Tuesday, January 28, 2014

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) effects from 12-21% of Australian women of reproductive age.[i] It is diagnosed by having 2 out of 3 of the following symptoms: irregular or absent ovulation, signs of excessive testosterone such as facial hair or acne, and polycystic ovaries.  The consequences of PCOS are reduced fertility, weight gain, irregular menstruation, insulin resistance (a pre-type II diabetic state in which cells do not respond to insulin leading to excess glucose in the blood) and increased risk of cardiovascular disease (CVD) and endometrial cancer.[ii]  There are other health problems that can seem similar so it is important to have appropriate testing done.  It is estimated that 70% of women with PCOS in Australia are undiagnosed. [iii] PCOS can have major health implications so if you have similar symptoms it is important to see your healthcare provider. Women with PCOS should have measurements taken for abdominal obesity, triglycerides, HDL, blood pressure, and glucose tolerance.

If you have been diagnosed with PCOS the biggest improvement can be seen with a 5-10% reduction in weight. This reduces insulin resistance as well as improving fertility and excess testosterone symptoms.  According to Australian guidelines, pharmaceutical fertility treatments should not be given to anyone with a BMI over 35 until weight is reduced because it is too big a health risk to mother and baby.[iv]  The best way to achieve weight loss is through diet modifications and exercise.  For advice on exercise please see my previous article.  A minimum of 150 minutes a week is needed to see results.  Even for women with PCOS who are not overweight exercise improves symptoms.

There are some supplements that can be helpful in improving symptoms.  Cinnamon can be taken as a supplement to help reduce fasting glucose and insulin resistance.  Berberine is a compound found in several plants and can be found in supplement form.  It has been shown to reduce insulin resistance, aid in weight loss, and improve lipid levels. Chromium and Magnesium can be helpful in reducing insulin resistance but will not help with the other symptoms of PCOS.  Inositol can also improve lipid levels, reduce CVD risk and improve fertility.

If you have PCOS and are planning on falling pregnant, it is important to improve the condition before conceiving.  Daughters of women with PCOS often have metabolic problems from infancy.[v]

If you have any questions about PCOS please see your local naturopath.



References

Some information for this article was taken from the following online presentation:
Villella S. Oligo and Amenorrhoea (unpublished lecture notes]. Health Masters Live, online; lecture given – 2013 Nov 14.



[i] Jean Hailes Foundation for Women’s Health. Evidence based guideline for the assessment and management of polycystic ovarian syndrome. Clayton South: Jean Hailes Foundation for Women’s Health; 2011. 130 p.

[ii] Barclay L. New Guidelines for Polycystic Ovary Syndrome (internet). Medscape Medical News; 2004 Jan 28. Available from: www.medscape.org/viewarticle/467811

[iii] Jean Hailes Foundation for Women’s Health. Evidence based guideline for the assessment and management of polycystic ovarian syndrome. Clayton South: Jean Hailes Foundation for Women’s Health; 2011. 130 p.

[iv] Jean Hailes Foundation for Women’s Health. Evidence based guideline for the assessment and management of polycystic ovarian syndrome. Clayton South: Jean Hailes Foundation for Women’s Health; 2011. 130 p.

[v] Barclay L. New Guidelines for Polycystic Ovary Syndrome (internet). Medscape Medical News; 2004 Jan 28. Available from: www.medscape.org/viewarticle/467811

Thursday, January 9, 2014

FAQs about Exercise

I talk about exercise in most of my articles as I believe it is one of the key factors to good health and long life.  The list of potential effects of exercise could take up most of my space but include improving cholesterol, blood pressure, diabetes, polycystic ovarian syndrome, depression, sleep apnoea, sleep, arthritis, immune health, and how you look and feel.  Most people know they should exercise but may be unsure about a few facts.  Here I will attempt to answer some of the more common questions about exercise in relation to weight loss.

How much do I need to do?   It has been found that doing at least 150 minutes of exercise in a week will have the best results for weight loss.  The duration is more important than the intensity.[i] This is because the longer you exercise the more fat you will burn.  The body stores carbohydrates in muscle as glycogen.  This muscle glycogen is used for energy in the first 20-30 minutes of exercise.  Between 30-50 minutes the body starts to use fat for energy.  At the transition point is when many people start to feel tired.  If you push through this feeling and do 50 minutes of moderate intensity exercise 3-4 times a week you will get the best results.

When should I exercise? Many people believe that exercising in the morning is the best time to get the best results.  Although this may bring slightly better results, time of day is less important than just getting out there. The best time is the time that fits into your schedule.

Should I eat before I exercise? The best results can be achieved with exercise on an empty stomach.  This will burn more fat, deposit more protein on the muscle and improve insulin sensitivity. [ii] Not everyone can exercise without eating first though.  If you feel lightheaded during exercise make sure you eat something first but just keep it small such as a piece of fruit.

Should I eat after exercise? Yes! This is the most important meal of the day. If you don’t eat then cortisol levels continue to rise leading to muscle breakdown, immune suppression and insulin resistance.  Your body also needs to replenish the glycogen it used so that you can exercise next time.  The best time to eat is within 30 minutes of exercising. [iii]

What should I eat after exercise? This is your chance to eat carbohydrates! Eat at a ratio of 3:1 carbohydrates to protein [iv] (this ratio is ONLY for post exercise).  Have some fruit or low GI grains with a good protein source.  Most protein powders will have a good ratio of protein to carbohydrates.

I’ve hit a plateau.  What do I do? As a person loses weight they need less energy to move around so they burn fewer calories.  If you have hit this point it means you need to step up your exercise.  You need to either exercise longer or increase the intensity.  Trying a different form of exercise can often be helpful too.


Many people are worried they may have gained weight over the holidays.  If you indulged a bit more than usual kick up the exercise level to compensate.  But remember that you don’t have to stop at every sausage sizzle you see.  If you have any questions about exercise talk to your local naturopath.  Make 2014 the year you get moving!

For those of you in the area, I will be practising in both Thirroul and Engadine starting in February. Check out my website for details: www.natactive.com.au





[i] Chambliss HO. Exercise duration and intensity in a weight loss program. Clin J Sports Med. 2005 Mar; 15 (2): 113-115.
[ii] [iii] [iv] Sutherland K. Nutrition & Fuelling for Exercise and Leanness (unpublished lecture notes]. Health Masters Live, online; lecture given – 2013 July 24.