PCOS Magazine - Spring 2010
The Spring 2010 issue of PCOS Magazine includes great information about artificial sweetners, finding a great food balance, and more!
Volume 3, Issue 1 Spring 2010 Food = Abuse? also: ~A review of the documentary, “Scrambled” ~PCOS on TV! ~Artificial Sweeteners From the Editor Did I order a roller coaster? What a wild ride 2010 has been. In this issue of “PCOS Magazine,” you’ll see some of the changes that have occurred this fine year. Sasha Ottey and the folks at PCOS Challenge have launched a new TV show. Our own Angela Grassi recently welcomed baby #2. Congrats Angela! Suzy Reyes continues to chronicle her very heart-felt adventure toward parenthood. Hopefully in our next edition, she’ll be telling us about pregnancy! And yours truly has weathered quite a few changes as well. New job, new town, and soon, I’ll be an ‘old married lady.’ This issue is also chock-full of lots of great related news about diabetes, insulin resistance, and women’s health. So with this air of change in mind, I hope you enjoy this issue of “PCOS Magazine.” As always, we love to hear your ideas, thoughts...you name it. We’re always looking for great new story ideas, new columnists, personal stories, and information about new research related to PCOS. Linda Harvey Editor email@example.com 2 Blank Page LLC Linda Harvey, member Joshua R. Yates, member Editor Linda Harvey Contributing Writers Holly Amarandei Angela Grassi Gretchen Kubacky Sasha Ottey Suzy Reyes Additional Content Courtesy of: Newswise PR Newswire Photography & Artwork Courtesy of: Morguefile.com Dreamstime.com The editorial content of PCOS Magazine is prepared in accordance with the highest standards of journalistic accuracy. Readers are cautioned, however, not to use information from the magazine as a substitute for regular professional health care. Editorial Contact Information: Phone: (417)942-1416 E-mail: editor@ pcosmagazine.com PCOS Magazine is available online from: PCOS Now We Can Face It Campaign Joslin Diabetes Center and dLife Launched Form New Online Partnership Joslin.org, the Internet site for Harvard-affiliated Joslin Diabetes Center, the world’s preeminent diabetes research and clinical care organization, and dLife. com, the leading online community for people living with diabetes, today announced a new online partnership. dLife will host a resource page on its web site featuring the clinical and research information from Joslin. Joslin will host on its website food and cooking videos from dLife’s award-winning TV show dLifeTV as well as links to relevant information on dLife.com. “Joslin.org is centered around educating people with diabetes and their families and providing up-to-date information on diabetes treatment and research,” said Jeffrey Bright, Director of Communications at Joslin. “Partnering with dLife.com will enable us to offer visitors to Joslin.org easy access to a wide variety of excellent online diabetes resources.” The two organizations believe Joslin’s deep clinical and research expertise and dLife’s vast online social communities can bring more accessible and credible information about diabetes to people with the condition. New Joslin information on the dLife website will include links to joslin.org, as well as segments about Joslin that have appeared on dLifeTV, information about how to donate to Joslin’s High Hopes Fund, how to volunteer for research and clinical trials at Joslin, and a link to the Joslin store, which offers various patient and professional education publications. Similarly, the dLife page on Joslin. org will link to the dLife site and will include links to dLife information, and the dLifeTV schedule. Joslin has already started hosting the popular, dLife-produced multimedia story about Joslin’s founder, Dr. Elliott P. Joslin. “Partnering with Joslin, a leader in diabetes care, education and research allows us to help people who use the dLife site to obtain deeper diabetes insight and knowledge,” said Gregg Zegras, COO, at dLife. “Together, we look forward to helping more people with diabetes live stronger and healthier lives.” The We Can Face It campaign for women with unwanted facial hair (UFH) has been launched today at a celebrity-backed event held at the Sunbeam Studios in West London. Television personalities Dr. Dawn Harper (Channel 4’s Embarrassing Bodies), Mica Paris (soul singer) and Jason Gardiner (style guru from ITV’s This Morning) announced the results from the We Can Face It: 1,000 Women’s Survey. The survey is the first of its kind in the UK and has revealed that 98% of women with UFH regularly have negative or critical thoughts about their appearance due to facial hair and a third experience anxiety if they can not remove the hair immediately The We Can Face It campaign, sponsored by Almirall Ltd, is an awareness campaign that aims to communicate the full health impact of excess, unwanted facial hair; create a supportive community of like-minded women with the condition and to encourage women to feel confident when speaking with their doctor about management and treatment options for their condition. Gloucestershire-based GP Dr. Dawn Harper, well known for addressing taboo health topics on Embarrassing Bodies and one of the expert panel leading the campaign said, “Unwanted facial hair is a condition that is much more common in the UK than the general public might believe. It affects around 40% of women and can have a detrimental ef- Continued on page 15 3 PCOS Now Obesity and Diabetes Study Weighs Influence of Genetics, Lifestyle A team of Northern Arizona University-led researchers is using nearly $1.3 million in new funding from the National Institutes of Health to continue with the world’s longest-running study on obesity and Type 2 diabetes. Obesity and diabetes have been described as the major public health concerns of the 21st century, explains Leslie Schulz, executive dean of NAU’s College of Health and Human Services and the study’s principal investigator. “This study is taking those necessary steps toward finding a way to protect people against the development of these pervasive diseases,” she says. Schulz is being joined by researchers from the National Institutes of Health, the Pennington Biomedical Research Center and Mexico’s Center for the Investigation of Nutrition and Development. 4 A related study already has shown that Pima Indians in Arizona—who have a diet and lifestyle similar to most Americans—have a much higher rate of diabetes than the national average: 38 study the relationship between the Mexican Pima Indians’ increasingly “westernized” lifestyle and their genetic predisposition for obesity and diabetes. Leslie Schulz, executive dean of Northern Arizona University’s College of Health and Human Services, and study principal investigator percent versus 8 percent nationally, giving them the distinction of being the most diabetes-prone group in the world. The Arizona Pima Indians have been genetically linked to a village of Pima Indians living a more traditional lifestyle in a remote, mountainous region of Mexico. A 1995 study of the Mexican Pimas revealed only a rare occurrence of diabetes. Schulz explains that the genetic similarities between the two groups of Pima Indians, along with the contrast in their lifestyles, provides an ideal setting to study the relationship between environmental circumstances and diabetes. The researchers returned in the fall after 15 years to the Mexican village to “Since we were last there, the environmental circumstances of the village have changed,” Schulz says, explaining how the electrical supply to the region has increased, cars have become more prevalent and grocery stores have appeared. She points out that this changing environment affects non-Pima Mexicans who also live in the village as much as it does the Mexican Pima Indians living there. “These two groups of people have undergone the same lifestyle changes over the past 15 years but they have different genes,” Schulz explains. “Therefore, we hope to separate out the role genes play versus the role lifestyle plays.” Schulz says the team of researchers will spend weeks at a time over the next two years living and working in “rustic” conditions in the Mexican village. “What is exciting is that we will be employing state-of-the-science methodology, the most cutting-edge techniques for looking at metabolic rate and the number of calories people burn, in a setting that is very challenging,” she says. Meanwhile, the extensive genetic aspects of the study will take place in the United States. The researchers are attempting to answer why a person who is genetically predisposed to develop diabetes does not develop it. “What is it about their environment or lifestyle that changes that?” asks Schulz. “This study is unique because we can actually measure the changes in lifestyle over the last 15 years.” Schulz says that the researchers are expecting to find an increase in Type 2 diabetes and obesity among the Mexican Pimas that parallels the changes in their lifestyle. It’s a pattern that has been documented in other countries undergoing dramatic industrial and economic development, like China, where diabetes prevalence has increased threefold over a 10-year period. Similar findings have been recorded in India. While this may seem like bad news for the developing world, Schulz said there is hope in the implication that diabetes can be prevented in populations with a predisposition for the condition. WSU Analysis Shows Minorities Less Likely to Receive “Cornerstone” Diabetes Test Ethnic and racial minorities bear a disproportionate share of America’s diabetes epidemic but are significantly less likely than whites to receive a commonly used test to monitor control of blood glucose, according to Washington State University researchers. In a commentary for the current issue of “The Diabetes Educator,” Assistant Professor of Pharmacotherapy Joshua Jon Neumiller and colleagues document how black and Hispanic patients diagnosed with diabetes are two to three times less likely than white patients to receive the A1C test during physician office visits. The A1C test is a “monitoring cornerstone,” providing a retrospective snapshot of a patient’s blood- glucose level, says David A. Sclar, a co-author of the commentary and the Boeing distinguished professor of health policy and administration at WSU. “Ensuring equitable access to care is crucial if we are to reduce the morbidity, mortality and expenditures associated with diabetes,” Neumiller said. The WSU researchers note that diabetes has become a global epidemic projected to affect 48 million Americans by 2050. Hispanics and blacks are more than twice as likely to develop diabetes and suffer the consequences of insufficient monitoring, say the WSU researchers. Earlier this year, the American Diabetes Association announced Joshua Jon Neumiller, assistant professor of pharmacotherapy, Washington State University guidelines encouraging use of the A1C test in both the monitoring and diagnosis of Type 2 diabetes, the most common form of the disease. Become a fan of PCOS Magazine on Facebook! Search for the “PCOS Magazine” page and join! 5 New Reality Series Provides Resources for Women with PCOS As part of its continuing mission to provide information and support resources for women with Polycystic Ovarian Syndrome, PCOS Challenge, Inc. is producing a new 13-week reality series that focuses on improving the lives of women with PCOS with the help of health and medical experts. The goal of the PCOS Challenge™ television show is to educate, inspire and spread awareness about PCOS while helping women with the condition to live healthier and happier lives. The women participating in the series will receive guidance from three main experts – a nutrition coach, fitness coach, and mental wellness coach. The women will also receive supplemental advice from other experts including a naturopathic physician, acupuncturist, and Reproductive Endocrinologist. As the participants compete in various fitness and healthy lifestyle challenges, they will have an 6 opportunity to win cash and prizes. “We are very excited to be launching the television show. It is a tremendous opportunity to help a lot of people. In the last year, the PCOS Challenge online and offline community has quickly grown to over 4,000 members, and this has been something that many people have been asking about for some time,” says Sasha Ottey, CEO of PCOS Challenge, Inc. “The television show is a natural extension of our popular PCOS Challenge Radio Show where we feature prominent PCOS experts. Now, through the television show, the audience will have an opportunity to see how to practically apply the information that they have learned in the face of daily life challenges and how to make sustainable healthy lifestyle choices.” wide, we feel the program will be an important vehicle to get more people involved.” “Since its inception, PCOS Challenge, Inc. has been innovative in its program- The PCOS Challenge television show is scheduled to begin shooting in midMarch and is currently casting for 6-10 women with PCOS in the DC metropolitan area to participate in the 13week series. ming and multimedia approach to spreading awareness and providing support for women with PCOS, which is one of the reasons the organization continues to gain traction so quickly and is able to keep people engaged,” says William R. Patterson, CEO of The Baron Solution Group and Executive Producer of the PCOS Challenge television show. “It is our aim to bring greater attention and resources to the PCOS community. With a condition that affects millions of lives and families world- Participants will meet with the experts 1-2 times per week for the duration of the series and commit to changing their lifestyles to promote healthier living with PCOS. The PCOS Challenge television show will air on various local cable stations across the United States as well as stream online. To become a participant, sponsor, or for more information about the PCOS Challenge television show, visit http://www.pcoschallenge.com/events/ pcos-challenge. Live Happier and Healthier with PCOS Answer: S ometimes feeling uncomfortable is about not having enough knowledge or information to feel like you can effectively communicate, but more often it’s about feeling embarrassed or ashamed. The first thing to remember is that PCOS is not your fault – you didn’t get it because you ate a bad diet, or didn’t exercise enough, or anything like that. PCOS is a genetically based disorder that you inherited, and/or that manifested as a result of a hormonal imbalance that you couldn’t possibly have known about until you were diagnosed. As long as you’re clear on that fact, you should be able to overcome any initial embarrassment. Getting educated about the condition, and, in particular, how it affects you, your moods and feelings, your eating behaviors, your sleep, your fertility, etc. will also help you feel more confident talking about PCOS. As you learn more about what works for you – what makes you feel better, as opposed to worse – you’ll be able to talk more effectively to your friends, family, and coworkers. Depending upon the extent of your PCOS, and how it impacts you, you might want to talk about: • • Dr. Gretchen Kubacky, Psy. D. Question: My health is a big concern to me, and my friends and family, but I’m uncomfortable talking about PCOS. How do I talk to them about such an intimate matter? • • • why you need to adhere to a schedule for eating (especially important in some work settings) or exercising; why you need to dedicate a bigger part of the family budget to medical appointments, supplements, or professional hair removal; why eating/exercising “normally” doesn’t result in weight loss for you, and how frustrated that makes you feel; how sometimes you feel moody, irritable, depressed or anxious about PCOS; the time you need to take for yourself for self-care, stress reduction, and ensuring that you get plenty of sleep; • how infertility affects you (if at all, or if you fear it might be a problem for you), and what your limitations are on talking about this potentially painful topic. I recommend starting slowly, with your most intimate circle – spouse or partner, and immediate family members. Answer what you can and point them to resources such as this magazine so they can get better educated about your condition. As you feel more comfortable, introduce the topic with friends, extended family, or perhaps your boss. The more you’re able to own your PCOS, be knowledgeable about it, and empower and incorporate others to support you in your PCOS management, the more confident you’ll feel with sharing your personal health concerns, worries, and triumphs. People want to help (most of the time), but they can’t help you with the often invisible condition of PCOS unless you start making efforts to educate them, and enlist their support. About the Author: Gretchen Kubacky, Psy.D. is a licensed clinical psychologist in West Los Angeles, who specializes in PCOS. She counsels you through your health challenges, work/life balance issues, and relationship issues. If you have questions for Dr. Gretchen or would like to learn more about her practice, please visit her website at www.drkubacky.com. © 2009. This article was excerpted with permission from Gretchen Kubacky, Psy. D. at www.drkubacky.com. Permission to reprint is granted by the author. All reprints must state, “Reprinted with permission by Gretchen Kubacky, Psy.D. at www. drkubacky.com. Originally published in PCOSMagazine.com, Spring 2010. DISCLAIMER: The information and opinions reflected in this article are solely those of the author and do not reflect on the publisher, editor, or editorial staff of PCOS Magazine. This article has been written and reviewed by the author. Any errors should be brought to the attention of the author. PCOS Now Patients with Diabetes Rank Health Concerns Differently than Their Doctors, Survey Shows to manage their diabetes,” Zulman says. “So putting these types of symptomatic problems on the back-burner might lead to worse outcomes in diabetes and other chronic conditions.” On average adults with diabetes have at least three other chronic health conditions. It means their doctors face the challenge of addressing multiple complex conditions in a brief office visit. A bout one-third of doctors and their patients with diabetes do not see eye to eye on the most important health conditions to manage, according to a survey by the University of Michigan Medical School. While both groups frequently ranked diabetes and hypertension among their top concerns, 38 percent of doctors were more likely to rank hypertension as the most important, while only 18 percent of diabetics said it was the most important. Patients were also more likely to prioritize symptoms such as pain and depression. The findings appear in the current issue of the Journal of General Internal Medicine and may shed light on why some patients manage their diabetes so poorly. 8 “If a patient and their doctor do not agree on which of these issues should be prioritized, it will be difficult for them to come up with an effective treatment plan together,” says lead author Donna M. Zulman, M.D., a Robert Wood Johnson Clinical Scholar at the University of Michigan Medical School and researcher at the Veterans Affairs Healthcare System in Ann Arbor. When a diabetic patient visits the doctor, the doctor is often concerned about the patient’s risk of long-term complications from high blood sugar or uncontrolled sugar such as heart disease or kidney disease. The patient, however, might have more pressing issues, such as back pain or depression. “Both sets of priorities are valid, however we know from previous studies that issues like pain interfere with a person’s ability Researchers at U-M and Veterans Affairs surveyed 92 doctors and their nearly 1,200 patients who had diabetes and hypertension. Of the 714 pairs, 28 percent did not prioritize health conditions the same way. The discord was strongest among the sickest patients. “One possible explanation for this is that patients with poor health or competing demands may be more likely to face functional limitations, financial stress, and other barriers to care,” she said. “For these patients, symptomatic problems might be of utmost importance because they exacerbate their existing challenges.” An estimated 18 million people in the U.S. have diabetes and another 5.7 million are undiagnosed. The number has nearly tripled since 1980 and people over age 65 account for 37 percent of all cases, according to the U.S. Centers for Disease Control and Prevention. Tackling Childhood Obesity is a Family Affair, Says Expert “We are at a crossroads, where the unfortunate reality is that the current generation of children is more likely to pre-decease their parents because of the development of early onset obesity and inactivityrelated diseases, such as type II diabetes,” said Betsy Keller, professor of exercise and sport sciences at Ithaca College. Keller explained that the greatest risk for childhood obesity is an obese parent. Typically, children with obese parents learn and practice family eating and lifestyle behaviors that contribute to the development of obesity, instilling such behaviors early in life. that a good way to start tackling this problem in young children is a three prong approach: 1) limit “screen” time to 2 hours per day; 2) eat the evening meal as a family most days of the week, 3) make sure your young child gets at least 10.5 hours/night of sleep. Being a role model for healthy eating and physical activity behaviors will impress your child of any age, and have long-lasting, healthful benefits for all. Betsy Keller, Ithaca College “Children of obese parents are themselves 13 times more likely to be obese; it is critical to effectively change the tide of what has become the norm in too many U. S. families. The solution is not simple, but efforts to regain healthful levels of body fat in children are more successful and long lasting than in adults. For that reason, First Lady Michelle Obama’s call to focus on children’s health is important and urgent,” said Keller. According to Keller preventing obesity in children is far easier than treating obesity. To successfully reverse the obesity trend the entire family must embrace the treatment program with regular and sufficient levels of physical activity coupled with a healthy diet and calorie count. Studies show the percentage of overweight children, pre-teens and teenagers has increased between 5 and 19 percent from the mid-1970s to the present. “More than 70 percent of parents incorrectly think their kids get enough physical activity. So it’s likely that your kid may not be getting enough physical activity either,” said Keller. “We now have more than one generation in which obesity has been highly prevalent. We have a generation whose parents, and perhaps even grandparents, are likely to be obese, and may very well have only obese family members as a frame of reference for body size,” she said. A fellow in the American College of Sports Medicine and the author of numerous journal articles on sport medicine and physical fitness, Keller examines the relationship between physical inactivity and the development of obesity in children and the effects of chronic fatigue syndrome on physical function. Keller cites recent research reported in the journal Pediatrics, which states 9 PCOS Now Women Underrepresented in Clinical Trials to Formulate Guidelines; Affected By Lack of Support After Heart Attack A special themed issue of Circulation: Cardiovascular Quality and Outcomes highlights studies about women and cardiovascular disease. In an editorial, researchers wrote that the pool of data on the topic is still limited and has left “more questions than answers.” Researchers in one featured study found women are underrepresented in research areas cited in the American Heart Association’s prevention guidelines for women. Another study found that after a heart attack, low social support is tied to poorer health outcomes, particularly among women. Women are substantially underrepresented in clinical trials used to formulate women’s guidelines and are affected more than men by low social support after a heart attack, according to two studies in the women-themed issue of Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association. In an editorial, Viola Vaccarino, M.D., Ph.D., notes that sexspecific research has revealed important differences in the causes, symptoms and treatment of heart disease. But the pool of data is still limited and key questions remain about the development, prevention and treatment of cardiovascular disease in 10 women. “After at least a decade of renewed interest in women’s cardiovascular health, we are left with more questions than answers,” wrote Vaccarino, professor of medicine at Emory University School of Medicine in Atlanta. Cardiovascular disease is the leading killer of U.S. women, causing more than 430,000 deaths per year. Here are highlights of two studies in the themed issue: In an analysis of 156 randomized clinical trials cited by the American Heart Association’s 2007 guidelines for cardiovascular disease prevention in women, researchers found females were substantially underrepresented compared with how frequently they are affected by various cardiovascular conditions. Overall, women made up just 30 percent of the patient population in the clinical trials used to support the 2007 guidelines. Also, only about one-third of the 156 trials reported sex-specific results. But women account for at least half the deaths in the affected patient populations studied -- “a proportion that is strikingly higher than their representation in the trials supporting the guidelines -- thereby underscoring the importance of having adequate representation of women in clinical trials to solidify the evidence base supporting practice guidelines,” researchers wrote. Among all the trials, women were most represented in those involving hypertension (44 percent of the research population were women vs. 53 percent of all patients with hypertension) and diabetes (40 percent of the research population vs. 50 percent of all patients with diabetes). Representation of women was lowest for heart failure (29 percent of the research population vs. 51 percent of all patients); coronary artery disease (25 percent vs. 46 percent); and hyperlipidemia, or high levels of fats such as cholesterol and triglycerides in the bloodstream, (28 percent vs. 49 percent). Furthermore, the studies’ enrollment of women varied among classes of therapies being tested, including aspirin, diabetes medications or statins. In a prospective study examining data from more than 2,400 male and female patients at 19 centers, researchers found that throughout the first year of recovery after a heart attack, low social support was linked with poorer ratings in several measures of physical and mental health -- particularly among women. Compared to the group of people who had the highest level of social support at baseline, those with the lowest level faced a higher risk for chest pain, lower quality of life due to heart disease, worse mental functioning and more symptoms of depression. The findings were based on multiple assessments over 12 months. “Our results demonstrate that low social support is linked to important outcomes for patients not only during the early recovery period, but throughout the first year after a heart attack,” said Judith Lichtman, Ph.D., M.P.H., senior author and associate professor, Yale School of Medicine, New Haven, Conn. When the researchers compared their data in men vs. women, the association between social support and health in the first year of recovery was stronger for women, particularly for disease-specific quality of life, physical functioning and depression symptoms. Women with low social support were more likely than their peers to be single and have a history of smoking and high cholesterol. Thirtythree percent of the patients in the study were women. Earlier work has linked low social support with higher hospitalization and death rates after heart attack, but the association of social support with other outcomes such as health status and symptoms of depression has not been well-studied. The findings are important, “because interventions that increase social support may represent effective, non-invasive opportunities to improve health outcomes within the first year of recovery, particularly for women,” said Erica Leifheit-Limson, M.Phil, lead author and doctoral candidate, Yale University. FDA Approves New Drug Treatment for Type 2 Diabetes The most common side effects observed with Victoza were headache, nausea, and diarrhea. Other side effects included allergic-like reactions such as hives. Lotte Bjerre Knudsen, who developed the liraglutide compound, pictured here in her laboratory at Novo Nordisk’s R&D facility in Måløv, Denmark. The U.S. Food and Drug Administration today approved Victoza (liraglutide), a once-daily injection to treat type 2 diabetes in some adults. Victoza is intended to help lower blood sugar levels along with diet, exercise, and selected other diabetes medicines. It is not recommended as initial therapy in patients who have not achieved adequate diabetes control on diet and exercise alone. Insulin is a hormone that helps prevent sugar (glucose) from building up in the blood. People with type 2 diabetes have difficulty making and using insulin. Victoza is in a class of medicines known as glucagon-like peptide-1 (GLP-1) receptor agonists that help the pancreas make more insulin after eating a meal. In five clinical trials involving more than 3,900 people, pancreatitis (inflammation of the pancreas) occurred more often in patients who took Victoza than in patients taking other diabetes medicines. Victoza should be stopped if there is severe abdominal pain, with or without nausea and vomiting, and should not be restarted if pancreatitis is confirmed by blood tests. Victoza should be used with caution in people with a history of pancreatitis. Victoza was not associated with an increased risk for cardiovascular events in people who were mainly at low risk for these events. FDA approved Victoza, however, with several post-marketing requirements under the Food and Drug Administration Amendments Act (FDAAA) to ensure that the company will conduct studies to provide additional information on the safety of this product. In addition to a cardiovascular safety study to specifically evaluate the cardiovascular safety of Victoza in a higher risk population, the company also is required to conduct a 5-year epidemiological study using a health claims database to evaluate thyroid and other cancer risks as well as risks for seriously low blood glucose levels (hypoglycemia), pancreatitis, and allergic reactions. To specifically evaluate the risk of medullary thyroid cancer, the company is required to establish a cancer registry to monitor the rate of this type of cancer in the United States over the next 15 years. To ensure the safe and effective use of this product, Victoza was approved with a Risk Evaluation and Mitigation Strategy consisting of a Medication Guide and a Communication Plan to help patients and providers understand the risks of Victoza and to ensure that the benefits of the drug outweigh the risk of acute pancreatitis and the potential risk of medullary thyroid cancer. Victoza is manufactured by Novo Nordisk of Bagsvaerd, Denmark. 11 Junk food is often like an abusive, controlling lover. You know it is not good for you, yet you tell yourself that you cannot resist the sweet (or salty or greasy) temptation. You know that it will not treat you well and that you must be a glutton for punishment, yet you tell yourself that you “love” it. It is a familiar friend and you are used to its abuse. In the short term, it makes you feel good. You may even describe your favorite junk food as “orgasmic” and eat it with passion as though you were ravishing a muscle-rippled rock star during a soap opera scene. In the moment of passion, your lover makes you feel like a million bucks. It comforts you when you are feeling sad or lonely. It is always there for you when you need it. And yes, you may profess your undying affection toward this unhealthy fare but alas, it will never love you back. Worse yet, it absolutely hates you and is working very hard to shorten your life. It lies to you. It tells you that you 12 Abusive Are You in an Relationship? By Holly Amarandei “deserve” to be with it. It tells you that there is nothing else that you can do to make yourself feel better so you might as well resort to a life stuffing your face. It tells you “you are not THAT fat, one or two little bites won’t hurt.” It rewards your devotion with excess body fat, high blood pressure, high cholesterol, diabetes, low self-esteem, low energy, and inflammation. If you take a break from your lover, it may even have some special rewards in store for you like explosive diarrhea, stomach cramps and indigestion. Why on earth would you stay in such a relationship? Much for the same reason as many women stay in unhealthy relationships with men. They think that they “deserve” to be treated badly. They lack self-respect and are vulnerable to predators. They believe the lies that they are told and believe that they can change him. It is easier to stay with something familiar than learn to seek comfort in more healthy ways. Sometimes the only way to avoid being tempted by this sort of lover is to end all contact with this person. The woman must not make or take phone calls from this person and absolutely must not visit this helping you reach your goals of being a healthy woman, and are not coping mechanisms for dealing with lifeâ€™s problems. Allowing these naughty lover boys into your life at this point will only stand in your way of finding out what you really need. You need to introduce healthy foods and habits into your life at this point in order to truly give them a chance. How will you truly know if eating 3-4 servings of vegetables per day is making you feel better if you are still sabotaging your good efforts by eating junk food that only makes you crave more of it? person face-to-face. Sometimes it works this way with unhealthy foods as well. Sometimes a little taste can lead to disaster; a slip can lead to a slide with just one bite. In these cases, it is better to stay far away from this scorned lover in order to avoid some pretty terrible loverâ€™s revenge. Would you stay with a man who is beating you up day after day? Would you continue a relationship with a man who keeps you isolated and discourages you from having other friends and other interests? Would you love a man who insults you day after day? Would you put a man like this before your own health and well-being? You may say no, but if you are in an unhealthy relationship with food you may know more than you think about being in an abusive relationship. The good news is that you can have a healthier relationship with food. Yes, it may be easier to go back to your old, familiar lovers that you know so well. It is never easy to begin a new relationship. It takes courage and determination. It takes time to get to know a new person, and just like in a human relationship you and healthy food may need to start out as acquaintances, become friends, and eventually you may fall in love with this new healthy fare and the more rewarding lifestyle that comes along with it. As your relationship progresses, you will realize that you prefer this healthier food to your old favorites. You may be able to remain friends with your ex-lovers, but there are likely some with whom this just will not be possible. It will just lead to falling back into old habits and seeking comfort from this sordid, nasty, evil lover that will do nothing but abuse you and make you feel bad about yourself. How do you know the difference between an old love with whom you can continue a civil relationship and one that must be kicked to the curb for good? The first step is to recognize which foods are problem foods for you and to put some distance between yourself and the unhealthy foods that you crave. You do not need to say goodbye forever at this point, just recognize that these foods are not what you need, are not When you come upon a situation where you will be faced with an old favorite or you just have a strong craving, make a choice to eat this food, recognizing that it is something that has been a problem food for you in the past. Do not re-introduce this food when you are upset, sad, angry, bored or lonely. Plan to resume your healthy eating immediately after consuming this food. Make the choice to eat the food and make the choice to stick with your healthy plan once it is gone. 1.) Lessen the damage. Plan to eat a small portion of this food and do it in a way that you cannot overdo it. Consume just a single serving, or share a dessert with a friend. Once you have eaten your portion, you Continued on page 14 Holly Amarandei is a life and wellness coach based in Grand Rapids, Michigan. She specializes in helping women with PCOS lose weight, gain a positive body image, face infertility and other health challenges, and 13 “Abusive” Relationship Continued from page XX are done. For example, go to an ice cream shop and order the smallest serving, buy just a small chocolate bar and take it home with you, or order a dessert in a restaurant and share it. As you eat it, tell yourself “I am in control. I am choosing to allow myself to have a treat and I will enjoy a small portion.” 2.) Evaluate how you feel when you are eating the food. Are you truly enjoying it for what it is? Are you feeling anxious as you eat it? Are you worried that you will not be able to stop? Hopefully you are only eating a small portion and this will not be an issue, but it is important to recognize these feelings if they come up for you. Take note of any negative or self-sabotaging thoughts that may be running through your head as you enjoy your treat. Beware of thoughts such as “I’ve blown it,” “I’m fat,” “I can not stick to a diet” and “it doesn’t matter anyway.” 3.) Take note of how you feel men- 14 tally after eating the food and how eating it has affected your behavior. How hard was it to resume your healthy way of eating? Did you continue to think of the food long after it was gone? Did you feel that it made you crave other unhealthy foods? Did eating this food make you feel excessively guilty? Have you had negative thoughts running through your head such as “I am so fat,” “I’m a failure,” “I’m so lonely, depressed, angry, etc.” or “I need more”? If you have slowly begun to go back to your old way of eating, this food is clearly not good for you and may be harmful to your healthy lifestyle. It may be best to avoid this food for the time being in order to stay in control. Acknowledge this and say it aloud. “Eating X is not good for me. I like who I am when I am eating healthy foods and nourishing my soul in healthy ways. I choose to eat healthy and take care of myself.” If you enjoy your treat without excessive guilt and self-sabotage, make a plan for how to continue to enjoy it and stay in control. Do not use your ability to temporarily stay in control as an excuse to overindulge or indulge on a regular basis. Use this method for each of your problem foods and distance yourself from the ex-lovers that are abusive and lead to a decline in your self-esteem and healthy behaviors. You cannot truly lead a healthy lifestyle if food is holding you hostage. Remember, no matter how you feel, food can never love you back. It cannot give you affection and will not respect you. It is not a friend or confidante and is no substitute for human companionship. A true friend or lover would not clog your arteries or raise your blood sugar. It is amazing what can happen when start devoting less of your time and energy to your fake lover and start focusing on what really matters: loving yourself. Try it and see what happens! PCOS Now Campaign, con’t. rimental effect on women’s physical and mental health, body image and self esteem. I am very pleased to be supporting this campaign, which will hopefully show women that they are not alone and that a range of treatment and support options are available to them through their GP.” The survey findings have highlighted that the impact of UFH on a woman goes far beyond the superficial or physical appearance of the hair and regularly impacts on women’s social lives and relationships. 89% of women admitted that they would feel more confident if they didn’t have facial hair and one third said that their unwanted facial hair has regularly stopped them from going out socially. Dating and relationships are also severely limited, with around 42% of women saying that facial hair had prevented them from going on dates (57% in the 18 to 35 age group)1 and over 40% saying that their unwanted facial hair has stopped them from forming relationships (a figure that rose to over half (54%) in the 18 to 35 age group). Mica Paris commented, “The We Can Face It campaign is really helping to bring UFH out of the shadows and onto the public radar. It is shocking that so many women are not fully enjoying their social life or forming relationships because they are so concerned about their fa- cial hair. I hope this campaign will help women to start talking about the condition with close family or friends so that they don’t have to suffer in silence.” Much–needed improvements in support were uncovered by the survey, with over half of women saying that they felt uncomfortable talking to their family and over two thirds being uncomfortable discussing facial hair with friends. More than two thirds use the internet as their primary source of information, but the majority are not seeking professional help from their GP, stating reasons such as not wanting to waste the GP’s time, feeling embarrassed or being concerned they won’t be taken seriously. Anxiety is commonplace and women also list other strong negative emotions such as embarrassment, depression and even stress, as a result of their facial hair. The negative psychological impact of UFH was found to be much higher in younger women aged between 18 and 35 years. UFH can also cause women to significantly limit their prospects and development at work: almost a quarter of women surveyed said that their unwanted facial hair had stopped them from going for a promotion at work and more than a quarter said that they hold back from putting themselves forward for tasks at work because of their facial hair. Jason Gardiner, This Morning’s style guru co-hosted the launch event as well as holding a style seminar for the attending women, he said “I’m delighted to support We Can Face It and hope that through highlighting the impact of UFH, more women will be inspired to take steps towards lifting their confidence and self image through style, beauty and health advice. I really enjoy talking to the women about feeling and looking good and would love to see the women who have negative feelings as a result of their facial hair taking my advice into their everyday lives to lift their outlook and overall confidence.” Additional information on coping with UFH and finding support can be found on the campaign website at www.wecanfaceit.com along with the full survey report and results. 15 Research Tracks Possible Links to Products with Estrogen and Cancer Dr. Jerry Darsey, professor of chemistry in UALR’s College of Science and Mathematics, has received $77,000 from a federal Food and Drug Administration grant to develop methods to track estrogen mimicking compounds in various products and assess how use of the products affect women. Darsey will help develop methods to study these estrogen-mimicking compounds found in many medications, food additives, and consumer products. “The project is important because of the link between taking estrogen and developing breast cancer,” said Dr. Michael Gealt, dean of the college. “Estrogenic compounds may also increase the possibility of heart disease and stroke.” The grant will allow the development of a methodology to track estrogen in consumer products and food to see if those additives add to women’s health risks. Dr. Jon Wilkes at the National Center for Toxicological Research – a branch of the FDA – is the principal investigator on the project. He will be assisted at NCTR primarily by Drs. Dan Buzatu and Richard Beger and staff scientist Elizabeth Geesaman. They have developed an accurate approach predicting biological responses based on mechanically calculated data and artificial intelligence and models developed using correlations to biological responses. The approach provides the possibility of evaluating hundreds or thousands of potential compounds in less time than it would take to evaluate a few compounds by more traditional methods. 16 Professor Jerry Darsey Their method also would reduce the need for test animals, reducing costs and ethical concerns regarding the use of animals in toxicology testing. In the last 35 years, more than 40 studies of factors affecting the health and illness of women have been conducted examining the risks of taking estrogen hormone replacement and developing breast cancer. A study by the Women’s Health Initiative released in 2005 also showed increased risk of heart disease and stroke as well as increased breast cancer risks from estrogen replacement. “A big problem, which is getting more scrutiny, is that estrogenic activity is known to be present in numerous environmental systems,” Darsey said. “Several compounds containing natural or synthetic estrogens are known to be present in water and some food products, although in very low concentrations.” The FDA requires extensive studies and screens during product development, regulatory, and approval processes. Often, processes testing products result in thousands of publications in hundreds of journals each year. “Very often, there are conflicting results which must be evaluated,” he said. “There has been considerable interest in the development of models to predict biological activities, including toxic effects, of these compounds. There is a need for methods for estimating biological response in humans.” Are You A Writer? is always looking fresh, new writers with interesting perspectives, and great story ideas! • • • • • • Personal stories New research studies Wellness ideas PCOS management Diabetes/IR management Infertility/TTC Please visit the “Writer’s Guidelines” section of the PCOS Magazine website for more information about how to submit your story ideas and original writing. www.pcosmagazine.com PCOS Now Patient-Physician Compatibility Increases Odds of Following Doctor’s Orders Doctors and patients have varying opinions on how much control a person has over their own health outcomes. A new study by University of Iowa researchers suggests that when doctor and patient attitudes on the issue match up, patients do a better job of taking their medications. Published online and in the May issue of the Journal of General Internal Medicine, the study is part of a growing body of evidence indicating that patientphysician compatibility affects adherence to doctor’s orders and even a patient’s health status. The study was led by Alan Christensen, Ph.D., professor of psychology in the UI College of Liberal Arts and Sciences and of internal medicine in the UI Carver College of Medicine. It involved 18 primary-care physicians and 246 male patients from the Iowa City VA Medical Center, where Christensen is a senior scientist. The patients had both diabetes and high blood pressure, conditions that require a high level of self-management and frequent checkups. Researchers used surveys to assess the extent to which doctors and patients believed patients have personal control over their health. They also looked at prescription refill records over a 13-month period to see whether patients had enough blood pressure medication on hand. If doctor and patient attitudes were in sync, patients only let their refills lapse about 12 percent of the days, on average. But if patients held higher control beliefs than their physicians, they went without their pills 18 percent of the time. The study also found evidence that patient blood pressure may be less well maintained when doctor and patient control beliefs do not match. “Patients who held high personal control beliefs about their health were 50 percent less likely to adhere to their medication regimen if they were being treated by physicians who didn’t share this belief in strong patient control,” Christensen said. “Frustration is one likely reason for this. If they’re not getting the control they expect or prefer, they become less satisfied with the healthcare they receive and react to that loss of control by being less likely to follow the doctor’s recommendations, including filling refills.” Christensen said the study highlights a need to pair up doctors and patients with similar views – or, when that’s not possible, for doctors to tailor their approach to suit the patient’s expectations. “There’s currently a movement toward patient-centered care, which gives patients the opportunity to be more involved. This is often a good thing, but it’s also important to remember that one patient’s empowerment is another’s burden,” he said. “Some patients like to receive a lot of information about their condition and prefer to be a leader or equal partner in making deci- Continued on page 19 17 Documenting the PCOS Journey Documentary Filmmaker Randi Cecchine investigates life with PCOS I was diagnosed with PCOS in 1994. At the time I had never heard of PCOS and I didn’t know any women who had it. By 1997 I was lucky enough to find the Polycystic Ovarian Syndrome Association (PCOSA) where I found online chat groups of other women struggling with many of the same issues as I was. It was there, reading about what they were all going through, that I began to understand PCOS. About that time I thought about making a film about PCOS. I was interested in how media could help communities, and I was a filmmaker who liked telling stories about the inside experiences we go through, and how they interact with the outside world. I researched, made a public access show, and applied to a graduate program where I would commit two years of my life to making this film. And it made me nervous! Suddenly I was in the position of talking with all my fellow students about PCOS—periods, fertilityhaving facial hair, being fat. I pushed myself to be honest, as I knew I wanted to make a film that would show how hard it is to reveal these very per- 18 sonal and vulnerable parts of ourselves. As I worked on the film I had the help of some very dear friends who seemed proud of me for doing this. When my graduate program was over in 2000 instead of going to my graduation I showed the film at the PCOSA conference in San Diego and it seemed that people really enjoyed it. I was nervous, and artistically I wasn’t satisfied with that cut of the film. It needed more editing, I needed time and money, and the demands of normal life took over. On some level I was tired of the process, of talking about PCOS every time I met a new person. I needed a breather. Finally, sometime in 2002 I managed to complete the 41 minute film to my satisfaction. I began distributing it online to women with PCOS (I made VHS copies at home) but I wanted to reach a larger audienceespecially professionals. I signed on with a distribution company and was no longer allowed to sell the film myself—and the film didn’t sell very well. I was frustrated and didn’t know what else to do with it. I was busy teaching, making another film and PCOS faded into the background. When I finally got the rights back from the distributor I decided that I wanted to re-release the film and add more updated material to it. I began interviewing people from a variety of healing modalities, and I felt like I was understanding PCOS in a broader context. I interviewed 3 women who generously shared with me their experiences with PCOS—and one was my sister! I was excited to share all this new information with people. But still I had trouble finishing the film. A part of me must have been nervous again about revealing myself and PCOS publicly. Facebook would be a great way to reach audiences—but did I really want to tell all those people from my high school that I had PCOS? When I began sharing about PCOS at Facebook it was those very people I went to high school with who revealed to me that, they, too had PCOS. Just as in 1998, when I was making the first documentary, people I had known for years suddenly told me that they had PCOS and were struggling with many of the same symptoms I had. Friends I was in the Women’s Art Collective with in College. A dear old friend who hadn’t told anyone yet that she shaved her face. The office manager at a job. The cousin of my neighborhood friend and computer guru. The woman I took the bus with in high school who I admired for her youthful social justice work. The daughter of a freelance client. The list goes on, but the details fade into what has become my new normal awareness of something that had previously been hidden. As I’ve become more public about PCOS I have had the privilege of sharing my film, and letting more women know that they are not alone. I’ve had some friends offer great support and understanding. I’ve also met people who seemed to avoid a discussion that centers around women’s reproductive health- who made me question my own willingness to reveal myself. The shame sometimes returned, and I didn’t feel all that eager to finish the DVD and begin a public marketing campaign. I felt the drag of an unfinished project- and moved ahead very slowly. I never could have imagined it, but then I met a wonderful man who not only didn’t run away when he saw the film, but he told me that it moved him and made him respect me more. He told me I was brave- but I wasn’t sure I could believe him. I wasn’t sure I was ready to go completely public with PCOS and I had all that tape to edit, a DVD to author, a distribution plan to create, and no funding. It wasn’t a massive amount of work, but it was hard to do alone. Patient-Physician Compatibility Continued from page 17 or equal partner in making decisions about their health. Others would rather just have the doctor sift through the information and tell them what to do.” But the evidence we have suggests that they’re often not doing so effectively,” Christensen said. “Our goal is to develop some tools to help.” In the meantime, he suggests that health professionals ask questions to find out Because pairing doctors and patients how much information patients want, could be difficult in some cases -- for and how involved they want to be in example, when only one specialist decision-making. is available in a rural area -- Christensen believes helping health care “It takes extra time up front, but the providers tailor their approach is a patients will be more satisfied and likely better way to boost patient satisfac- to follow treatment recommendations tion and adherence. The next step in the long run,” he said. “If a doctor in his research is to develop a short can see that someone prefers an active questionnaire to assess patient pref- role, even providing patients a seemingly erences -- perhaps one that could be trivial choice like whether to take a pill filled out in the waiting room along twice a day or the long-acting form once with routine health history forms a day can make a big difference in how -- and translate that information in a well the relationship works.” way that’s easy for providers to apply right there on the spot. The study was funded by a grant from the Department of Veterans Affairs “Physicians, with few exceptions, say Health Service Research Development that they already attempt to tailor Service. Co-authors of the paper are: M. their approach. I don’t doubt that Bryant Howren, Ph.D., Stephen Hillis, they do try, within the time conPh.D., Peter Kaboli, M.D., Barry Carter, straints they have and their ability to discern what the patient wants. But he helped mewatched interviews with me and discussed which sections to keep, which were irrelevant or unclear or repetitive. He helped me see connections between the different interviews. Although he wasn’t a film editor, he had a very literary mind that intuitively understood the process. Even working longdistance—with his help I finished the edit. Friends helped me by taking time to watch everything and make corrections to sound, text and editing mistakes. My family helped in many ways. A friend designed the DVD cover, others wrote the text, and another friend’s financial contribution allowed me the time to do the work. Since announcing the film I’ve received so much support from people I know, and from the PCOS community. I was on a radio show and written about in the PCOSA Newsletter. A woman I just met has offered incredible help in my distribution/outreach efforts. We will work to get the film to universities and community groupsand to reach women with PCOS online. PCOS—this thing that once felt secret, hidden, shameful is now something I’m pleased to speak about publicly. I also know deeply we need help from those who care about us and our mission, and that we shouldn’t spend too much time with those who can’t see, encourage and love us for who we are. Making this film —and having PCOS—has been in many ways a blessing in disguise- a chance to connect with people in new ways, hopefully to serve others, and to harness something that was once a struggle of solitude into a celebration of community, friendship and honesty. Visit Randi’s site, www.pcosdocumentary.com, for more information on Scrambled. 19 ASK ANGELA: Artificial Sweeteners: A Safe Alternative to Sugar? Angela Grassi, MS, RD, LDN, is a registered and licensed dietician specializing in the treatment of PCOS and eating disorders. Located in Haverford, Penn., Angela provides in-person or phone consultations. Visit her website at www.pcosnutrition.com. 20 Dear Angela, I drink several diet sodas each day but worry about possible health effects from the artificial sweeteners. The more I drink them, the more I want. How bad are artificial sweeteners for you? Thanks! Allison-Pittsburgh, PA Many people have been using artificial sweeteners in place of regular sugar to save calories, manage weight and help control blood sugars. There are several different types of artificial sweeteners on the market with some of the most popular brands being Equal (aspartame), Splenda (sucralose) and Sweet N’Low (saccharin). These low-calorie sweeteners, usually 30 to 8,000 times as sweet as regular sugar, are used in many common food items such as water, sodas, yogurt and ice cream. Despite the popularity of artificial sweeteners, America is only getting fatter and rates for diabetes continue to be on the rise. Allison asks a very important question: How safe are artificial sweeteners? According to the National Cancer Institute, there’s no evidence showing that artificial sweeteners approved for use in the United States cause cancer. Studies show that sugar substitutes are safe for the majority of the population. People seem to have different responses and tolerances to sugar substitutes with headaches, diarrhea, and bloatedness being the most common complaints from use. According to TheMayoClinic.com, The Food and Drug Administration (FDA) has approved the following low-calorie sweeteners for use in a variety of foods. The FDA has established an “acceptable daily intake” Artificial sweetener ADI* Aspartame 50 mg per kg Saccharin Est. ADI equivalent** 5 mg per kg 18-19 cans of diet cola 9-12 pkts. of sweetener Acesulfame K 15 mg per kg 30-32 cans of diet lemon-lime soda*** 6 cans of diet cola*** Sucralose 5 mg per kg *FDA-established acceptable daily intake (ADI) limit per kilogram (2.2 pounds) of body weight. **Product-consumption equivalent for a person weighing 150 pounds (68 kilograms). ***These products usually contain more than one type of sweetener times less than the smallest amount that might cause health concerns. (ADI) for each sweetener. This is the maximum amount considered safe to eat each day during your lifetime. ADIs are intended to be about 100 Despite its low-calorie content, some researchers are speculating that some sugar substitutes, especially those found in diet sodas may actually cause weight gain, interfere with metabolism, and even contribute to metabolic syndrome. One study showed that rats fed saccharin gained more weight than those fed regular sugar. When researchers examined the diets of over 9,500 men and women between the ages of 45 to 64, they found that the risk of developing metabolic syndrome was 34 percent higher among those who drank one can of diet soda a day compared with those who drank none. Some researchers suggest that artificial sweeteners may mess with the brain, signaling it to prepare for a calorie load. This may lead to a preference for sweets and overeating and may even stimulate insulin. My advice: until there is more research, if you do consume foods with artificial sweeteners limit your intake to as little as possible. Inositol: What is it and does it help? Inositol is a member of the B-vitamins and a component of the cell membrane. There are many reasons women with PCOS may want to take this supplement, as inositol has been linked to improved insulin, triglyceride, and testosterone levels, as well as improved blood pressure, ovulation and weight loss. A handful of studies were conducted on inositol and PCOS, but all showed favorable results, especially when it came to fertility. In the most recent, largest study, 25 women received inositol for six months. Twenty-two out of the 25 (88%) patients had one spontaneous menstrual cycle during treatment, of whom 18 (72%) maintained normal ovulatory activity. A total of 10 pregnancies (40% of patients) occurred. It is believed that inositol increases the action of insulin, thereby improving ovulation, decreasing testosterone, and lowering blood pressure and triglycerides. Generally, inositol is tolerated but can cause nausea, fatigue, headaches and dizziness. No interactions with herbs and supplements are known. There is concern that high consumption of inositol might exacerbate bipolar disorder. Inositol is sold as myo-inositol or d-chiro-inositol. Dosage is 200 to 2,000 mg daily. As always, check with your physician before starting inositol or any other dietary supplement. Dieting Alone May Not Help Stave Off Type 2 Diabetes FINDINGS: Sarcopenia â€” low skeletal muscle mass and strength â€” is often found in obese people and older adults; it has been hypothesized that sarcopenia puts individuals at risk for developing Type 2 diabetes. performed a cross-sectional analysis of data on 14,528 people from the National Health and Nutrition Examination Survey III. To gauge the effect of sarcopenia on insulin resistance (the root cause of Type 2 diabetes) and blood glucose levels in both obese and non-obese people, UCLA researchers They found that sarcopenia was associated with insulin resistance in both obese and non-obese individuals. It was also associated with high blood-sugar levels in obese people but not in thin people. These associations were stronger in people under age 60, in whom sarcopenia was associated with high levels of blood sugar in both obese and thin people, and with diabetes in obese individuals. ular, to have good muscle mass and strength. AUTHORS: Preethi Srikanthan, Andrea L. Hevener and Arun S. Karlamangla of UCLA JOURNAL: The study appears in the peer-reviewed journal PLoS One: http://dx.plos. IMPACT: org/10.1371/journal. Dieting to be thin is on its pone.0010805. own not enough to stave off diabetes. It is also important to be fit and, in partic- 21 PCOS Now Sleep Apnea May Increase Insulin Resistance When compared to the control group, the IH mice demonstrated impaired glucose tolerance and reduced insulin sensitivity; the CH group, however, showed only a reduction in glucose tolerance but not insulin sensitivity compared to controls. ence in New Orleans. Sleep apnea may cause metabolic changes that increase insulin resistance, according to researchers from the University of Pittsburgh Medical Center. The intermittent hypoxia associated with sleep apnea causes a distinct drop in insulin sensitivity in mice, even though chronic hypoxia, such as that associated with high altitude, did not. The research will be reported at the American Thoracic Society 2010 International Confer- 22 To determine whether intermittent hypoxia (IH) and chronic hypoxia (CH) would have different metabolic effects, Dr. Lee and colleagues fitted adult male mice with arterial and venous catheters for continuous rapid blood monitoring of glucose and insulin sensitivity. They then exposed the mice to either seven hours of IH, in which treatment, oxygen levels oscillated, reaching a low of about 5 percent once a minute, or CH, in which they were exposed to oxygen at a constant rate of 10 percent, and compared each treatment group to protocol-matched controls. “Both intermittent hypoxia and continuous hypoxia exposed mice exhibited impaired glucose tolerance, but only the intermittent hypoxia exposed animals demonstrated a reduction in insulin sensitivity,” said Euhan John Lee, M.D., a fellow at the Medical Center. “The intermittent hypoxia of sleep apnea and the continuous hypoxia of altitude are conditions of hypoxic stress that are known to modulate glucose and insulin homeostasis. Although both forms of hypoxia worsen glucose tolerance, this research demonstrated that the increase in insulin resistance that accompanies intermittent hypoxia, or sleep apnea, is greater than that seen with con- tinuous hypoxia, or altitude,” explained Dr. Lee. The specific finding that intermittent, but not continuous, hypoxia induced insulin resistance was not expected. Increased generation of reactive oxygen species, initiation of pro-inflammatory pathways, elevated sympathetic activity, or upregulation of insulin counter-regulatory hormones in IH may contribute to the greater development of insulin resistance in those mice versus those exposed to continuous hypoxia. “As sleep apnea continues to rise with the rate of obesity, it will be increasingly important to understand both the independent and interactive effects of both morbidities on the development of metabolic disorders. This research demonstrated that intermittent hypoxic exposure can cause changes in insulin sensitivity and insulin secretion, which may have important consequences in metabolically vulnerable diabetic patients who present with co-morbid sleep apnea,” said Dr. Lee. “Future research will explore potential inflammatory and lipotoxic pathways by which intermittent hypoxia disrupts glucose and insulin homeostasis.” PCOS Now Inhaling Diabetes? Study Suggests Link Between Air Pollution and Type 2 Diabetes in Women Traffic-related air pollution, known to raise the risk for cardiovascular disease, may also increase the risk of developing type 2 diabetes in women. Low-grade inflammation may contribute to the higher incidence of type 2 diabetes in women exposed to air pollution, according to German researchers. icantly associated with a higher risk of type 2 diabetes. An increase in NO2 or PM corresponding to the difference between exposure at the 75th percentile and exposure at the 25th percentile was associated with a 15–42% higher risk of type 2 diabetes. Living within 100 meters of busy roadways more than doubled the diabetes risk. Published online May 27 in the peer-reviewed journal Environmental Health Perspectives (EHP), the study comprised German women living in highly polluted industrial areas and in rural regions with less pollution. The researchers analyzed data from 1,775 women who were 54 or 55 years old when they enrolled in the study in 1985. Between 1990 and 2006, 187 participants were diagnosed with type 2 diabetes, which often starts in middle age. Air pollution data from monitoring stations and emission inventories run by local environmental agencies were used to estimate each woman’s average exposure levels. Measurements of C3c, a blood protein and marker for subclinical inflammation, predicted the elevated diabetes risk. Only women with the highest C3c levels at enrollment had an increased risk for type 2 diabetes related to traffic pollution during the 16-year follow-up period. Just how C3c might affect diabetes remains unknown. Immune cells in the airways may first react with air pollutants, setting off a widespread chronic inflammatory response, which in turn may make individuals more susceptible to developing diabetes. Exposure to components of traffic pollution, particularly nitrogen dioxide (NO2) and soot in ambient fine particulate matter (PM), was signif- Although the study focuses only on women, study leader Wolfgang Rathmann says, “We have no reason to assume sex differences in the association between air pollution and diabetes risk, but we do not have data on this issue.” To the authors’ knowl- edge, this is the first population-based study to reveal a statistically significant association between traffic-related air pollution and type 2 diabetes. Previous epidemiologic research shows that city dwellers have a higher prevalence of diabetes than do rural residents, especially in developing countries undergoing rapid industrialization. Changes in diet and physical activity and resulting increases in obesity are believed to be the primary culprits. These changes, however, do not totally explain the increased diabetes risk. The results of the current study suggest traffic-related air pollutants may be an unidentified environmental factor related to the development of type 2 diabetes. Air pollutants can cause low-grade inflammation, insulin resistance, and impaired glucose metabolism. Additionally, C3c is a risk factor for diabetes, and C3c levels are higher in individuals living in highly polluted areas. The latest findings further support the role of traffic air pollutants and low-grade inflammation in diabetes risk. Authors of the study are Ursula Krämer, Christian Herder, Dorothea Sugiri, Klaus Strassburger, Tamara Schikowski, and Ulrich Ranft. The full article, “Traffic-Related Air Pollution and Incident Type 2 Diabetes: Results from the SALIA Cohort Study,” is available on the EHP website at http://ehponline.org/ article/info:doi/10.1289/ ehp.0901689. EHP is published by the National Institute of Environmental Health Sciences, part of the U.S. Department of Health and Human Services. EHP is an open-access journal. More information is available online at http://www. ehponline.org/. 23 Baby? Suzy Reyes’ path toward pregnancy continues in this edition of PCOS Magazine. She still answering the ever-lurking question, “when are you going to have a B ack to that inescapable question… “When are you going to have a baby???” Following my PCOS diagnosis, this question became even more difficult to answer. After we got the news from the infertility specialist, my husband and I were faced with many decisions. We had been placed on a brief hiatus from treatment (for about three months), in which my husband was instructed to take the “super sperm” vitamins (as we called them) recommended by the doctor, and where I managed to lose almost twenty pounds. While these efforts couldn’t hurt, they didn’t seem to help either; his stats didn’t improve, and I was still not ovulating. This is where all of the options came into play. Our doctor, the young and 24 handsome “Dr. H”, was undoubtedly convinced that he would be able to get me pregnant (OK, get your minds out of the gutter!) but we had to choose which route to take. After reviewing our medical histories and test results once again, he informed us that we basically had two choices: artificial insemination or in vitro fertilization. Both options would require drugs in order to get me to ovulate. The first of the two options, artificial insemination, was the much less expensive, much less invasive option, whereas the in vitro fertilization, although being the much pricier as well as more invasive and complex option, also had a much higher success rate. Dr. H was convinced, based on his past experiences with patients similar to myself, that in vitro was the way to go. “My job is to get you pregnant as quickly and efficiently as possible”, he told us. He let us know that he was willing to take us through the insemination process as many times as we wanted or were necessary, but that with the PCOS and my history, our chances of conceiving through insemination may be very slight. He also wanted us to be aware of the reality that although the insemination process would in fact be less expensive and invasive than in vitro, we would most likely undergo similar emotional experiences with both. We definitely saw where he was coming from, but, being young-ish, and just at the beginning of this journey, (not to mention broke), we chose to pursue the first option, and began the process to prepare for insemination. We started with Clomid (Clomiphene), lots of Clomid, to induce ovulation. We tried Clomid by itself in small and then larger dosages, and even combined with so many other things I felt like I was popping one pill or another all throughout the day and night. Although I know many women who have had great success with Clomid, my body was completely unresponsive to the drug. That’s when we moved on to injectable medications (gonadotropins). While I don’t necessarily have a strong aversion to needles, the idea of having to inject myself was not my idea of fun. Right about now you’re probably thinking, “You should’ve just had your husband do it for you.” Well, although he was willing to make many sacrifices and do all other thoughts that began to swim through my head. “What if it DOES work?”, I worried. “What if, after all of this time, we do actually become pregnant?” Compared to these random thoughts, the side effects of the drugs, and the hormonal roller coaster I was on, giving myself the injections was a piece of cake! ton. I swabbed the area with the alcohol pad, clicked the pen to just the right dose, and I froze. There were lots of 1’s and 2’s, but it took about ten minutes for me to get the courage to get to 3. sorts of interesting (and sometimes possibly emasculating) things to help and support me throughout this process, he made it clear that stabbing me with needles would not be one of them (however, after putting up with me through the emotional roller coaster ride caused by the side effects from all of the meds, he may have ended up regretting that decision)! The first time I had to inject myself was quite dramatic. I read the directions over and over, and chose just the right spot below my belly but- Finally, I just went for it, jabbing the needle into my abdomen and releasing the medication. I felt nothing. It didn’t hurt at all. I had been a big baby for nothing. Sure, there were a few times throughout this process where I did feel a little pinch, but overall, it ended up being a fairly simple, systematic, and painless process—at least physically. Emotionally, on the other hand, it was a long and winding road. Along with being constantly tired and irritable, I was also always extremely anxious. Now that we were being so proactive, I was constantly worrying—“What if we go through all of this and it doesn’t work?” I think that is a normal reaction, but then I was surprised by Because of my polycystic ovaries, I had been started on an extremely low dose of the medication, as a precautionary measure. I continued to use the injectables for a few weeks, visiting the doctor after every other injection, to check our progress. It was a long, slow process, because of the fact that we did need to proceed with caution. If I took too large of a dose, there was a chance of overstimulation, which would have meant starting back at square one. As Dr. H said, “I’m OK with twins, but we don’t want you on the cover of Time Magazine!” On that, we definitely agreed! We were eager to become parents, but had no desire to become the next John & Kate (even during the happy years)! It seemed like we were never making any progress, but each night I continued to inject myself with a slightly larger dose of the medication. This became increasingly frustrating, as well as extremely costly. I even remember crying one day after leaving the pharmacy with a single dose of medication so pricey it made me second-guess the entire process. pharmacy with this one dose of medication that cost nearly half of our monthly rent, I was trying to justify the purchase I had just made. Had we made a huge mistake? I was emotionally and financially drained; I had gotten used to the frequent trips to the doctor’s office, the pills, and the shots, but was finding it harder and harder to rationalize the cost of what we were doing. Luckily, at my appointment the next morning, the ultrasound showed that we had enough viable eggs to proceed. Just one more injection—this time to release the eggs—and we would be ready to inseminate! The morning of the procedure was unbelievably emotional. It seemed like it had taken so long just to get to the point where we could proceed with the insemination, and that by all means did not guarantee anything. My husband held my hand throughout the procedure, which, although not painful, was uncomfortable. When the nurse finally finished and left the office, I laid back and wept. I knew at that moment that we were closer than we had ever been to becoming parents. Even if it was not a success, it was, for the first time, something. At that point all that was left to do was wait, and as Tom Petty said, “the waiting is the hardest part”.... As I drove away from the 25 PCOS Now CA-125 Change Over Time Shows Promise as Screening Tool for Early Detection of Ovarian Cancer Evaluating its change over time, CA-125, the protein long-recognized for predicting ovarian cancer recurrence, now shows promise as a screening tool for early-stage disease, according to researchers at The University of Texas MD Anderson Cancer Center. The findings were presented by Karen Lu, M.D., professor in MD Anderson’s Department of Gynecologic Oncology, in advance of the American Society of Clinical Oncology (ASCO) annual meeting. If a larger study shows survival benefit, the simple blood test could offer a muchneeded screening tool to detect ovarian cancer in it early stages - even in the most aggressive forms - in post-menopausal women at average risk for the disease. MD Anderson has a long history in the research of the important biomarker. In the 1980s, Robert Bast, M.D., vice president for translational research at MD Anderson and co-investigator on 26 the ASCO study, discovered CA-125 and its predictive value of ovarian cancer recurrence. Since then, researchers at MD Anderson and beyond have been trying to determine its role in early disease detection. The marker, however, can become elevated for reasons other than ovarian cancer, leading to false positives in early screening. “Over the last ten years, there’s been a lot of excitement over new markers and technologies in ovarian cancer,” said Lu, the trial’s principal investigator. “I and other scientists in the gynecologic oncology community thought we would ultimately find a better marker than CA-125 for the early detection of the disease. After looking at new markers and testing them head-to-head in strong, scientific studies, we found no marker better than CA125.” According to the American Cancer Society, 21,550 women were diagnosed with ovarian cancer in 2009 and another 14,600 died from the disease. The challenge, explained Lu, is that more than 70 percent of women with ovarian cancer are diagnosed with advanced disease. “Finding a screening mechanism would be the Holy Grail in the fight against ovarian cancer, because when caught early it is not just treatable, but curable,” said Lu. For the prospective, single-arm study, 3,252 women were enrolled from seven sites across the country, with MD Anderson serving as the lead site. All were healthy, post-menopausal women, ages 50-74, with no strong family history of breast or ovarian cancer. The study’s primary endpoint was specificity, or few false positives. In addition, the study looked at the positive predictive value, or the number of operations required to detect a case of ovarian cancer. Each woman received a baseline CA-125 bloodtest. Using the Risk of Ovarian Cancer Algorithm (ROCA), a mathematical model based on the patient’s age and CA-125 score, women were stratified to one of three risks groups, with the respective follow-up: “low,” came back in a year for a followup blood test; “intermediate,” further monitoring with repeat CA125 blood test in three months; and “high,” referred to receive transvaginal sonography (TVS) and to see a gynecologic oncologist. Based on the women’s CA-125 change over time, the average annual rate of referral to the intermediate and high groups were 6.8 percent and .9 percent, respectively. Cumulatively, 85 women (2.6 percent) were determined to be high risk, and thereby received the TVS and were referred to a gynecologic oncologist. Of those women, eight underwent surgery: five were found to have ovarian cancer, three with invasive and two with borderline disease; and three had benign tumors - a positive predictive value of 37.5 percent. Consequently, no more than three operations would be required to detect each case of ovarian cancer, explained Lu. The screening failed to detect two borderline ovarian cancers. Of great importance, said Lu, is that the three invasive ovarian cancers detected were high-grade epithelial tumors, the most aggressive form of the disease, and were caught early (stage IC or IIB), when the disease is not only treatable, but most often curable. Lu also noted that all three women found to have invasive disease were monitored at low risk for three years or more prior to a rising CA-125. a large, randomized prospective screening trial still needs to be conducted. Such research is ongoing in the United Kingdom; results from more than 200,000 women should be known by 2015. “CA-125 is shed by only 80 percent of ovarian cancers,” explained Bast. “At present, we are planning a second trial that will evaluate a panel with four blood tests including CA-125 to detect the cancers we may otherwise miss with CA-125 alone. The current strategy is not perfect, but it appears to be a promising first step.” “As a clinician treating women with this disease for more than ten years, I’ve become an admitted skeptic of ovarian cancer screening. Now, with these findings, I’m cautiously optimistic that in the not too distant future, we may be able to offer a screening method that can detect the disease in its earliest, curable stages and make a difference in the lives of women with this now-devastating disease.” While encouraging, the findings are neither definitive, nor immediately practice-changing, stressed Lu; who also said The study is continuing; and, as follow-up, Lu and her team plan to look at combining other markers with CA-125 to determine the screening impact of their combined change over time. The study was supported by the National Cancer Institute, and was a research project of MD Anderson’s ovarian cancer Specialized Program of Research Excellence (SPORE). The University of Texas MD Anderson Cancer Center in Houston ranks as one of the world’s most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. 27