DR. COURTENAY BOER
NATUROPATHIC PHYSICIAN
RESEARCH REVIEW
I am a huge advocate for health education and I'm passionate about sharing the most up to date information and current research on health topics and natural medicine. This space is dedicated to that sharing.
September 20, 2019
You read that right - women with PCOS tend to have lower Vitamin D status than their “healthy” counterparts. The prevalence of Vitamin D deficiency in women with PCOS is striking: one study found Vitamin D deficiency in 44% of women with PCOS (versus 11% in control groups), while another found deficiency to be as high as 70%! Lower Vitamin D levels were associated with metabolic syndrome features in PCOS women, such as higher BMI, fasting insulin (and HOMA-IR), blood pressure, and cholesterol levels. Part of this might be explained by genetic polymorphisms (variations) for the Vitamin D receptor in PCOS women.
Supplementation in Vitamin D deficient women with PCOS can improve metabolic status and markers of inflammation. But it is of course most beneficial when repleting vitamin deficiencies!
The bottom line: Vitamin D deficiency should be screened in anyone with PCOS. Have you been tested?
September 4, 2019
September is PCOS Awareness Month!
If you’ve been following along here, you’ll know that I love sharing research relating to polycystic ovarian syndrome (PCOS). This became a clinical passion of mine after a close friend undergoing fertility struggles learned she had PCOS. At the time, I knew very little about this syndrome, but soon learned just how common it is (affecting 1 in 10 women of childbearing age) and how treatable it is, especially through nutrition and lifestyle.
Today I want to share research around one of my favourite adjunct treatments for PCOS: myo-inositol (MI). MI is a stereoisomer of inositol, a sugar alcohol. It acts as a messenger in the regulation of several hormones, including follicle-stimulating hormone (FSH) and insulin.
In women with PCOS, a recent meta-analysis found MI to improve fasting insulin levels, HOMA-IR (a measure of insulin resistance that compares fasting glucose with fasting insulin), and SHBG (sex-hormone binding globulin) levels, which can in turn improve androgen features. SHBG is a protein that binds excess testosterone, making it unavailable. Higher SHBG levels lead to lower bioavailability of androgens such as testosterone.
Another study showed inositol regulated menstrual cycles and improved ovulation in women with PCOS. It is also well-tolerated and shown to be safe to use within recommended dosing strategies. In a 2019 head-to-head trial with Metformin, researchers found MI to perform just as well and recommended it above Metformin due to its better tolerability. That’s pretty awesome!
There are still questions that remain on the use of MI, especially in pre-treatment for IVF. For example, one meta-analysis that looked at MI's impacts on markers of ovarian reserve such as anti-Mullerian hormone and antral follicle count showed no effect, as well as no change in clinical pregnancy rates. A 2018 Cochrane review was inconclusive - the evidence was not sufficient to say whether MI was beneficial or not. Yet, a randomized clinical trial and literature review suggested MI had a positive effect on embryo quality, clinical pregnancy rates, and IVF outcomes. While we can't be sure, one thing is certain - this is an adjunct therapy that needs more research attention, and I am excited to see what comes of that!
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August 23, 2019
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Let’s talk endocrine-disrupting chemicals (EDCs): bisphenols and phthalates. In a recent study, BPA (bisphenol A) and a phthalate known as MCOP (monocarboxyoctyl phthalate) were associated with shorter luteal phases in women (recall that the luteal phase is the second half of the cycle, when progesterone is made - and essential for female health and fertility!). Of course, association is not causation, but the body of research surrounding EDCs is pretty damning: they are affecting our health and reproductive abilities.
Keep in mind that research compares highest to lowest concentrations - the goal is to reduce your exposure. Although toxin exposure can feel overwhelming, my goal is to encourage you to make small changes, which have profound impacts for your health.
Bisphenols are frequently found in plastics (bottles, food and take-out containers, baby bottles), linings of canned foods, and thermal papers (receipts). Phthalates are found in cosmetics, as well as perfumes, soaps, and shampoos (disguised under the name ‘Fragrance’).
Here are some practical tips to reducing your BPA and phthatale exposure:
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Switch out plastic food containers for glass or metal (at very least, do not heat food in plastic containers)
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Choose a glass or stainless steel water bottle over plastic water bottles
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Leave the receipt at the counter - choose an e-receipt rather than handling paper receipts
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Check the labels of canned foods and choose BPA-free cans
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Check your cosmetics labels and look for fragrance-free products
July 21, 2019
I recently came across a paper (linked below) that discussed the use of prebiotics (food for beneficial bacteria), probiotics (the bacteria themselves) and synbiotics (a mix of pre and probiotics) in women with PCOS. The authors of this meta-analysis found that supplementation with probiotics and synbiotics in women with PCOS had beneficial outcomes for hormonal indices (FAI = free androgen index and SHBG = sex hormone binding globulin) and measures of inflammation (NO = nitric oxide and MDA = malondialdehyde).
“So interesting!” I thought, and then the next question “But why?” Why might this be beneficial? How can probiotics affect these markers? So I did dug into the research.
As it turns out, there’s a good body of research looking into differences in the gastrointestinal microbiome in women with PCOS and those without. What these studies show is that the diversity and composition of the bacteria in the gut are vastly different in women with PCOS.
We know that PCOS is both a hormonal and metabolic condition - it is greatly affected by diet and nutrition (read my article on PCOS here to learn more) - so perhaps it shouldn’t come as a shock that how we metabolize is also implicated. Then comes the next question - is what we eat and our gut microbiota affecting our hormones, or are our hormones affecting our microbiota and how we metabolize?
It's a bit of a chicken and egg question, and the answer probably lies somewhere in the middle. Some studies suggest a correlation - a relationship showing trends - but not causation. Other studies conclude there is a definite influence (more of a causation). All of these studies recognize a link between PCOS and dysbiosis (imbalanced baceria), and conclude that the microbiome should be considered in clinical treatment of PCOS.
More and more studies are investigating how probiotics can affect different measures in PCOS - including weight and BMI, insulin resistance, hirsutism (hair growth), and mental health, and how co-supplementation with other nutrients such as selenium or Vitamin D can have an even greater effect.
More research certainly needs to be done to determine which probiotics may offer the greatest benefit (there are hundreds of strains and combinations!), but it certainly is a great starting place and I am excited to see the research delving into this important piece of the PCOS puzzle!
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July 8, 2019
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We know that progesterone is made after ovulation, during the luteal phase. And we know that progesterone is critical for supporting and maintaining a pregnancy. So the question remains - can we supplement progesterone to support a healthy pregnancy?
What about in patients undergoing Assisted Reproductive Technology (ART), such as Frozen Embryo Transfer (FET)? The success of ART involves not only creating a viable embryo, but also a receptive endometrium. Progesterone is important for the maturation and maintenance of the uterine lining - that is, the creation of that receptive endometrium. In this retrospective study, researchers looked at pregnancy rates among women with regular cycles who underwent FET after either IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection). The women were split into 2 groups: one group received 400mg of vaginal micronized progesterone daily, starting from the day of ovulation, and the other did not. Pregnancy rates in the progesterone group were 39% vs. 24% in the non-treatment group: a statistically significant increase! Importantly, this study did not look at live birth rates - this is an important next step in research, as pregnancy vs. live birth rates can vary significantly.
Given these striking results, the researchers concluded that vaginal progesterone should be used more widely during natural-cycle FET.
June 21, 2019
Parabens are a ubiquitous ingredient in many cosmetic products and part of a group of chemicals known as EDCs or Endocrine Disrupting Chemicals. There is a growing body of research that EDCs affect both fertility and pregnancy outcomes. In this study, researchers measured urinary levels of preconception parabens in relation to fecundity (measured here as time to pregnancy). What they found was striking: there was a 34% reduction in fecundity in the 25% of women with the HIGHEST concentrations of parabens when compared to the 25% of women with the LOWEST concentration of parabans. In short, those with higher paraben concentrations had a longer time to achieve a pregnancy.
Why do research papers about EDCs frequently report highest vs. lowest quartiles? This is because exposure to EDCs is not all-or-nothing. All of us are exposed to them, so we’ll never be at “zero levels.” The good news? You can decrease your exposure, and research such as this study shows us that reducing your exposure does have significant effects on health and fertility. Here’s a starting place:
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Check your cosmetics and toiletries (shampoo, conditioner, deodorant) for parabens. If you want to replace your current products with safer ones, start small and build from there - you don’t need to throw out all of your cosmetics, but reducing exposure is key.
Click here to read the entire study.
Click here to learn more about EDCs and what you can do to minimize exposure.
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June 12, 2019
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That’s a mouthful! This long list of acronyms strung together in a sentence is actually an exciting piece of research investigating nutrition and Polycystic Ovary Syndrome (PCOS).
This study had women with PCOS who were overweight follow the DASH or a control diet. DASH stands for Dietary Approaches to Stop Hypertension, and is often recommended for those with high blood pressure.
Following the DASH in overweight women with PCOS for 12 weeks showed significant decreases in BMI (body mass index), AMH (anti-mullerian hormone), insulin, FAI (free androgen index), and MDA (malondialdehyde) and significant increases in SHBG (sex-hormone binding globulin) and NO (nitric oxide). AMH is an indirect measure of ovarian cysts (it is secreted by small antral follicles in the ovary), FAI is a measure of androgens (such as testosterone), and MDA is a marker of oxidative stress, all of which are often elevated in women with PCOS. SHBG is a protein made in the liver which binds testosterone, and is decreased by high insulin levels (and therefore often low in PCOS), while NO is important in blood pressure regulation.
Researching nutrition can be difficult, but this study was randomized and well-designed. The diets were controlled for total calories, as well as carbohydrate, protein, and fat content.
We know that PCOS is not only hormonal, but has significant metabolic components as well (read by article on PCOS here to learn more). That means that nutrition plays a big role in the pathogenesis, and can have therapeutic value in the treatment as well. This is where preventative and lifestyle medicine have such importance, and where Naturopathic medicine shines!
June 6, 2019
Resveratrol is a potent anti-oxidant found in grapes, red wine, legumes, and berries which is beginning to be studied as a potential therapy for endometriosis.
Endometriosis is a gynecological condition which can present with debilitating and chronic pain, as well as pose significant fertility challenges. Unfortunately, is still not fully understood, but is now known to have a significant inflammatory component.
Until recently, only animal studies had been done to investigate resveratrol’s therapeutic potential. This recent, small, randomized exploratory trial (with humans!) was published in February of this year. The authors measured levels of matrix metalloproteinases (MMPs) - which are a hallmark of inflammation - in the blood, endometrial tissue, and fluid of women with endometriosis and found that those treated with resveratrol had significantly lowered levels of MMPs. This suggests that resveratrol may play an important role in modulating the inflammation that is common to endometriosis.
Although more research is certainly needed this is an exciting step in exploring resveratrol as a therapy for treatment and prevention of endometriosis - and win for women's health!
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