Wednesday, April 23, 2008

PCOS and LC; is pregnancy a side effect?

This review dropped out of Pubcrawler today. How to get pregnant if you have PCOS.

"Fat should be restricted to < or =30% of total calories with a low proportion of saturated fat"

Of course it must, what else would you expect? Now here's the real giggle:

"High intake of low GI carbohydrate contributes to dyslipidaemia and weight gain and also stimulates hunger and carbohydrate craving"

I'm sure it does, but who would have expected the low fat brigade to realise this? I can't get the full text to see if this is a typo (it MUST be!), but if not, you can't eat fat and you can't eat low GI carbs. Sounds like sugar on your veggie burger is all that's left! The abstract gives no indication of how likely you are to conceive if you follow this advice. I don't think I'd trust it as a form of contraception but...

Of course you could always try living within the limits of your insulin resistance, but (gasp) you might have to eat >30% of calories from fat. This was a pilot study. Only five of the eleven women completed the 24 weeks on the diet. Which diet?

"They were instructed to limit their carbohydrate intake to 20 grams or less per day for 24 weeks"


"Two women [out of five] became pregnant despite previous infertility problems"

For anyone who might not want to get pregnant, you do have to do something more than eat LC for pregnancy to happen... and be female!



donny said...

One of the authors also co-authored the above study. I haven't read it fully yet (I'm 'sposed to be working), but it seems to support low carb for diabetes.)
Maybe each author of your study wrote one line? Or maybe they compromised and ended up at the Zone diet.
My links never seem to work here. Got my fingers crossed.

Peter said...

Hi donny,

Link works fine, thanks. I loved this sentence:

"Low-carbohydrate diets should not be the first line of treatment, and they certainly should not replace the carefully considered and evidence-based guidelines that form the basis of current clinical practice"

You could add this in his own voice "Arghhhh but they work, gnash teeth... but I'm afraid of fat, especially arterycloggingsaturatedfat, so they're bad and protein will kill kidneys, oh no it won't and and and... "

Cognitive dissonance or cognitive dissonance? Just love it.


Dr. B G said...

Could the editors have made them compromise their LC faith to publish?

So now this explains why I'm a fertile-myrtle? Too insulin sensitive for my own good... (immaculate conception? that would probably be me)

Anonymous said...

Some women might want to know about natural diets to prevent pregnancy. What do you think, Peter? Could you design a healthy low-carb diet that would also prevent conception? That is the holy grail to a lot of women today. I imagine that eating a pure meat diet (without eggs or dairy or organ meats) might provide a decent level of health while preventing or greatly reducing odds of pregnancy. What do you all think?

Peter said...

Hi Bruce,

Lutz certainly speculates along these lines in Life Without Bread. He has a publication in German on egg production in hens here.

Summary from LWB: More corn=more eggs plus more arteriosclerosis. He suspects the same is true in humans.

The converse would be LC=lower fertility. Assuming insulin drives reproduction, the insulin resistance in PCOS is why the system fails. I wouldn't rely on either aspect of reproductive physiology to space our children!


Manda said...

okay,am i reading this correctly--that eating a LC diet will prevent me from becoming pregnant? this is very interesting to me b/c we have been trying to conceive for the past 2 months and i have been wondering if it's failing b/c of the things i eat/or don't eat.

do i need to eat more sugar to be able to conceive? i eat eggs, dairy and meat, but i do not eat many carbs and i don't eat much sugar at all. anyone have any suggestions as to what i should be eating if i want to get pregnant?

thanks, amanda

JohnN said...

High insulin level is the body signaling for growth - probably including procreation. The reverse or depressed level of insulin (which Atkins amusingly called fat mobilizing hormone or FMH) is the signal for maintenance and repair and even hibernation in some species.
In a related note I'd think children in the growing phase should not rely on hyperlipid exclusively. Perhaps episodic boosting of insulin or the HGH-IGF1 cascade chain is useful.

Unknown said...

Amanda of Team Smith,
If you want to have a healthy baby, I would check out the Weston A Price Foundation website. This is one of their main purposes. There is a lot to it, but grass fed animal fat and organ meats are important and not on most peoples diets from conventional foods. I would add cod liver oil for DHA for brain function of the infant. Do not eat sugar. Many primitive peoples had plenty of children w/o sugar. Stick to whole foods and get your carbs that way.


Manda said...

hi porter, thanks for the comment, but actually WAPF is what i have been eating for the last 3 years. it is only recently in the past 5 months that i have been eating a high fat, low carb diet. i cut out grains for other health reasons and i do not eat sugar (or very very little--not even fruit). i have been taking CLO for 3 years as well.

i guess my main question is whether eating a low-carb (50 grams carbs or less) could cause me to not get pregnant. i'll try to eat more carbs, though, if that will help. i don't eat very many vegetables, mostly potatoes at dinner, but hmmm, i'll figure something out. :)


Anna said...

Hope this isn't too personal. I seem to have little modesty left after birthing, especially after a gaggle of ob-gyn interns showed up at the last minute to see a Pitocin "induced" delivery without pain meds or epidural. :-)

My husband and I got our family off to a late start, meeting and marrying quite a bit later than average (age 34 for me, 41 for him). So we didn't exactly have age on our side. We spent most of the first 7 years of our marriage trying to conceive, and have one 9 yo child as a result, born when I was almost 37 yo.

Other than during the last third of my pregnancy when a LC diet was prescribed for a dx of gestational diabetes, my 20s and 30s were two decades of carb eating for me: pasta or homemade pizza many nights a week, baking bread several times a week with my nifty bread machine, and regular consumption of pancakes, waffles, breakfast cereals (whole grain, of course ;-) ), potatoes, cookies, cakes, etc. We moved right after our wedding to CA, trying right away to start a family. For the first time since age 14, I didn't have a job so I relished the time in the kitchen, especially with baking.

So, my anecdotal experience is that carbs don't enhance fertility, at least not for me. I'm quite sure my BG was abnormally high much of my 30s, because my FBG was never below 100 back once it was regularly checked beginning in 1996 at age 34 when we starting to conceive. My weight had starting creeping up at age 29, after being somewhat underweight since my early teens so my guess is my BG and insulin production was up there.

Especially in those first few years we didn't eat nearly enough daily protein and SFAs (I was following the recommendations make those things less of a focus in the meal), and what oils I did use had too many PUFAs, probably. I used to cut up a single boneless chicken breast, small steak, or bratwurst/Italian sausage and toss it with lots of pasta and some vegetables, with a tossed salad for both my husband and I to share, to give you an example of average macronutrient ratios. While I didn't scrupulously avoid fat and animal protein, I did casually avoid what I thought was an excess.

Seems so stupid now, that's not even enough protein and fat for one of us, let alone two adults wanting to reproduce. Plus too much starch and sugar, for sure. We both gained 20-35 pounds in that decade, too, though I only weighed a few pounds too much after the birth thanks to the LC pregnancy diet, and that disappeared quickly with breast-feeding, only to gain it right back in the five years after weaning and resuming bread and pizza baking.

I didn't know it at the time (nor did my doctors notice, despite regularly testing TSH but still using a controversial and outdated reference range), but I was slowly becoming mildly hypothyroid (creeping TSH) at the same time, so low thyroid function or low T4->T3 conversion at tissue level probably figured into the infertility problems, too.

When I finally had the hypothyroidism treated at age 44 (I am pretty sure LC did not cause my hypothyroidism nor make it worse, but it didn't seem to help, either and it looks like might have developed simultaneous to the loss of BG control), my doctor warned me not to count on my infertility history for BC, as he had seen patients' fertility restored even at later ages (oops) after the thyroid deficiencies were treated. Even in my current pre-menopausal age of 46, my "fertility-awareness signals" are often more apparent now, on LC and a T4/T3 thyroid hormone therapy, than when I was in my 30s, eating lots o' carbs, and trying to conceive.

If I was younger and still wanted to conceive, I would definitely consult the WAPF recommendations to maximize nutrient dense foods to enhance fertility, not the baloney I was recommended (lean meats & legumes, low fat dairy, whole grain products for folic acid, etc.). Wish I had known about WAPF back then. Might have saved us a lot of grief, trouble, and time.

Better late than never, though, eh? And we've learned to be grateful for the small family we have, even though it isn't exactly the one we had hoped for.

Peter said...

Hi Amanda,

Most of the information I have suggests LC without ketosis with an emphasis on nutrient dense foods, meat, butter, cream and organ meats. Keeping well out of ketosis is probably a good idea, carbs up around Lutz's 72g/day. I know of two women who didn't cycle properly in full ketosis. Carbs from vegetables rather than sugar or refined starches. You certainly shouldn't be aiming to loose weight or be stable at a very low body fat %, but that applies across all diets...

Certainly at the time Squiggs happened we were both on LC and the happy event did not involve any specific planning.

Good luck and enjoy.


Dr. B G said...

OMG... Amanda and Anna,

You need to read the below from Dr. Mark Hyman -- a doc from the Bay Area and often on our PBS public station. Many physicians are using vitamin D to correct thyroid disorders (i'm acutely aware of it b/c my younger sister had Grave's after a bout of severe stress and sunlight deprivation).

Infertility and hypothyroidism (and hyperthyroidism) are intimately related to vitamin D (as well as vit A, magnesium, calcium) deficiency. As John N was mentioning, sunlight rules our universe. Getting a little biblical, but what was created after the heavens and the earth?

Studies show that vitamin D (and A) reverse infertility in female and male animals. My OB told me last fall that they give vitamin D in the infertility to men with low sperm counts (!!). I couldn't figure that out, but I found a few animal studies (no luck w/ any human ones). So with adequate vitamin D levels (25(OH)D of 50-60 ng/ml), estrogen and testosterone levels increase.

Amanda -- do you get enough protein? this is essential for function of the PPAR receptor which works with the estrogen receptors.

Anna -- I'm a lot like you! making many discoveries later in life! discovered WAPF only about 2 wks ago!! in my teens and 20s I probably had undiagnosed hypothyroidism. Instead of the freshman fifteen lb weight gain, I had forty!! Then I discovered LC 6 yrs ago and then vitamin D 6 mos ago. I agree, never too late!! My 2nd child's birth was kinda like yours... I had a professor and 3 of her students watching my lovely birth. And subsequent 3rd degree laceration... yeah fun...!!!
Vitamin D is important for brain development and functioning too...

read this pedi neurosurgeon:

Good luck and get your D tested :)

Anna said...

After 6-8 months of taking 2000-4000 D3, I asked my new endo for a 25 OHD test last December. My result was 44, which he was just fine with. Tells me that I wasn't overdoing the D3 and I can even take more to get my level higher. Now, when I remember, I try to take 4000+ with no worries. I also try to get a bit of daily non-burning sun exposure now, after 9 years of consistent sun shunning (post MOHS surgery for basal cell carcinoma).

Interestingly, I have a fair-skinned friend (age 46-47) in the Pacific NW who was diagnosed with breast cancer early last fall (so far, so good). I asked about her Vit D levels and it had been tested during her diagnosis workup - 25 OHD in the mid or high teens! - shockingly low, but perhaps not so surprising with the PNW climate, a full-time indoor job, and adherence to the recommended daily high SPF sunscreen use. What was more surprising was that no recommendation was made to supplement with D3 (she bought a juicer, though!). I have been gently pushing her to take a lot more than the low RDA dose and to avoid a lot much fruit juice/sugars/high insulin driving foods.

Peter said...

Hi Anna,


Re the juicer:
Idea behind the WHEL study
Results of the WHEL study

Unfortunately I don't know of any double blind placebo controlled therapeutic trial showing D3 really helps prevent recurrence. It should do, but I think it's too soon for anyone to have checked. Open to correction on that one!

However, having a 25 OH D3 within the standard lab ref range seems like a good idea. If that takes 10,000iu D3 per day in the pacific NW, so be it. Someone motivated enough to buy a juicer ought to be motivated to maintain normal blood 25 OH D3 levels!

You could always try giving her the abstracts...


Manda said...

first, i was kind of kidding about just eating a bunch of sugar to boost fertility. :) i would never do that. i may just add a few more vegetables.

secondly, i have been taking about an extra 2000 D3 since my mom gave me her extra bottle and i feel like it's a good thing. i think i'll take more. (up until about 2 years ago i was petrified of the sun--always wore high SPF, and stayed out of it as much as possible--i was a mess!)

i am considering ordering some Lugol's iodine to see if that helps me overall. i am tempted to get my thyroid checked, but we'll see.

re: protein. i don't know if i get enough protein. certainly when i got pregnant the first time i wasn't since i was vegan/raw vegan! i eat beef almost every night and lots of egg yolks and cream.

i am now looking into "food chemical sensitivies" as the culprit to many of my health issues that i have had in the past and some right now. i know this does not have anything to do with this post, but does anyone have an opinion about it? i have been reading emma's blog/site about food chemicals and trying to figure it all out.

thanks for all the comments!

Peter said...

I find Emma's blog very interesting. As with everything your genes are your genes and that's it. But there are levers which affect which genes get expressed at what level. Particularly interesting is the roll of salt in ACE expression level and the knock on effect on MAO. And the near ubiquitous finding in people with food sensitivities of mutations in ACE which INCREASE its activity. "Is there a roll for a low salt diet in migraine management?" is what sprang to mind here. It's very clear that OD is generally much lower in salt than the SAD and lower in salicylates too. Some care with amines and combining OD with Feingold would be easy.

This brings up a discussion I had with my wife about diminishing returns from diet interventions. The big changes, dumping sugar, starch and PUFA produce big improvements. Getting to 90% of whichever health parameter you want seems easy. After that you end up with how big a change are you willing to make for how much improvement... And do you know what changes will produce improvement anyway?

Eating to OD is obviously far more than just LC. Feingold is far less aimed at metabolic problems. But there are big overlaps and you can never change one aspect without several others being affected.


PS two aspects of the low salt idea are that Gerson (of the coffee enemas) developed his metabolic diet for the management of his own migraine. Zero salt and very high potassium. These factors have huge knock on effects in the renin/angiotensin/aldosterone system. It worked despite the rest of his diet being LOADED with salicylates. Devoid of meat and dairy derived amines though. And Cordain (wash my mouth with soap and water) has a publication on low salt diet for asthma management which is a cross over design, quite convincing for Cordain. You have to fit all of these facets in to whatever framework you have diet wise. There does have to be a framework and logic, otherwise life is just....

Anonymous said...

Peter, I read Wolfgang Lutz's book, and remember the part about chicken fertility. The Eskimos were fertile too. Stefansson said that many were grandmothers by age 22. PUFAs might have something to do with that. I'm still thinking whether a diet could allow a man or woman to be healthy, but unable to conceive. It would be great to have natural birth control without pills and contraceptives. I think you would have to combine low carbs and/or low protein and/or low PUFA and/or low Vitamin A/D intake. The Eskimos ate low carbs, but they ate lots of protein, PUFAs, Vitamin A and D, so they were very fertile. The trick is to be healthy in every other way, except fertility.

Peter said...

Hi Bruce,

Perhaps is comes down to the similarities between caloric restriction and ketogenic eating. There looks to be an evolutionary advantage in not producing offspring in the absence of adequate calories. Anorexia stops fertility. Whether this would apply to non anorexic ketosis would be the question. I feel probably that full blown adequate caloric ketosis is a pretty strange condition for humans to live in. When you look at the lengths HGs go to to get hold of some of the most disgusting carbs imaginable (soaking acorns for a week in running water, burying crab apples in the ground over winter, extracting the neurotoxins from cycads, you know the sort of stuff), it makes me thing we are driven to avoid full ketosis, perhaps for this reason.

PCOS seems to be the opposite. Insulin resistance mimicking the lack of insulin. Dropping you carb intake to more reasonable, but not zero, levels would then allow fertility.

As insulin controls fatty acid desaturation and elongation it is certainly plausible that PUFA mimmick the effects of insulin in an inappropriate way. I've certainly seen suggestions, possibly by Eades, that elevated insulin promotes cell membrane fluidity by fatty acid desaturation. PUFA might do the same. Working on the basis that high insulin levels signal an organism to breed asap, live fast, die young, then PUFA could be triggering this response... Interesting area to speculate.


Noelie said...

My sister was finally able to get pregnant after some 12-13 years, when she quit her stressful job, stayed home to enjoy her family(I know this won't work for everyone,it was just part of the ticket for her), did some muscle training exercise, and yup.. you guessed it, ate a low carb(more moderate fat-we are still working on that part) diet.

Not once... but twice.

Tony said...

Two thoughts on this:

1. I think the glycoalkaloids (steroid alkaloids) in potatoes/nightshades can interfere with the steroid hormone system. I couldn't find much in pubmed, but then again I am new to this and not sooo good at finding studies...

2. Regarding hypothyroidism: Avoid fluoride, avoid water with fluoride, avoid salt with fluoride, avoid toothpaste with fluoride (you get enough sun/cholecalciferol, you don't eat cereal-grains and avoid sugar? Then you don't need fluoride for your teeth anyway...).