WHAT IS INTEGRATIVE MEDICINE?

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3 WHAT IS INTEGRATIVE MEDICINE? Integrative medicine is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual and environmental influences that affect a person s health. Employing a personalized strategy that considers the patient s unique conditions, needs and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health.

4 WHY INTEGRATIVE MEDICINE FOR PCOS? Lifelong condition Adjustment of care required at different stages of life. Affects entire body including: Endocrine system Mental/emotional Reproductive system Skin Cardiovascular Metabolism Immune system Impacted by external factors such as stress, environmental agents, nutrition/diet, exercise/activity

5 WHAT DO WE KNOW ABOUT THE ROOT OF PCOS? Genetic Insulin Resistance Inflammation

6 Sciencephotolibrary.com

7 Adapted from Trayhurn, P. (2013). Hypoxia and Adipose Tissue Function and Dysfunction in Obesity. Physiological Reviews, 93(1).

8 Adapted from Trayhurn, P. (2013). Hypoxia and Adipose Tissue Function and Dysfunction in Obesity. Physiological Reviews, 93(1).

9 Healthy IL 6 Type Inflammation IL 6 Type Inflammation (close up) IL 8 Type Inflammation Bester et al Effects of IL-1β, IL-6 and IL-8 on erythrocytes, platelets and clot viscoelasticity, 6,

11 ANTI-INFLAMMATORY DIET: Does It Help?? THEN: A 2013 ASRM committee opinion titled "Optimizing natural fertility" stated that "there is little evidence that dietary variations, vitamin-enriched diets, antioxidants, or herbal remedies improve fertility NOW: There are emerging epidemiologic data demonstrating that diet may influence reproductive health outcomes. Furthermore, translational work with human specimens and animal models lends biologic plausibility to the epidemiologic data, particularly in the context of female reproductive diseases associated with inflammation, including polycystic ovary syndrome (PCOS) and obesity. We outline epidemiologic and translational work demonstrating a potential role for diet in the regulation of inflammatory processes associated with these disorders. Riley et al Is there a role for diet in ameliorating the reproductive sequelae associated with chronic lowgrade inflammation in polycystic ovary syndrome and obesity? Fertility and Sterility, 106(3),

12 Sciencephotolibrary.com

COMMON INTEGRATIVE MODALITIES IN PCOS Supplements: N-Acetyl-Cysteine Myo-Inositol D-Chiro-Inositol Resveratrol Omega 3 Fatty Acids Vitamin D Exercise/Lifestyle

13 COMMON INTEGRATIVE MODALITIES IN PCOS Supplements: N-Acetyl-Cysteine Myo-Inositol D-Chiro-Inositol Resveratrol Omega 3 Fatty Acids Vitamin D Exercise/Lifestyle Psychology/Counseling Acupuncture/Electro-Acupuncture Nutrition/Diet Ketogenic diet Mediterranean diet Low Glycemic index diet (or Food Insulin Demand) Low Carbohydrate

14 HOW QUICKLY DO WE LEARN NEW INFORMATION? Search for all new integrative interventions 106 Studies on PCOS and nutrition or diet 91 New Studies on PCOS and Complementary Medicine 88 New Studies on Dietary Supplements 33 New Studies on PCOS and Exercise 56 New Studies on PCOS and Mood 15 New Studies on PCOS and Acupuncture From SEP 1ST SEP 2016 To 11TH 2017 Total of 398 Studies This does NOT include research on integrative medicine for mechanisms such as insulin resistance which could be applied to PCOS!

15 VITAMIN D DOSING IS IMPORTANT 60 Participants were randomly allocated into 3 groups to receive either IU of vitamin D (or IU of vitamin D or placebo per day for 12 weeks. Vitamin D supplementation (4 000 IU), compared with vitamin D (1 000 IU) and placebo. Vitamin D supplementation at a dosage of IU/day for 12 weeks in insulin-resistant patients with PCOS benefitted glucose metabolism and lipid profiles compared to IU/day and placebo groups. Foroozanfard et al Effect of Two Different Doses of Vitamin D Supplementation on Metabolic Profiles of Insulin-Resistant Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Hormone and Metabolic Research, 49(8),

16 VITAMIN D AND EVENING PRIMROSE OIL RCT, Double Blind, Placebo-controlled 60 vitamin D Deficient women with PCOS Compared with the placebo group, women in vitamin D and EPO cosupplementation group had significant increases in serum 25-hydroxyvitamin D and plasma total glutathione, while there were significant decreases in triglycerides, VLDL cholesterol levels, total/high-density lipoprotein cholesterol ratio, and malondialdehyde concentration. Nasri et al. The effects of vitamin D and evening primrose oil co-supplementation on lipid profiles and biomarkers of oxidative stress in vitamin D-deficient women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. EndocrRes Jul 25:1-10.

17 MAGNESIUM-ZINC-CALCIUM-VITAMIN D Sixty PCOS women were randomized into two groups and treated with: 100 mg magnesium, 4 mg zinc, 400 mg calcium, 200 IU vitamin D OR Placebo Twice a day for 12 weeks. After the 12-week intervention, compared with the placebo: magnesium-zinc-calcium-vitamin D co-supplementation resulted in: significant reductions in hirsutism serum high sensitivity C-reactive protein and plasma malondialdehyde, and a significant increase in plasma total antioxidant capacity concentrations Maktabi et al Magnesium-Zinc-Calcium-Vitamin D Co-supplementation Improves Hormonal Profiles, Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial. Biological Trace Element Research.

18 REDUCING CARBOHYDRATES, REPLACING WITH FAT REDUCES HYPINSULINEMIA IN PCOS Stanford University Clinical Research Center: Two diets given to two groups of women with PCOS GROUP 1 GROUP 2 60% CARBOHYDRATE / 25% FAT 40% CARBOHYDRATE / 45 % FAT SAME NUMBER OF CALORIES GIVEN DAILY FOR EACH GROUP Daylong glucose did not differ according to diet. Daylong insulin concentrations were 30% lower on the low Carbohydrate/higher fat diet. Beneficial changes in lipid profile were also observed. Perelman, D. (2017). Substituting poly- and mono-unsaturated fat for dietary carbohydrate reduces hyperinsulinemia in women with polycystic ovary syndrome, 33(4).

19 OMEGA 3 FATTY ACIDS AND VITAMIN E CO-SUPPLEMENTATION 68 women with PCOS mg omega-3 fatty acids conplus 400 IU vitamin E supplements Or placebo for 12 weeks Omega-3 fatty acids and vitamin E co-supplementation for 12 weeks in PCOS women significantly improved indices of insulin resistance, total and free testosterone. Ebrahimi et al. (2017). The Effects of Omega-3 Fatty Acids and Vitamin E Co-Supplementation on Indices of Insulin Resistance and Hormonal Parameters in Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Experimental and Clinical Endocrinology & Diabetes, 125(6),

OMEGA 3 AND HAIR Control High Cholesterol &

Hypercholesterolemic Wistar Albino Rats and

20 OMEGA 3 AND HAIR Control High Cholesterol & Diabetes High Cholesterol & Diabetes with Fish oil El-Sayyad et al Hair Growth Defects of Diabetic and Hypercholesterolemic Wistar Albino Rats and Amelioration of Fish Oil-Treatment. J Nutri Health. J Nutri Health August, 1(61).

21 PROBIOTIC SUPPLEMENTATION Double Blind RCT Supplementation for 12 weeks in 60 women with PCOS. Favorable effects on weight loss, insulin resistance, triglycerides and VLDL concentrations Ahmadi et al Probiotic supplementation and the effects on weight loss, glycaemia and lipid profiles in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Human Fertility, 1 8.

22 COMBINED LIFESTYLE AND HERBAL MEDICINE IN PCOS: RCT All participants were helped to construct a personalized lifestyle plan. Both groups implemented the lifestyle intervention. One group implemented two tablets of herbal medicine and the other placebo. Tablet 1: Cinnamon, Licorice, St. John s Wort and White Peony. Tablet 2: Tribulus terrestris. At 3 months, women in the combination group recorded a reduction in oligomenorrhoea of 32.9% compared with controls. Other significant improvements were found for : body mass index Insulin LH blood pressure quality of life depression, anxiety and stress Arentz et al Combined Lifestyle and Herbal Medicine in Overweight Women with Polycystic Ovary Syndrome (PCOS): A Randomized Controlled Trial. Phytotherapy Research : PTR, 31(9)

CHROMIUM AND PCOS Systematic review and meta-analysis 7 RCTs This systematic review and meta-analysis shows that using Cr picolinate supplementation has beneficial effects on decreasing BMI, fasting

23 CHROMIUM AND PCOS Systematic review and meta-analysis 7 RCTs This systematic review and meta-analysis shows that using Cr picolinate supplementation has beneficial effects on decreasing BMI, fasting insulin and free testosterone in PCOS patients. Fazelian et al Chromium supplementation and polycystic ovary syndrome: A systematic review and meta-analysis. Journal of Trace Elements in Medicine and Biology, 42,

24 GREEN TEA AND PCOS Double Blind RCT 60 women with PCOS 500mg capsules of Green Tea Extract twice per day for 12 weeks The consumption of green tea extract by women with high body mass index and PCOS leads to weight loss, a decrease in fasting insulin, and a decrease in the level of free testosterone. Mombaini et al. (2017). The Impact of Green Tea Supplementation on Anthropometric Indices and Inflammatory Cytokines in Women with Polycystic Ovary Syndrome. Phytotherapy Research, 31(5),

25 VITEX VS METFORMIN ON OLIGOMENORRHEA IN PCOS Double blind RCT 60 PCOS Women mg of Chasteberry Dry Extract once per meal for 3 months vs 500mg 3x/day of Metformin The two drugs had similar effects on menstrual cycle regulation, menstruation length and the number of pads used. More side effects were reported in the group using Metformin. Shayan et al Comparing the Effects of Agnugol and Metformin on Oligomenorrhea in Patients with Polycystic Ovary Syndrome: A Randomized Clinical Trial. Journal of Clinical and Diagnostic Research : JCDR, 10(12)

28 Thank you!

29 drfionand.com/2017show Grab a Guide to PCOS Testing

The Impact of Insulin Resistance on Long-Term Health in PCOS

Saturday, April 16 th, 2016 PCOS Challenge & Thomas Jefferson University PCOS Awareness Symposium Philadelphia The Impact of Insulin Resistance on Long-Term Health in PCOS Katherine Sherif, MD Professor