Practical PCOS Solutions - The Nutrition Network · Insulin resistance & PCOS • Most women with PCOS are metabolically insulin resistant, in part due to genetic predisposition and

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Practical PCOS Solutions

A practical lesson in how to support

patients with PCOS and infertility

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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

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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

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• 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?

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Polycystic Ovaries

• Multiple cyst formation on the ovaries

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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

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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

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What should I

do?

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Insulin & Cortisol Balance

Nutrient Deficiencies

Hormonal dysregulation

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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


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Milk Protein

Hydrolysate &

Theanine

Powdered Myo-

inositol, vitamin

B6, Magnesium &

Calcium

Low GI Metabolic

Food

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Milk Protein

Hydrolysate &

Theanine

Milk Protein Hydrolysate & Theanine Technical Review

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Milk Protein Hydrolysate (Lactium®)

and Theanine

Each tablet provides:

L-Theanine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 mg

Milk Protein Hydrolysate (Lactium®) . . . . . . . . . . . 150 mg

Dose: 1-2 capsules daily

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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).

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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.

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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

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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

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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

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Powdered Myo-

inositol, vitamin

B6, Magnesium &

Calcium

Magnesium Technical Review

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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.


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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.

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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

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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


Magnesium & Calcium

Magnesium Clinical Guide

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Low GI Metabolic

Food

Metabolic Food Clinical

Guide & Patient Guide

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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

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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

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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

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Diagram from Nutri News 113: Nutritional Influences on Oestrogen Metabolism

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Production

Reduce Oxidation

Metabolism

Receptors

Elimination

Diagram from Nutri News 113: Nutritional Influences on Oestrogen Metabolism

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Hormonal Dysregulation

Metabolic Food

for Oestrogen

Metabolism

Powdered Myo-

inositol, vitamin

B6, Magnesium &

Calcium

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Metabolic Food

for Oestrogen

Metabolism

Metabolic Food Clinical

Guide & Patient Guide

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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

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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

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Powdered Myo-

inositol, vitamin

B6, Magnesium &

Calcium


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Myo-inositol restores hormonal

balance in women with PCOS

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Myo-inositol restores ovulation

and improves pregnancy rates

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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.

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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.

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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

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Dietary Guidelines for PCOS

• Minimise sugar, simple carbs, alcohol, and

caffeine.

• Eat organic if possible, with emphasise on

brassica vegetables.

• Minimise xenoestrogen exposure.

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Pure & Fresh

Omega-3 Fish Oil

Vitamin D

Powdered Myo-

inositol, vitamin

B6, Magnesium &

Calcium

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Pure & Fresh

Omega-3 Fish Oil

Fish Oil Technical Review

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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

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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

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Vitamin D

Vitamin D Technical Review

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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.

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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

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Powdered Myo-

inositol, vitamin

B6, Magnesium &

Calcium


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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.

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Magnesium + B6 Reduces Symptoms of

Premenstrual Syndrome M

ea

n c

ha

ng

e i

n S

ym

pto

ms

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Further ConsiderationsInsulin & Cortisol Balance


Thyroid Function

Detox Mechanisms

GI Health

4R Programme


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Ongoing wellness

programme

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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

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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

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Documents

Practical PCOS Solutions - The Nutrition Network · Insulin resistance & PCOS • Most women with PCOS are metabolically insulin resistant, in part due to genetic predisposition and