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Baby Ian is now 6 months old and I am JUST starting to get my life back in order again in terms of meeting my long term health goals.  I promised myself when I first started this experiment that I would not abandon my health and wellness goals once I was no longer seeking pregnancy.  I’ve been enjoying reading back through this blog to remind myself all of the wonderful meals I created and lifestyle choices I made to get the fertility results I was after.  As it turns out, I don’t think they are all that different from what my new, “post baby” health plan should be.  After all, I still have PCOS and Celiac Disease, and will for the rest of my life.  It’s time to start thinking about my health for the long term and how to stay trim, healthy, happy, and vital as I age.  I recently saw an interview with Deborah Szekely, one of the founders of the health and wellness movement, who just turned 90 years old this week.   Not only did she look great, but she was as eloquent and vivacious as someone half her age.  What a testament to practicing what you preach, but really, what an inspiration!  I’m 35 now, and so I will set my health goals at living to 100+ years old.  That leaves 65 years, or 780 months.  I hear-by rename this blog, My 780 month PCOS Experiment.  To christen the name, I’m going to round-up and share all of the new health/wellness information I’ve come across recently as this passion of mine has slowly emerged in importance again in my post pregnancy life.

1) A more nutritious and PCOS friendly gluten free bread

I’ve often been dismayed at how refined and lacking in nutrition most commercially available gluten free breads are.  And when you look at the carbohydrate content, it’s not something a woman with PCOS should be eating either.  After some searching around, I came across a woman’s website, http://www.elanaspantry.com/, who has developed many gluten free baking recipes using primarily almond flour.  She also uses coconut flour and several types of alternative sweeteners that I’ve grown to like.  I’ve taken her “Paleo” bread recipe and adapted it for myself and I’m really happy with the results.  It is packed with protein and has almost no carbohydrates.  It’s easy to make, nutritious, and filling.

2) Grain Free Diet

The woman I mentioned above, Elana, is a celiac, but she also has Multiple Sclerosis, and has developed her own grain-free, healing diet that keeps her symptom free.  I was not aware before reading her website that many people with Celiac Disease and other kinds of auto-immune disease do better with no grains in their diet, in addition to avoiding the gluten producing ones.   I also found out on her site that both Celiac Disease and Diabetes have the same gene in common and so it makes a lot of sense that I have insulin problems/PCOS AND Celiac Disease.   The diet that I followed at the beginning of this experiment was primarily grain free, as well as low carb and low sugar and obviously I did very well with this way of eating, so I am going back to it, but with renewed vigor as I now better understand the hows and whys.  I do want to mention that it is not a “Paleo” diet though.  I eat dairy and beans and probably all sorts of other things that are not allowed on the Paleo diet.  It’s simply a diet that I have tailored to my own, particular health needs.

3) Xylitol

Xylitol is a natural sweetener that is primarily derived from birch trees (and the fiber of other fruit and vegetables).  It’s low in calories and carbs unlike sugar and it also does not affect blood sugar the same way sugar does.  I’ve been a big fan of agave nectar in the past as my alternative sweetener of choice, but with the recent studies showing a correlation between fructose and high triglycerides, I have decided to limit my use of it, as it is a “high fructose” product.  I am REALLY picky about my sweeteners, as I cannot stand that weird artificial aftertaste that many, even natural, sweeteners have.  I don’t use stevia for that very reason.  Xylitol tastes very much like cane sugar to me.  Xylitol has many other health benefits though that I am also very interested in.  When ingested, it creates an environment in your mouth that is not welcoming to the bacteria that cause plaque and so it can do wonders for one’s oral health if used in sufficient quantities over time.  In fact, it can help remineralize your teeth, virtually healing them from within.  It’s been shown to do the same things for bones too.  There is also research that shows that it prevents ear and respiratory infections.  It’s amazing to me that there is such a product out there that I am only recently hearing much about.  My whole family is using it now with great results.

4) Unsweetened, unflavored protein powder

I’ve been looking for a protein powder that I can add to baked goods and smoothies to boost protein without adding a flavor (vanilla for example) or any sweetness (such a stevia).  Both hemp and pea protein powders were recommended by Dr Frank Lipman.  I found hemp powder at my store, and I can say that so far I am really happy with it.  It has a very mild and pleasing natural flavor and I like the green color too – it just “looks” healthy!  I use it in my new bread recipe as well as smoothies to replace the yogurt that baby Ian can’t tolerate right now while breastfeeding.  I can see lots of ways to use it in the future as the package says that it can be used replace up to 25% of the flour in a recipe.

5) Dr. Frank Lipman

I mention Dr. Frank above, and for good reason.  He’s an MD who practices “Functional Medicine” in NYC, and a wonderful source of health and wellness information.  He gives truly sane, well researched, and highly usable advice to stay on the cutting edge of health.  After reading his website, I can wholeheartedly recommend him as a valuable guide to health.  I love his site and his Facebook presence.  The best thing I can say about him though is that I trust him.

6) Misclaneous – Here’s a list of some of the other things that I’m still doing regularly (or have resumed doing recently) to help treat my PCOS:

-cooking with and making salad dressing with organic apple cider vinegar

– having green tea every morning

– having sufficient protein with each meal and snack

– taking a multi-vitamin, B-multi, vitamin C and D, calcium, magnesium, omega 3s/fish oils, and probiotic.  I’m keeping my supplement list quite simple right now since I’m breastfeeding.

– deep, mediative breathing any time I can

– avoiding toxins and chemicals in my cleaning and personal care

– eating whole, mainly organic foods

– avoiding sugar, most grains, and things with a high carbohydrate and glycemic load

– eating lots of healthy fats (unrefined olive and coconut oil, pastured butter, avocado, nuts/seeds, fish/sardines)

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I broke the news of the Femara cycle to my acupuncturist last week, and, as usual, she was all for it and quickly switched gears to tailor my treatment plan accordingly.  The TCM herbs I’ve been taking for several weeks now are still the correct ones to be taking.  We also went down the list of my supplements to make sure that all of them were safe to take while trying to conceive.  We found nothing that needed to be changed for now.  So far nothing has changed in regards to this experiment either.  I am still eating and exercising as before.  I’m also trying to stay in a good place emotionally and take time out of my day to do some deep breathing or meditating.

As I mentioned before, I induced a period with Provera.  I’m currently on CD 4, and the period has been encouraging.  When I did the two Femara cycles this past summer (right before I started this experiment), the Provera induced period was so light, it was almost nonexistent.  I was only about 8 weeks past breastfeeding at that point and there were a lot of signs that my body and hormones had not recovered yet.  I was not 100% surprised when neither cycle worked.  Things are already starting off better with a normal period and a now fully recovered body from pregnancy and the hormonal suppression of lactation.  Obviously my hormones are not balanced and perfect, but at least they are present in enough quantity for the fertility meeds to actually do something with.  Today I take my second of five days of Femara.  I am taking 4 pills per day (10mg/day) this cycle.  I took 7.5 mg/day on my last 3 Femara cycles, including the one that I conceived my son on.  The goal is earlier ovulation this cycle.  I go in for my first ultrasound monitoring appointment a week from today on CD 11.

I realized that a lot of the anxiety I was having, just in general, and in regards to jumping on the TTC bandwagon again was about the great unknown.  Would my doc insist that I be on Metformin again?  Would my new insurance cover treatment again?  Can I continue my experiment while I undergo conventional fertility treatments?  Will I be able to stay sane enough to be functional and “present” for my 21 month old toddler?  I started this experiment because I was really having a hard time with the fertility medications and being a good Mom through it all.  I’m turning 34 next month and that only leaves one year between me and “AMA” or Advanced Maternal Age.  To make a long story short, the anxiety of not actively TTC is starting to override the anxiety of going through a medicated fertility cycle.

I decided to put a call in to my insurance company and it looks like they will pay for some monitored cycles.  I then called my fertility doctor’s office and told them that I wanted to do another Femara cycle, this time monitored.  I’m now taking Provera to induce a period so I can take the Femara.  There was no mention on Metformin, whether I was still taking it or if I should be, so that’s one worrisome question answered.  I see my acupuncturist tomorrow and we will form a new game plan for using acupuncture/herbs/supplements to compliment conventional fertility treatments.  This is my acupuncturist’s specialty.  What I am hoping is that all of my hard work with this experiment has created a hormonal profile that is mediated enough from PCOS that I won’t need Metformin.  I’m willing to take it again if absolutely necessary, but it will definitely be a last ditch effort.  Obviously I will continue with my eating plan and will exercise every other day, or 3-4 times a week.  I plan on taking all of my supplements and herbs until a pregnancy is confirmed (unless explicitly contraindicated while TTC or in the luteal phase of a TTC cycle)

A Change of Plans…

Whether it is justified or not, I’ve reached the point where I am getting a little anxious about my progress in this experiment.   I’ve given my current supplement regimen 3+ months and I just don’t feel like we’re (my acupuncturist and I) on the right track.  When I first started doing acupuncture, way back in 2006, my practitioner was fairly traditional and I boiled a weekly tea made from Chinese herbs that I would procure from China Town in NYC every 4-5 days.  It was only then that my stubborn amenorrhea and anovulation came to an end.  Heck, I even became pregnant naturally, although it was not with a healthy egg.  After we moved away from NYC, I’ve tried several other acupuncturists, but have never gotten the same benefits as I did originally.  I brought all of this up to my current acupuncturist and she agreed that it was time to shake things up, so as of yesterday, I have gone back to taking Chinese herbs.  For starters, she has put me on a Nourish Ren & Chong Formula (Jia Wei Gui Shao Di Huang Wan) plus a few other herbs for yin deficiency.  It’s been fun reading up on the different herbs and their usages.  I’m not about to begin to understand the intricacies of Traditional Chinese Medicine, but I do know that it worked for me before, so I have faith that it will work for me again.

In addition, I will continue to take Chaste Tree (Vitex), NAC, myo-inositol, D-Chiro-Inositol, Gymnema, fish oils, antioxidant blend, and lots of daily supplements for general health and illness prevention during cold and flu season.  Everything else about this experiment remains the same – diet, exercise, etc.

Ever since I can remember I’ve had blood sugar issues, namely hypoglycemia, when I was overdue for a meal, even by a little bit.  My Dad has the same problem and my mother adopted the phrase, “feed ’em or fight ’em” when dealing with the two of us.  It’s like all of a sudden our evil twins would possess us and turn us into belligerent psychos.  Despite the fact that it was a regular occurrence, we never recognized the signs, and after we had eaten, there were apologies to give for our insane behavior.  It’s like having a multiple personality at times.

The foods I was drawn to when I was in this state were very carby and very refined.  In fact, as a child/teen, I routinely chose meals that were mostly starch with very little protein.  I ate frozen waffles with fake maple syrup most mornings, that or canned biscuits with white gravy.  When I was around 17, I became a vegetarian, but what it really should have been called was a Carbotarian.  French fries and pasta were on the menu every day and in large quantities.  This was the first time I started putting on weight, although I would have still been considered a healthy weight.  When I started college, I became very preoccupied with losing the extra weight, but I got fairly obsessive about it and got WAY too thin, probably about 95 lbs (not shocking for 5 ft, 0 inches, but still noticeably skinny, especially for me).  I got a lot of attention and praise from my family and friends for losing my “baby fat” and blossoming into a young woman (with no boobs or butt).  I lost the weight by eating lots of fat free, but high glycemic carbohydrates.  For the next 10 years, I yo-yo’ed in my weight, always trying to stay slim, and usually doing a pretty good job of it, but usually only by calorie restriction and eating “diet” foods.

When I was in 7th grade, already far into puberty, I contracted the chicken pox and got very ill.  I missed a full 6 weeks of school and lost every bit of extra fat that was on my body.  My breast buds went away and my puberty was halted for about a year while I was able to gain back my weight.  I did not get my period until the following year, long after most of my friends had gotten theirs.  It never became regular, but I was still having one every 6 weeks to 2 months.  That is until the unhealthy vegetarian eating started and I started gaining weight.  I noticed that I was getting my period less often, but I was not about to mention it to my Mom because I knew she would have made me see a doctor about it.  It was after I lost too much weight in college that my period stopped pretty much all together.  Despite not having a cycle, when I was 20, I went to the health center at college and got on birth control pills.  I failed to mention that anything was wrong with my cycle because I was worried that they would not give the BCPs to me and would want to do testing.  I continued on the pills until about 6 months before I got married at around 25 years old.  I was having migraines and intermittent depression and I just felt like it was the pills.  I stopped taking them and the symptoms went away.  I grew concerned when my period did not come back, even after most of a year.  I was concerned about my future fertility by that point and so I went to a Reproductive Endocrinologist to get checked out.  She had a hard time diagnosing me because I fit some of the criteria for both Hypothalamic Amenorrhea (what anorexics and athletes get when they do not get their period anymore) and PCOS.  I had a high LH: FSH ratio, multiple cysts on my ovaries, and acne, but I also had a very thin lining despite not having menstruated for many months and low estrogen.  I did have a light withdraw bleed with Provera, so she decided on PCOS as the diagnosis.  I think very little was known back then about PCOS, and especially Thin PCOS.  As the years have passed, there in no question in my mind that I have PCOS.

In conclusion, I began with blood sugar issues and then had one assault after another on my HPO axis – starvation from illness, eating a diet comprised almost completely of carbohydrates, disordered/restrictive eating, and years of birth control pills.  I also have Celiac Disease, which supposedly has some correlations to PCOS.  It’s no wonder that I am having a hard time getting my cycles back despite working very hard for it.  It’s a complicated medical picture for conventional and holistic practitioners alike.   It definitely confounds me.

The day after acupuncture last week, I started spotting (on Wednesday 12/8/10).  I had been taking Progon B for about 8 days at that point.  I continued lightly spotting until Friday, when it became a very light flow.  I realize that it was an anovulatory, progesterone withdraw bleed, but it sure was a weird one.  There was barely any blood and what was there was mostly brown with some occasional pink and red.  I usually have much more blood with a Provera induced period and usually some cramping too, but none of that this go around.  As of today, the period is over.  It lasted about 4 days.

Not sure what else to report.  I’m still stepping up my dose on myo-inositol every few days, but so far I have not reached the amount I was taking before I quit.  I have also not achieved the same remission from the OCD type of skin/acne preoccupation that I got when taking it the first time.  I still need more time to reach my goal dose and then I need to be on it for a while to see if it will work again for me.

While I was waiting for the D-Chiro-Inositol to arrive from Australia, my acupuncturist put me on regular inositol (called myo-inositol).  I did quite a bit of research into myo-inositol and is has been found to really help with OCD and panic/anxiety disorders, in addition to increasing insulin sensitivity (the main reason why I’m taking it).  I’ve had issues with OCD-ish type issues and anxiety before, off and on throughout my life, so I took it upon myself to increase the dosage from 6 tablets at 400 mg each/day to 9 tablets which is getting closer to the 4-20 gram therapeutic dosage for OCD.  I mean, why not kill two birds with one stone since I am taking it anyway, right?  Over the next few days after starting the myo-inositol, I noticed that I was spending less time in the mirror, inspecting my acne and grungy pores, and I was resisting the urge to pick and squeeze.  My face miraculously cleared up, except for a scant few spots making me realize that my acne is really not as bad as it seems.  I am actually creating some or most of the problem myself.  This last Saturday though, the DCI arrived and I stopped taking the myo-inositol, forgetting the effortless improvement in my self-caused acne.  Since that time I have gradually started feeling more anxious (with no real cause) and I have found myself scrutinizing my pores in the mirror more than I would like, and sadly, my face is looking bad again.  It just dawned on me that stopping the myo-inositol is to blame and started it back up again today.  I actually just found a really great article from Incyst.com, explaining the use of inositol (both DCI and myo-inositol) for PCOS and when and why women might need both.  Fascinating.  I will report back in a few days if adding the myo-inositol helps me again.  It will be a valuable experiment for me.

I was able to survive Thanksgiving with my weight and this experiment intact!  I decided to eat everything I wanted (and then some), including pie, for my Thanksgiving meal.  I just did not eat leftovers day after day like I normally would have.  I had a couple of pieces of pie in the days following, but nothing else really naughty.  I exercised a little while we were away and even tried jogging for about 15 minutes one day.  I have never been able to run for very long before, but all of my work-outs from the last 3 months must have helped my endurance a lot.  When we returned home (11/27/10) the D-Chiro-Inositol that I ordered a few weeks back was in the mailbox and I took my first dose that evening.

At my acupuncture appointment prior to Thanksgiving, I told her about the constantly positive saliva microscope results and she agreed that it was time to start some supplemental progesterone to balance out my estrogen dominance.  I will continue to take the Symplex F/Ovatrophin until tomorrow, making it a two week course, and then I will start an oral natural progesterone called Progon B for two weeks, or until I get my period.  I asked her about natural progesterone cream and she said she did not prescribe it anymore because studies have found it to accumulate in fatty tissue and then it releases into the blood stream when you may not want it to – definitely not something she wants someone with mixed up hormones to use!

Three months are now completed in this PCOS Experiment!  This month the experiment went from a highly regimented plan to a sustainable way of life.  I’ve been so self-disciplined since this experiment began that I no longer felt the need to record my progress daily, and so I ditched my daily format.  I was feeling stressed until I could stop and type out everything I had eaten for the day, and with a toddler, finding the time was getting tough.  The new, free-form blogging is much better suited to where I am in my progress.

I decided to take my exercise requirements down just a slight notch, from 5-6 days a week to working out every other day, alternating cardio and strength/resistance training.  I also started adding in a little bit more complex carbohydrates in the form of gluten free rolled oats a few mornings a week.  I made these changes in the hopes that I will be able to not only finish this six month experiment, but to keep it going for the rest of my life.  I’ve been afraid of burning out as things in my life become more complicated and prevent me from adhering to a strict lifestyle.  I have only seen the scale go down since I made these amendments to the original plan.  I started the month a solid 115 lbs and now I’m seeing the scale hover around 113 lbs most mornings.   I’ve continued to find my clothing slowly getting looser and more comfortable.   I just did my body measurements since the last monthly report and I have dropped more inches (see below).  Wow, that is satisfying to see!

Since last month I’ve noticed my weight being less vulnerable to restaurant meals and changes in my diet.  This weight stability gives me a lot of confidence when we do have a family dinner out or I want a glass of wine or a square of dark chocolate as a treat.  I might have seen the damage to the scale a few months back, but I have come far enough now that it’s no longer a problem.  I’m assuming it’s because I have raised my metabolism and healed a fair amount of insulin resistance.  The other more noticeable change since last month is the appearance of my face.  I have a quite naturally fleshy/full type face and even at times of being thin, it looked chubby, especially in photos.  I can see the reduction in puffiness and fullness in the mirror and can see it in photos too.  What an awesome and unexpected side effect of this experiment!

Since I am not reporting on my diet and lifestyle daily anymore, I want to give a synopsis of the things I am still currently doing on a weekly basis to help control my PCOS symptoms and to help my body heal.  I continue to add a splash of apple cider vinegar to every glass of water I drink.  I have half a grapefruit several days a week.  I drink green and spearmint tea once or twice a day.  I work out every other day, doing both cardio and strength training.  I go to acupuncture once a week.  I try to reserve a few minutes a day for a relaxing bath, usually with Epsom salts and essential oils.  I’m still eating very cleanly, with an emphasis on low carbohydrates and whole foods.  I eat small snacks that contain protein in between meals to keep my blood sugar stable.  I take a wide range of daily supplements prescribed by my acupuncturist to help my body heal my PCOS.  I record all info about my supplements here, including changes as they occur, and there is lots of change monthly.

So, I guess we should take a look back at the success criteria for this 6 month experiment, noting my progress since last month:

1) Ovulation and Menstruation – This month I started having almost daily fertile signs and symptoms which has lead both my acupuncturist and myself to believe that I am now experiencing some Estrogen Dominance (a build up of estrogen that is never balanced by progesterone because of the lack of ovulation).  I started experimenting with a saliva microscope and it shows that I am in the presence of increased estrogen every time I use it.  A week ago, I started back on Symplex F for two weeks to try to stimulate ovulation.  I had my first high temperature this morning, so this is not proof of ovulation, but a girl can hope.  Suffice it to say, this goal is an ever evolving work in progress.

2) Stable weight and body measurements – Overwhelmingly, this goal has been met and exceeded!  I started this experiment at 117 lbs, went down to 115 lbs for a while, and I’m now around 113 lbs consistently.  My abdomen is pretty darn flat and not reactive to eating.  See my reduction in body measurements below.

3) Little or no acne – I’ve experienced both total clarity and an upsurge in acne at different points this month.  I had not experienced a completely clear face at any point in the months prior, so I would say that I have had at least some success in this department.  When I don’t fuss about and pick or squeeze on my face and keep it clean and doctored up with my various acne preparations, I can now have relatively clear skin.  Even with that though, I still had some breakthrough pimples that surfaced no matter what I did to prevent them.  This goal, while I’ve seen moderate improvement, is still a work in progress.

4) Stable and positive emotions – Like my acne progress I spoke about above, my emotional health has been both very good and wavering at times as well.  I’ve had some mild depression and reduction in motivation in regards to this experiment during this month, but I really think I solved this problem by changing the parameters of this experiment as I mentioned earlier.  My self-assurance and confidence has been quite good and I have felt more like reaching out to people and less introverted.  I am going to call this goal accomplished for now, especially since I’m no longer dealing with rocky emotions on a daily basis, just in isolated drips and drabs.

Body Measurements:

1) Natural waist:
a- 27″ on 10/7
b- 26″ on 10/23
c- 25″ on 11/23

2) Lower abdomen (around fattest part of tummy):
a- 32″on 10/7
b- 29 1/2″ on 10/23
c – 28 1/2″ on 11/23

3) Lower hips (around largest part of butt):
a- 35 3/4″ on 10/7
b- 35″ on 10/23
c- 33 3/4″ on 11/23

4) Individual thigh circumference (around thickest part of one thigh):
a- 20 3/4″ on 10/7
b- 19 3/4″ on 10/23
c – 18 3/4″ on 11/23

Without getting too graphic, I’ve noticed my body gearing up to ovulate for many weeks now, but yet no rise in basal body temperature .  Every week I report to my acupuncturist the same hope, that ovulation is probably on the horizon.  Last week she gave me a saliva microscope to experiment with to see if I could make some sense of my constant fertile signs.  Sure enough, I have seen at least some crystalline “ferning” every time I have used it.  This is not normal.   You should only get it before a true ovulation.  We also discussed the possibility that I am suffering from “estrogen dominance” and a constantly positive saliva ferning test proves that my body is pumping out estrogen, and androgens along with it, to mature an egg that never actually ovulates, and therefore does not produce any progesterone to mediate and balance the estrogen and androgens.  This explains the acne, spotting, and headaches.  When I was first diagnosed with PCOS in 2002/2003, I had low estrogen, as shown with a blood test, so this is a different pattern than I have had in the past.  Based on online research, this is a much more typical PCOS presentation.  My acupuncturist has not wanted to prescribe any natural progesterone cream because she has wanted to give my body a chance to try making some on its own.  I’m going to ask her about the possibility of trying some when I see her the day after tomorrow.  Again, from online research, this seems to be an appropriate natural treatment for estrogen dominance, especially since I’ve not had a period in a while.

Also at my last visit to my acupuncturist, she started me back on Symplex F for two weeks, to try to replicate a normal 2 week luteal phase.  The goal being to get a sort of induced period at the end of the two weeks.  A day after I started taking it, I started waking up with headaches and nausea, pretty much the same symptoms that I had on it last time.  I stopped taking it for a day and I started it back again today to see it I am right in my suspicions.  I’ll update this info on my PCOS Supplement Page.

Other than that, I don’t have too much to report.  The three month anniversary of this experiment is on Tuesday!  I’ll be doing my monthly progress report in the next few days.