endometriosis and/or pelvic adhesions.
- Cervical factor: 5% of infertility - abnormalities with the cervix that hamper sperm movement.
- Unexplained infertility: 10-15% of infertility - infertility that remains undefined in spite of an extensive medical evaluation.
It's not uncommon for couples to have a combination of two or more of the above causes of infertility. Even though your primary concern is about ovarian problems (the first category), you should remain aware of the additional causes of infertility.
The inability of some women with PCOS to produce and release an egg is due to a complex web of multiple hormone disorders. They include insulin, androgens, estrogens, progesterone, luteinizing hormone, follicle stimulating hormone, adrenal hormones, thyroid hormones, prolactin, and others. All of these hormones influence each other in some way. Therefore, if you can optimize any one of them, you are taking a step towards optimizing the others and increasing your chances of becoming fertile.
In this issue, we'll focus on insulin and insulin resistance. If you can lessen insulin resistance, you improve your chances of becoming pregnant.
4) WHAT IS INSULIN RESISTANCE?
Insulin is a hormone that performs many functions in your body. One of its primary functions is to help transfer glucose (blood sugar) from the blood into the cells where it is stored. Insulin resistance occurs when your cells don't follow insulin's instructions to accept blood sugar. Your pancreas then tries to compensate for this problem by increasing its insulin production, resulting in hyperinsulinemia, or too much insulin in the blood. A chronic high level of insulin is a very serious health problem that you must handle.
Insulin resistance is a contributing factor to:
- Polycystic ovary syndrome
- Infertility
- Hirsutism
- Obesity
- Diabetes
- High blood pressure
- Cardiovascular disease
- Inflammatory disorders
- Cancer
- Other degenerative disorders
- Shortened lifespan.
Insulin resistance is a big problem for women with PCOS because it is “selective”. Your muscle and fat cells can be insulin resistant while other types of cells and organs are not. For instance, your pituitary, ovaries and adrenal glands may be over-stimulated by high levels of insulin, thus increasing androgens and luteinizing hormone. This hormonal imbalance may render you infertile, in addition to creating other health problems.
5) HOW DO I KNOW IF I HAVE INSULIN RESISTANCE?
You may have insulin resistance if you have three or more of these clinical markers.
- High blood pressure chronically over 140/90 (optimal is 120/80).
- 15 or more pounds over your ideal weight.
- Triglycerides over 160 (optimal is less than 100).
- Total cholesterol over 240 (optimal is 180-200).
- HDL “good” cholesterol less than 1/4 of total cholesterol.
- Fasting glucose over 115 (optimal is less than 100).
6) IS INSULIN RESISTANCE GENETIC?
It's thought that perhaps 50% of people have an inherited propensity for insulin resistance. You may be in this group if you have a family history of diabetes, cardiovascular disease, hypertension or PCOS. The other 50% who develop insulin resistance probably do so because of unhealthy diet, no exercise, and obesity.
Although obesity is a major risk factor, lean women with PCOS can also have insulin resistance.
Although you can't change your genes, there's plenty you can do to change how they behave. What you eat, whether you exercise, how well you sleep, how you manage stress, and the pollutants you are exposed to will directly influence what your genes do. So to a great extent, insulin resistance can be controlled by you.
7) HOW TO LESSEN INSULIN RESISTANCE
7-A). EXERCISE!
As we've said before, any exercise is beneficial, for a multitude of reasons. However, you may need to increase the intensity of your exercise to get the desired effect. A recent study reported that intense aerobic exercise for 30 minutes at least 5 times a week improves insulin sensitivity. Women who exercised less or not at all didn't have an improvement in insulin sensitivity. Of course, we strongly recommend you consult with your physician before starting any exercise program.
We also recommend that you be as physically active as you possibly can. Take the stairs instead of the escalator or elevator. When shopping, park farther away from the store door. Develop active recreational activities such as gardening. If you have a desk job, get up every hour or two and briskly walk around the office building.
7-B) DON'T OBSESS ABOUT LOSING WEIGHT.
In our view, it's more important to lose inches than weight.
First of all, overweight women with PCOS appear to have a genetic predisposition that makes it more difficult for them to lose weight. So you need to be patient and very persistent with your physical activity program. There's no need for you to get discouraged if you don't lose 30 pounds in 30 days. (In fact, we discourage such extreme measures).
A better indicator of progress is your percentage of body fat, which is the ratio of fat to lean body mass. For example, if you compare two women of the same height and weight, but one has a body fat percentage of 25% and the other has 50%, you will notice how different they look. The woman with the lower body fat percentage will be noticeably smaller, even though she is the same weight. One reason is that muscle is heavier than fat. The other reason is that muscle cells are smaller than fat cells.
Regular exercise causes your muscles cells to multiply, and they get better at burning fat. So building muscle mass actually adds to your weight. However, your fat cells shrink as you burn up stored fat. You will still have all of your fat cells, but they will be smaller, and thus you lose fat weight. In other words, consistent exercise helps you to gain muscle weight and lose fat weight. So long as you are doing that, you are heading in the right direction.
We recommend that you get a periodic body fat percentage test from your health practitioner or health club.
7-C) IMPROVE YOUR DIET
We gave you some dietary advice in our August newsletter. To
review that information, please go to the PCOS Health
Review archive
.
Here, we'll just give you a quick reminder to increase your consumption of omega-3 fats. Among other benefits, omega-3 fatty acids help to reduce obesity and improve insulin sensitivity. This in turn improves your odds of becoming fertile. Common sources of omega-3 fats are fish, cod liver oil, and EPA/DHA capsules.
Again, we warn you to avoid trans-fats, which are listed on package labels as “partially hydrogenated” oils. However, other processed but unlabeled foods such as baked goods may also contain trans-fats. We haven't yet come across any human studies, but in one study of female pigs, the group consuming a trans-fat diet had fertility problems while the groups consuming either lard or omega-3 fats did not.
7-D) USE CAREFULLY SELECTED SUPPLEMENTS
Medical studies have demonstrated that people who are insulin resistant or have diabetes are lacking in vitamins, minerals, essential fatty acids and other specialty nutrients. These lacks contribute to insulin resistance and blood sugar problems.
Your doctor may say that there's no need for supplementation because you get all you need from your food. The facts don't support this assertion. Studies have clearly shown that our food supply is not as nutrient-dense as it used to be.
Modern agricultural practices, soil depletion and food processing have stripped away a lot of the nutrients you need to prevent insulin problems and be healthy. Moreover, our busy lifestyle doesn't allow us the time needed to prepare nutritious meals. Instead, we eat prepared meals or processed convenience foods. Unless you're growing and preparing your own food, it's not likely you're getting everything you need from your diet.
In a future issue (and in our book), we'll talk about some of the supplements that will help you deal with insulin resistance.
8) LONG-TERM 'PILL' USERS ARE JUST AS FERTILE AS OTHERS
ARTICLE TITLE: Prolonged use of oral contraception before a planned pregnancy is associated with a decreased risk of delayed conception, Farrow, A et al, Hum Reprod, 2002, (10):2754-2761
The aim of this study was to investigate the association of total duration of oral contraceptive usage with time to conception. This was a prospective study of 8,497 planned pregnancies drawn from a population expecting a baby in a 21 month period.
Of the participants, 74% conceived in </=6 months, 14% in 6-12 months and 12% after 1 year. Previous prolonged oral contraceptive usage was statistically significantly associated with a decreased risk of delayed conception. Prolonged use of oral contraception was also associated with improved fecundity independent of other factors.
ARTICLE CONCLUSIONS: Women who have prolonged use of oral contraceptives might be reassured that they will not be disadvantaged in terms of time taken to achieve conception.
DR. DUNNE'S COMMENTS: Women who take birth control pills for at least 5 years are able to conceive just as easily as non-users when trying to get pregnant. The study also suggested that long-term users were likely to get pregnant sooner than non-users. The reason isn't known, but the study authors speculated that long-term use of the pill increases iron stores in the body, which may account for the increased ability to get pregnant.
This study contradicts some earlier studies in which women took birth control pills for shorter periods of time. However, this new research should reassure women who wonder if taking birth control pills might actually make them less fertile.
However, still unanswered to my satisfaction are questions regarding a suspected connection between oral contraceptives and worsening glucose metabolism. Oral contraceptives are not a solution to the causes of or the problems ensuing from PCOS. The fact that taking contraceptives over the long term does not seem to affect fertility in this study population is good news. I am not convinced oral contraceptives are 100% beneficial for women with PCOS.
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