What is Polycystic Ovary Syndrome?

Polycystic (literally, many cysts) ovary syndrome (PCOS or PCO) is a complex condition, characterise by hormonal imbalances that affects the ovaries (the organs in a woman’s body that produce eggs). In PCOS, the ovaries are generally bigger than average. The outer surface of the ovary has an abnormally large number of small follicles (the sac of fluid that grows around the egg under the influence of stimulating hormones from the brain).The ovaries are polycystic, with many small follicles scattered under the surface of the ovary (usually more than 10 or 15 in each ovary) and almost none in the middle of the ovary. In PCOS, these follicles remain immature, never growing to full development or ovulating to produce an egg capable of being fertilised.

This means that ovulation (releasing an egg) may rarely occur and can therefore lead to reduced fertility. In addition, periods may be irregular or absent. Other features include excess weight and body hair.

What are the symptoms of Polycystic Ovary Syndrome?

Symptoms that occur if you do not ovulate

• Absent, irregular or light periods- periods can be as frequent as every five to six weeks, but might only occur once or twice a year, if at all
• Fertility problems – you need to ovulate to become pregnant. You may not ovulate each month, and some women with PCOS do not ovulate at all. PCOS is one of the most common causes of infertility.

Symptoms that can occur if you make too much testosterone (male hormone)

• increased facial and body hair (hirsutism): usually found under the chin, on the upper lip, forearms, lower legs and on the abdomen (usually a vertical line of hair up to the umbilicus) .This is the only symptom in some cases.
• Acne: which may persist beyond the normal teenage years.
• Thinning of scalp hair (similar to male pattern baldness) occurs in some cases .

Other symptoms

• Being overweight or obese: a common finding in women with PCOS because their body cells are resistant to the sugar-control hormone insulin. This insulin resistance prevents cells using sugar in the blood normally and the sugar is stored as fat instead
• Miscarriage (sometimes recurrent): one of the hormonal abnormalities in PCOS, a raised level of luteinising hormone (LH – a hormone produced by the brain that affects ovary function), seems to be linked with miscarriage. Women with raised LH have a higher miscarriage rate (65 per cent of pregnancies end in miscarriage) compared with those who have normal LH values (around 12 per cent miscarriage rate).

• Depression or poor self-esteem may develop as a result of the other symptoms.

Diagnosis

At least two of the following occur in PCOS, and often all three:

• At least 12 follicles (tiny cysts) develop in your ovaries.
• The balance of hormones that you make in the ovaries is altered. In particular, your ovaries make more testosterone (male hormone) than normal. The main hormones that are made in the ovaries are oestrogen and progesterone – the main female hormones, but the ovaries also normally make small amounts of male hormones (androgens) such as testosterone.
• You do not ovulate each month. Some women do not ovulate at all. In PCOS, although the ovaries usually have many follicles, they do not develop fully and so ovulation often does not occur. If you do not ovulate then you do not have a period.

Therefore, it is possible to have polycystic ovaries without the typical symptoms that are in the syndrome. It is also possible to have PCOS without multiple cysts in the ovary.

Incidence

PCOS is relatively common among infertile women. If affects up to 10 per cent of all women between the ages of 15 and 50. In the general population, around 25 per cent of women will have polycystic ovaries seen on an ultrasound examination. But most have no other symptoms or signs of PCOS and have no health problems. The ultrasound appearance is also found in up to 14 per cent of women on the oral contraceptive pill.

What causes polycystic ovary syndrome?

The exact cause is not totally clear. Several factors probably play a part. These include the following:

1. A small increase in the amount of insulin and cellular resistance to its actions- insulin is a hormone that you make in your pancreas and its main role is to control your blood sugar level. Insulin acts mainly on fat and muscle cells to stimulate them to take in sugar (glucose) when your blood sugar level rises (as excess levels are toxic to cells). Insulin also stimulates the ovaries to produce testosterone (male hormone).

Women with PCOS have what is called insulin resistance, meaning that cells in the body are resistant to the effect of a normal level of insulin. Thus, more insulin is produced to keep the blood sugar normal.  Raised levels of insulin in the bloodstream are thought to be the main underlying reason why PCOS develops because this causes the ovaries to make too much testosterone. A high level of insulin and testosterone interfere with the normal development of follicles in the ovaries. As a result, many follicles tend to develop but often do not develop fully. This causes problems with ovulation: hence period problems and reduced fertility. Increased testosterone levels in the blood cause excess hair growth on the body and thinning of the scalp hair.
2. Raised luteinising hormone (LH) in the early part of the menstrual cycle- This hormone is made in the pituitary gland and stimulates the ovaries to ovulate and works alongside insulin to promote testosterone production. A high level of LH is found in about 4 in 10 women with PCOS. A high LH level combined with a high insulin level means that the ovaries are likely to produce too much testosterone.

3. Lower amounts of the blood protein that binds to and carries all sex hormones (called sex-hormone-binding globulin)- this  means that testosterone levels are higher and therefore more active. Sex-hormone-binding globulin levels are reduced in insulin resistance (meaning there are high insulin levels).

4. Hereditary factors- one or more genes may make you more prone to developing PCOS. PCOS is not strictly inherited from parents to children, but it may run in some families.

5. Weight- Being overweight or obese is not the underlying cause of PCOS. However, if you are overweight or obese, excess fat can make insulin resistance worse, a contributing factor to PCOS. This may then cause the level of insulin to not only rise even further, but high levels of insulin can contribute to further weight gain, producing a ‘vicious cycle’.

Risk factors for PCOS

• a tendency in the family towards Type 2 diabetes (non-insulin dependent diabetes)
• a close relative who already has PCOS
• a tendency towards early baldness in the men in the family (before 30 years of age).

Nutritional and lifestyle approaches to PCOS

Research has shown that weight control improves many aspects of PCOS. Menstrual cycles become more regular, testosterone levels are reduced, fat and sugar metabolism improves, and spontaneous pregnancy may follow. Obese patients do not have to reach the normal body mass index; a weight reduction of even a few percent has clinical benefits. This is because visceral fat (intra-abdominal fat located inside the abdominal cavity, packed between the organs) is metabolically more hormonally active, and weight loss of a few percent is associated with significant loss of visceral fat.

Weight management through nutrition and exercise is now recommended to all overweight/obese women with PCOS (Kovacs 2006).

So, here are some tips to help reduce the hormonal imbalances associated with PCOS:

1. Research has shown that fat intake should be restricted to not more than 30% of total calories with a low proportion of saturated fat, which is found mostly in animal products such as meat and dairy. Healthy fats such as olive oil, nuts/seeds, avocados, and fish oil, and avocado are important parts of a PCOS–friendly diet however (Farshchi et al 2007).

2. Choose whole grain carbohydrates. The insulin level in your blood goes up after you eat. It increase the most after you eat or drink something that contains carbohydrates. Carbohydrates are found in grains (such as bread, pasta, rice, cereal, and potatoes), vegetables, fruits and drinks such as soda and juice. Even if you eat two foods that have the same amount of carbohydrate, they may have a different effect on your insulin level. This effect has a lot to do with the type of carbohydrate the food has.

Whole grain carbohydrates which contain fibre such as brown rice, whole wheat bread and pasta, oats, barley, etc. have a low Glycaemic Index (GI). GI is a term used to describe how a food affects blood sugar; the higher a food raises blood sugar, the higher the glycaemic index. The benefit of consuming low GI foods is that it helps keep your insulin level down, and also keeps hunger at bay for longer, thus aiding weight management. Sugary foods or refined grains (such as white bread, white rice and white pasta) on the other hand have a high GI and can cause insulin levels to go up and are also not very filling (which means you may feel hungry again shortly after eating them.

3. Always have some protein with each meal or snack- combining a carbohydrate food with protein lowers the GI because protein slows the release of sugar from foods into the bloodstream. This helps reduce blood sugar spikes and therefore helps prevent high insulin levels. Protein can be found in lean meats, fish, poultry, dairy products, tofu, eggs, beans, nuts and seeds. Try to consume plenty of plant proteins which are often high in fibre and low in fat, rather than just sticking to animal proteins.

4. Have balanced meals containing carbohydrates, protein, and fat - combining foods that contain protein or fat with a carbohydrate will help to slow down the absorption of the carbohydrate and keep insulin levels low. For example, have almond butter or hummus on bread rather than just a piece of bread by itself. A typical plate of food should consist of ¼ carbohydrates, ¼ protein and the remaining ½ plate of vegetables!

5. Have smaller, more frequent meals (every 3-4 hours) to help control blood glucose levels. Your insulin will go up much more if you have 3 cups of pasta than if you have 1 cup of pasta. This means it’s usually better to have small meals and snacks during the day than it is to have fewer really big meals to keep your insulin level lower.

6. Exercise- Research has shown that at least 150 minutes of moderate or vigorous activity per week for diabetes prevention. This is because exercise helps  your cells become more receptive to the effects of insulin which in turn helps lower insulin levels (Knowler et al 2002).

7. Supplements- there are a number of supplements which can be very helpful to rebalance hormones. Recommendations are based on your individual health profile and are discussed at your visit.

References

Cahill D (2010) Polycystic ovary syndrome (PCOS) last accessed 21.3.2013 online at http://www.netdoctor.co.uk/womenshealth/facts/pcos.htm

Farshchi H Rane A Love A Kennedy RL (2007) Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management.  J Obstet Gynaecol 27 8 762-73

Kenny T (2010) Polycystic Ovary Syndrome last accessed 21.3.2013 online at http://www.patient.co.uk/health/Polycystic-Ovary-Syndrome.htm

Knowler WC Barrett-Connor E Fowler SE et al (2002) Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346 393-403

Kovacs P (2006) Viewpoint: Lifestyle Modification is First-Line Treatment for PCOS last accessed 21.3.2013 online at http://www.medscape.com/viewarticle/522390

By London Nutritionist Sylvia Hensher

Introduction

Brian Wansink from Cornell University has spent much of his scientific career trying to understand what influences our food choices. His conclusion is that most of us are unaware of what influences how much we eat. We all think we’re too smart to be tricked by packages, lighting or the size of plates. We might acknowledge that others can be tricked, but not us. Yet every single one of us is influenced by what’s around us when it comes to deciding what and when we will eat.

In other words, we over-eat not because of hunger, but because of family and friends, packages and plates, names and numbers, labels and lights, colours, shapes and smells, cupboards and containers.

Read on to hear about his fascinating findings from decades of research into behaviour and eating patterns.

Brian Wansink on how to lose weight without thinking about it

The average person makes well over 200 decisions about food every day. Breakfast or no breakfast? Bread, bun or bagel? Part or all of it?

Every time we pass a dish of sweets or open up our desk drawer and see a piece of chewing gum, we make a food decision. Yet we can’t really explain most of these 200-plus decisions. Most of us are blissfully unaware of what influences how much we eat. Because although you can eat too much without knowing it, you can also eat less. Because, let’s face it, the best diet is the one you don’t know you’re on…

Strategy 1- Remove The Mindless Margin

Just ten extra calories a day – one stick of gum or three jelly beans – will make you a pound heavier in a year. And 140 calories a day – or one can of soft drink – will make you put on a stone. And you won’t even notice.

Fortunately, the same thing happens in the opposite direction. This is known as the mindless margin: those few extra calories that you can consume – or not consume – every day that you really don’t notice. By cutting out 100 to 200 calories a day, you can lose weight. That can mean not having one of your daily Starbucks. Or not tucking into a packet of crisps when you get in from work.

Cutting out your favourite foods entirely, however, is a bad idea: you’ll just feel deprived. Cutting down on how much you eat of them, on the other hand, is mindlessly do-able.

Simply dish out 20 per cent less than you think you will want before you start to eat. You probably won’t miss it. For fruit and vegetables, though, think 20 per cent more. If you cut down the pasta you eat by 20 per cent, increase the veggies by 20 per cent.

Strategy 2- See All You Eat

When people put their food on a plate, they eat about 14 per cent less. So instead of eating directly out of a package or box, put everything you want to eat on a plate before you start eating – whether it’s a snack, dinner, ice cream or even crisps. Leave the packaging in the kitchen and eat elsewhere. You’ll also eat less if you are able to see what you’ve already eaten.

Strategy 3- Be Your Own Tablescaper

(more…)

Copyright secured by Digiprove © 2011 Sylvia Hensher

by London Nutritionist Sylvia Hensher

There is a connection between our adrenal glands, thyroid glands and weight gain. When these two glands are not kept in a healthy state, the result can often be weight gain. The good news is that on the other hand, if these two glands are supported through proper nutrition and a healthy lifestyle, it can lead to a natural weight loss.

What our adrenal glands do

The adrenal and thyroid glands are very closely connected in how they enable the body to function properly. The adrenals are small triangular shaped glands that sit on top of both kidneys. They are responsible for releasing the hormones adrenaline and cortisol which among other functions, help control body fluid balance, blood pressure, blood sugar and are designed to help the body deal with physical and psychological stress. In addition, the adrenal glands produce small amounts of oestrogen when women enter into menopause and the ovaries reduce their oestrogen output. This is why it’s so important to maintain adrenal function in the menopause years.

Adrenal Fatigue

Adrenal Fatigue is a collection of signs and symptoms, known as a “syndrome” that results when the adrenal glands function below the necessary level.  This happens most often when you are exposed to constant , uninterrupted stress so that your body (and adrenal glands) cannot fully recover, or during or after acute or chronic infections. Consequently, the adrenal glands become fatigued and are unable to continue responding adequately to further stress.

You may look and act relatively normal with adrenal fatigue and may not even have any obvious signs of physical illness, yet you live with a general sense of feeling unwell, tiredness or “grey” feelings. People suffering from Adrenal Fatigue often have to use coffee, tea and other stimulants to get going in the morning and to prop themselves up during the day.

Some Manifestations Of Adrenal Fatigue: (more…)

Copyright secured by Digiprove © 2011 Sylvia Hensher

By London Nutritionist Sylvia Hensher

Different Types Of Food Reactions

Type 1 Immune Reactions

The best known and well-studied form of food allergies is called a Type 1 immune reaction, also known as a classical food allergy. Type 1 food allergies occur in approximately only 2-5% of the population, mostly in children and are less frequent in adults.  The reaction is immediate, usually appearing 15 – 30 minutes from the time of exposure to the offending food substance. Usually occurring in people who are genetically predisposed, the immune system begins creating a specific type of antibody called Immunoglobulin E (IgE) to certain foods. One side of the IgE antibody will recognise and bind to the allergic food.  The other side of the antibody is attached to a specialised immune cell called a mast cell which is packed with histamine. Histamine is one of the chemicals that is released in the body as part of an allergic reaction, and which causes the itching, sneezing, wheezing, and swelling typical of allergic symptoms.  Primed for action, the IgE antibody now patiently waits for re-exposure to food allergens.

So, when you eat the allergic food the next time, IgE antibodies hungrily latch onto the food.  Instantaneously, histamine and other allergy-related chemicals are released from the mast cell, quickly bringing on the unwelcome symptoms of stomach cramping, diarrhoea, skin rashes, hives, swelling, wheezing or the most dreaded of all Type 1 reactions, anaphylaxis. Anaphylaxis is a severe, potentially life-threatening allergic reaction which causes your blood pressure to drop suddenly and your airways to narrow, blocking normal breathing. It requires immediate emergency medical attention.

Clinical approach: In Type 1 food reactions, offending foods are completely avoided and nutritional immune and digestive support provided.

Type 3 immune reactions

Type 3 immune reactions are much more commonly involved in food sensitivities than Type 1 reactions.  In fact, 45-60% of the population has been reported as having delayed food allergies.  A delayed food sensitivity also involves the immune system and occurs when your immune system creates an overabundance of antibody Immunoglobulin G (IgG) to a specific food.  The IgG antibodies, instead of attaching to Mast cells, like IgE antibodies in Type 1 allergies, bind directly to the food as it enters the bloodstream, forming food allergens bound to antibodies circulating in the bloodstream.  The allergic symptoms in Type 3 immune reactions are delayed in onset – appearing anywhere from a couple of hours to several days after consuming allergic foods.  This delayed onset makes pinpointing the culprit food difficult. In this instance, laboratory testing may be useful.

Delayed food reactions may occur in any organ or tissue in the body and have been linked to over 100 allergic symptoms and well over 150 different medical diseases.

Clinical approach: In Type 3 immune reactions, it is important to identify food triggers, either through food exclusion tests or laboratory testing (more on this below).Depending on the symptoms,  these foods are then excluded for a period of time, and then reintroduced on a rotational diet to avoid retriggering symptoms. In addition, nutritional immune and digestive support is provided.

Why Has the Incidence of Food Sensitivities Risen? (more…)

Copyright secured by Digiprove © 2011 Sylvia Hensher

PART 2

by London nutritionist Sylvia Hensher

Hi again! In part 1 of this series on the thyroid we talked about what the thyroid is, how it might be affecting your weight, symptoms of an underactive thyroid and a simple test you can do at home to give you an indication, but no firm diagnosis, as to how well your thyroid is functioning.

In this 2^nd part of the series, we’ll look at how you can support optimal thyroid functioning, and therefore optimal weight management, through nutrition.

Foods to help support optimal thyroid functioning

1. Iodine is required to manufacture the thyroid hormones. Without sufficient iodine, your thyroid cannot produce adequate thyroid hormones to help your body function on an optimal level. Seafoods, iodised salt and sea vegetables such as kelp, as well as foods grown in iodine rich soil, are rich sources of iodine. It should be noted, however, that too much iodine can actually trigger thyroid problems and worsen symptoms, so it’s important to have a healthy balance.

2.       Zinc is another essential mineral for optimising thyroid health.

3.      Selenium: This mineral is critical for the proper functioning of your thyroid gland, and is used to produce and regulate the active T3 hormone. Selenium can be found in foods such as shrimp, snapper, tuna, cod, halibut, calf’s liver, button and shitake mushrooms and Brazil nuts.

4.      Zinc, Iron and Copper are needed in trace amounts for your healthy thyroid function. Low levels of zinc have been linked to low levels of TSH, whereas iron deficiency has been linked to decreased thyroid efficiency. Copper is also necessary for the production of thyroid hormones. Seafood, whole grains, green leafy vegetables, nuts and seeds can help provide these trace metals in your diet.

5.      B vitamins help to manufacture thyroid hormones and play an important role in healthy thyroid function. They are found in whole grains, pulses and green leafy vegetables. (more…)

Copyright secured by Digiprove © 2011 Sylvia Hensher

Part 1

By London nutritionist Sylvia Hensher

Have you tried every diet known to man, really watch what and how much you eat, exercise regularly and find that you STILL CAN’T LOSE THE WEIGHT???!! Well, here’s some good news. Research is pointing to the fact that an underactive thyroid might be the number one cause of weight problems, especially among women.

So what is the thyroid and how might it be affecting your weight? Well, the thyroid gland is a small butterfly shaped gland with two lobes found just in front of your neck below the Adams Apple. One of its main functions is to control metabolism- that is, the rate at which we burn calories to maintain vital functions. Our bodies need fuel just as a car needs fuel to power itself, so whether we are sleeping, shopping or exercising, we are constantly burning calories.

Now, your thyroid gland produces two main hormones. One is called thyroxine (T4) and the other is called triiodothyronine (T3). The thyroid produces approximately 80% T4 and 20% T3. T4 is generally considered to be inactive and only becomes active when converted to T3, although some researchers believe that T4 does, in fact, have a function. T3 is an active hormone needed by all of the cells and tissues of the body and is the one which does all the work of regulating the body’s metabolism.

Thyroid problems often run in families and can happen at any age. Things can go wrong with the thyroid in two ways:

Hyperthyroidism, also called an overactive thyroid where the thyroid produces more thyroid hormone than it should which causes the metabolism to run too fast.

Hypothyroidism, also called an underactive thyroid where the thyroid doesn’t produce enough thyroid hormone which causes our metabolism to work too slowly.

What are the symptoms Of An Underactive Thyroid (Hypothyroidism) (more…)

Copyright secured by Digiprove © 2011 Sylvia Hensher

By London nutritionist Sylvia Hensher

1. Nutrition-the danger of insulin resistance

If you want to lose weight it’s very important to eliminate obvious sugar from your diet. We’re not just talking about obvious forms found in desserts and processed foods, but also to reduce our consumption of hidden ones in foods most of us consider to be healthy. Hidden sugars are also found in carbohydrates such as grains which break down to simple sugars and can contribute to insulin resistance. What is insulin resistance you may ask? Well, the cells in our body need a continuous supply of glucose (or sugar) for their energy requirements. Glucose, however, cannot penetrate the outer membrane of a cell without the assistance of insulin, a hormone which acts as a gatekeeper, allowing glucose to enter cells. Insulin stimulates the body to convert excess glucose (or sugar) which our cells don’t need (i.e. think too much chocolate etc) into fat and then helps to block the breakdown of this stored fat for energy production, making weight loss difficult.

For various biochemical reasons, the body may become less sensitive to its own insulin and compensates by producing more. Higher insulin levels not only make your body store even more fat, it also makes it more difficult to lose weight by blocking the release of fat from the fat cells so it can be burned for fuel. This explains why so many people have problems losing weight.

2. Exercise- high-intensity interval training & weight lifting

High-intensity interval training done 2-3 times weekly can boost your metabolism and increase fat loss, but is also a potent “anti-aging” strategy, as it will naturally increase your body’s production of human growth hormone (HGH).HGH promotes muscle, effectively burns fat and plays an important role in promoting overall health/longevity.

Weight lifting is another essential part of a programme for kick-starting your metabolism. Having more muscle is one of the best ways of burning fat you will ever come across because it helps you burn more calories, without you having to actually “do” more.

This is because muscle is metabolically very active and requires energy just to sit on your frame – even when you sleep. For every pound of muscle that you gain, your body will burn approximately 50-70 calories more per day, and burning more calories leads to a reduction of excess fat.

3.  Are you getting enough sleep? (more…)

Copyright secured by Digiprove © 2011 Sylvia Hensher