Chastetree berry is a very common supplement used by women with PCOS. Does it work? If so, how?
In order to better understand this interesting but complex herb, I thought I'd make this a series spread across several posts. I'm starting with the hormones affected by chastetree berry: luteinizing hormone (LH), estrogen, progesterone, and prolactin. Today I'll focus on LH.
Luteinizing hormone is the hormone that causes ovulation. It is also the hormone that promotes development of the follicle into a corpus luteum, the intermediary step between egg and embryo.
Luteinizing hormone is interesting in that what constitutes a"normal" level depends on what stage of a menstrual cycle you are referring to. Levels are low at the beginning of a cycle, they ramp up to a peak just before ovulation. After ovulation, they drop back down again. This graph shows a typical LH cycle in a woman who does not have PCOS.
In PCOS, there are two key variations on normal LH function to consider. First of all, when levels are supposed to be low, they tend to be high. Secondly, at the point they should be surging in order to induce ovulation, they are too low to do so. Here is a graph of LH function that is common to women with PCOS.
As you can see, restoring good LH function is not a matter of raising or lowering LH levels. It's a matter of restoring cyclicity…in other words, making sure LH is high when it should be high, and making sure it's low when it should be low. When you read information about vitex, or LH, in your own research, you should be looking for the word"normalize", rather than"raise" or"lower".
Results of a research study are going around today, and it appears as though it's got some women with PCOS more than a little bummed out.
Entitled,"True and Sham Acupuncture Produced Similar Frequency of Ovulation and Improved LH to FSH Ratios in Women with Polycystic Ovary Syndrome," it reports the finding that when 84 women with PCOS were divided into two acupuncture treatment groups, one receiving the"official" treatment and one receiving a treatment that looked and felt like acupuncture but really wasn't…both groups showed some improvements in ovulation rate, LH to FSH ratio, and serum LH. The immediate summary/news byte that's being circulated, is that acupuncture doesn't work for PCOS.
Not so fast, Tweeters!!!
Here are some other things the study reported.
1. Both groups improved. So there was something about going into an acupuncture office that helped. Could it be the fact that acupuncture treatment is more hands on than Western medicine? There are studies documenting the healing power of human touch. Could it be that the subjects themselves were biased already, going into the study, believing they would get better? This study could really be documenting the power of the mind in healing. These women may have reduced their stress, and cortisol levels, simply by believing they were going to heal, rather than being controlled by fear and anxiety that we write about so often on this blog.
2. Secondly, in the acupuncture group, there were better correlations between insulin and ovulation, and testosterone and ovulation than in the other group. In other words, hormones were communicating better and responding to each other better. Meaning that acupuncture may not be the answer on its own, but it may help prep the body to start responding to other things like better diet and yoga.
I personally know, I've referred several clients for acupuncture and they've become pregnant. However, they spent a couple of months improving their diet, exercise, and stress management skills before going for treatment. In other words, they didn't use the option with the mentality that it was going to give them license to eat potato chips, not exercise, sleep two hours a night, and let acupuncture do all the work. It was the jump start that allowed the fruits of their commitment to blossom and ripen.
3. Thirdly, it didn't hurt anyone. So if it's doing no harm, and something about the process is helping, there's no need to completely discount it. It can certainly be a successful adjunct to healthier living.
Bottom line, acupuncture may not be a miraculous stand alone treatment, but there may be something about the nature of the delivery of the treatment that encourages healing and hormone balance.
Lisa M. Pastore, Christopher D. Williams, Jeffrey Janekins and James T. Patrie. True and Sham Acupuncture Produced Similar Frequency of Ovulation and Improved LH to FSH Ratios in Women with Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism August 3, 2011 jc.2011-1126
Our Chicago network member Lesli Bitel-Koskela sent me this great article about myoinositol, a nutrition supplement that was recently studied in comparison to metformin for its effect on anovulation and infertility.
In a study with 120 women who were required to have both a PCOS diagnosis and confirmed 14 to 16 months infertility prior to starting the research protocol, half were randomly assigned to a regimen of 1,500 mg metformin daily, while the rest were assigned a combination regimen of 4 grams myoinositol and 400 mcg folic acid. Here's how their stories played out.
Metformin 50% restored spontaneous ovulation, and 18.3% of those who did, achieved pregnancy. Total pregnancies for the 60 women: 5.
Myoinositol 65% restored spontaneous ovulation, and 30% of those who did, achieved pregnancy. Total pregnancies for the 60 women: 12.
My thoughts:
1. Myoinositol is a metabolic intermediate, and it's relatively inexpensive (looks like about 78 cents per 4 g dose as described above).
2. It certainly makes sense to try this first before moving into metformin.
3. If it doesn't succeed in achieving ovulation and pregnancy on its own, it certainly wouldn't hurt to use it in conjunction with metformin, hopefully achieving more effects with metformin on lower doses less likely to cause the horrible side effects our readers consistently complain about.
4. If you choose to try this regimen, be sure to include both the myoinositol and the folic acid, as it was not clarified which of the two is the most active one, or whether they work in conjunction.
5. This is a different compound from d-chiro-inositol, a popular supplement with women who have PCOS. Both appear to have benefit, as research evolves, we'll understand the particulars.
Lesli, I can guarantee you made a lot of readers happy by sharing this!
Readers, if you do experience success with this, please come back and share with us so those coming along behind you can benefit.
If you're REALLY interested in this, over the weekend I'll talk about where you can find myoinositol in food.
Raffone E, Rizzo P, Benedetto V. Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women. Gynecol Endocrinol. 2010;26(4)275-280.
The topic for this blog post was suggested by a reader. I figured it was likely important, since many of you struggle with depression and arthritis or some sort of chronic pain, and you're self-medicating. The effects of THC, the active ingredient in marijuana, on hormones, is quite extensive. I am summarizing the findings reported in the reference I list at the end. Bottom line, it's probably not the greatest idea to be regularly introducing marijuana into your system if your hormones are out of balance and you're trying to correct that problem. Even if you're not trying to become pregnant but you're sexually active. The effects outside of your own self are potentially significant.
Interestingly, improving your omega-6 to omega-3 dietary ratio helps to correct some of your own human cannabinoid levels, which may help to decrease the desire to get them from an external source. It may also alleviate the depression and joint pain that you may be using marijuana for in the first place. Some experts suggest that this imbalance of our "natural THC" may be one reason women with PCOS have strong carbohydrate cravings--it's another form of the munchies!
Reduced FSH and LH levels. Suppressed prolactin, thyroid, growth hormone Provokes cortisol release and reduces production of adrenal steroids, which makes it hard to maintain hormone levels. Interferes with ovarian prostaglandin synthesis.
HCG-stimulated and FSH-stimulated progesterone secretion is inhibited. Inhibits estradiol release.
Inhibits cholesterol esterase manufacture, and cholesterol is the building block for many reproductive hormones. Hyperplasia and hypertrophy of the uterus Changes in vaginal cell thickness, character and mucoid presentation Reduced uterine weight Suppresses thyroid function.
A dose of LH that routinely caused ovulation in normal rats was only able to induce ovulation in 40% of the rats exposed to THC. Two to fourfold greater doses of LH were required to restore ovulation in THC-exposed rats.
The equivalent of one marijuana cigarette per day interfered with cell division and embryonic growth in fertlized eggs. It also reduced intrauterine weight gain by the fetus.
Offspring of rats exposed to THC had abnormal eggs, meaning the fertility of future generations was also affected.
Prevents reuptake of serotonin, dopamine, norepinephrine into the brain, increasing, not decreasing, depression over the long term.
The topic for this blog post was suggested by a reader. I figured it was likely important, since many of you struggle with depression and arthritis or some sort of chronic pain, and you're self-medicating. The effects of THC, the active ingredient in marijuana, on hormones, is quite extensive. I am summarizing the findings reported in the reference I list at the end. Bottom line, it's probably not the greatest idea to be regularly introducing marijuana into your system if your hormones are out of balance and you're trying to correct that problem. Even if you're not trying to become pregnant but you're sexually active. The effects outside of your own self are potentially significant.
Interestingly, improving your omega-6 to omega-3 dietary ratio helps to correct some of your own human cannabinoid levels, which may help to decrease the desire to get them from an external source. It may also alleviate the depression and joint pain that you may be using marijuana for in the first place. Some experts suggest that this imbalance of our "natural THC" may be one reason women with PCOS have strong carbohydrate cravings--it's another form of the munchies!
Reduced FSH and LH levels. Suppressed prolactin, thyroid, growth hormone Provokes cortisol release and reduces production of adrenal steroids, which makes it hard to maintain hormone levels. Interferes with ovarian prostaglandin synthesis.
HCG-stimulated and FSH-stimulated progesterone secretion is inhibited. Inhibits estradiol release.
Inhibits cholesterol esterase manufacture, and cholesterol is the building block for many reproductive hormones. Hyperplasia and hypertrophy of the uterus Changes in vaginal cell thickness, character and mucoid presentation Reduced uterine weight Suppresses thyroid function.
A dose of LH that routinely caused ovulation in normal rats was only able to induce ovulation in 40% of the rats exposed to THC. Two to fourfold greater doses of LH were required to restore ovulation in THC-exposed rats.
The equivalent of one marijuana cigarette per day interfered with cell division and embryonic growth in fertlized eggs. It also reduced intrauterine weight gain by the fetus.
Offspring of rats exposed to THC had abnormal eggs, meaning the fertility of future generations was also affected.
Prevents reuptake of serotonin, dopamine, norepinephrine into the brain, increasing, not decreasing, depression over the long term.
Braude MC, Ludford MP, eds. Marijuana: Effects on the Endocrine Reproductive Systems. 1984
I've been writing this blog long enough to know that as soon as I recommend a supplement, the post is circulated, reposted, retweeted, ad nauseum. If I talk about changing food choices, it sits there like a bump on a log.
I posted the information about myoinositol supplementation because I knew that many of you are having such a hard time with the side effects of metformin, that it might be helpful to try this compound as an adjunct.
In the process of researching the topic, however, I came to understand that part of the reason many of you have a problem with your myoinositol levels in the first place…is that your dietary choices may have backed you into a corner.
Myoinositol isn't new news, really. Back in 1980 a physician and a dietitian wrote a very nice review article and developed some recommendations for increasing dietary inositol that I'm going to summarize here. In a nutshell, it's a dietary intermediate that is found in high quantities in nerve cells. If your nerves are working harder than they were designed to, as is the case when you don't manage your stress, don't attend to good sleep hygiene, overexercise, and eat a poorly varied diet, there is a really good chance you're going to deplete your myoinositol levels more quickly than you can replete them. That is a consequence for ANYONE not taking good care of themselves, it's not a unique feature of PCOS.
For anyone struggling with medical issues related to hyperexcitable brains, including migraines, epilepsy, anxiety disorder, OCD, PTSD, bipolar disorder, etc., it's highly possible that your daily myoinositol needs are simply higher than average. Everything you see us write about on this blog, from omega-3's to antioxidants, is designed to reduce that hyperexcitability and make it easier for your brain to function as it should. It certainly is not going to hurt to take a supplement, and if you've been asking your brain to run on nutritional empty for a long time, or if you've been working hard to turn your PCOS around with good habits and just don't seem to be getting over the hump with it, supplementing may be a great tool to add to your already good habits.
There is some thought that people with insulin function problems may have alterations in myoinositol function, which could also increase the daily needed dose.
I must iterate, however, that a myoinositol supplement is NOT a substitute for a healthy diet. There is no such thing as a donut for breakfast, a Snickers for lunch, and a binge for dinner…cancelled out by a few pills in a bottle. So my guess is that those of you who are making good changes diet and stress management-wise in conjunction with the supplement are the most likely to achieve the benefit of the supplement. That is just how biochemistry works!
The study I recently quoted (focusing on neuropathy, not ovulation) used a myoinositol dose of 4 grams. The study I quote today found an effective response from a highest dose of 1,500 mg. It doesn't mean that these are the doses recommended for each particular diagnosis, or type of inositol, pill or food…it simply means those are the doses the reseachers decided to study.
However, since that is the dose reported in the ovulation study, and more of you reading this are interested in conception than nerve pain, I'll post the values of the highest myoinositol containing foods and let you figure out what your best food/supplement combination is to achieve that dose (4000 mg or 4 g daily).
I'm going to tell you, what I was thinking as I compiled this list was that if you're only concentrating on carb/protein/fat content, you're cutting out all your myoinositol sources. It looks like Mother Nature makes sure that when we eat carbohydrate as it appears in nature, that it comes packaged with a nutrient important for metabolizing it. It's when we refine that sugar and eat it out of context, as with sodas, candy, baked goods, etc…that we dig a hole for our nervous systems.
We just can't outsmart her, can we?
The complete list can be found at this link.
Myoinositol Containing Foods with more than 100 mg/serving 1/2 cup grapefruit juice 456 1/2 cup canned great northern beans 440 1/4 fresh cantelope 355 1 fresh orange 307 1 slice stone ground wheat bread 288 1/2 cup rutabaga 252 1/2 cup kidney beans 249 1/2 cup orange juice 245 1/2 cup canned oranges 240 1/2 cup canned peas 235 1/2 fresh grapefruit 199 1 fresh lime 194 1/2 cup canned blackberries 173 1/2 cup mandarin oranges 149 1/2 cup canned lima beans 146 1/2 cup kiwi fruit 136 1 cup split peas 128 2 T. creamy peanut butter 122 1 fresh nectarine 118 1/2 cup canned black-eyed peas 117 1/2 cup grapefruit sections, canned 117 Rex S. Clements, Jr., M.D. and Betty Darnell, M.S., RD. Myo-inositol content of common foods: development of a high-myo-inositol diet. Am J Clin Nutr September 1980 vol. 33 no. 9, 1954-1967.
Scientists have reported that myo-inositol can be a safe supplement to use to promote ovulation and fertility.
I have known about inositol for years, as it is also a supplement that can be helpful in the treatment of anxiety, obsessive-compulsive disorder, and panic disorder.
Since 80% of the women with PCOS coming to my website are reporting some kind of anxiety, depression, and/or mood swings, it seems that using inositol as part of your overall health and fertility program may not be a bad idea. Even if you don't have a DIAGNOSIS of anxiety, it's so easy to feel stressed out when all you want is to conceive!
The supplement can be a bit expensive…but it's far cheaper than in vitro fertilization. And it's simply a form of a water-soluble B vitamin. If it can't hurt, and it might help, at least one issue you are looking for help with…why not give it a shot?
Papaleo E, Unfer V, et al. A novel method for ovulation induction," Gynecol Endocrinol, 2007; 23(12): 700-3.
Harvey BH, Brink CB, Seedat S, Stein DJ. Defining the neuromolecular action of myo-inositol: application to obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2002 Jan;26(1):21-32.
Palatnik A, Frolov K, Fux M, Benjamin J. Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 2001 Jun;21(3):335-9.
Here's an interesting Cochrane Review hot off the presses, evaluating the effects of insulin-sensitizing agents on fertility.
A group of 31 studies that compared the effectiveness of these agents to a placebo were evaluated for what they said overall about the potential benefit for their use in women with PCOS who are trying to conceive. Of these, 27 were studies about metformin (likely because it is the most widely researched/used and more studies exist in the first place).
What the researchers concluded:
There is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene. However, metformin does improve ovulation and pregnancy rates. (Interpreted, this suggests that metformin does not help to prevent miscarriage.)
Metformin was also associated with a significantly higher incidence of gastrointestinal disturbance, but no serious adverse effects were reported. (I don't know about those of you reading this blog post who have tried metformin, but I would question the assertion that the gastrointestinal disturbance this medication causes is not a"serious adverse effect"!
IN THE WORDS OF THE AUTHORS:"In agreement with the previous review, metformin is still of benefit in improving clinical pregnancy and ovulation rates. However, there is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene, or when compared with clomiphene. Therefore, the use of metformin in improving reproductive outcomes in women with PCOS appears to be limited."
D-chiro-inositol was not even mentioned in the abstract, suggesting that the findings were not significant.
As with any information shared in this blog, only you and your provider can make the ultimate decision. I can tell you what went through my own mind--and heart--as I read this, was that this medication may create a lot of false hope and hurt for those who trust that it has more power than it actually does. I wouldn't wish a miscarriage on anyone.
Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003053.
Chaste-tree [Vitex agnus-castus] has the effect of stimulating and normalizing pituitary gland functions, especially its progesterone function. When working with Chaste-tree berries, I classify her as amphoteric type of herb, which means that she tends to have a balancing effect specific to the pituitary gland function, the reproductive system, and libido. An example of the amphoteric effects of Chaste-tree are best observed in libido changes: if the individual is prone to having a higher libido, one of the effects of using Chaste-treethat may be noticed is a decrease in libido, however, if the individual is more prone to a lower libido, Chaste-tree may act as a libido booster, which would then increase the activity desires of the user. It will always enable what is appropriate to occur in order to help restore the body or system back to homeostasis, which is the optimal balanced state.
Primarily, Chaste-tree is used to help normalize the activity of the female sex hormones but is also used regularly for assisting with symptoms like dysmenorrhea, PMS, and other disorders related to hormone function. It is especially beneficial during menopausal changes. In a similar way, it may be used to aid the body to regain a natural balance after the use of birth control pills or major changes in hormone levels. Chaste-tree may also be helpful with skin ailments like premenstrual herpes outbreaks or acne on the lower half of the face, premenstrual breast pain, fibrocystic breast disease, endometriosis, luteal-phase deficiency, infertility, spotting during ovulation, ovarian or uterine cysts or tumors, menopausal hot flashes, low progesterone, high prolactine, and low dopamine.
Recommended dosage: as an infusion – pour a cup of boiling water onto (1)tsp of the dried berries and let steep for 10-15mins. Drink 2-3 times per day. As a tincture – take one dropper full twice daily
CONTRAINDICATIONS: -- concurrently with contraceptives, progestins, dopamine-receptor antagonists --consult with a trained medical profession regarding use during pregnancy --monitor usage and consult a trained professional if any abnormal changes occur with menstruation (heavy flow, increased clotting, flooding, etc)
Luisa Evonne Valdez, AKA The Herbalista, is a formally-trained herbalist practicing in Phoenix, Arizona. She is a member of the inCYST Network and has conducted a training for our members about herbs for PCOS. She is on the schedule at Dr. Lundgren's upcomingPCOS Boot Camp. Visither websiteand follow her onFacebookandTwitter.
This question comes up from time to time, and since inCYST is so big on flaxseed, it's a good idea to have information at your fingertips.
Around the Internet, caution regarding the use of flax while pregnant is easy to find. The rationale for this caution is that mothers and fetuses are especially sensitive to hormones.
The Internet is also full of advice from flaxseed manufacturers promoting its use, because it can be converted to DHA, which as this blog consistently discusses, is crucial for conception, pregnancy, and development of a healthy baby.
Neither of those assertions is totally correct.
I dove into Pub Med last night and looked for any research to support the advice against flax during pregnancy. I couldn't find it. What I DID find was a whole host of animal studies, primarily done on pigs and cows, with mostly positive findings. It's always important to remember that animal studies do not always extrapolate completely to humans, but they do give us an idea of what's going on.
Effects of flaxseed consumption during pregnancy (again, in pigs and cows) included: --healthier immune systems in babies --better growth in babies --after having one baby, a shorter time to ovulation (restored fertility) --breast milk with a higher omega-3 fatty acid content and a lower omega-6 to omega-3 fatty acid ratio --higher brain omega-3 content in babies --increased levels of EPA, another omega-3 important for prostaglandin function and healthy blood clotting --higher pregnancy rates --larger follicle size --higher conception rates --lower miscarriage rates --higher progesterone levels
IMPORTANT DISCLAIMERS While I'm always excited to report positive links between nutrition and fertility, you all should know when I look through the research I am actually searching hard for the BAD news. This is such a high-risk specialty! The very last thing I would want to do is encourage our readers to make choices leading to frustration, disappointment, heartache, and loss of our own credibility. So I want to make it clear, the benefits of flax can be achieved only if it's used with respect.
Flax cannot replace fish oil. Some flax supplement manufacturers promote its use because it is converted into DHA and therefore can be used as a supplement for flax. Not true! The studies I perused found different effects for both, meaning you need both in your diet.
If your diet is imbalanced, flax won't make up for it. One study I found showed that when protein intake was low, flax supplementation was not beneficial. This would be a scenario not uncommon with our vegetarian readers, if their definition of vegetarian eating focuses more on what to eliminate rather than what to include, or is the remnant of an eating disorder. As always, supplements work best in a well-nourished environment; they cannot replace balanced, nourished eating.
Finally, if you choose to use flax…IT MUST BE GROUND. In other words, the flaxseed tortilla chips at Trader Joe's were not what made these studies work.: )
I've heavily referenced this post to save the skeptics the work.
I hope you find this helpful!
Rao SS, Kale AA, Joshi SR, Mahadik SP. Sensitivity of fetus and pups to excess levels of maternal intakes of alpha linolenic acid at marginal protein levels in Wistar rats. Reprod Toxicol. 2007 Nov-Dec;24(3-4):333-42. Epub 2007 Jul 28. Yu B, Khan G, Foxworth A, Huang K, Hilakivi-Clarke L. Maternal dietary exposure to fiber during pregnancy and mammary tumorigenesis among rat offspring. Int J Cancer. 2006 Nov 15;119(10):2279-86. Ambrose DJ, Kastelic JP, Corbett R, Pitney PA, Petit HV, Small JA, Zalkovic P. Lower pregnancy losses in lactating dairy cows fed a diet enriched in alpha-linolenic acid. J Dairy Sci. 2006 Aug;89(8):3066-74.
Petit HV, Twagiramungu H. Conception rate and reproductive function of dairy cows fed different fat sources. Theriogenology. 2006 Sep 15;66(5):1316-24. Epub 2006 Jun 2. Farmer C, Giguère A, Lessard M. Dietary supplementation with different forms of flax in late gestation and lactation: Effects on sow and litter performances, endocrinology, and immune response. J Anim Sci. 2010 Jan;88(1):225-37. Epub 2009 Sep 25.
Colazo MG, Hayirli A, Doepel L, Ambrose DJ. Reproductive performance of dairy cows is influenced by prepartum feed restriction and dietary fatty acid source. J Dairy Sci. 2009 Jun;92(6):2562-71. Farmer C, Petit HV. Effects of dietary supplementation with different forms of flax in late-gestation and lactation on fatty acid profiles in sows and their piglets. J Anim Sci. 2009 Aug;87(8):2600-13. Epub 2009 Apr 24. Brazle AE, Johnson BJ, Webel SK, Rathbun TJ, Davis DL. Omega-3 fatty acids in the gravid pig uterus as affected by maternal supplementation with omega-3 fatty acids. J Anim Sci. 2009 Mar;87(3):994-1002. Epub 2008 Nov 7.
Galbreath CW, Scholljegerdes EJ, Lardy GP, Odde KG, Wilson ME, Schroeder JW, Vonnahme KA. Effect of feeding flax or linseed meal on progesterone clearance rate in ovariectomized ewes. Domest Anim Endocrinol. 2008 Aug;35(2):164-9. Epub 2008 Jun 5.
I received a very important call from one of my patients this morning…"yes, Michele I am pregnant!". The words that I LOVE to hear and recently been hearing a lot!! This experience marks the sixth consecutive client of mine who has conceived 4-8 weeks after starting to work with me! What makes this especially exciting is that all of these women have been trying for at least over a year with one who was trying for 2 1/2 years with a failed IVF.
My client who was trying for over 2 1/2 years, tried IVF and was working with one of the best reproductive medicine clinics in the city. She presented to me with concern that she might have PCOS and a desire to lose weight. She was sophisticated and well educated on treatments for fertility, however after 2 1/2 years she found herself depressed, exhausted and believing that she would never conceive. She never had any expectation that she would leave my office with a plan to promote ovulation, but that day we did exactly that and at her 5-week visit, she shared in tears that she was PREGNANT!
I used to always joke and say that I was single handedly responsible for milk consumption going up in the Twin Cities, now I believe that I might be responsible for a baby boom!
Michele Gorman, MS, RD, LD Twin City Nutrition, LLC www.twincitynutrition.com
There are three reasons you may have a deficiency in your diet.
1. Your dietary choices are not providing you with adequate levels of a nutrient, or are increasing your need for a nutrient.
With PCOS, for example, if you're eating a lot of processed carbohydrates, you're increasing your needs for chromium, which is needed to metabolize carbohydrates. The problem is not really that you're lacking in chromium, but rather that your dietary choices have caused your body to use more chromium than it would lke to.
2. Medications you are taking may be increasing your need for certain nutrients.
Metformin, for example, has been found to increase your need for vitamin B12. If you are using metformin, (especially if you are a vegetarian), you may need to increase your current intake of this vitamin.
3. The disease itself may create its own unique metabolic needs.
For example, some women with PCOS are thought to have a variation in the way their bodies manufacture d-chiro-inositol that can be overridden with supplementation.
But throwing the supplemental kitchen sink at your PCOS is not the answer! There are a few supplements on the market that are"PCOS-friendly" combinations. But they're expensive, and they don't really look at you as an individual. Everyone's PCOS is different. It's going to respond to different treatments. It's important to have a game plan to avoid spending unnecessary money and depriving yourself of the effect you were hoping to have.
Here is my checklist for supplement game planning to be sure you're being a properly scientific detective about the process.
1. Take a look at your diet. Do a diet analysis and see where your most common dietary deficiencies fall. Is it vitamin D? Iron? Omega-3 fats? Is the deficiency caused by your voluntary dietary choices? Then do your best to correct the deficiency with food. This is important for two different reasons:
--You're likely going to need less supplement down the road if the environment you choose to put the supplement in is best able to benefit from having it. --A supplement will never replace good nutrition. Yes, we do know a lot about the biochemistry of PCOS, but that doesn't mean we know everything about it! So you can supplement away based on what is known, and completely be missing the boat with what you need. Foods have lots of things in them we understand. Some of the ways they deliver nutrition and interact with each other, we don't. When you isolate, and separate, until breakfast is a lineup of colored capsules instead of a variety of textures, flavors, colors, and nutrients…
2. Identify what it is that you're trying to change. Better skin? Enhanced ovulation? Improved moods? Research how long it is going to take, with a supplement, to notice that kind of change. When you DO decide to take that supplement…take it consistently enough and long enough so that you can be scientific about how well it's working for you.
3. Identify the dose you're going to need. I cannot emphasize this enough! Even physicians are guilty of this. I'll ask a client how much fish oil she's taking and she knows how many capsules, but not the strength of the capsule or the dose of DHA. And that is what her physician advised her to do. Even if you're using food, you need to have an idea of where you're trying to go, if you're ever going to get there.
4. Add one supplement at a time. If you take one of these multi-component supplements and you kind of feel better, but not all the way there…worse yet, if you take one and have a reaction, you have so many possible culprits to try to identify that sorting through the possibilities is an impossible task. Pick one, dose it correctly, take it long enough to evaluate if it's working or if it's causing trouble, or doing nothing at all…and once you've determined what's happening, then think about whether or not another layer of supplements is necessary.
5. Don't base your dose on what your friend is doing for HER PCOS. Don't recommend to your friend what you're doing for YOUR PCOS. Everyone's situation is different, it is the farthest thing from one size fits all. You may be hurting more than helping.
I'm not anti-supplement at all. I just sense sometimes that it's easier to keep the responsibility for the symptoms outside of yourself if you can position the problem as being a deficiency. Owning that your own food habits may be a significant part of the problem takes a little more humility…even courage…but it may be where the most effective answers lie.
Important Lab Tests for PCOS Many women who have PCOS have not had the correct blood work done or don't know what blood tests to ask to have done.I would like to post some important labs used to diagnose and monitor PCOS 1. Total testosterone (elevated levels are > 50ng/dl 2. Free testosterone 3. Luteinizing Hormone (LH) (plays a role in ovulation and egg development) 4. Follicle Stimulating Hormone (FSH) (responsible for egg release from the ovaries) 5. LH/FSH ratio (results should be under 2) 6. DHEA-sulfate (this test tells how much androgens or"male hormones" your body is producing) DHEA sulfate converts into testosterone. 7. Prolactin 8. Thyroid Stimulating Hormone (TSH) this test will help to rule out hypo or hyperthyroidism (slow vs fast metabolism issues) 9. Liver Function tests (LFT's). Important since medications pass through the liver, to check for possible damages. Checking every 3-6 months is recommended. 10. Fasting Lipid Profile: Total Cholesterol (<>45 mg/dl is ideal)Low Density Lipoproteins (LDL) (<130 mg/dl is ideal)Triglycerides (fat in blood) (<150 mg/dl is ideal) 11. Fasting Insulin (results should be <10) difficult to do, it needs to be frozen when brought to the lab and tested before it reaches a certain temperature, expensive but would be very beneficial in determining and monitoring insulin resistance. 12. Fasting blood chemistry panel (includes glucose, electolytes and sometimes renal labs) 13. Fasting glucose to insulin ratio (used to diagnose and monitor insulin resistance, ratio under 4.5 usually indicated insulin resistance)
Ellen Reiss Goldfarb, RD 11500 W. Olympic Blvd, Suite 400 Los Angeles, CA 310-408-1770 info@ellenreissgoldfarb.com
I've mentioned before that receiving any kind of medical diagnosis that can leave you backed into a corner, with no place to go, is one of life's most extreme stresses. If you're someone who is used to being in control, losing that control can throw you into a complete tailspin. That is when you are most likely to be susceptible to something called"magical thinking". This type of behavior is something you engage in to allow yourself to feel as if you you have more control over a situation than you actually have. Some examples in recent months that I've personally experienced:
-- A gentleman I really wanted to do business with because I liked his product, started to panic because sales of that product were not matching his projections. I started receiving e-mails from him about all kinds of interesting"effects" he was personally noticing that he attributed to the special powers of his product. I mentioned to him once that if his observations were true, science would validate them. He told me he didn't have time to wait for science. Can you hear the desperation and wishful thinking that was interfering with his overall long-term success? I felt sad, because his product was good, but he was gradually burning business bridges before he could get the sales he wanted and should have had.
--A young woman who had failed one IVF and was scheduled for another, afraid she'd lose that success too, wrote me asking to help her with a detox/cleanse, less than a week before her procedure. She wanted to rid her body of any negative influences that might work against her. We decided against the detox, and simply set up a very balanced eating/exercise/relaxation plan focusing on nurturing instead. (She's pregnant, BTW). I don't think she really wanted to detox, she really needed something constructive to do as an anxiety outlet, and to give her hope she wasn't going to fail again.
Supplements are the place where magical thinking really takes control. I watch women with PCOS throw the entire kitchen sink at a problem, without knowing exactly what kind of effect they're looking for, what dose, what brand, what kind of interactions their multiple supplements may have with each other…which ones duplicate the effects of others…all it seems to take is for one person out there to mention one supplement and the"wave" rolls across the PCOS blogs and Facebook pages. Because no one ever really took the time to figure out how to use the supplement in a scientific fashion, it doesn't work, women give up on it before it might have a chance to work, and they're off on a search for the next magical supplement.
We're starting to understand here at inCYST that there is more than one kind of PCOS. So if anyone is recommending any particular supplement, and it's a one-size-fits-all recommendation, they're either telling you what worked for them (which may not work for you), or they are throwing together a little bit of something from every study they could find, which makes their answer extremely expensive because half of what is in it, most women don't even need.
Just because you can buy supplements yourself over the counter, and dose them yourself, does not mean they're safe. If your physician is anti-supplement and you're not telling him/her about the supplements you're taking because you know s/he is against them, you could be negating the effects of both your medications and your supplements. There are ways to use both, but it's only going to work if whoever you are asking for help, is amenable to combining both approaches.
The supplement that currently seems to be the rage right now seems to be n-acetyl-cysteine, or NAC. I'm not sure where this wave got started. I'm not going into the nuts and bolts of the chemistry, you can find that elsewhere. But here are some things to consider.
1. NAC has also been shown to reduce the symptoms of bipolar disorder and schizophrenia. I'm guessing that the subpopulation of women with PCOS who also have one of these diagnoses (and that's a pretty significant percentage of the PCOS population BTW), are the ones most likely to benefit from NAC. But since mood regulating medications are powerful, it's super important, if this is you, to let the prescribing physician of any mood stabilizers know so that you don't experience a dangerous adverse reaction between medication and supplement. And by all means, DO NOT stop taking medication for schizophrenia or bipolar disorder because you read what I just wrote!!!
2. NAC is also being considered as a treatment for obsessive-compulsive disorder, something I know is also very common with PCOS. If you're going to use a supplement, I'm more comfortable with your using myoinositol for this purpose, which has also been shown to help improve fertility rates. Again, please let your caregiver know what you're doing. One of our fans recently shared that she took a blog post regarding inositol to her physician, who now recommends it to his PCOS patients. In talking to your doctors, you have to potential to teach them important things. (That's why I reference posts, so your doctors can read the research themselves and know my thoughts are evidence-based.)
2. There is some evidence that large doses of NAC can increase the risk of pulmonary hypertension, a very dangerous condition. I can't stop you from taking this supplement, but I can encourage you, if you decide you want to use it, to do so in conjunction with a knowledgeable health professional who can help you to properly dose it.
3. In the most recent study I found regarding NAC compared to metformin/clomiphene, metformin/clomiphene was found to be superior. But if you remember, I wrote pretty extensively not too long ago about the peer-reviewed finding that metformin increased ovulation and pregnancy rates but not live births (thus increasing the miscarriage rate). Perhaps you should think a little bit about whether or not this is the path you wish to embark on, using a supplement that has not been proven to be as"effective" as a medication that hasn't even been proven to be effective.
4. One reason NAC is thought to be useful is that it protects against"glucose toxicity". Here's a thought — why not eat less glucose? Even if you choose myoinositol over NAC based on what you're reading, consider that your own inositol stores may have found themselves depleted in the first place from imbalanced eating. No way around it, supplements do not replace healthy choices. If you're going to experience the greatest benefit from a supplement, it needs to complement, not replace, better eating.
You're all grown women and you can make your own choices. I hate seeing you struggle with PCOS. But worse than that, I hate seeing you jump around from supplement to supplement without any kind of plan of action for how you're going to use it, how you're going to know if it's working, and how you're going to know if you need to not use it.
The people who benefit the most from magical thinking…are the ones who play on your anxiety and frustration and take your money, offering"solutions". Be a wise consumer. And remember, something you ALWAYS have control over…is healthier food choices, activity schedules, and stress management.
Berk M, Dean O, Cotton SM, Gama CS, Kapczinski F, Fernandes BS, Kohlmann K, Jeavons S, Hewitt K, Allwang C, Cobb H, Bush AI, Schapkaitz I, Dodd S, Malhi GS. The efficacy of N-acetylcysteine as an adjunctive treatment in bipolar depression: An open label trial. J Affect Disord. 2011 Jun 28. [Epub ahead of print]
Camfield DA, Sarris J, Berk M. Nutraceuticals in the treatment of obsessive compulsive disorder (OCD): a review of mechanistic and clinical evidence. Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jun 1;35(4):887-95. Epub 2011 Feb 23. Abu Hashim H, Anwar K, El-Fatah RA. N-acetyl cysteine plus clomiphene citrate versus metformin and clomiphene citrate in treatment of clomiphene-resistant polycystic ovary syndrome: a randomized controlled trial. J Womens Health (Larchmt). 2010 Nov;19(11):2043-8. Epub 2010 Oct 12.
Kaneto, H. Kajimoto, Y. Miyagawa, J. Matsuoka, T. Fujitani, Y. Umayahara, Y. Hanafusa, T. Matsuzawa, Y. et al. (1999). Beneficial effects of antioxidants in diabetes: possible protection of pancreatic beta-cells against glucose toxicity. Diabetes 48 (12): 2398–406.
This past Wednesday, Sasha Ottey of PCOS Challenge interviewed Walter Futterweit, MD, a longtime PCOS researcher and advocate. He provided a great summary of the laboratory tests you should be getting and why. I'm providing that summary here.
If you'd like to listen to the interview with Dr. Futterweit in its entirety, please visit Sasha's Blog Talk Radio page.
Adrenal hormones--these test rule out an adrenal problem, necessary to do to be sure it's actually PCOS
17 hydroxy progesterone (drawn between 5 and 9 of a menstrual cycle)--rules out the diagnosis of nonclassic congenital adrenal hyperplasia.
(Normal levels are 15-70 ng/dl prior to ovulation, and 35-290 ng/dl during the luteal phase. )
DHEAS (dehydroepiandrosterone sulfate)
Typical normal ranges, according to NIH, for females, are:
Prolactin levels, which rule out a prolactin producing tumor, as well as the effects of some medications such as Risperdal, which can elevate prolactin levels
•Non-pregnant females: 2 — 29 ng/mL
•Pregnant women: 10 — 209 ng/mL
Tests to monitor thyroid function
T4
A typical normal range is 4.5 to 11.2 micrograms per deciliter (mcg/dL).
TSH
Normal values are 0.4 — 4.0 mIU/L.
SHBG (sex hormone binding globulin) — helps to evaluate how much of your testosterone is bound/inactive and how much is free and available to cause androgen-related symptoms.
Normal values:
Follicular phase of menstrual cycle 24 — 200 nmol/L Luteal phase of menstrual cycle 48 — 185 nmol/L Contraceptive use 89 — 379 nmol/L Postmenopausal 46 — 200 nmol/L
Insulin function
Fasting insulin level Normal values: less than 13 mIU/ml
2 h glucose tolerance test Depends on the laboratory's protocol. Typical values can be found at the link directly above.
***************************************************************************** Dr. Futterweit did not mention vitamin D testing but since low vitamin D levels are commonly found in women with PCOS, I'd recommend that as well.
This is an interesting study out of Finland about women who sought IVF treatment. The researchers were interested to know if a history of induced abortion in any way might be connected to fertility treatments later on in life. A total of 19,429 charts were reviewed, which is a significant sample size. Twelve percent of women seeking IVF treatment and 11% of women seeking ovulation induction treatment reported having had a previous abortion. According to the researchers, this was statistically significant. The researchers encouraged that women receiving treatment for abortion be advised of the possibility of infertility at a later age. They also encouraged practitioners providing fertility treatments to be thorough in their assessment of patients and be sure to ask if this is part of a patient's reproductive profile.
There are many reasons why this relationship may occur. The important thing is, if it describes YOU, and you have not shared this information with your physician, it is important to be sure you do so. Every little piece of information you have to share allows your physician to develop a treatment plan with the best possible chances of succeeding.
Hemminki E, Klemetti R, Sevón T, Gissler M. Induced abortions previous to IVF: an epidemiologic register-based study from Finland. Hum Reprod. 2008 Jun;23(6):1320-3. Epub 2008 Mar 27.
Yesterday I reported on research suggesting that myoinositol was effective in creating more viable eggs than d-chiro-inositol, but qualified that the study was performed on women with PCOS whose insulin function was normal. Guess what…myoinositol does that too!
Again, this experiment was conducted in conjunction with the administration of folate, so realistically re-creating this in your own home laboratory may require both.
Forty-two women with PCOS were treated in a double-blind trial with myoinositol plus folic acid or folic acid alone by itself. The myoinositol group, at the end of the study, experienced lower serum total testosterone, serum free testosterone, plasma triglycerides, systolic blood pressure, diastolic blood pressure, and area under the plasma insulin curve after oral administration of glucose. And insulin sensitivity increased. 16 out of 23 women given myoinositol group ovulated, compared to 4 out of 19 in placebo group.
When this information is combined with the information I wrote about yesterday, what it seems to say is that myoinositol creates an environment where a pregnancy is not only more likely to occur and but also to sustain itself. One of the frustrations I have expressed here before is that while metormin helps to increase ovulation rate, it doesn't transfer to babies at the end of the path. I don't have to tell you how frustrating it is to know you've got half the system up and running and nothing you try seems to make the other half cooperate.
Costantino D, Minozzi G, Minozzi E, Guaraldi C. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):105-10.
Genazzani AD, Lanzoni C, Ricchieri F, Jasonni VM. Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Gynecol Endocrinol. 2008 Mar;24(3):139-44.
New Infertility Program Puts Mother Nature Back Into The Equation
Phoenix, AZ and Marina del Rey, CA (August 19, 2008). Monika M. Woolsey, a registered dietitian, knows the story well. “Can you please help me? I failed fertility treatment, and I’m desperate for a baby, but I’m emotionally and financially exhausted.” She finally decided to do something about it. During ten years of specializing in infertility, she used her training in nutrition and exercise physiology to create a lifestyle program that naturally balances hormones. She’s trained a few dozen colleagues in the concept, and they’re confirming her findings—a few simple tweaks in diet and lifestyle can greatly enhance fertility.
Michele Gorman, MS, RD, LD, of Twin City Nutrition in Minneapolis, trained with Monika. “My client who was trying for over 2 1/2 years, tried in-vitro fertilization, and was working with one of the best reproductive medicine clinics in the city. She was sophisticated and well educated on treatments for fertility, however after 2 1/2 years she found herself depressed, exhausted and believing that she would never conceive. She never had any expectation that she would leave my office with a plan to promote ovulation, but that day we did exactly that and at her 5-week visit, she shared in tears that she was PREGNANT!”
The results from this program have been so profound that Gorman and Woolsey, along with dietitian Susan Dopart of Santa Monica, are now setting up their first research study to officially document their findings.
In the meantime, Woolsey has created a day spa, Fertile Intentions, for couples who would like to learn more about a natural option to try either as a first step or as an adjunct to traditional medical treatment. The first event will be Saturday, October 25, 2008, at Creative Chakra Spa in Marina del Rey. In addition to teaching the science and application of this program, this day spa will focus on emotionally supporting couples whose pursuit of familyhood has started to erode their relationship.
“The entire day is filled with information and experiences completely devoted to the COUPLE. And how that couple can live, relax, and communicate in ways that promote better balance all around. If the goal is to bring children into this world, as much as possible, I want those parents to be happy and excited, not completely exhausted when it finally comes to be,” says Woolsey. For further information on Fertile Intentions Couples Day Spas, visit www.afterthediet.com/fertileintentions.htm
Phoenix, AZ (June 2, 2010). Monika M. Woolsey, a registered dietitian, knows the story well. “Can you please help me? I failed fertility treatment, and I’m desperate for a baby, but I’m emotionally and financially exhausted.” She finally decided to do something about it. During ten years of specializing in infertility, she used her training in nutrition and exercise physiology to create a program that naturally balances hormones. She’s trained a few dozen colleagues in the concept, and they’re confirming her findings—a few simple tweaks in diet and lifestyle can greatly enhance fertility.
Michele Gorman, MS, RD, LD, of Twin City Nutrition in Minneapolis, trained with Monika. “My client who was trying for over 2 1/2 years, tried in-vitro fertilization, and was working with one of the best reproductive medicine clinics in the city. She found herself depressed, exhausted and believing that she would never conceive. She never had any expectation that she would leave my office with a plan to promote ovulation, but that day we did exactly that and at her 5-week visit, she shared in tears that she was PREGNANT!”
Woolsey has teamed with the Clarendon Hotels to offer a Full Moon Couples Fertility Getaway, where the specifics of this program will be presented in a relaxed, nonclinical environment. One, two, and three night packages will provide information about simple natural choices as either a first intervention or as an adjunct to traditional medical treatment. In addition to lectures, a variety of experiences (couples massages, rooftop starlight yoga, couples facials, and individual consultations) will focus on emotionally supporting couples whose pursuit of familyhood has started to erode their relationship. The first program will be held June 24-27, with additional programs during full moons scheduled through 2010.
“The entire program is devoted to the couple and their relationship. If the goal is to bring children into this world, as much as possible, I want those parents to be happy and excited, not completely exhausted when it finally comes to be,” says Woolsey.
For further information on Fertile Intentions Couples Day Spas, visit www.afterthediet.com/fertileintentions.html
Yesterday I shared some great news from an Italian research group about myoinositol for improving fertility. In the process of corresponding, they sent me a series of articles from their lab. One of their most recent investigated the combination of myoinositol and melatonin in fertility treatment.
Here's how it looks like the story goes.
Ovulation is an inflammatory process Yes, the process of releasing an egg, and giving life, is pro-inflammatory. It takes a lot of energy to do this, and as that energy is metabolized, it's oxidizing tissue around it.
Melatonin is one of the most powerful antioxidants we have You know, if you think about this the way Mother Nature does, it makes sense that we'd want to roll over and sleep all cuddled up after sex. It is her way of protecting that fragile egg from all of the stresses of the day.
The research I read yesterday was about INOFOLIC PLUS, an Italian proprietary blend of inositol, folic acid, and melatonin. Forty-six women who had previously undergone in-vitro fertilization (IVF) and failed, used this supplement daily for 3 months before undergoing another IVF procedure. They also continued to take INOFOLIC throughout the entire IVF cycle. This study, by the way, did NOT focus on women with PCOS, merely women who had failed IVF.
Here are some of the results of the second IVF in which the supplement was used: --Higher number of embryo transfers --Higher embryo quality --Where all of the subjects had failed with their first IVF the first time, 13 (28%) became pregnant during the study, 4 miscarried.
What is remarkable about this study is that the average age of these women was 39 years, an age where fertility is starting to become difficult even without a diagnosis of infertility.
The supplement is not perfect, but it shows promise for helping women for whom other strategies have failed. It seems to be a great combination of compounds for peeling off the layers of inflammatory/oxidative damage have inflicted on reproductive systems…talking your ovaries down out of the tree, so to speak. What it seems to do, is both create a higher quality egg and then protect it from the ravages of oxidation long enough for it to meet a sperm, conceive, and create an embryo.
Ahhhhhh…just love the power we have within ourselves to create healing solutions!
As I mentioned yesterday, unfortunately, INOFOLIC is not available in the United States. However, there is an important bottom line message here that cannot be ignored.
When you're not eating enough antioxidants, not delegating, working too hard, not sleeping well, not managing your stress, the melatonin Mother Nature given you to protect your eggs, may likely be channeled into fighting other damages those lifestyle choices have promoted.
Not trying to shake the eFinger at you here, it's just becoming apparent from listening to so many of your stories that when we don't take good care of ourselves, the effects can stick around for a very long time. And when we do things in an effort to eat well but don't do our homework first (such as eating vegan but not making sure all nutrients are still adequate in the diet or panicking and going on a crash diet in order to get pregnant, or overexercising as the only way to manage stress), they can hurt us in the long run.
If you start to think about your choices as"What can I do to not unnecessarily use my own antioxidant power so it can be there for that egg?"…perhaps making some of those choices you've been reluctant to take on, might become easier to embrace.
Unfer V, Raffone E, Rizzo P, Buffo S. Effect of a supplementation with myo-inositol plus melatonin on oocyte quality in women who failed to conceive in previous in vitro fertilization cycles for poor oocyte quality: a prospective, longitudinal, cohort study. Gynecol Endocrinol. 2011 Apr 5. [Epub ahead of print]
![Chaste-tree Berries [Vitex agnus-castus]](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEia_cDxvXATK7NvDvO3BI3E68WG_FJpkCzGsuA5O5Ef_-EQFWoiuxEIN1ozE0NzKhjqRjhPCZK4R04X2OrHznPDLmJ0NJYvc2nFaQi0acQ_gSnVJl1KRPCGKSP6GTNQqtupcESngBPgYg/s1333/Vitex_agnus-castus_Montrose_Purple-6.jpg)
