Just a quick thought for Earth Day. Have you ever considered how sustainable living and PCOS management go hand in hand?
If you walk more instead of driving, you use less gasoline and improve your insulin resistance.
If you choose less processed foods, you reduce your consumption of preservatives and unhealthy fats, in addition to your use of packaging and energy.
If you eat locally produced foods, you increase your antioxidant intake and reduce your consumption of fossil fuels.
If you eat organic foods, you reduce the amount of artificial estrogens you put into your body and into the surrounding environment.
If you eat lower on the food chain, you do a lot of all of the above.
If you improve your sleep hygiene and turn the lights out earlier, you improve your melatonin metabolism at the same time you reduce your electricity consumption.
It all fits together. If you sustain the planet, you bring your body into balance.
What are you going to do today, to pay homage to Mother Nature?
Not long ago I created a webinar about bioidentical hormone replacement therapy. I found a great graphic that explains something most people have not considered when it comes to reproductive hormone health. Many of the hormones that we need for proper function of our reproductive systems (whether we're trying to conceive or slow down aging), are made out of cholesterol. Just look at this picture below!
As you can see, we need a decent supply of cholesterol in the body in order to even make progesterone and estrogen! However, we've become very obsessed with the idea that cholesterol is a"bad" thing. So much so that in 2001 the National Cholesterol Education Program lowered the level of ideal cholesterol so much that the number of people who ideally should be on cholesterol-lowering medications…tripled. This may be more pertinent to women with PCOS, approaching menopause, who are more likely to be placed on statin medications than younger women who are trying to conceive. However, I just wonder, a lot, if it's not really a coincidence that as we focus on cholesterol and getting it out of our bodies, we also seem to be developing more problems related to hormone imbalances…infertility, early menopause, even Alzheimer's, which is starting to be recognized as a consequence of insulin resistance, which is associated with PCOS. Bottom line: Eat well, and be careful of obnoxiously high cholesterol levels, but try to avoid an obsession with a"lower is better" mentality. Cholesterol is an essential compound, and not to be feared.
For anyone who is interested in the topic of bioidentical hormone replacement therapy, I will be presenting a webinar comparing this treatment to nutritional options.
This webinar will be held on February 23, at 6 PM Eastern time. The cost is $35.
Information can be found at our Facebook page.
You can register at this link.
There is an option to purchase the recorded version of this webinar if you are interested in the information but cannot attend the live presentation.
I engaged in a Facebook discussion about grapefruit recently. Ruby Reds are currently cheap at Trader Joe's, a fact which made one friend very happy. One of HER friends cautioned that grapefruits have been associated with breast cancer.
I promised to look into it and blog, which is what you're reading now!
In a survey of 50,000 women, researchers found that grapefruit may increase estrogen levels, a known breast cancer risk. It is thought that this relationship may be related to the fact that grapefruits alter a metabolic pathway involved in estrogen metabolism, called"cytochrome p450".
The cytochrome P450 pathway is also important for the metabolism of many medications commonly used with PCOS. Grapefruit and grapefruit juice may alter the metabolism of this pathway in the following ways: --may induce excessive sedation with benzodiazepenes --may induce rhabdomyolysis with statins --may cause hypotension with calcium antagonists --may alter electrocardiograms with astemizole, cisapride, pimozide, and terfenadine --may induce overdose with SSRI medications such as Paxil
Wow…sounds like grapefruit could be the kiss of death, doesn't it? Well, those studies certainly sell newspapers and drive up advertising rates on websites who post them, but that's not the whole story.
First of all…when it comes to your medications, if you eat grapefruit regularly, tell your physician. She can calibrate the dose of the medication to reduce the risk of these side effects. Since grapefruits are a winter fruit, you may need to communicate with your physician to account for seasonal changes in your diet.
With regard to breast cancer, even though a couple of years ago the grapefruit/breast cancer link got lots of press time…a recent study reported no association between the two. None of the studies looked specifically at this issue with PCOS, but I suspect with the already present tendency toward high estrogen, there may be an altered metabolic system that could be grapefruit sensitive…and could be problematic…IF YOUR RELATIONSHIP WITH GRAPEFRUIT IS NOT ONE OF MODERATION.
Where women with PCOS might go wrong is if they cycle in and out of diets with limited variety and which focus on grapefruit…um…THE GRAPEFRUIT DIET. If you have PCOS, you may already have a tendency to be hyperestrogenemic. You may be on at least one of the medications mentioned above. And your relationship with food may be more one of feast/famine than one of moderation and variety.
Also, if you have a family history of breast cancer, eating too much grapefruit, all the time, may not be a good idea. Enjoying a seasonal box of Ruby Reds once a year…probably isn't going to be the worst thing you could do to yourself. Even if you have PCOS.
If you moderate the diet, so that grapefruit is one of many fruits you enjoy, and you practice moderation instead of yo-yo dieting, you should be ok with grapefruit.
And you might even get yourself off of some of the medications that were of concern in the first place.: )
http://www.globalrph.com/gfruit.htm
Monroe KR, Murphy SP, Kolonel LN, Pike MC. Prospective study of grapefruit intake and risk of breast cancer in postmenopausal women: the Multiethnic Cohort Study. Br J Cancer. 2007 Aug 6;97(3):440-5. Epub 2007 Jul 10.
Spencer EA, Key TJ, Appleby PN, van Gils CH, Olsen A, Tjønneland A, Clavel-Chapelon F, Boutron-Ruault MC, Touillaud M, Sánchez MJ, Bingham S, Khaw KT, Slimani N, Kaaks R, Riboli E. Prospective study of the association between grapefruit intake and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control. 2009 Aug;20(6):803-9. Epub 2009 Feb 18.
I had the most wonderful Sunday afternoon with a newly pregnant client and her husband. She's been told that her progesterone is low, and she was interested in knowing if there is anything she can do, naturally, to help improve the outcome of her pregnancy. We discussed five different categories of actions. Since this is an issue many women face, I'm adding them to the lineup of planned posts, today being the first of five installments.
Progesterone can be low if estrogen is high. In many cases, it's not the natural estrogen your own body is making, but environmental chemicals resembling estrogen that confuse the body.
To reduce your exposure to unnecessary estrogen…
1. Stay away from plastic. Store your leftovers in glass containers. Be absolutely sure your food does not come in contact with plastic or Saran during heating. Avoid plastic water bottles; metal varieties are pretty easy to find in your Whole Foods or REI store.
2. Use natural cosmetics and hair dyes. inCYST Provider Carmina McGee, who is a licensed aesthetician as well as a registered dietitian, has shared that the primary offending chemical, phthalate, is gradually disappearing out of cosmetics. But just to be sure, read your cosmetic and nail polish labels. Make your cosmetic shopping easy by using an all-natural brand such as Body Shop or Arbonne.
3. Get to know your local eco-friendly decorating and remodeling stores. I recently painted my condo with paint that was free of volatile organic compounds (also known as non-VOC). I used the Benjamin Moore brand which was available at a local Ace Hardware, because I liked the color selection…but there were several eco-friendly brands, and remodeling stores I found while shopping around. One store also had quite a few"green" cleaning supplies as well as carpet glue.
4. If you are not sure of the contents of inks, glues, cleaning solvents, fertilizers, pesticides, fire retardant fabrics, etc., minimize your contact with it. Here's a great list from the National Institutes of Health for your reference.
5. Minimize your intake of dietary estrogens. This one can be a little tricky, since one of the tricks we've been recommending for getting pregnant has been supplementing with flaxseed oil, a natural source of estrogen. Once you know you're pregnant, best to back off on the flaxseed. (Special note: This release I'm linking is so new the actual study is not yet listed in the National Library of Medicine database. As soon as it is, I'll be sure to evaluate and report in more detail here.)
The other food to be aware of is soy--whole soy foods such as edamame and tofu are ok, but stay away from isolates that are often used as fillers.
6. Keep your sleeping environment as dark as possible at night. Close the drapes. Use eye shades. Eliminate televisions and computers from the bedroom.
What I really like about this first list is that it is, really, about living cleaner and greener. So choices you make for your pregnancy are doing double duty and helping out the planet!
A client recently handed me a supplement called"DIM" and told me her physician gave it to her. The physician said it would help her hyperestrogenemia. She had stopped taking it, and asked if I thought she should resume with it.
Here's the lowdown on DIM, which is the abbreviation for diindolylmethane.
DIM occurs naturally in cruciferous vegetables, such as cabbage, cauliflower, and Brussels sprouts. It was first researched for its cancer-fighting properties; we all know that these vegetables have this quality.
Soon after that, it was discovered that DIM influences estrogen metabolism, promoting the creation of estradiol, or beneficial estrogen (E2) and inhibiting the creation of estrone, or cancer-related estrogen (E1).
DIM may also be an anti-androgen. Although the research I was able to find looked at DIM in the prostate, not in women with PCOS, there is much information on websites selling DIM promoting it as a natural way to reduce facial hair.
If you are considering taking a DIM supplement, be sure to consider the following warnings found on the WebMD website: Special Precautions & Warnings:
Pregnancy and breast-feeding: Diindolylmethane is safe when consumed in the small amounts found in foods. But don’t take larger amounts. Not enough is known about the safety of larger amounts during pregnancy and breast-feeding.
Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: Diindolylmethane might act like estrogen, so there is some concern that it might make hormone-sensitive conditions worse. These conditions include breast, uterine, and ovarian cancer; endometriosis; and uterine fibroids. However, developing research also suggests that diindolylmethane might work against estrogen and could possibly be protective against hormone-dependent cancers. But stay on the safe side. Until more is known, don’t use diindolylmethane if you have a hormone-sensitive condition.
The client who asked the question feels the supplement may actually have helped her facial hair. Note, this is a one-person observation and a testimonial only, it is NOT an endorsement of the supplement.
What I would recommend to this client, and to others who are interested in using DIM:
1. Start with your diet: eat more cabbage, cauliflower, brussels sprouts, and broccoli. (Click herefor a cauliflower curry recipe).
2. Be sure your diet contains adequate omega-3 fatty acids and is not high in omega-6 fatty acids (discussed many times in other posts on this blog). Omega-3 fatty acids found in both fish and flax have similar effects on estrogen metabolism.
3. Be scientific about the supplement use. Have your hormone levels measured for a baseline, and have them remeasured 6 months after consistent use of the supplement. Too many times, supplements are recommended without any way to evaluate whether or not they are having any effect. In the case of my client, the supplement was sold to her by her physician and there was never any followup scheduled to evaluate how well it was working. (You'd never do that with a blood pressure medication or antipsychotic, would you?!?!?)
4. Don't assume that once you start taking the supplement you do not need to follow a healthy diet. Supplements usually seem to work better in a healthy body where the biochemistry promotes their effectiveness.
5. Even though eating these foods has never been found to be dangerous to pregnant women, because the supplemental form is much more concentrated than what is found in food, it is strongly recommended not to take this supplement if you are trying to conceive or if you are pregnant. As it's been with us since we've been in existence, we are of the opinion that it is not appropriate to be treating hirsutism while you are trying to conceive. There is time for that later.: )
Wattenberg LW, Loub WD, Lam LK, Speier JL. Dietary constituents altering the responses to chemical carcinogens. Fed Proc. 1976 May 1;35(6):1327-31. Jellinck PH, Makin HL, Sepkovic DW, Bradlow HL. Influence of indole carbinols and growth hormone on the metabolism of 4-androstenedione by rat liver microsomes. J Steroid Biochem Mol Biol. 1993 Dec;46(6):791-8.
Chen I, McDougal A, Wang F, Safe S. Aryl hydrocarbon receptor-mediated antiestrogenic and antitumorigenic activity of diindolylmethane. Carcinogenesis. 1998 Sep;19(9):1631-9.
Lord RS, Bongiovanni B, Bralley JA. Estrogen metabolism and the diet-cancer connection: rationale for assessing the ratio of urinary hydroxylated estrogen metabolites. Altern Med Rev. 2002 Apr;7(2):112-29.
Le HT, Schaldach CM, Firestone GL, Bjeldanes LF. Plant-derived 3,3'-Diindolylmethane is a strong androgen antagonist in human prostate cancer cells. J Biol Chem. 2003 Jun 6;278(23):21136-45. Epub 2003 Mar 27.
Tadi K, Chang Y, Ashok BT, Chen Y, Moscatello A, Schaefer SD, Schantz SP, Policastro AJ, Geliebter J, Tiwari RK. 3,3'-Diindolylmethane, a cruciferous vegetable derived synthetic anti-proliferative compound in thyroid disease. Biochem Biophys Res Commun. 2005 Nov 25;337(3):1019-25. Epub 2005 Oct 3.
In my last post, I talked about the relationship between depression and PCOS; this post addresses anxiety and PCOS. Although we may tend to think of anxiety and depression as two different and distinct conditions or diagnoses, in fact, there's a lot of overlap. As a therapist, I end up assessing to see whether depression or anxiety is the more dominant condition, but I almost always end up treating some degree of both conditions.
Women with PCOS are well aware that their state of well-being is affected by their hormonal balance. Estrogen, progesterone, testosterone, melatonin, and cortisol all play vital roles in mood regulation as well as physical well-being. Depression is often a symptom of estrogen deficiency. Irritability and anxiety can be indicators of progesterone deficiency or estrogen excess. Likewise, testosterone deficiency can contribute to symptoms of anxiety, not to mention reduced energy and initiative (which is where you can start to see the overlap with depression symptoms). Melatonin deficiency contributes to anxiety and nervousness and disrupts sleep, which can further contribute to development of insomnia and depression. Inadequate cortisol as a result of too much stress can also result in symptoms of anxiety and depression.
The endocrine system is so complex, and PCOS patients typically are managed with hormone-affecting medications such as birth control pills and diabetes medications. If not properly balanced, side effects of such medications may include moodiness, irritability, and other symptoms that either mimic or exacerbate anxiety conditions. Medications that are prescribed for treatment of anxiety may include special anti-anxiety medications, but anxiety symptoms are often treated with depression medications, like the SSRIs (Zoloft, Celexa, etc.). Some anti-anxiety medications can be addictive if overused or misused.
To further complicate matters, your physician may not be aware of the complex interaction and possible healing benefits of proper nutrition and PCOS-specific supplementation that can dramatically lessen symptoms, and even eliminate the need for some medications. All of our neurotransmitters (those things in the brain that help generate the happy, sad, and anxious feelings) can be positively affected by the proper fuel as well as mind/body treatments that include stress management, meditation, mindfulness, exercise, yoga, hypnotherapy, etc. Just as the body yearns for homeostasis, so does the brain. The brain actually reshapes itself in response to stress, trauma, and our interactions with other people — that's true for the good as well as the bad.
So even if you have experienced a lot of negative things that are contributing to feelings of being anxious, there are many ways to approach the problem — and medication is only one of the possibilities in a big bag of therapeutic tools. Although your hormones are powerful influencers of mood and anxiety, so are nutrition, supplementation, and a proactive approach to therapy and other forms of support.
Awhile back, a good friend of mine who is an airline pilot shared with me that despite the fact that pilots must pass routine and rigorous physicals, most live only about 10 years after retirement…and currently the mandatory retirement age for airline pilots is 60!
I've been interested ever since in why a demographic of individuals who meet our current definition of"healthy" may not necessarily be so. My ulterior motive, of course, is to keep my friend around as long as possible, but in the process of studying about sleep and health, I continue to find some really interesting things relevant to PCOS.
Such as the relationship between shift work and breast cancer. The connection here is that women with PCOS are more prone to cancer in estrogen-sensitive tissues.
Researchers have known for a long time that women who work shift jobs, such as nurses, are more prone to breast cancer. Now, research is emerging to suggest that melatonin physically suppresses the growth of breast cancer cells. Melatonin exerts its effect in numerous ways, from suppressing receptor genes, reducing the activity of proteins that regulate tumor growth, changing genes, inhibiting cell reproduction. The study I'm referring to in this post literally referred to melatonin as an"antiestrogenic" compound.
So 'splain me something, Lucy. Why is it, when I go to the Susan Komen Race for the Cure website…that the keywords"sleep" and"shift work" bring up nothing? Seems to me that the Breast Cancer 3 Day Walk would be more relevant…and preventive to those who participate…if it was a Breast Cancer 3 Day Slumber Party!
Srinivasan V, Spence DW, Pandi-Perumal SR, Trakht I, Esquifino AI, Cardinali DP, Maestroni GJ. Melatonin, environmental light, and breast cancer. Breast Cancer Res Treat. 2008 Apr;108(3):339-50.
The first post on this topic was very popular. I didn't forget it, I have been busy traveling on behalf of inCYST and haven't had many free, quiet moments to collect my thoughts. They're here today, so I am capitalizing on them to get on with this thread!
Today I want to share some thoughts about estrogen.
As with luteinizing hormone, estrogen levels cycle throughout the month. There is no such thing, really, as a simple"high" or"low" estrogen, it depends on what day in your menstrual cycle you are looking at your estrogen levels. So, as with luteinizing hormone, the goal is to NORMALIZE estrogen levels: to make them high when they should be high, and low when they should be low.
One of the most important, but not frequently discussed aspects of estrogen metabolism to understand, is that we live in an environment that increasingly contains chemicals that interfere with natural estrogen function.
Every hormone in your body comes with a unique shape, designed to allow it to fit only into the receptors made to work with it. So an estrogen molecule won't mistakenly fit in a progesterone molecule, for example. There are many man-made chemicals that are very similar in shape to estrogen. They are so similar to estrogen, that they can fit into the estrogen receptor.
BUT…they are not similar enough that they can fool the receptor into being activated. What happens when your estrogen receptors are filled with inactive estrogen impostors? The body doesn't get the message that there is estrogen in the system, and it starts to make and release more of its own estrogen to make up the (nonexistent) deficiency that it perceives is in need of being corrected.
So your receptors are filled with inactive estrogen, which messes up your reproductive function and your real estrogen, because it is being blocked out of action in those receptors, is available to be active in estrogen-sensitive tissues, which is where some cancers are thought to get their jump start.
Your ultimate goal is not to put more estrogen into your system. Rather, it is to remove the"environmental estrogens" from your body, which gives your own estrogen a fighting chance to work. It's not just about YOUR infertility. Environmental scientists are reporting that other species are also becoming infertile due to the very same chemical influences. (Hence the lizard graphic on this post.) If you want to learn more, here is my favorite website:
As I continue with this series, you will understand why I am explaining all of this. For now, I just want you to understand that hormones are complex, and there are many reasons why they may be out of balance. My personal philosophy is that it is best to identify the source of the imbalance rather than try to force hormones in a direction that may not correct the core problem.
