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Those with PCOS can benefit from Lo Carb Diet

Reprinted from the University of Chicago Center for Polycystic Ovarian Syndrome

Polycystic ovary syndrome is an endocrine (hormonal) disorder. Most often, symptoms first appear in adolescence, around the start of menstruation. However, some women do not develop symptoms until their early to mid-20's. Although PCOS presents early in life, it persists through and beyond the reproductive years.

PCOS is estimated to affect between 5% and 10% of women of reproductive age, thus making it the most common hormonal disorder among women in this age group.  It affects women of all races and nationalities.

No two women have exactly the same symptoms. The following characteristics are very often associated with PCOS, but not all are seen in every woman:

    • Hirsutism (excessive hair growth on the face, chest, abdomen, etc.)
    • Hair loss (androgenic alopecia, in a classic "male baldness" pattern)
    • Acne
    • Polycystic ovaries
    • Obesity
    • Infertility or reduced fertility

In addition, women with PCOS appear to be at increased risk of developing the following health problems during their lives:

    • Insulin resistance
    • Diabetes
    • Lipid abnormalities
    • Cardiovascular disease
    • Endometrial carcinoma (cancer)

Because there is such variability in how PCOS presents itself, there is not universal agreement among health professionals on how to best define PCOS.  What is clear, however, is that women with the disorder do not ovulate in a predictable manner and that women with PCOS also produce excessive quantities of androgens (particularly testosterone).  

It is important to note that polycystic ovaries are not present in all women diagnosed with PCOS.  Also, many women with regular menstrual periods and normal testosterone levels  have cystic ovaries.

If women with PCOS don't always have polycystic ovaries, why is it called "polycystic ovary syndrome"?
It is important to make the distinction between polycystic ovaries and polycystic ovary syndrome. Polycystic ovaries are often, but not always, seen in women with PCOS. But, approximately 20% of women without menstrual or hormonal abnormalities have polycystic ovaries.  The syndrome is thus defined by the menstrual and hormonal abnormalities with or without polycystic ovaries.

PCOS is also sometimes called "functional ovarian hyperandrogenism" or "ovarian androgen excess." But, because the term "polycystic ovary syndrome" has been used for more than six decades, and is well-entrenched in both common usage and medical literature, its use is likely to continue.  

What causes PCOS?
PCOS develops when the ovaries overproduce androgens (eg, testosterone).   Androgen overproduction often results from overproduction of LH (luteinizing hormone), which is produced by the pituitary gland. 

Research also suggests that when insulin levels in the blood are high enough, the ovary can be stimulated to produce more testosterone.   That is, the combination of having ovaries which are responsive to insulin and high insulin levels in the blood, can result in the overproduction of testosterone.

Obesity, which itself can cause insulin levels to rise, may intensify PCOS. Yet, not all women who are overweight develop PCOS. Thus, there appears to be something unique about PCOS both in the excessively high insulin production and the increased sensitivity of the ovaries to the insulin that is produced.

How is PCOS diagnosed?
Initially, many of the symptoms of PCOS acne, obesity, excessive hair growth, and irregular periods are viewed as unpleasant but unrelated. Many women are not diagnosed until the symptoms become advanced, or until they experience difficulty with fertility.

There is no single, quick test to identify PCOS.   Accurate diagnosis depends on the experienced skills of the clinician, a detailed medical history, and laboratory studies.  Some clinicians may choose to use some of the following diagnostic tools:

    • Ultrasound, to assess whether ovaries are enlarged and cystic.
    • Blood tests, to detect eleveated levels of androgens.
    • Blood test to detect high levels of LH (luteinizing hormone) or an elevation in   the ratio of LH to FSH (follicle stimulating hormone).
    • Monitoring of the ovary's response to either a stimulatory dose of gonadotropin-releasing hormone agonist (such as leuprolide -- This test was developed at the University of Chicago and has been used worldwide) or a suppressive dose of medications such as dexamethasone.

The physician will also try to rule out other possible causes of irregular menstruation and excessive hair growth, such as Cushing's syndrome, congenital adrenal hyperplasia, or other disorders of the pituitary or adrenal glands. 

Does PCOS run in families?
Evidence is accumulating to suggest that there is likely to be a hereditary basis for PCOS and its associated metabolic abnormalities such as diabetes.

At the University of Chicago Hospitals, we have found that 1 in 3 women with PCOS will have an abnormal glucose tolerance test and that 1 in 10 will be diabetic by age 40. It is important to note that women with PCOS who have a family history of diabetes appear to be at highest risk for abnormalities in glucose tolerance. 

Thus, we are actively engaged in trying to understand whether the tendency for PCOS and glucose intolerance has a familial, genetic basis. To date, over 200 families of women with PCOS have participated in testing in our Clinical Research Center.

How can you and your family participate?
If you and your immediate family members (parents or siblings) would like to participate in our study of the role of genetics in PCOS, please contact us. Most of the study can be done through the mail, so you can still participate even if you don't live close to Chicago.

Many medical approaches can relieve or reduce specific symptoms for a comprehensive list click here.

Many non-medical approaches can relieve or reduce specific symptoms, one of them is:

Weight loss.  Because of excess testosterone and insulin resistance, losing weight can be quite challenging for women with PCOS.  These women truly have a metabolic cause for their extra weight.  Many women with PCOS follow a low-carbohydrate diet designed  to lose or maintain their weight.

However, weight loss achieved through dietary changes and exercise can help women with PCOS in several ways.  Like men and women without PCOS, losing weight reduces a person's risk of cardiovascular disease and non-insulin dependent (type 2) diabetes.  Weight loss also helps to lower the level of insulin which, in turn, reduces the ovaries' production of testosterone.

For more information visit the University of Chicago Center for Polycystic Ovarian Syndrome

Syndrome X - What is it and do you have it?

It's silent, it's dangerous (even if your total cholesterol is perfect) -- and a low carb diet helps!

Syndrome X is the mystery man of the medical world. He sneaks into our hearts, roughs them up, and we hardly know what hit us.

The barely known Syndrome X is a cluster of slippery symptoms, so slippery that researchers themselves aren't sure which is most important. They include too many fatty triglycerides, not enough good HDL cholesterol, and too many small, dense lipoprotein particles -- attack dogs of the arteries. Then there's elevated blood pressure, not to mention too much abdominal fat. Throw in a tad too much blood sugar and a ton too much insulin, and you've got yourself one big medical mystery.

Even the name itself is a slippery topic, depending on the symptoms. Some scientists call it "Syndrome X." Others call it Insulin Resistance Syndrome, Polymetabolic Syndrome or even Visceral Fat Syndrome. But for simplicity's sake, we're going to call it Syndrome X.

But keep in mind, by any name, one thing is undebatable: In combination, these silent signs that we've just described are starting to be recognized as a very important new risk factor for heart disease.

Not a moment too soon. Some researchers think Syndrome X may be linked to at least half the cardiovascular disease in America today. "It's the most important public health problem in North America," says prominent investigator Jean-Pierre Despres, Ph.D., director of the lipid research center at Laval University Hospital in St. Foy, Quebec. "Having this syndrome is as high a cardiovascular risk as having high cholesterol, yet most of the people who have it have normal or close-to-normal cholesterol -- so they think they're fine," he says.

"You miss detecting these people because frequently they have a total cholesterol under 200," says Prevention advisor William Castelli, MD, medical director of the Framingham Cardiovascular Institute in Massachusetts. "But these people account for about a third of the heart attacks in the Framingham studies."

"This syndrome is a very major risk factor. And we have enough information about it at this stage to let people know about it. There are very simple lifestyle things they can do to lower and even normalize their risk," says Dr. Despres.

That's exciting news. Once you have the clues to identify this skulking syndrome, you have the tools to make it shrink or even disappear.

Three easy pieces
Insulin resistance seems to be the core of Syndrome X. (See The X File.) Yet despite the hormone's importance, it's a bear to measure -- the best test is complicated, expensive and unpleasant, investigators say. They're working on a more practical solution, though. "I think 4 or 5 years from now, people will know their insulin levels the way they know their lipid levels now," says researcher George Howard, Ph.D., professor of biostatistics and epidemiology at Bowman Gray School of Medicine in Winston-Salem, NC. "Insulin resistance is very bad, and it turns out to be related to everything -- to atherosclerosis, to hypertension, to diabetes, to elevated triglycerides, and to clotting factors like fibrinogen. It's a very important risk factor for heart disease."

Until an acceptable insulin test comes down the pike, here are three easy measures that may help point the finger at sly Syndrome X:

  • Measure your waist. "Most of the time, this cluster of symptoms is found with excess abdominal fat," says Dr. Despres. To find out if you have too much abdominal fat, simply measure your waist. That's right, your waist alone. New research suggests that a waist measurement may be more accurate than a waist-hip ratio when it comes to estimating the fat around your middle. Dr. Despres' studies have shown that a waistline over 1 meter (about 39 inches) in both men and women usually indicates the presence of Syndrome X. "The best correlate of the insulin resistance syndrome is too much abdominal-visceral fat," he says. And measuring your waist is a no-brainer.
  • Get your ratio. Another suspicious number is a ratio of total cholesterol to HDL larger than 5, says Dr. Despres. (While a ratio over 4 puts you at risk for heart disease in general, a ratio over 5 points to Syndrome X.) Syndrome X is yet one more good reason to make sure you get your cholesterol checked with a lipid profile test. That will give you the numbers you most need to know-your total cholesterol, HDL, and triglycerides. (To find your ratio, divide total cholesterol by HDL.) This test will also give you your LDL numbers, but beware: LDL is often within the normal range in people with Syndrome X. If your LDL is higher than 130, you may have cardiovascular disease not related to X. If your cholesterol is somewhat high and your doctor has already put you on drugs to lower it, be aware that nicotinic acid-type medications can increase insulin resistance. So if you have Syndrome X and don't know it, such a drug regimen to treat your cholesterol would end up being futile.
  • Tally up your triglycerides. Triglycerides are the bad companions small, dense lipoproteins keep. When we eat too many calories or drink too much alcohol, the excess turns into triglycerides. It's enough to take your appetite away. While the National Cholesterol Education Program's guidelines suggest 200 milligrams (mg) per deciliter as the upper limit for triglycerides, many researchers think that number is too high. Dr. Castelli suggests 150 as the limit for heart health. In the case of Syndrome X, a number above 150 paired with low HDLs and a big waist is the metabolic trinity that pretty clearly indicates the presence of the harmful syndrome.

Here are two other markers of cardiovascular disease risk that usually turn up as part of X. Researchers haven't linked them to the syndrome as conclusively as they have linked low HDLs, high triglycerides, and abdominal fat. But their presence may help zero in on a diagnosis of Syndrome X.

1. Elevated blood sugar. This symptom is quite likely the result of out-of-whack insulin. When the hormone can't push glucose into the cells, then glucose clutters up the bloodstream. About 25% of those with Syndrome X, however, are veritable insulin machines, says Dr. Despres. They pump out so much of the hormone they're actually able to heave excess sugar into balky cells. So their glucose level may be normal or only slightly elevated, while their insulin level is secretly sky high. Most Syndrome X'ers will register increased levels of glucose, though. Anything over 100 mg per deciliter could be suggestive of X, says Dr. Castelli, especially if it partners high triglycerides, low HDLs, and a big waist.

The standard procedure for measuring blood sugar is the fasting plasma glucose test, something you can get when you get your cholesterol checked at your regular physical. Even if your HDLs and triglycerides test out fine, blood sugar over 100 signals a need for additional tests to make sure you don't have diabetes.

2. High blood pressure. This symptom is an easy measure. Your doctor probably takes it every time you visit his office. Your systolic pressure should be under 130 and your diastolic pressure under 85, says Dr. Castelli. That's easy to remember: Those are the same numbers you use for general health, in addition to monitoring Syndrome X.

"It's been suggested, but not proven, that insulin resistance is related to the development of hypertension," says Dr. Howard. So far, researchers haven't gathered enough evidence to fix the blame for X-related high blood pressure on the insulin-resistance syndrome.

Nevertheless, high blood pressure is a common branch heading out from the X cluster of symptoms. And it's a risk factor for all heart disease, X-related or not.

Suspecting or knowing you have Syndrome X is even more important if you're under treatment for blood pressure. Drugs in the thiazide and beta-blocker families, used to treat the condition, can increase insulin resistance, too. So attempts to lower your blood pressure significantly would be foiled, and your heart health would suffer in the long run.

Off-kilter triglyceride, HDL, and waist circumference numbers should tip your doctor off to the probability of X, no matter what moniker he uses. But your doctor may not be hip to the syndrome yet, say the experts -- not if your total cholesterol is normal or nearly so.

If your doctor's not familiar with the syndrome or doesn't take it seriously, discuss it with him. Take along this article for backup and leave him a copy.

For Lo Carb/Syndrome X Related info: Insulin Resistance Reseach Pages

Article Source Healthy Living September 1999


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