Step # 10
Eat a healthy diet by increasing foods which are beneficial and avoiding substances which harm: Reduce caffeine consumption
Caffeine is a drug. A legal drug and a commonly consumed one, but a drug nonetheless. It is a stimulant and can help make us more alert and energetic when used sparingly and appropriately, such as when driving long distances or working extra hours. When overused however, it can exhaust the adrenal glands causing chronic lethargy, hormonal disruption, anxiousness and irritability.
The bulk of the scientific literature seems to suggest that a moderate caffeine intake, up to 3 caffeinated drinks per day, may be beneficial. A cup or two of tea a day can reduce your risk of heart disease. A cup or two of coffee may reduce the risk of diabetes and improve brain function and memory. More than this, however, can have negative effects.
What you eat along with your caffeinated drink also impacts the effect that the caffeine will have. Drinking coffee along with carbohydrates increases insulin resistance and blood sugar levels, so if you are going to have a cup of coffee, enjoy it by itself without any muffins, toast or fruit.
A study published in the journal Diabetes Care in 2002 found that caffeine reduced insulin sensitivity by 15%. As insulin resistance is already a key issue for women with PCOS, caffeine restriction or avoidance may be helpful in managing this condition.
Step # 11
Supplement with herbs and nutrients which support healthy carbohydrate metabolism: D-chiro inositol
D-Chiro Inositol (DCI) is a member of a family of substances referred to as inositols and generally considered to fall within the B vitamin complex.
It can be found in small amounts in a range of foodssuch as buckwheat, chickpeas, soya lecithin, pumpkin and pumpkin seeds as well as in the Ayurvedic herb bitter melon (momordica charantia). It is also produced by healthy human bodies from d-pinitol and myo-inositol, both of which are relatively abundant in the average diet.
DCI plays an important role in insulin signal transduction in human metabolism as a secondary messenger. Insulin transports the sugar from the blood into the cell where a d-chiro inositol-containing Inositol Phosphoglycan or DCI-IPG converts the sugar into either adenosine triphospate (ATP) to be used as energy or glucagon to be stored for later use.
It is currently thought that many cases of insulin resistance, polycystic ovarian syndrome and even type II diabetes mellitus are caused by a functional deficiency of this substance through both dysfunction of the enzyme which produces DCI as well as an overly efficient method of excreting what DCI is present in the body.
Studies have found that women with PCOS excrete DCI in their urine at 6 times the rate of healthy control subjects, whilst tissue biopsies taken from people with Type II diabetes have shown a significantly decreased level of DCI-IPG in their cells.
Supplementing with d-chiro inositol can help to address the functional deficiency and may increase the amount of DCI-IPG available in the cells to properly metabolise glucose into energy.
There is early evidence that DCI may also help those with Type II Diabetes Mellitus, however, further clinical trials will be required before this will be known definitively and the effect quantified. For the time being, taking DCI is an excellent way help minimise the risk of PCOS developing into Diabetes.
Human clinical studies have so far shown that DCI supplementation in women with PCOS and those who are insulin resistant can improve a whole raft of symptoms and clinical markers such as:
- Increasing cellular insulin sensitivity
- Increasing fertility
- Improved ovulation frequency by 300%
- Increased low progesterone levels
- Reduced serum insulin levels
- Reducing raised serum androgens (testosterone) both free and total
- Reducing glycosylated haemoglobin (HbA1c) an indicator of long term sugar levels
- Reducing plasma triglyceride levels (the amount of fat in your blood)
- Reducing (bad) LDL cholesterol
- Increasing (good) HDL cholesterol
- Reducing raised blood pressure, both systolic and diastolic
Step # 12
Supplement with herbs and nutrients which support healthy carbohydrate metabolism: Vitamin D
Vitamin D deficiency occurs in a very high percentage of women with PCOS, over 70%, and appears to be a contributing factor to some of the biochemical abnormalities seen in the condition such as irregular menstruation and infertility. Increasing Vitamin D levels has been shown to improve insulin sensitivity and help in the treatment of obesity. Researchers at the Medical University of Graz in Austria have found that low Vitamin D levels correlate with the occurrence and severity of belly fat, weight gain, high blood pressure, elevated blood sugar levels, insulin resistance, elevated insulin levels, elevated triglycerides and high cholesterol levels.
In a study of 13 women with PCOS, 8 were found to have a degree of vitamin D deficiency – some quite severe. All 13 women were treated with vitamin D2 (not the recommended form of Vitamin D by the way D3 is much much better) at a dose of 50,000 IU once or twice a week, and also received 1,500 mg of supplemental calcium per day.
Nine women in the study had either irregular or completely absent menstruation prior to the study. After Vitamin D supplementation 7 had their cycles return and/or normalise within 2 months and … here’s the good bit … the 2 who didn’t have their cycles return or normalise … were pregnant! Any incidences of dysfunctional uterine bleeding also resolved within 2 months of Vitamin D supplementation.
Other studies have also shown that a percentage of women with polycystic ovary syndrome had sub-optimal levels of vitamin D. Low vitamin D has been clearly linked to insulin resistance and obesity.
Step # 13
Work with a qualified professional to choose a selection of herbs and nutrients which support healthy carbohydrate metabolism.
Chromium is an essential component of glucose tolerance factor (GTF) which works along with insulin to transport the blood sugar into the cells of our body so that it can be used as fuel to generate energy. If you have enough chromium in your body, then you need less insulin to maintain a healthy blood sugar range. It also plays a part in protein and fat metabolism and in maintaining healthy cholesterol ratios and levels.
Magnesium deficiency in the general population results in increased insulin resistance, as well as increased smooth muscle and platelet reactivity,and is associated with both cardiovascular disease and diabetes. Women with PCOS have been found to have significantly lower serum and total magnesium compared with the controls, and this may contribute to the progression from insulin resistance to type 2 diabetes and heart disease. Population studies have confirmed that a high daily magnesium intake is associated with a lower incidence of type 2 diabetes, while individuals with low serum magnesium have a higher incidence. Magnesium deficiency occurs more frequently in diabetics despite adequate dietary intake, because urinary excretion is increased in the presence of elevated insulin and glucose in the urine.
Manganese is an essential trace element which is involved in energy production and metabolism, being an integral part in the creation of glycogen, fatty acids and cholesterol – all of which we need to stay healthy and energetic. It has been found in clinical studies to increase the efficacy of d-chiro inositol at reducing elevated blood sugar by a factor of 2. It is a potent antioxidant and improves the strength of cell walls and boosts the immune system which helps the body fight off viruses and bacteria.
Vanadium mimics many of the actions of insulin in the body and has been studied for a potential role in the treatment of obesity, hypertension, diabetes and insulin resistance. Whilst very high doses are required to achieve a therapeutic effect, it does appear to be long-lasting. One human study found that 100 mg of vanadium daily for three weeks reduced fasting blood sugar and HbA1c levels by 10-15% and this effect was sustained two weeks after the therapy ceased.
Zinc plays an important role in the synthesis, secretion and storage of insulin. High blood sugar causes zinc to be lost in the urine more quickly than normal.
Step # 14
Work with a qualified professional to choose a selection of herbs and nutrients which support healthy carbohydrate metabolism: St Mary’s Thistle, Gymnema sylvestre, Cinnamon, Fenugreek, Green Tea, American Ginseng, Aloe vera, cruciferous vegetables
Gymnema sylvestre is considered the gold standard treatment for blood sugar and carbohydrate metabolism problems by herbalists. Gymnema takes away the desire to eat sweet foods, reduces the amount of sugar and carbohydrate that is digested from the food you eat, stimulates the production of insulin and increases cellular sensitivity to insulin. It has been shown in animal studies to reverse the damage that high blood sugar can do to the liver. It has been the subject of many clinical trials providing evidence of its ability to lower fasting blood glucose, increase glucose uptake by cells reducing insulin resistance, increase C-peptide (a measure of how much insulin the pancreas is producing), reduce HbA1c and glycosylated plasma protein levels and reduce the amount of insulin that diabetics require.
Cinnamon is a potent antioxidant containing nearly 7000 ORAC units per teaspoon. It also has a high manganese content and potent antimicrobial activity in addition to being very effective at lowering blood sugar, by up to 29% according to one study. Interestingly, although the study compared the efficacy of 1, 3 or 6 gram dosages and the higher dosage had a quicker and more profound response, the effect of the lowest dosage persisted for longer – 20 days after people stopped taking it.
American ginseng (panax quinquefolius) has been found in several studies to decrease fasting blood glucose levels and HbA1c levels without affecting insulin levels. It also reduces blood sugar levels after a meal.
Fenugreek has been found to reduce fasting blood sugar levels and both blood sugar and insulin levels after a meal.
Green Tea contains a substance called epigallocatechin gallate (EGCG) which is a potent insulin sensitizer, improving glucose tolerance and reducing the risk of Type II diabetes developing. EGCG also re reduces the amount of glucose produced by the liver.
Aloe vera juice has been found in a study from Thailand to reduce fasting blood glucose levels with just a tablespoon of 80% juice twice a day.
St Mary’s thistle contains a compound called silymarin which has been found to decrease fasting blood glucose, mean blood glucose, HbA1c, insulin levels, C-peptide levels, insulin requirement and urinary glucose.
Cruciferous vegetables like broccoli, cabbage, kale, bok choy, Brussels sprouts and contain a compound called 3,3′-diindolemethane or DIM which has a raft of potent biological actions including anti-cancer, anti-inflammatory, anti-androgen and anti-microbial activity.
Step # 15
Work with a qualified professional to choose a selection of herbs and nutrients which support healthy carbohydrate metabolism.
Alpha-lipoic acid has been found to greatly increase insulin sensitivity in addition to being an incredible antioxidant and having the ability to help the body ‘recycle’ other antioxidants. Unusually, it is both fat and water soluble, meaning it is capable of passing into any body tissues including crossing the blood-brain barrier.
Carnitine has been shown to increase glucose uptake by cells, improve glucose storage, decrease serum insulin levels and improve insulin sensitivity in several studies. It is also commonly used as an aid to weight loss.
Vitamin C has been found to reduce blood sugar levels as well as having protective effects on the kidneys, eyes and nervous system. In people with high blood sugar, it has been shown to prevent accumulation of a kind of sugar known as sorbitol that can lead to serious complications with these organs. Diabetics accumulate high levels of sorbitol, which results in the cells leaking important molecules including nutrients. Researchers have found vitamin C to be superior in normalizing sorbitol levels to drugs designed for the same purpose.
Vitamin E has been shown to reduce insulin resistance as well as protecting cells against the damage caused by high blood sugar levels. Studies have shown that a dose of between 400 – 800 i.u. depending upon the weight of the subject is effective for this purpose.
B-vitamin group nutrients are all vitally important for energy regulation and frequently at less than optimal levels in women with PCOS, particularly if they have taken the drug metformin.
Co-enzyme Q10 is a very powerful antioxidant which may improve pancreatic beta-cell function and enhance insulin sensitivity.
Step # 16
Supplement with herbs and nutrients which support healthy hormone balance: Liquorice, Paeony, Vitex, Dong Quai, Blue Cohosh, Saw Palmetto
Liquorice and Paeony are the two ingredients in the traditional Japanese herbal formulation Shakuyaku-Kanzo-To (TJ-68) which has been found in studies to normalise the hormones which are dysregulated in PCOS. It is suggested that TJ-68 acts directly on the ovary first, increasing the activity of aromatase, which promotes the synthesis of estradiol from testosterone, thus lowering serum testosterone levels. Furthermore, the effect on catecholamines results in gradually improving the dissociate phenomenon of LH/FSH ratio.
Vitex agnus castus is one of the most popularly taken herbs for female hormonal and menstrual disorders in Europe with a solid body of clinical evidence supporting it’s 2500 year history of traditional use. It has a gentle and effective mechanism of action, working to stimulate the hypothalamus-pituitary axis to secrete the right hormones in the right amounts at the right time to restore hormonal balance naturally. The timing of hormones released from the pituitary governs menstruation, fertility and other processes. It is through Vitex’s subtle action on the pituitary gland that it can encourage the restoration of hormonal balance and regulate the female reproductive cycle.
Dong quai (angelica sinensis) is a herb which has been used in traditional Chinese medicine for over 1000 years. It is sometimes called “female ginseng” for its ability to relieve painful periods, cramps, irregular menstrual cycles, infrequent periods, premenstrual syndrome (PMS), and menopausal symptoms. It also improves circulation, relieves pain, particularly to the female reproductive organs and stimulate and relax the muscles of the uterus. In combination with other herbs it is frequently used in the treatment of PCOS.
Blue cohosh is a herb that is used to tone the uterus, ease spasms and regulate the menstrual cycle. It is particularly helpful for amenorrhoea, or bringing on delayed or absent periods. It is a herb that is frequently used in combination with other herbs in the treatment of PCOS.
Saw palmetto can be helpful in regulating the hormones oestrogen and testosterone which are frequently disordered in PCOS. Saw palmetto has been shown in studies to inhibit the production of dihydrotestosterone (DHT), increase the rate at which DHT is broken down and inhibit the ability of DHT to bind to receptor sites in the body where it causes problems like hirsutism and hair loss.
Step # 17
Practice stress management techniques: Meditation, Yoga, Exercise
The effects of stress on the human body are profound. Stress is an essential part of the human experience and some forms of stress are beneficial, for instance, strength training, cardio, a challenging career are all forms of stress.
Too much stress, or the wrong kind of stress, however, as many of us suffer in today’s hectic modern lifestyle, can contribute to all sorts of negative effects from high blood pressure, to thinning hair, a low sex-drive,weight loss or gain, digestive problems, chest pain and a rapid heartbeat or palpitations. Stress can also wreak havoc on our hormones causing changes in the serum level of many hormones including glucocorticoids, catecholamines, growth hormone and prolactin.
Of particular importance to women with PCOS is one of the glucocorticoid hormones, cortisol, sometimes called the stress hormone as it is produced under times of stress. The primary role of cortisol is to prepare for fight or flight by increasing blood sugar, suppressing the immune system and inhibiting bone formation. Although cortisol is necessary for health, as with most things, balance is the key.
Meditation, yoga and physical exercise are all excellent ways to control stress. Find something you enjoy doing and make it a habit, for your health’s sake.
Step # 18
Minimise your exposure to chemicals which may have a negative effect on hormonal balance: bisphenol-A (BPA)
Most people have heard about bisphenol-A (BPA) in recent years due to the media coverage it has received since it was discovered in baby formula in China, making over 50,000 little babies very, very sick and killing 3.
BPA is an oestrogen-mimic – it attaches to the same receptors in the body that oestrogen does and has a similar effect. Women with PCOS tend to have elevated levels of oestrogen in the first place, so compounding this with a synthetic hormone-analogue is not going to help at all. Scientists have also found that BPA can decrease sperm count and increase the rate at which breast cancer cells grow. The incidence of breast and prostate cancer is increased, fertility is reduced along with menstrual cycle disturbances and the risk of diabetes is increased.
In 2004 the US Centers for Disease Control (CDC) collected samples of urine from 2,157 people between the ages of six and 85 to test it for traces of BPA. 93% of those tested had detectable levels of BPA, in amounts ranging between 33 and 80 nanograms per kg of bodyweight, as well as the metabolic products of BPA as it is broken down. Children have the highest levels, followed by adolescents, then adults. Mice that were given a dose of BPA 10 times smaller (per kilogram) than the average 6 year old has today developed cancers and other diseases.
Step # 19
Get the right amount of sleep each night
An average of 8 hours’ sleep each night is the optimal amount
Getting a good night’s sleep is one of the cornerstones of good health. We are all familiar with the effects of too little sleep, but not everyone is aware that too much sleep can also be bad for your health and energy levels. The human body needs an average of 8 hours sleep each night to repair itself from the previous day and prepare for the day ahead. Much less than this, especially on an ongoing basis, can negatively impact health. Although you will never persuade a teenager of this fact, it is possible to have too much of a good thing. More than 9 hours of sleep a night can make you lethargic and increase your risk of diabetes as does napping during the day.
A study of 1486 men and women published in the Archives of Internal Medicine in 2005 has shown that people who get either less than 6 hours sleep a night or more than 9 hours have a higher risk of developing Impaired Glucose Tolerance, which is defined as a fasting plasma glucose level of more than 5.3 mmol/L or 95 mg/dL and is particularly prevalent amongst women who have PCOS or Diabetes Mellitus, another disease for which women with PCOS have a significantly increased risk of developing.
Don’t nap during the day
I am sad to have to report that the odd afternoon nap also appears to significantly increase the risk of blood sugar elevation and diabetes.
For a while now we have known that getting less than the optimal 7-8 hours of sleep at night can have a negative effect on insulin resistance and blood sugar levels, but now it appears that napping during daytime hours is also bad for our health.
A study published in Diabetes Care has found from a prospective study of nearly 175,000 people that those who napped for less than 1 hour a day increased their long term risk of developing elevated blood sugar levels by 23%. Those who napped for more than 1 hour a day increased their long term risk of developing elevated blood sugar levels by 55%! Even more recent research by Dr Shahrad Taheri of Birmingham University has found from studying 16,000 people that as little as one afternoon nap a week increases the risk of developing elevated blood sugar by 23%.
The bottom line is that we need to make certain that we get a good night’s rest of around 8 solid hours overnight and resist the temptation to nap during the day.
Step # 20
Consume probiotics to ensure a healthy environment in your gut
“Supplementing with probiotics such as acidophilus, bifidus and lactobacilli may assist in maintaining a normal weight or losing weight in overweight or obese individuals”
There are two major phyla or families of bacteria which inhabit our intestines and help to digest the food that we eat. They are Firmicutes and Bacteroides.
Researchers have discovered that obese people have a different ratio of these gut flora to lean people. It turns out that the microbes in the Firmicutes family have a larger arsenal of enzymes at their disposal to digest complex carbohydrates, making them much more efficient at what they do and allowing for more energy to be derived from the same amount of food. So this lends credit to those people who eat less than their acquantainces, whilst doing the same amount of exercise and still tend towards the heavier end of the scale. We have traditionally put this down to individual rates of metabolism, however gut flora may also play a large part.
A related study found that lean people had a larger population of Bacteroides group microbes, comprising 20% of their gut flora, than obese people who only had 5% of these less efficient microbes.
All is not lost, however, whilst we share a core variety of gut microbes with our family even amongst identical twins there are differences and it is these deviations from the core set of microbes that can influence whether a person is lean or obese. It is also possible to alter the composition of the gut flora through dietary changes. When obese people followed either a low fat or a low carbohydrate diet for a year, the amount of Bacteroides microbes increased from 5% to 15% of total stool volume. This means that if you follow a reduced fat/carbohydrate diet for a year you significantly improve the ratio of gut flora to be more in line with that of lean individuals and in theory, will then obtain less energy from carbohydrate-based foods. Unfortunately researchers in the UK have failed to find the same effect with a shorter term study of 4 weeks, so it is likely that to obtain the benefits described the diet would need to be followed strictly for at least one year.
“There is a lot of uncertainty as to whether individual probiotic supplements are effective. There is a lot of variability between the strains both in terms of their effects in the body, their care prior to ingestion and whether or not they can survive the acidic environment of the stomach and remain alive in the intestine for long enough to do their job. Some strains need to be stored in the refrigerator. A simple way of increasing the numbers of beneficial bacteria in your digestive system is to reduce the amount of sugar and refined carbohydrates in your diet and eat lots of fresh vegetables, a moderate amount of fresh fruit, whole grains and legumes (which often contain d-chiro inositol). You can alsouse fresh fermented milk products such as kefir and naturally fermented, unpasteurised soy products such as tamari, tempeh and natto to re-seed your gut with beneficial micro-organisms“
Kirsi Laitinen, a nutritionist and senior lecturer at the University of Turku in Finland presented findings at the European Congress on Obesity in 2009 which found that supplementing with lactobacilus and bifidobacterium, commonly available probiotics, when a woman is pregnant from the first trimester continuing until she stops breast feeding exclusively (or 6 months post-partum) reduces excess fat around the abdomen in particular and total body fat percentages in general. Women who received probiotic supplements and nutritional counselling specific to pregnancy had 1-2 % less body fat on average than women who received either a placebo and nutritional counselling or no counselling or probiotics whatsoever. In fact, the study found that only 25% of the women who received the probiotic supplement were found, on review one year later to have central obesity (a BMI of 30 or above or a waist circumference of 80cm of greater) compared with 43% in women who received only dietary counselling but no probiotics and 40% in women who received neither nutritional counselling nor probiotic supplements.
Another Finnish study, this time on children, found that disturbances in the gut flora actually precededchildren becoming overweight. Children who had a greater percentage of bifidobacteria in their gut remained of normal weight, whilst overweight children were found to have only half the amount of bifidobacteria as their leaner cohorts. In addition, overweight children were found to have more than twice the amount ofstaphylococcus aureus bacteria in their stools as their leaner cohorts.
Studies have found that probiotics may be beneficial to many aspects of our health, including:
- Managing Lactose Intolerance – Some strains of bacteria convert lactose into lactic acid, so supplementation can increase the threshold of lactose that a lactose intolerant person can tolerate).
- Lowering Risk of Colon Cancer – Population studies have found that cultures that consume fermented dairy products such as kefir have a lower incidence of colon cancer. Laboratory studies indicate that this may be due to lactobacillus bulgaricus’ ability to bind to heterocyclic amines, carcinogenic substances which are formed when meat is charred and by inhibiting an enzyme called beta-glucuronidase which can form carcinogens in the gut.
- Lowering cholesterol
- Lowering blood pressure
- Improving Immune System Function – Increasing the number of Ig-A containing plasma cells, T-lymphocytes and Natural Killer cells and increasing the rate of phagocytosis.
- Preventing Infections – It is thought that this occurs through competitive inhibition. Studies have found that probiotic supplementation reduces the number of dental caries in children as well as the number of respiratory infections.
- Treating Peptic Ulcers - Through inhibiting the bacterium heliobacter pylori which causes the ulcers.
- Reducing Inflammation – Through down-regulating bacteria-produced inflammatory cytokines. Studies found that probiotics caused a reduction in C-Reactive Protein (CRP) a common inflammatory marker which is commonly elevated in women with PCOS.
- Reducing the Risk of Allergy Development – Probiotics help to train your immune system distinguish between good proteins (antigens) and bad proteins (pathogens) and to respond appropriately – killing pathogens but not over-reacting to antigens. It is when this process goes awry that allergies can develop.
- Improving the Absorption of Trace Minerals – especially in those whose diets are high in grains, legumes and nuts.
- Producing Vitamin K and some B Group Vitamins – B Group vitamins are very important for carbohydrate metabolism, so of particular importance to women with PCOS.
- Relieving the symptoms of IBS and ulcerative colitis, reducing the severity of antibiotic-associated diarrhorea and the severity and duration of rotavirus in children and acute diarrhoea in travellers.
If you decide that you do want to take a probiotic supplement, you may want to consider the bacillus coagulans strain as it is available as a spore so it has a long shelf life, doesn’t need refrigeration and can even tolerate warm temperataures. They are also robust enough to survive the acidic environment of the stomach and reach the small intestine and remain active there for long enough to do some good.
Another good option is kefir, which can be made at home using a culture incubated in fresh milk for 1-2 days. Kefir contains a multitude of beneficial organisms in large quantities.