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PCOS and Mental Health

Polycystic ovarian syndrome is the most common hormone imbalance in women and yet very few people are talking about how significantly this imbalance is impacting women’s lives.

PCOS can impact any woman, at any age – from puberty to perimenopause, and in addition to the typical symptoms of irregular or absent periods, acne, facial hair growth and scalp hair loss, there can also be an increased incidence of mental health concerns.

PCOS and Depression

It has been my experience in practice that women with PCOS often have signs of depression – many of them due to the effects the symptoms of PCOS have on their body image. Researchers have found that nearly ¼ of women with PCOS have depression and they too suggest it may be linked to the “emotionally distressing” symptoms associated with PCOS, rather than the underlying hormone imbalance itself.

PCOS and Anxiety

Rates of anxiety are also higher in women with PCOS, with 11.5% of women in one study having both diagnoses (compared to an average 9% in the general female population).

Anxiety may be associated both with the physical symptoms of PCOS, but potentially may also stem from the hormone imbalances, such as low progesterone, that are common in PCOS. Progesterone is an anxiety-lowering hormone and low levels of progesterone occur when there is no ovulation – such as in PCOS.

PCOS and ADHD

Another interesting finding from the 2018 study on PCOS and mental health – women who have PCOS have an increased risk of having children who are diagnosed with ADHD (attention deficit hyperactivity disorder) or an autism spectrum disorder. The researchers suggest that it may be due to higher circulating androgens during development.

Support for PCOS and Mental Health

Focusing on whole body health, rather than just the visible symptoms of PCOS is important for all women with PCOS. While most women will want to focus on clearing acne and decreasing body weight, we must look at women as a complex entity of interlacing systems – ladies, we are all unicorns – we need to be treated individually and with attention to our specific wants and needs. Our mental and physical health are one and the same, and we should seek care from health care providers who recognize that.

Your Naturopathic Doctor can help you to put together a plan that focuses on your diet, lifestyle, obstacles to health, hormonal imbalances and mental and spiritual health.  Looking at your life and health as a whole, rather than individual symptoms to be managed, your ND works with you to achieve optimal health – in all areas of your life.

Select References

Thomas R Berni Christopher L Morgan Ellen R Berni D Aled Rees.  Polycystic ovary syndrome is associated with adverse mental health and neurodevelopment outcomes.  The Journal of Clinical Endocrinology & Metabolism, jc.2017-02667

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

 

PCOS and Hair Loss

My personal experience with hair loss in my early 20s has given me a keen passion to support women with hair loss of any cause. In other articles I’ve discussed the Root Causes of Female Hair Loss and Alopecia Areata but in this article I’m discussing the hormonal hair loss associated with PCOS.

PCOS: Hormone Havoc

In polycystic ovarian syndrome (PCOS) the ovaries do not respond appropriately to hormonal cues from the brain (the pituitary gland to be precise), resulting in the formation of cysts in the ovaries.

These cysts are actually unsuccessfully ovulated follicles – in normal ovulation the follicle ruptures and releases an egg. But in PCOS the follicle continues to grow and becomes a cyst.

Because the follicle does not release the egg, and continues to grow, it also continues to release hormones – mostly estrogen and testosterone. And it is this hormonal havoc that can lead to hair loss.

Testosterone and Hair Loss

High levels of testosterone are known to contribute to hair loss, and women with PCOS often have elevated levels of testosterone and other androgens (including dihydrotestosterone – a super powerful form of testosterone).

The testosterone can bind to receptors in the scalp hair follicles, stimulating hair loss in a male pattern – typically hair is lost at the front of the hair line, and at the very top of the head. It’s usually in a diffuse pattern – meaning the hair falls out all over rather than in patches.

The low progesterone that occurs in PCOS (progesterone is only produced after ovulation – no ovulation, no progesterone) also binds to those same hormone receptors in the hair follicle – preventing hair loss from occurring. So the balance of high (or even normal) testosterone and little to no progesterone causes the hair loss we see in PCOS.

Treating PCOS Hair Loss

The goal of treatment in hair loss associated with PCOS is to get you ovulating again. The balance of hormones in a healthy menstrual cycle should prevent hair loss from occurring. In the early stages of treatment we may also use treatments like saw palmetto, spearmint, berberine or inositol to decrease the testosterone levels.

As with all treatments for hair loss, the benefits take time to become apparent. The life cycle of the hair is three months – any hairs that have already been triggered by testosterone to fall out will do so for the first few months. So don’t give up on your treatment if you don’t see a benefit right away. The work you do now will benefit future you.

If you have any questions about your hair loss – whether it is associated with PCOS or any other condition, book a free 15 minute consultation so we can talk.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

PCOS & Berberine

While your medical doctor may not have heard of it, the functional and naturopathic medicine community is raving about berberine for polycystic ovarian syndrome (PCOS). And if you haven’t heard about it – you are about to go to school on WHY berberine may be exactly the treatment you have been looking for.

What is Berberine?

Berberine is a compound (technically a quaternary ammonium salt – damn! science!) found in several plants – most notably barberry, Oregon grape and goldenseal.  It has been used as a medicine in Traditional Chinese Medicine for over 5000 years.

Berberine Improves Insulin Responsiveness

One of the key findings in many women with PCOS is a poor response to insulin. When the cells (including those of the ovaries) stop responding to insulin, energy goes down, weight gain goes up and many of the hormone imbalances associated with PCOS show up.

One of the most common prescription treatments for PCOS is metformin, a drug that improves insulin response. But studies have found that berberine is able to do this too – and maybe even a bit better than metformin!

Berberine stimulates cells to take up glucose, so blood sugar and insulin levels drop. This can result in ovulation for women with PCOS. One study also found that the women taking berberine lost more weight than the women on metformin. Win-win!

Berberine Lowers Testosterone

The elevated testosterone associated with PCOS is the one hormone imbalance most women want addressed quickly. Elevated testosterone leads to the acne, head hair loss, chin and upper lip hair growth that women despise. Studies have demonstrated that berberine can lower testosterone levels and speed the resolution of these symptoms.

Berberine Benefits Your Gut

Berberine is not just great for your ovaries, but it’s great for your gut too. Berberine has been used for generations to treat symptoms of gas, bloating, constipation and diarrhea. Now we understand that it does this by helping increase the production of short chain fatty acids and supporting the healthy bacteria (probiotics) in our guts. Healthy bacteria help us to eliminate estrogen – minimizing the potential for estrogen dominace – another common hormone imbalance in PCOS.

Berberine Loves Your Liver

Your liver is essential in hormone balance. Berberine has been found in studies to increase the production of sex hormone binding globulin (that’s a mouthful…) or SHBG that binds to testosterone and makes it unavailable for use in your body.

Berberine has also been found to lower liver enzymes in non-alcoholic fatty liver disease, a condition that is commonly found in women who are overweight and have PCOS.

Berberine Benefits Fertility

Whether you are trying to get pregnant or just balance your hormones, it is reassuring to know that berberine can improve ovulation and pregnancy rates in women with PCOS. In women with PCOS undergoing IVF procedures, those who took berberine (no matter whether they were normal weight or overweight) had higher pregnancy rates than women using metformin or a placebo.

Berberine Boosts Weight and Fat Loss

Not every woman with PCOS is overweight (I talk about that more in the PCOS Types article), but if you are even mildly overweight berberine can help you to shed some unwanted fat.

Berberine has been found in multiple studies to support weight loss and to help target fat loss from the midsection of the body. Berberine helps to lower the production of our hunger hormone, leptin – a hormone that stimulates our appetite. Women with PCOS and women who are overweight often have abnormal levels of leptin.

Building on Berberine

Berberine is an excellent option for many women with PCOS. It can be the cornerstone for PCOS treatment and help you to achieve your dreams of hormone harmony.

Discuss with your Naturopathic Doctor if berberine is the best bet for you.  It may be used in combination with other natural treatment options, diet and lifestyle changes to improve your health and hormones, naturally.

Select Resources

Toronto Naturopath, Dr. Lisa Watson discusses the use of berberine for PCOS - polycystic ovarian syndromeAn Y, Sun Z, Zhang Y, Liu B, Guan Y, Lu M. The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. Clin Endocrinol (Oxf). 2014 Mar;80(3):425-31

Wei W, Zhao H, Wang A, Sui M, Liang K, Deng H, Ma Y, Zhang Y, Zhang H, Guan Y. A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome. Eur J Endocrinol. 2012 Jan;166(1):99-105.

Wu X, Yao J, et al. Berberine improves insulin resistance in granulosa cells in similar way to metformin. Fertility and sterility.2006; supplement S459-S460.

Yang J et al. Berberine improves insulin sensitivity by inhibiting fat store and adjusting adipokines profile in human preadipocytes and metabolic syndrome patients. Evid Based Complement Alternat Med. 2012

Zhao L et al. Berberine improves glucogenesis and lipid metabolism in nonalcoholic fatty liver disease. BMC Endocr Disord. 2017 Feb 28;17(1):13.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Men’s Quiz: Is My Testosterone Low?

My work in hormone balance isn’t just with women – men can experience symptoms of hormone imbalance with age as well.  Testosterone is about much more than libido – it is also essential for mood, energy, muscle strength, bone density and many, MANY other actions in the body.

We know that testosterone levels decline with age – with that decline starting as early as 30 years old.  Additionally it has been found that men today are making up to a quarter less testosterone than their grandfathers did.

If you suspect you may have low testosterone, take this quiz.  And if the results suggest you have low testosterone book an appointment to discuss further testing, lifestyle and treatment options.  There are options available, including bio-identical hormone replacement therapy.

 

ADAM – Androgen Deficiency in Aging Men

This symptom based questionnaire will help diagnose low testosterone levels in men. When used with laboratory testing a diagnosis of low testosterone, or andropause, can be made.

If you answered yes to questions 1 or 7, or at least three of the other questions you may have low testosterone levels. Be sure to discuss the results of this quiz with your Naturopathic Doctor, don’t delay – the effects of low testosterone can negatively impact your quality of life and future health.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Empowered Menopause: Hot Flashes and Acupuncture

The most common complaint in menopause, hot flashes (and the dreaded night sweats) are experienced by 80% of women. For at least half of women these symptoms can last 7 to 10 years (years!!) and impact sleep, mood, comfort and quality of life.

There are many excellent treatments for hot flashes, bioidentical hormone replacement therapy, black cohosh, chaste berry, phytoestrogens and others, but acupuncture has been found in studies to be another excellent choice for women.

Acupuncture for Hot Flashes

Studies in the past 10 years have found that women with mild to moderate hot flashes and night sweats, acupuncture administered weekly can reduce the frequency of hot flashes by half (and for some women there was a nearly 90% reduction!) Compared to women who did not have acupuncture, who reported only a 10% reduction over the 8 week study, acupuncture was a very successful intervention.

How Acupuncture Works

While we don’t know all of the reasons acupuncture works so well, many researchers think that it may be due to the impact on the hypothalamus – the master regulator of our body temperature. Acupuncture has also been found to promote blood vessel dilation, increase the release of different pain-reducing endorphins, and balance the production of stress and reproductive hormones.

Why Acupuncture?

For women looking for a low risk intervention, with virtually no side effects, acupuncture can be an ideal option. Acupuncture is also very cost effective, especially for women with health care insurance coverage.

You will know within 4-6 weeks whether acupuncture is going to benefit your hot flashes. And if acupuncture is effective for you the great news is that it may continue to be effective even after you are done your sessions. One study found that the benefits seen 6 months of treatment was still providing benefit 6 months later.

If you are experiencing hot flashes or night sweats, book in today to discuss with Dr. Lisa whether acupuncture is the solution you have been looking for.

Select References

Avis NE, et al. Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause: June 2016;23(6):626-637

De Valois BA, et al. Using traditional acupuncture for breast cancer-related hot flashes and night sweats. J Alt Comp Med. 2010;16(10):1047-1057

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

DUTCH test, hormone testing,hormone test, women's hormones, hormone health

DUTCH: Gold Standard in Hormone Testing

In my work with women’s health and hormones, one of the biggest areas of debate is hormone testing. Women are confused about when and how to test their hormones, and if I’m honest, a lot of doctors are confused as well. Which is leaving women under-diagnosed and under-treated for their very real (and very annoying) hormone imbalances.

But no more. Science has come a long way and right now we have the ability to test for hormones in ways that we never have been able to before. And women everywhere can benefit. So if you’ve ever wondered, “Do I have a hormone imbalance?”, now we can easily answer that question.

The DUTCH Test

Hormone testing with the DUTCH testDUTCH is an acronym that stands for Dried Urine Test for Comprehensive Hormones. It is a simple, but sophisticated test that looks not just at your hormones, but how your body processes and metabolizes them.

The DUTCH test looks not just at your reproductive hormones (although it does look at those quite thoroughly), but it also looks at your stress hormones, your androgens (male pattern hormones), your melatonin and the new DUTCH test also looks at organic acids – markers for mood and nutritional balance in the body.

8 Reasons the DUTCH Test is the Gold Standard for Hormone Testing

  1. Simple collection

Nothing is easier than peeing on a piece of filter paper. (Ok… some people might get a little pee on themselves, but still… is that the worst thing that can happen to you today?)

  1. In depth hormone levels

If you have a question about your hormones, the answer is likely to be found in the DUTCH test. While your Naturopathic Doctor may still recommend blood testing for hormones like thyroid hormone, FSH or LH, just about every other hormone is covered in the DUTCH test.

  1. Metabolism matters

Hands down, the reason the DUTCH test is the best, is that it measures metabolites. The absolute level of your hormones matter – but what can matter more is what your body does with those hormones. This is metabolism – does your body turn testosterone into nasty acne-promoting 5a-DHT?? Does your body turn estradiol into DNA damaging 4-OH estrone? Are you healthfully metabolizing and eliminating estrogen from your body? The DUTCH test can tell you.

  1. It’s all about those curves

Not every hormone has stable levels over the entire day. In particular, our primary stress hormone, cortisol, and its metabolite cortisone, have a curve that changes over the course of the day. Blood tests only give us a single snapshot of your cortisol levels, but the dried urine test gives us not only the total levels of cortisol and cortisone, but also the curve – how those levels change over the day. This is some VALUABLE information for people who are struggling with stress, fatigue, anxiety, decreased libido, trouble sleeping and insomnia.

  1. Balanced estrogen

Estrogen is one of the most important hormones in our bodies, and it has so many benefits for our health, but it can also have negative impacts if it is not in balance.

Typical hormone testing for estrogen looks just at estradiol, the dominant estrogen in the body. But that only tells us such a small bit of information. If we want to balance our estrogen, and prevent complications of estrogen dominance, then we want to understand how our body copes with our burden of estrogen. What metabolism pathways does our body use? Are those the best pathways?

If you are considering bioidentical hormones (BHRT) for perimenopause, or menopause symptoms, then the DUTCH test is highly recommended at the initial visit to understand how you will metabolize the hormones.

  1. Androgens and acne and hair health

In my work with women, no one condition is more loathed or baffling than acne. WTF, am I right ladies? How did we reach our 30s and still have to deal with acne?? Often it’s an issue of androgen metabolism. But typical hormone testing just looks at the amount of testosterone being made, and not what your body is doing with it. If your body is sending more testosterone towards the DHT metabolites, you will have more acne and possibly hair loss (and chin/ upper lip hair growth!) The DUTCH test will tell you if this is happening – and then we can talk about what to do about it!

  1. Melatonin

If you are having difficulty sleeping, knowing your melatonin levels is amazing information to have. But not only those with insomnia or sleep challenges should know their melatonin levels. Melatonin is also a powerful antioxidant in our bodies, and optimal levels of melatonin have been found to reduce the incidence of hormonal cancers (including breast cancer). No other hormone test looks at melatonin, but the DUTCH test does.

  1. Organic acids

Natural treatments and testing for depression and anxietyA new addition in 2018 to the DUTCH test is the 6 OAT (organic acid tests). I’m so excited for this new information!

Three new markers for neurotransmitters – to help us understand your mood. If you struggle with depression, anxiety or insomnia, this information can be very significant. If you have tried antidepressants without benefit, your organic acid markers for specific neurotransmitters, like serotonin, may tell you why.

Additionally there are three new markers for nutritional levels – looking at your B6 and B12 metabolism as well as your glutathione status. If you are concerned about weight gain or inflammation as part of your hormone imbalance, now we may be able to identify why.

The 1 Reason I don’t love DUTCH Testing

  1. The test results are ugly

I know. Such an aesthetic issue. But the test results are ugly – seriously. The results are clear. The information is valuable. But the results look a lot like a airplane dashboard, and some patients find this overwhelming. So take the time to talk through the results with your ND to understand what they mean for you.

Toronto, naturopath, doctor, naturopathic doctor, holistic, functional doctor

Next Steps

If you are interested in DUTCH testing, I suggest booking a 15 minute complimentary meet and greet to discuss the details. It is an amazing, useful, sophisticated test. But it’s not the right test for everyone. So let’s talk and see if it is the right test for you.

Dr. Lisa

Further Reading

https://dutchtest.com

https://articles.mercola.com/sites/articles/archive/2016/05/08/dutch-hormone-test.aspx

 

When it’s NOT PCOS: Non-Classic Congenital Adrenal Hyperplasia

A woman, let’s call her Nicole, enters my office with a concern of acne. Acne in an adult woman is, unfortunately, not uncommon these days. After spending some time talking to Nicole we find that she also has hair loss from her scalp, and hair growth on her chin as well as irregular periods.

If you’re familiar with PCOS you may recognize these as the most common symptoms of PCOS – irregular (or absent periods), acne and hair growth on the face or hair loss from the scalp.

But it wasn’t PCOS for Nicole. It was something else.

Non-Classic Congenital Adrenal Hyperplasia

Non-classic congenital adrenal hyperplasia (NCAH) is a condition that usually develops around the age of puberty and can impact both boys and girls (this article is just about the girls – sorry guys!)

NCAH is an inherited condition where a person does not make enough of a specific enzyme, 21-hydroxylase, that converts the hormone progesterone into cortisol. When this enzyme doesn’t work more progesterone is shifted into testosterone and levels of testosterone and other androgens increase.

Why Does NCAH Look Like PCOS?

Both PCOS and NCAH have symptoms that are the result of high androgens – testosterone, androstenedione, and dihydrotestosterone. However, the source of the high androgens is different.

In PCOS the elevated androgens come from overstimulation of the ovaries by follicle stimulating hormone (FSH), without the corresponding ovulation – leading the ovaries to continue to produce large amounts of testosterone over time.

In NCAH, the testosterone comes from the conversion of progesterone (and 17-OH progesterone) into androstenedione and subsequently testosterone.

In either case, high testosterone in a woman leads to oily skin, acne, facial hair, and scalp hair loss. Not such a pretty picture.

So, is my PCOS actually NCAH??

There are some warning signs that your PCOS may actually be NCAH.

  • Did your puberty start early – before 10 years of age? Or was it significantly delayed – after 15 years of age?
  • Did you have premature development of pubic or underarm hair?
  • Are you shorter than average height for an adult?

All of these findings are more common in NCAH than in PCOS.

But ultimately the diagnosis of NCAH requires a blood test.

17-OH Progesterone Testing

The first test for non-classic congenital adrenal hyperplasia is a 17-OH progesterone test. If your levels of this test are elevated, then you most likely have NCAH. While this test is routinely done in newborns, the non-classic variant can be missed until puberty.

If the 17-OH test is positive then a follow up test, known as the ACTH stimulation test, is done to confirm the diagnosis.

As NCAH is the most common autosomal recessive disorder in humans (you have to have two mutated copies of the gene to get this condition) – impacting around 1 in 100 people, this test is highly recommended if you have PCOS – especially if you don’t seem to fit the typical PCOS picture.

Moving Forward

NCAH, for some women, causes little to no difficulty. Other women have issues with abnormal hair growth/ hair loss or acne that can be difficult to treat. Other women have issues with infertility. It is a variable condition. Talk to your Naturopathic Doctor or Medical Doctor if you think your PCOS may actually be NCAH, and learn about your diagnosis and treatment options.

 

Pregnancy and Thyroid Health

Pregnancy is a time when we expect a lot of hormonal changes – but not every woman is aware of the changes that can occur in her thyroid function – and what that can mean for both her health, and the health of her baby.

A Brief Introduction to your Thyroid

Your thyroid is a hormone-producing gland, located at the front of the neck. It produces thyroid hormones (T4 and T3) that regulate our metabolic rate – our ability to make energy in our cells.

Thyroid Hormone Changes in Pregnancy

During pregnancy the body has a significant increase in metabolic activity – a lot of energy is required to make a baby! As such, the need for thyroid hormone increases. Women need approximately 40% more thyroid hormones during pregnancy to sustain the increases in energy needed for a healthy pregnancy.

Many women with thyroid disease are not immediately identified in pregnancy, as many of the symptoms of hypothyroidism (low thyroid function) are the same as symptoms of pregnancy. Weight gain, depression, fatigue, constipation and dry skin are all common in pregnancy and are also signs of an under-performing thyroid gland.

If you know prior to pregnancy that you have an underactive thyroid (half of people with hypothyroidism don’t know it), then increasing your thyroid medication soon after a positive pregnancy test is recommended. An increase in the medication dose of 25-40% is suggested for most women.

An underactive thyroid, challenged by the increased energy demands in pregnancy, may also be exacerbated by the increased clearance of iodide by the kidneys in pregnancy (all those increased trips to the bathroom have consequences as well!) Many prenatal supplements still do not contain adequate amounts of iodine to address this issue, worsening an already delicate hormone balance in pregnancy.

Consequences of Thyroid Disease in Pregnancy

Hypothyroidism in pregnancy is a serious health concern. Recurrent miscarriages have been found in women with even mild and asymptomatic thyroid disease. Increases in fetal death, birth defects, premature birth, low birth weights, placental abruption and intellectual disability have all been linked to hypothyroidism in pregnancy, especially in early pregnancy.

Hypothyroid is not the only thyroid concern that is problematic in pregnancy. The presence of autoimmune antibodies against the thyroid (TPO or anti-TG) can also increase the chances of miscarriage – in some studies doubling the risk of an early miscarriage.

Thyroid Testing in Pregnancy and Pre-Conception

Unfortunately, thyroid testing is not standard care for women who are trying to conceive, or who are pregnant. It is not even standard for women who have experienced an early miscarriage, in spite of the association of hypothyroidism and autoimmune thyroid antibodies and miscarriage.The demand for thyroid hormone in pregnancy increases most in the first half of pregnancy – especially in the first 6-12 weeks. This means we need to be testing women sooner – ideally before pregnancy, and certainly after a positive pregnancy test. Most experts believe that testing should be done before 9 weeks gestation – within the first month after a positive pregnancy test.

More comprehensive thyroid testing should also be offered to women trying to conceive, or who are pregnant. A simple TSH is not enough to fully assess the thyroid – autoimmune antibodies, T3 and T4 levels should also be tested.

And please keep in mind, the lab ranges for “normal” on thyroid testing are not the same as those that are optimal for pregnancy. Even mild or asymptomatic hypothyroidism, or any elevation in thyroid antibodies, can increase risk for an unsuccessful pregnancy.

If your doctor is unwilling to run these tests for you, speak to your Naturopathic Doctor. They can advocate for you, or run the tests to ensure you are getting the optimal support you need both before, and during, pregnancy.

The risks of not identifying a thyroid condition in pregnancy are significant. Don’t let a lack of knowledge, a lack of testing, or a lack of an appropriate diagnosis impact your pregnancy. Speak up, get the testing, and have a healthy, happy pregnancy.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select References

Alexander EK, Mandel SJ – Diagnosis and Treatment of Thyroid Disease During Pregnancy. Endocrinology: Adult and Pediatric 7th Ed, 2016. Chapter 84; 1478-1499.

 

 

 

PCOS Types

Syndrome of PCOS

Polycystic ovarian syndrome (PCOS) is condition impacting up to 1 in 10 women in North America. PCOS is a “syndrome” – a medical term for a condition that can have different symptoms in different people. In PCOS we can see a wide variety of presentations. Some women have many symptoms, while others have few. Some of the symptoms that can present in PCOS are:

  • Irregular periods
  • Long time between periods (prolonged cycles)
  • Infertility
  • Hair growth where you don’t want hair (chin, upper lip, neck, chest, back, breasts, buttocks)
  • Hair loss where you do want hair (scalp)
  • Weight gain
  • Oily skin
  • Acne

Diagnosis of PCOS

Ultimately the diagnosis of PCOS is based on the Rotterdam criteria – you must have 2 of the 3 criteria (irregular periods, cysts on your ovaries, signs or laboratory evidence of elevated androgens) to be diagnosed. To learn more about diagnosis, read this article by Dr. Lisa on PCOS Diagnosis.

As a Naturopathic Doctor I think we should move beyond mere diagnosis, and really get to the underlying causes of PCOS. And this is where the PCOS Types come into play.

Types of PCOS

Type 1: Insulin-Resistant PCOS

The classic presentation of PCOS – a woman experiencing weight gain, irregular or no periods, acne and facial hair – is represented by Type 1 PCOS, a condition associated with insulin resistance. The lack of response of the ovaries to insulin leads to a hormonal cascade that results in increased testosterone levels, the underlying cause of those unfortunate symptoms.

Women with insulin resistant PCOS have an increased risk of developing diabetes and depression – two other conditions associated with insulin resistance.

Treatment for insulin resistant PCOS involves improving the body’s response to insulin. Supplements such as inositol, chromium and cinnamon can be helpful. Spearmint tea can help to decrease testosterone levels and reduce facial hair growth and acne.

Weight optimization and following the PCOS Diet can also be part of this process. However, please keep in mind that not all women with insulin resistant PCOS are overweight. Slender women can also have insulin resistance as a result of their diet.

Type 2 PCOS: Non-Insulin Resistant PCOS

What once was a rare occurrence, I am now seeing many more women in my practice with non-insulin resistant PCOS. This can be caused by a number of different causes including:

  • Inflammation
  • Immune system challenges (including autoimmune diseases)
  • Vitamin D deficiency
  • Iodine deficiency
  • Thyroid hormone imbalance
  • Stress
  • Low dose chronic environmental exposures
  • Discontinuation of the birth control pill
  • A diet inconsistent with your body’s individual biochemistry

This type of PCOS requires more investigation and understanding that the classic insulin-resistant PCOS. Often I will run more extensive blood work than is typically offered to a woman with PCOS. Depending on the woman I may look at nutritional levels, hormone balance (prolactin, thyroid, LH, progesterone, cortisol, DHEA, testosterone), autoimmune antibodies, inflammatory markers, and food sensitivity testing.

The approach to managing non-insulin resistant PCOS is a personalized medical approach. It is essential that we uncover the root cause of the PCOS and address it directly with an approach that encourages balance and optimum function. Often women respond quickly once the cause has been identified and balance is restored.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

 

Hormones in Weight Loss

We believe we can get healthy by losing weight – but we need to be healthy to lose weight

Weight loss is a lot more than just watching what you eat and how much you exercise.  While diet and exercise are essential components of a weight loss program, if your hormones are not in balance you will always be fighting against your body to lose fat and improve your body composition and health.

In this article I discuss some of the most important hormones for weight loss – our hormone helpers, and our hormone haters.  For a more in depth look at your personal hormone balance, consider booking an appointment with a naturopathic doctor for individual testing and hormone assessment.

Weight Loss: Hormone Helpers

Thyroid Hormone

Thyroid hormones are our metabolism masters – they control the rate of energy production (metabolism) throughout the body. When thyroid hormones are too low symptoms of fatigue and weight gain can occur. When thyroid hormones are too high symptoms of anxiety, jitteriness and weight loss are common.

The optimal range for TSH (a measure of thyroid function) for weight loss is 0.75-2.5.  Outside of this range can alter metabolism and make weight loss difficult.

Glucagon

Glucagon hormone works with insulin to balance blood sugar – insulin rises when blood sugar is high, glucagon rises when blood sugar is low. Improving glucagon levels helps us to keep our blood sugar stable and support weight loss.

Not surprisingly, activities that support stable blood sugar can improve glucagon levels. Specifically exercise and healthy protein consumption can increase glucagon levels while a diet high in sugar decreases glucagon.

Growth Hormone

Growth hormone is produced throughout our lifetime although it’s production is highest during our younger years. Growth hormone is necessary for tissue repair, muscle building and improving the density of bone.

The majority of growth hormone is produced overnight but it is also produced during exercise. Low levels of growth hormone (associated with poor sleep, eating too close to bed and lack of exercise) can lead to fatigue, depression, cholesterol imbalances, and abdominal weight gain.

Leptin

One of our weight-loss helpers, leptin is our appetite-suppressing, full-sensation hormone. It is released by fat cells and communicates with our brain that we have had enough to eat.

We can improve our leptin levels through our lifestyle. Sleep, regular exercise, sufficient calories from our food and weight loss all help to balance leptin and improve our body composition.

We can also sabotage our leptin balance through our lifestyle choices. A regular intake of excess saturated fat and sugar leads to “leptin resistance”. When this occurs the brain no longer respond to high circulating levels of leptin and allows you to keep eating despite not being hungry.

Weight Loss: Hormone Haters

Ghrelin

Ghrelin works very closely with leptin to maintain our body weight. Ghrelin is the hunger hormone, produced when your digestive tract is empty. If you stomach is growling, ghrelin is being produced.

Ghrelin tells our brain when we’re hungry, and leptin tells us when we’re full.

Cortisol

Cortisol is most commonly known as our “stress hormone”. It is produced in high levels during stress, but our bodies produce varying levels over the course of every day.

High levels of cortisol can influence our eating habits and our hormone balance. People with elevated cortisol often crave sugary and salty foods, leading to an increase in insulin levels and all the symptoms associated with that imbalance.

Cortisol also stimulates a process in the liver known as “gluconeogenesis” – our body makes sugar to provide us fuel to get away from our stress. If we don’t use this extra sugar (by exercising) it gets deposited as fat around our midsection.

Insulin

Insulin helps our cells get energy in the form of sugar. When we eat foods that contain sugar (fruits, vegetables, grains, processed foods) our body releases insulin as a way of controlling blood sugar levels – getting the sugar out of the blood stream and into our cells.

When insulin levels are too high our cells can become less sensitive to it’s effects – leading to ‘insulin resistance’. This then leads to cravings for more sugar to meet the needs of our cells. And more insulin is released, and a vicious cycle ensues.

High levels of circulating insulin are associated with weight gain (especially around the belly). When you have excess insulin you can not burn fat as energy – your body will just demand more sugar to bring the insulin levels down. This makes losing abdominal fat almost impossible.

Serotonin

Serotonin is one of our feel-good neurotransmitters (along with dopamine and norepinephrine). When serotonin is out of balance symptoms of anxiety and depression are common. These emotions contribute negatively to weight loss by altering our motivation, drive, commitment and self esteem.

The depression associated with low serotonin leads to increases in inflammation and cortisol levels – both of which make it harder for our body to burn fat as fuel and lose weight.

Low levels of serotonin also decrease mood and lead us to crave foods that are rich in carbohydrates – a source of tryptophan, which our body uses to create serotonin.

Estrogen

Estrogen is the most common female hormone (although men have it too!) It is produced mainly in the ovaries but fat cells also produce large quantities of estrogen. High levels of estrogen, or “estrogen dominance” is as great a risk factor for obesity as having a poor diet or not exercising.

Estrogen balance is greatly impacted by our lifestyle and environment. Exposure to chemical estrogen-mimicking compounds, alcohol consumption, a high fat diet, lack of exercise and sleep deprivation can all lead to abnormally high levels of estrogen.

Hormones are incredibly important for our overall health, energy and metabolism.  If you are struggling to lose weight, or are stuck at a weight loss plateau, perhaps hormones are your issue.  Book a free 15 minute consultation now to discuss your options, and get your hormones back in balance.   

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.