PCOS: A Metabolic Puzzle for Women, Girls, and Future Generations

September 14, 2015 | Linda J. Dobberstein, Chiropractor, Board Certified in Clinical Nutrition

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PCOS: A Metabolic Puzzle for Women, Girls, and Future Generations
Polycystic ovary syndrome (PCOS) is the most common endocrine problem in women of child bearing age. It is even more common than the epidemic levels of thyroid dysfunction that our society is facing. As the number of women with PCOS is soaring, researchers have been working diligently to identify the various factors linked with this disorder.

What is PCOS?


PCOS is named for the growth of many small cysts on the ovaries. It often begins in teenage girls shortly after they have started their periods. It can also develop later in a woman’s life. Symptoms tend to be mild at first, but often progress. The most common symptoms are severe adolescent or adult onset acne, weight gain and trouble losing weight, irregular periods, prolonged periods with either light or heavy bleeding, and extra facial or chin hair, or hair on the chest, belly and back. There may be hair loss (male-pattern baldness), fertility problems, oily skin, small breast size, and depression. PCOS is the leading cause of infertility in women today.

PCOS is a syndrome that reflects a hormonal and metabolic disorder with widespread effects. Hormonal imbalances occur with excess androgens. Androgens are hormones like testosterone and androstenodione that both men and women have. Women have much smaller amounts than men. Androgens stimulate and control male characteristics. About fifty percent of androgens are produced in the ovaries (or testes for men) and adrenal glands. The other fifty percent is produced in body fat and skin from the conversion of DHEA and from the adrenal glands and androstenodione from the ovaries. The disorder is primarily due to excess androgens. There may be imbalances of other sex steroid hormones like excess estrogen relative to the amount of progesterone in the body. Work with your health care provider to measure these hormone balances for proper evaluation.

PCOS is correlated with many metabolic changes in the body. These include insulin resistance, impaired glucose tolerance, type 2 diabetes, obesity and cholesterol elevations. These issues are much more common in women of reproductive age with PCOS than in women of the same age without PCOS. Women who are normal body weight or lean may still have these metabolic changes, but obesity will worsen the picture.

PCOS, Heart Disease, and Endometrial Cancer


Research increasingly shows that there are serious concerns with very high risk for heart disease in women with PCOS. This means that heart attacks, atherosclerosis, high blood pressure, cholesterol imbalances, and heart disease are likely to be present in women with PCOS. Anxiety and depression are non-classic cardiovascular risk factors, but are often part of the PCOS complications and risk for heart disease. Research also shows an increased risk for blood clots, fatty liver disease, endothelial dysfunction or vascular disease, sleep apnea, higher levels of adipose tissue pro-inflammatory factors, and higher risk for cardiac disease and death. The focus on heart disease and women has been primarily in menopause, but certainly if PCOS is present during the teen years, twenties, and thirties, this adds a whole new layer of threat to women’s heart health much earlier in life.

In addition, new research shows that women with PCOS show an increased risk for endometrial or uterine cancer, particularly during the premenopause period as compared to women without PCOS.

PCOS and Hashimoto’s Thyroiditis


Thyroid disorders like Hashimoto’s thyroiditis are often closely related with PCOS. Individuals with PCOS are more likely to develop Hashimoto’s. These disorders share similar factors as related with a genetic predisposition and autoimmune inflammation. Researchers took blood samples of women with PCOS and found elevated lab levels of TSH (thyroid stimulating hormone), anti-TPO (thyroid antibody), anti-thyroglobulin antibodies, LH (luteinizing hormone) DHEA, and testosterone. In this test sample, women’s estradiol levels were also elevated and progesterone levels were low, showing an imbalanced estrogen/progesterone ratio.

Just like with the other metabolic changes and heart disease that correlate with PCOS, women with this syndrome must be evaluated for thyroid disorders. Often women think of a heavy irregular cycle and acne as a “normal” part of the monthly cycle. Hashimoto’s autoimmune thyroiditis is often silent until significant inflammation has destroyed the gland and the disease process is full blown. This type of inflammatory breakdown in the body often happens over several months to years to the point of gland failure. It’s like watching an ice cube melt in the middle of winter. If your family history reflects difficult menses, infertility and other symptoms of excess androgens and thyroid problems, don’t dismiss these symptoms. It’s a warning light indicating help is needed. It also means that regardless of the diagnosis, you need to reduce the inflammation and improve gut health, detoxification and nutritional support as outlined below.

Chronic Inflammation Drives PCOS


New information shows that chronic, low-grade inflammation linked with insulin resistance and excess androgens drives the development and pathology of PCOS. This inflammation is in part driven by the tone of the nervous system. Research published just a few weeks ago has demonstrated dysfunction of the sympathetic autonomic nervous system. This part of the nervous system is involved with the fight/flight adrenaline-type response regulating your internal organs. It is constantly active to maintain internal homeostasis at a basic level, but gets turned up with each grizzly bear stressor. This information is telling us that the high level of output and stressors facing teenage girls and women may in fact up-regulate the role of chronic inflammation driving the PCOS.

The chronic low-level inflammation negatively impacts the ovarian follicle (the basic function unit of the ovary. The inflammation impedes the development of the follicle and over time prevents ovulation from occurring. The inflammation becomes a larger factor when insulin resistance, obesity, and especially abdominal fat co-exist. The internal environment itself provokes more inflammation and perpetuates the cycle. The failure to ovulate can easily perpetuate the imbalance between estrogen and progesterone. High stress and chronic elevated cortisol steal away from progesterone production. Stress management and adaptogenic herbs help support homeostasis with the nervous system and hormone management.

Recent research shows that adolescent girls ages 14 to 19 with PCOS were more likely to have serious metabolic problems in young adulthood (ages 20 to 28). Just a mere decade later, problems with heart disease, metabolic syndrome and type 2 diabetes were substantially identified. Women who are in the prime of their life and ready to start a family should be at their healthiest level, but PCOS is fast becoming a major problem for millions of women across the world.

The medical approach to PCOS is the standard advice of losing weight, a healthy diet, and exercise. Women who smoke are advised to stop. Smoking was found to worsen facial hair growth, elevate testosterone levels and increase problems with insulin resistance. Birth control medications and blood sugar regulating meds like metformin and clomephen citrate are recommended for these metabolic concerns. There is much more to PCOS than this.

PCOS, Gene Studies, and Prenatal Health


In the world of gene studies and understanding fetal development, researchers recognize that PCOS may originate very early on in life, even during intrauterine life. This focus suggests that PCOS is genetically transmitted or is due to genetic alterations that occur during pregnancy from impaired nutritional status. Scientists have developed two hypotheses. One theory states that poor nutritional status of the mother may lead to lower insulin secretion and insulin resistance as a type of internal programming mechanism in the unborn child. In order to compensate for this later in life, insulin resistance occurs when there are abundant calories in adulthood. As a result of improper nourishment in the womb, certain genes that are related with methylation defects or detoxification become impaired. The ability to detoxify hormones is hampered, resulting in the imbalance of the sex steroid hormones and compounds the risk for insulin resistance.

Methylation Defects


Recent research expands on this theory of methylation defects triggered by insufficient, improper nutrition during prenatal life. If you have had your gene profile tested thru direct to consumer testing or a methylation genomics panel completed, check your results. Scientists newly confirmed that MTHFR gene C677T polymorphism is associated with PCOS. The genotype CT and TT increase the risk for PCOS. The genotype TT increases the risk of insulin resistance. The A1298C polymorphism of the MTHFR gene is not associated with PCOS.

It has been identified that nearly one out every two individuals have methylation gene defects. Nutrients that are required for methylation include folate, B6 as pyridoxal 5’-phosphate, B12 as methylcobalamin, choline, methionine, zinc, and B2 as riboflavin 5’-phosphate. These nutrients should be at optimal levels to prevent this gene dysfunction from occurring. A very high quality coenzyme B-complex or coenzyme multiple vitamin is the foundation for supporting healthy methylation. Also consume a diet rich in dark, green leafy vegetables that naturally contain methylated forms of these nutrients.

Mom’s Excess Androgens Triggers Imbalanced Hormones in Offspring


The second theory suggests that exposure to androgens in the uterus can set the stage for PCOS development in adult life. Other research is collaborating on this topic and indeed there are findings that correlate. Researchers have observed that mothers who have PCOS or high levels of androgens while they are pregnant are more likely to have female children who develop PCOS later in their life. One reason for this may be related to genetic polymorphisms or SNPs with the cytochrome p-450 aromatase gene, a gene involved with hormone detoxification. It may also be related with the methylation defect that compromises detoxification. In addition to this observation, it has been shown that exposure to androgen-like chemicals (Endocrine Disrupting Compounds) like Bisphenol A can lead to PCOS.

Men Are Affected Too


This research on fetal life exposure to the mother’s excess androgens and endocrine disrupting compounds also affects men. Male children of mothers with PCOS also have increased problems with impaired glucose tolerance, insulin resistance, type 2 diabetes, cholesterol or lipid imbalances, and pancreatic dysfunction later in life. The prevalence of these disorders in men (brothers) was similar to women (sisters) who had PCOS.

PCOS Linked with Leaky Gut Syndrome


In addition to the above factors, a research study in 2012 brought to light the strong likelihood that the low-level inflammation and insulin resistance starts in the gut with imbalanced gut bacteria. This view point suggested that breakdown and disturbances of healthy gut bacteria as a result of a poor diet created an increase in gut permeability, i.e. leaky gut syndrome. As a consequence of the broken down mucosal lining, it allows toxins called lipopolysaccharides or LPS to be released into circulation. LPS is a toxic by-product of non-beneficial bacteria. This toxin causes the immune system to activate, which then causes insulin receptor function to lose function. As a result, insulin levels rise which then triggers the ovaries to produce more androgens and interferes with normal ovarian follicle development.

Now in 2015, we see further identification and acknowledgement that increased gut permeability and disturbances in gut flora is fundamental to PCOS development and disease expression. The European Journal of Endocrinology released a case-controlled study involving 78 women recently diagnosed with PCOS. They measured a compound specific to increased gut permeability, serum zonulin. Compared to women who did not have PCOS and those who did, serum zonulin levels were significantly elevated. The lab marker also correlated with insulin resistance and menstrual difficulties. The greater the problem with intestinal permeability, the worse menstrual irregularities and blood sugar levels. The scientists recommended that serum zonulin be used as a test to measure the presence and progress of “leaky gut syndrome” and PCOS. Specialty labs that focus on gut health and autoimmune disorders provide this type of testing.

PCOS and Environmental Toxins


It is now estimated that PCOS affects 6 to 10 percent of all women of child-bearing age and the numbers are climbing. When the disorder was first described in 1935, the incidence was quite rare. Many believe the incidence is climbing because of the amount endocrine disrupting compounds in the environment. Worldwide environmental toxins found in air, food, and water drives this complicated domino effect. Two studies confirm the association of PCOS with environmental toxins including PCBs, pesticides, polycyclic aromatic hydrocarbons, and perfluorinated compounds (PFC’s). These toxins are found in plastics with bisphenol A (BPA), materials that resist fire damage and stains (Scotchguard), non-stick pans (Teflon), cleaning products, paints, water proofing materials, clothing, bedding, automotive, building/construction materials, electronics, and certain pesticides.

There is no doubt that these chemicals are a major cause of diabetes and obesity. Research is simply identifying that these toxic chemicals are linked with another disorder. Although Roundup and glyphosate have not yet been implicated with PCOS, we know that Roundup and glyphosate are gut microbiome disruptors and endocrine disrupting compounds. I suspect it won’t be too long before information comes forth.

Dietary Recommendations for PCOS


Recent research showed that a diet low in starch and low in dairy caused a reduction of PCOS problems. Women with PCOS adhered to the diet for 8 weeks and experienced a lower BMI with a weight loss of 15-24 pounds. Lab results also documented improved fasting insulin, and lowered androgen/testosterone levels.

Helpful Nutrients for PCOS


Several nutrients have been specifically shown to improve PCOS. These include N-acetyl cysteine, inositol, calcium, vitamin D and r-alpha lipoic acid. Women with PCOS and insulin resistance may benefit from the use of magnesium and chromium. If your progesterone levels are deficient through lab measurement, then consider natural progesterone support.

Check DHEA and Iron Levels


The adrenal steroid DHEA should be avoided unless there are specific lab tests that truly show insufficient DHEA. DHEA levels have been shown to be elevated with PCOS.Increased serum ferritin levels or elevated iron stores in the body may contribute to the development of insulin resistance and PCOS. This was independent of obesity, but was related to a gene mutation. Get your serum ferritin levels measured along with an iron panel to determine if iron is contributing to PCOS. It may seem counter intuitive to not need iron when menstrual cycles are heavy with PCOS, but the issue is far more complex than meets the eye.

Summary


PCOS is much more than problems with acne, facial hair growth, and irregular menstrual cycles. It reflects a metabolic conundrum. If you or your daughter have PCOS or there is a family history of PCOS, then the risk is high for obesity, insulin resistance, chronic inflammation, heart disease, endometrial cancer, Hashimoto’s thyroid problems and other autoimmune disorders. Teenage girls with stressful menstrual cycles may end up with significant health consequences decades later. A man also has a higher risk of metabolic problems and heart disease if his mother had PCOS during pregnancy.

Insulin resistance, elevated blood sugar and leptin resistance must be approached with good dietary habits. Follow the Five Rules of The Leptin Diet. Do the Ten-Day Detox; repeat as many times as you need. Remove the grains, starches, and dairy from your diet. Repopulate the beneficial bacteria in the gut with a high quality probiotic supplement. Remove as many sources of endocrine disrupting compounds from your environment and diet as possible.

Reduce stress, as cortisol and adrenaline worsen gut permeability. Consider herbal adaptogens to balance the stress load on the body. Work on reducing problems with “leaky gut syndrome” with nutrients like the omega oils DHA, GLA, along with probiotics, glutamine, vitamin D and noni. Support proper methylation with the coenzyme forms of B vitamins and methylated folate. Identify any problems with iron overload or hemochromatosis and is so avoid iron rich foods and iron supplements. If iron levels are low, then supplement with high quality iron supplements. Provide the necessary nutrients to help detoxify the hormonal imbalances like cruciferous vegetables, DIM and I3C and support healthy blood sugar function with magnesium and chromium. Like any syndrome, PCOS is a syndrome that affects multiple parts of the body and the health of your future children. Health requires diligence and commitment to give your body what it needs in order to restore balance. Start today with the Ten-Day Detox!

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