I can still recall my first research work in Monash University which was on Insulin Resistance in PCOS women. This is one of the most researched condition in women as it affects 12%-18% of women in reproductive age and an estimated of 70% of them remain undiagnosed. Often, women do not seek help unless they have issues with menstrual irregularities or infertility, this is when they usually find out that they have PCOS which could be mild, moderate or severe.
What is PCOS?
PCOS is a complex condition which it is characterised by hormonal imbalance, menstrual irregularities with or without appearance of multiple ovarian cysts on ultrasound. It is true that even if you have multiple ovarian cysts on ultrasound, you might not be diagnosed with PCOS.
Symptoms of PCOS:
The symptoms of PCOS are largely due to the fact that there is increased androgen (male hormone) in PCOS. Symptoms include excess hair (hirsutism), hair loss, acne, weight gain, difficulties with fertility, increased anxiety and depression and missed or irregular periods (defined as having 8 or less menstrual cycles a year or menstrual cycles longer than 35 days).
Causes of PCOS:
The cause of PCOS is unknown, although immediate female relatives (i.e. daughters or sisters) of women with PCOS have up to a 50 per cent chance of having PCOS.
Long Term Health Risks of PCOS (1):
- Increased risk of diabetes or prediabetes
- Increased risk of heart attack
- Increased risk of high blood pressure
- Increased risk of hypercholesterolemia
- Sleep apnea
- Anxiety and depression
- Increased risk for endometrial cancer.
Diagnosis of PCOS is likely to involve:
- Medical history (most importantly menstrual history)
- Ultrasound for any ovarian cysts
- Blood tests to measure hormone levels
Treatment of PCOS:
Multidisciplinary approach is needed and management of PCOS can include lifestyle modifications, weight reduction, and treatment with hormones or medications. Research has shown that even a five to 10 per cent loss of weight in those who are overweight can restore normal hormone production and help regulate periods and improve fertility.
If you suspect that you might have PCOS, it is recommended that you speak to your gynecologists or endocrinologists to further assist you in diagnosis and treatment of this condition.
1: Palomba S, Santagni S, Falbo A, La Sala GB. Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Womens Health. 2015 Jul 31;7:745-63. doi: 10.2147/IJWH.S70314. eCollection 2015. Review. PubMed PMID: 26261426; PubMed Central PMCID: PMC4527566.
Magnesium is an essential mineral required by every organ in the body for a range of activities including proper growth and maintenance of bones, as well as protein and fatty acid formation. It is also essential in activating vitamins B and D, relaxing muscles, regulating calcium levels and helping blood to clot and is required for the secretion of insulin. In the stomach, magnesium helps neutralize stomach acid and moves stools through the intestine.
According to population studies of average magnesium intake, less than 55% of U.S. adults consume the Recommended Daily Allowance (RDA) of magnesium and nearly 20% get only half of the magnesium they need daily to remain healthy. Adults require about 310 to 420 milligrams a day (1).
Warning Signs of Deficiency may include:
Studies show that too much stress, processed food, caffeine and alcohol, or heavy periods, can lower your levels. In fact, drinking too much carbonated sodas can flush magnesium out of your system despite having a balanced diet (2). Hence it is relatively easy to become mildly deficient in magnesium, but simple dietary changes or supplements can restore your levels. Magnesium chloride supplements are generally considered to be the form that allow for the greatest uptake and availability.
1: King DE, Mainous AG 3rd, Geesey ME, Woolson RF. Dietary magnesium and C-reactive protein levels. J Am Coll Nutr. 2005 Jun;24(3):166-71. PubMed PMID: 15930481.
2. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007 Apr;97(4):667-75. Epub 2007 Feb 28. Review. PubMed PMID: 17329656;
PubMed Central PMCID: PMC1829363.
I've came across quite a few cases of obese patients who would really like to get pregnant and have read a fair share of pregnancy journey stories on various pregnancy forums. Even though most IVF centres have a 35 BMI cut off line, personally I believe losing weight is a number one priority if you wish to get pregnant and are on the higher side of the BMI. The reason is simple, in order to have a healthy baby, you should be healthy first and to me a BMI of more than 30 is definitely not healthy.
Obesity is associated to a variety of endocrine abnormalities that might lead to chronic anovulation in women. Progesterone on the other hand is an extremely important hormone in supporting the implantation of a fertilized egg in the uterus as well as help maintain a pregnancy by preventing menstruation. To have a successful pregnancy, progesterone levels should maintain high and sustained throughout the pregnancy. Failure to keep progesterone level high will result in miscarriage.
In this study of 30 anovulatory obese patients between 18 and 35 years old without any thyroid disease, researchers found that with the mean weight loss of 9.5 kg, which represents a weight loss of 10.96% from initial body weight, 26 patients (86.6%) resumed spontaneous ovulation (1). The results demonstrated that with a small weight reduction and a decrease in total body fat percentage, it will improve the hormonal profile and restore ovulation in anovulatory obese women. Thus weight loss should be considered before starting with ovulation induction therapy.
In a more recent study in Singapore, researchers investigated the association between maternal body mass index (BMI) and serum progesterone level in first trimester singleton pregnancies for 194 women at a tertiary maternity hospital in Singapore, from January 2012 to February 2014. Obesity (maternal BMI ≥30 kg/m2) has an increased risk for serum progesterone <35 nmol/L. Results indicate that maternal obesity is associated with low first trimester serum progesterone.
In conclusion, pre-pregnancy weight optimization is beneficial in regulation of serum progesterone level and maintenance of healthy pregnancy.
1: Hernández García IA, Gutiérrez Gutiérrez AM, Gallardo Lozano E. [Effect of weight reduction on the clinical and hormonal condition of obese anovulatory women]. Ginecol Obstet Mex. 1999 Sep;67:433-7. Spanish. PubMed PMID: 10544539.
2. Goh JY, He S, Allen JC, Malhotra R, Tan TC. Maternal obesity is associated with a low serum progesterone level in early pregnancy. Horm Mol Biol Clin Investig. 2016 Jan 9. pii:/j/hmbci.ahead-of-print/hmbci-2015-0030/hmbci-2015-0030.xml. doi:10.1515/hmbci-2015-0030. [Epub ahead of print] PubMed PMID: 26751901
Omega-3 remains one of the most researched nutrition in pregnancy. Omega-3 contains eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which are uniquely important for our human body. While omega-3 has multiple benefits, from slowing ageing to aiding depression as highlighted in my blog earlier, one should not overlook its usage in pregnancy.
Preterm birth also known as premature birth whereby a baby is delivered before 37 weeks of gestation continues to be the one of the leading causes of infant deaths worldwide. Every year an estimated 15 million babies are delivered preterm. Results from a systemic review published in European Journal of Obstetrics & Gynecology and Reproductive Biology has shown that Omega-3 fatty acids are effective in preventing early and any preterm delivery. They also concluded that this intervention is simple and easily available and has the potential to influence population based strategies in the prevention of preterm birth (1).
Omega-3 fatty acids have also been shown to decrease incidence of pre-eclampsia (disorder of pregnancy characterized by high blood pressure and a large amount of protein in the urine), increase birth weight and aid in postpartum depression. American Pregnancy Association suggests 300mg DHA (docosahexaenoic acid) daily for pregnant and lactating women.
It is well known that the best sources of omega-3 fatty acids are cold water fish such as salmon, tuna, sardines, anchovies, and herring. But in terms of pregnancy, many people are justifiably concerned about mercury and other toxins in fish. For this reason, purified fish oil supplements are often the safest source of EPA and DHA.
1: Kar S, Wong M, Rogozinska E, Thangaratinam S. Effects of omega-3 fatty acids in prevention of early preterm delivery: a systematic review and meta-analysis of randomized studies. Eur J Obstet Gynecol Reprod Biol. 2015 Nov 30;198:40-46. doi:10.1016/j.ejogrb.2015.11.033. [Epub ahead of print] PubMed PMID: 26773247.
All nuts have different nutrition credentials and will offer various health benefits. Frequent nut consumption has been associated with better metabolic status, decreased body weight as well as lower body weight gain over time and thus reduce the risk of obesity (1). Moreover, nut consumption has been linked with reduced risk of certain cancers (such as colorectal, endometrial, and pancreatic neoplasms) and protects against depression, mild cognitive disorders and Alzheimer’s disease.
Here's a rundown of a couple of our favourite nuts:
1. Grosso G, Estruch R. Nut consumption and age-related disease. Maturitas. 2016 Feb;84:11-6. doi: 10.1016/j.maturitas.2015.10.014. Epub 2015 Nov 2. Review. PubMed PMID: 26586104.
2. Wien MA, Sabaté JM, Iklé DN, Cole SE, Kandeel FR. Almonds vs complex carbohydrates in a weight reduction program. Int J Obes Relat Metab Disord. 2003 Nov;27(11):1365-72. Erratum in: Int J Obes Relat Metab Disord. 2004
Mar;28(3):459. PubMed PMID: 14574348.
Vitamin E is an antioxidant. Antioxidants help protect protect the body from the damage caused by free radicals. Several studies have been performed in relation to fertility health, revealing its importance for reproductive function and health.
A study published by Fertility and Sterility in April, 2010, showed that vitamin E supplementation may aid in increasing the thickness of the endometrium in women with thin uterine lining of <8mm (1). Researchers also wanted to see if this supplement could increase uterine radial artery (uRA) blood flow. Results showed Vitamin E given at 600mg a day increased uRA in 72% of patients and endometrial thickness (EM) in 52% of patients
In a more recent study published in 2015 , Vitamin E has been linked with miscarriage whereby researchers looked at two forms of vitamin E – alpha-tocopherol (the most active form of the vitamin in the body) and gamma-tocopherol. Nearly three out of four women in the study had what was considered vitamin E deficiency, with low alpha-tocopherol levels. When looking at alpha-tocopherol, 5.2 percent of women with adequate levels in their blood miscarried in the first or second trimester as compared with 10.2 percent of women who miscarried with low levels (2).
“For nearly a century, we have known about vitamin E and its role in the fertility of animals,” says one of the study’s leaders, Kerry Schulze, PhD, an associate scientist in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. Furthermore “Vitamin deficiencies are considered a form of hidden hunger because they are not readily apparent but they can have huge health consequences,” Schulze says. “What we really want to do is optimize health before women become pregnant, because if they don’t start with a good vitamin E status, they are at a high risk of negative outcomes.”
Vitamin E should be taken before and during pregnancy as it has also been shown that Vitamin E administered antenatally can result in a higher level of natural antioxidants in children's body (3).
Please note that Vitamin E supplements may be harmful for people who take blood thinners and other medicines. Check with your health care provider before taking the supplements.
1. Takasaki A, Tamura H, Miwa I, Taketani T, Shimamura K, Sugino N (April 2010). “Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium”. Fertil. Steril. 93 (6): 1851–8. doi:10.1016/j.fertnstert.2008.12.062. PMID 19200982.
2. Shamim AA, Schulze K, Merrill RD, Kabir A, Christian P, Shaikh S, Wu L, Ali H, Labrique AB, Mehra S, Klemm RD, Rashid M, Sungpuag P, Udomkesmalee E, West KP Jr.
First-trimester plasma tocopherols are associated with risk of miscarriage in rural Bangladesh. Am J Clin Nutr. 2015 Feb;101(2):294-301. doi: 10.3945/ajcn.114.094920. Epub 2014 Nov 26. PubMed PMID: 25646326.
3. Kukushkina IP, Dmitrieva NV. [Evaluation of the effect of vitamin E on the fetus and newborn baby]. Pediatriia. 1991;(5):13-6. Russian. PubMed PMID: 1866229.
As a mother of one, I am rather shocked that there are still many women out there who are planning for pregnancy but doesn't understand the importance of nutrient supplement for pregnancy (or rather the fetus). Folic acid, also known as folate or Vitamin B9 is one particular important nutrient that has to be taken as a supplement before conception. It is a proven nutrient to prevent neural tube birth defects (NTD), such as spina bifida (1). Why do you need it as a supplement? The reason is because it is extremely difficult to eat enough foods rich in the vitamin to supply the amount that experts recommend you take in pregnancy. In Australia about 70 babies per year are born with a neural tube defect, which is around 2.5 in every 10,000 babies born. Neural tube defects remain an important, preventable cause of mortality and morbity.
Recommended by The Royal Australian and New Zealand College of Obstetricians and
Gynaecologists, folic acid should be taken for a minimum of one month before conception and at least for the first 12 weeks of pregnancy. The recommended dose of folic acid is at least 0.4mg daily on top of a normal diet to aid the prevention of NTD. Where there is a known increased risk of NTD (patients taking anticonvulsant medication, pre-pregnancy diabetes mellitus, previous child or family history of NTD or BMI>30), or a risk of malabsorption, a 5mg daily dose is recommended. Deficiency in folate not only increases the chances of miscarriage but also causes abnormalities in both mothers (anemia, peripheral neuropathy) and fetuses (congenital abnormalities).
Because folic acid is so important, fortification of grain products with folic acid has been mandatory in the United States since January 1998 and in Canada since December 1998. The many other benefits of folic acid in pregnancy includes: prevention of anemia, prevention of preterm birth, prevention of congenital heart diseases and oral clefts (2).
The recommended upper limit for folate supplementation is currently at 1mg for a normal pregnancy but more research is needed in terms of the risks of high dose folate supplementation. Early data suggest supplementation with l-methylfolate (a derivative of vitamin folate) rather than folic acid may mitigate these risk.
Please note that folic acid in foods is destroyed by overcooking, so opt for a big bowl of green leafy salad daily to top up your folic acid requirement.
1. Greenberg JA, Bell SJ, Guan Y, Yu Y. Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention.
Reviews in Obstetrics and Gynecology. 2011;4(2):52-59.
2. Bailey LB, Berry RJ. Folic acid supplementation and the occurrence of congenital heart defects, orofacial clefts, multiple births, and miscarriage. Am J Clin Nutr. 2005 May;81(5):1213S-1217S. Review. PubMed PMID: 15883454.
There is increasingly more evidence that omega-3 supplements (aka. fish oil) plays an important role in depression.
In 2010, a group of researchers did a meta-analytic review comparing the levels of polyunsaturated fatty acids between depressive patients and control subjects (1). The result ---Compared with control subjects, the levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and total omega-3 (n-3) polyunsaturated fatty acids were significantly lower in depressive patients. There was no significant change in arachidonic acid (AA) or total omega-6 (n-6) polyunsaturated fatty acids. Thus this implies that omega-3 plays a vital role in pathogenesis of depression. This result is in line with research done back in 1998 and published in Journal of Affective Disorders where researchers noted significantly lower levels of omega-3s in the red blood cell membranes of patients with depression (2).
More recently, a study published in Jan 2016 in Journal of Psychiatric Research shows white matter deficits in depression improved after 6 weeks of fish oil supplementation (3). These therapeutic effects of omega-3 PUFAs may be related to improvements in white matter integrity.
Fish oil is not a definitive treatment of depression, but it may be helpful as an addition to prescribed medications or other treatment. Although more studies are needed to determine exactly what role omega-3s play in depression, it's possible that fish oil supplements high in omega-3s may help lower the risk of depression — and omega-3 has many other health benefits.
1: Lin PY, Huang SY, Su KP. A meta-analytic review of polyunsaturated fatty acid compositions in patients with depression.
Biol Psychiatry. 2010 Jul 15;68(2):140-7. doi: 10.1016/j.biopsych.2010.03.018. Epub 2010 May 10. PubMed
2: Edwards R, Peet M, Shay J, Horrobin D. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disord. 1998 Mar;48(2-3):149-55. PubMed PMID: 9543204.
3: Chhetry BT, Hezghia A, Miller JM, Lee S, Rubin-Falcone H, Cooper TB, Oquendo MA, Mann JJ, Sublette ME. Omega-3 polyunsaturated fatty acid supplementation and white matter changes in major depression. J Psychiatr Res. 2016 Jan 11;75:65-74.
doi: 10.1016/j.jpsychires.2015.12.007. [Epub ahead of print] PubMed PMID: 26802812.
A study in Ohio State University found that Omega-3 supplement (aka Fish Oil) can slow the process of ageing by lengthening Telomeres which are small DNA segments that acts like end caps of chromosomes and protects the chromosome (1). Telomeres play a vital role in human ageing process, they keep the double helix strands of our DNA from unraveling and help our cells divide. As shown in the image above, the more they divide, the shorter they get, and when telomeres get too short it can lead to cell inactivity or death.
In this particular study, 106 overweight or obese adults (average age 51) who live fairly sedentary lifestyles participated in the study. Some were given a placebo, while others took either 2.5 grams or 1.25 grams of active omega-3 polyunsaturated fatty acids. Of those who took one of the two dosages of omega-3 supplements, a definite lengthening in the telomeres was apparent when compared to the telomeres in the placebo group.
According to Jan Kiecolt-Glaser, the study's lead author and professor of psychiatry and psychology at Ohio State University, they find the connection between omega-3 supplements and telomere length exciting because "it suggests the possibility that a nutritional supplement might actually make a difference in aging,"
Interestingly, a past study on mice "engineered to age faster" found that lengthening the rodent's telomeres reversed the aging process. After gene therapy, researchers noticed that the mice's fur went from grey back to its original dark brown and its brain size -- which had decreased by 75 percent much like the brain's of Alzheimer's patients -- returned to normal.
So is Omega-3 supplementation the key to not just slow ageing but to reverse ageing?
1: Kiecolt-Glaser JK, Epel ES, Belury MA, Andridge R, Lin J, Glaser R, Malarkey, WB, Hwang BS, Blackburn E. Omega-3 fatty acids, oxidative stress, and leukocyte telomere length: A randomized controlled trial. Brain Behav Immun. 2013
Feb;28:16-24. doi: 10.1016/j.bbi.2012.09.004. Epub 2012 Sep 23. PubMed PMID:
23010452; PubMed Central PMCID: PMC3545053.
Vitamin C is vital in all stages of preconception, pregnancy and childbirth. Interestingly the concentration of Vitamin C (ascorbic acid) is reported to be much higher in human follicular fluid than in blood serum. This suggests that vitamin C may play a role as an antioxidant vitamin during follicular maturation.
According to a study done in Japan on women with luteal phase defects, serum progesterone levels were significantly elevated in the treatment group after one cycle of Vitamin C (750 mg/day until positive pregnancy test) treatment, but not in the control group (1). What is statistically significant was nineteen patients (25%) in the ascorbic acid supplementation group and 5 patients (11%) in the control group became clinically
pregnant. All pregnancies occurred in patients in whom the luteal phase defect resolved, whether spontaneously or as a result of vitamin C supplementation.
In the same study it was also found that vitamin C supplementation significantly improved progesterone levels in 53% of luteal phase defect cases. It is important to highlight that ascorbic acid's principal functions, namely its promotion of collagen synthesis, its role in hormone production, and its ability to protect cells from free radicals, which may explain its reproductive actions (2).
1: Henmi H, Endo T, Kitajima Y, Manase K, Hata H, Kudo R. Effects of ascorbic acid supplementation on serum progesterone levels in patients with a luteal phase defect. Fertil Steril. 2003 Aug;80(2):459-61. PubMed PMID: 12909517.
2. Luck MR, Jeyaseelan I, Scholes RA. Ascorbic acid and fertility. Biol Reprod. 1995 Feb;52(2):262-6. Review. PubMed PMID: 7711198.2.
Dr Nicole Ng (MBBS) is a medical doctor with a passion in women's health and medical research