Dyslipidaemia, Cholesterol and Triglycerides 

Dyslipidaemia is the term used to describe unhealthy fat (lipid) levels in the blood. Whilst often this condition is oversimplified to being just “high cholesterol”, there are actually two types of fats this involves – cholesterol and triglycerides. 

What is Cholesterol and how does it affect my health?

Cholesterol is a type of fat that is vitally important for health. Most of our cholesterol is made by our bodies, primarily in the liver but also in cells throughout the body. Cholesterol is the precursor for vitamin D and for hormones such as oestrogen, testosterone, and cortisol. It is also needed for healthy cell walls and helps the body to digest and absorb important nutrients such as fat-soluble vitamins A, D, E, and K. Cholesterol is also an important molecule used in the healing process. The liver will produce extra cholesterol to be sent to sites requiring healing, and we will naturally have higher cholesterol levels when we are sick, after surgery, or even during periods of high stress. 

So, if cholesterol does so much good in the body, why does it have such a bad rap? The answer lies in the misnomer that is “good” vs. “bad” cholesterol. This type of oversimplified language has led many people to believe that it is cholesterol itself that causes health problems, but this is not the case. It is actually the transporter molecules that the body makes to move cholesterol around the body which can cause health issues. 

Because the physical structure of cholesterol means it does not circulate in blood easily on its own, the body creates small carrier molecules called “lipoproteins”, which transport cholesterol around the body to be used by cells. There are 5 types of these transporters, but the main two are HDL and LDL. 

HDL (high density lipoproteins): the “good” cholesterol transporter. This transporter carries cholesterol away from cells and back to the liver, where it can be metabolised and excreted. HDLs also “mop up” damaged LDLs. Higher levels of HDL are generally good. 

LDL (low density lipoproteins): the “bad” cholesterol transporter. This transporter carries cholesterol from the liver out to the cells throughout the body to be used. 

LDLs are much more easily damaged by oxidative stress. Too many LDLs, particularly when exposed to inflammation or low antioxidant levels, can lead to LDLs becoming damaged via oxidation. It is these oxidised LDLs which cause tissue damage and health issues. The oxidised LDLs are “sticky” and can attach to artery walls, leading to narrowing of arteries. So, when we discuss “high cholesterol”, what we are really saying is that a person has an imbalance in their cholesterol transporters – low levels of HDL and high levels of LDL. 

Causes of High Cholesterol 

Naturopathy always looks to address the underlying causes and drivers of illness, so it’s important to understand what may be causing your cholesterol issues. Causes of high cholesterol include:

Inflammation: This is a common one and in fact, high cholesterol levels may be the body’s way of telling us that there is inflammation happening that needs to be addressed. Inflammation leads to higher levels of LDL and lower levels of HDL, meaning more cholesterol is transported to the tissues and less is transported back to the liver for metabolising and excretion. The excess LDLs then become damaged, leading to even more inflammation. Oxidative stress: this can be caused by low antioxidant intake, inflammation, trans fats, excess saturated fats and sugar, smoking, and insulin resistance. 

Diet: dietary intake of cholesterol through animal products (meat, dairy and eggs), has only a minimal effect on our cholesterol levels (remember that much of the cholesterol in the body is made by the liver). Instead, it is low vegetable and fruit intake, and high intake of inflammatory foods such as sugar, trans fats, and saturated fats, which can contribute to high LDL cholesterol levels. Stress: chronic stress is bad for our health in so many ways. Stressed people and people with type A personalities can be especially susceptible to high LDL cholesterol and even heart disease. Stress drives up our cortisol levels which worsens insulin function and signals to our body to store extra body fat, further worsening cholesterol levels. The body also sees lack of sleep as stress. 

Insulin resistance and high blood sugars: high blood sugar causes many biochemical changes in the body and can lead to abnormal cholesterol levels – low HDL and high LDL levels. Sugar compounds can also exacerbate cholesterol issues by attaching to LDL molecules and making them more likely to cling onto artery walls. 

Hypothyroid: thyroid hormones are needed in order to both make cholesterol and remove it from the body. If your thyroid is not working optimally, it can greatly affect your cholesterol levels.

What are Triglycerides and How Do They Affect my Health? 

Triglycerides are a common type of fat made up of chains of fat linked by glycerol (a type of sugar-alcohol) and are the most common form of body fat. Triglycerides are found in foods and are also formed in the liver as a way for our bodies to store unused calories. Glucose and fats are bonded together to form triglycerides, which make a convenient package of the two energy sources ready to be stored for future use. These triglycerides are then stored in fat cells throughout the body and can be released by the body during periods when calorie intake doesn’t meet the body’s requirements. 

As with cholesterol, triglycerides cannot travel freely through the bloodstream – they require a transporter to move them from the liver to other body cells. There are two main transporters that carry triglycerides: 

Chylomicrons: These are very large transporters. They are the largest type of lipoprotein and typically carry triglycerides, phospholipids, proteins, as well as some cholesterol from the intestines throughout the body. 

VLDL lipoproteins: These are a very small transporter, similar in structure to HDL and LDL, which carry triglycerides primarily from the liver to the body tissues. As with LDL, they can be considered a “bad” type of cholesterol/ transporter, or a sign that your lipid levels are in the unhealthy range. Unlike with HDL and LDL, there is no way to directly measure your VLDL levels – triglyceride levels are measured instead.

When we say, “high triglycerides”, what is really meant is that the levels of triglycerides in your blood are high (as opposed to how many triglycerides are being stored in fat cells). It is these “free”, un-stored triglycerides in the bloodstream that can cause issues for cardiovascular health. Triglycerides, particularly within VLDL, can attach to artery walls to cause blockages, contributing to atherosclerosis and increased risk of stroke, cardiovascular disease and heart attack. 

Causes of High Triglycerides 

• Eating excess calories: Eating more calories than your body requires means your body will produce more triglycerides, as the body needs to store the excess calories for future use. Consuming calorie dense foods like refined carbohydrates, sugars, and foods high in saturated fats are especially easy for the body to use to form triglycerides. High GI carbohydrates also release more glucose into the blood which hinders the absorption of triglycerides out of the bloodstream. 
• Hypothyroid: The thyroid regulates much of our metabolism, including the production of 
• triglycerides for calorie storage and their release for use as energy. Low thyroid function means slower metabolic processes and a higher retention of triglycerides in the body. 
• Alcohol: When alcohol is metabolised in the liver, it is converted into fat, which can then be used to form triglycerides. 
• High blood sugar: prediabetes and diabetes can lead to high triglycerides levels, as high levels of glucose in the blood makes it more difficult for the body to absorb fat from the bloodstream and prompts the liver to produce more triglycerides. 
• Prescription drugs: certain medications, including the oral contraceptive pill, beta blockers, hormone replacement therapy, steroids, and even some diuretics can cause high triglyceride levels.

Naturopathic Treatment

In your consultation, Tanya works closely with you to understand the main drivers for your cholesterol imbalance, what dietary and lifestyle changes would be beneficial and prescribe herbs or supplements once she has an understanding of your unique health situation. Please contact me for a complimentary fact finding call or book an initial naturopathic consultation here.

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Summary of PCOS Causes

• Insulin resistance – elevated insulin stimulating excess androgen (testosterone) production
• Excess androgens from non-insulin causes – including adrenal hormones such as DHEA and androstenedione
• Androgen sensitivity – normal testosterone levels, but increased tissue response causing acne, hair growth or hair loss
• Post-pill hormonal disruption – temporary androgen surge after stopping oral contraceptives
• Inflammation – gut issues, autoimmune or inflammatory conditions influencing hormone receptors
• Adrenal conditions – including non-classical congenital adrenal hyperplasia (21-hydroxylase deficiency)
• Hormonal imbalances – high prolactin, thyroid dysfunction or chronic stress
• Nutrient deficiency or under-eating – especially low carbohydrate intake affecting ovulation
• Rare endocrine disorders – such as Cushing’s syndrome

What causes PCOS? Insights from our Sydney Clinic

Whilst insulin driven PCOS that drives elevated testosterone is a common cause, more and more in clinic I am finding women that been diagnosed with PCOS, yet their testosterone levels are normal and when I check insulin at fasting, 1 and 2 hours I find that insulin is also normal.

Often the hair growth or hair loss on the head, acne and fertility issues are the main trigger for women to seek answers as they are all events that can seriously impact quality of life and life dreams.

So, its androgens that are normally to blame but they can be stimulated by not just insulin.  I also see many women with hair growth and male pattern baldness that assume they have PCOS however they are having regular periods and testosterone on a blood test is normal.  Women in these cases can be suffering from a hypersensitivity to a normal amount of testosterone so the support I give is to reduce the impacts of testosterone on hair growth and also on acne and look I depth at why they are so sensitive.

How I diagnose my Sydney clients struggling with PCOS

There are several interpretations of how to correctly diagnosis PCOS, however it absolutely cannot be diagnosed on simply having polycystic ovaries as you must show signs or symptoms of excess androgens.  This may not just be on a blood test but can be acne, hair growth on the face or male pattern baldness.

• Androgens to test:   sometimes total testosterone and free testosterone are normal however our adrenal glands also produce androgens so in some cases, and I look at whether androstenedione and DHEA have also been tested.  I explain the different types of PCOS in my last PCOS blog as even inflammatory conditions in the body such as eczema, arthritis, gut disorders, food sensitivities may be driving the excess androgens due to the impact that inflammatory chemicals produced by your body have on hormone receptors

Other Causes of PCOS

It is important that other causes for androgen excess have been considered and they can include:

• Having just come off the pill = post pill means disrupted hormones and a surge of testosterone
• Non classical congenital adrenal hyperplasia: This is a genetic condition and is an often forgotten cause of excess androgens and I always make sure it has been ruled out.  It is a condition where an important enzyme, 21-hydroxylase that changes progesterone into cortisol doesn’t work as it should and progesterone becomes testosterone and other androgens.  It can look like PCOS and is often diagnosed as PCOS.  The test recommended to know for sure is 17-OH progesterone.
• High prolactin: this can be a cause and be a result of thyroid issues, stress and even excess stomach acid tablets so it needs to be looked at too.
• Lack of nutrients in your diet: Hypothalamic amenorrhea is when you don’t ovulate, and this is common when you under eat especially carbs. 
• Cushings Syndrome: This would be rare however this condition shows similar symptoms to PCOS.

As you can see, PCOS does not always mean inositol and zinc.  It is a deep investigation to make sure you are strategically focussing on the right treatment and strategies.

Personalised PCOS Treatment in Sydney’s Inner West

For support on managing or investigating your PCOS more thoroughly or an investigation as to hair growth/loss or acne, please book your initial consultation at our Stanmore clinic, our Leura clinic, or via telehealth.

The post A Conversation Around PCOS: Insights from a Sydney Naturopath appeared first on Performance in Health.

What is Menopause?

Menopause is quite simply the end of menstruation. It is diagnosed retroactively, one year after your final period. This means that if you are the right age and have been experiencing perimenopausal symptoms, then one year after your last menstrual period you are deemed as having entered menopause one year ago. In Western society, menopause is something which is diagnosed and treated, which frames menopause as some kind of disease, disorder, or deficiency. However, the truth is that menopause is none of these things. Much like puberty, menopause is simply a normal transition and a part of life – the shift to post-reproductive life.

What is Perimenopause?

Perimenopause is the time that precedes menopause. This is the period of 2-10 years before menopause where women typically experience “menopausal” symptoms – hot flashes, weight gain, irregular periods, night sweats, insomnia. It is a transitional phase as the body shifts and adapts to a state of lower oestrogen. For some women, perimenopause is a long, drawn-out time full of difficult to manage symptoms. For others, it is brief and relatively easy to cope with. If you’d like to learn more about perimenopause and the symptoms associated with this phase of life, see our blog post here.

Hot Flushes

One of the most frequent complaints of women during perimenopause is hot flushes, however within a few years of reaching menopause these resolve for the majority of women.  For a minority of women hot flashes can continue into menopause and a more detailed review of causes is recommended so that you can reduce these symptoms.

What happens to the body after Menopause?

Interestingly, menopause still occurs at around 50 years of age even despite our longer life expectancies in modern times, which researchers believe suggests that longevity of our ovarian function is predetermined and possibly genetic. At birth, females have around 500,000 eggs in their ovaries, but this number declines throughout their lives. The rate of loss accelerates from around our mid-30s in the lead up to the perimenopausal period in our 40s.

The majority of the oestrogen in our bodies up until menopause is produced by the ovaries. After menopause, oestrogen levels significantly decline, because the ovaries are no longer producing any. Small amounts of oestrogen are still produced elsewhere in the body such as the adrenal glands, and fat cells convert androgens (“male” hormones made in the adrenal glands) into oestrogen, however this is a much weaker type of oestrogen than the ovaries produced. Progesterone levels also decline because of the loss of ovarian function. Small amounts of a weaker type of oestrogen are still produced in the adrenal glands, and fat cells convert some androgens (“male” type hormones) into weak oestrogen, too. The overall effect of this is that the body shifts into a low-oestrogenic state, and it is this significant change in our hormonal balance that triggers perimenopausal symptoms.

Oestrogen is a vitally important hormone that performs many, many functions in the body during the reproductive years, beyond simply being involved in ovulation and the menstrual cycle.

In fact, oestrogen is involved in many different functions, including the following:

• Maintains bone density by promoting osteoblast (bone-building) cell function
• Protects against heart disease via a range of complex mechanisms
• Improves cognition and protects against dementia by improving blood flow to the brain and helping certain brain cells to function
• Supports mental wellbeing by increasing serotonin production

Progesterone, too, plays many roles in the body other than ovulation, including:

• Helps to support skin and bone health
• Supports pancreas function and normal insulin signalling
• Plays a role in regulating immune system function

It’s easy to see why the loss of these hormones trigger so many physiological changes, and why it can take some time for our bodies to adapt.

Health Conditions Associated with Menopause

With the significant physiological changes that occur in menopause, there are unfortunately an increased risk of certain other conditions developing in post-menopause.

High Cholesterol

After menopause, our bodies metabolise fats differently, which can unfortunately lead to an increase in “bad” LDL cholesterol and triglycerides.

Cardiovascular Disease

Low oestrogen increases the risk of CVD because of the protective role of oestrogen on the heart and blood vessels.

Osteoporosis

Our bones are living tissue, which is in a constant state of remodelling, thanks to specialised cells that break down bone to release minerals for use throughout the body, and then rebuild the bone again. This process is in part controlled by hormones, including oestrogen. Bone density is protected by oestrogen, so when oestrogen levels drop post-menopause, one of our protections against osteoporosis is lost, and bone loss can be quite rapid particularly in the first couple of years of menopause. Osteoporosis can have no symptoms for many years.

Metabolic Syndrome

Metabolic Syndrome is a collection of signs and symptoms that together increase the risk of other adverse health outcomes. The loss of both oestrogen and progesterone puts as at higher risk of developing Metabolic Syndrome. Signs, symptoms, and conditions associated with metabolic syndrome include:

• Impaired glucose metabolism – leading to high blood sugar
• High cholesterol and triglycerides
• High blood pressure
• Obesity

Weight Gain

Although not a health condition in itself, weight gain is a very common concern for post-menopausal women that shouldn’t be dismissed. Changes to hormones affect both metabolism and the way fat is stored in the body. Weight gain can begin during the perimenopausal period (the period 2-10 years before your period ends), and may continue after menopause, too. The weight gained during this time is often largely around the abdominal area and is due to the decline in oestrogen.

Insulin Resistance

Post-menopausal weight gain and the loss of progesterone can increase the risk of developing insulin resistance. Visceral fat – the kind that accumulates around abdominal organs – places additional strain on the liver because of the way it metabolises fatty acids. This extra strain on the liver can cause the liver to become insulin resistant.

Urinary Tract Infections and Thrush

UTIs can unfortunately rear their ugly head after menopause. Oestrogen is responsible for maintaining our vaginal secretions, pH and microbiome, which all act to protect against invading bacteria that cause UTIs.

Be aware that recurrent UTIs and thrush may also be a sign of other health issues, such as diabetes. If you are experiencing frequent UTIs or thrush, it is important that you seek advice so that further testing can be arranged if necessary.

Urinary Incontinence

Both oestrogen and progesterone are involved in maintaining healthy, toned muscles in the bladder and pelvis. Without this hormonal protection, muscle tone may be lost, leading to symptoms of urinary incontinence.

Sexual Wellbeing

Oestrogen is responsible for keeping the vagina lubricated and elastic. After menopause, the tissue of the vagina changes and can lead to dryness and painful intercourse. Some women may also experience reduced libido or sex drive, but others may not find this to be the case.

Ability to handle stress

With the loss of estrogen and progesterone, the ability to handle the same level of stress we once did is impacted.  Women with senior careers and busy, demanding lives can feel this change in stress management ability quite significantly.

How a Naturopathic Approach Supports Menopause Symptoms and Post-Menopause

Diet

Eat Plenty of Vegetables and Fruits Daily

The antioxidants in vegetables and fruits protect against cardiovascular disease, while the fibre in these foods can help to lower blood pressure and keep our blood sugar levels in check, too. Fruits and vegetables also contain high amounts of anti-inflammatory compounds that are crucial for wellbeing after menopause. Aim for 2 serves of fruit and at least 5 serves of vegetables each day.

Reduce Your Intake of Red Meat

Red meat intake is associated with a higher incidence of heart disease. Additionally, and excess of certain protein can cause less calcium to be absorbed from food, leaving us at risk of calcium insufficiency and bone density issues. Keep red meat to no more than twice per week, and instead enjoy other protein sources such as fish, chicken, seafood, lentils and legumes, and soy.

Include Phytoestrogens in your Diet

Phytoestrogens are molecules found in many plant foods which can bind to oestrogen receptors in the body. Some examples of phytoestrogens include isoflavones and lignans. Phytoestrogens have a bad rap in Western culture as being damaging to our health, but this unfortunate misconception is due to a misunderstanding of how these molecules really work. Phytoestrogens have a “modulating” effect on oestrogen levels, so when oestrogen levels are low (such as in menopause), they can help to slightly increase oestrogen function in the body. Phytoestrogens can help to protect against bone mineral loss and osteoporosis, reduce hot flushes, and even reduce symptoms associated with vaginal dryness. Phytoestrogens can be found in a huge range of foods, including tofu, flax seeds, chickpeas, mung beans, olives, pumpkin seeds, parsley, buckwheat, and even whole grains.

Reduce Your Alcohol Consumption

Alcohol dilates blood vessels and increases luteinising hormone, which can make hot flushes worse. It can also be detrimental for sleep, which can be a particular concern after menopause. Alcohol is best avoided, but if you do choose to drink, stick to no more than 2 standard glasses one or two nights a week, and choose heart-healthy options such as red wine.

Reduce Your intake of Sugar

Added sugars in foods are a huge problem and high intake of sugar is associated with a number of health problems that are worsened after menopause, including heart disease and diabetes. Sugar intake can also be a big culprit when it comes to recurrent thrush. Always read labels and be aware of hidden added sugars in foods. Unexpected added sugar can be found in foods such as yoghurt, breakfast cereals, pasta sauce, peanut butter and other spreads, salad dressings, sauces, canned fruits, protein bars, bread, and even microwave meals.

Mediterranean Diet

The Mediterranean Diet is a fantastic eating plan for post-menopausal women, as it follows many of the above dietary recommendations. The evidence backs up its use, too. Studies have found it to be beneficial in reducing obesity and cardiovascular disease rates in postmenopausal women.

Individual Nutrients

Vitamin D and Calcium

Vitamin D and calcium regulate one another and are absolutely vital for strong bones.

To boost your vitamin D levels:

• Get daily sun exposure – 15 minutes of morning or late afternoon sun exposure is typically plenty.
• Foods – free range eggs, dairy, fortified foods
• Supplements may be necessary depending on your lifestyle, diet and current vitamin D levels

To boost your calcium levels:

• Sardines and other tinned fish
• Dark green leafy vegetables such as spinach, Bok choy and kale
• Tahini, tofu, legumes
• Note that while dairy has traditionally been promoted as the ideal high-calcium food, it is very high in protein, which can in fact put pressure on the kidneys and lead to an overall loss of calcium. This is why excessive protein intake is not a good idea, especially post-menopause. Be mindful of your protein and dairy intake and remember to include non-dairy calcium foods in your diet.

Omega 3 Fatty Acids

Omega 3 fatty acids are essential in our diet, because the body isn’t able to produce them. Omega 3 fatty acids are anti-inflammatory and can help to protect against developing cardiovascular disease and insulin resistance. Food sources of omega 3 fatty acids include nuts and seeds, fatty fish, flax seeds, walnuts, and soy. You may also benefit from a supplement but be aware that many over-the-counter omega-3 supplements are poor quality and may even contain rancid fish oil. Our clinic only prescribes the highest quality of practitioner only, clean fish oil supplements.

Probiotics & Prebiotics

A good quality probiotic supplement can make a big difference to your wellbeing after menopause if this is determined that this is what you need, particularly for maintaining vaginal health. Probiotic foods such as sauerkraut, Kim chi, and unsweetened Greek yoghurt can be great additions to your diet.  Prebiotic supplements and foods are also helpful and our blog on sustaining healthy gut bacteria is here https://www.performanceinhealth.com.au/2020/06/11/microbiome-family-gut-health/

Lifestyle

Daily Weight-Bearing Exercise

Daily exercise is a must for good health post-menopause. Weight-bearing exercises such as walking, jogging, team sports like netball or hockey, are all great choices, as they help to promote bone density and protect against osteoporosis. Daily vigorous exercise of 30 minutes or more is good for more than just your physical health. It can also help to improve mental health, reducing anxiety and feelings of stress. Exercising outdoors in the mornings can also be an opportunity to get some vitamin D through sun exposure, as well as being good for your circadian rhythm (the body’s innate clock that helps us to sleep at night).

Quit Smoking

If you are a smoker, now is the time to quit. Smoking increases the risk of heart disease, stroke and high blood pressure. Whilst we can’t go back in time and increase our oestrogen levels, we can reduce our risk of heart disease by addressing these other, modifiable risk factors in our lifestyle.

Take Steps to Prevent UTIs

• Always wipe from front to back
• Urinate before and after sex
• Avoid wearing synthetic underwear or using douches and perfumed feminine hygiene products
• Shower and change your clothes after exercising
• Don’t ignore the urge to urinate
• Keep hydrated each day – around 2L

Keep Up to Date with Health Screening

There are a number of routine screening tests that you should keep up to date with as part of keeping healthy after menopause. These screening tests include:

• Mammograms
• Cervical smear (PAP smear)
• Osteoporosis risk assessment
• Heart disease risk assessment and blood pressure check
• Screen for bowel cancer
• Blood cholesterol testing

Put in place stress management & self-care strategies

This is a chapter in life where it is important to reduce stress and out in place ways to reduce cortisol, nurture the adrenals and commit to self-care each week for yourself.  If this is neglected, you will feel it’s impact and your health will suffer.

Navigating this post-menopausal chapter with naturopathic guidance

For many women, this is in fact an empowering chapter of their lives.  Whilst areas of negative changes are reflected above, it is also a time of significant emotional and mental well-being.  Many women adore this stage of their lives.  They are happier in their own skins and life can often become much more enjoyable.  This aspect of menopause needs to be celebrated.

Whilst our risk factor for many diseases increase significantly after the loss of these precious hormones, it simply means that it is a time where you need to reassess how you do things.

A strategic review of your diet and may be something worth investing in, given the average weight gain at menopause is 12 kilos.  Simple strategies can support you to make different choices.

Herbal medicine and supplement support

In my clinic, one of the most important priorities in supporting menopausal clients is to support and nurture adrenal health whilst providing guidance on a holistic approach to stress management.  I do this with beautiful, gentle adrenal herbal medicines.

Higher cholesterol, blood sugar levels and weight gain can also be supported with some beautiful herbal remedies and dietary strategies.

Knowledge is power at this new female chapter, and I hope you find this blog valuable.

Personalised Menopause Support with a Sydney Naturopath

If you are looking for a menopause naturopath in Sydney, I offer face-to-face consultations at my clinics in Stanmore (Inner West) and Leura (Blue Mountains) or via telehealth options for clients across Australia.

References

Ko, S.-H., & Kim, H.-S. (2020). Menopause-associated lipid metabolic disorders and foods beneficial for postmenopausal women. Nutrients, 12(202).

Lee, K., & Church, K. (2021, August 23). 5 health risks women face after menopause. https://www.everydayhealth.com/menopause/health-risks-women-face-after-menopause/

Mallorie, A., & Shine, B. (2022). Normal bone physiology, remodelling and its hormonal regulation. Surgery (Oxford), 40(3), 163–168.

Novella, S., Perez-Cremades, D., Mompeon, A., & Hermenegildo, C. (2019). Mechanisms underlying the influence of oestrogen on cardiovascular physiology in women. The Journal of Physiology, 597(19), 4873–4886.

Pugliese, G., Barrea, L., Laudisio, D., Aprano, S., Castellucci, B., Framondi, L., Di Matteo, R., Savastano, S., Colao, A., & Muscogiuri, G. (2020). Mediterranean diet as tool to manage obesity in menopause: A narrative review. Nutrition, 79–80.

Seifert-Klauss, V., Schmidmayer, M., Hobmaier, E., & Wimmer, T. (2012). Progesterone and bone: A closer link than previously realized. Climacteric, 15.

Trickey, R. (1998). Women, hormones and the menstrual cycle. Trickey Enterprises.

Walton, C., Godsland, I. F., Proudler, A. J., Wynn, V., & Stevenson, C. (1993). The effects of the menopause on insulin sensitivity, secretion and elimination in non-obese, healthy women. European Journal of Clinical Investigation, 23(8).

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This blog provides some helpful strategies that reduce your risk from things you may be doing on a day to day basis.  These are known as preventable risk factors.

Your Heart & Cardiovascular Disease

Of the common preventable health conditions prevalent in Australia today, heart attack and cardiovascular disease remain one of the deadliest. In fact, cardiovascular disease accounts for one in four deaths in Australia. Research, education and advances in both treatment and prevention have helped to reduce deaths, but it remains a significant health issue for many of us; three-quarters of Australians are at risk of developing cardiovascular disease due to both preventable and non-preventable risk factors.

What is a Heart Attack?

A heart attack, also known as a myocardial infarction, usually occurs when one of the arteries supplying blood to the heart become blocked, cutting off blood (and oxygen) to the heart. Heart attacks can occur spontaneously but are most often caused by cardiovascular disease and can be seen as the culmination of the many different damaging processes that occur in cardiovascular disease.

The cardiovascular system, made up of the heart, arteries, veins, and capillaries, is a delicate and finely tuned system that supplies oxygen and nutrients to every cell in the body. It relies on flexible, unobstructed blood vessels to maintain the pressure and flow of blood within a very tight range, and its function affects many other systems within the body. High blood pressure, cholesterol, and chronic inflammation leave the cardiovascular system and the heart vulnerable to dangerous plaque build-up in arteries. These plaques can occlude arteries and cut off blood supply entirely and can even break away from artery walls to form blockages in other areas, including veins in the leg and even the lungs. These plaques may occlude the arteries of the heart itself and block its own blood supply, triggering a heart attack.

Some of the warning signs and symptoms of a heart attack include:

• Chest pain, such as a feeling of pressure or fullness in the chest. Pain may radiate into the jaw, back, arm, or neck
• Nausea and vomiting
• Feelings of anxiety and dizziness
• Sweating
• Shortness of breath or difficulty breathing

Symptoms including pain may come and go and typically last for several minutes. Some people may have no symptoms at all – something that is known as a “silent heart attack”.

Risk Factors for Heart Attack

Some risk factors are things you can’t change about yourself, such as:

• Age – the risk of heart attack increases as you get older
• Sex – being male increases your risk until menopause for women when risk factors increase
• Family history – you are more likely to have a heart attack if other people in your family have

Other risk factors are things within your control (or are issues that can be addressed through treatment strategies), such as:

• Smoking
• High cholesterol
• High blood pressure
• Low physical activity
• Obesity and overweight
• Type 2 diabetes
• Stress
• Sleep deprivation
• Drinking too much alcohol

Assessing Your Risk

If you are in a higher risk category, your GP may assess your risk of heart attack and may refer you for tests, including:

• Electrocardiogram
• Angiogram
• Cholesterol blood test (also known as a lipid profile)
• Hs-CRP (a blood test that looks for markers of inflammation)

You may also be referred to a cardiologist for more advanced assessment.

In addition to the above testing, naturopaths may refer you for tests such as:

• Blood glucose and blood insulin tests
• Homocysteine test (can indicate deficiencies in nutrients that can impact your cardiovascular health)
• Fatty acid profiles (to assess your level of good omega-3 fats compared to omega-6)

Other tests may also be recommended, depending on your individual health needs, such as thyroid testing, to better understand other factors which may be contributing to your condition.

Naturopathic Strategies for Heart Health

The good news is that diet and lifestyle changes can make a huge positive impact on your risk of cardiovascular disease and heart attack. Protecting yourself from heart attack means working towards maintaining a healthy cardiovascular system overall, as well as looking after your general health and wellbeing. Naturopathic strategies for protecting heart health take a holistic approach, looking at both the cardiovascular system specifically, as well as fostering healthy daily lifestyle practices to support your health more generally.

Diet

Eat Plenty of Fibre-Rich Fruits and Vegetables

It is recommended that we eat 5 or more serves of vegetables and 2 serves of fruit every day, yet a whopping 90% of us don’t currently meet this recommendation. Increasing your fruit and vegetable intake is a great place to start with supporting your heart health, as eating 5+ serves of vegetables can reduce your risk of CVD by nearly 17%.

Fruits and vegetables protect against cardiovascular diseases in a number of different ways:

• They contain heart-healthy vitamins, minerals, and phytochemicals such as vitamin C, magnesium, potassium, carotenoids
• They are rich in inflammation-fighting antioxidants
• They contain both soluble and insoluble fibre, which help to lower LDL cholesterol levels and reduce blood pressure

Choose a variety of vegetables and fruits and try to eat many different colours of vegetables and fruits each day. This way you can be sure you are maximising your nutrition, as many of the antioxidant and health-promoting nutrients in vegetables and fruits are found in the pigments that gives them their colour.

Reduce your intake of refined and added sugars

Eating foods and drinks that are high in refined and added sugars significantly increases your risk of developing cardiovascular disease, even if you are a healthy weight. A high intake of sugar signals to the liver to make more LDL (“bad”) cholesterol, and also leads to higher levels of triglycerides. Sugar also increases inflammation in the body, a risk factor for developing cardiovascular disease. Keep an eye on food labels and avoid foods with added sugars, even if they are “natural”. Better yet, focus on foods found in the outside edges of the supermarket that don’t require packaging – these foods are typically lower in sugar and other additives.

Make no mistake that processed carbohydrates turn to glucose in your blood and have a huge impact on insulin spikes and cholesterol.  Blood sugar spikes and lows affect blood vessels, blood pressure and more – eat more raw and wholegrain food is always my philosophy when improving cardiovascular health.

Reduce your intake of trans and saturated fats

Trans fatty acids, a type of dietary fat found in deep fried foods, increases the risk of cardiovascular disease by increasing “bad” LDL cholesterol and lowering “good” HDL cholesterol levels. These types of fats increase inflammation through the body and have been found to increase the risk of not only heart disease but also diabetes. In fact, research suggests that on a “per calorie” basis, trans fats increase the risk of heart disease more than any other nutrient!

The evidence for saturated fats, on the other hand, is less clear cut. While previous evidence has suggested that their intake needs to be reduced for heart health, emerging evidence shows that reducing intake of saturated fats may not have as significant an effect in the long term as was once thought, although the jury is still out. Reducing your intake of saturated fats will help to reduce serum cholesterol levels and may also be protective against heart disease but may not be the panacea for heart health that it was once thought to be. It is still prudent to be mindful of your consumption of saturated fats, which can easily take the place of unsaturated fats such as olive oil, which have positive health effects. Replacing even some of your saturated fat intake with unsaturated fats from foods such as walnuts and olive oil can help to improve your health and reduce your risk of cardiovascular disease.

Limit your Intake of Red Meat

Our modern Western diets contain far too much red meat, and it is making us sick. Consumption of both processed and unprocessed varieties of red meat is significantly associated with cardiovascular disease. Fish and poultry, on the other hand, don’t raise your risk, and fish in particular can be beneficial in protecting heart health. Keep red meat intake to a minimum – once a week or so – and instead choose fish, poultry, and vegetarian protein sources such as lentils, beans, tofu, and eggs.

Reduce your intake of salt

Excess salt in your diet can increase your blood pressure, putting you at risk of developing cardiovascular disease and even stroke. Added salt is difficult to avoid in processed foods, so reading labels is imperative when it comes to cutting down on your salt intake. You can also reduce your salt use in cooking by instead using plenty of fresh herbs and spices to keep dishes full of flavour, while adding in extra antioxidant goodness to your meals.

The Mediterranean Diet

I adore the original Mediterranean diet and it continues to be the healthiest way of eating in most studies.  If you prefer to have a more structured dietary plan, the Mediterranean diet is a wonderful, healthy option for improving heart health. Based on the traditional diets of people from the Mediterranean region in the 1960s, the Mediterranean diet is low in processed foods like pastries and pre-packaged foods, and rich in nutrient-dense vegetables, fruits, and whole grains. Fish is eaten in moderate amounts, and meat, dairy and eggs are consumed in low amounts – about once a week or less.

Some of the heart-healthy benefits of the Mediterranean diet include:

• Reduces cholesterol levels
• Protects against oxidative stress
• Protects against inflammation
• Reduces the “stickiness” of platelets to help slow down the development of plaques in arteries
• Reduces other risk factors of cardiovascular disease, including waist-hip ratio,

The DASH Diet

Another diet to consider for heart health is the DASH diet. The DASH diet was developed specifically to tackle hypertension and is similar to the Mediterranean diet in terms of both its content and its beneficial effects on heart health. In addition to helping manage blood pressure, the DASH diet has been shown to help with high cholesterol levels and can even be a useful tool for weight loss and is now used as a treatment tool for other chronic diseases, too.

Functional Foods and Heart Healthy Nutrients

Garlic

The humble garlic is a fantastic food for helping to keep your heart healthy. Extensive research has shown that garlic can help to combat cardiovascular diseases in a variety of ways. Garlic can help to reduce blood pressure, cholesterol, and triglyceride levels, as well as inflammation, and has been shown to improve several markers of cardiovascular disease such as arterial wall thickness. In addition to its benefits for heart health, garlic has been shown to be good for kidneys and liver health, and even helps to feed good gut bacteria, making it a fabulous addition to the diet for overall wellbeing. Buy whole garlic bulbs and crush fresh yourself to add to cooking and salad dressings, or roast whole bulbs to go with Sunday night roast vegetables.

Cacao

Cacao is a powerhouse food when it comes to heart health, thanks to its heart-healthy flavonoids, and minerals such as magnesium. Studies have found cacao can help to lower blood pressure and reduce the stickiness of platelets, to help prevent the build-up of plaques on artery walls. Remember to choose raw cacao or dark chocolate and avoid heavily sweetened products like milk chocolate – the sweetener, dairy, and food additives in these types of products will counteract any benefit offered by the cacao.

Green Tea

Green tea is a great option to include in your diet for heart health. It contains an abundance of heart healthy polyphenols like epigallocatechin and resveratrol, which protect against cardiovascular disease.  Green tea also has much less caffeine than black tea of coffee.  Be mindful however that caffeine can be stimulatory which is why I never recommend in excess especially when someone has high blood pressure.  In the right quantities it is a beautiful cardiovascular food source.

Spices

Spices such as turmeric, cinnamon, ginger, paprika, cumin, and pepper, have all been found to help with cardiovascular health. These foods contain high levels of phytochemicals that can reduce blood pressure and fight oxidative stress and inflammation. Add to soups, stews, and curries, or use in drinks such as chai and turmeric lattes. They can also be a great addition to foods to replace salt for flavouring dishes.

Antioxidants

Antioxidants fight inflammation and oxidative damage in the body, processes which can help to fight the damaging effects of the Western diet on heart health. There are so many different types of antioxidants in our foods, especially in vegetables and fruits. Some of the most-studied antioxidants for heart health include:

• Lycopene: found in tomatoes, lycopene is a type of carotenoid that is even more potent at fighting oxidation than vitamin E. It has been found to fight atherosclerosis and may even help to reduce blood lipid levels. Lycopene levels are highest in cooked tomatoes, so try adding grilled tomatoes to your breakfast or salad, or even cook up a tomato soup with plenty of garlic.
• Resveratrol: an antioxidant found in grapes, red wine, and green tea. Resveratrol has been extensively studied for its health benefits, including helping with cardiovascular disease, type 2 diabetes, and even cancer. Resveratrol reduces inflammation and helps with blood pressure, as well as preventing platelets clumping together in the blood.   If you are going to drink alcohol, low to moderate red wine consumption is what I recommend.  Excess red wine, as with any alcohol is damaging to your cardiovascular health.
• Quercetin: this antioxidant is found in a wide range of foods, including berries, cacao, citrus fruits, onions, broccoli, tomatoes, red grapes, and tea. Quercetin helps to lower blood pressure and prevent atherosclerosis, as well as opening blood vessels and reducing overall inflammation.
• Vitamin C: a potent antioxidant that helps to protect blood vessels from oxidative damage and protects LDL cholesterol molecules from being damaged.  Vitamin C is also essential for healthy tissue repair, so getting sufficient in your diet is vital. Vitamin C can be found in foods such as citrus fruits, strawberries, broccoli, and capsicum.

CoQ10

CoQ10 (AKA coenzyme Q10) is another antioxidant but deserves its own section because of its powerful antioxidant effects and its affinity for protecting the heart specifically. CoQ10 is produced by all cells of the body and is typically found in high concentrations in the heart, but our levels of this all-important micronutrient decrease with age, resulting in a need to supplement.  CoQ10 supplementation is particularly important for those on statins, as these medications can deplete the body of coQ10. Multiple different forms of CoQ10 supplement are available on the market right now, so speak to your naturopath for advice on the right supplement form for you.

Magnesium

Magnesium is a vitally important mineral in the body and plays a role in over 300 functions! It is a mineral that many people can become deficient in, particularly as it can become depleted when we are stressed – and in our high-stress world, chronic stress affects many of us. Frequent leg cramps are a sign that you may be low in magnesium. Supplementing with magnesium has been shown to help reduce blood pressure, prevents plaques from become calcified and hardened, and helps to open up arteries and veins for better blood flow (a process known as vasodilation).  It is also essential for balancing blood sugar levels, improving sleep and reducing stress which are all risk factors for reduced heart health.   Magnesium can be found in abundance in many foods, including dark green leafy vegetables, nuts and seeds, and legumes such as lentils.

Magnesium is the blood of plants – remember this statement…..

Omega 3 Fatty Acids

Omega 3 fatty acids truly are so important to good health, so it’s no surprise to find them on the list of nutrients for heart health. They are vital for counteracting the inflammation of their cousins, omega-6 fatty acids, which can be found in many of the foods popular in the Western diet. They have a demonstrated positive effect on the heart, helping reduce arrhythmia (irregular heartbeat), preventing platelets from sticking together to form clots, and improving the health of blood vessels. They also help to reduce inflammation and lower blood pressure, too. Omega 3 fatty acids are found in oily fish such as salmon, tuna, and sardines, as well as in walnuts, sunflower seeds, and flax seeds. Enjoy one or two serves of fatty fish per week and try adding walnuts and sunflower seeds to salads. Ground flax seeds can easily be added to porridge or even smoothies!

Fish oil supplements can also be helpful, but many supplements on the market are very poor quality and can even contain rancid oils. Speak with your naturopath about finding a high-quality product. Vegan options are also available and are usually algae-based.

Lifestyle

Exercise Daily

Almost two thirds of Australian adults are overweight or obese, and the number is unfortunately rising. Our cardiovascular system relies on physical activity to help it pump blood through the body – our veins contain specialised valves that work through physical movement, so keeping active is important for cardiovascular health. Aim for at least 30 minutes of vigorous physical activity each day, working hard enough to at least break a sweat.

Quit Smoking

We know that smoking is detrimental to health in so many ways, including affecting the cardiovascular system. The oxidative stress and toxin exposure from smoking causes damage to blood vessels, among a litany of other negative health outcomes. Quitting smoking can make a big difference to your cardiovascular disease and heart attack risk. If you’re ready to quit, speak to your naturopath to learn about strategies that can help you on your journey.

Stress

Stress is part of our everyday lives and is a protection mechanism, helpful to you when managed well.  But, if stress is constant, it can harm you as you are constantly in a “fight or flight” position, and this has enormous biochemical implications as far as your body is concerned. The hormone cortisol is released in response to this stress with scientific studies showing that chronic high levels of cortisol can increase your blood pressure, blood sugar levels, insulin spikes, blood cholesterol and plaque in your arteries, triglycerides and more. All of these things increase your risk factors for cardiovascular disease and heart related problems.

Lack of sleep

Your body considers lack of sleep as a stress on the body also which is why it is now considered “the new carcinogen”.  Not only does it affect cardiovascular disease but many other health related conditions.  If you are not sleeping well, have sleep apnoea or have terrible sleep habits, the time to fix this is now.

Conclusion

Preventable risk factors are something all of us need to consider for our health.  A good diet, daily exercise, stress management, giving up smoking and quality sleep are all enormously important whether you are managing genetic risk factors or proactively improving your overall heart health.   

References

Ansari, S. (2020). Heart health and nutraceuticals. In Preparation of phytopharmaceuticals for the management of disorders: The development of nutraceuticals and traditional medicine (pp. 255–272). Elsevier.

Aune, D. (2019). Plant foods, antioxidant biomarkers, and the risk of cardiovascular disease, cancer, and mortality: A review of the evidence. Advances in Nutrition, 10(4), 404–421.

Heart Foundation. (2022). Key statistics: cardiovascular disease—Statistics and information on cardiovascular disease in Australia. https://www.heartfoundation.org.au/activities-finding-or-opinion/key-stats-cardiovascular-disease

Imaizumi, V. M., Laurindo, L. F., Manzan, B., Guiguer, E. L., Oshiiwa, M., Machado Nueno otoboni, A. M., Arauko, A. C., Tofano, R. J., & Barbalho, S. M. (2022). Garlic: A systematic review of the effects on cardiovascular diseases. Critical Reviews in Food Science and Nutrition.

Imo, C., & Za’aku, J. S. (2019). Medicinal properties of ginger and garlic: A review. Current Trends in Biomedical Engineering & Biosciences, 18(2).

Kim, Y., & Giovannucci, E. L. (2021). Association between dietary fat intake and mortality from all causes, cardiovascular disease, and cancer: A systematic review and meta-analysis of prospective cohort studies. Clinical Nutrition, 40(3), 1060–1070.

Lari, A., Sohouli, M. H., Fatahi, S., Cerqueira, H. S., Santos, H. O., Pourrajab, B., Rezaei, M., Saneie, S., & Rahideh, S. T. (2021). The effects of dietary approaches to stop hypertension (DASH) diet on metabolic risk factors in patients with chronic disease: A systematic review and meta-analysis of randomized controlled trials. Nutrition, Metabolism and Cardiovascular Diseases, 31(10), 2766–2778.

Morelli, M. B., Gambardella, J., Castellanos, V., Trimarco, V., & Santulli, G. (2020). Vitamin C and cardiovascular disease: An update. Antioxidants, 9(12).

Mozaffarian, D., Katan, M. B., Ascherio, A., Stampfer, M. J., & Willett, W. C. (2006). Trans fatty acids and cardiovascular disease. The New England Journal of Medicine, 354(15), 1601–1613.

Rabanal-Ruiz, Y., Llanos-Gonzalez, E., & Alcain, F. J. (2021). The use of coenzyme Q10 in cardiovascular diseases. Antioxidants, 10(5).

Ridker, P. M., Koenig, W., Kastelein, J. J., Mach, F., & Luscher, T. F. (2018). Has the time finally come to measure hsCRP universally in primary and secondary cardiovascular prevention? European Heart Journal, 39, 4109–4111.

Samad, G., & Roshanravan, N. (2019). The role of nutraceuticals in the prevention and treatment of hypertension: An updated review of the literature. Food Research International, 128.

Soliman, G. A. (2019). Dietary fibre, atherosclerosis, and cardiovascular disease. Nutrients, 11(5).

Strazzullo, P., D’Elia, L., Kandala, N.-B., & Cappuccio, F. P. (2009). Salt intake, stroke, and cardiovascular disease: Meta-analysis of prospective studies. BMJ, 339.

Tindall, A. M., Petersen, K. S., Skulas-Ray, A. C., Richter, C. K., Proctor, D. N., & Kris-Etheron, P. M. (2019). Replacing saturated fat with walnuts or vegetable oils improves central blood pressure and serum lipids in adults at risk for cardiovascular disease: A randomized controlled-feeding trial. Journal of the American Heart Association, 8(9).

Widmer, R. J., Flammer, A. J., Lerman, L. O., & Lerman, A. (2015). The Mediterranean diet, its components, and cardiovascular disease. The American Journal of Medicine, 128(3), 229–238.

Zhong, V. W., Van Horn, L., Greenland, P., Carnethon, M. R., Ning, H., Wilkins, J. T., Lloyd-Jones, D. M., & Allen, N. B. (2020). Associations of processed meat, unprocessed red meat, poultry, or fish intake with incident cardiovascular disease and all-cause mortality. JAMA Internal Medicine, 180(4), 503–512.

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This blog post breaks down the underlying mechanisms of PCOS, how it develops and how it affects your health. We will also look at each of the 4 major types of PCOS, including the underlying causes and how they manifest, to help give you a better understanding of what might be going on for you. We will also look at some treatment strategies PCOS naturopaths use to help combat this condition, including diet, nutritional supplements, and herbal medicines.

What is PCOS?

So, what is PCOS? The answer is complicated. Whilst PCOS (or polycystic ovary syndrome) is often discussed as if it is a singular condition, it is in fact a complex syndrome with many varying presentations and causes. Being a syndrome means PCOS isn’t one condition; the term ‘PCOS’ is simply the name given to a collection of similar symptomatic presentations. There are four major ‘types’ of PCOS, and each type has its own constellation of symptoms and underlying causes, but there is a considerable amount of overlap, too.

There are a wide range of symptoms associated with PCOS, but the most common symptoms include acne, missed periods (or a very long and irregular menstrual cycle), male-pattern hair growth on the face, chest and back (also known as hirsutism), overweight or obesity, acne, hair loss, and infertility. PCOS is a very common condition, affecting around 5-10% of women of reproductive age worldwide. PCOS is the most common hormonal disorder affecting women and one of the leading causes of infertility. Despite how common it is, there is still much that isn’t understood about how it manifests or its underlying causes. Making it even more complicated is that with some aspects of PCOS, such as insulin resistance, it is unclear whether it is a cause of PCOS, or whether insulin resistance is in fact a symptom. And whilst many symptoms such as hair loss and acne might seem superficial to some, the long term risks of PCOS are serious. The syndrome places women at higher risk of developing cardiovascular conditions in later life, including heart disease, high blood pressure and high cholesterol. It can also lead to an increased risk of developing type 2 diabetes and metabolic syndrome. The health risks of PCOS aren’t all physical, either. PCOS increases the risk of low self-esteem, eating disorders, depression, and anxiety, and leads to significantly reduced quality of life.

So, what exactly is going on in the body? Contrary to popular belief, PCOS and ovarian cysts are not the same condition, and, in fact, the “cysts” in PCOS aren’t really cysts at all. Confusing, isn’t it! The underlying mechanisms of PCOS are complicated, but primarily it is a disorder of disrupted ovarian function and hormone imbalance, with higher-than-normal levels of both oestrogen and androgens (“male” hormones like testosterone), and a higher ratio of androgens to oestrogen overall. Most PCOS cases also involve insulin resistance, too. This hormone imbalance is what disrupts the ovaries from functioning normally and stops ovulation from occurring.

In a normal menstrual cycle, hormones released by the pituitary gland in the brain trigger the ovary to produce multiple follicles (small, immature eggs). These follicles grow and secrete oestrogen, until day 7 of your cycle, when all but one of the follicles will be dissolved. The one remaining follicle will continue developing and maturing into an egg or “oocyte”, ready for ovulation on day 14 of the menstrual cycle. In PCOS, elevated insulin levels over-stimulate the ovaries and cause them to release higher than normal amounts of hormones. This leads to higher overall levels of both oestrogen and androgens in the body. Insulin then further exacerbates this hormonal imbalance, as insulin resistance in fat tissues converts oestrogen into male hormones inside fat cells. This means even higher androgen levels and an even bigger hormonal imbalance. Back in the ovaries, this hormonal imbalance causes too many follicles being produced each month, but their development is halted part way through the menstrual cycle before they can either mature into a functioning egg or be dissolved by the body. The follicles remain, partially matured, in the ovaries and appear as cyst-like formations on the ovaries during ultrasound. This is the reason for the “polycystic” portion of PCOS’s name. They are not really cysts but are, in fact, immature follicles that merely look like cysts. To make matters even more complicated, the presences of these “cysts” is also not diagnostic for PCOS and in fact, for many women, having lots of follicles in your ovaries can be normal, especially for younger women.

It’s important to remember that pain is not a symptom of PCOS. As discussed above, the “cysts” in PCOS are not actually cysts but immature follicles. If you are experiencing pain, this is not a part of PCOS and warrants investigation with your health care practitioner.

Diagnosis of PCOS

Diagnosis of PCOS will often have at least two of the following:

• Evidence of multiple “cysts” (immature ovarian follicles) demonstrated on ultrasound
• High androgens (e.g., testosterone or DHEAs) on blood tests
• Physical signs and symptoms of PCOS, such as acne, hirsutism, and hair loss

It is important to note however that it is normal for some women to have a higher number of follicles, especially younger women and for this reason, relying purely on an ultrasound to confirm a PCOS diagnosis cannot be done.  Polycystic ovaries, whilst common in PCOS can simply be follicles or eggs on a normal ovary so other tests must be part of the diagnosis.

In addition to this, women can still have PCOS whilst also having ovaries that appear normal.

This is why naturopathically speaking, further tests might also be done to help determine some of the underlying causes and to help guide treatment plans. Tests might include an oral glucose tolerance test, and blood tests to assess levels of insulin, SHBG (sex hormone binding globulin), and the ratio of luteinising hormone and follicle stimulating hormone (to assess for ovulation and hormone balance).

Causes of PCOS

So, what really causes PCOS? It is often discussed as being a “lifestyle” disease (i.e., a condition that is caused by a sedentary lifestyle and poor diet), but the truth is more complicated than that, and framing it as a lifestyle condition can be upsetting for women who have spent years trying to manage symptoms through lifestyle habits without success. PCOS is generally the result of both genetic and environmental causes, and whilst lifestyle can certainly play a role, it is not the only underlying trigger to the development of PCOS. Other underlying causes include:

• Genetics: Several genes have been identified by scientists as playing a role in the development of PCOS. Although it’s not clear yet how strongly they are linked, it is clear these genes at least predispose certain women to developing PCOS. Studies also show that it is at least partly inheritable, and often runs in families.
• Inflammation: Chronic inflammation can work in much the same way as insulin resistance, triggering the ovaries to produce excess androgens.
• The pill: Although post-pill PCOS is not “true” PCOS, coming off the pill can cause a temporary hormone imbalance that can lead to PCOS-type symptoms
• Stress: Although not necessarily a cause of PCOS, studies do suggest that stress can worsen symptoms.

The 4 Types of PCOS

• Insulin Resistant PCOS

Insulin-resistant PCOS is by far the most common type of PCOS, accounting for upwards of 80% of PCOS cases. This is the “classic” PCOS type with the underlying mechanisms as described above. Women with this type of PCOS often struggle with their weight and may be overweight or obese even despite efforts to lose weight. Reducing insulin resistance is the primary focus for treatment with this type of PCOS, through the use of dietary and lifestyle changes, and supplements such as inositol, magnesium, and even chromium.

• Post-Pill PCOS

Post-pill PCOS is less common. Whilst many women may first discover they have PCOS when they come off the pill and develop symptoms, it doesn’t always mean that they have post-pill PCOS. Sadly, many women are unaware they even have PCOS until they come off the oral contraceptive pill in order to start having children. They may have been prescribed the pill in their early teens for “irregular periods” (which is normal in early adolescence), or to “treat” acne, and have stayed on the pill ever since. It is only when they come off the pill that their hormonal imbalance is identified. Its’s important to note, however, that the pill does not actually treat PCOS – it simply masks its symptoms. This is why symptoms return once you stop taking the pill.

It is only considered to be post-pill PCOS if your periods were well-established (you’d had them for 7 or more years) and regular before you went on the pill and are only irregular since stopping the pill. While uncommon, for some women, coming off the pill leads to a temporary rebound effect on hormones, leading to a hormonal imbalance that causes PCOS-type symptoms. Although it is temporary, it can be distressing, and naturopathic approaches can help to mitigate symptoms while hormone levels balance out again. Treatments such as the herbs liquorice and peony can be helpful in re-establishing normal ovarian function and hormone levels, as can supplements such as zinc.

• Inflammatory PCOS

Chronic inflammation is something that is common in many women with PCOS. Chronic inflammation affects the ovaries by stimulating higher than normal androgen production, disrupting ovarian function and ovulation in much the same way as insulin resistance does. Women with inflammatory PCOS will generally have other symptoms associated with chronic inflammation that aren’t typical to PCOS, such as fatigue, joint pain, or chronic skin issuses like eczema. In inflammatory PCOS, it’s important to address the underlying cause (or causes) of the chronic inflammation. For some, this may be a food intolerance, commonly gluten or dairy. For others, it may be chronic gut issues or dysbiosis, or even histamine intolerance.

• Adrenal PCOS

Adrenal PCOS is much less common than insulin-resistant PCOS, accounting for around 10% of cases. This is where adrenal dysfunction leads to high levels of cortisol (the “stress” hormone). High cortisol leads to increased levels of just one type of androgen – DHEAS – but doesn’t affect testosterone levels. This means that for women with adrenal PCOS, blood tests will show high DHEAS levels and normal levels of the other androgens, testosterone and androstenedione. For this type of PCOS, stress management and adrenal tonic herbs such as ashwagandha are the priority for treatment. As mentioned above, studies do suggest that stress in general plays a role in PCOS and therefore needs to be addressed even if your PCOS doesn’t fit the adrenal type.

Naturopathic Treatment Strategies for PCOS

The specific types and combinations of treatments that are used for PCOS vary depending on the type of PCOS. The following is an example of some of the common naturopathic treatment strategies used.

Eliminate Sugar

Sugar is often a significant driver of disease when it comes to PCOS. This is because sugar increases insulin requirements in the body, leading to the development and worsening of insulin resistance. All forms of refined and added sugar should be eliminated from the diet. This includes “hidden” sugars that can be found in supposedly healthy foods such as smoothies, commercial muesli and protein bars – see our blog post on hidden sugars in smoothies. Too much fruit can also be an issue, so it’s best to keep it to no more than 2 serves per day. Whilst eliminating sugar from the diet can be really tough, it’s worth it to get your insulin levels back on track. The good news is, once your insulin function improves, you’ll be able to enjoy the occasional sweet treat again.

 The Mediterranean Diet

Multiple studies have demonstrated the beneficial effects of the Mediterranean diet on PCOS, and it stands to good reason – this diet is low in sugar and pro-inflammatory foods and high in antioxidants, good quality proteins, and healthy fats – all the foods needed for managing PCOS symptoms.

16-8 Fasting

16/8 intermittent fasting (fasting for 16 hours per day and eating only during an 8-hour window each day) can help with PCOS symptoms by improving insulin sensitivity.

Exercise

Daily exercise is an absolute must when it comes to PCOS! Whatever your choice of exercise may be, aim to work up a good sweat each day and engage in at least 30 minutes of vigorous activity (but preferably aim for 60 minutes). Exercise helps to utilise glucose in the blood and improve insulin sensitivity. Over time, increased muscle mass from exercise can make our bodies even more efficient at maintaining our glucose and insulin levels even when we are at rest.

Supplements and Herbs

There are a whole host of supplements and herbs that are marketed towards PCOS management, but the truth is that the treatments that will suit you best will depend on your PCOS type and your individual symptom picture. Your naturopath will be able to guide you towards the best treatment plan for you, but the info below gives you some insight into how these treatments can help.

Liquorice and Peony

These two herbs are a common combination for treating PCOS. The two work synergistically together; liquorice helps balance hormone levels by improving the ovary’s ability to transform testosterone into oestrogen, while peony works to heal the ovaries.

Ashwagandha

Ashwagandha is an Ayurvedic herb that acts as an adrenal tonic, helping to improve adrenal function and improve cortisol function. This is particularly helpful for adrenal PCOS, or for instances where stress is making your symptoms worse.

Spearmint

Spearmint tea might be a surprising addition to the list, but several studies have found it to be effective. Drinking spearmint tea 3 times a day has been found to be effective at reducing androgen levels and has even been found to reduce hirsutism (chin and chest hair growth).

Supplements

Supplements are also frequently used, including:

• Inositol: One of the most popular supplements on the market for PCOS, and for good reason. Multiple studies have shown that inositol can improve many aspects of PCOS, including lowering testosterone levels, improving insulin sensitivity, reducing acne, and improving fertility.
• Zinc: helps improve insulin function but is also a great supplement for healthy ovary functioning and hormone health. Studies have shown it can help to reduce hair loss and hirsutism in people with PCOS.
• Magnesium: a powerhouse mineral that is involved in hundreds of different processes in the body. Magnesium helps to make cells more sensitive to insulin but is also important for reducing high cortisol levels associated with adrenal dysfunction.
• Omega 3 fatty acids: a vital nutrient that so many of us are lacking, omega 3s are needed for healthy cell walls and reducing inflammation. Omega 3 fatty acids are found in fatty fish such as salmon and tuna but can also be taken in supplement form if required.
  – Many omega 3 supplements on the market are poor quality, so I do recommend you look to your naturopath for a quality product, to make sure you’re getting benefit from your supplement. Vegan omega 3 supplements are also available and are usually algae derived.
• Chromium: Another nutrient needed for healthy insulin function. Studies have shown chromium supplementation to improve menstrual cycles and ovarian health and reduce testosterone levels in people with PCOS.

To find out more about how a PCOS naturopath can help you, please contact Performance in Health in Sydney. We are an award winning clinic located in Stanmore, in Sydney’s Inner West and you can contact us or book an appointment online.

References

Akdogan, M., Tamer, M. N., Cure, E., Cumhur Cure, M., Koroglu, B. K., & Delibas, N. (2007). Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism. Phytotherapy Research, 21(5), 444/447.

Amr, N., & Abdel-Rahim, H. E. (2015). The effect of chromium supplementation on polycystic ovary syndrome in adolescents. Journal of Pediatric and Adolescent Gynecology, 28(2), 114–118.

Arentz, S., Abbott, J. A., Smith, C. A., & Bensoussan, A. (2014). Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; A review of the laboratory evidence for effects with corroborative clinical findings. BMC Complementary and Alternative Medicine, 14.

Barrea, L., Arnone, A., Annunziata, G., Muscogiuri, G., Laudisio, D., Salzano, C., Pugliese, G., Colao, A., & Savastano, S. (2019). Adherence to the Mediterranean Diet, dietary patterns and body composition in women with polycystic ovary syndrome (PCOS). Nutrients, 11(10).

Briden, L. (2021). 4 types of PCOS (a flowchart). https://www.larabriden.com/4-types-of-pcos-a-flowchart/

Cuciureanu, M. D., & Vink, R. (2011). Magnesium and stress. In Magnesium in the central nervous system. University of Adelaide Press.

Damone, A. L., Joham, A. E., Loxton, D., Earnest, A., Teede, H. J., & Moran, L. J. (2018). Depression, anxiety and perceived stress in women with and without PCOS: A community-based study. Psychological Medicine, 49(9).

Fazelian, S., Rouhani, M. H., Bank, S. S., & Amani, R. (2017). Chromium supplementation and polycystic ovary syndrome: A systematic review and meta-analysis. Journal of Trace Elements in Medicine and Biology, 42, 92–96.

Grant, P. (2010). Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome: A randomized controlled trial. Phytotherapy Research, 24(2), 168–188.

Jamilian, M., Foroozanfard, F., Bahmani, F., Talaee, R., Monavari, M., & Asemi, Z. (2016). Effects of zinc supplementation on endocrine outcomes in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. Biological Trace Elements Research, 170(2), 271–278.

Khan, M. J., Ullah, A., & Basit, S. (2019). Genetic basis of polycystic ovary syndrome (PCOS): Current perspectives. Applied Clinical Genetics, 12, 249–260.

Merviel, P., James, P., Bouee, S., Le Guillou, M., Rince, C., Nachtergaele, C., & Kerlan, V. (2021). Impact of myo-inositol treatment in women with polycystic ovary syndrome in assisted reproductive technologies. Reproductive Health, 18.

Sadinpour, A., Seyedi, Z. S., Arabdolatabadi, A., Razavi, Y., & Ajdary, M. (2020). The synergistic effect of Paeonia spp and Glycyrrhiza glabra on polycystic ovary induced in mice. Pakistan Journal of Pharmaceutical Sciences, 33(4), 1665–1670.

Unfer, V., Facchinetti, F., Orru, B., Giordani, B., & Nestler, J. (2017). Myo-inositol effects in women with PCOS: A meta-analysis of randomized controlled trials. Endocrine Connections, 6(8), 647–658.

Wekker, V., van Dammen, L., Koning, A., Heida, K. Y., Painter, R. C., Limpens, J., Laven, J. S. E., Roesters van Lennep, J. E., Roseboom, T. J., & Hoek, A. (2020). Long-term cardiometabolic disease risk in women with PCOS: A systematic review and meta-analysis. Human Reproduction Update, 26(6), 942–960.

Yang, K., Zeng, L., Bao, T., & Ge, J. (2018). Effectiveness of omega-3 fatty acid for polycystic ovary syndrome: A systematic review and meta-analysis. Reproductive Biology and Endocrinology, 16.

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You may have heard the term “insulin resistance” before, particularly when it comes to reducing risk factors for common health conditions. But what exactly is insulin resistance, and how does it really affect your health? In this week’s blog post, we will be examining the role of insulin in the body and the effects of insulin resistance on health and wellness. We will also explore ways to help reduce your risk of developing insulin resistance and improve insulin function for better wellbeing.

What is Insulin and What Does it Do?

Insulin is our main hormone for controlling blood sugar levels in the body. It is a crucial hormone for normal body functioning, as it is the main way for the cells in our bodies to receive glucose (sugar) for energy. Insulin is also important for telling the liver to store glucose for later use. Insulin is particularly important for muscles, liver and fat cells – it is these cells which are most affected by insulin resistance.

Most cells in our bodies require glucose in order to function – it is the main energy source our cells use to perform their normal functions (and keep us alive!). However, too much glucose inside a cell can cause issues, so the amount of sugar entering the cell needs to be carefully controlled. Enter, insulin. Insulin molecules are released by the pancreas when extra sugar is detected in the blood stream (e.g., after eating). The insulin then circulates throughout the body via the blood. These insulin molecules bind onto the outside surface of cells and act like a “key” to unlock a passageway for glucose to enter the cell. Once glucose has entered, the insulin detaches from the cell wall to prevent too much sugar moving into the cell. The pancreas will keep producing/ releasing insulin until glucose levels in the blood return to normal. In this way, our body can carefully control blood sugar levels to ensure we have the energy needed for optimal function, without sugar levels becoming dangerously high.

In addition, insulin is a fat-storage hormone, meaning that high levels of insulin and insulin resistance may result in weight gain and elevated triglycerides.

Insulin Resistance

Insulin resistance is a condition where the body becomes resistant to the effects of the glucose-regulating hormone insulin, resulting in prolonged periods of high blood sugar. It is often asymptomatic, but left unchecked, it can progress to serious health issues including diabetes and metabolic syndrome. Insulin resistance can also occur due to other underlying health conditions, such as PCOS or Cushing’s disease. So, what causes insulin resistance and how can we reduce our risk of developing it? 

How does insulin resistance develop? Essentially, when blood sugar levels remain high (as can occur with continued excess sugar consumption), the pancreas compensates by continuing to produce more and more insulin in an attempt to get blood sugar levels back down to a safe level. Eventually, the prolonged presence of insulin in the blood stream leads to cells becoming less responsive to insulin. This means more and more insulin needs to be produced in order to prompt cells to properly uptake the glucose present in the blood. Eventually, our cells are no longer able to use the insulin or to uptake glucose as effectively as before, and as a result, glucose levels in the blood remain high. This is known as insulin resistance.

Symptoms of insulin resistance

Insulin resistance can be completely asymptomatic, so many people are unaware there is an issue. However, some symptoms may include:

• Acanthosis nigricans – darkening of the skin under the armpits, in the groin, or even at the back of the neck
• Irregular menstruation – insulin resistance can disrupt normal hormone balance
• Excess thirst and frequent urination – due to your kidneys attempting to filter out the excess glucose in your blood
• Fatigue
• Skin tags
• Recurrent or chronic infections
• Gaining weight easily or an inability to lose weight
• Anxiety and feeling irritated commonly referred to as “hangry”

Risk factors for developing Insulin Resistance

There are a number of risk factors that can contribute to or increase your risk of developing insulin resistance. Addressing these risk factors where possible can reduce your overall risk of developing insulin resistance and other cardiovascular conditions.

Sedentary Lifestyle/ Low Physical Activity

Our skeletal muscles are one of the biggest users and storers of glucose. Physical activity is required for our muscles to use up their glucose stores, ready to absorb the glucose from the foods we eat. Inadequate physical activity means our muscles aren’t using up any glucose, leaving too much glucose circulating in the blood.

Being Overweight or Obese

Being overweight or obese, particularly if you carry your excess weight in your abdomen, can increase your risk of insulin resistance, as fatty tissue (especially abdominal fatty tissue) secretes hormones that promote insulin resistance.

High Glycemic Load & highly processed carbohydrate diet

Eating a diet that is rich in high glycemic loaded foods which includes processed carbohydrates cause powerful spikes in blood sugar levels and this leads to an increased risk of insulin resistance.

Smoking

Cigarette smoking and nicotine use directly increase insulin requirements and insulin resistance in a dose-dependent manner, meaning the more heavily you smoke, the greater the impact on insulin.

Sleep Issues

Turns out our circadian rhythm – the internal clock that keeps us awake in the day and make us sleepy at night – also influences blood sugar levels. When our circadian rhythm is disrupted (such as through ongoing insomnia/ sleep issues or shift work), it alters not only our sleep-wake behaviours but also our food intake, the sensitivity of muscles and fat tissue to insulin, and even the production of insulin in the pancreas itself.

Stress

Stress turns on our fight-or-flight response and puts us into a state known as parasympathetic dominance, increasing cortisol so the body is ready to respond to perceived threats. Unfortunately, when in parasympathetic dominance, the body down-regulates certain biological activities such as digestion, and also reduces the body’s sensitivity to insulin. From a biological point of view, this makes sense, as it means the glucose in our blood stream is readily available for rapid uptake to the muscles if we find ourselves needing to physically run from a threat. However, the chronic types of stress we encounter in the modern world don’t require us to physically run away from danger, so our glucose levels remain high, impairing the function of insulin.

Genetics

A number of hereditable genetic mutations have been identified that increase the risk of both insulin resistance and diabetes.

Health Effects of Insulin Resistance

The health effects of insulin resistance are due to the presence of excessive amounts of glucose in the bloodstream, which damages cells and disrupts normal body functioning, including hormonal balance and cell signalling.

Insulin resistance and high blood sugar can lead to:

• Inflammation – animal studies have shown that insulin resistance leads to an increased production of inflammatory molecules and activates inflammatory pathways in the body. Conversely, chronic inflammation can itself lead to reduce insulin sensitivity in cells, further exacerbating insulin resistance.
• Increased blood pressure – insulin can trigger sodium retention and also affects blood vessels, contributing to higher blood pressure.
• Abnormal cholesterol levels – insulin resistance prompts the body to produce more cholesterol and have lower levels of the good HDL cholesterol
• An inability to lose weight
• Brain fog, mood changes and cognitive issues – studies have demonstrated that insulin resistance can lead to reduced cognitive function, at least partly due to its effect on blood vessels, as well as the effects of high blood sugar on mood.

Insulin Resistance and Other Health Conditions

Insulin resistance doesn’t exist just on its own. Whilst diabetes is the most commonly thought of condition associated with insulin resistance, there are several other health conditions that can contribute to, or be exacerbated by insulin resistance, including polycystic ovarian syndrome (PCOS), non-alcoholic fatty liver disease, and even hypothyroidism. Insulin resistance also forms part of the symptom picture of metabolic syndrome, also known as syndrome X. Insulin resistance also leaves us more prone to other health conditions, including cardiovascular disease. Recent research also suggests a potential link between insulin resistance and an increased risk of developing Alzheimer’s disease in later life.

Diabetes

One of the most common health conditions associated with insulin resistance is diabetes. There are two types of diabetes – type 1, which is an autoimmune condition that most often begins in childhood or early adulthood, and type 2, which is classed as a “lifestyle condition”. This second type of diabetes more commonly begins well into adulthood, as a result of ongoing sugar consumption in excess of what our bodies are able to effectively process with insulin. Type 2 diabetes is essentially the disease state that results from ongoing insulin resistance – the pancreas becomes too fatigued to be able to produce sufficient insulin anymore and blood glucose levels cannot be controlled. For more information on type 2 diabetes, check out my blog post here.

Non-alcoholic fatty liver disease (NAFLD)

This is a condition that involves the accumulation of fat in the liver in individuals who do not consume an excessive amount of alcohol with scientific studies establishing that insulin resistance plays a major role in this disease.

PCOS

Insulin resistance is a common factor in PCOS, however there is contention regarding whether PCOS leads to insulin resistance or vice versa. PCOS is a complex and multifactorial condition, however there is a clear role of insulin resistance in the disease for many women. Insulin resistance contributes to PCOS because of the hormonal effects of insulin on the body. Insulin stimulates the production of androgens (“male” type hormones) and also increases inflammation in fatty tissues, which leads to fatty tissues converting oestrogen into androgen, leading to excess androgens and the development of PCOS symptoms.

Thyroid Conditions

The thyroid is an important organ for metabolism and energy use, so it’s no surprise that thyroid conditions and insulin resistance can be linked. In fact, thyroid hormones play a role in regulating insulin levels. Hypothyroidism in particular is associated with higher insulin levels and insulin resistance, and studies have shown that even subclinical hypothyroidism (that is, low thyroid function that might not necessarily be low enough for a standard diagnosis) can lead to insulin resistance.

Menopause

Menopause, although not so much a health condition as it is a normal life phase, is also associated with changes to insulin sensitivity due to the hormonal and metabolic changes that occur during this time. Oestrogen is involved in insulin sensitivity and balancing glucose levels, and naturally declines during menopause, leading to poorer insulin function and an increased risk of insulin resistance. This is also a time when many women will gain weight around their abdomen, which increases insulin resistance as discussed above.

Testing for Insulin Resistance

There are a number of different types of tests that can be used to assess insulin function. It is common that you have had fasting glucose tested previously and it is only when this is elevated that further testing is performed.  As a naturopath, I need to understand what your insulin is doing behind the scenes to keep blood glucose levels normal.  Based on your symptoms, I will often request further testing to assess this.  Checking thyroid levels, hormone levels, liver function, cholesterol and triglycerides can also provide valuable information.

Naturopaths typically use more in-depth testing to assess for insulin resistance, as well as to obtain a more complete symptom picture to understand the underlying root cause of your condition.

Managing Insulin Resistance

Fortunately, there are plenty of dietary and lifestyle strategies that can help to combat insulin resistance and reduce the risk of developing conditions such as diabetes, weight gain, or PCOS.

With so many possible components to the development of insulin resistance, one size does not fit all with this condition and a review of your unique health situation including family history is highly recommended.  Some basic tips that are helpful include:

Dietary Strategies

Eat regularly and avoid skipping meals

Eating regular, healthy meals will prevent excessive rises and falls in blood sugar (and will also help to prevent sugar cravings!)

Include protein in every meal

Protein helps to keep you full and also helps to slow down the uptake of sugar from meals. Slower sugar absorption means avoiding rapid spikes in blood sugar, which can trigger excessive insulin output from the pancreas

Eat plenty of fruits, vegetables and spices

Fruits, vegetables and spices are rich in antioxidants, which can help to reduce inflammation associated with insulin resistance. Fruits and vegetables are also an excellent source of fibre which can help to slow down sugar absorption

Other Management Strategies

Exercise daily

As we discussed above, our muscles are one of the main users of glucose in the body, so we need to be using our muscles to make sure we are making actually utilising the sugars in the foods we eat. Exercise also make cells more sensitive to insulin.  30 minutes of moderate intensity exercise (strenuous enough that you break a sweat) is a great place to start.

Focus on quality sleep

Insomnia is associated with insulin resistance so keep a regular sleep schedule and avoid disruption to your normal circadian rhythm. 

Reduce your exposure to artificial lights and bright screens at night

Promote optimal circadian function by ensuring adequate sunlight exposure in the mornings (before 10am)

For additional tips on sleep click here

Quit smoking

Smoking directly increases the risk for insulin resistance

In addition to dietary and lifestyle changes, as a naturopath I prescribe herbs and nutritional supplements to help support your insulin function, depending on the underlying causes of your insulin resistance. As always, it is important to discuss your current medications and any diagnosed health conditions before taking herbs or supplements.

References

Baptiste, C. G., Battista, M.-C., Trottier, A., & Baillargeon, J.-P. (2010). Insulin and hyperandrogenism in women with polycystic ovary syndrome. The Journal of Steroid Biochemistry and Molecular Biology, 122(1–3), 42–52.

Brown, A. E., & Walker, M. (2016). Genetics of insulin resistance and the metabolic syndrome. Current Cardiology Reports, 18.

Bugianesi, E., Moscatiello, S., Ciaravella, M. F., & Marchesini, G. (2010). Insulin resistance in nonalcoholic fatty liver disease. Current pharmaceutical design, 16(17), 1941–1951. https://doi.org/10.2174/138161210791208875

Czech, M. P., Tencerova, M., Pedersen, D. J., & Aouadi, M. (2013). Insulin signalling mechanisms for triacylglycerol storage. Diabetologia, 56(5), 949–964. https://doi.org/10.1007/s00125-013-2869-1

Chiolero, A., Faeh, D., Paccaud, F., & Cornuz, J. (2008). Consequences of smoking for body weight, body fat distribution, and insulin resistance. The American Journal of Clinical Nutrition, 87(4), 801–809.

Ferreira, L. S. S., Fernandes, C. S., Vieira, M. N. N., & De Felice, F. G. (2018). Insulin resistance in Alzheimer’s disease. Frontiers in Neuroscience.

Geroldi, C., Frisoni, G. B., & Paolisso, G. (2005). Insulin resistance in cognitive impairment: The InCHIANTI study. Archives of Neurology, 62(7), 1067–1072.

Petersen, M. C., & Shulman, G. I. (2018). Mechanisms of insulin action and insulin resistance. Physiology Reviews, 98, 2133–2223.

Shimobayashi, M., Albert, V., Wolnerhanssen, B., Frei, I. C., Weissenberger, D., Meyer-Gerspach, A. C., Clement, N., Moes, S., Colombi, M., Meier, J. A., Swierczynska, M. M., Jeno, P., Beglinger, C., Peterli, R., & Hall, M. N. (2018). Insulin resistance causes inflammation in adipose tissue. The Journal of Clinical Investigation, 128(4), 1538–1550.

Shoelsen, S. E., Lee, J., & Goldfine, A. B. (2006). Inflammation and insulin resistance. The Journal of Clinical Investigation, 116(7), 1793–1801.

Stenvers, D. J., Scheer, F. A. J. L., Schrauwen, P., la Fleur, S. E., & Kalsbeek, A. (2019). Circadian clocks and insulin resistance. Nature Reviews Endocrinology, 15, 75–89.

Vyakaranam, S., Vanaparthy, S., Nori, S., Palarapu, S., & Bhongir, A. V. (2014). Study of insulin resistance in subclinical hypothyroidism. International Journal of Health Science Research, 4(9), 147–153.

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Type 2 Diabetes Prevention Advice

• Start eating more strategically.
• Replace the processed foods in your diet with fresh wholefoods. This involves take-aways, ready meals that you heat up and packaged foods only being eaten on special occasions.
• Eat a low glycaemic load (GL) Diet. A simplified explanation is that high glycaemic means that food eaten moves from your gastrointestinal tract into your blood really quickly. Carbohydrates are sugar so large amounts of sugar enter your blood all at once. Your insulin then increases very quickly, and this is a major cause of becoming insulin resistant, not to mention the energy slumps that soon follow. So, remember that if you eat a large amount of carbohydrates during a meal or snack, blood sugar levels will rise, making insulin levels spike and then as a consequence your blood sugar levels drastically fall.  This may also mimic anxiety for some people and weight management may also become more difficult.
• Adding a quality protein and a good fat at every meal will lower the GL (Glycaemic load) when eaten with a high GL food. Avoid high GL foods in excess such as white bread, pasta, white rice, biscuits, cakes, processed cereals, honey, fruit juice, soft drinks, sweetened yoghurts, alcohol, excess dairy, lollies, chocolate, ice cream and potato chips.
• Good quality protein includes lean meats, eggs, chicken, seafood, legumes (lentils, chickpeas, beans), quinoa, tempeh, tofu. Protein is king as it slows the speed of sugar into your blood and gives you energy throughout the day.
• With a growing focus on vegetarian and vegan diets, it should be noted that as long as a wide variety of protein rich foods are eaten, then protein requirements are usually met. Just as with meat eaters however, there are many vegans and vegetarians relying on heavily processed and packaged foods which also impacts blood sugar levels and overall health.
• Good quality fats are important to eat. It is the type of fat that is important.  The natural fats you want to eat include avocado, raw nuts and seeds, cold pressed olive oil, flaxseeds, olives, avocado oil and fatty fish. Man-made fats to eliminate include margarine, canola oil and deep-fried foods. Look at added ingredients always!

To learn more about incorporating protein into your diet, click here.

• Increase the fibre in your diet by adding more fresh, preferably organic whole fruit, salad and vegetables to your diet.
• Be dairy wise: Dairy foods including milk, cheese and yogurt contain carbohydrates, so although they are a good source of calcium and vitamin D, they can significantly raise your blood sugar if excess is consumed. Some people have large glasses of milk hot chocolates or a large cappuccino without realizing the impact on blood sugar and nut milks in cafes are often full of sugar and the wrong fats.
• If you experience energy slumps or feeling “Hangry”, don’t leave too large a gap between meals. Eating 15 grams of raw nuts with a piece of whole fruit is a great option for morning or afternoon tea.  Another good choice is humous with carrot or celery sticks.
• Exercise each day: exercise is one of the easiest ways to keep blood sugar levels healthy and to increase the sensitivity of your cells to insulin. Daily walking is an excellent exercise for improving energy levels and weight loss, especially in the morning. Walking in the sun has so many health benefits including improving blood glucose & cholesterol levels, improving mood, heart health and improving sleep.  Walking is the only exercise I have ever found people stick to long time because they really enjoy it. The important thing is to choose an exercise you can stick to long-term.
• Commit to improving your sleep: 7-8 hours of uninterrupted sleep is a good KPI as lack of sleep impacts blood sugar levels and increases the risk of Type 2 Diabetes.
• Consciously address the stress in your life: chronic stress impacts blood sugar, insulin and is a main risk factor for Type 2 Diabetes.

Creating an appropriate treatment plan needs to be tailored specifically to each individual as people have different requirements based on age, weight, exercise levels and other health related conditions. I will say that I am a big fan of the Mediterranean diet for all of my clients as opposed to diets that restrict whole food groups. I see many people go to the extremes in reducing carbohydrates and they end up eating only small amounts of fibre and nutrients from fruit, salad and vegetables and way too much protein and fat. This is not the intention of this blog as vegetable components of your eating plan are essential and diets that are too high in protein and fat can also lead to unfavourable health outcomes.

If you need extra help to create a unique dietary and lifestyle plan to reduce your risk of illness and support optimal health, please reach out.

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