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This study was a double blind clinical trial in 150 women in Iran. Two groups of 75 women each were evaluated for severity and duration of breast pain which was measured according to a breast pain chart and something called a Visual Analog Scale.

Chewable tablets of either vitamin E 200 mg tablets or a placebo were given twice a day for 4 months, and again, the severity and duration of breast pain was evaluated at the end of the second and fourth month. The results at two months for vitamin E were dramatically better than placebo in severity and duration, and appear to be achievable in about 70% of the women. The improvement was seen as soon as two months, and no continued improvement after 4 months.

Commentary: Other studies have been conducted in vitamin E and breast pain. In 1997, Khanna et al compared vitamin E with a drug called Danazol. Vitamin E reduced pain in 41% of the women in the studies and Danazol had similar pain reduction in 72% of the women. Clearly the drug helped more women, but the side effects of that drug are significant and one third of the women developed other side effects. Meyer et al did a study in 1990 but did not show any benefit from Vitamin E. Ernester in 1985 studied 201 women with mastalgia as it relates to fibrocystic breast disease. He concluded that vitamin E was not effective, but he was not evaluating breast pain as a distinct issue. In 2004, Bespalov et al studied 66 women with a combination of beta-carotene, vitamin E, vitamin C and garlic powder. There was a reduction in the severity of mastalgia, premenstrual syndrome, infrequent menses and menstrual cramping as well as a reduction in symptoms of fibromatosis in 75% of the women compared with 45% of women on placebo.

If vitamin E alone is not sufficiently helpful in reducing mastalgia, evening primrose or borage oil should be considered, as well as carotenoids, iodine, eliminating caffeine, lowering saturated fats in the diet and increasing fiber.

References

Parsay S, Olfati F, Nahidi S. Therapeutic effects of vitamin E on cyclic mastalgia. The Breast Journal 2009;15(5):510-514.

In each of the studies, women who consumed the highest dietary intake of soy had a lower risk for endometrial and ovarian cancers compared with the women who had the lowest intake.

Commentary: It is not surprising to see this report as we have seen previous observational studies with similar results, showing lack of endometrial proliferation, endometrial safety and/or reduced risk of endometrial cancer. Only one previous study that I’m aware of, did demonstrate that after 5 years, but not after one year or 3 years, who were given 150 mg per day of soy isoflavone tablets had an increased occurrence of endometrial hyperplasia (but no cases of atypical hyperplasia or endometrial cancer).[ii]

The mechanisms whereby soy appears to have an influence on lowering the risk of hormonal cancers, including breast, appear to be multiple. These include: through its ability to bind to certain estrogen receptors and actually have an estrogen blocking effect, raising sex hormone-binding globulin which decreases circulating estrogens, affecting selected enzyme pathways which result in anti-carcinogenic effects, direct tumor growth inhibition, and having antioxidant effects.

My advice: for most women, and for those who are not allergic to soy or have indigestion with soy products, I recommend 1-2 servings per day of the following soy foods: cooked soy beans, roasted soy nuts, soy milk, tofu, tempeh, edamame, tofu pate (my favorite).

[i] Myung S- K et al. Soy intake and risk of endocrine-related gynaecological cancer: A meta-analysis. BJOG 2009 Dec; 116:1697

[ii] Unfer V, et al. Endometrial effects of long-term treatment with phytoestrogens: a randomized, double-blind, placebo-controlled study. Fertility and Sterility 2004;82:145-148). 150 mg of soy isoflavones per day is above the average intake in an Asian diet (ranging from about 40-90 mg per day

Dear all,
I’m taking another group trip to the sacred holy land of the Navajo-Canyon de Chelly. 
Our base camp is in the valley of the canyon, surrounded by beautiful canyon walls, moon and sun rises and sets.   We do group cooking and eating in an outdoor kitchen.  We camp in our tents with an outhouse and primitive outdoor shower.  Our Navajo guides are Lupita and Jon McClanahan, who are local canyon residents, and very special people.  We will be camping on their ancestral land, in the remote regions of the canyon.

Our daily activities include incredible hikes.  Not too strenuous although for some people the heights can be a problem occasionally.  We hike up and down the canyon walls, hike to Anasazi ruins, and visit a traditional birthing Hogan.  One of my favorite parts is that we will hear incredibly wonderful stories-Navajo and Anasazi history, cultural insights, ceremonial healing ceremonies and some of the healing traditions of the Navajo.  We hear of the birthing traditions, Navajo spirituality, and "the beauty way".    At night, we sit around the fire and talk; Jon or Lupita also tell some stories= grandfather fire, stories from Lupita’s childhood living in the canyon in the traditional ways, and more. 

I have been to the canyon many times in the last 6 years.  Jon and Lupita have become close friends and deeply meaningful teachers.  They are beautiful in their ways and speaking and living.  Their spirituality and their commitment to living their lives in keeping with their traditional spirituality is evident in all that they do.  My life has changed in extraordinary and powerful ways as a result of knowing them. 

If you are interested in this fantastic trip, write Tori Hudson, N.D. at womanstime@aol.com or call, 503-222-2322. You can also learn a bit more about the canyon and Jon and Lupita, from their website, www.footpathjourneys.com

The cost of the trip is affected by the number of people on the trip but I anticipate it to be between 750.00 and 950.00. Your transportation costs to and from Chinle, Arizona are extra. I can work with you to arrange car pools from Phoenix, Arizona.

                                                                                    Tori Hudson, N.D.

Guidelines for screening cervical cancer and abnormal cells of the cervix are regularly evaluated and updated, based on statistics and health data. Both  liquid-based and the conventional pap smear slide methods of screening are acceptable, but the majority of current screening uses the liquid-based process. The liquid-based technology will filter out most of the blood and inflammatory cells and debris, and in addition, can be used for HPV testing as well as gonorrhea and chlamydia infections.

As of December 2009, the American College of Obstetricians and Gynecologists (ACOG) have updated their clinical guidelines as follows:

• Cervical cancer screening should begin at age 21 years. Screening before age 21 should be avoided because it may lead to unnecessary and harmful evaluation and treatment in women at very low risk of cancer.
• Cervical cytology screening is recommended every 2 years for women between the ages of 21 years and 29 years
• Women aged 30 years and older who have had three consecutive negative cervical cytology screening test results and who have no history of moderate cervical dysplasia (CIN 2) or severe cervical dysplasia (CIN 3), are not HIV infected, are not immunocompromised, and were not exposed to DES in utero may extend the interval between cervical cytology exams to every 3 years.
• Both liquid-based and conventional methods of cervical cytology are acceptable for screening.
• In women who have had a total hysterectomy (all of uterus removed) for a benign indications (ex/ uterine fibroids, endometriosis, abnormal bleeding unrelated to cancer) and have no prior history of a moderate or severe dysplasia, routine cytology testing should be discontinued.
• Co-testing using the combination of cytology plus the HPV test is an appropriate screening test for women older than 30 years. Any low-risk woman aged 30 years or older who receives negative test results on the pap/liquid based pap screen and HPV test should be rescreened no sooner than 3 years subsequently.
• Sexually active adolescents (women younger than age 21) should be counseled and tested for sexually transmitted infections, and should be counseled regarding safe sex and contraception.
• It is reasonable to discontinue cervical cancer screening between 65 years and 70 years of age in women who have three or more negative cytology test results in a row and no abnormal test results in the past 10 years.
• Women treated for moderate or severe dysplasia or cervical cancer are at risk for persistent or recurrent disease for at least 20 years and should continue to have annual screening for at least 20 years.
• Women who have had a hysterectomy with a history of moderate or severe dysplasia should continue to be screened even after treatment.
• ANNUAL GYNECOLOGIC EXAMS ARE STILL APPROPRIATE, EVEN IF CERVICAL CYTOLOSY SCREENING IS NOT PERFORMED AT EACH VISIT.
• Women who have been immunized against HPV-16 and HPV-18 should be screened by the same regimens.

Commentary:  These guidelines are regularly changed based on statistics on incidence of cervical dysplasias and cervical cancer, treatment outcomes, new information on the cause and progress of a disease, and the influence of cost effectiveness and benefits and risks of overtreatment and undertreatment. With the development of liquid based collection systems (ex/ Thin Prep and Sure Path), and the ability to test for low risk and high risk strains of HPV, this has led to some of the guidelines where the pap is needed less often, as long as the cytology and the HPV are negative.  My main concern about this development is that many women, and even practitioners, interpret this to mean they do not still need an annual physical exam.

Source: ACOG practice bulletin Number 109, December 2009

Commentary: We know that elevated homocysteine levels are associated with the risk for AMD and B vitamins lower homocysteine levels. The current study suggests that supplementation with these three B vitamins can lower the risk for AMD, although it is not clear if this result is indeed related to homocysteine lowering or some other mechanism.

References

Christen W,et al. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: The women’s antioxidant and folic acid cardiovascular study. Arch Intern Med 2009. Feb 23;169:335

It has been known for a considerable amount of time, that folic acid when given to women planning for pregnancy and during pregnancy, can lower the risk for neural tube defects. Based on the research up to that time, the US Preventive Services Task Force (USPSTF) first published their recommendations in 1996. This has recently been updated and the USPSTF has issued a new statement in May, 2009. Based on the observational evidence and randomized controlled trials published since 1996, the USPSTF found convincing evidence that supplements containing 0.4 to 0.8 mg of folic acid during the preconception period lowers the risk for neural tube defects.[1]

There now appears to be additional benefits for folic acid before conception and during pregnancy, possibly the prevention of cleft lip (BMJ 2007;334:464) and most recently, lowering the rates of severe congenital heart defects. In a Quebec study, investigators observed a drop in the prevalence of severe congenital heart defects after mandatory folic acid fortification of grains. The average prevalence of severe congenital heart defects at birth was 1.64 per 1000 births during the 9 years before the folic acid food fortification began and the rate fell by 6.2% yearly during the seven years studied, after the mandatory fortification.[2]

Following the recommendation that all women of child bearing age should take a daily supplement containing 0.4 mg to 0.8 mg per day of folic acid is good, safe medicine and perhaps even more beneficial than previously thought.

References

[1] Woffe T, Takacs-Witkop C, Miller T, Syed S. Folic acid supplementation for the prevention of neural tube defects: An update of the evidence for the U.S. Preventive Services Task Force. May 2009.150; (9): 632-639

[2] Ionescu-Ittu R, et al. Prevalence of severe congenital heart disease after folic acid fortification of grain products: Time trend analysis in Quebec, Canada. BMJ 2009;338:b1673

St John’s wort was compared with a placebo in a double-blind, randomized clinical trial on symptoms and quality of life issues in perimenopausal women. Forty-seven 40 to 65 y.o. perimenopausal women who experienced three or more hot flashes per day were randomized to receive either 900 mg three times daily of a St. John’s wort extract or placebo for 3-months. Hot flash severity and frequency were evaluated and the Menopause-Specific Quality of Life questionnaire was used to evaluate menopause related quality of life.

After 12 weeks, only a small difference was seen favoring St. John’s wort in the frequency of hot flashes. A 30% improvement in 50% of the women was seen in the St. John’s wort group and only 23% in the placebo group. A significant reduction in sleep problems and depression was seen with St. John’s wort and the St. John’s wort group scored significantly better menopause related quality of life.

References

Al-Akoum M, Maunsell E, Verreault R, et al. Effects of Hypericum perforatum (St. John’s wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause 2009; 16(2):307-314

Folic acid updates for pregnant women

It has been known for a considerable amount of time, that folic acid when given to women planning for pregnancy and during pregnancy, can lower the risk for neural tube defects. Based on the research up to that time, the US Preventive Services Task Force (USPSTF) first published their recommendations in 1996. This has recently been updated and the USPSTF has issued a new statement in May, 2009. Based on the observational evidence and randomized controlled trials published since 1996, the USPSTF found convincing evidence that supplements containing 0.4 to 0.8 mg of folic acid during the preconception period lowers the risk for neural tube defects.[i]

There now appears to be additional benefits for folic acid before conception and during pregnancy, possibly the prevention of cleft lip (BMJ 2007;334:464) and most recently, lowering the rates of severe congenital heart defects. In a Quebec study, investigators observed a drop in the prevalence of severe congenital heart defects after mandatory folic acid fortification of grains. The average prevalence of severe congenital heart defects at birth was 1.64 per 1000 births during the 9 years before the folic acid food fortification began and the rate fell by 6.2% yearly during the seven years studied, after the mandatory fortification.[ii]

Following the recommendation that all women of child bearing age should take a daily supplement containing 0.4 mg to 0.8 mg per day of folic acid is good, safe medicine and perhaps even more beneficial than previously thought.

References

[i] (Woffe T, Takacs-Witkop C, Miller T, Syed S. Folic acid supplementation for the prevention of neural tube defects: An update of the evidence for the U.S. Preventive Services Task Force. May 2009.150; (9): 632-639)

[ii] (Ionescu-Ittu R, et al. Prevalence of severe congenital heart disease after folic acid fortification of grain products: Time trend analysis in Quebec, Canada. BMJ 2009;338:b1673.)

Soybeans contain a class of compounds called phytoestrogens, comprising mostly genistein, daidzein and glycitein, all of which have a biochemical structure similar to 17- beta estradiol.  The binding of isoflavones to estrogen receptors is preferential for the estrogen receptor beta and thus indicates that soy isoflavones act as selective estrogen modulators.  Daidzein is similar in shape to a drug called Ipriflavone, which is used in Europe to treat osteoporosis.  In the U.S., Ipriflavone is available as a nutritional supplement. 

Bone mineral density (BMD) is the gold standard for determining fracture risk due to non-traumatic events.  Bone turnover is an independent predictor of fracture risk.  While research on the effects of soy on bone metabolism has been inconsistent, many positive studies do exist that suggest a role for soy in slowing bone turnover and increasing bone density in women.  Soy appears to have an estrogenic effect on bone in some experimental evaluations. The bone density of ovariectomized rats was evaluated in a study in which soy replaced casein in the diet and compared to another group that received estrogen. The addition of soy inhibited bone loss, although not to the same extent as was achieved with the estrogen treatment.  Another study of ovariectomized rats also reported a positive effect of the soy phytoestrogen, genistein in maintaining bone.  These authors also reported that genistein suppresses osteoclasts, the cells responsible for bone resorption, both in the test tube and in vivo.  Arjmandi also did a double-blind, randomized, and controlled trial using 40g of soy protein containing isoflavones over 3 months in postmenopausal women.  Bone resorption was decreased, when compared to milk protein.

Several human studies have provided further insight and comfort in the possible role of soy in our bone health. A study conducted at the University of Illinois found that menopausal women had an increase in mineral levels and density in their lumbar spines after taking 55-90 mg of soy isoflavones for six months.  The placebo group showed the lowest bone density and the greatest bone loss, while the estrogen group showed the highest bone density and the slowest bone loss. What was surprising was that the isoflavone diet was effective in preventing bone loss in the fourth lumbar vertebra and, although less so, in the right hip. Soy isoflavones seem to have more of an effect on trabecular bone (more predominant in the spine) than on cortical bone (more predominant in the hip). The soy did not show as great of ability in preventing bone loss as the estrogen group, but the positive effect it showed is encouraging. 

An analysis of the relationship of soy isoflavone intake and bone mineral density was conducted from the Study of Women’s Health Across the Nation, a US cohort study of women aged 42-52 years.  For African-American and Caucasian women, median intakes of genistein were too low to pursue analyses. For Chinese women, no association between genistein and bone mineral density was found. Premenopausal, but not perimenopausal Japanese women whose intakes were greater had a higher bone density of the spine and femoral neck. The mean spinal bone density of those women in the highest group was 7.7% greater than that of women in the lowest group. Bone density of the femoral neck was 12% greater in the highest intake group versus the lowest.
 
Other positive studies on soy and bone density also give some credence to the role of soy and bone health. In a study estimating the daily intakes of soy isoflavones in the diets of 478 postmenopausal Japanese women who reported soy consumption, high consumption of soy products was associated with increased bone mass.

A recent meta-analysis further increases our optimism about using soy to inhibit bone resorption.  Nine studies with a total of 432 menopausal women were evaluated in this meta-analysis.  Amount of soy intake varied amongst the nine studies from 37 mg of isoflavones per day to 118 mg of isoflavones per day. Testing for urinary peptides (deoxypyridinoline), a marker of bone turnover, demonstrated that those who consumed isoflavones had a decrease in these biomarkers of -2.08nmol/mmol, when compared to those who did not consume isoflavones.  In five of the studies where isolated soy protein was used there was no significant effect on urinary deoxypyridinoline.  In the current analysis, a significant reduction in urinary deoxypyridinoline was not observed in those studies with isoflavones of less than 90 mg/day.  In a review of the research in 2003, the author concluded that 90 mg of isoflavones per day is required to achieve benefits on bone health.

In contrast to the positive studies, several clinical trials using a variety of soy protein isolate formulations found no clinically important effects of soy on bone metabolism and bone turnover markers.  Further inconsistent research can be seen with several clinical trials using soy protein or isoflavones demonstrating a positive effect on BMD, while others have not had positive findings.

I mentioned variations in dosing, duration, soy formulations used, and different study populations as possible reasons for inconsistent results on the effects of soy isoflavones on bone turnover and bone density.  But, another significant consideration may be due to how the isoflavones are metabolized in the gut.  In the meta-analysis mentioned above which analyzed nine studies the significant effects on urinary peptides occurred in Asian women but not Caucasian women.  This may be due to the conversion of daidzein into its active metabolite equol by intestinal flora, and by the fact that only one-third of Caucasian women can metabolize isoflavones into equol, whereas more than half of Asian women possess this ability. 

Soy isoflavones may also have more of an effect in post-menopausal women than in pre or perimenopausal women.  In one study, 53.3 mg of isoflavones per day was associated with an increase in bone density in postmenopausal women, but not pre-menopausal women.

A nutritional influence of soy foods that may be overlooked is the amount of calcium in some of these foods or in diets that contain soy foods. A diet that includes greater amounts of soy products can account for a meaningful amount of calcium, and some soy foods can offer as much, or more, calcium than a serving of dairy products.
 

CALCIUM CONTENT OF SELECTED SOY FOODS

With the inconsistent research, it is difficult to draw confident conclusions about the role of soy in bone health.  My clinical advice is to increase soy foods as part of a regular diet in prevention strategies for all pre, peri and postmenopausal women.  For all women who have significant risk factors for osteoporosis, I would in addition, recommend soy supplementation so that their total daily soy isoflavone intake would deliver approximately 90 mg of soy isoflavones per day.  For treatment of peri and postmenopausal women who already have osteoporosis, I would not consider soy an adequate treatment alone.  For these women who already have osteoporosis, I am in favor of proven conventional therapies to reduce fracture risk in addition to the 90 mg per day of soy isoflavones and typical supplementation including calcium, vitamin D and other potential nutrients (K, boron, magnesium, manganese, and more), and dietary and exercise advice.

References
  Weaver C, Cheong J.  Soy isoflavones and bone health: the relationship is still unclear.  J Nutr 2005; 135:1243-1247.

  Setchell K.  Soy isoflavones-benefits and risk from nature’s selective estrogen receptor modulators (SERMS).  J Am Coll Nutr 2001; 20: 354S-362S.

  Garnero P, Hausherr E, Chapuy M, et al.  Markers of bone resorption predict hip fracture in elderly women: the EPIDOS Prospective Study.  J Bone Miner Res 1996; 11:1531-1538.

  Arjmandi B, Alekel L, Hollis B, Amin D, Stacwicz-Sapuntzakis M, Guo, Kukreja S.  Dietary soybean protein prevents bone loss in an ovariectomized rat model of osteoporosis.  J Nutr 1996;126:161-167.

  Blair H, Jordan S, Peterson T, Barnes S.  Variable effects of tyrosine kinase inhibitors on avian osteoclastic activity and reduction of bone loss in ovariectomized rats. J Cell Biochem  1996;61:629-637.

  Arjmandi B, Khalil D, Smith B, et al.  Soy protein has a greater effect on bone in postmenopausal women not on hormone replacement therapy, as evidenced by reducing bone resorption and urinary calcium excretion. J Clin Endocrinol Metab  2003; 88: 1048-1054.

  Erdman J, Stillman R, Lee K, Potter S.  Short-term effects of soybean isoflavones on bone in postmenopausal women.  Program and Abstract Book, Second International symposium on the Role of Soy in Preventing and Treating Chronic Disease.  Brussels, Belgium, 1996.

  Greendale G, FitzGerald G, Huang M, et al.  Dietary soy isoflavones and bone mineral density: Results from the study of women’s health across the nation. Amer J Epidemiology 2002;155(8):746-754.

  Somekawa Y, Chiguchi M, Ishibashi T, Takeshi A. Soy intake related to menopausal symptoms, serum lipids, and bone mineral density in postmenopausal Japanese women. Obstet Gynecol  2001;97:109-115.

  Ma DF, Qin LQ, Want P-Y, Katoh R.  Soy isoflavone intake inhibits bone resorption and stimulates bone formation in menopausal women:  meta-analysis of randomized controlled trials.  European J of Clinical Nutrition 2008; 62:155-161.

  Branca F.  Dietary phyto-oestrogens and bone health.  Proc Nutr Soc 2003; 62: 877-887.

  Wangen K, Duncan A, Merz-Demlow B, et al.  Effects of soy isoflavones on markers of bone turnover in premenopausal and postmenopausal women.  J Clin Endocrinol Metab 2000; 85:3043-3048.

  Knight D, Howes J, Eden J, Howes L.  Effects of menopausal symptoms and acceptability of isoflavone-containing soy powder dietary supplementation. Climacteric 2001; 4:13-18.

  Dalais F, Ebeling P, Kotsopoulos D, McGrath B, Teede H.  The effects of soy protein containing isoflavones on lipids and indices of bone resorption in postmenopausal women.  Clin Endocrinol 2003; 58:704-709.

  Potter S, Baum J, Teng H, et al.  Soy protein and isoflavones: their effects on blood lipids and bone density in postmenopausal women.  Am J Clin Nutr 1998; 68:1375S-1379S.
  Alekel D, Germain A, Peterson C, et al.  Isoflavone-rich soy protein attenuates bone loss in the lumbar spine of perimenopausal women.  Am J Clin Nutr 2000; 72:844-852.

  Morabito N, Crisafulli A, Vergara C, et al.  Effects of genistein and hormone-replacement therapy on bone loss in early postmenopausal women:  a randomized double-blind placebo controlled study. J Bone Miner Res 2002; 17:1904-1912.

  Chen Y, Ho S, Lam S, Ho S, Woo J.  Soy isoflavones have a favorable effect on bone loss in Chinese postmenopausal women with lower bone mass: a double-blind, randomized, controlled trial. J Clin Endocrinol Metab 2003;88:4740-4747.

  Lydeking-Olsen E, Beck-Jensen J, Setchell K, Holm-Jensen T.  Soymilk or progesterone for prevention of bone loss: a 2 year randomized, placebo-controlled trial. Eur J Nutr 2004;43:246-257.

  Gallagher J, Satpathy R, Rafferty K, Haynatzka V.  The effect of soy protein on bone metabolism.  Menopause 2004; 11:290-298.

  Kreijkamp-Kaspers S, Kok L, et al.  Effects of soy protein containing isoflavones on cognitive function, bone mineral density, and plasma lipids in postmenopausal women.  JAMA 2004; 292:65-74.

  Mei J, Yeung S, Kung A.  High dietary phytoestrogen intake is associated with higher bone mineral density in postmenopausal but not premenopausal women. J Clin Endocrinol Metab 2001; 86:5217-5221.

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

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