Managing Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal problem affecting 1 in 15 women. PCOS displays symptoms of missed or irregular menstrual cycles, high levels of male hormone (androgens) resulting in facial hair, male pattern baldness and/or acne, obesity and multiple fluid filled cysts in either ovaries as seen on an ultrasound. PCOS is the most common cause of female infertility.

What causes PCOS?

One of the common conditions PCOS women have is insulin resistance. Insulin resistance and increased luteinising hormone (LH) stimulate ovarian androgen production, resulting in higher levels of free testosterone in a woman’s body.  This increase in androgens causes acne, hirsutism (excessive hair growth on a woman’s face or body) and male pattern baldness.  Metabolic syndrome, insulin resistance and obesity are frequently present in women with PCOS.  A decrease in follicle stimulating hormone (FSH) cause impaired development of follicles.  This is a major cause of missed menstrual cycles (anovulation).  Metabolic syndrome is a condition of high levels of small low density cholesterol, elevated triglycerides, hypertension and high blood glucose levels and low level of high density cholesterol.

What other health problems are PCOS women at risk of?

Women with PCOS are at a much higher risk of developing diabetes before age 40.  The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.  Women with PCOS are also at higher risk of developing endometrial cancer due to irregular menstrual periods and low levels of progesterone.  Progesterone causes the endometrium to shed each month as a menstrual period.  Without progesterone, the endometrium becomes thick in the absence of menstrual periods and this increases the risk of endometrial cancer.  Women with PCOS tend to have higher rates of gestational diabetes, miscarriage, preeclampsia and premature delivery of babies.  Insulin resistance and metabolic syndrome are modifiable conditions for PCOS and these can be improved with a good PCOS diet and exercise.

Diet for Managing PCOS

Because insulin resistance is the result of high level of insulin production that causes the cells to be less sensitive to insulin signaling for glucose update, successful management of insulin resistance can help manage PCOS. Successful management of insulin resistance will involve an uptake of low carbohydrate, low sugar and high protein foods. Low glycemic load carbohydrates cause less fluctuations in blood sugar levels and is beneficial for women with PCOS who normally suffer from insulin resistance. Therefore, women with PCOS should reduce consumption of processed foods and saturated fats, and revert to a diet high in fresh vegetables and fruits, meat, eggs, legumes, seeds and nuts provide the nutrients without the unnecessary blood sugar fluctuations. Because women with PCOS have an increased risk of cardiovascular disease, fresh fruits and vegetables, seeds, nuts and legumes provide the diet with fibre, essential minerals and good fats for better lipids and cardiovascular risk management.  Chromium and magnesium are important to help maintain normal blood sugar and insulin levels. It is difficult to obtain a high level of chromium from food sources.  So, supplementation may be required.  Combining chromium with vitamin C and niacin can enhance its absorption. Foods containing chromium include brewer’s yeast, broccoli, romaine lettuce, raw onions and ripe tomatoes. Magnesium rich foods include green vegetables, broccoli, beans and nuts. Cinnamon and licorice are herbs known to improve insulin sensitivity and lower androgen levels.

Tips for creating vibrant, healthy skin

If you are suffering from distressing skin conditions like dermatitis, eczema, psoriais or acne, you will find that many of the conventional treatments available do not manage your symptoms effectively.  This is because skin problems are rarely caused by one single factor.  Your skin is the largest organ of your body.  Its function is to eliminate toxins, regulate body temperature and provide protection to the inside of your body from potential micro-organisms’ invasion. Your body literally shed millions of skin cells every day and your skin completely replaces itself roughly every 27 days.  This means that if you can identify and treat the factors contributing to your skin problems, you should start to see dramatic improvements to your skin within one to two months.

What causes skin conditions?

The skin is a reflection of the health of your internal environment.  There are often many things that can contribute to a skin condition.  Here are some possible reasons:

• if your internal digestive and detoxification systems are not functioning properly, your skin will suffer;
• if you are experiencing a high level of stress, then the inflammation this causes can become visible through the skin;
• if your circulation and / or lymphatic systems are congested, then your skin will reflect this; and
• if your diet lacks certain nutrients your body and your skin needs, you will be presented with a skin condition indicating that your body is not getting the nutrients it needs.

Improving the health of your skin is not just about applying creams or lotions onto your skin and hoping that the problem will go away.  You also need to address the underlying contributing factors to the skin problem.  Here are some simple tips to improve the health of your skin:

• Eat well, avoid junk foods and feed your skin.  Poor diet is one of the major contributing factors to skin issues.  A poor diet can lead to nutritional deficiencies as well as inflammation and your skin will be the first to show the effect of a poor or inappropriate diet.  Your skin needs certain nutrients.  Nutrients such as zinc, vitamin D and fish oil are vital for your skin health as well as for the immune system.  Deficiencies in these nutrients have been shown to have an impact on skin conditions. 
• Keep your bowel movement regular and maintain healthy bowel flora.  If you are constipated and not moving your bowel regularly, toxins will not be removed from your body efficiently.  Toxins reabsorbed back into your system may be removed through your skin and this can aggravate skin conditions.  Adequate good bacteria (or bowel flora) is essential for healthy skin.  Bowel flora is key for maintaining proper immune function and digestion, to prevent constipation and harmful microbial overgrowth of the skin and digestive system.  So, improving constipation and sluggish digestion will assist in treating skin conditions. 
• Manage your stress and exercise regularly.  Stress is one of the major contributing factors to skin conditions especially acne as it causes inflammation, depletes your immune system and destroys bowel flora.  If you feel that you are stress out, try some relaxation techniques such as yoga or meditation.  Exercise can be a way to relax and manage stress as well.  Exercise helps the skin remove toxins through sweating as well as being anti-inflammatory.
• Detoxify your body regularly. If any of your five major channels of elimination, ie., the skin, the bowel, the kidneys, the lymphatic system and the lungs, is not functioning effectively and efficiently, the other channels are forced to work harder to help remove toxins the body is trying to eliminate. In most cases, congestion in one of these channels is expressed via the skin in the form of skin conditions such as acne, dermatitis, eczema and psoriasis. Therefore, improving the capacity of your elimination channels through regular integrated detoxification program will help to improve the health of your skin.
• Skin conditions can be caused by a number of factors.  A personalised treatment program is often needed to address the specific underlying causes of your individual condition.  While treating the cause is key to the long term solution of your skin condition, you can also use natural topical creams containing natural herbs (such as chamomile, calendula, aloe vera), essential oils (such as lavender, sandlewood) and nutrients (such as vitamin D, E, B12, zinc) to help manage your symptoms, reduce skin inflammation and promote healing.

Skin conditions can be caused by a number of factors.  A personalised treatment program is often needed to address the specific underlying causes of your individual condition.  While treating the cause is key to the long term solution of your skin condition, you can also use natural topical creams containing natural herbs (such as chamomile, calendula, aloe vera), essential oils (such as lavender, sandlewood) and nutrients (such as vitamin D, E, B12, zinc) to help manage your symptoms, reduce skin inflammation and promote healing.

Which diet is the best? Do you have to be vegan, eat raw food in order to be healthy?

I have often been asked what the best diet is.  I have clients presenting in clinic who are following one diet or another or switching from one diet to another and not feeling any better.  Many would ask me if I am a vegetarian.  As a naturopath and practitioner of Chinese Medicine, I feel it is important for me to share with you what my thoughts are on this subject. 

When I was undergoing my naturopathic training many years ago, we had to study and analyse a number of diets.  We had to practise the way of eating of one diet whilst we researched the nutrition and science behind the many, often contradictory diets.  The one I had to work on practically and did a fair amount of research on was the vegetarian diet.  I cut out all meats and fish.  To start with I am not a big meat eater, so I thought vegetarianism should suit me.  Much to my surprise, even over a 2 week period, I found my energy dropping and my sleep unrefreshed.  The last few days were really a drag, as I was looking forward to adding in my small amount of chicken and fish again.  What I learned out of that exercise was that, even though I consumed just a small amount of chicken and fish, those foods provided me with essential nutrients like magnesium and B12 that helped with energy production and nervous system support.  Moreover, the protein helped with tryptophan production that helped me sleep better.  Whilst I still consume a large proportion of plant based foods, including vegetables, seeds, nuts and some sea vegetables, adding a small amount of meat made all that difference.

There is also a misconception about the word "vegetarian".  There are a lot of people whose health is no better, but worse after becoming vegetarians.  I have seen a lot of my patients who say they are vegetarians, but in fact, they are carbotarians!  Most of their meals are full of carbohydrate, not vegetables, seeds or nuts! They always wonder why they are getting fatter and their health deteriorated after becoming "vegetarians".  Whilst we are designed to eat plenty of plant based foods, we are not designed to consume large amounts of processed foods, like breads, pastries, biscuits, potato chips, cheese flavoured onion rings, chocolate, cakes, etc.  Eating a large portion of processed foods is vegetarianism turned bad, as the fluctuations in blood sugar levels is creating cravings and more intake of sugar laden or high glycemic load foods.

I cannot say that one diet is superior to another, because it all depends on your constitution and needs.  Some people say eat everything in moderation.  I vehemently object to that statement!  Some things that do not agree with a person should just be removed, not even in small amounts!  Drug addicts who go through rehabilitation are taken away from the substance, they are not given a small amount of drug so they don’t react adversely!  And what should be in your diet or not depends on your objective, is it for convalescence, for weight loss, for better energy, etc.  It also depends on what type of physical and mental activity you are experiencing and what your needs are.  I advise you to seek professional guidance but as a starting point, if you are looking at doing it yourself, you should keep a food and symptom diary.  Tracking your progress gives a cheap and objective way of ascertaining what works and what does not.  If there is no consistent pattern you can observe, then seek naturopathic advice, we talk about food and nutrition all the time!

Eggs and butter don’t cause heart disease, sugar does!

I have always preached the benefits of having 1-2 eggs a day, it is a nutritious food, rich in protein, Vitamin A, choline, folate, B12 and some minerals.  It is one of the most affordable wholefoods that has been demonised by many. 

For half a century, we have been hearing doctors preaching that fats cause heart disease, and patients have been advised to reduce intake of eggs and swap butter out for margarine.  Most patients would be swapping eggs out for cereal for breakfast, which apparently was thought to be good for you.  Half a century on, cardiovascular disease is still the leading and growing cause of death, causing 30% of all deaths in New Zealand.

The problem is we have got it wrong!  Eggs and butter don’t cause heart disease, the cause of heart disease is in the consumption of sugar!  Swapping eggs out for breakfast for cereal that is a highly processed carbohydrate is a green card to causing increase in insulin and blood sugar which increases the risk factor for heart disease.

Sugar is the culprit to increasing inflammation and narrowing of the arteries from inflammation increases the risk of a stroke or heart attack.  Sugar is addictive, whether it comes in the form of refined cane sugar or high fructose corn syrup.

Butter is a saturated fat, but it is a naturally occurring fat.  Our bodies need saturated fats, adequate amounts of them are required to reduce the levels of lipoproteins in our blood, which is protective of the cardiovascular system. Margarine, on the other hand, is often made out of a vegetable oil.  Vegetable oils are often liquid at room temperature.  In order to solidify it, the structure of the oil needs to be manufactured and firmed up.  What firms up the oil also firms up your arteries.  It is therefore not a substitute for butter.  If you need to have butter, have it but without the sugar, because it is the sugar that causes heart disease more than the butter!

Do you really need statins when you have high cholesterol? What are the natural alternatives to statins?

High cholesterol has been preached so much as a cause of heart attacks making statins one of the best selling drugs in the world.  In 2010 alone, Simvastatin was the third most prescribed drug in New Zealand with 1.3 million prescriptions, according to the 2010 Pharmac Annual Report.  The USA Food and Drug Administration has issued warning on the use of statins with increasing the risk of diabetes, raised blood pressure and memory loss.  The first two risks are specifically related to cardiovascular health, and it is a paradox to work on lowering cholesterol and the side effects of the drug is causing the increase in cardiovascular risk itself!

So what does the scientific research say about the use of statins?  In a nutshell, statins are protective against heart disease for patients who have had a heart attack.  However, in healthy patients who have not had any cardiac event, especially women, there is no evidence to support the use of statins!  It is interesting that many doctors are still trying to push statins onto their patients just because their cholesterol is elevated even though the patient is healthy otherwise.

You need to know that your liver produces the bulk of your cholesterol.  Eating well – with adequate good fats, not low fats!  The Heart Foundation Diet has not been found to be effective in the reduction of cholesterol. Looking for the Heart Foundation tick is not the answer.  The tick is given to companies willing to pay to get the tick.  We should really have the tick on every head of cabbage and broccoli, should we not?

Have 2-3 tablespoons of cold pressed olive oil in your diet daily.  Eating plenty of raw seeds and nuts will help with the plant based fibre and healthy fat intake.  And keeping your liver well is the key, removing excess sugar, processed carbohydrates and having lots of fresh vegetables will help you win the game.

If working through all these strategies still leaves your cholesterol in limbo, you need additional help.  These are people who would benefit from a Hemaview Live Blood Screening test to take a snapshot about your nutritional status, oxidative stress status and inflammation status to address any other underlying causes of your elevated cholesterol.

I have emphasized the importance to keep your blood pressure in the normal or low-normal range.  The increase in blood pressure puts you at high risk of a cardiac event, probably higher than having high cholesterol!  And if you have high homocysteine levels, correct that!  You need to know your homocysteine levels if you are truly interested in having a healthy cardiovascular system. 

Why using Proton Pump Inhibitors long term can be detrimental to your health?

If you suffer from gut pain and have been using proton pump inhibitors to control that pain for more than 12 weeks, you need to read this!

Professor John Cooke, in his paper published in Circulation in August 2013, showed that long term use can increase risk for heart disease from it causing low magnesium levels, deficiency in Vitamin B12 and low calcium levels.  Other studies have also shown long term use of PPIs causing an increase in bacterial overgrowth in the intestines, particularly C. difficile, increases the risk of pneumonia, osteoporosis and it increases the risk of gastric carcinoma!

A study done on 138 hospitalised patients 88 who developed C.difficile infections were on PPIs and 63% of them had no valid indication for the PPI use!

  

The worst outcome anyone can get from a drug is dependence on it.  This is shown for PPIs that on withdrawal without correcting the underlying problem, an increase in acid production is noted.  Therefore, this is a drug that needs supervision on withdrawal and if you have been on it for a long time, DO NOT go cold turkey.  The underlying pathophysiology needs to be corrected while maintaining manageable amounts of acid in the stomach.

It is more important that there is an investigation as to why there is persistent high level of acid in the stomach.  Some diet and lifestyle modifications could be safer and more natural.  The common foods that trigger overacidity and reflux include, but not limited to, chocolate, citrus, tomatoes, peppermint, onions, garlic, dense fat foods, and carbonated drinks.  To remove these foods is a good starting point.  And not eating within 3 hours of sleeping!

If you have been using proton pump inhibitors to control your over-acidity symptoms, you should work on why you are overacidic and correct the problem rather than mask the problem.  When the red light comes on your car dashboard, you don’t plaster over the red light and pretend that the light is not there, so don’t do that to your stomach!

Simple recipe ideas for winter

In the last month, I have very commonly heard from many clients that they have found it difficult to eat well because of the cold.  I would like to give you some ideas about eating well with warm foods.  Eating well does not mean raw salads everyday.  Especially in the cold winter, balancing the energetics of the cold with some warm food is great.  Warm food can still be very healthy.  I find it hard to have a meal, especially dinner, without soups these days. 

Making a bone broth on the weekend, with quantity enough for a whole week helps to keep cooking time on the weekday manageable.  I often get over 1kg of chicken carcass, add onions and garlic, carrots and about 5L-6L of water to boil for 1-2 hours.  I strain the soup, throw out the carcass, divide the soup into small containers and freeze them ready to use for the week.  Adding broccoli to it makes a good broccoli soup, adding turnip and lotus root makes one of the soups my children love, or simply chopping up some leek and ham makes a good chunky soup. Other options include leafy greens like watercress or spinach and/or some seaweed for the extra minerals and iodine that you can benefit from.  Another popular option I use is barley, lentils, cauliflower and carrot cubes added to the stock and boiled. Vegetable stir fries with a protein of your choice makes a simple, warm and satisfying dinner.

If you want to make some warm breakfast without cereal, grains or flour, try our flourless pancake.  It’s our family favourite when eaten with cashew or almond butter:

Flourless Pancake Recipe

1 rounded scoop Shape Up Protein Plus or 1 sachet Shape Up

1 rounded scoop ground almond

100ml soy milk (or any milk of your choice)

1 egg

Mix above mixture and pour into a heated stainless steel pan with coconut oil.  Cook until mixture sets.  Makes 2 medium size pancakes.  Add some cashew or almond butter or some blueberry coulis to serve.  Blueberry coulis can be very simply made by cooking 1 cup frozen blueberries (bruise them), 1 teaspoon honey and some lemon juice. Cook until mixture thickens.