Polycystic ovary syndrome - beyond metformin and oral contraceptives
Polycystic ovary syndrome, or PCOS for short, has recently made its way into our media headlines, thanks to a candid Instagram post that Star Wars actress Daisy Ridley released earlier this month. In this post, she hinted at the difficulties of living with PCOS but more importantly about how some changes she made to her diet had a positive effect on her skin. This made me think that a blogpost is long overdue from me on the many ways in which women can help their symptoms of PCOS.
If you're undergoing a course of acupuncture or Chinese herbal medicine with me, you'll notice that I place a great deal of emphasis on things that you can do for yourself alongside our treatments. The integrated approach I take means that any advice I offer will always take into consideration what is currently going on with your conventional medical treatment, as well as the key areas of concern for you. Although metformin and oral contraceptives can be helpful for various symptoms of PCOS, not everyone responds to them and it's these people who I tend to see in my practice. For these girls and women with PCOS, the three most common pieces of advice I've been offering over the years are as follows:
1. Make cinnamon part of your diet
Cinnamon is used alongside other herbs in Chinese herbal medicine for various symptoms of PCOS, but it is probably one of the most well-researched herbal medicines for PCOS. Cinnamon is being increasingly investigated for its insulin-sensitising properties and a pilot study in the US suggested that an 8-week course of cinnamon resulted in significant reductions in insulin resistance compared to placebo (Wang 2007). I tend to recommend cinnamon for women who have difficulties with post-meal energy dips, sugar cravings or a tendency to gain weight. Take a teaspoon of cinnamon a day by adding it to porridge or to a stir-fry. Higher doses than this are considered medicinal and should be prescribed by a qualified herbalist, and additional care should be taken if you're already being prescribed an insulin-sensitiser such as metformin, or are taking blood-thinners. In these circumstances, speak to somebody who's registered with the Register for Chinese Herbal Medicine (RCHM) or the Association of Traditional Chinese Medicine (ATCM) and make sure your GP or endocrinologist is aware of any supplements you're currently taking.
2. Activity is an important ally in PCOS
Before you roll your eyes at this recommendation, take a moment to hear me out on this one! The reason why I find activity to be so important for women with PCOS is not just because of its effects on weight, but also because of its potential effects on the sympathetic nervous system (Straznicky 2011). The sympathetic nervous system regulates our fight our flight response in response to stress and also has important functions in regulating cardiac function and blood pressure. Current medical thinking and research suggests that the sympathetic nervous system could be working overtime in women with PCOS compared to those without the condition (Lansdown 2012, Li 2014). Chronic overactivity of the sympathetic nervous system has been associated with PCOS, as well as other conditions like cardiovascular disease and metabolic syndrome (Carmina 2013, Lansdown 2012). To my mind, anything that can address this imbalance has the potential to be of considerable benefit and increasing physical activity is one of the most effective ways to do this (Straznicky 2011). This is why physical activity matters in all women with PCOS, regardless of whether they are overweight or not. (Incidentally, effects on the sympathetic nervous system may also be one of the ways in which acupuncture can help with symptoms of PCOS but more on this in another post!). Increase physical activity gradually by finding opportunities in your daily life, such as going out for a walk at lunch, or taking the stairs instead of the escalators. However, you will need to work this up gradually to include activity that gets your heart rate going. If you're not (yet!) a sports enthusiast, try different exercises out - going with a friend or a partner can provide additional support or motivation, but use the time to find a pattern that works for you and that you're likely to keep to.
3. Find out if cutting down on diary is right for you
Dairy gets a lot of stick and I'm not sure it deserves it entirely. Whether or not to cut out diary depends on many factors, including how you feel symptomatically after having dairy, what kind of dairy you tend to take in, and what your other sources of protein or calcium may be. The link between dairy and inflammation has additionally been of significant interest to the PCOS community partly because of the potential role of inflammation in PCOS (Duleba 2012). Although some studies suggest that dairy may be pro-inflammatory, other studies have contradicted this and my take on this is that the evidence isn't yet clear cut, not least because measuring inflammation is a pretty trick process in itself, but also because the relationship between inflammation and disease processes is far from linear (Rajaeieh 2014, O Markey 2014, Pasin 2015, Kalergis 2013). As Daisy Ridley has reported though, limiting dairy can been helpful for some of women. If you're interested in seeing how this goes for your own symptoms, my advice would be to start off by cutting down firstly on cheese, butter, ice-cream and cream-based foods and sauces for around 4 weeks. These heavier dairy products can be the key culprits for some women. During these 4 weeks, you can keep having milk and yoghurt but stick to organic where possible.
I never thought I'd be quoting from Daisy Ridley in my blogposts, but her final remark in her Instagram post beautifully sums up the core approach that we always use in acupuncture and Chinese medicine:
'From your head to the tips of your toes we only have one body, let us all make sure ours our (sic) working in tip top condition.'
References
RIDLEY, D. 2016. https://www.instagram.com/p/BGcShMNlE7m/?taken-by=daisyridley&hl=en.
CARMINA, E. 2013. Obesity, adipokines and metabolic syndrome in polycystic ovary syndrome. Front Horm Res, 40, 40-50.
DULEBA, A. J. & DOKRAS, A. 2012. Is PCOS an inflammatory process? Fertil Steril, 97, 7-12.
KALERGIS, M., LEUNG YINKO, S. S. & NEDELCU, R. 2013. Dairy products and prevention of type 2 diabetes: implications for research and practice. Front Endocrinol (Lausanne), 4, 90.
LANSDOWN, A. & REES, D. A. 2012. The sympathetic nervous system in polycystic ovary syndrome: a novel therapeutic target? Clin Endocrinol (Oxf), 77, 791-801.
LI, W., CHEN, Y. & XU, L. 2014. Association of sympathetic nervous system activity with polycystic ovarian syndrome. Clin Exp Obstet Gynecol, 41, 499-506.
MARKEY, O., VASILOPOULOU, D., GIVENS, D. I. & LOVEGROVE, J. A. 2014. Dairy and cardiovascular health: Friend or foe? Nutr Bull, 39, 161-171.
MARTINO, E. A., WINTERTON, D., NARDELLI, P., PASIN, L., CALABRO, M. G., BOVE, T., FANELLI, G., ZANGRILLO, A. & LANDONI, G. 2016. The Blue Coma: The Role of Methylene Blue in Unexplained Coma After Cardiac Surgery. J Cardiothorac Vasc Anesth, 30, 423-7.
PASIN, G. & COMERFORD, K. B. 2015. Dairy foods and dairy proteins in the management of type 2 diabetes: a systematic review of the clinical evidence. Adv Nutr, 6, 245-59.
RAJAEIEH, G., MARASI, M., SHAHSHAHAN, Z., HASSANBEIGI, F. & SAFAVI, S. M. 2014. The Relationship between Intake of Dairy Products and Polycystic Ovary Syndrome in Women Who Referred to Isfahan University of Medical Science Clinics in 2013. Int J Prev Med, 5, 687-94.
STRAZNICKY, N. E., GRIMA, M. T., EIKELIS, N., NESTEL, P. J., DAWOOD, T., SCHLAICH, M. P., CHOPRA, R., MASUO, K., ESLER, M. D., SARI, C. I., LAMBERT, G. W. & LAMBERT, E. A. 2011. The effects of weight loss versus weight loss maintenance on sympathetic nervous system activity and metabolic syndrome components. J Clin Endocrinol Metab, 96, E503-8.