Practical PCOS Solutions A practical lesson in how to support patients with PCOS and infertility 1 2 1
Polycystic Ovary Syndrome Affects 5-10% of women of reproductive age Characterised by anovulation, hyperandrogenism and polycystic ovaries Is associated with insulin resistance and obesity, which is present in approx50% of women with PCOS. One of the most common causes of infertility Hirschberg AL. (2009) Polycystic ovary syndrome, obesity and reproductive implications. Womens Health (Lond Engl). Sep;5(5):529-40 3 Female Infertility - Causes Autoimmune conditions/cancer or tumour/clotting disorders / birth defects Diabetes Uterine/cervical growths (such as fibroids or polyps) Excessive exercising Eating disorders or poor nutrition Too much alcohol Obesity Older age PCOS PID Scarring associated with endometriosis and STIs Thyroid disease Hormonal imbalance Certain medications, including chemo drugs 4 Vorvick L. Storck S. and Zieve D. Infertility. PubMed Health. Updated: February 28, 2011 2
Practical PCOS Solutions What is PCOS? Signs & Symptoms Infertility & PCOS What can we do to help? Insulin dysregulation Female hormonal disruption Nutrient deficiency Further considerations Maintenance 5 What is Polycystic Ovary Syndrome? 6 3
Polycystic Ovaries Multiple cyst formation on the ovaries 7 Polycystic Ovarian Syndrome Presence of polycystic ovaries plus: Excess androgens (male hormones) Facial hair (hirsutism) Acne Infertility Obesity (50%) Little or no menstrual flow Mood swings Increased incidence of CVD risk factors 8 4
Testing for PCOS Ultra Sound Blood test LH FSH DHEA Testosterone Prolactin Thyroid hormones Low SHBG Adrenal Function GTT/fasting glucose Questionnaire? 9 Usual Treatments for PCOS Anti-androgens Oral contraceptive Metformin Clomifene Diuretics 10 5
What should I do? 11 Practical PCOS Solutions Insulin & Cortisol Balance Hormonal dysregulation Nutrient Deficiencies 12 6
Stress Clinical Depression Elevated adrenal cortisol Elevated androgen production Insulin & Cortisol Balance Elevated blood glucose levels Excessive insulin secretion More androgen hormone production Converts excess androgen to oestrone Insulin resistance Increase in pancreatic insulin production Centripetal obesity Metabolic Syndrome Disruption of GnRH Excess LH and insufficient FSH Hyperandrogenism Normal menstrual cycle ceases Acne Hirsutism Male hair distribution Amenorrhea Anovulation Infertility 13 Milk Protein Hydrolysate & Theanine Insulin & Cortisol Balance Powdered Myoinositol, vitamin B6, Magnesium & Calcium Low GI Metabolic Food 14 7
Milk Protein Hydrolysate & Theanine Insulin & Cortisol Balance Milk Protein Hydrolysate & Theanine Technical Review 15 Milk Protein Hydrolysate (Lactium ) and Theanine Each tablet provides: L-Theanine................................. 200 mg Milk Protein Hydrolysate (Lactium )........... 150 mg Dose: 1-2 capsules daily 16 8
Milk Protein Hydrolysate A unique natural milk protein fraction that contains a natural bioactive peptide with relaxing properties. Has anti-anxiety effects without side effectssuch as drowsiness. Human studies show benefit for mental and physical symptoms of stress, improved sleep and reduced levels of the stress hormone cortisol. An experimental study suggests benefit for stress related sweet cravings and overeating. Safe for lactose intolerant people and hypoallergenic (avoid in true anaphylactic dairy allergy). 17 Theanine A natural amino acid with relaxing and cognitive enhancing properties derived from green tea. Human clinical studies suggest stress relieving and mood enhancing effects. May also improve mental performance under stress. Experimental studies suggest cognitive performance enhancing, anti-stress, anti-depressant and neuroprotectiveactivities. 18 9
Stress Stress (increased cortisol) lowers progesterone and increases oestrogen effect Stress (increased spent cortisol) increases inflammation Stress (increased cortisol) increases insulin resistance which increases aromatase 19 Insulin resistance & PCOS Most women with PCOS are metabolically insulin resistant, in part due to genetic predisposition and in part secondary to obesity. In the past 20 years there has been growing evidence supporting that defects in insulin actions or in the insulin signalling pathways are central in the pathogenesis of the syndrome J Steroid Biochem Mol Biol. 2010 Oct;122(1-3):42-52 20 10
Not all PCOS patients are obese Approximately 50% of women with polycystic ovary syndrome are lower than BMI 25kg/m 2 Womens Health (Lond Engl). 2009 Sep;5(5):529-40 21 Body composition determines insulin sensitivity Eaton SB, Cordain L, Sparling PB. Prev Med. 2009 Aug 15. [Epub ahead of print] 22 11
Insulin & Cortisol Balance Powdered Myoinositol, vitamin B6, Magnesium & Calcium Magnesium Technical Review 23 What is Myo-inositol? Myo-inositol is a naturally occurring isomer of glucose and has been shown in studies to play several important roles in supporting fertility. In particular, it has been shown to support healthy ovaries, ovulation, follicular function and egg development. It has also been shown to be helpful in supporting insulin control and androgen dominance in those with ovarian issues. As the second messenger of serotonin, myo-inositol has also shown some success in supporting mood and behaviour in the premenstrual phase of women s hormone cycles. 24 Magnesium Technical Review 12
Myo-Inositol improves insulin resistance in women with PCOS Insulin sensitivity significantly improved in this study of 20 overweight PCOS patients. Also after 12 weeks of myo-inositol administration, presented plasma LH, PRL, T, insulin levels and LH/FSH reduced. Furthermore menstrual cyclicity was restored in all amenorrhoic and oligomenorrhoic subjects. European Journal of Obstetrics & Gynecology 25 and Reproductive Biology 147 (2009) 120 123 Balancing insulin with myo-inositol results in improved hormone levels A combination of the contraceptive pill (OCP) and myo-inositol (4 grams daily for 12 months) has been shown to be more effective in controlling the endocrine, metabolic and clinical profile in patients with PCOS than the OCP alone, and also reduced insulin levels and insulin resistance. Minozzi M, Gynecol Endocrinol. Nov;27(11):920-4. 2011 26 13
Powdered Myo-Inositol, Vitamin B6, Magnesium & Calcium Featuring myo-inositol: clinical research has demonstrated an important role of myo-inositol in female health Clinical doses of myo-inositol are best achieved in powdered delivery Also contains vitamin B6, which contributes to the regulation of hormonal activity Contains magnesium and calcium, which both contribute to normal muscle function Mixes easily into water or juice to make a refreshing easily-digested drink Tasty orange flavour 27 Powdered Myo-Inositol, Vitamin B6, Magnesium & Calcium One scoop supplies: Magnesium............................ 200mg Vitamin B1............................ 25mg Vitamin B2............................. 20mg Vitamin B3............................. 20mg Vitamin B5............................. 20mg Vitamin B6............................. 25mg Vitamin C............................... 500mg L-glutamine............................. 500mg Calcium................................. 50mg Myo-inositol............................. 2000mg Folic acid................................ 100mcg Manganese...............................1 mg Vitamin E 100 IU...........................67mg Recommendation: 1-2 servings per day Magnesium Clinical Guide 28 14
Metabolic Food Clinical Guide & Patient Guide Insulin & Cortisol Balance Low GI Metabolic Food 29 Low GI Metabolic Food Nutritionally balanced, low-glycaemic index foods in the form of a convenient and delicious shake. Designed to enhance weight loss and support lean muscle growth. Help to control appetite and reduce overeating. Contains 15g of protein per serving. Supports cardiovascular health (Plant Sterols) and blood glucose control (Acacia and Hops). Available in Vanilla or Chocolate 30 15
Clinically Studied and Shown Successful What they say Fructose has been hypothesized to cause: Obesity Elevated LDL Cholesterol Elevated triglycerides Leads to metabolic syndrome What we know In UltraMeal & UltraMeal Plus it: Decreases Fat while increasing muscle Lowers LDL Cholesterol while Increasing HDL Decreases Cholesterol Is the best nutritional support option for metabolic Syndrome 31 Low GI Metabolic Food with Plant Sterols, Acacia and Hops far more effective than diet alone Intervention TG TG/ HDL Low FLTplan GI Metabolic with UltraMeal Food with Plus Plant 360 Sterols, Acacia and Hops Insulin ApoB/ Apo A1-33% -39% -26% -15-30% -16-28% FLT plan alone -12% -14% -19% -4-6% -8-11% LDL-C HDL-C BP +7.0% -4.9% (SBP) -5.7% (DBP) +2.2% -3.6% (SBP) -0.9% (DBP) CVD Risk 5.6% 2.9% Key: Triglycerides (TG), Triglyceride: High Density Lipoprotein Cholesterol Ratio (TG/HDL), Apo-lipoprotein B: Apo-lipoprotein A1 Ratio (ApoB/ApoA1), Low density lipoprotein Cholesterol (LDL-C), High Density Lipoprotein Cholesterol Ratio (HDL-C), Blood pressure (BP), Framingham 10 year myocardial infarction risk (CVD Risk),. 32 16
Practical PCOS Solutions Insulin & Cortisol Balance Hormonal dysregulation Nutrient Deficiencies 33 Diagram from Nutri News 113: Nutritional Influences on Oestrogen Metabolism 34 34 17
Diagram from Nutri News 113: Nutritional Influences on Oestrogen Metabolism Production Receptors Metabolism Elimination Reduce Oxidation 35 35 Metabolic Food for Oestrogen Metabolism Hormonal Dysregulation Powdered Myoinositol, vitamin B6, Magnesium & Calcium 36 18
Metabolic Food for Oestrogen Metabolism Hormonal Dysregulation Metabolic Food Clinical Guide & Patient Guide 37 Metabolic Food for Healthy Oestrogen Metabolism Features: Each serve contains 15 g of high-quality rice protein fortified with the amino acids threonine and lysine, resulting in a complete, high quality, and easily digestible vegetable protein. Specifically designed to support oestrogen metabolism, detoxification and elimination. Provides non-soy phytoestrogens from kudzu and flax, which modify the effects of circulating estrogens. Contains targeted nutrients such as folic acid, vitamin B6, iron, calcium, magnesium, chromium and iodine Can be enjoyed as a meal option and mixes easily with water or juice. Delicious Tropical Mango flavour. Dose: 1-2 serves daily 38 19
Ingredients: Each 3-scoop serving typically provides: Potassium (as citrate) 350mg Sodium 50mg Vitamin A (as beta-carotene) (2132IU) 646µg RE* Vitamin A (as retinyl palmitate) (1584IU) 480µg Vitamin C (as ascorbic acid) 160mg Vitamin D (as cholecalciferol) (100IU) 2.5µg Vitamin E (as d-alpha tocopheryl succinate) (45IU) 30mg Vitamin K (phytonadione) 40µg Vitamin B1 (as thiamin HCl) 1.1mg Vitamin B2 (as riboflavin) 1.4mg Vitamin B3 (as niacinamide) 16mg Vitamin B6 (as pyridoxine HCl) 2.8mg Vitamin B12 (as cyanocobalamin) 2.5µg Biotin 150µg Folic acid 400µg Pantothenic acid (as d-calcium pantothenate) 6mg Phosphorous 513mg Iron (as gluconate) 9mg Calcium (as citrate) 300mg Iodine (as potassium iodide) 75µg Magnesium (as citrate and oxide) 240mg Zinc (as citrate) 10mg Selenium (as selenomethionine) 55µg Copper (as gluconate) 1mg Chromium (as picolinate) 80µg Molybdenum (as sodium molybdate) 50µg L-Lysine 17.5mg L-Threonine 17.5mg Isoflavones (from kudzu) 25mg Flaxseed Extract 350mg Choline (bitartrate) 450mg N-Acetyl-Cysteine 100mg Turmeric Extract (Curcuma longa) 210mg Metabolic Food for Oestrogen Guide for use 39 Magnesium Technical Review Hormonal Dysregulation Powdered Myoinositol, vitamin B6, Magnesium & Calcium 40 20
Myo-inositol restores hormonal balance in women with PCOS 41 Myo-inositol restores ovulation and improves pregnancy rates 42 21
And the rest? Magnesium has been shown to improve symptoms of PMS and hot flashes. Vitamin B6 has been shown to improve PMS symptoms when used with magnesium. Manganese + Vitamin E may improve dysmenorrhoea and other PMS symptoms, physical and mental energy as well as cognitive function. 43 Practical PCOS Solutions Insulin & Cortisol Balance Hormonal dysregulation Nutrient Deficiencies 44 22
Diet and environment can disrupt hormonal balance Obesityup-regulates conversion of androgens to oestrogens via aromatase. Hyperinsulinaemiaincreases ovarian testosterone production and reduces SHBG, increasing free oestrogen levels. Low antioxidant intake may promote the formation of 2-OH and 4-OH oestrogens. High fatdietspromote a high 16-OH: 2-OH ratio. Alcohol interferes with oestrogen detoxification, increasing levels and breast cancer risk. Environmental toxins, hormones and antibioticsin the food supply may disrupt hormonal balance. Hyman MA. Altern Ther Health Med. 2007 May-Jun;13(3):10-4, 16. 45 Components for Creating Healthy Cells Container: Good Fats Omega 3 s DHA/EPA (fish oils) Function: Amino Acids High quality lean protein Fuel: Glucose/Fructose Complex Carbs Efficiency: Cofactors Vitamins/Minerals Clean Water 46 23
Dietary Guidelines for PCOS Minimise sugar, simple carbs, alcohol, and caffeine. Eat organic if possible, with emphasise on brassica vegetables. Minimise xenoestrogen exposure. 47 Pure & Fresh Omega-3 Fish Oil Nutrient Deficiencies Vitamin D Powdered Myoinositol, vitamin B6, Magnesium & Calcium 48 24
Pure & Fresh Omega-3 Fish Oil Nutrient Deficiencies Fish Oil Technical Review 49 Supplementation with n-3 PUFA improves androgenic profiles in PCOS A greater plasma n-6 PUFA concentration and n-6:n-3 PUFA ratio were associated with higher circulating androgens in women with PCOS. In addition, long chain n-3 PUFA supplementation reduced plasma bioavailable testosterone concentrations (P, 0.05), with the greatest reductions in subjects who exhibited greater reductions in plasma n-6:n-3 PUFA ratios. 50 Am J Clin Nutr 2011;93:652 62 25
Pure & Stable Omega-3 Fish Oil Pure Free from contaminants and superior purity to other fish oils. Stable Patented Pufanox ensures stability and enhances clinical effectiveness. Effective More than 100 articles have been published about the effect of Stable Fish Oil in scientific journals, based on 20 clinical studies and 15 experimental investigations. Sustainable From one of the worlds most strictly enforced sustainable fisheries. Quality Is a registered pharmaceutical in several countries and is produced according to GMP for pharmaceuticals. Fish Oil Clinical Guide 51 Nutrient Deficiencies Vitamin D Vitamin D Technical Review 52 26
Vitamin D Status & PCOS 67-85% of women with PCOS have levels of vitamin D <50nmol/l. This low level of vitamin D may exacerbate the disorder. Lower vitamin D status is associated with: Insulin resistance Ovulatory & menstrual irregularities Lower pregnancy success Hirsutism Hyperandrogenism Obesity and elevated cardiovascular risk factors 53 Clinical Endocrinology (2012) 77, 343 350 Correcting deficiency Recommended Regime: 50,000 IU of vitamin D once a week for 8 weeks (in most patients blood levels of 25 (OH)D will rise on average by 100%) Vitamin D Clinical Guide 54 27
Magnesium Technical Review Nutrient Deficiencies Powdered Myoinositol, vitamin B6, Magnesium & Calcium 55 Powdered Myo-Inositol, Vitamin B6, Magnesium & Calcium Key uses: Polycystic ovarian syndrome (PCOS), Premenstrual syndrome (PMS), menstrual migraines, infertility, Pregnancy, Menopause. Folic acid have been well studied for PCOS and infertility Magnesium has been shown to improve symptoms of PMS and hot flashes. Vitamin B6 has been shown to improve PMS symptoms when used with magnesium. Manganese + Vitamin E may improve dysmenorrhoea and other PMS symptoms, physical and mental energy as well as cognitive function. 56 28
Magnesium + B6 Reduces Symptoms of Premenstrual Syndrome Mean change in Symptoms 57 Practical PCOS Solutions Insulin & Cortisol Balance Hormonal dysregulation Nutrient Deficiencies 58 29
Further Considerations Hormonal dysregulation Insulin & Cortisol Balance Nutrient Deficiencies GI Health 4R Programme Thyroid Function Detox Mechanisms 59 Ongoing wellness programme 60 30
Premium One-A-Day Multivitamin/Mineral Formula for Pregnancy Designed specifically for pregnancy, pre-conception and breastfeeding Provides higher levels of calcium and magnesium in a 2:1 ratio Features iodine at recommended levels for pregnancy and breast feeding Contains 25mg of zinc per tablet to prevent deficiency Provides 18mg of easily absorbed iron Provides 400 mcg of folic acid Free from vitamin A 61 Premium One-A-Day Multivitamin/Mineral Formula for Women Provides 100mg of pomegranate extract for healthy skin and general antioxidant support Features 100mg of broccoli and 10mg of di-indolylmethane (DIM) to support hormone balance Contains 200mcg of iodine and extra selenium to support reproductive and thyroid health Features 1000mcg of boron to support bone health 62 31
Practical PCOS Solutions Insulin & Cortisol Balance Hormonal dysregulation Nutrient Deficiencies 63 32