By Breea Johnson, MS RD

Women with PCOS (polycystic ovary syndrome) may endure a lot to get pregnant – from utilizing medications to induce ovulation to undergoing IVF – all while experiencing the typical PCOS symptoms. But, does PCOS also impact miscarriage rates? Pregnancy loss rates amongst women with PCOS have been reported to be as high as 30% to 50%, but some research has shown that information to be conflicting. In a recent study, women with PCOS were found to have a 2-fold increase of miscarriage loss after undergoing ART (IVF or IUI) (Chason et al, 2010).  While not the 30-50%  reported previously, the rate found by Chason et al.  is pretty substantial considering the general reproductive population has about an 11% miscarriage rate.  PCOS has also been found in approximately 40% to 80% of women with recurrent miscarriages (Palomba et al, 2009).

Insulin levels also seem to play a factor in miscarriage, as studies have shown that Metformin has positive effects on reducing miscarriage rates in women with PCOS.  In a study comparing three groups of women with PCOS on Metformin, all rates of miscarriage decreased while on Metformin but the groups that stopped at 8 weeks and 12 weeks had a statistically significant drop in miscarriage rates while the group that stopped immediately after a positive pregnancy diagnosis did not have a statistically significant drop (from roughly 20-40% down to 4-8%). However, a meta-analysis of randomized controlled trials showed that preconception intake of Metformin did not have a beneficial effect on reducing miscarriage rates in women with PCOS (Palomba et al, 2009). The research is still very limited in this area.

Factors in women with PCOS that may be contributing to increased miscarriage rates include higher Lutenizing Hormone (LH) levels which can be increased by elevated insulin. Elevated testosterone levels, obesity, insulin levels and infertility treatments are also factors that may be involved (Palomba et al, 2009). Many of these altered hormone levels seen frequently with PCOS are greatly affected by diet and lifestyle and may be improved through working with a nutritionist.  Acupuncture has also been used to minimize the chance of miscarriage.  Please call Pulling Down the Moon at (312) 321-0004 or visit our website at www.pullingdownthemoon.com for more information.

Chason et al. A Diagnosis of Polycsytic Ovary Syndrome (PCOS) is associated with an increased likelihood of pregnancy loss with Assisted Reproduction.  October 2010.

Palomba et al. Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Fertility Sterility. 2009.

Margaret Wertheim M.S., R.D., L.D.N.

By Margaret Wertheim M.S., R.D. , L.D.N.

When most people hear the word “inflammation,” they think of a swollen ankle, red and irritated eyes, or the pain of an injury. This is called acute inflammation which occurs over a short period of time and is a helpful process in the body in response to any sort of trauma or injury. This type of inflammation helps to promote healing and prevent infection. On the other hand, prolonged or chronic inflammation in the body is harmful and is associated with many health conditions including PCOS, type II diabetes, and cardiovascular disease.

As Breea discussed in her earlier post entitled The Many Faces of PCOS, women with PCOS have differing characteristics. PCOS is present not only in overweight women, but also in normal weight women. According to a 2009 study in the journal Metabolism, levels of inflammatory markers in the blood are increased not only in overweight or obese women with PCOS but also in normal weight women with PCOS compared to women who do not have PCOS. For certain markers of inflammation, having PCOS and being obese increased inflammatory marker levels even more. This increase in chronic inflammation in PCOS is concerning, because chronic inflammation is associated with increased risk for cardiovascular disease as well as problems with fertility.

Another study from the journal Mediators of Inflammation notes that pathways in the body involved in blood sugar regulation overlap with pathways involved in inflammation which may explain a relationship between blood sugar regulation and inflammation in PCOS. Insulin resistance exists in obese and normal weight women with PCOS, but obesity worsens the insulin resistance much the same as obesity worsens the inflammation in PCOS. These results make a strong case for the beneficial role of weight loss if needed in PCOS. The importance of decreasing this chronic inflammation cannot be overemphasized, because not only may it be helpful for managing PCOS and improving fertility, but also in the prevention of cardiovascular disease.

While the cause and best treatment for PCOS has yet to determined, the research indicates that insulin resistance, blood sugar regulation, inflammation, and hormone levels appear to be linked. The nutritionists here at Pulling Down the Moon can help you to implement changes to your diet and/or recommend supplements which can help you to lose weight if needed, better regulate your blood sugar, and decrease the inflammation associated with PCOS which may help to improve your chances of conception and decrease your risk for cardiovascular disease.

References:

1. González F, Rote NS, Minium J, Kirwan JP. Evidence of Proatherogenic Inflammation in Polycystic Ovarian Syndrome. Metabolism; 2009 July; 58(7):954-962.

2. Sathyapalan T, Atkin SL. Mediators of Inflammation in Polycystic Ovary Syndrome in Relation to Adiposity. Mediators of Inflammation

; 2010.

By Breea Johnson, MS RD

In the world of PCOS, most people are familiar with the common recommended medications such as Metformin and the birth control pill to help regulate the cycle and sensitize the body’s tissues to insulin (helping to lessen insulin resistance). While research shows benefits of these medications there are still many side effects that some women do not want to risk.

At Pulling Down the Moon, we recommend FlowPro (if you visit this page, click on the research tab for a summary of the studies that have been done) for PCOS, as the nutritional supplement contains myo-inositol and magnesium that when taken daily have been shown to restore ovulation and menstruation in some women. Myo-inositol can be synthesized by the body from other nutrients but when deficient can impact the ability of the body to be sensitive to insulin. Supplementation with myo-inositol in women has been clinically shown to lower levels of circulating insulin and testosterone, promote ovulation, improve egg quality, improve hirsutism and acne, and lower the risk of ovarian hyperstimulation during an IVF cycle. Some research has found it to be equally effective as Metformin in restoring ovulation.

Another closely-related and popular supplement for PCOS is D-Chiro Inositol (DCI). There are actually nine different forms of inositol (part of the B-vitamin complex), with DCI and Myo-inositol being the two most heavily researched in conjunction with PCOS and insulin sensitivity. There has been no research comparing the effects of both supplements for PCOS, however, both have been found to be beneficial in helping insulin sensitivity.

Do you have PCOS? Have you tried Myo-inositol or D-Chiro Inositol to help manage symptoms? Please feel free to post your stories here. Thanks!

By Breea Johnson, MS RD

When most people hear the term “insulin” they immediately think of someone with diabetes- not knowing why or how they use insulin but knowing that something with their levels just isn’t right. Most diabetics in this country have Type II diabetes which is developed later in life and usually attributed to “insulin resistance.” Insulin resistance is also common in PCOS (Polycystic Ovary Syndrome), as a large percentage, but not all, of women with PCOS also have insulin resistance.

To understand insulin resistance it is first important to understand how glucose and insulin work together to provide energy for our body. Glucose is derived from the food we eat. Carbohydrates break down most efficiently into glucose.  Protein and fat eventually can eventually convert to glucose but take a longer time to do so.

Insulin is a hormone that is secreted by the pancreas that enables the liver to utilize and/or store glucose.  Insulin is absolutely necessary to life.  Without it, glucose circulates at high levels in the blood but cannot penetrate into cells and provide energy for our bodies.  Normally, a person would eat a meal containing carbohydrates, their blood sugar (glucose) would rise and insulin would signal cells to allow glucose to enter and be used for energy or stored for later use.  When insulin is present but cells don’t respond to its signals the condition is termed “insulin resistance” because insulin and glucose are both being produced but are unable to communicate.  This communication breakdown causes glucose levels to be very high (outside the cells) but very low (inside the cells) resulting in increased hunger. Because insulin is our “store and save” hormone, higher levels of this hormone in the bloodstream discourage our body from burning the existing stores of energy in our fat reserves.   Taken together these conditions can make it very difficult for a person with insulin resistance to lose weight.

So, what causes insulin resistance? The largest contributor is excess body weight, as an increase in adipose (fat) tissue can interfere with the communication between glucose and insulin. Weight gain in the central stomach area is most detrimental to insulin resistance.  Vitamin D deficiency is also associated with insulin resistance (so be sure to get your Vitamin D levels checked). Chronic inflammation is also a leading cause of insulin resistance and can be improved by a change in diet and lifestyle.  A lifelong diet of highly processed carbohydrates (cakes, cookies, sodas, candy, desserts, etc.) and poor nutritional intake may also be a key cause in the development of insulin resistance. While the causal connection of insulin resistance and PCOS has yet to be established, it is something of concern as the associated conditions of insulin resistance – overweight/obesity, increased risk of developing gestational and Type 2 diabetes, increased cognitive aging, increased risk of some cancers – are very serious conditions.

Luckily, insulin resistance is something that can be modified through diet and exercise.  There are many nutritional strategies to help with insulin resistance and PCOS.  If you are interested in learning more about our nutrition program to help with PCOS, please call (312) 321-0004 or visit www.pullingdownthemoon.com for more info.

Beth Heller, M.S.

Has your fertility journey caused you to ask your mother questions about her experience trying to conceive?  Many women at Pulling Down the Moon report that their challenges have prompted their mothers to reveal  previously untold stories of struggles to conceive, miscarriages and losses.  Others learned for the first time that their mothers had irregular cycles or experienced strong menstrual cramps.

Unfortunately, modern society has lost touch with the value of this transmission of “woman-wisdom.”  I am not advocating a return back to “the red tent,” but I do lament that the menstrual cycle has arguably been demoted in our world.   As a holistic fertility practitioner, I am trained to view the menstrual cycle as a fountain of valuable information about the physical and even emotional health of a woman.  The shedding of menstrual blood is an important detoxification process.  The downward flow of energy that governs the menses (called apana in yoga physiology) can be strengthened with yoga poses and other lifestyle practices.  This same energy channel also allows us to excrete bodily wastes and let go of negative thoughts and emotions.  From a yoga perspective, when apana is blocked or impeded overall health (and fertility and emotional well-being in particular) suffer.

The very idea that there are now birth control pills that advocate limiting menses to four times a year makes my teeth itch.

Medical research is now revealing that some fertility challenges may be hereditary.  Many women are not aware that Polycystic Ovarian Syndrome (PCOS) has a hereditary component.   Sisters and daughters of women diagnosed with PCOS have a 50% chance of developing this syndrome.  If a young woman knows that her mother experienced irregular cycles or had difficulty getting pregnant, she may be more aware and proactive about her own reproductive health.  An early diagnosis of PCOS can help a young woman enormously.  Some of the external manifestations of PCOS – acne, hirsutism, weight gain – can be mistakenly attributed to normal adolescent changes.   However, these  symptoms are not necessarily an “inevitable” part of growing up and if PCOS is present they may be treated with diet, lifestyle and pharmaceutical methods.

So, while  mom may not be able to diagnose our PCOS or other fertility issues, her menstrual history, her experiences of trying to conceive, and other reproductive wisdom can prompt us to be more aware of our own bodies.  Opening a line of communication early on with young women to discuss their cycles – even the gritty details of flow, cramps, PMS and cycle length – should be an important pulbic health issue.

By Breea Johnson, MS RD LDN

September is PCOS Awareness Month which helps bring attention to women with Polycystic Ovarian Syndrome (PCOS).  Did you know about 7 million women in the U.S. have PCOS? PCOS is one of the leading causes of infertility and afflicts nearly 5-10% of women of childbearing age.  Common symptoms of PCOS include irregular or missing periods, anovulation, an inability to lose weight and facial hair growth, however, PCOS is a collection of symptoms and can look very different in different women. Many of the women I see at Pulling Down the Moon are actually within their ideal weight range and have few of the classic symptoms of PCOS. Check out this past blog I wrote titled The Many Faces of PCOS.

Nutrition can greatly impact and help to manage PCOS – even the atypical case of PCOS can benefit from a diet which helps with blood sugar regulation and nutrients that help with insulin sensitivity. While there is no known cause of PCOS, there are some identified factors which may be contributing to PCOS. In my next post, I’ll look at some of these factors that have been connected to PCOS such as thyroid disease, insulin resistance, hormonal imbalances and genetic causes – and discuss in more detail. Stay tuned.

by Breea Johnson, MS RD LDN

An important aspect of PCOS (Polycystic Ovary Syndrome) is the fact that it is a syndrome, not a disease, meaning it’s a collection of symptoms.  Working in fertility nutrition, I’m constantly fascinated by the many faces of PCOS.  Gone are the days where the typical PCOS patient is overweight, has insulin resistance, adult acne, facial hair growth and elevated testosterone levels.  Normal body weight and thin women can present with PCOS.  Women also may or may not have insulin resistance, which has been so commonly associated with PCOS.

When I see clients with PCOS, 90% of the time it is because a woman wants to conceive in the coming months and does not get a regular period.  The other 10% want to conceive at some point in their life, have tried medication and were not happy with the side effects and want a more natural way to manage PCOS and induce ovulation.  Many women do not even realize they do not have a normal cycle until they discontinue the birth control pill which has medically induced their cycle for many years.

While the causes of PCOS is unclear, we do know that it is related to an underlying hormonal imbalance and that working to balance hormones and increase the sensitivity of the hormone, insulin, can definitely benefit a woman with PCOS.  While we have a comprehensive nutritional treatment strategy for PCOS at Pulling Down the Moon, a few of our important recommendations are:

• Eat low glycemic carbs: Lowering the intake of refined carbohydrates such bread and pastries and increasing nutrient-dense foods can be beneficial to decrease insulin levels.  Insulin is the “store and save” hormone, as elevated insulin levels make it difficult to lose weight.
• Try FlowPro: Myo-inositol, part of the B-vitamin complex , has been found in multiple research studies to help increase insulin sensitivity and induce ovulation in a high percentage of women with PCOS.  Some research has found it to be equally effective as Metformin in restoring ovulation.  Myo-inositol has also been found to increase progesterone levels and decrease testosterone levels. 
• Have your Vitamin D levels checked:  Studies have shown that women with PCOS have very low levels of Vitamin D (25-OH) which may contribute to insulin resistance.  The lab test is a blood test that your primary care physician can administer.

• Get screened for autoimmune thyroid disease: PCOS has been linked to autoimmune thyroiditis) with studies showing a three-fold increase of autoimmune thyroid disease among women with PCOs.  In addition to having the standard thyroid tests performed by your primary care physician, have you thyroid antibodies checked.

While PCOS is not a well-understood syndrome, there are many treatments both conventional and alternative that really work to help reduce symptoms and induce ovulation.  A client recently emailed to tell me that after 3 weeks of taking FlowPro she got her period for the first time naturally and within a few cycles was pregnant.  If you have any questions about PCOS and nutrition or would like to set up an appointment with a Pulling Down the Moon nutritionist, please click here or call (312) 321-0004.

 By Anna Pyne, L.Ac.A TCM

Polycystic ovarian syndrome (PCOS) is a common reproductive endocrine disorder and something we frequently treat at Pulling Down the Moon. Up to 75% of women with this diagnosis do not ovulate, which is hardly ideal when trying to conceive.   In fact, it’s not until they have trouble conceiving that many women learn they have PCOS, which in addition to causing infertility can also have negative long-term health consequences including heart disease and diabetes.

In Traditional Chinese Medicine, PCOS is considered an anovulation disorder related to ovarian insulin resistance.*  Chinese medicine initially acknowledged PCOS in the 1200′s describing it as a “Tian Gui” disorder, meaning a genetic disorder with the main symptoms being cycle irregularity and infertility due to anovulation.  There are a number of TCM patterns of diagnosis to describe PCOS, the main one being a (Chinese) Kidney Deficiency. The kidney in TCM is the organ system that is regarded with any genetic disorder and considered the root cause in PCOS.  The absence of the period, and therefore the absence of ovulation is a kidney pathology.  Interestingly, modern science has just recently identified a genetic component to PCOS and now think of PCOS as a hereditary problem in which symptoms often do not present until later in life.

A secondary pattern in TCM is Spleen Deficiency, which has to do with the insulin resistance part of the PCOS diagnosis. The Chinese spleen is responsible for the metabolism of nutrients from foods, as well as the transformation and transportation of fluids in the body. In patients with actual cysts in the ovaries, TCM considers the spleen to be dysfunctional. This is also the organ that relates to weight gain. Obesity is seen in 30%-60% of patients with PCOS. By improving the function of the spleen we help regulate blood sugar and resolve the excess fluid accumulation from ovarian cysts and/or fat from weight gain.  A third, related TCM pattern is Liver Stagnation, which can manifest as blood stasis or excess heat in the channels. Blood Stasis in the channels causes hair follicles to be nourished excessively creating coarse unwanted hair. This represents the hirsutism symptom, of which 70% of patients with PCOS have. Excess heat in the channels also promotes the acne component of PCOS.

When trying to improve fertility in patients with PCOS the primary focus is to induce ovulation.  According to TCM pattern diagnosis, the main organs treated for this condition are the kidney, spleen, and liver.  Treatment using TCM pattern diagnosis is greatly successful in inducing ovulation and a skilled TCM practitioner can use a combination of acupuncture, electro-acupuncture, moxabustion and herbal therapy to treat Polycystic Ovarian Syndrome. 

*Different phenotypes of polycystic ovary syndrome by Rotterdam criteria are differently steroidogenic but similarly insulin resistant. Fertil Steril. 2010 Mar 1;93(4):1362-5. Epub 2009 Sep 26.

Book an initial consultation with Anna Pyne in Chicago here.

More evidence in support of yoga for fertility:

A new study examining the potential stress-reduction benefits of hatha yoga practice compared the inflammatory and endocrine responses of healthy women to a restorative hatha yoga session and to control activity.  Half of the 50 subjects were “expert yoginis” (women with a regular yoga practice) and half were yoga novices.  Prior to each intervention session the women were subjected stress challenges in order to guage the extent that yoga speeds recovery from stress.  The results of the study were very interesting.

1. The yoga session boosted mood compared to the control activities, but no change was found in subjects’ response to stress before and after yoga or any of the control sessions.  HOWEVER…
2. In response to the stress events the novices, who were not statistically different in age or other variables from the expert yoginis, had C-Recative Protein levels (a marker of inflammation) that were 4.75 times as high as the experts.

The researchers concluded “the ability to minimize inflammatory responses to stressful encounters” lowers the burden that stress places on an individual.  They also suggested that their research supports the idea that regular yoga practice dampens stress-related changes and can have lasting health benefits.

These findings are extremely relevent for women struggling with infertility.  Stress is an inflammatory condition and inflammation is implicated in many infertility diagnoses including PCOS, endometriosis, miscarriage and potentially even poor egg and sperm quality.   The take-home from this research is that yoga may do more for a woman who is trying to conceive than reduce her anxiety levels and improve her mood.  Regular yoga practice may actually improve her physiological response to stress events and protect her body from the negative effects of chronic inflammation.