WHATISINTEGRATIVEMEDICINE?

“Integrativemedicineisanapproachtocarethatputsthepatientatthecenterandaddressesthefullrangeofphysical,emotional,mental,social,spiritualandenvironmentalinfluencesthataffectaperson’shealth.

Employingapersonalizedstrategythatconsidersthepatient’suniqueconditions,needsandcircumstances,itusesthemostappropriateinterventionsfromanarrayofscientificdisciplines tohealillnessanddiseaseandhelppeopleregainandmaintainoptimumhealth.”

WHYINTEGRATIVEMEDICINEFORPCOS?

Lifelongcondition

Adjustmentofcarerequiredatdifferentstagesoflife.

Affectsentirebodyincluding:• Endocrinesystem• Mental/emotional• Reproductivesystem• Skin• Cardiovascular• Metabolism• Immunesystem

Impactedbyexternalfactorssuchasstress,environmentalagents,nutrition/diet,exercise/activity

WHATDOWEKNOWABOUTTHEROOTOFPCOS?

Genetic

InsulinResistance

Inflammation

Sciencephotolibrary.com

AdaptedfromTrayhurn,P.(2013).HypoxiaandAdiposeTissueFunctionandDysfunctioninObesity.PhysiologicalReviews,93(1).

AdaptedfromTrayhurn,P.(2013).HypoxiaandAdiposeTissueFunctionandDysfunctioninObesity.PhysiologicalReviews,93(1).

Healthy IL6TypeInflammation

IL6TypeInflammation(closeup) IL8TypeInflammationBesteretal2016.EffectsofIL-1β,IL-6andIL-8onerythrocytes,plateletsandclotviscoelasticity,6,32188.

ANTI-INFLAMMATORY DIET:DoesItHelp??

THEN:

A2013ASRMcommitteeopiniontitled"Optimizingnaturalfertility"statedthat"thereislittleevidencethatdietaryvariations,vitamin-enricheddiets,antioxidants,orherbalremediesimprovefertility

NOW:

“Thereareemergingepidemiologicdatademonstratingthat…dietmayinfluencereproductivehealthoutcomes.Furthermore,translationalworkwithhumanspecimensandanimalmodelslendsbiologicplausibilitytotheepidemiologicdata,particularlyinthecontextoffemalereproductivediseasesassociatedwithinflammation,includingpolycysticovarysyndrome(PCOS)andobesity.

“Weoutlineepidemiologicandtranslationalworkdemonstratingapotentialrolefordietintheregulationofinflammatoryprocessesassociatedwiththesedisorders.”

Rileyetal2016.Istherearolefordietinamelioratingthereproductivesequelaeassociatedwithchroniclow-gradeinflammationinpolycysticovarysyndromeandobesity?FertilityandSterility,106(3),520–527.

Sciencephotolibrary.com

Supplements:N-Acetyl-CysteineMyo-InositolD-Chiro-InositolResveratrolOmega3FattyAcidsVitaminD

COMMONINTEGRATIVEMODALITIESINPCOS

Exercise/LifestylePsychology/CounselingAcupuncture/Electro-Acupuncture

Nutrition/DietKetogenicdietMediterraneandietLowGlycemicindexdiet(orFoodInsulinDemand)LowCarbohydrate

HOWQUICKLYDOWELEARNNEWINFORMATION?

Searchforallnewintegrativeinterventions

This does NOT include research on integrative medicine for mechanisms such as insulin resistance which could be applied to PCOS!

Totalof398Studies

SEP

1ST 2016 SEP

11TH 2017From To

106StudiesonPCOSandnutritionordiet91NewStudiesonPCOSandComplementaryMedicine88NewStudiesonDietarySupplements33NewStudiesonPCOSandExercise56NewStudiesonPCOSandMood15NewStudiesonPCOSandAcupuncture

VITAMINDDOSINGISIMPORTANT

60Participantswererandomlyallocatedinto3groupstoreceiveeither4 000IUofvitaminD(or1 000IUofvitaminDorplaceboperdayfor12weeks.VitaminDsupplementation(4 000IU),comparedwithvitaminD

(1 000IU)andplacebo.

VitaminDsupplementationatadosageof4 000IU/dayfor12weeksininsulin-resistantpatientswith PCOS benefittedglucosemetabolismandlipidprofilescomparedto1 000IU/dayandplacebogroups.

Foroozanfard etal.2017.EffectofTwoDifferentDosesofVitaminDSupplementationonMetabolicProfilesofInsulin-ResistantPatientswithPolycysticOvarySyndrome:ARandomized,Double-Blind,Placebo-ControlledTrial.HormoneandMetabolicResearch,49(8),612–617

VITAMINDANDEVENINGPRIMROSEOIL

RCT,DoubleBlind,Placebo-controlled

60vitaminDDeficient womenwithPCOS

Comparedwiththeplacebogroup,womeninvitaminDandEPOco-supplementationgrouphadsignificantincreasesinserum25-hydroxyvitaminDandplasmatotalglutathione,whilethereweresignificantdecreasesintriglycerides,VLDLcholesterollevels,total/high-densitylipoproteincholesterolratio,andmalondialdehydeconcentration.

Nasri etal.TheeffectsofvitaminDandeveningprimroseoilco-supplementationonlipidprofilesandbiomarkersofoxidativestressinvitaminD-deficientwomenwithpolycysticovarysyndrome:Arandomized,double-blind,placebo-controlledtrial.Endocr Res.2017Jul25:1-10.

MAGNESIUM-ZINC-CALCIUM-VITAMIND

Sixty PCOS womenwererandomizedintotwogroupsandtreatedwith:

Afterthe12-weekintervention,comparedwiththeplacebo:

magnesium-zinc-calcium-vitaminDco-supplementationresultedin:significantreductionsinhirsutismserumhighsensitivityC-reactiveproteinandplasmamalondialdehyde,andasignificantincreaseinplasmatotalantioxidantcapacityconcentrations

100 mgmagnesium,4 mgzinc,400 mgcalcium,200 IUvitaminDORPlaceboTwiceadayfor12 weeks.

Maktabi etal2017.Magnesium-Zinc-Calcium-VitaminDCo-supplementationImprovesHormonalProfiles,BiomarkersofInflammationandOxidativeStressinWomenwithPolycysticOvarySyndrome:aRandomized,Double-Blind,Placebo-ControlledTrial.BiologicalTraceElementResearch.

REDUCINGCARBOHYDRATES,REPLACINGWITHFATREDUCESHYPINSULINEMIAINPCOS

StanfordUniversityClinicalResearchCenter: TwodietsgiventotwogroupsofwomenwithPCOS

Daylongglucosedidnotdifferaccordingto diet.Daylonginsulinconcentrationswere30%loweronthe low Carbohydrate/higherfat diet.

Beneficialchangesinlipidprofilewerealsoobserved.

40% CARBOHYDRATE / 45 % FATGROUP2

60% CARBOHYDRATE / 25% FATGROUP1

SAMENUMBEROFCALORIESGIVENDAILYFOREACHGROUP

Perelman,D.(2017).Substitutingpoly- andmono-unsaturatedfatfordietarycarbohydratereduceshyperinsulinemiainwomenwith polycysticovarysyndrome,33(4).

OMEGA3FATTYACIDSANDVITAMINECO-SUPPLEMENTATION

68womenwithPCOS

Omega-3fattyacidsandvitaminEco-supplementationfor12weeksin PCOS womensignificantlyimprovedindicesofinsulinresistance,totalandfreetestosterone.

1 000 mgomega-3fattyacidsconplus 400IUvitaminEsupplementsOrplacebofor12weeks

Ebrahimi etal.(2017).TheEffectsofOmega-3FattyAcidsandVitaminECo-SupplementationonIndicesofInsulinResistanceandHormonalParametersinPatientswithPolycysticOvarySyndrome:ARandomized,Double-Blind,Placebo-ControlledTrial.ExperimentalandClinicalEndocrinology&Diabetes,125(6),353–359.

Control HighCholesterol&Diabetes HighCholesterol&DiabeteswithFishoil

OMEGA3ANDHAIR

El-Sayyadetal2015.HairGrowthDefectsofDiabeticandHypercholesterolemic WistarAlbinoRatsandAmeliorationofFishOil-Treatment.JNutriHealth.JNutriHealthAugust,1(61).

PROBIOTICSUPPLEMENTATIONDoubleBlindRCT

Supplementationfor12weeksin60womenwithPCOS.

Favorableeffectsonweightloss,insulinresistance,triglyceridesandVLDLconcentrations

Ahmadietal.2017.Probioticsupplementationandtheeffectsonweightloss,glycaemiaandlipidprofilesinwomenwithpolycysticovarysyndrome:arandomized,double-blind,placebo-controlledtrial.HumanFertility,1–8.

COMBINEDLIFESTYLEANDHERBALMEDICINEINPCOS:RCT

Allparticipantswerehelpedtoconstructapersonalizedlifestyleplan.Bothgroupsimplementedthelifestyleintervention.Onegroupimplementedtwotabletsofherbalmedicineandtheotherplacebo.

At3 months,womeninthecombinationgrouprecordedareductioninoligomenorrhoeaof32.9%comparedwithcontrols.

Othersignificantimprovementswerefoundfor:

bodymassindexInsulinLH

bloodpressurequalityoflifedepression,anxietyandstress

Tablet1:Cinnamon,Licorice,St.John’sWortandWhitePeony.Tablet2:Tribulus terrestris.

Arentz etal.2017.CombinedLifestyleandHerbalMedicineinOverweightWomenwithPolycysticOvarySyndrome(PCOS):ARandomizedControlledTrial.Phytotherapy Research:PTR,31(9)

CHROMIUMANDPCOS

Systematicreviewandmeta-analysis

7RCTs

Thissystematicreviewandmeta-analysisshowsthatusingCrpicolinatesupplementationhasbeneficialeffectsondecreasingBMI,fastinginsulinandfreetestosteronein PCOS patients.

Fazelian etal.2017.Chromiumsupplementationandpolycysticovarysyndrome:Asystematicreviewandmeta-analysis.JournalofTraceElementsinMedicineandBiology,42,92–96.

GREENTEAANDPCOS

DoubleBlindRCT

60womenwithPCOS

500mgcapsulesofGreenTeaExtracttwiceperdayfor12weeks

Theconsumptionofgreenteaextractbywomenwithhighbodymassindexand PCOS leadstoweightloss,adecreaseinfastinginsulin,andadecreaseintheleveloffreetestosterone.

Mombaini etal.(2017).TheImpactofGreenTeaSupplementationonAnthropometricIndicesandInflammatoryCytokinesinWomenwithPolycysticOvarySyndrome.Phytotherapy Research,31(5),747–754.

VITEXVSMETFORMINONOLIGOMENORRHEAINPCOS

DoubleblindRCT60PCOSWomen

3.2-4.8mgofChasteberry DryExtractoncepermealfor3monthsvs500mg3x/dayofMetformin

Thetwodrugshadsimilareffectsonmenstrualcycleregulation,menstruationlengthandthenumberofpadsused.MoresideeffectswerereportedinthegroupusingMetformin.

Shayan etal.2016.ComparingtheEffectsofAgnugol andMetforminonOligomenorrheainPatientswithPolycysticOvarySyndrome:ARandomizedClinicalTrial.JournalofClinicalandDiagnosticResearch:JCDR,10(12)

Thankyou!

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