1
Practical PCOS Solutions
A practical lesson in how to support
patients with PCOS and infertility
1
2
2
Polycystic Ovary Syndrome
• Affects 5-10% of women of reproductive age
• Characterised by anovulation, hyperandrogenism and polycystic ovaries
• Is associated with insulin resistance and obesity, which is present in approx 50% of women with PCOS.
• One of the most common causes of infertility
Hirschberg AL. (2009) Polycystic ovary syndrome, obesity and reproductive implications. Womens Health (Lond Engl). Sep;5(5):529-40
3
Female Infertility - Causes
• Autoimmune conditions/cancer or tumour/clotting disorders / birth defects
• Diabetes
• Uterine/cervical growths (such as fibroids or polyps)
• Excessive exercising
• Eating disorders or poor nutrition
• Too much alcohol
• Obesity
• Older age
• PCOS
• PID
• Scarring associated with endometriosis and STIs
• Thyroid disease
• Hormonal imbalance
• Certain medications, including chemo drugs
Vorvick L. Storck S. and Zieve D. Infertility. PubMed Health. Updated: February 28, 2011
4
3
Practical PCOS Solutions
• What is PCOS?
• Signs & Symptoms
• Infertility & PCOS
• What can we do to help?
– Insulin dysregulation
– Female hormonal disruption
– Nutrient deficiency
• Further considerations
• Maintenance5
What is Polycystic Ovary
Syndrome?
6
4
Polycystic Ovaries
• Multiple cyst formation on the ovaries
7
Presence of polycystic ovaries plus:
• Excess androgens (male hormones)
• Facial hair (hirsutism)
• Acne
• Infertility
• Obesity (50%)
• Little or no menstrual flow
• Mood swings
• Increased incidence of CVD risk factors
Polycystic Ovarian Syndrome
8
5
Testing for PCOS
• Ultra Sound
• Blood test – LH FSH DHEA Testosterone
• Prolactin
• Thyroid hormones
• Low SHBG
• Adrenal Function
• GTT/fasting glucose
• Questionnaire? 9
Usual Treatments for PCOS
• Anti-androgens
• Oral contraceptive
• Metformin
• Clomifene
• Diuretics
10
6
What should I
do?
11
Practical PCOS Solutions
Insulin & Cortisol Balance
Nutrient Deficiencies
Hormonal dysregulation
12
7
Elevated androgen
production
Increase in
pancreatic insulin
production
Centripetal obesity
Metabolic
Syndrome
Converts excess
androgen to
oestrone
Disruption of GnRH
Excess LH and
insufficient FSH
Acne
Hirsutism
Male hair distribution
Hyperandrogenism
Amenorrhea
Anovulation
Infertility
Normal menstrual
cycle ceases
Stress
Elevated adrenal
cortisol
Insulin resistanceElevated blood
glucose levels
Clinical Depression
Excessive insulin
secretion
More androgen
hormone
production
Insulin & Cortisol Balance
13
Insulin & Cortisol Balance
Milk Protein
Hydrolysate &
Theanine
Powdered Myo-
inositol, vitamin
B6, Magnesium &
Calcium
Low GI Metabolic
Food
14
8
Insulin & Cortisol Balance
Milk Protein
Hydrolysate &
Theanine
Milk Protein Hydrolysate & Theanine Technical Review
15
Milk Protein Hydrolysate (Lactium®)
and Theanine
Each tablet provides:
L-Theanine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 mg
Milk Protein Hydrolysate (Lactium®) . . . . . . . . . . . 150 mg
Dose: 1-2 capsules daily
16
9
Milk Protein Hydrolysate
� A unique natural milk protein fraction that contains a natural bioactive peptide with relaxing properties.
� Has anti-anxiety effects without side effects such as drowsiness.
� Human studies show benefit for mental and physical symptoms of stress, improved sleep and reduced levels of the stress hormone cortisol.
� An experimental study suggests benefit for stress related sweet cravings and overeating.
� Safe for lactose intolerant people and hypoallergenic (avoid in true anaphylactic dairy allergy).
17
Theanine
• A natural amino acid with relaxing and cognitive enhancing properties derived from green tea.
• Human clinical studies suggest stress relieving and mood enhancing effects.
• May also improve mental performance under stress.
• Experimental studies suggest cognitive performance enhancing, anti-stress, anti-depressant and neuroprotective activities.
18
10
Stress
• Stress (increased cortisol) lowers
progesterone and increases oestrogen
effect
• Stress (increased “spent” cortisol) increases
inflammation
• Stress (increased cortisol) increases insulin
resistance which increases aromatase
19
Insulin resistance & PCOS
• Most women with PCOS are metabolically insulin
resistant, in part due to genetic predisposition
and in part secondary to obesity.
• In the past 20 years there has been growing
evidence supporting that defects in insulin
actions or in the insulin signalling pathways are
central in the pathogenesis of the syndrome
J Steroid Biochem Mol Biol. 2010 Oct;122(1-3):42-52 20
11
Not all PCOS patients are obese
Approximately 50% of women
with polycystic ovary syndrome
are lower than BMI 25kg/m2
Womens Health (Lond Engl). 2009 Sep;5(5):529-4021
Body composition determines insulin
sensitivity
Eaton SB, Cordain L, Sparling PB. Prev Med. 2009 Aug 15. [Epub ahead of print]22
12
Insulin & Cortisol Balance
Powdered Myo-
inositol, vitamin
B6, Magnesium &
Calcium
Magnesium Technical Review
23
What is Myo-inositol?
• Myo-inositol is a naturally occurring isomer of glucose and
has been shown in studies to play several important roles
in supporting fertility.
• In particular, it has been shown to support healthy
ovaries, ovulation, follicular function and egg
development.
• It has also been shown to be helpful in supporting insulin
control and androgen dominance in those with ovarian
issues.
• As the second messenger of serotonin, myo-inositol has
also shown some success in supporting mood and
behaviour in the premenstrual phase of women’s
hormone cycles.
Magnesium Technical Review
24
13
European Journal of Obstetrics & Gynecology
and Reproductive Biology 147 (2009) 120–123
Myo-Inositol improves insulin resistance in women with PCOS
Insulin sensitivity significantly improved in this study of 20
overweight PCOS patients. Also after 12 weeks of myo-inositol
administration, presented plasma LH, PRL, T, insulin levels and
LH/FSH reduced.
Furthermore menstrual cyclicity was restored in all amenorrhoic
and oligomenorrhoic subjects.
25
Balancing insulin with myo-inositol
results in improved hormone levels
A combination of the contraceptive pill (OCP)
and myo-inositol (4 grams daily for 12
months) has been shown to be more
effective in controlling the endocrine,
metabolic and clinical profile in patients with
PCOS than the OCP alone, and also reduced
insulin levels and insulin resistance.
Minozzi M, Gynecol Endocrinol. Nov;27(11):920-4. 201126
14
Powdered Myo-Inositol, Vitamin B6,
Magnesium & Calcium
• Featuring myo-inositol: clinical research has demonstrated an important role of myo-inositol in female health
• Clinical doses of myo-inositol are best achieved in powdered delivery
• Also contains vitamin B6, which contributes to the regulation of hormonal activity
• Contains magnesium and calcium, which both contribute to normal muscle function
• Mixes easily into water or juice to make a refreshing easily-digested drink
• Tasty orange flavour 27
One scoop supplies:
• Magnesium. . . . . . . . . . . . . . . . . . . . . . . . . . . . 200mg
• Vitamin B1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25mg
• Vitamin B2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20mg
• Vitamin B3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20mg
• Vitamin B5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20mg
• Vitamin B6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25mg
• Vitamin C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500mg
• L-glutamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500mg
• Calcium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50mg
• Myo-inositol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2000mg
• Folic acid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100mcg
• Manganese . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 mg
• Vitamin E 100 IU . . . . . . . . . . . . . . . . . . . . . . . . . . .67mg
Recommendation: 1-2 servings per day
Powdered Myo-Inositol, Vitamin B6,
Magnesium & Calcium
Magnesium Clinical Guide
28
15
Insulin & Cortisol Balance
Low GI Metabolic
Food
Metabolic Food Clinical
Guide & Patient Guide
29
Low GI Metabolic Food
• Nutritionally balanced, low-glycaemic index foods
in the form of a convenient and delicious shake.
• Designed to enhance weight loss and support
lean muscle growth.
• Help to control appetite and reduce overeating.
• Contains 15g of protein per serving.
• Supports cardiovascular health (Plant Sterols) and
blood glucose control (Acacia and Hops).
• Available in Vanilla or Chocolate
30
16
What “they” say…– Fructose has been hypothesized to cause:
• Obesity
• Elevated LDL Cholesterol
• Elevated triglycerides
• Leads to metabolic syndrome
What we know…• In UltraMeal & UltraMeal Plus it:
– Decreases Fat while increasing muscle
– Lowers LDL Cholesterol while Increasing HDL
– Decreases Cholesterol
– Is the best nutritional support option for metabolic Syndrome
Clinically Studied and Shown Successful
31
Low GI Metabolic Food with Plant Sterols, Acacia
and Hops far more effective than diet alone
Intervention TG TG/
HDL
Insulin ApoB/
Apo A1
LDL-C HDL-C BP CVD Risk
FLT plan with UltraMeal
Plus 360
-33% -39% -26% -15-30% -16-
28%
+7.0% -4.9%
(SBP)
-5.7%
(DBP)
5.6%
FLT plan alone -12% -14% -19% -4-6% -8-
11%
+2.2% -3.6%
(SBP)
-0.9%
(DBP)
2.9%
Key: Triglycerides (TG), Triglyceride: High Density Lipoprotein Cholesterol
Ratio (TG/HDL), Apo-lipoprotein B: Apo-lipoprotein A1 Ratio (ApoB/ApoA1),
Low density lipoprotein Cholesterol (LDL-C), High Density Lipoprotein
Cholesterol Ratio (HDL-C), Blood pressure (BP), Framingham 10 year
myocardial infarction risk (CVD Risk),.
Low GI Metabolic Food
with Plant Sterols, Acacia
and Hops
32
17
Practical PCOS Solutions
Insulin & Cortisol Balance
Nutrient Deficiencies
Hormonal dysregulation
33
34
Diagram from Nutri News 113: Nutritional Influences on Oestrogen Metabolism
34
18
35
Production
Reduce Oxidation
Metabolism
Receptors
Elimination
Diagram from Nutri News 113: Nutritional Influences on Oestrogen Metabolism
35
Hormonal Dysregulation
Metabolic Food
for Oestrogen
Metabolism
Powdered Myo-
inositol, vitamin
B6, Magnesium &
Calcium
36
19
Hormonal Dysregulation
Metabolic Food
for Oestrogen
Metabolism
Metabolic Food Clinical
Guide & Patient Guide
37
Metabolic Food for Healthy
Oestrogen MetabolismFeatures:
• Each serve contains 15 g of high-quality rice protein fortified with the amino acids threonine and lysine, resulting in a complete, high quality, and easily digestible vegetable protein.
• Specifically designed to support oestrogen metabolism, detoxification and elimination.
• Provides non-soy phytoestrogens from kudzu and flax, which modify the effects of circulating estrogens.
• Contains targeted nutrients such as folic acid, vitamin B6, iron, calcium, magnesium, chromium and iodine
• Can be enjoyed as a meal option and mixes easily with water or juice.
• Delicious Tropical Mango flavour.
Dose: 1-2 serves daily
38
20
Ingredients:
Each 3-scoop serving typically provides:
Potassium (as citrate) 350mg
Sodium 50mg
Vitamin A (as beta-carotene) (2132IU) 646µg RE*
Vitamin A (as retinyl palmitate) (1584IU) 480µg
Vitamin C (as ascorbic acid) 160mg
Vitamin D (as cholecalciferol) (100IU) 2.5µg
Vitamin E (as d-alpha tocopheryl succinate) (45IU) 30mg
Vitamin K (phytonadione) 40µg
Vitamin B1 (as thiamin HCl) 1.1mg
Vitamin B2 (as riboflavin) 1.4mg
Vitamin B3 (as niacinamide) 16mg
Vitamin B6 (as pyridoxine HCl) 2.8mg
Vitamin B12 (as cyanocobalamin) 2.5µg
Biotin 150µg
Folic acid 400µg
Pantothenic acid (as d-calcium pantothenate) 6mg
Phosphorous 513mg
Iron (as gluconate) 9mg
Calcium (as citrate) 300mg
Iodine (as potassium iodide) 75µg
Magnesium (as citrate and oxide) 240mg
Zinc (as citrate) 10mg
Selenium (as selenomethionine) 55µg
Copper (as gluconate) 1mg
Chromium (as picolinate) 80µg
Molybdenum (as sodium molybdate) 50µg
L-Lysine 17.5mg
L-Threonine 17.5mg
Isoflavones (from kudzu) 25mg
Flaxseed Extract 350mg
Choline (bitartrate) 450mg
N-Acetyl-Cysteine 100mg
Turmeric Extract (Curcuma longa) 210mg
Metabolic Food for Oestrogen
Guide for use
39
Hormonal Dysregulation
Powdered Myo-
inositol, vitamin
B6, Magnesium &
Calcium
Magnesium Technical Review
40
21
Myo-inositol restores hormonal
balance in women with PCOS
41
Myo-inositol restores ovulation
and improves pregnancy rates
42
22
And the rest…?
• Magnesium has been shown to improve
symptoms of PMS and hot flashes.
• Vitamin B6 has been shown to improve PMS
symptoms when used with magnesium.
• Manganese + Vitamin E may improve
dysmenorrhoea and other PMS symptoms,
physical and mental energy as well as cognitive
function.
43
Practical PCOS Solutions
Insulin & Cortisol Balance
Nutrient Deficiencies
Hormonal dysregulation
44
23
Diet and environment can disrupt
hormonal balance
• Obesity up-regulates conversion of androgens to oestrogens
via aromatase.
• Hyperinsulinaemia increases ovarian testosterone production
and reduces SHBG, increasing free oestrogen levels.
• Low antioxidant intake may promote the formation of 2-OH
and 4-OH oestrogens.
• High fat diets promote a high 16-OH: 2-OH ratio.
• Alcohol interferes with oestrogen detoxification, increasing
levels and breast cancer risk.
• Environmental toxins, hormones and antibiotics in the food
supply may disrupt hormonal balance.
Hyman MA. Altern Ther Health Med. 2007 May-Jun;13(3):10-4, 16.
45
Components for
Creating Healthy Cells
• Container: Good Fats
• Omega 3’s DHA/EPA (fish oils)
• Function: Amino Acids
• High quality lean protein
• Fuel: Glucose/Fructose
• Complex Carbs
• Efficiency: Cofactors
• Vitamins/Minerals
• Clean Water
46
24
Dietary Guidelines for PCOS
• Minimise sugar, simple carbs, alcohol, and
caffeine.
• Eat organic if possible, with emphasise on
brassica vegetables.
• Minimise xenoestrogen exposure.
47
Nutrient Deficiencies
Pure & Fresh
Omega-3 Fish Oil
Vitamin D
Powdered Myo-
inositol, vitamin
B6, Magnesium &
Calcium
48
25
Nutrient Deficiencies
Pure & Fresh
Omega-3 Fish Oil
Fish Oil Technical Review
49
Supplementation with n-3 PUFA
improves androgenic profiles in PCOS
A greater plasma n-6 PUFA concentration and n-6:n-3 PUFA ratio
were associated with higher circulating androgens in women
with PCOS. In addition, long chain n-3 PUFA supplementation
reduced plasma bioavailable testosterone concentrations (P ,
0.05), with the greatest reductions in subjects who exhibited
greater reductions in plasma n-6:n-3 PUFA ratios.
Am J Clin Nutr 2011;93:652–6250
26
Pure & Stable Omega-3 Fish OilPure
• Free from contaminants and superior purity to other fish oils.
Stable
• Patented Pufanox ensures stability and enhances clinical effectiveness.
Effective
• More than 100 articles have been published about the effect of Stable Fish Oil in scientific journals, based on 20 clinical studies and 15 experimental investigations.
Sustainable
• From one of the worlds most strictly enforced sustainable fisheries.
Quality
• Is a registered pharmaceutical in several countries and is produced according to GMP for pharmaceuticals.
Fish Oil Clinical Guide
51
Nutrient Deficiencies
Vitamin D
Vitamin D Technical Review
52
27
Clinical Endocrinology (2012) 77, 343–350
Lower vitamin D status is associated with:
• Insulin resistance
• Ovulatory & menstrual irregularities
• Lower pregnancy success
• Hirsutism
• Hyperandrogenism
• Obesity and elevated cardiovascular risk factors
Vitamin D Status & PCOS
67-85% of women with PCOS have levels of vitamin D
<50nmol/l. This low level of vitamin D may exacerbate
the disorder.
53
Correcting deficiency
Recommended Regime:
50,000 IU of vitamin D once a
week for 8 weeks (in most
patients blood levels of 25
(OH)D will rise on average by
100%)
Vitamin D Clinical Guide
54
28
Nutrient Deficiencies
Powdered Myo-
inositol, vitamin
B6, Magnesium &
Calcium
Magnesium Technical Review
55
Powdered Myo-Inositol, Vitamin B6,
Magnesium & Calcium
• Key uses: Polycystic ovarian syndrome (PCOS), Premenstrual
syndrome (PMS), menstrual migraines, infertility, Pregnancy,
Menopause.
• Folic acid have been well studied for PCOS and infertility
• Magnesium has been shown to improve symptoms of PMS
and hot flashes.
• Vitamin B6 has been shown to improve PMS symptoms when
used with magnesium.
• Manganese + Vitamin E may improve dysmenorrhoea and
other PMS symptoms, physical and mental energy as well as
cognitive function.
56
29
Magnesium + B6 Reduces Symptoms of
Premenstrual Syndrome M
ea
n c
ha
ng
e i
n S
ym
pto
ms
57
Practical PCOS Solutions
Insulin & Cortisol Balance
Nutrient Deficiencies
Hormonal dysregulation
58
30
Further ConsiderationsInsulin & Cortisol Balance
Nutrient Deficiencies
Thyroid Function
Detox Mechanisms
GI Health
4R Programme
Hormonal dysregulation
59
Ongoing wellness
programme
60
31
Premium One-A-Day Multivitamin/Mineral
Formula for Pregnancy
• Designed specifically for pregnancy, pre-conception and breastfeeding
• Provides higher levels of calcium and magnesium in a 2:1 ratio
• Features iodine at recommended levels for pregnancy and breast feeding
• Contains 25mg of zinc per tablet to prevent deficiency
• Provides 18mg of easily absorbed iron
• Provides 400 mcg of folic acid
• Free from vitamin A
61
Premium One-A-Day Multivitamin/Mineral
Formula for Women
• Provides 100mg of pomegranate extract for healthy skin and
general antioxidant support
• Features 100mg of broccoli and 10mg of di-indolylmethane
(DIM) to support hormone balance
• Contains 200mcg of iodine and extra selenium
to support reproductive and thyroid health
• Features 1000mcg of boron to support
bone health
62