The Maitake extract tablets contained 18 mg of an extract called “SX-fraction” (MSX), a water-soluble glycoprotein, and 250 mg of dried Maitake mushroom powder. Each patient was given 3 tablets, 3 times a day. For those who received the CC, they were given 50 mg/day from days 5 to 9 of menses and repeated up to 3 cycles. For patients who then took the combination, the same dosing regimen was used.

Twenty-six patients in the MSX group and 31 in the CC group were evaluated for ovulation with pelvic ultrasounds. The ovulation rate for MSX was 76.9% (20/26) and 93.5% (29/31) for CC. For the combination treatment, 7 of 7 patients who failed the MSX monotherapy and 6 of 8 patients who failed the CC monotherapy demonstrated ovulation.

Commentary: This study demonstrated the ability of a Maitake extract to induce ovulation in patients with PCOS and can be used as a monotherapy or as an adjunct to clomiphene citrate. The ovulation rate of 76.9% is quite impressive, even though the clomiphene citrate rate was much better at 93.5%.

Maitake extract is reported to modulate serum glucose levels, reduce blood pressure, optimize serum lipids and enhance insulin sensitivity in animal studies, all important core issues in women with PCOS.

Reference

Chen J, Tominaga K, Sato Y, et al. Maitake mushroom (Grifola frondosa) extract induces ovulation in patients with polycystic ovary syndrome: a possible monotherapy and a combination therapy after failure with first-line clomiphene citrate. J Alternative and Complementary Medicine 2010;12(12):1295-1299

Results: The total MRS II score for women while on black cohosh treatment reduced from 17.6 to 13.6, a statistically significant reduction. Symptoms of hot flashes, sweating, sleep problems, and anxiety improved, but vaginal dryness and body aches/pains did not change. Twenty two patients reported adverse events, but none were linked with the black cohosh; 90% of the women reported the tolerability of the black cohosh extract as very good or good.

Commentary: This is one more positive study using black cohosh extract for menopausal symptoms and even more meaningful, women on tamoxifen can have more problematic menopause symptoms and so a significant benefit of black cohosh is especially needed. Readers will also want to be reminded that we do have safety data on black cohosh in breast cancer patients—there is no estrogen in black cohosh, no phytoestrogens in black cohosh, no ability to stimulate breast cancer cells and laboratory data showed that black cohosh inhibited proliferation of estrogen receptor positive breast cancer cells and augmented the anti-estrogen effect when using black cohosh with tamoxifen. Black cohosh is clearly the first choice herb for menopause symptoms in breast cancer patients, and in breast cancer patients on tamoxifen.

Reference:

Rostock M, Fischer J, Mumm A, et al. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints – a prospective observational study. Gynecol Endocrinol. 2011 Jan 13;

The current diagnostic criteria from the 2003 Rotterdam PCOS consensus workshop is that at least two of the following three features must exist (and exclusion of other etiologies of their hyperandrogenism and/or amenorrhea/oligomenorrhea):

• Oligo- or anovulation
• Clinical and/or biochemical signs of hyperandrogenism
• Polycystic ovaries (> 12 follicles 2-9 mm or volume > 10 ml)

So many variables exist with this syndrome, that it’s no wonder it can be hard to come up with a definitive diagnosis. There can be other manifestations of hyper-androgenism (hair loss, acne) in And, not all PCOS women are infertile because of random unpredictable ovulation. Yet PCOS is likely the single most common cause of a lack of ovulation, leading to abnormal menstrual cycles and infertility

An important feature of PCOS is that there are some hormonal changes including hyperinsulinism and/or insulin resistance and elevated total testosterone. Total testosterone is not a very accurate laboratory test in women, and the range of normal has not been established, so testing testosterone levels has limited value.

The underlying cause of PCOS is varied and still evolving. What we currently know is the following:

1. elevated secretions of androgens from the ovaries and/or adrenal glands that overwhelm the body’s ability to convert these androgens to estrogen
2. abnormal ratios of the pituitary hormones, leutinizing hormone (LH) to follicle stimulating hormone (FSH)
3. failure of the monthly maturing of a follicle in the ovaries
4. a resistance to insulin
5. likely a genetically driven defect in the action of insulin

Metabolic dysfunctions including abnormalities in lipid levels, insulin and blood sugar levels, and high blood pressure are significant medical problems, that can be related to the underlying syndrome of PCOS.

Besides the potential changes including increased body weight, acne, facial hair, hair thinning, the irregular menstrual cycles and potential of infertility, there are significant diseases that can result from the underlying syndrome, including an increased risk of cardiovascular disease, type II diabetes and uterine cancer.

The metabolic goals of a holistic natural medicine approach are to:

1. lower androgens
2. inhibit the conversion of testosterone to the more potent dihydrotestosterone
3. to induce regular ovulation, and
4. to modify insulin resistance and lower the hyper-secretion of insulin

Diet and exercise are common to both conventional and alternative treatments of PCOS-to promote weight loss, increase insulin sensitivity, decrease male hormone levels, and thus restoring ovulation. Dietary changes that may improve insulin resistance are the primary emphasis with a reduction of refined carbohydrates and total calories, while increasing the high fiber foods of vegetables, legumes and whole grains. Many individuals with PCOS will respond to a diet that is not more than 80 gm/day of carbohydrates, and 60-90 gm per day of protein.

There are several natural substances that bind to and stimulate sex hormone binding globulin (SHBG), which then binds some of the testosterone in our blood stream, which in turn reduces the hyperandrogenism of PCOS. The root of the nettles plant contains many lignans and these compounds have an affinity to SHBG in humans. Nettles root can also affect aromatase inhibition which could inhibit the conversion of the weaker testosterone to dihydrotestosterone.
Caffeine containing beverages (coffee, green tea, black teak, oolong tea and even colas), were seen to have a relationship between intake and increases in SHBG. This then, had a favorable effect on hormone levels,. As caffeine intake and SHBG increases, estrogen level decreases. This is just one of the mechanisms by which green tea may have breast health implications and favorably influencing the risk of breast cancer.

Flax seeds and soy, are two important foods groups relevant in a PCOS diet. The flax seeds again, containing lignans, which increases SHBG, lowering blood testosterone levels and perhaps reducing the hyperandrogenic effects.1 I recommend 1-2 tbsp per day of flax seeds or ground flax meal.

One of the potential significant aspects of PCOS is a buildup of the lining of the uterus. This occurs because the ovaries still produce adequate estrogen, but not enough progesterone, due to a lack of ovulation. The uterus then receives what is called unopposed estrogen stimulation. This thickening is called hyperplasia, and the cells over time can become atypical or even malignant. The potential role of soy foods in the diets of women with PCOS may have some contradictions but basically, it is thought that soy can reduce blood estrogen levels and increase SHBG and that women with higher soy diets excrete more than twice the amount of estrogen in their stool in one study, and increased the excretion of estrogens in the urine in another. There are indeed, other soy studies that do not show the same results. I recommend one to two servings of a soy food per day, or something equivalent to 50mg-100 mg of soy isoflavones daily.

Saw palmetto inhibits the activity of an enzyme, 5-alpha reductase, thereby reducing the conversion of testosterone to dihydrotestosterone, the more potent form. This may have implications in reducing acne, excess facial and body hair, as well as hair loss from the scalp. Saw palmetto was recently studied as part of a formula and was able to initiate a reduction in hair loss and an improvement in hair density in patients with testosterone related hair loss.

3.5 gms of a licorice root extract standardized to contain 7.6% W.W. glycyrrhizic acid (0.25 grams total glycyrrhizic acid per day), q.d. for 2 months was given to nine “healthy” women, ages 22-26 years. Outcome measures included blood pressure, plasma renin activity (PRA), plasma cortisol, plasma aldosterone, total serum testosterone, androstenedione, 17-OH-progesterone (17OHP) and gonadotropins, which were tested at baseline, after 1 and 2 months taking licorice, and one month post-treatment. Mean total serum testosterone significantly decreased after one and two months of treatment (27.8 ± 8.2 vs. 19. ± 9.4 and 17.5 ± 6.4 ng/dL, respectively).

It’s interesting to note that this is the first trial to follow-up on earlier trials that found that licorice may reduce testosterone secretion in women with polycystic ovary syndrome (Acta Obst Gynecol Jpn 1988;40:789-92) and another showing a similar result in hyperandrogenic and oligomenorrheic women.

Calcium and vitamin D are two of the most reaching nutrients our body needs affecting muscles, bones, thyroid, brain, heart, hormones, colon, breast and more. Calcium and vitamin D regulation may also contribute to the development of faulty ovarian follicle development in women with PCOS, resulting in reproductive and menstrual dysfunction. Vitamin D also plays a role in glucose metabolism and is commonly deficient in individuals with type 2 diabetes. Supplementing with vitamin D has been shown to improve glucose tolerance, insulin secretion and insulin sensitivity in those with DM., A deficiency of vitamin D may be more frequent in women with PCOS and in a small study, five of thirteen women had an overt vitamin D deficiency. Seven of the nine women with no menses or infrequent menses, had a return to a normal menstrual cycle within two months of being given 50,000 IU once or twice per week of vitamin D and 1,500 mg per day of calcium.10

Chromium is a trace mineral that enhances the action of insulin. Supplementing with chromium has been shown in some studies to improve the blood sugar control in those with type 2 DM. Giving PCOS women 1,000 mcg per day of chromium for as little as two months was able to improve insulin sensitivity by 30% and by 38% in obese women with PCOS.

A little known supplement, D-chiro-inositol is not commercially available, but pinitol, a compound similar to D-chiro-inositol, is available. Pinitol appears to mediate insulin activity. In an important study about this nutrient, 600 mg of pinitol twice per day for three months lowered blood glucose levels by 19%, lowered average glucose levels by 12% and significantly improved insulin resistance.

Conventional treatment of PCOS includes diet and exercise, and a drug, Metformin, used to improve insulin resistance. This can lead to normal ovulation. Other medications are used to induce ovulation such as clomiphene citrate, spironolactone to decrease testosterone on the hair follicle, and oral contraceptives to address irregular menstrual cycles and excess body hair. A topical medication, Vaniqa, is used topically, to reduce facial hair.

PCOS is a complicated condition, requiring long term attention and regular medical attention, keeping in mind the potential for increased risks of diabetes, hypertension, hyperlipidemia, uterine cancer.

As a practitioner with more awareness and experience with PCOS, we have an important role in detecting the long undiagnosed patient, the inadequately managed patient, and the discouraged patient.

In summary, a comprehensive plan for PCOS would include:

Weight loss in those who are overweight
Daily aerobic exercise one hour per day
Low simple carbohydrates (Up to 80 gm/day of carbohydrates and 60-90 gm per day of protein)
Flax seeds 1-2 tbsp per day
Soy food 1 to 2 servings per day
Vitamin D 2,000 i.u. per day or without testing, up to 5,000 i.u. per day
Calcium 1,000mg-1,500 mg per day (including dietary sources)
Chromium 1,000 mcg per day
Green tea (90% polyphenols, 80% catechins, 45% EGCG) 300mg-500 mg per day or 3 cups of tea per day
Nettles root 600 mg per day
Saw Palmetto extract 400 mg per day
Pinitol 600 mg twice per day

Consider Licorice root extract

Important resources:

Women’s Encyclopedia of Natural Medicine. Tori Hudson, N.D., McGraw/Hill publishing

PCOS, A Woman’s Guide to Dealing with Polycystic Ovary Syndrome. Colette Harris with Dr. Adam Carey. Thorson’s publishing

PCOS, The Hidden Epidemic. Samuel Thatcher, M.D., PhD. Perspectives Press

The Natural Diet Solution for PCOS and Infertility. Nan Dunne, N.D. (paperback and e-book

PCOS Health Review – free newsletter; Nan Dunne, N.D. and Bill Slater

References

• Schottner M, Gansser D, Spiteller G. Lignans from the roots of Urtica dioica and their metabolites bind to human sex hormone binding globulin. Planta Med 1997; 63(6): 529-532
• Gansser D, Spiteller G. Plant constituents interfering with human sex hormone-binding globulin. Evaluation of a test method and its application to Urtica dioica root extracts. Z Naturforsch 1995;50(1-2):98-104.
• Schottner M, GanBer D, Spiteller G. Lignans from the roots of Urtica dioica and their metabolites bind to human sex hormone binding globulin (SHBG). Planta Med 1997; 63:529-532
• Gansser D, Spiteller G. Aromatase inhibitors from Urtica dioica roots. Planta Med. 1995;61(2): 138-140.
• Nagata C, Kabuto M, Shimizu H. Association of coffee, green tea, and caffeine intakes with serum concentrations of estradiol and sex hormone-binding globulin in premenopausal Japanese Women. Nutrition and Cancer 1998; 30(1): 21-24.
• Kumar N, Cantor A, Allen K, et al. The specific role of isoflavones on estrogen metabolism in premenopausal women. Cancer 2002;94:1166-1174.
• Goldin B, Adlercreutz H, Gorbach S, et al. The relationship between estrogen levels and diets of Caucasian American and Oriental immigrant women. Am J Clin Nutr 1986;44:945-953
• Xu X, Duncan A, Wangen K, Kurzer M. Soy consumption alters endogenous estrogen metabolism in postmenopausal women. Cancer Epidemiology, Biomarkers and Prevention 2000;9:781-786.
• Martini M, Dancisak B, Haggans C, Thomas W, Slavin J. Nutrition and Cancer 1999;34(2): 133-139.
• Prager N, Bicket K, French N, Marovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. JAH and Comple Med 2002;8(2): 143-152.
• Armanini D, et al. Steroids 2005;69:763-6.
• Acta Obst Gynecol Jpn 1982;34:939-44
• Thys-Jacobs S, Donovan D, Papadopoulos A, et al. Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Steroids 1999;64:430-435.
• Raghuramulu N, Raghunath M, Chandra S, et al. Vitamin D improves oral glucose tolerance and insulin secretion in human diabetes. J Clin Biochem Butr 1992;13:45-51.
• Borissova A, Tankova T, Kirilov G, et al. The effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patients, Int J Clin Pract 2003;57:258-261.
• Gaby A. Chromium. Integrative Med 2006;5(4):22-26.
• Lydic L, McNurlan M, Komaroff E, et al. Effects of chromium supplementation on insulin sensitivity and reproductive function in polycystic ovarian syndrome: a pilot study. Fertil Steril 2003;80 (Suppl 3): S45-S46.
• Lydic M, McNurlan M, Bembo S, Mitchell L, Komaroff E, Gelato M. Chromium picolinate improves insulin sensitivity in obese subjects with polycystic ovary syndrome. Fertil Steril 2006;86:243-246.
• Davis A, Christiansen M, Horowitz J, et al. Effect of pinitol treatment on insulin action in subjects with insulin resistance. Diabetes Care 2000;23:1000-1005.
• Kim J, Kim J, Kang M, et al. Effects of pinitol isolated from soybeans on glycaemic control and cardiovascular risk factors in Korean patients with type II diabetes mellitus: a randomized contolled study. Eur J Clin Nutr 2005;59:456-458.

Armanini D, Castello R. Scaroni C, et al. Treatment of polycystic ovary syndrome with spironolactone plus licorice. Eur J Obstet Gynecol 2007;131:61-67.

Commentary: It’s very useful to find a second study on licorice and it’s role in PCOS. Glycyrrhetinic acid has been shown to reduce serum testosterone and induce regular ovulation. (Yaginuma T, Izumi R, Yasui H, et al. Effect of traditional herbal medicine on serum testosterone levels and its inductions of regular ovulation in hyperandrogenic and oligomenorrheic women. Nippon Sanka Fujinka Gakkai Zasshi 1982;34:939-944) ( Takahashi K, Yoshino K, Shirai T, et al. Effect of a traditional herbal medicine on testosterone secretion in patients with polycystic ovary syndrome detected by ultrasound. Nippon Sanka Fujinka Gakkai Zasshi 1988;789-92.)

Spironolactone is often used as part of a treatment plan in PCOS women with bothersome hirsutism. While Spironolactone can be helpful, fatigue and polyuria are a frequent side effect. It may be that licorice and glycyrrhetinic acid have a potential synergistic effect on the androgen receptors, reduce the side effects associated with Spironolactone, as well as reducing serum testosterone and inducing regular ovulation. Licorice extract along with a lower carbohydrate/higher protein diet, therapies that increase SHBG such as nettles root, green tea, flax seeds and soy and insulin sensitizing strategies such as daily aerobic exercise, fenugreek powder, cinnamon extract, d-pinitol, chromium (and possibly glucophage) offer a comprehensive approach for women with PCOS.

Vitamin D deficiency is associated with increased parathyroid secretion, increased bone turnover, osteoporosis, and increase risk of hip and other fractures. Lower levels of vitamin D as measured in the blood, is also associated with risks of cancers of the colon, breast and ovary in several observational studies. Vitamin D deficiency has other serious implications and has been associated with multiple sclerosis, type-1 diabetes, Chrohn’s disease , and even increases in the risk of hypertension and cardiovascular disease.
Causes of vitamin D deficiency include hereditary disorders, reduced skin synthesis and absorption of vitamin D, and acquired disorders of vitamin D absorption, metabolism and responsiveness.

We get our vitamin D from exposure to sunlight, from our diet and from supplementation. Vitamin D3 is produced in the skin on exposure to ultraviolet radiation, and vitamin D2 is derived from plants and enters our body only through the diet or supplementation. There are two major supplemental forms of vitamin D; vitamin D2 (ergocalciferol) and vitamin D3 (holecalciferol). Vitamin D2 is manufactured through the ultraviolet irradiation of ergosterol from yeast. Vitamin D3 is made through the ultraviolet irradiation of 7-dehydrocholesterol from lanolin. Vitamin D2 is considered to be vegetarian suitable, and vitamin D3 is animal derived, from the lanolin. Both forms are often added to foods such as milk, orange juices, infant formulas, cheeses and breakfast cereals. Natural food sources of vitamin D3 include salmon, sardines, mackerel, tuna, shiitake mushrooms, egg yolks, cod liver oil and exposure to sunlight. Both vitamin D2 and vitamin D3 are available in over the counter supplements, including low doses, and moderately higher doses, typically not more than 5,000 IU. High and higher doses of vitamin D2 are available by prescription.

The back story on whether or not vitamin D2 and vitamin D3 are equally effective, goes back to studies in the 1930s where they were assumed to be equally effective in humans. Over time, human studies comparing the increase in blood levels of vitamin D with the supplementation of vitamin D2 vs vitamin D3 have been inconsistent in their results and few in number. They have also been wrought with problems in small sample sizes, lack of vitamin D stability of the products used, wide variations in the seasons the blood was drawn (serum levels of vitamin D are naturally higher in the sunnier months), variable intestinal absorption amongst individuals, variable baseline serum levels of vitamin D, previous history of vitamin D supplementation and variations in age (older people have less vitamin D absorption). While it is common thought that vitamin D2 is about a third of the potency of vitamin D3, these variables in the studies, make it extremely difficult to make comparisons and draw accurate conclusions. One small study done in 1998 did demonstrate that vitamin D3 yielded a small increase in serum 25-hydroxyvitamin D over the vitamin D2. A study of 30 men in 2004, between the ages of 20 and 61, demonstrated that the rise in blood levels within the first few days of receiving a single high dose was the same for both forms, indicating equivalent absorption. However, the vitamin D3 treated individuals had a continued rise over two weeks and peaked at 2 weeks, while the vitamin D2 treated men, had a decline to their baseline, by day 14. One might conclude from these two well designed studies, that the rise in serum levels with vitamin D3 might be only a very small amount, as in the first study. Or, rather than give one dose to last 2 or more weeks where there was a greater effect with vitamin D3, as in the second, this same study showed that within the first 3 days of either form, the rise in blood levels, was the same, indicating that a daily dose of either form of vitamin D would be equivalent.

The newest study addressing this question, challenges the long held belief that vitamin D2 is less potent or less effective than vitamin D3 in raising and maintaining blood levels. This was a randomized, placebo-controlled, double-blinded study of healthy individuals ages 18-84 years who received either placebo, 1,000 IU of vitamin D3, 1,000 IU of vitamin D2, or 500 IU of vitamin D2 plus 500 IU of vitamin D3 daily for 11 weeks at the end of the winter. Sixty percent of the study subjects were vitamin D deficient at the start of the study (< 20 ng/ml). This three month study of 68 individuals found that supplementation with both forms produced similar results. Neither 1,000 IU of vitamin D2 or vitamin D3 raised 25-hydroxyvitamin D levels in vitamin D deficient subjects to a level above 30 ng/ml. The authors concluded that vitamin D2 is equally as effective as vitamin D3 in maintaining 25-hydroxyvitamin D status.

My main point in this article is not to prove that the vegetarian supplementation of vitamin D2 is as potent as the non-vegetarian supplement vitamin D3, but rather, that we cannot state with reasonable certainty that D3 is a third more potent, as is generally thought. Vegetarians may find some comfort in this article about vitamin D2 and vitamin D3 yielding similar results, at least when taken daily. If not, then the most we could assert, is that we may need a one third higher dose of vitamin D2 to yield the same results.

References

• MacLaughlin J, Holick M. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 1985; 76: 1536-1538.
• Parfitt A. Osteomalacia nd related disorders. In: Avioli L, Krane S, eds. Metabolic bone disease and clinically related disorders. 2nd ed. Philadelphia: WB Saunders; 329-396.
• Trivedi D, Doll R, Khaw K. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomized double blind controlled trial. BMJ 2003; 326: 469- 474.
• Garland C, Garland F, Gorham E, et al. The role of vitamin D in cancer prevention. Am J Public Health. 2006; 96: 252-261.
• Cantorna M, Zhu Y, Froicu M, Wittke A. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr 2004; 80: Suppl 6: 1717S-1720S.
• Ponsonby A-L, McMichael A, van der Mei I. Ultraviolet radiation and autoimmune disease: insights from epidemiological reearch. Toxicology 2002; 181-182:71-78.
• Zittermann A. Vitamin D and disease prevention with special reference to cardiovascular disease. Prog Biophys Mol Biol 2006; 92: 39-48.
• Rostand S. Ultraviolet light may contribute to geographic and racial blood pressure differences. Hypertension 1997; 30: 150-6.
• Trang H, Cole D, Rubin L, et al. Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2.
• Armas L, Hollis B, Heaney R. Vitamin D2 ismuch less effective than vitamin D3 in humans. J Clinical Endocrinology and Metabolism. 2004;89(11): 5387-5391.
• Holick M, Biancuzzo R, Chen T, et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab 2007; Dec 18.

PCOS is not really classified as a disease, because it is not a specific and constant set of symptoms and physical characteristics. Rather, it is better described as a syndrome, with a collection of symptoms, physical and laboratory findings. There are two consistent aspects of PCOS: hyper-androgenism (or an increase in male hormones) and a lack of or infrequent ovulation. The most common characteristics of PCOS are obesity, excess body hair (hirsutism), and irregular/infrequent/lack of ovulation and thus irregular menses and poor fertility. Over 95% of women who have all three of the classic signs of obesity, hirsutism and infertility and/or irregular menses, have PCOS. One of the problems with PCOS, is that many women have this syndrome, but don’t have all three of the classic signs. So, not all women with PCOS are obese, in fact not even 50%. Many PCOS women are of normal weight or even underweight, have no excess hair growth on the face of chest or legs, and may even have pretty regular menses.

So many variables exist with this syndrome, that it’s no wonder it can be hard to come up with a definitive diagnosis. There can be other manifestations of hyper-androgenism in women including hair thinning or acne. And, not all PCOS women are infertile, yet PCOS is likely the single most common cause of a lack of ovulation, leading to abnormal menstrual cycles and infertility

An important feature of PCOS is that there are some kind of changes in hormones- for sure, elevated levels of the male hormones, although this is often not detected by the poor sensitivity of laboratory testing. The underlying cause of PCOS is varied and still evolving. What we currently know is the following:

1. elevated secretions of male hormones from the ovaries and/or adrenal glands that overwhelm the body’s ability to convert these male hormones to estrogen
2. abnormal ratios of the pituitary hormones, leutinizing hormone (LH) to follicle stimulating hormone (FSH)
3. failure of the monthly maturing of a follicle in the ovaries
4. a resistance to insulin
5. and likely a genetically driven defect in the action of insulin

Metabolic dysfunctions including abnormalities in blood fat(lipid) levels, insulin and blood sugar levels, and high blood pressure are significant medical problems, that can be related to the underlying syndrome of PCOS.

Besides the potential changes in one’s appearance of weight gain, acne, facial hair, or hair thinning, the irregular menstrual cycles and potential of infertility, there are significant diseases that can result from the underlying syndrome, including and increased risk of cardiovascular disease, type II diabetes and uterine cancer.

With all this going on, you might wonder how could it possibly be underdiagnosed? The answers lie in more than one area. Women with PCOS often have a similar story to tell: they went to their dermatologist for acne- then were given topical treatments or antibiotics. Or, they went to their gynecologist for irregular menses and were put on birth control pills. These two common stories are the result of compartmentalization in medicine, and not enough health care providers understanding this syndrome and all the body systems it can affect. Things are changing though, and this multiple system syndrome, is now better understood, with more common accurate diagnoses being made, and better treatments both natural and conventional.

The metabolic goals of a holistic natural medicine approach are to…

1. lower androgens
2. inhibit the conversion of testosterone to the more potent dihydrotestosterone
3. to induce regular ovulation
4. to modify insulin resistance and lower the hyper-secretion of insulin.

Diet and exercise are common to both conventional and alternative treatments of PCOS – to promote weight loss, increase insulin sensitivity, decrease male hormone levels, and thus restoring ovulation. Dietary changes that may improve insulin resistance are the primary emphasis with a reduction of refined carbohydrates and total calories, while increasing the high fiber foods of vegetables, legumes and whole grains. Many individuals with PCOS will respond to a diet that is not more than 80 gm/day of carbohydrates, and 60-80 gm per day of protein

There are several natural substances that bind to and stimulate sex hormone binding glogulin (SHBG), which then binds some of the testosterone in our blood stream, which in turn reduces the hyperandrogenism of PCOS. The root of the nettles plant contains many lignans and these compounds have an affinity to SHBG in humans. , Nettles root can also affect aromatase inhibition which could inhibit the conversion of the weaker testosterone to dihydrotestosterone.

Caffeine containing beverages (coffee, green tea, black teak, oolong tea and even colas), were seen to have a relationship between intake and increases in SHBG. This then, had a favorable effect on hormone levels,. As caffeine intake and SHBG increases, estrogen level decreases. This is just one of the mechanisms by which green tea may have breast health implications and favorably influencing the risk of breast cancer.

Flax seeds and soy, are two important foods groups relevant in a PCOS diet. The flax seeds again, containing lignans, which increases SHBG, lowering blood testosterone levels and perhaps reducing the hyperandrogenic effects1 I recommend 1-2 tbsp per day of flax seeds or ground flax meal.

One of the potential significant aspects of PCOS is a buildup of the lining of the uterus. This occurs because the ovaries still produce adequate estrogen, but not enough progesterone, due to a lack of ovulation. The uterus then receives what is called unopposed estrogen stimulation. This thickening is called hyperplasia, and the cells over time can become atypical or even malignant. The potential role of soy foods in the diets of women with PCOS may have some contradictions but basically, it is thought that soy can reduce blood estrogen levels and increase SHBG and that women with higher soy diets excrete more than twice the amount of estrogen in their stool in one study, and increased the excretion of estrogens in the urine in another. There are indeed, other soy studies that do not show the same results. I recommend one serving of a soy food per day, or something equivalent to 50mg-100 mg of soy isoflavones daily.

Saw palmetto inhibits the activity of an enzyme, 5-alpha reductase, thereby reducing the conversion of testosterone to dihydrotestosterone, the more potent form. This may have implications in reducing acne, excess facial and body hair, as well as hair loss from the scalp. Saw palmettos was recently studied as part of a formula and was able to initiate a reduction in hair loss and an improvement in hair density in patients with testosterone related hair loss.

Calcium and vitamin D are two of the most reaching nutrients our body needs affecting muscles, bones, thyroid, brain, heart, hormones, colon, breast and more. Calcium and vitamin D regulation may also contribute to the development of faulty ovarian follicle development in women with PCOS, resulting in reproductive and menstrual dysfunction. Vitamin D also plays a role in glucose metabolism and is commonly deficient in individuals with type 2 diabetes. Supplementing with vitamin D has been shown to improve glucose tolerance, insulin secretion and insulin sensitivity in those with DM., A deficiency of vitamin D may be more frequent in women with PCOS and in a small study, five of thirteen women had an overt vitamin D deficiency. Seven of the nine women with no menses or infrequent menses, had a return to a normal menstrual cycle within two months of being given 50,000 IU once or twice per week of vitamin D and 1,500 mg per day of calcium.10

Chromium is a trace mineral that enhances the action of insulin. Supplementing with chromium has been shown in some studies to improve the blood sugar control in those with type 2 DM. Giving PCOS women 1,000 mcg per day of chromium for as little as two months was able to improve insulin sensitivity by 30% and by 38% in obese women with PCOS.

A little known supplement, D-chiro-inositol is not commercially available, but pinitol, a compound similar to D-chiro-inositol, is available. Pinitol appears to mediate insulin activity. In an important study about this nutrient, 600 mg of pinitol twice per day for three months lowered blood glucose levels by 19%, lowered average glucose levels by 12% and significantly improved insulin resistance.

Conventional treatment of PCOS includes diet and exercise, and a drug, Metformin, used to improve insulin resistance. This can lead to normal ovulation. Other medications are used to induce ovulation such as clomiphene citrate, spironolactone to decrease testosterone on the hair follicle, and oral contraceptives to address irregular menstrual cycles and excess body hair. A newer drug, Vaniqa, is used topically, to reduce facial hair.

Working with a licensed alternative medicine provider with knowledge of this condition, the ability to run laboratory tests and to assess for complications of the syndrome and an understanding of the mechanism of the natural ingredients, would be optimal. It’s a complicated condition, requiring long term attention and regular medical care. But, don’t despair if you have this syndrome. We finally have lots of options to address the symptoms and the metabolic dysregulation, and natural medicines play a big part.

In summary, a comprehensive plan for PCOS would include:

Weight loss in those who are overweight
Daily aerobic exercise one hour per day
Low simple carbohydrates
Up to 80 gm/day of carbohydrates
60-80 gm per day of protein
Flax seeds 1-2 tbsp per day
Soy food 1 serving per day
Vitamin D 2,000 i.u. per day (or more under doctor’s supervision)
Calcium 1,000mg-1,500 mg per day
Chromium 1,000 mcg per day
Green tea (90% polyphenols, 80% catechins, 45% EGCG) 300mg-500 mg per day or 3 cups of tea per day
Nettles root 600 mg per day
Saw Palmetto extract 400 mg per day
Pinitol 600 mg twice per day

Important resources:

Women’s Encyclopedia of Natural Medicine. Tori Hudson, N.D., McGraw/Hill publishing

PCOS, A Woman’s Guide to Dealing with Polycystic Ovary Syndrome. Colette Harris with Dr. Adam Carey. Thorson’s publishing

PCOS, The Hidden Epidemic. Samuel Thatcher, M.D., PhD. Perspectives Press

The Natural Diet Solution for PCOS and Infertility. Nan Dunne, N.D. (paperback and e-book) 
PCOS Health Review- free newsletter; Nan Dunne, N.D. and Bill Slater

Schottner M, Gansser D, Spiteller G. Lignans from the roots of Urtica dioica and their metabolites bind to human sex hormone binding globulin. Planta Med 1997; 63(6): 529-532

Gansser D, Spiteller G. Plant constituents interfering with human sex hormone-binding globulin. Evaluation of a test method and its application to Urtica dioica root extracts. Z Naturforsch 1995;50(1-2):98-104.

Gansser D, Spiteller G. Aromatase inhibitors from Urtica dioica roots. Planta Med. 1995;61(2): 138-140.

Nagata C, Kabuto M, Shimizu H. Association of coffee, green tea, and caffeine intakes with serum concentrations of estradiol and sex hormone-binding globulin in premenopausal Japanese Women. Nutrition and Cncer 1998; 30(1): 21-24.

Kumar N, Cantor A, Allen K, et al. The specific role of isoflavones on estrogen metabolism in premenopausal women. Cancer 2002;94:1166-1174.

Goldin B, Adlercreutz H, Gorbach S, et al. The relationship between estrogen levels and diets of Caucasian American and Oriental immigrant women. Am J Clin Nutr 1986;44:945-953

Xu X, Duncan A, Wangen K, Kurzer M. Soy consumption alters endogenous estrogen metabolism in postmenopausal women. Cancer Epidemiology, Biomarkers and Prevention 2000;9:781-786.

Martini M, Dancisak B, Haggans C, Thomas W, Slavin J. Nutrition and Cancer 1999;34(2): 133-139.

Prager N, Bicket K, French N, Marovici G. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. JAH and Comple Med 2002;8(2): 143-152.

Thys-Jacobs S, Donovan D, Papadopoulos A, et al. Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Steroids 1999;64:430-435.

Raghuramulu N, Raghunath M, Chandra S, et al. Vitamin D improves oral glucose tolerance and insulin secretion in human diabetes. J Clin Biochem Butr 1992;13:45-51.

Borissova A, Tankova T, Kirilov G, et al. The effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patients, Int J Clin Pract 2003;57:258-261.

Gaby A. Chromium. Integrative Med 2006;5(4):22-26.

Lydic L, McNurlan M, Komaroff E, et al. Effects of chromium supplementation on insulin sensitivity and reproductive function in polycystic ovarian syndrome: a pilot study. Fertil Steril 2003;80 (Suppl 3): S45-S46.

Lydic M, McNurlan M, Bembo S, Mitchell L, Komaroff E, Gelato M. Chromium picolinate improves insulin sensitivity in obese subjects with polycystic ovary syndrome. Fertil Steril 2006;86:243-246.

Davis A, Christiansen M, Horowitz J, et al. Effect of pinitol treatment on insulin action in subjects with insulin resistance. Diabetes Care 2000;23:1000-1005.

Kim J, Kim J, Kang M, et al. Effects of pinitol isolated from soybeans on glycaemic control and cardiovascular risk factors in Korean patients with type II diabetes mellitus: a randomized contolled study. Eur J Clin Nutr 2005;59:456-458.