need help with newly-dx pre-DM/PCOS

[Guest guest]

Please consider making a referral to another colleague that has the expertise.

This is a win -win relationship for everyone, including you.

Good luck. Where is she living?

Thank you,

Nodvin-WedRD

Sent from my iPhone

On Mar 9, 2011, at 12:15 PM, ne

wrote:

> Dear Colleagues,

> I have very little experience with DM, and none with PCOS, and am hoping

> for some insights, resources, and direction.

>

> My 30-year-old niece is Korean; adopted and raised in the U.S. midwest.

> She has just emailed me asking for help. Here is her concern:

>

> " My doctor advised me to consult with a nutritionist b/c I've been asked

> to lose about 15-20 pounds in the next 6 months b/c she said I am

> showing signs of pre-diabetes. Besides telling me to cut back on the

> " bad " carbs and sweets, I don't really know where to start. I am

> obviously getting more serious about my exercise program.

>

> " Another important thing to mention is that I was also diagnosed with

> polycystic ovarian syndrome. This presents other issues, but it goes

> hand in hand with the pre-diabetes it sounds like.

>

> " Do you have suggestions for how many calories I should be taking in?

> How to fill up and not feel like I'm depriving myself, etc? I'm

> embarrassed to share my stats, but I will if that helps. I'm 5'1 and 150

> pounds. Two years ago I was 133 pounds, so I've definitely gained quite

> a bit in a short amount of time which I'm not happy about. For me, 133

> is a good place for me and my body. I don't think I could be a 110-120

> pounds to be honest with my body shape. "

>

> Colleagues, I agree with her that around 130 pounds is probably about

> right. Though not tall, she is quite muscular, with large bones and body

> frame.

>

> However, in view of dx'd PCOS, I do not know how/where to direct her.

> Does anyone know if Monika Woolsey has patient ed materials available?

> Any guidance, re pre-diabetes and/or PCOS would be greatly appreciated.

>

> Best regards,

> ne

> --

> " Ask About Nutrition " www.parkinson.org/

> " Eat Well, Stay Well with Parkinson's Disease "

> " Parkinson's disease: Guidelines for Medical Nutrition Therapy "

> www.nutritionucanlivewith.com

>

> ----------------------------------------------------------

>

[Guest guest]

> Please consider making a referral to another colleague that has the expertise.

This is a win -win relationship for everyone, including you.

>

> Good luck. Where is she living?

, a referral is a given. DM is not my area at all, nor is PCOS.

Plus she lives in a different state (Iowa). I will refer her to the ADA

" Find A Dietitian " site, but was hoping for additional tips or resources.

Best,

ne

[Guest guest]

> Please consider making a referral to another colleague that has the expertise.

This is a win -win relationship for everyone, including you.

>

> Good luck. Where is she living?

, a referral is a given. DM is not my area at all, nor is PCOS.

Plus she lives in a different state (Iowa). I will refer her to the ADA

" Find A Dietitian " site, but was hoping for additional tips or resources.

Best,

ne

[Guest guest]

> Please consider making a referral to another colleague that has the expertise.

This is a win -win relationship for everyone, including you.

>

> Good luck. Where is she living?

, a referral is a given. DM is not my area at all, nor is PCOS.

Plus she lives in a different state (Iowa). I will refer her to the ADA

" Find A Dietitian " site, but was hoping for additional tips or resources.

Best,

ne

[Guest guest]

Monika Woosely is the PCOS guru- check out her website afterthediet.com

Staci Freeworth MS RD LD CDE

Sent from my Verizon Wireless BlackBerry

Re: Need help with newly-dx pre-DM/PCOS

> Please consider making a referral to another colleague that has the expertise.

This is a win -win relationship for everyone, including you.

>

> Good luck. Where is she living?

, a referral is a given. DM is not my area at all, nor is PCOS.

Plus she lives in a different state (Iowa). I will refer her to the ADA

" Find A Dietitian " site, but was hoping for additional tips or resources.

Best,

ne

[Guest guest]

Monika Woosely is the PCOS guru- check out her website afterthediet.com

Staci Freeworth MS RD LD CDE

Sent from my Verizon Wireless BlackBerry

Re: Need help with newly-dx pre-DM/PCOS

> Please consider making a referral to another colleague that has the expertise.

This is a win -win relationship for everyone, including you.

>

> Good luck. Where is she living?

, a referral is a given. DM is not my area at all, nor is PCOS.

Plus she lives in a different state (Iowa). I will refer her to the ADA

" Find A Dietitian " site, but was hoping for additional tips or resources.

Best,

ne

[Guest guest]

Monika Woosely is the PCOS guru- check out her website afterthediet.com

Staci Freeworth MS RD LD CDE

Sent from my Verizon Wireless BlackBerry

Re: Need help with newly-dx pre-DM/PCOS

> Please consider making a referral to another colleague that has the expertise.

This is a win -win relationship for everyone, including you.

>

> Good luck. Where is she living?

, a referral is a given. DM is not my area at all, nor is PCOS.

Plus she lives in a different state (Iowa). I will refer her to the ADA

" Find A Dietitian " site, but was hoping for additional tips or resources.

Best,

ne

[Guest guest]

Weight loss seems to be the best therapy for long term return of function and

fertility rather than continual decline with pharmaceutical strategies.

1. http://www.ncbi.nlm.nih.gov/pubmed/1322430

Cellular mechanisms of insulin resistance in polycystic ovarian syndrome.J Clin

Endocrinol Metab.1992 Aug;75(2):577-83.Ciaraldi TP, el-Roeiy A, Madar Z,

Reichart D, Olefsky JM, Yen SS. Department of Medicine, University of

California, La Jolla 92093.

Abstract

Insulin resistance is a predominant feature in women with polycystic ovarian

syndrome (PCO). The cellular mechanisms for this insulin resistance have not

been defined. In this study, major steps in the insulin action cascade,

receptor binding, kinase activity, and glucose transport activity were

evaluated in isolated adipocytes prepared from PCO subjects (n = 8) without

acanthosis nigricans and in a group of age and weight-matched controls [normal

cycling (NC) n = 8]. The PCO group was hyperinsulinemic and displayed elevated

insulin responses to an iv glucose load. The binding of 125I-insulin to

adipocytes was similar in cells from PCO and NC subjects. In PCO,

autophosphorylation of the insulin receptor-subunit in the absence of insulin

was normal but a significant decrease (30% below control) in maximal insulin

stimulated autophosphorylation was observed. However, receptor kinase activity

measured against the exogenous substrate poly glu:tyr (4:1) was normal. Cells

from PCO subjects transported glucose at the same rate, in both the absence and

presence of a maximal insulin concentration, as those from NC subjects.

Strikingly, there was a large rightward shift in the insulin dose-response

curve for transport stimulation in PCO cells (EC50 = 87 +/- 14 pmol in NC vs.

757 +/- 138 in PCO, P less than 0.0005); 8-fold greater insulin concentrations

were required to attain comparable glucose transport rates in cells from PCO

against NC.In conclusion, our results suggest that insulin resistance in PCO,

as assessed in the adipocyte, is accompanied by normal function of insulin

receptors, but involves a novel postreceptor defect in the insulin signal

transduction chain between the receptor kinase and glucose transport.

PMID: 1322430 [PubMed - indexed for MEDLINE]

2. http://www.ncbi.nlm.nih.gov/pubmed/6400287

Ultrasound Med Biol. 1983;Suppl 2:603-8.

Ultrasonographic and endocrinological studies of ovarian function.

Geisthövel F, Skubsch U, Zabel G, Schillinger H, Breckwoldt M.

Abstract

Ovarian morphological alterations in 6 physiological menstrual cycles were

studied by sonography and compared to 13 inadequate cycles with a short or

missing luteal phase. In addition, basal body temperature (BBT) and

17-beta-estradiol (E2), luteinizing hormone (LH), progesterone (P),

testosterone (T) and dehydro-epiandrosterone-sulfate (DHEA-S) levels in serum

were measured. Maximal follicle were significantly smaller in insufficient

cycles (17.7 +/- 2.9 mm) than in physiological cycles (23 +/- 2.3 mm). Corpus

luteum (CL) structure was visualized in 5 of the 6 physiological cycles but was

not detected in insufficient cycles. Persistent poly-follicular reaction

(greater than 3 follicles/ovary) without a dominant follicle larger than 10 mm

was detected in the ovaries of 3 patients with clinical and hormonal signs of

polycystic ovarian disease (PCOD).

PMID: 6400287 [PubMed - indexed for MEDLINE]

*** Insulin receptors that work but not quite right and follicles that are

pumping out immature cells in excess numbers sounds a lot like what I've been

reading about in white and red blood cell production problems in magnesium

deficiency. I have many studies relating insulin resistance to magnesium

deficiency. Chromium also helps.

If she was my relative I would encourage magnesium (and iodine). I didn't find

any studies linking an ovary problem to iodine but all glands need iodine. I

think it is involved in pancreas problems and endometreosis. Always use selenium

if adding iodine to reduce risk of hyperthyroid overproduction. that rapid of a

weight change could involve low grade hypothyroidism too. Checking the Basal

Metabolic Temperature by taking temperature first thing upon awaking, before

getting out of bed, three days in a row and average. For women I think the first

days of the new menstrual cycle is recommended. A temp in the 96 range or lower

suggests hypothyroidism.

The only recent article mentioning poly cystic ovarian syndrome found

inconclusive results for use of acupuncture.(2010) (minor cases were helped ,

severe cases weren't)

*** I searched with " PCOS, iodine " instead of " poly cystic ovarian syndrome "

and what do you know but a study of iodine deficiency in men found 30 balding

men with hormonal patterns suggestive of PCOS

3. http://www.ncbi.nlm.nih.gov/pubmed?term=PCOS%20iodine

Endocr Regul. 2005 Dec;39(4):127-31.

Premature androgenic alopecia and insulin resistance. Male equivalent of

polycystic ovary syndrome?

Starka L, Duskova M, Cermakova I, Vrbiková J, Hill M.

Institute of Endocrinology, Narodni 8, CZ 116 94 Prague 1, Czech Republic.

lstarka@...

Abstract

BACKGROUND: Polycystic ovary syndrome (PCOS), the most frequent endocrinopathy

in women with estimated prevalence of 5-10 %, is characterised by a hormonal

and metabolic imbalance of polygene autosomal trait. The complexity of

symptoms and genetic base started up the hypothesis on the existence of male

equivalent of PCOS. Precocious loss of hair before 30 years of age was

suggested as one of the male symptoms of this syndrome.

OBJECTIVES: The aim was to confirm the association of lower levels of follicle

stimulating hormone (FSH) and sexual hormone binding globulin (SHBG) or higher

free androgen index (FAI) in premature balding men with a reduced insulin

sensitivity.

PATIENTS/METHODS: The study included 30 men with premature hair loss (defined

as grade 3 vertex or more on the alopecia classification scale by Hamilton with

Norwood modification) starting before 30 years of age. The hormonal values of

the investigated group were compared with those regarded as normal reference

values obtained in a group of 256 males in the age of 20-40 years during the

Czech population study of iodine deficiency. In all men with premature baldness

besides hormonal level determinations insulin tolerance test was carried out.

RESULTS: The observed group was divided into two subgroups. The first one

showed similar hormonal changes as women with PCOS, namely subnormal SHBG, FSH

or increased FAI. The other had either no anomalies in steroid spectrum or only

lower SHBG. The groups did not differ either in BMI or in age. The group with

hormonal profile resembling that of women with PCOS, showed significantly

higher insulin resistance than the group without these changes.

CONCLUSIONS: The findings are consistent with the hypothesis that at least a

part of the men with premature androgenic alopecia could be considered as a

male equivalent of the polycystic ovary syndrome of the women. These premature

balding men represent a risk group for the development of impaired glucose

tolerance or diabetes mellitus type 2.

PMID: 16552990 [PubMed - indexed for MEDLINE]

**Hair loss is associated with hypothyroidism.

4. http://www.ncbi.nlm.nih.gov/pubmed/21362574

J Pediatr. 2011 Feb 28. [Epub ahead of print]

Sex Hormone-Binding Globulin, Oligomenorrhea, Polycystic Ovary Syndrome, and

Childhood Insulin at Age 14 Years Predict Metabolic Syndrome and Class III

Obesity at Age 24 Years.

Glueck CJ, on JA, s S, Wang P, Stroop D.

Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH.

5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039006/?tool=pubmed

Int J Womens Health. 2011 Feb 8;3:25-35.

Treatment options for polycystic ovary syndrome.

Badawy A, Elnashar A.

Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt;

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in

women. The clinical manifestation of PCOS varies from a mild menstrual disorder

to severe disturbance of reproductive and metabolic functions. Management of

women with PCOS depends on the symptoms. These could be ovulatory

dysfunction-related infertility, menstrual disorders, or androgen-related

symptoms. Weight loss improves the endocrine profile and increases the

likelihood of ovulation and pregnancy. Normalization of menstrual cycles and

ovulation could occur with modest weight loss as little as 5% of the initial

weight. The treatment of obesity includes modifications in lifestyle (diet and

exercise) and medical and surgical treatment. In PCOS, anovulation relates to

low follicle-stimulating hormone concentrations and the arrest of antral

follicle growth in the final stages of maturation. This can be treated with

medications such as clomiphene citrate, tamoxifen, aromatase inhibitors,

metformin, glucocorticoids, or gonadotropins or surgically by laparoscopic

ovarian drilling. In vitro fertilization will remain the last option to achieve

pregnancy when others fail. Chronic anovulation over a long period of time is

also associated with an increased risk of endometrial hyperplasia and

carcinoma, which should be seriously investigated and treated. There are

androgenic symptoms that will vary from patient to patient, such as hirsutism,

acne, and/or alopecia. These are troublesome presentations to the patients and

require adequate treatment. Alternative medicine has been emerging as one of

the commonly practiced medicines for different health problems, including PCOS.

This review underlines the contribution to the treatment of different symptoms.

PMID: 21339935 [PubMed - in process]PMCID: PMC3039006Free PMC Article

***Metformin helped people get pregnant but didn't promote live births - net

result - tragedy.

Magnesium and iodine both could help weight loss and glandular function - but

pharmaceutical options look like the going plan of action - glucocorticoids for

example - kill the body that isn't working to satisfaction - give it a couple

years before total immune collapse. a working solution for profit margin to some

people but for someone you love? Hypothyroidism causes infertility and

miscarriages.

Vajda, R.D.

www.GingerJens.com

________________________________

To: rd-usa Listserv <rd-usa >; Dietetics in Health Communities

(DHCC)

Sent: Wed, March 9, 2011 12:15:17 PM

Subject: Need help with newly-dx pre-DM/PCOS

Dear Colleagues,

I have very little experience with DM, and none with PCOS, and am hoping

for some insights, resources, and direction.

My 30-year-old niece is Korean; adopted and raised in the U.S. midwest.

She has just emailed me asking for help. Here is her concern:

" My doctor advised me to consult with a nutritionist b/c I've been asked

to lose about 15-20 pounds in the next 6 months b/c she said I am

showing signs of pre-diabetes. Besides telling me to cut back on the

" bad " carbs and sweets, I don't really know where to start. I am

obviously getting more serious about my exercise program.

" Another important thing to mention is that I was also diagnosed with

polycystic ovarian syndrome. This presents other issues, but it goes

hand in hand with the pre-diabetes it sounds like.

" Do you have suggestions for how many calories I should be taking in?

How to fill up and not feel like I'm depriving myself, etc? I'm

embarrassed to share my stats, but I will if that helps. I'm 5'1 and 150

pounds. Two years ago I was 133 pounds, so I've definitely gained quite

a bit in a short amount of time which I'm not happy about. For me, 133

is a good place for me and my body. I don't think I could be a 110-120

pounds to be honest with my body shape. "

Colleagues, I agree with her that around 130 pounds is probably about

right. Though not tall, she is quite muscular, with large bones and body

frame.

However, in view of dx'd PCOS, I do not know how/where to direct her.

Does anyone know if Monika Woolsey has patient ed materials available?

Any guidance, re pre-diabetes and/or PCOS would be greatly appreciated.

Best regards,

ne

--

" Ask About Nutrition " www.parkinson.org/

" Eat Well, Stay Well with Parkinson's Disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

www.nutritionucanlivewith.com

----------------------------------------------------------

[Guest guest]

Weight loss seems to be the best therapy for long term return of function and

fertility rather than continual decline with pharmaceutical strategies.

1. http://www.ncbi.nlm.nih.gov/pubmed/1322430

Cellular mechanisms of insulin resistance in polycystic ovarian syndrome.J Clin

Endocrinol Metab.1992 Aug;75(2):577-83.Ciaraldi TP, el-Roeiy A, Madar Z,

Reichart D, Olefsky JM, Yen SS. Department of Medicine, University of

California, La Jolla 92093.

Abstract

Insulin resistance is a predominant feature in women with polycystic ovarian

syndrome (PCO). The cellular mechanisms for this insulin resistance have not

been defined. In this study, major steps in the insulin action cascade,

receptor binding, kinase activity, and glucose transport activity were

evaluated in isolated adipocytes prepared from PCO subjects (n = 8) without

acanthosis nigricans and in a group of age and weight-matched controls [normal

cycling (NC) n = 8]. The PCO group was hyperinsulinemic and displayed elevated

insulin responses to an iv glucose load. The binding of 125I-insulin to

adipocytes was similar in cells from PCO and NC subjects. In PCO,

autophosphorylation of the insulin receptor-subunit in the absence of insulin

was normal but a significant decrease (30% below control) in maximal insulin

stimulated autophosphorylation was observed. However, receptor kinase activity

measured against the exogenous substrate poly glu:tyr (4:1) was normal. Cells

from PCO subjects transported glucose at the same rate, in both the absence and

presence of a maximal insulin concentration, as those from NC subjects.

Strikingly, there was a large rightward shift in the insulin dose-response

curve for transport stimulation in PCO cells (EC50 = 87 +/- 14 pmol in NC vs.

757 +/- 138 in PCO, P less than 0.0005); 8-fold greater insulin concentrations

were required to attain comparable glucose transport rates in cells from PCO

against NC.In conclusion, our results suggest that insulin resistance in PCO,

as assessed in the adipocyte, is accompanied by normal function of insulin

receptors, but involves a novel postreceptor defect in the insulin signal

transduction chain between the receptor kinase and glucose transport.

PMID: 1322430 [PubMed - indexed for MEDLINE]

2. http://www.ncbi.nlm.nih.gov/pubmed/6400287

Ultrasound Med Biol. 1983;Suppl 2:603-8.

Ultrasonographic and endocrinological studies of ovarian function.

Geisthövel F, Skubsch U, Zabel G, Schillinger H, Breckwoldt M.

Abstract

Ovarian morphological alterations in 6 physiological menstrual cycles were

studied by sonography and compared to 13 inadequate cycles with a short or

missing luteal phase. In addition, basal body temperature (BBT) and

17-beta-estradiol (E2), luteinizing hormone (LH), progesterone (P),

testosterone (T) and dehydro-epiandrosterone-sulfate (DHEA-S) levels in serum

were measured. Maximal follicle were significantly smaller in insufficient

cycles (17.7 +/- 2.9 mm) than in physiological cycles (23 +/- 2.3 mm). Corpus

luteum (CL) structure was visualized in 5 of the 6 physiological cycles but was

not detected in insufficient cycles. Persistent poly-follicular reaction

(greater than 3 follicles/ovary) without a dominant follicle larger than 10 mm

was detected in the ovaries of 3 patients with clinical and hormonal signs of

polycystic ovarian disease (PCOD).

PMID: 6400287 [PubMed - indexed for MEDLINE]

*** Insulin receptors that work but not quite right and follicles that are

pumping out immature cells in excess numbers sounds a lot like what I've been

reading about in white and red blood cell production problems in magnesium

deficiency. I have many studies relating insulin resistance to magnesium

deficiency. Chromium also helps.

If she was my relative I would encourage magnesium (and iodine). I didn't find

any studies linking an ovary problem to iodine but all glands need iodine. I

think it is involved in pancreas problems and endometreosis. Always use selenium

if adding iodine to reduce risk of hyperthyroid overproduction. that rapid of a

weight change could involve low grade hypothyroidism too. Checking the Basal

Metabolic Temperature by taking temperature first thing upon awaking, before

getting out of bed, three days in a row and average. For women I think the first

days of the new menstrual cycle is recommended. A temp in the 96 range or lower

suggests hypothyroidism.

The only recent article mentioning poly cystic ovarian syndrome found

inconclusive results for use of acupuncture.(2010) (minor cases were helped ,

severe cases weren't)

*** I searched with " PCOS, iodine " instead of " poly cystic ovarian syndrome "

and what do you know but a study of iodine deficiency in men found 30 balding

men with hormonal patterns suggestive of PCOS

3. http://www.ncbi.nlm.nih.gov/pubmed?term=PCOS%20iodine

Endocr Regul. 2005 Dec;39(4):127-31.

Premature androgenic alopecia and insulin resistance. Male equivalent of

polycystic ovary syndrome?

Starka L, Duskova M, Cermakova I, Vrbiková J, Hill M.

Institute of Endocrinology, Narodni 8, CZ 116 94 Prague 1, Czech Republic.

lstarka@...

Abstract

BACKGROUND: Polycystic ovary syndrome (PCOS), the most frequent endocrinopathy

in women with estimated prevalence of 5-10 %, is characterised by a hormonal

and metabolic imbalance of polygene autosomal trait. The complexity of

symptoms and genetic base started up the hypothesis on the existence of male

equivalent of PCOS. Precocious loss of hair before 30 years of age was

suggested as one of the male symptoms of this syndrome.

OBJECTIVES: The aim was to confirm the association of lower levels of follicle

stimulating hormone (FSH) and sexual hormone binding globulin (SHBG) or higher

free androgen index (FAI) in premature balding men with a reduced insulin

sensitivity.

PATIENTS/METHODS: The study included 30 men with premature hair loss (defined

as grade 3 vertex or more on the alopecia classification scale by Hamilton with

Norwood modification) starting before 30 years of age. The hormonal values of

the investigated group were compared with those regarded as normal reference

values obtained in a group of 256 males in the age of 20-40 years during the

Czech population study of iodine deficiency. In all men with premature baldness

besides hormonal level determinations insulin tolerance test was carried out.

RESULTS: The observed group was divided into two subgroups. The first one

showed similar hormonal changes as women with PCOS, namely subnormal SHBG, FSH

or increased FAI. The other had either no anomalies in steroid spectrum or only

lower SHBG. The groups did not differ either in BMI or in age. The group with

hormonal profile resembling that of women with PCOS, showed significantly

higher insulin resistance than the group without these changes.

CONCLUSIONS: The findings are consistent with the hypothesis that at least a

part of the men with premature androgenic alopecia could be considered as a

male equivalent of the polycystic ovary syndrome of the women. These premature

balding men represent a risk group for the development of impaired glucose

tolerance or diabetes mellitus type 2.

PMID: 16552990 [PubMed - indexed for MEDLINE]

**Hair loss is associated with hypothyroidism.

4. http://www.ncbi.nlm.nih.gov/pubmed/21362574

J Pediatr. 2011 Feb 28. [Epub ahead of print]

Sex Hormone-Binding Globulin, Oligomenorrhea, Polycystic Ovary Syndrome, and

Childhood Insulin at Age 14 Years Predict Metabolic Syndrome and Class III

Obesity at Age 24 Years.

Glueck CJ, on JA, s S, Wang P, Stroop D.

Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH.

5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039006/?tool=pubmed

Int J Womens Health. 2011 Feb 8;3:25-35.

Treatment options for polycystic ovary syndrome.

Badawy A, Elnashar A.

Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt;

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in

women. The clinical manifestation of PCOS varies from a mild menstrual disorder

to severe disturbance of reproductive and metabolic functions. Management of

women with PCOS depends on the symptoms. These could be ovulatory

dysfunction-related infertility, menstrual disorders, or androgen-related

symptoms. Weight loss improves the endocrine profile and increases the

likelihood of ovulation and pregnancy. Normalization of menstrual cycles and

ovulation could occur with modest weight loss as little as 5% of the initial

weight. The treatment of obesity includes modifications in lifestyle (diet and

exercise) and medical and surgical treatment. In PCOS, anovulation relates to

low follicle-stimulating hormone concentrations and the arrest of antral

follicle growth in the final stages of maturation. This can be treated with

medications such as clomiphene citrate, tamoxifen, aromatase inhibitors,

metformin, glucocorticoids, or gonadotropins or surgically by laparoscopic

ovarian drilling. In vitro fertilization will remain the last option to achieve

pregnancy when others fail. Chronic anovulation over a long period of time is

also associated with an increased risk of endometrial hyperplasia and

carcinoma, which should be seriously investigated and treated. There are

androgenic symptoms that will vary from patient to patient, such as hirsutism,

acne, and/or alopecia. These are troublesome presentations to the patients and

require adequate treatment. Alternative medicine has been emerging as one of

the commonly practiced medicines for different health problems, including PCOS.

This review underlines the contribution to the treatment of different symptoms.

PMID: 21339935 [PubMed - in process]PMCID: PMC3039006Free PMC Article

***Metformin helped people get pregnant but didn't promote live births - net

result - tragedy.

Magnesium and iodine both could help weight loss and glandular function - but

pharmaceutical options look like the going plan of action - glucocorticoids for

example - kill the body that isn't working to satisfaction - give it a couple

years before total immune collapse. a working solution for profit margin to some

people but for someone you love? Hypothyroidism causes infertility and

miscarriages.

Vajda, R.D.

www.GingerJens.com

________________________________

To: rd-usa Listserv <rd-usa >; Dietetics in Health Communities

(DHCC)

Sent: Wed, March 9, 2011 12:15:17 PM

Subject: Need help with newly-dx pre-DM/PCOS

Dear Colleagues,

I have very little experience with DM, and none with PCOS, and am hoping

for some insights, resources, and direction.

My 30-year-old niece is Korean; adopted and raised in the U.S. midwest.

She has just emailed me asking for help. Here is her concern:

" My doctor advised me to consult with a nutritionist b/c I've been asked

to lose about 15-20 pounds in the next 6 months b/c she said I am

showing signs of pre-diabetes. Besides telling me to cut back on the

" bad " carbs and sweets, I don't really know where to start. I am

obviously getting more serious about my exercise program.

" Another important thing to mention is that I was also diagnosed with

polycystic ovarian syndrome. This presents other issues, but it goes

hand in hand with the pre-diabetes it sounds like.

" Do you have suggestions for how many calories I should be taking in?

How to fill up and not feel like I'm depriving myself, etc? I'm

embarrassed to share my stats, but I will if that helps. I'm 5'1 and 150

pounds. Two years ago I was 133 pounds, so I've definitely gained quite

a bit in a short amount of time which I'm not happy about. For me, 133

is a good place for me and my body. I don't think I could be a 110-120

pounds to be honest with my body shape. "

Colleagues, I agree with her that around 130 pounds is probably about

right. Though not tall, she is quite muscular, with large bones and body

frame.

However, in view of dx'd PCOS, I do not know how/where to direct her.

Does anyone know if Monika Woolsey has patient ed materials available?

Any guidance, re pre-diabetes and/or PCOS would be greatly appreciated.

Best regards,

ne

--

" Ask About Nutrition " www.parkinson.org/

" Eat Well, Stay Well with Parkinson's Disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

www.nutritionucanlivewith.com

----------------------------------------------------------

[Guest guest]

Weight loss seems to be the best therapy for long term return of function and

fertility rather than continual decline with pharmaceutical strategies.

1. http://www.ncbi.nlm.nih.gov/pubmed/1322430

Cellular mechanisms of insulin resistance in polycystic ovarian syndrome.J Clin

Endocrinol Metab.1992 Aug;75(2):577-83.Ciaraldi TP, el-Roeiy A, Madar Z,

Reichart D, Olefsky JM, Yen SS. Department of Medicine, University of

California, La Jolla 92093.

Abstract

Insulin resistance is a predominant feature in women with polycystic ovarian

syndrome (PCO). The cellular mechanisms for this insulin resistance have not

been defined. In this study, major steps in the insulin action cascade,

receptor binding, kinase activity, and glucose transport activity were

evaluated in isolated adipocytes prepared from PCO subjects (n = 8) without

acanthosis nigricans and in a group of age and weight-matched controls [normal

cycling (NC) n = 8]. The PCO group was hyperinsulinemic and displayed elevated

insulin responses to an iv glucose load. The binding of 125I-insulin to

adipocytes was similar in cells from PCO and NC subjects. In PCO,

autophosphorylation of the insulin receptor-subunit in the absence of insulin

was normal but a significant decrease (30% below control) in maximal insulin

stimulated autophosphorylation was observed. However, receptor kinase activity

measured against the exogenous substrate poly glu:tyr (4:1) was normal. Cells

from PCO subjects transported glucose at the same rate, in both the absence and

presence of a maximal insulin concentration, as those from NC subjects.

Strikingly, there was a large rightward shift in the insulin dose-response

curve for transport stimulation in PCO cells (EC50 = 87 +/- 14 pmol in NC vs.

757 +/- 138 in PCO, P less than 0.0005); 8-fold greater insulin concentrations

were required to attain comparable glucose transport rates in cells from PCO

against NC.In conclusion, our results suggest that insulin resistance in PCO,

as assessed in the adipocyte, is accompanied by normal function of insulin

receptors, but involves a novel postreceptor defect in the insulin signal

transduction chain between the receptor kinase and glucose transport.

PMID: 1322430 [PubMed - indexed for MEDLINE]

2. http://www.ncbi.nlm.nih.gov/pubmed/6400287

Ultrasound Med Biol. 1983;Suppl 2:603-8.

Ultrasonographic and endocrinological studies of ovarian function.

Geisthövel F, Skubsch U, Zabel G, Schillinger H, Breckwoldt M.

Abstract

Ovarian morphological alterations in 6 physiological menstrual cycles were

studied by sonography and compared to 13 inadequate cycles with a short or

missing luteal phase. In addition, basal body temperature (BBT) and

17-beta-estradiol (E2), luteinizing hormone (LH), progesterone (P),

testosterone (T) and dehydro-epiandrosterone-sulfate (DHEA-S) levels in serum

were measured. Maximal follicle were significantly smaller in insufficient

cycles (17.7 +/- 2.9 mm) than in physiological cycles (23 +/- 2.3 mm). Corpus

luteum (CL) structure was visualized in 5 of the 6 physiological cycles but was

not detected in insufficient cycles. Persistent poly-follicular reaction

(greater than 3 follicles/ovary) without a dominant follicle larger than 10 mm

was detected in the ovaries of 3 patients with clinical and hormonal signs of

polycystic ovarian disease (PCOD).

PMID: 6400287 [PubMed - indexed for MEDLINE]

*** Insulin receptors that work but not quite right and follicles that are

pumping out immature cells in excess numbers sounds a lot like what I've been

reading about in white and red blood cell production problems in magnesium

deficiency. I have many studies relating insulin resistance to magnesium

deficiency. Chromium also helps.

If she was my relative I would encourage magnesium (and iodine). I didn't find

any studies linking an ovary problem to iodine but all glands need iodine. I

think it is involved in pancreas problems and endometreosis. Always use selenium

if adding iodine to reduce risk of hyperthyroid overproduction. that rapid of a

weight change could involve low grade hypothyroidism too. Checking the Basal

Metabolic Temperature by taking temperature first thing upon awaking, before

getting out of bed, three days in a row and average. For women I think the first

days of the new menstrual cycle is recommended. A temp in the 96 range or lower

suggests hypothyroidism.

The only recent article mentioning poly cystic ovarian syndrome found

inconclusive results for use of acupuncture.(2010) (minor cases were helped ,

severe cases weren't)

*** I searched with " PCOS, iodine " instead of " poly cystic ovarian syndrome "

and what do you know but a study of iodine deficiency in men found 30 balding

men with hormonal patterns suggestive of PCOS

3. http://www.ncbi.nlm.nih.gov/pubmed?term=PCOS%20iodine

Endocr Regul. 2005 Dec;39(4):127-31.

Premature androgenic alopecia and insulin resistance. Male equivalent of

polycystic ovary syndrome?

Starka L, Duskova M, Cermakova I, Vrbiková J, Hill M.

Institute of Endocrinology, Narodni 8, CZ 116 94 Prague 1, Czech Republic.

lstarka@...

Abstract

BACKGROUND: Polycystic ovary syndrome (PCOS), the most frequent endocrinopathy

in women with estimated prevalence of 5-10 %, is characterised by a hormonal

and metabolic imbalance of polygene autosomal trait. The complexity of

symptoms and genetic base started up the hypothesis on the existence of male

equivalent of PCOS. Precocious loss of hair before 30 years of age was

suggested as one of the male symptoms of this syndrome.

OBJECTIVES: The aim was to confirm the association of lower levels of follicle

stimulating hormone (FSH) and sexual hormone binding globulin (SHBG) or higher

free androgen index (FAI) in premature balding men with a reduced insulin

sensitivity.

PATIENTS/METHODS: The study included 30 men with premature hair loss (defined

as grade 3 vertex or more on the alopecia classification scale by Hamilton with

Norwood modification) starting before 30 years of age. The hormonal values of

the investigated group were compared with those regarded as normal reference

values obtained in a group of 256 males in the age of 20-40 years during the

Czech population study of iodine deficiency. In all men with premature baldness

besides hormonal level determinations insulin tolerance test was carried out.

RESULTS: The observed group was divided into two subgroups. The first one

showed similar hormonal changes as women with PCOS, namely subnormal SHBG, FSH

or increased FAI. The other had either no anomalies in steroid spectrum or only

lower SHBG. The groups did not differ either in BMI or in age. The group with

hormonal profile resembling that of women with PCOS, showed significantly

higher insulin resistance than the group without these changes.

CONCLUSIONS: The findings are consistent with the hypothesis that at least a

part of the men with premature androgenic alopecia could be considered as a

male equivalent of the polycystic ovary syndrome of the women. These premature

balding men represent a risk group for the development of impaired glucose

tolerance or diabetes mellitus type 2.

PMID: 16552990 [PubMed - indexed for MEDLINE]

**Hair loss is associated with hypothyroidism.

4. http://www.ncbi.nlm.nih.gov/pubmed/21362574

J Pediatr. 2011 Feb 28. [Epub ahead of print]

Sex Hormone-Binding Globulin, Oligomenorrhea, Polycystic Ovary Syndrome, and

Childhood Insulin at Age 14 Years Predict Metabolic Syndrome and Class III

Obesity at Age 24 Years.

Glueck CJ, on JA, s S, Wang P, Stroop D.

Cholesterol Center, Jewish Hospital of Cincinnati, Cincinnati, OH.

5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3039006/?tool=pubmed

Int J Womens Health. 2011 Feb 8;3:25-35.

Treatment options for polycystic ovary syndrome.

Badawy A, Elnashar A.

Department of Obstetrics and Gynecology, Mansoura University, Mansoura, Egypt;

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in

women. The clinical manifestation of PCOS varies from a mild menstrual disorder

to severe disturbance of reproductive and metabolic functions. Management of

women with PCOS depends on the symptoms. These could be ovulatory

dysfunction-related infertility, menstrual disorders, or androgen-related

symptoms. Weight loss improves the endocrine profile and increases the

likelihood of ovulation and pregnancy. Normalization of menstrual cycles and

ovulation could occur with modest weight loss as little as 5% of the initial

weight. The treatment of obesity includes modifications in lifestyle (diet and

exercise) and medical and surgical treatment. In PCOS, anovulation relates to

low follicle-stimulating hormone concentrations and the arrest of antral

follicle growth in the final stages of maturation. This can be treated with

medications such as clomiphene citrate, tamoxifen, aromatase inhibitors,

metformin, glucocorticoids, or gonadotropins or surgically by laparoscopic

ovarian drilling. In vitro fertilization will remain the last option to achieve

pregnancy when others fail. Chronic anovulation over a long period of time is

also associated with an increased risk of endometrial hyperplasia and

carcinoma, which should be seriously investigated and treated. There are

androgenic symptoms that will vary from patient to patient, such as hirsutism,

acne, and/or alopecia. These are troublesome presentations to the patients and

require adequate treatment. Alternative medicine has been emerging as one of

the commonly practiced medicines for different health problems, including PCOS.

This review underlines the contribution to the treatment of different symptoms.

PMID: 21339935 [PubMed - in process]PMCID: PMC3039006Free PMC Article

***Metformin helped people get pregnant but didn't promote live births - net

result - tragedy.

Magnesium and iodine both could help weight loss and glandular function - but

pharmaceutical options look like the going plan of action - glucocorticoids for

example - kill the body that isn't working to satisfaction - give it a couple

years before total immune collapse. a working solution for profit margin to some

people but for someone you love? Hypothyroidism causes infertility and

miscarriages.

Vajda, R.D.

www.GingerJens.com

________________________________

To: rd-usa Listserv <rd-usa >; Dietetics in Health Communities

(DHCC)

Sent: Wed, March 9, 2011 12:15:17 PM

Subject: Need help with newly-dx pre-DM/PCOS

Dear Colleagues,

I have very little experience with DM, and none with PCOS, and am hoping

for some insights, resources, and direction.

My 30-year-old niece is Korean; adopted and raised in the U.S. midwest.

She has just emailed me asking for help. Here is her concern:

" My doctor advised me to consult with a nutritionist b/c I've been asked

to lose about 15-20 pounds in the next 6 months b/c she said I am

showing signs of pre-diabetes. Besides telling me to cut back on the

" bad " carbs and sweets, I don't really know where to start. I am

obviously getting more serious about my exercise program.

" Another important thing to mention is that I was also diagnosed with

polycystic ovarian syndrome. This presents other issues, but it goes

hand in hand with the pre-diabetes it sounds like.

" Do you have suggestions for how many calories I should be taking in?

How to fill up and not feel like I'm depriving myself, etc? I'm

embarrassed to share my stats, but I will if that helps. I'm 5'1 and 150

pounds. Two years ago I was 133 pounds, so I've definitely gained quite

a bit in a short amount of time which I'm not happy about. For me, 133

is a good place for me and my body. I don't think I could be a 110-120

pounds to be honest with my body shape. "

Colleagues, I agree with her that around 130 pounds is probably about

right. Though not tall, she is quite muscular, with large bones and body

frame.

However, in view of dx'd PCOS, I do not know how/where to direct her.

Does anyone know if Monika Woolsey has patient ed materials available?

Any guidance, re pre-diabetes and/or PCOS would be greatly appreciated.

Best regards,

ne

--

" Ask About Nutrition " www.parkinson.org/

" Eat Well, Stay Well with Parkinson's Disease "

" Parkinson's disease: Guidelines for Medical Nutrition Therapy "

www.nutritionucanlivewith.com

----------------------------------------------------------

[Guest guest]

Yes, Monika is the best! She was just on CBS News and you may friend

her on Facebook!

Sent from my iPhone

> Monika Woosely is the PCOS guru- check out her website

> afterthediet.com

> Staci Freeworth MS RD LD CDE

> Sent from my Verizon Wireless BlackBerry

>

> Re: Need help with newly-dx pre-DM/PCOS

>

>

> > Please consider making a referral to another colleague that has

> the expertise. This is a win -win relationship for everyone,

> including you.

> >

> > Good luck. Where is she living?

>

> , a referral is a given. DM is not my area at all, nor is PCOS.

> Plus she lives in a different state (Iowa). I will refer her to the

> ADA

> " Find A Dietitian " site, but was hoping for additional tips or

> resources.

> Best,

> ne

>

>

>

>

[Guest guest]

Yes, Monika is the best! She was just on CBS News and you may friend

her on Facebook!

Sent from my iPhone

> Monika Woosely is the PCOS guru- check out her website

> afterthediet.com

> Staci Freeworth MS RD LD CDE

> Sent from my Verizon Wireless BlackBerry

>

> Re: Need help with newly-dx pre-DM/PCOS

>

>

> > Please consider making a referral to another colleague that has

> the expertise. This is a win -win relationship for everyone,

> including you.

> >

> > Good luck. Where is she living?

>

> , a referral is a given. DM is not my area at all, nor is PCOS.

> Plus she lives in a different state (Iowa). I will refer her to the

> ADA

> " Find A Dietitian " site, but was hoping for additional tips or

> resources.

> Best,

> ne

>

>

>

>

[Guest guest]

Yes, Monika is the best! She was just on CBS News and you may friend

her on Facebook!

Sent from my iPhone

> Monika Woosely is the PCOS guru- check out her website

> afterthediet.com

> Staci Freeworth MS RD LD CDE

> Sent from my Verizon Wireless BlackBerry

>

> Re: Need help with newly-dx pre-DM/PCOS

>

>

> > Please consider making a referral to another colleague that has

> the expertise. This is a win -win relationship for everyone,

> including you.

> >

> > Good luck. Where is she living?

>

> , a referral is a given. DM is not my area at all, nor is PCOS.

> Plus she lives in a different state (Iowa). I will refer her to the

> ADA

> " Find A Dietitian " site, but was hoping for additional tips or

> resources.

> Best,

> ne

>

>

>

>

[Guest guest]

ne,

I invite your niece to visit our network blog, www.incyst.com. I post

testimonials whenever I receive them, just put one up last week from someone

wh's made good progress simply from reading the blog and listening to the radio

episodes.

From there she can link to our Facebook fan page (inCYST Programs for Women with

PCOS) as well as to episodes of our radio program which are very lay-centric. I

even conducted a sample counseling session with a client so women could become

familiar with what to expect when working with a dietitian.

Many of our network members also conduct Skype counseling, she can look through

the list of options at www.afterthediet.com/pcoshelp.htm

I apologize for having things scattered across two different sites; I am

currently working on consolidating everything.

A crucial point of clarification: Weight loss is NOT the primary recommendation

we should be making. Up to 70% of women with PCOS are not overweight and are

practicing disordered eating as an unhealthy attempt at self-medication. Being

overweight does not cause PCOS; it does, however worsen symptoms if they are

there.

The absolute worst thing you can do to your credibility with women with PCOS is

to jump on the preaching weight loss bandwagon. If they could have figured that

out, as smart, well-informed, and hard working as most of them are, they

wouldn't be coming to you asking for help.

Monika M. Woolsey, MS, RD

http://www.afterthediet.com

[Guest guest]

ne,

I invite your niece to visit our network blog, www.incyst.com. I post

testimonials whenever I receive them, just put one up last week from someone

wh's made good progress simply from reading the blog and listening to the radio

episodes.

From there she can link to our Facebook fan page (inCYST Programs for Women with

PCOS) as well as to episodes of our radio program which are very lay-centric. I

even conducted a sample counseling session with a client so women could become

familiar with what to expect when working with a dietitian.

Many of our network members also conduct Skype counseling, she can look through

the list of options at www.afterthediet.com/pcoshelp.htm

I apologize for having things scattered across two different sites; I am

currently working on consolidating everything.

A crucial point of clarification: Weight loss is NOT the primary recommendation

we should be making. Up to 70% of women with PCOS are not overweight and are

practicing disordered eating as an unhealthy attempt at self-medication. Being

overweight does not cause PCOS; it does, however worsen symptoms if they are

there.

The absolute worst thing you can do to your credibility with women with PCOS is

to jump on the preaching weight loss bandwagon. If they could have figured that

out, as smart, well-informed, and hard working as most of them are, they

wouldn't be coming to you asking for help.

Monika M. Woolsey, MS, RD

http://www.afterthediet.com

[Guest guest]

Hi ne and all,

I specialize in PCOS and founded The PCOS Nutrition Center

www.PCOSnutrition.com. I have a lot of information on my site and a

great book for women with PCOS called The PCOS Workbook: Your Guide to

Complete Physical and Emotional Health. I provide phone/skype sessions

and would be happy to help your niece.

--

Grassi, MS, RD, LDN

The PCOS Nutrition Center

551 West Lancaster Avenue, Suite 305

Haverford, PA 19041

www.PCOSnutritionCenter.com

Now Available! The PCOS Workbook: Your Guide to Complete Physical and

Emotional Health, The Dietitian's Guide to Polycystic Ovary Syndrome

with self-study course and PCOS Nutrition Handout CD Series. Sign up

for FREE PCOS Nutrition Tips.

Linked In: http://www.linkedin.com/in/angelagrassi

Facebook:

http://www.facebook.com/pages/The-PCOS-Nutrition-Center/141014599267433?v=wall

Twitter:

[Guest guest]

> Yes, Monika is the best! She was just on CBS News and you may friend

> her on Facebook!

Thanks -- I should have thought of FB; did not know she was on CBS news,

that is fantastic. I will pass this on.

- ne

[Guest guest]

Hi ne,

I was out of the office and emails piled up while I was gone. Sorry for the

delayed response.

It is always a privelege to help someone with PCOS. I know these women have

gone through much before finding us, much of it not helpful, insightful, or

respectful. I hope what we've put together is helpful, and that anything that

is not answered is something you know you can ask us about.

Monika