Acne is such a common issue that people ask a naturopath to help with. It can really affect your self esteem, and in some instances can be painful and uncomfortable.

There’s no magic, quick fix for acne whether you see a naturopath or try the conventional medicine route, and sometimes you have to try a few different approaches before finding what works best for you. Typical timelines are often small improvements within two weeks, and more visible results around 3 months. When treating the underlying causes of acne naturopathically, this can sometimes take even longer, however the benefits of treating these underlying causes are often wide reaching.

As with most naturopathic approaches to health issues, it’s about finding out what the underlying cause of the issue is.

In the case of acne, it’s important to consider that skin is connected to other body systems – in particular the nervous system, the endocrine system (that’s hormones) and the digestive system. Imbalances in one or more of these systems will very commonly cause skin problems.

I’ll talk in more detail about these systems later, how to tell whether they’re the issue for you, and what you can do to help them.

Listen to the audio of this article here

It’s been a hot minute since my last episode of Guts and Girl Bits, I have been occupied with my busy home clinic and I have also been writing some e-courses, which I will talk a bit about later. Of course, I have also been spending time with family, would you believe my youngest Lara is now in Kindergarten? How time flies!

It was almost a year ago I started planning this podcast episode but I got rather distracted by everything else. However I’ve had some spare time to sit down and record, and I am hoping to stay on this momentum and release some more podcasts in the next few months. Please get in touch if you enjoy these podcasts, and if you have any questions or requests for future episodes I’d love to hear from you.

Sorting out your skin issues can be sooo frustrating when you’re doing it by yourself – do I need to go on medication? Does my diet make a difference? Are my hormones out of balance? Maybe this skin product will help? No, maybe this one, no, this one, no this one. Maybe I need a skin peel? Maybe I need laser? Maybe I need to go vegan? Maybe paleo? Do I need to detox? AUUUGH!

Rest assured you’re not alone, soo many women (and I do treat men occasionally to) come to me at their wits end with their acne.

Naturopathic approaches to any type of health condition always stem from one of the core naturopathic philosophies: treat the cause.

What the cause of acne is may vary from person to person, and that’s where a naturopaths consultation questions come in handy – delving into the different body systems like gut health, nervous system health and hormones, and sometimes using functional testing to get to the bottom of it. I’m going to try and give you some clues about it later so you can get a bit of an idea for yourself, and I will also discuss some of my favourite treatment options.

Emunctories

When it comes to root cause medicine, the way that the body is able to eliminate waste is an important consideration for any skin concern.

Naturopathic medicine is built around a set of philosophies, and one of these is the theory of emunctories.

The term emunctories is a bit of a funny word, but it refers to an organ or duct that removes or carries waste from the body.

Traditional naturopaths often consider the theory of emunctories when establishing a treatment plan, they may not use the term emunctories (I do, I think it’s a fun word to say, can you tell, I’m saying it a lot) but we always want the body to be eliminating waste efficiently, and to minimise the burden on our elimination systems. If our eliminatory system is unable to handle the load that is placed onto it, this will cause symptoms to express.

The emunctory system exists in tiers. These tiers will prioritise the primary emunctories, and if that system is overloaded it will progress downwards.

Primary emunctories are the main channels of elimination of the body that we want to be carrying the majority of our waste burden.

The primary emunctories are:

• Sweat
• Through the liver and intestines, passing bowel motions
• Through the kidneys and bladder, urination
• Through our breath

We can support our primary emunctories by drinking adequate water, eating lots of fibre and supporting our gut microbiome, breathing exercises, sweating through exercise or saunas.

The secondary emunctories include the skin and the mucous membranes of the urogenital tract, the respiratory tract, the digestive system. If our primary emunctories are overloaded or not working effectively, then toxins can be excreted through the secondary emunctories. This often shows itself as skin conditions, phlegm, diarrhoea (usually this may be a bit more mucousy).

What can commonly occur is that symptoms that express on this level are treated with suppressants, for example cortisone based creams, decongestants or cough suppressants.

If the secondary emunctories are suppressed or unable to cope, symptoms may start to appear in other areas such as in menstruation, emotions, swollen lymphatic glands, fevers and other irritations of mucous membranes.

So if we were to look at treating acne in keeping with this philosophy of emunctories it would look like this:

1. Making sure you’re eliminating properly through your bowels, by working on your diet and using herbal medicines that support this
2. Using herbs that are classed as ‘depuratives’ – these are herbs such as burdock and clivers, and they help to improve the elimination of the primary emunctories
3. Drinking plenty of water to support kidney function
4. Encouraging good lymphatic flow with lymphatic drainage techniques and exercise
5. Making sure you’re getting your sweat on – exercise or saunas

The importance of the gut

So let’s talk a bit about the digestive system how does that affect acne. It’s no secret that the health of your gut will impact on almost every system of the body, so of course it affects skin. There’s a few ways in which it can do this.

Think back to what we talked about with the concept of emunctories and how important that is. An overburdened digestive system will overburden the emunctories, leading to skin congestion and inflammation. Your skin is like a looking glass to your gut health.

Gut health impacts on hormonal health. Oestrogen has to be metabolised through the liver and bowels, and if that’s not eliminating effectively than oestrogen doesn’t get fully eliminated, instead it gets recycled in a more active form, and too much oestrogen will have a proliferative effect on your acne.

Intestinal permeability, or leaky gut, can cause inflammation, often via histamine excess. Histamine and inflammation will often show up as redness and acne. Histamine will also be driven up by oestrogen, which is why acne may be worse at certain times in your cycle.

One of the subtypes of acne which is caused by a fungal overgrowth often goes hand in hand with an altered gut microbiome.

Gut issues are linked to other types of skin condition as well such as eczema psoriasis and rosacea.

Clues that your gut may a problem for your skin health:

• You experience gut symptoms like bloating, altered bowel motions, IBS, gas.
• You experience fungal infections such as thrush or tinea.
• Your acne flares up after eating certain foods
• Your acne is mostly around forehead, mouth and cheeks.

Improving gut health

The main things that we want to be focusing on when improving your gut function is

• making sure that you’re digesting food appropriately with good levels of digestive acids and enzymes
• ensuring that you have the right balance of gut bacteria, and that you are absorbing your nutrients effectively as well
• supporting the lining of the gut health with herbs and nutrients
• avoiding highly inflammatory foods and any foods that you might be intolerant to as these will aggravate inflammation worsening any type of skin condition.

The nervous system

Does stress cause health issues? I’ve heard this concept dismissed a lot, but I am a firm believer that yes, stress can cause physical symptoms, especially things to do with the skin.

When we’re going through high periods of stress we will experience impacts on our inflammation levels due to an increase in our cortisol and histamine levels, and our reproductive hormones can be affected which increases sebum and keratin production, and increased hormone sensitivity in your skin.

Stress will also impact on our gut health, which will contribute towards skin inflammation and increased chance of skin infections.

Signs your nervous system could be a player with your skin health:

• Feeling like you’re constantly on edge
• Oversensitivity to sensory stimulation e.g. noise
• Brain fog, difficulty thinking clearly
• Poor quality sleep
• You’ve been living off coffee and stimulants
• Feeling out of balance emotionally, anxious or depressed
• Fatigue
• Low libido

How to support your nervous system

1. Make sure you’re doing fun things and laughing, as these are great ways to burn off your stress hormones
2. Try to reduce sources of stress, if that’s at all possible – maybe that might be asking for help with something that is putting a burden on your shoulders.
3. Make sure you’re eating enough – low calorie, and nutrient poor diets can be a source of stress to the body. Similarly for those who are in need of nervous system nourishment, focus more on weight training and low intensity exercise rather than high intensity exercise.
4. Get plenty of sleep
5. Practice screen boundaries
6. Practice mindfulness exercises each day
7. Get someone to talk to, perhaps a psychologist or a counsellor.

Stress can have such a big role on our health that I consider it to be one of the most important things to address. I have created an online group Naturopathic program that provides individualised care in a group setting, focusing on the pivotal factors for a healthy nervous system and adrenal gland health. If you are feeling like your nervous system needs some nourishment, I’d love for you to join me in my program Beat Burnout.

Hormone Balance

One of the most well known hormones that cause acne is testosterone. Testosterone and it’s family of hormones, androgens, cause acne by binding to receptors in the skin, increasing oil and keratin production, resulting in oilier skin with a potential for blocked pores. The bacteria (and sometimes fungi) which causes inflammation in our skin loves to feed on this, so extra fuel for the bacteria means the bugs grow, triggering an immune response in the area, resulting in more acne.

If you have a irregular periods, hirsutism (excess hair growth, such as chin hair) or have been diagnosed with PCOS there’s a good chance that high testosterone levels are a driver for your acne.

If your acne tends to get worse around the time that you are ovulating as well as when you are about to get your periods but then gets better when you start your period that’s a sign that the fluctuating levels of oestrogen are playing a role.

We need oestrogen, it can be our best friend but if we’re not metabolising or excreting it properly then it can elevate histamine, causing inflammation. Oestrogen needs to get metabolised and excreted through the gut to be in a good balance, otherwise it can be too proliferative.

Oestrogen and histamine work closely together when oestrogen is at its highest histamine will follow suit and if you have issues with high histamine that can also cause oestrogen to be high as well.

If you are not ovulating regularly or well, you may not have enough progesterone to counter oestrogen, and lack of progesterone doesn’t help skin health either.

Signs you may have hormonal acne

• Your acne worsens around ovulation or premenstrually
• Acne is located on the chin, jawline, back and chest
• Your period is irregular or painful
• You may also experience PMS symptoms
• You have oilier skin than normal
• You have thicker, coarser or more hair than normal for your genetics

How to assess your hormones

There are several ways to get an insight into your hormones

I am a big fan of using the DUTCH test, which is performed using urine sample to measure hormone metabolites. It can give you insight into not just the overall level of your hormones, but also the quality of metabolism of your hormones, whether they are being metabolised down the friendly or the angry pathways.

Blood tests don’t look at metabolites but they are very useful to get insight into your overall hormone balance. It’s vital to test on specific times in your cycle to be able to make use of these results.

Testing at day 2 or 3 of your cycle (the 2^nd or 3^rd day of your bleed) will give a baseline of low levels. Test FSH, LH and Oestradiol at this time.

After you ovulate, your hormones will start to raise, and usually peaks 7 days after ovulation, so at this time you want to do another test, measuring progesterone and oestradiol.

At either of these tests you will want to also measure testosterone profile (SHBG, androstenedione, testosterone, DHEA, free testosterone), prolactin, thyroid profile and fasting insulin.

If you are on the OCP, the female reproductive tests will not be reliable by thyroid function and insulin can be measured.

Does your diet make a difference to acne?

Yes, it does.

Your diet can affect your skin in different ways but one of the big drivers of acne we know is inflammation and then another big driver for acne as well is your hormone balance.

It makes sense that if we’re eating foods that are inflammatory then that’s going to make your gut health and acne worse. Inflammatory foods may be foods that you are intolerant to, or it may be foods which are generally considered to be inflammatory.

Some of the big ones for that is wheat and dairy. I often recommend cutting out dairy as a first step when you try to address acne because it reduces inflammation and so you could swap that for almond milk or oat milk or rice milk whatever your preference is. Lactose free milk isn’t really going to make that much of a difference because a lot of the inflammation comes from the protein. Some people find that A2 milk can be helpful for them but initially I recommend cutting it out altogether to get an insight.

After inflammatory foods, bad guy #2 is sugar. Sugar, in particular refined sugar and highly processed foods are an issue because it can increase the production of a substance called insulin like growth factor 1 (IGF-1). This acts to increase the hormones known as androgens in our body such as testosterone and what these can do is make our skin produce more oil and keratin. Rewind back to the section on hormones if you need a refresher on this.

Insulin is an important hormone but when we’re eating a high GI diet it’s often going to be making acne worse so aiming for a low GI diet is going to make a big difference there. Imbalances in blood sugar levels can also trigger cortisol and histamine imbalance so you really want to be keeping your blood sugar levels nice and stable.

If you have a blood test that shows up high levels of insulin then this can actually be a marker that you do have a bit of insulin resistance which is a sign that you really need to get your blood sugar levels back under control. Insulin resistance is a leading cause of high testosterone and PCOS.

Now don’t get me wrong sugar is not all bad I am a big fan of fruit and potato but what we want to avoid is foods that have a lot of sugar and have a lot of refined carbohydrates and not much else and so that might look like ice creams, jams, juices, packaged foods, excessive amounts of white breads and pasta, sauces with added sugar, soft drinks, lollies, cakes and other sweets.

The other important dietary consideration is your fibre and water intake. Because one of the goals when supporting skin health is improving elimination through the gut and supporting our emunctories, you want to ensure that you’re getting plenty of water and fibre.

Fungal acne

Let’s talk about fungal acne.

For some people, the cause of their acne is actually fungul.

Some people experience a little bit of a different type of acne that can be more stubborn and doesn’t respond to the typical types of treatments. One of the reasons that this is so stubborn is that because a lot of skin products that are recommended for conventional acne will feed this fungus.

Fungal acne is also known by the term pityrosporum folliculitis – an infection with a type of yeast called Malassezia which lives in the hair follicles and eats our natural oils and any oil that you happen to apply onto it. This type of acne tends to express itself more on your forehead, and may also show up on your back, chest, shoulders and along the hairline and in the T zone.

When tackling this type of acne the treatment goals are to support your immune system, gut microbiome and balance hormonal health.

If you suspect that you have fungal acne, you may like to try an anti-fungal shampoo or cream which, if beneficial will provide insight into your acne cause.

Q&A Transcript

I did a shout out for some questions when planning this podcast:

One of the submitted questions was how to prevent acne coming off the pill and this is such a fantastic question because it’s a really common thing that people consult with me about. If you had acne before you went on the pill there’s a pretty good chance that you’re going to experience some acne when you come off the pill again. Unfortunately taking the oral contraceptive pill doesn’t always fix any underlying issues that might have caused the acne to be there in the first place but what it does a fantastic job of is reducing the oil production in the skin which means that you’re going to have very little acne if any. When you come off the pill this oil production is going to increase and it gets a little bit confused because you haven’t really been making any oil for however long so it’s like hang on how do I do this how much oil do I have to make again and so it goes a bit crazy and usually it’s going to be crazy for around six months or so then it starts to settle down but there are things that we can do to help reduce the intensiveness intensity of the crazy.

So what can you do if you’re about to come off the pill? I recommend starting with cutting down inflammatory foods and for most people I recommend supplementing with zinc. I typically don’t prescribe hormonal regulating herbs for three months after coming off the pill because I want the body to try and set up that communication through that HPO axis itself but what I do like to do is encourage emunctory support with herbs, support liver function to improve the clearance of the contraceptive and to make sure your lymphatic system and your immune system is happy.

Question 2 – How long does it take to fix acne?

How long remedies may take to fix acne will depend on what the underlying cause is.

In my experience the redness and inflammation will settle down within a few weeks, and then the frequency and severity of breakouts reduces, and healing time improves.
It’s different with everyone, and as much as I wish everyone had great results there are some people who take a bit longer to see changes, and some people who get occasional relapses.

On the whole I find 6-12 months a typical length of time until someone is able to ease off the herbs and supplements, they’re feeling good about their skin at this point. If there’s a lot of scarring this then needs to get sorted with a beautician, especially one who does laser treatments for scarring.

Question 3 – Are probiotics helpful for acne?

Yes, I usually do have a focus on gut health when treating acne, especially if it’s on the cheeks. But probiotics can be helpful.

A general reminder with probiotics is that you want to be strain specific. The code at the end of the probiotic name tells you which species it is, and therefore you understand which role it plays.

Some of the strains I look at using are Lactobacillus salivaris ls-03, lactobacillus rhamonsus LL, lactobacillus casei lc03, and some Bifidobacterium such as the breve br03, or the animalis ssp.

Question 4 – My teenager has acne, I don’t want her to go on harsh medications, is there anything that can be done?

Yes of course! Treating teen acne is not too dissimilar to treating adult acne. We want to be balancing blood sugar levels to reduce it’s impact on hormones, and reducing inflammation by cutting down on inflammatory foods such as dairy, and potentially high histamine foods. Supplements can be handy, for instance zinc, vitamin B5, inositol and or berberine rich herbs.

A summary of my favourite treatments for acne:

• A probiotic specific for acne health
• Balancing mineral health – typically this may be zinc, but in some cases copper may be needed. You can use a HTMA to assess mineral levels
• Support gut function with gut healing nutrients and diet
• Lower inflammation by eating a low dairy, or low histamine diet
• If hormones are out of balance you can address this. Here is where it gets a bit more individual. Ensuring good ovulation is an important first step. Some common nutrients I provide for this is inositol which supports blood sugar level balance and ovulation. Zinc has an anti-androgen effect and can be helpful.
• Balancing omega- fatty acids through diet, and potentially supplements.
• Herbal medicine to support emunctories, stress levels and hormone balance, as well as reduce infection and support immune health. Some common herbs I opt for are Coptis, which is rich in berberine, Chaste tree, if indicated for ovulation, Withania for stress support, burdock as an emunctory support.

Thank you for listening, if you have enjoyed this episode please leave a review, subscribe if you haven’t already and as always feel free to get in touch.

The post A Naturopath’s Deep Dive Into Acne appeared first on Alison Mitchell Naturopath.

PCOS, also known as Polycystic Ovarian Syndrome is a complex condition that can significantly affect a woman’s quality of life. One of the biggest ways it does this is by impacting on a women’s ability to conceive and maintain a pregnancy, but it can also impact a woman’s self-esteem by making it difficult to lose weight, it causes acne and hair issues, such as too much hair where a woman doesn’t want it to be, and potentially thinning of scalp hair.

Of course, there is more to it than that, but those are the major things that women report as the issues they’re most upset by.

In this article and podcast I will discuss the lack of awareness and poor understanding surrounding PCOS, how it is often misunderstood and why its name has a role in this. I discuss the common, and not so common signs and symptoms of PCOS and talk about the driving factors that can cause PCOS to develop. I talk about how PCOS is often diagnosed and discuss some of the key ways PCOS can be addressed naturally.

You can listen to this article on the podcast links below, or in the embedded player.

iPhone   Stitcher   Youtube   Soundcloud  Spotify 

Understanding PCOS

Lack of awareness

Sadly, but not unexpectedly there is a lack of awareness and understanding of PCOS, with many people who have not been diagnosed not aware of the condition at all, but also women who have been diagnosed, and some health practitioners as well, not properly understanding the condition. A big part of this lack of awareness is the lack of research into the condition, but also I believe it is part of the bigger picture of gender bias in medicine, and many conditions that are specific to women do not have the attention they deserve, perhaps the exception being breast cancer. One of the other things that doesn’t help this lack of awareness and understanding is the name of the condition itself – polycystic ovarian syndrome.

The name makes a few false implications which cause overall confusion – so here are a few points I want you to know:

1. The condition doesn’t originate in ovaries and the condition is not all about ovaries either, after menopause, the condition can persist. It is more of a metabolic condition, with systemic high androgens and insulin resistance being the core drivers.
2. A PCOS ovary doesn’t actually have ‘cysts’, rather what you can see on ultrasound is immature follicles. Follicles are the little sacks that your oocyte, or eggs sit in waiting for the hormones from the brain to tell it to mature and then ovulate. The issue is these follicles in PCOS is they aren’t developing properly, so if we got them to develop fully these so-called cysts would be a baby (if met with a sperm).

A new name?

Many physicians and researchers have proposed a name change for PCOS, however, that was being proposed in 2013 and it’s 2020, so who knows when that will happen. I agree the condition does need a name change, as I feel PCOS is not a good representation. One of the names suggested which I like is ‘metabolic reproductive syndrome’, however other names suggested were Poly-follicular ovarian syndrome with metabolic dysfunction and/or hyperandrogenic manifestations (PFOS-MD and/or -HM).

The list of potential signs and symptoms is long for PCOS, which explains why there are so many women out there that don’t know why they have the symptoms they do.

PCOS Symptoms

Most common symptoms of PCOS include:

• Irregular periods or absent periods
• Acne
• Weight gain
• Excessive hair growth, also known as hirsutism. This can vary in locations and intensity and it will also be different dependant on your nationality.

Less well known, but still common symptoms:

• Anxiety and/or depression
• Fatigue
• Brain fog
• Skin tags
• dark patches on the skin
• low libido
• Sleep disturbances and snoring (Sleep apnoea can also be more common due to the higher level of androgens. Poor sleep can worsen PCOS by worsening insulin resistance.)

And more than that, there are other complications, especially regarding fertility and baby’s health. The higher levels of androgens can increase the risk of miscarriage and are also linked with some increased risk for baby such as higher birth weight. Women with PCOS also tend to have difficulty with breastfeeding and a higher risk of diabetes after birth.

Thankfully, many of these risks are modifiable by correcting the underlying causes of PCOS, which I will discuss later.

Causes of PCOS – How does the switch get turned on

There are different ways PCOS can express, and for these different subtypes, there are different causes.

The main cause is insulin resistance, which causes the male hormones androgens to become high. Insulin, when it is too high, can trigger more production of testosterone, but it can also lower the amount of SHBG (sex hormone-binding globulin) which means our bodies can’t bind up the excessive testosterone as well, and so more is circulating our body, causing the symptoms of PCOS such as acne and hair issues. Insulin excess also affects our FSH : LH ratio which is important for ovulation, and high testosterone stops our follicles from maturing completely, so this means woman’s ability to ovulate is affected, and if that is affected their chances of conceiving is reduced, and oestrogen and progesterone balance is also affected.

There are different types of androgens, such as testosterone, DHEA and androstenedione, and depending on which one is elevated we can get an idea of what is driving your PCOS. For instance, if DHEA is high, we know that stress is a big driver.

It is also possible to have PCOS without insulin resistance and this is typically due to inflammation. this is a much rarer subtype, but certainly something to consider.

Something else to consider is your gut health can play a role in both hormone balance and metabolism. Your gut bacteria are responsible for so many things in the body, and if you’ve listened to my previous podcasts or read some of my other blog posts you’ll know that your microbiome is of vital importance in improving health. How does it affect PCOS? Well, if your microbiome is out of balance it can affect your metabolism, which can worsen insulin resistance. And an out of balance microbiome can also cause hormone problems, by allowing more of your ‘bad’ hormone metabolites to cycle back through the body.

Why do you have a PCOS ‘switch’ in the first place?

We know there is a genetic component to it, and there is some possibility that your genetic likelihood can be influenced by exposure to endocrine-disrupting chemicals in past generations, substances that are passed through generations. So effectively, what chemicals and diet your Grandmother was exposed to will impact your risk for PCOS.

This transgenerational effect has been demonstrated in animal studies when mice were fed an obesogenic diet and were given substances that mimic a high androgen state to bring about a metabolic state of PCOS, and it was found that their subsequent generations also expressed this condition.

It was also found that women with PCOS had levels of chemicals in their system that were not in use anymore and was found to have been passed through in utero from their mothers and grandmothers.

These chemicals are increasing the activity of the androgens and also acting as obesogens, contributing to the weight gain and insulin resistance.

Diagnosis issues

So how common is PCOS? The prevalence is about 8-13%, effectively 1 in 10 women. But it is a condition that is it is both over-diagnosed in young girls, and under-diagnosed in older women.

One of the issues in getting diagnosed is that there isn’t one specific diagnostic criteria, so you can get mixed messages.

Three main diagnostic criteria exist- the National Institutes of Health, the Rotterdam criteria and the Androgen Excess Society criteria.

All of the criteria require all other possible endocrine disorders to be excluded.

My criteria of choice is the Rotterdam diagnostic criteria. It requires a female to have two of these three criteria:

1. Irregular periods
2. Clinical and/or biochemical hyperandrogenism
3. “Polycystic ovaries”

Many young girls are being prematurely diagnosed with PCOS. But it is normal for young girls to present with some symptoms of PCOS and this often resolves in a few years without intervention. It can take 3-6 years for a menstrual cycle to regulate itself, however if there is early intervention this can prolong this process, and it is thought that the most common recommendation given at this time – the oral contraceptive pill (OCP) can worsen insulin resistance, which perpetuates the condition.

What are the other causes that need to be excluded?

This could be conditions such as Cushing’s, Adrenal tumours or congenital adrenal hyperplasia. Screening would include blood tests for TSH, prolactin, FSH and anything else your practitioner feels warranted based on your signs and symptoms.

PCOS and Teens

Getting back to teenage girls and their periods, it’s not uncommon for girls to have irregular periods when they’re young, and this will usually regulate itself within 6 years. My personal preference in clinic is to not interfere with hormones in young girls but to allow their bodies to regulate themselves. If hormones are interfered with too early, then it will typically delay the regulation until later. This is relevant to not just herbs, but especially to things such as hormonal contraceptives.

A common understanding is that women with PCOS literally have cysts on their ovaries. But this isn’t the case, as the name implies. the polycystic ovarian appearance that some (but important to note, not all) women have on ultrasound is actually a higher count of immature eggs within their follicles. These eggs aren’t getting the signal from the brain to mature further, triggering ovulation and release.

If you can remember the diagnostic criteria, the presence of 2 of the 3 criteria is what it takes to get diagnosed, so if a woman has irregular periods and signs of high androgens, she can have PCOS without the presences of any ‘cysts’ on her ovaries at all.

A more positive perspective.

One of the perspectives I have heard before about PCOS which I love is that this is an evolutionary trait which in years gone by was protective. if you consider that being pregnant and giving birth was a life-threatening thing at worst, and a depleting event at best, it can make sense why a condition like PCOS which can reduce one’s fertility may be protective in tough times. Insulin resistance is beneficial in times of scarcity as it allows you to store more of the energy from foods, which in famine times if beneficial. In times of plenty such as now, this, unfortunately, works against us. In a time without contraception, women may have gone from one baby to the next without a break, which can be quite a high level of stress and depletion. So, for women with PCOS who have longer times between ovulation, and so fewer opportunities to conceive, this could be considered a positive thing. Nowadays this might not be much comfort especially if you’re wanting to conceive, but I believe anytime you can view your health from more a positive light it is beneficial, so ladies with PCOS you might like to shift your frame of thinking to more of an ‘I’m a survivor’ mindset.  

Other considerations for PCOS

Sleep

Sleep disturbances are reported to be twice as likely for women with PCOS. Studies show found that women with PCOS are more likely to report difficulty falling asleep, to have restless sleep occasionally and often feel severely tired. Sleep problems also occurred in women with PCOS who were in the normal weight range.

It’s still unclear how PCOS affects sleep but we know that the metabolic impacts of the condition play a big role. The hormones melatonin and cortisol are responsible for our sleep cycles to a large degree and these are strongly influenced by insulin resistance and elevated testosterone, as well as the stress placed on the body if obese.

Sleep apnoea is also often reported in women with PCOS, more often in those who are overweight. In those people who are considered to be ‘severely obese’, (BMI >40kg/m2) the prevalence of sleep apnoea in both men and women can be as high as 92%.

The mental health impacts of PCOS which is an increase of anxiety and depression have a bidirectional association with poor sleep quality and insomnia.

Weight loss and exercise is one of the best ways to improve sleep quality in women with PCOS, and if needed there are herbal medicines which can be of support.

Nutrients such as magnesium and calcium and the amino acid l-theanine can also be supportive to calm the nervous system and promote relaxation and sleep.

PCOS and Mental Health

Women with PCOS have higher rates of anxiety and depression. PCOS can be a very distressing condition for many women and this varies from person to person, with some of the highest reported contributors to the anxiety and depression is the impact to fertility, the impact on physical appearance and self-esteem such as weight issues, hirsutism and acne, and also the frustration about the lack of a clear cut solution, and a lack of awareness and understanding of the condition. There was a study that found that women with PCOS were physically active reported less depression and anxiety than those who were inactive. So, while I love to use herbal medicines to support mood and the nervous system, I do frequently recommend exercise to support mood in women with PCOS.

Potential pregnancy risks

There are a few things to consider when trying to conceive, as women with PCOS have an increased risk of some complications during pregnancy. The good news is that if PCOS has been treated, these risks return to almost the same levels as women who do not have PCOS. The risks include an increased likelihood of developing gestational diabetes, pregnancy-induced hypertension and preterm birth, and an increased risk of neonatal complications.

The increase in birth weight of babies born to women with PCOS also suggests an increased likelihood of c-section deliveries.

The treatment used in the study I mentioned before was anti-androgenic therapy, which means correcting hormonal balance before conceiving will improve pregnancy outcomes.

one small study looked at the incidence of gestational diabetes in women with PCOS and found the prevalence was 30.2%, and that these women had impaired blood sugar levels after having their babies. What we can take from this is that PCOS can have a long term impact on glucose metabolism, and again it highlights how important it is to try and take steps to improve your hormones and blood sugar level balance before conceiving.

I recommend that all couples do a preconception care program before conceiving, which at a minimum entails taking a high quality preconception care nutrient complex for 3-4 months before conceiving but if there are hormonal imbalances its important to work on this with a practitioner before trying to conceive.

Complications with breastfeeding

A lesser-known complication with PCOS is that it can cause some difficulties with breastfeeding and milk supply – however, this can also be supported by working on hormones before pregnancy, and with the support of a lactation consultant after birth. Thankfully not all women with PCOS experience difficulties breastfeeding and the information that says it is potentially problematic is only based on small studies. In the research that we do have available, the breastfeeding difficulties were only experienced in the first 3 months and seemed to regulate after that time.

Breastfeeding requires the hormones prolactin and oxytocin to work properly, but we also need adequate progesterone during pregnancy for the breast tissue to develop properly. Insulin resistance and high androgens can affect hormones in all these aspects.

How to manage PCOS

There are so many options for treating PCOS, and as it usually the case with naturopathic remedies, you get the best results when you are treated holistically. This means considering various things like what exactly is happening with your PCOS subtype.

The information I am giving you is a starting point to take to your practitioner to discuss whether it is right for you and to give you hope that there are so many possibilities to help.

while there have not been studies finding some remedies that tend to be universally helpful for most PCOS sub-types, and one of that does seem to be of great benefit is the amino acid Inositol. Taking 2g twice a day is my recommended dose for this.

Diet and lifestyle changes are great for treating insulin resistance, and while it’s tricky to find research specifically for this in PCOS we know it helps address the cause.

I recommend 150 minutes of exercise a week, which can be split into small blocks of exercise such as 30 minutes 5 times a week, or larger chunks such as 50 minutes three times a week. Eating a low GI/GL diet is also very important to address insulin resistance, and having a diet rich in antioxidants and low in inflammatory foods is also very helpful.

If you are overweight and have PCOS, then aiming to lose 5-10% of your body weight is a fantastic goal, and this amount seems to be the magic number that improves fertility rates and reduces risks for diabetes. Losing weight ideally would be done through a combination of diet and exercise.

Nutrients such as magnesium, b vitamins, particularly activated B vitamins, vitamin D and chromium can also be helpful.

Omega-3 fatty acids such as fish oil or algae oil can also help with some of the components of PCOS such as high cholesterol and inflammation.

Other herbs that I would consider is Berberine containing herbs such as Phelledendron which helps with improving insulin resistance and regulates blood lipid levels. There is also evidence showing that Black Cohosh can be helpful alongside other PCOS treatment.

The combination of Peony and Licorice has been looked at in Chinese medicine studies, and this is still a good inclusion in treatment, depending on the individual. Bulgarian Tribulus can also be helpful to regulate ovulation.

Spearmint can be helpful to reduce excessive androgens. I like this when used in a tea and is why I included it in one of my tea blends that supports skin health, to address this aspect.

Supporting gut health is also very important, as a poor microbiome can impair metabolism and worsen inflammation. So eating a diet rich in vegetables with lots of diversity is fantastic for improving the flora diversity in the gut, but it can also be helpful to take probiotics or prebiotics, so discuss this with your practitioner to make sure you’ve got the right type for you.

References

Bahri Khomami, M., Boyle, J. A., Tay, C. T., Vanky, E., Teede, H. J., Joham, A. E., & Moran, L. J. (2018). Polycystic ovary syndrome and adverse pregnancy outcomes: Current state of knowledge, challenges and potential implications for practice. Clinical Endocrinology, 88(6), 761-769. https://doi.org/10.1111/cen.13579

Bahri Khomami, M, Joham, AE, Boyle, JA, et al. Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—A systematic review, meta‐analysis, and meta‐regression. Obesity Reviews. 2019; 20: 659– 674. https://doi.org/10.1111/obr.12829

Fernandez, R. C., Moore, V. M., Van Ryswyk, E. M., Varcoe, T. J., Rodgers, R. J., March, W. A., Moran, L. J., Avery, J. C., McEvoy, R. D., & Davies, M. J. (2018). Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nature and science of sleep, 10, 45–64. https://doi.org/10.2147/NSS.S127475

Guerrero-Bosagna C, Weeks S, Skinner MK (2014) Identification of Genomic Features in Environmentally Induced Epigenetic Transgenerational Inherited Sperm Epimutations. PLOS ONE 9(6): e100194. https://doi.org/10.1371/journal.pone.0100194

Guo Z, Qiu H, Wang L, et al. Association of serum organochlorine pesticides concentrations with reproductive hormone levels and polycystic ovary syndrome in a Chinese population. Chemosphere. 2017 Mar;171:595-600. DOI: 10.1016/j.chemosphere.2016.12.127.

Holton, S., Papanikolaou, V., Hammarberg, K., Rowe, H., Kirkman, M., Jordan, L., McNamee, K., Bayly, C., McBain, J., Sinnott, V., & Fisher, J. (2018). Fertility management experiences of women with polycystic ovary syndrome in Australia. European Journal of Contraception and Reproductive Health Care, 23(4), 282-287. https://doi.org/10.1080/13625187.2018.1483020

Mo L, Mansfield DR, Joham A, et al. Sleep disturbances in women with and without polycystic ovary syndrome in an Australian national cohort [published online December 26, 2018]. Clin Endocrinol (Oxf). doi:10.1111/cen.13922

Rosenwaks, Z. (2017). Polycystic ovary syndrome, an enigmatic syndrome begging for a name change. Fertility and Sterility, 108(5), 748–749. https://doi.org/10.1016/j.fertnstert.2017.09.030

The post A Holistic Guide to PCOS appeared first on Alison Mitchell Naturopath.

Polycystic ovarian syndrome is a condition that is affecting more and more women and girls – it affects 1 in 7 women worldwide making it one of the most common endocrine disorders to affect women of reproductive age.

This is one of the most common conditions that I see in our clinic, as women are usually frustrated by the lack of conventional treatment options available to them.  Unfortunately, this condition is often incorrectly diagnosed and misunderstood in a lot of women. It is also being increasingly diagnosed in young girls – often unnecessarily

It really seems that PCOS is becoming an epidemic, and information about this condition is greatly lacking!  PCOS is a 20th century condition, along with the increase of heart disease, diabetes and obesity.  And the reason they are all increasing together is because they are all being (mostly) caused by the same things.  We’ll get into what that is later, but first we should cover what PCOS actually is.

The name poly-cystic ovarian syndrome implies that the main feature of the condition is the presence of small cysts on the ovaries, however with current diagnostic criteria this is actually not required for a diagnosed, and not all women with PCOS have cysts on their ovaries.  This is just one of the possible symptoms that makes up this condition.

In this article I wrote for Western Sydney Mum’s Hub I discuss what PCOS actually is, as well as outline the symptoms of PCOS and debunk some myths. I also talk about the causes of PCOS, and my key natural treatments.

PCOS SYMPTOMS

Symptoms may include:

·       Irregular or absent periods

·       Insulin resistance (high insulin levels picked up in a blood test)

·       High testosterone (androgen) levels in a blood test

·       Hirsutism (Excess hair growth, usually in areas such as the lip, arms, lower back)

·       Acne

·       Sugar cravings

·       Blood sugar fluctuations (e.g. feeling irritable or dizzy if you skip a meal)

·       Weight gain or difficulty losing weight, especially from around the middle

·       Ovarian cysts (picked up by ultrasound)

·       Thinning head hair

·       Painful periods or pain on ovulation

·       Fertility problems including difficulty conceiving and increased miscarriage rates

·       Skin tags

·       High cholesterol levels

Diagnosis

The condition is diagnosed differently according to different criteria, however most commonly it is by the presence of 2 of the following 3 factors:

·      Irregular or absent ovulation/periods

·      High androgen levels (the male hormone) found in blood tests

·      Symptoms of high androgen levels such as hirsutism and acne.

·      Other conditions which cause these symptoms must be ruled out.

LET’S CLEAR UP SOME PCOS MYTHS

1. 1. Having cysts on the ovaries is not the main way of diagnosing PCOS. Not all women with PCOS have cysts, and as a stand-alone symptom having cysts on the ovaries isn’t enough to diagnose PCOS.
   2. It’s normal for cysts to grow on the ovaries – these are actually your ovarian follicles (or eggs) growing and releasing, however in PCOS these do not grow properly and this is what can result in the typical appearance of a PCOS ovary.
   3. PCOS doesn’t always affect your fertility negatively. This understanding is mostly based on people with severe cases of PCOS and so the understanding of to what degree it affects the fertility of those with milder forms of PCOS is lacking.
   4. You aren’t always stuck with PCOS for life. Many young girls who are diagnosed with PCOS can grow out of this condition by the 30s.
   5. The oral contraceptive pill is not the best way to treat PCOS. Yes it can bring on a regular, predictable bleed, but remember that this is not a true period, and the pill can make the condition worse after stopping.
   6. If you get period pain it is not due to PCOS – there is likely something else going on that is contributing to the period pain such as endometriosis or primary dysmenorrhea (the fancy term for period pain not attributed to an obvious cause). It is possible to have both endometriosis and PCOS.
   7. Thin women and girls can have PCOS too, and can still have insulin resistance.

Top causes of PCOS

Insulin Resistance

Nearly all cases of PCOS have insulin resistance.  Insulin resistance is when the cells have difficulty taking up glucose from the bloodstream, often resulting in an increased secretion of insulin, which worsens the symptoms of PCOS.

Even if your blood sugar levels are normal, you can still have insulin resistance. It is vital that insulin levels are tested too, but they aren’t always automatically done, so you may need to ask.

As I was mentioning earlier, I believe that insulin resistance is the link between these 20^th century conditions.   Insulin resistance can be a genetic problem, but the food choices that we make play the biggest role in the development of this condition.  Highly processed foods, refined carbohydrates and excess sugar are the evil culprits that lead to the development of insulin resistance by causing our blood sugar levels to be elevated over a long period of time.  Insulin is a hormone that is secreted by the pancreas in response to high blood sugar levels.  Its job is to put the sugar into the cells.  When the levels of sugar in our blood are high for an extended period of time, insulin is produced more and more, and our cells begin to ignore it (like in The Boy Who Cried Wolf).  This leads to high circulating insulin, and this is where the problem comes from.

Insulin is known for its ability to lower blood sugar levels.  The way that insulin does this is by storing the sugar in the form of glycogen – but the body can only store so much of this, and when it’s full the sugar gets stored as fat (most commonly in the abdomen, causing the typical apple body shape).

High androgen levels

Androgen are a group of hormones that includes testosterone. They may be called ‘male hormones’ but both men and women produce androgens, just in different amounts and with different actions.

There are a few different types of androgen markers that are tested in blood tests, including total testosterone, SHBG, androstenedione and DHEA.

For most women with PCOS the insulin resistance is usually the biggest issue which causes high androgen levels. However, for some (approximately 20%), high androgen levels may be present unrelated to insulin resistance, and this is most often due to stress.

Other causes

Sometimes there can be some less common causes of PCOS. This can include nutritional deficiencies (such as iodine or zinc), inflammation and thyroid disorders. For some women they may have developed PCOS because of taking the oral-contraceptive pill. Often this will resolve within about a year (herbal medicine can reduce this time frame to 3-4 months).

Key Natural Treatments for PCOS

What treatment is used for PCOS depends on the underlying cause and a practitioner can guide you further on this. These are some of my favourite treatment tools:

1. Test for and treat insulin resistance, typically with an exercise regime and a low-GI diet (you can read some tips for a Low GI, Nutrient Dense Diet here).
2. Cut out/down sugar in the diet.
3. Cut out/down dairy.
4. If androgen levels are high without insulin resistance, herbs and nutrients that can reduce the excess of this hormone include Saw Palmetto, Peony and Licorice, and the mineral Zinc.
5. If DHEA is high or there is a lot of stress around the time of puberty or currently, herbal medicine to support the nervous system such as nervine and adaptogen herbs, the mineral magnesium and B vitamins can be helpful.
6. The amino acid myo-inositol is helpful for supporting blood sugar levels and reducing anxiety and can be a great tool in the kit to treat PCOS.

If you or your daughter has been diagnosed with PCOS or you suspect that this may be an issue for you, seek advice from a naturopath experienced in this area as there is much that can be done to help.

The post Busting the PCOS Myths appeared first on Alison Mitchell Naturopath.

Are hormone imbalances affecting your ability to lose weight?

Did you know that hormonal imbalances can cause us to gain weight?  Most people know that if their thyroid gland isn’t making hormones correctly they can start to pile on the kilos, but some other lesser known hormones can do this as well such as our stress hormone cortisol.  Another interesting aspect of hormonal problems causing weight gain is that they often target specific areas of our body.

If you’re trying to lose weight but finding yourself struggling despite doing all the right things, it might be time to investigate if your hormones are sabotaging your efforts.   Below I will cover some of the key hormones that can be involved, how to identify if they’re out of balance and what to do about it.

In the next newsletter I will cover some of the other issues that can affect your abililty to lose weight that aren’t because of hormones.

Stress

When we are stressed our adrenal glands produce more of the hormone cortisol.  This was originally designed as a reaction to help us run away from the hungry tiger, but now when the cortisol is being produced from our work, family and financial stress it’s so as helpful.  Excess levels of cortisol can cause fluid retention, bloating and weight gain around the neck, trunk and abdomen.  Women with higher levels of this hormone have been shown to have larger waists than those women with normal cortisol levels.

If stress is severe or prolonged, it can cause chronic elevation of the hormones cortisol and adrenaline and this can result in weight gain, most likely due to our body thinking we need to stock up on nutrients to deal with famine or heal potential injuries.  Some people may get certain food cravings in times of stress, and this can impede weight loss, especially if you are cravings sugary or fatty foods.

Stress can be assessed not only by how you feel and the stressful events that you have been through, but also by testing the function of your adrenal hormones by a saliva test.  Our cortisol levels should rise moderately in the morning, then gradually reduce throughout the day.  I often find that cortisol is too low in the morning (which causes fatigue), then too high in the afternoon (causing cravings) and still high at night (causing sleep problems).

If you are experiencing high levels of stress then a treatment program combining herbal medicine and high quality nutritional supplements designed to balance the adrenal glands and help improve your ability to cope with stress will help to balance the cortisol levels and also reduce food cravings, therefore improving weight loss.  This works best when combined when targeted to the results of a cortisol test, as the herbs can be given at the times we know you need to be balanced.

Thyroid Disorders

Thyroid imbalance can strongly affect metabolism and make it difficult to lose weight.  Approximately 6-10% of women have hypothyroidism.  However, the prevalence increases with age and up to 25% of women aged 65 years or older may be affected.  Men are also affected, but less frequently.   People with an underactive thyroid may experience weight gain, fluid retention, bloating.  An overactive thyroid usually causes weight loss, oily skin and an increase in irritability.  In some cases the symptoms can be the opposite.  The different symptoms are covered in the table below.

Thyroid imbalance is very common in post-menopausal women and often goes unnoticed.  A blood test by your doctor can assess your thyroid levels, but the range of what is considered normal thyroid hormone levels is very broad and so all too often people are told their thyroid is normal, yet they are showing signs of a struggling thyroid and metabolism.  Research has shown that even a small increase in TSH, the main thyroid hormone tested in blood tests, can lead to weight gain.   By combining information from your blood test results with your symptoms, a basal body temperature chart and/or an iodine test we can help to put the picture together of whether your thyroid is working as it should.

If you have an imbalance in your thyroid function, consult a naturopath for a treatment plan to correct its functioning and bring your metabolism back on track.

Insulin resistance

Insulin resistance, also known as Syndrome X is a metabolic disorder which affects insulin and blood sugar level metabolism.  In individuals with insulin resistance your body cells’ insulin receptors have become resistant, which leads to high levels of circulating insulin.  If left unmanaged, this syndrome can develop into diabetes.

People with insulin resistance tend to carry weight around the abdomen (visceral fat).

Insulin is tested via blood.  You have to ask your doctor for this test, as it isn’t performed in routine check ups.  If your insulin level is 10 or greater this is suggestive of insulin resistance.

Insulin resistance makes it very difficult for you to lose weight successfully.  The best way to tackle insulin resistance is a combination of exercise, diet modification and nutritional supplementation.

Polycystic Ovarian Syndrome (PCOS)

PCOS is a very common condition in women and presents with several symptoms such as excess hair growth (hirsuitism), acne, irregular periods, and difficulty losing weight.  This condition is usually caused by a combination of insulin resistance, excess androgens and low levels of progesterone.

Naturopathic treatment can help to treat PCOS by regulating hormone levels and treating insulin resistance.  Once the insulin resistance and hormonal levels are improved, weight loss can occur more easily.

Oestrogen Dominance

High levels of the hormone oestrogen can cause several health complaints such as endometriosis, breast tenderness, pre-menstrual syndrome and period pain, however it can also affect your weight.  Too much oestrogen encourages fat and cellulite to build up around the highs, thighs and buttocks.

In women with oestrogen dominance, herbs and nutrients that boost progesterone and support liver function can help fat loss to occur more effectively from areas that you want, instead of the face and breast area (which women usually don’t want to lose).

Hormones can be tested via blood or saliva.  Saliva hormone testing is able to identify imbalances more easily than blood, however is more expensive than blood tests which can sometimes be covered by Medicare when ordered by a doctor.  Hormone testing can help identify PCOS, Oestrogen dominance and testosterone deficiency in males.

If you feel like you have one or more of the above issues that is affecting your ability to lose weight, make an appointment to see how we can help you.  We will go through your case history and can suggest which factors may be relevant for you, and can discuss your testing options with you.  Once we have identified what is happening we can create a treatment plan to naturally and safely balance your hormones.

The post Internal Barriers to Weight Loss – Part 1 appeared first on Alison Mitchell Naturopath.