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Do not fear PCOS. With a little help from your gynaec, you can deal with it and beat back infertility

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Increasingly, young women are showing up at clinics complaining of irregular menstruation, one of the markers of the Polycystic Ovarian Syndrome (PCOS), which is one of the most common endocrine disorders in women of reproductive age, with prevalence estimates of around 15 to 22 per cent. The exact causes of PCOS are unknown but it is thought to be a result of hormonal disturbances (increased androgens and/or insulin) induced by a combination of genetic (X linked dominant gene) and environmental factors.

Common symptoms of PCOS are hirsutism, excess hair on chin, upper lip or lower abdomen, acne, irregular menstruation, male pattern alopecia (hair loss), dark thick pigmentation of skin, weight issues, obesity and infertility.

Consequences of PCOS include:

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1. Reduced psychological and emotional well-being due to negative self-body image

2. Hyperandrogenism manifesting as hirsutism and acne

3. Menstrual dysfunction

4. Infertility

5. Metabolic syndrome: Increased risk of Type 2 diabetes and cardiovascular risks.

6. Long term risk of endometrial cancer.

Diagnosis

Myth 1: Any cyst in the ovary means you have polycystic ovaries

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There are several types of cysts in the ovaries. Polycystic appearance of ovaries on ultrasound may be a sign of PCOS but this may not always be seen on ultrasound. Many women have cysts but don’t have PCOS. Similarly, women may not have cysts but have signs of PCOS, like irregular periods or extra hair growth on the face or body, acne etc.

The diagnosis is straightforward using Rotterdam criteria. Two of the following three markers are needed for confirmation

1. Irregular menstruation showing anovulation

2. Ultrasound of the pelvis showing PCOS patterns

3. Clinical or biochemical hyperandrogenism

Myth 2: PCOS is only seen in obese women

There can be lean as well as obese PCOS patients although 80 per cent of PCOS patients are obese.

MYTH 3: PCOS can be cured completely

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There is no cure but there are many ways to decrease or eliminate PCOS symptoms and make you feel better.

Myth 4: Patients with PCOS can never conceive

Women with PCOS do not ovulate, which causes irregular menstruation resulting in infertility. So, the best way to increase the odds of conception is to give the ovaries a push using fertility medications like ovulation induction drugs. We can help 80 per cent of women with PCOS ovulate with these drugs. Of course, there is an increased chance of miscarriage in patients of PCOS. There is also an increased risk of developing diabetes during pregnancy and other complications. But a good obstetrician will be able to guide you through these conditions.

Management

· Goals of treatment may be considered in four categories:

1. Lowering of insulin resistance levels

2. Restoration of fertility

3. Treatment of hirsutism or acne

4. Restoration of regular menstruation and prevention of endometrial hyperplasia and endometrial cancer.

The primary treatment for PCOS includes:

1.Lifestyle changes that include a calorie-restricted diet

2. Regular exercise

3. No smoking;

4. Medication

5. Emotional and psychological support

Diet

Methods that help to reduce weight or insulin resistance can be beneficial for all these symptoms. Even five to 10 per cent weight loss can improve symptoms markedly.

What diet is suggested in PCOS?

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A low GI and high-fibre diet, in which a significant part of total carbohydrates is obtained from fruits, vegetables, and whole grain sources, has resulted in greater menstrual regularity

What not to eat with PCOS?

Avoid sweetened juice, canned fruit in heavy syrup, starchy

vegetables such as potatoes, corn, white flour products such as

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white bread, pasta or white rice, sugary food such as cookies, cakes. Team this up with regular exercise of at least 150 minutes per week.

A diagnosis of PCOS suggests an increased risk of the following:

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· Insulin resistance/Type II diabetes: Women with PCOS have an elevated prevalence of insulin resistance and type II diabetes, independent of body mass index (BMI).

· High blood pressure in those obese or pregnant

· Depression and anxiety

· Dyslipidaemia– disorders of lipid metabolism

· Cardiovascular disease: There’s a two-fold risk of arterial disease for women with PCOS relative to women without PCOS, independent of BMI.

· Stroke

· Obesity

· Miscarriage

· Sleep apnea, particularly if obesity is present

· Non-alcoholic fatty liver disease, again particularly if obesity is present

· Acanthosis nigricans (patches of darkened skin under the arms, in the groin area, on the back of the neck)

· Endometrial hyperplasia and endometrial cancer are possible due to prolonged stimulation of uterine cells by estrogen. It is not clear whether this risk is directly due to the syndrome or from the associated obesity, hyperinsulinemia and hyperandrogenism.

Key Messages

PCOS is associated with a range of metabolic abnormalities, which can lead to long-term health problems

· PCOS limits fertility but can be treated.

· Early family initiation where practicable.

· Women with PCOS have increased risk of endometrial cancer with prolonged amenorrhea.

· Increased cardiovascular risk factors.

· Increased risk of diabetes.

· Lifestyle changes are the first line of therapy.

· 5-10 per cent weight loss will greatly assist in symptom control.

· Assess mental and emotional health.

· Management has to be tailored for each patient.

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Model With Lifestyle, Health Behavior Information Predicts CKD – The Suburban Newspaper

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TUESDAY, Jan. 31, 2023 (HealthDay News) — Self-reported lifestyle and health behavior information can predict incident chronic kidney disease (CKD), according to a study published in the January issue of the Clinical Journal of the American Society of Nephrology.

Ariana J. Noel, M.D., from the University of Ottawa in Canada, and colleagues developed and validated a survey-based prediction equation to identify individuals at risk for incident CKD. Data were obtained from 22,200 adults with an estimated glomerular filtration rate (eGFR) ≥70 mL/min/1.73 m2 who completed a comprehensive general population health survey between 2000 and 2015. Demographics, comorbidities, lifestyle factors, diet, and mood were included in prediction equations. Models with and without baseline eGFR were derived and validated externally in 15,522 participants from the U.K. Biobank. The primary outcome was new-onset CKD.

The researchers found that during a median follow-up of 4.2 years, new-onset CKD occurred in 1,981 participants (9 percent). Lifestyle factors (smoking, alcohol, physical activity) and comorbid illnesses (diabetes, hypertension, cancer) were included in the final models. For individuals with and without a baseline eGFR measure, the model was discriminating (five-year C statistic, 83.5 and 81.0, respectively) and was well calibrated. The five-year C-statistic was 78.1 and 66.0 in external validation with and without baseline eGFR, respectively, and maintained calibration.

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“Our equation demonstrated excellent discrimination and calibration, and may serve as a patient-facing tool to improve CKD awareness and education,” the authors write.

Several authors disclosed financial ties to the biopharmaceutical industry.

Abstract/Full Text (subscription or payment may be required)

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Gendered gap puts Calgary woman at increased heart disease risk: new report – Calgary Herald

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Research into heart disease has often evaded complexities of menstrual cycles and pregnancy, a new report says

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Christina Stuwe’s triple-bypass, open-heart surgery in 2018 was a life-saving procedure for the Calgary mother.

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But the need for the surgery nearly went undetected by health professionals, as tests for her irregular heartbeat came back inconclusive and she was told to come back in a year.

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It was only after Stuwe and her husband pushed for further testing, including an angiogram, that they discovered multiple blocked arteries in her heart — and the fact she unknowingly had a heart attack three years earlier.

“The way my heart was reacting really put everyone off, and they couldn’t really explain it,” Stuwe said.

“Once something was identified with my heart, it was like it was being put off even though we obviously knew something was wrong . . . If I had waited a year, who knows, I might have had another heart attack and been gone.”

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Stuwe’s experience highlights a Canadian health system that sometimes struggles to provide adequate care to women with cardiovascular disease.

Gendered gaps in medical diagnosis and care, as well as research and awareness, put women at heightened risk from both heart and brain disease, according to a report from the Heart and Stroke Foundation released Wednesday.

That report says women face different risk factors than men for heart disease due to biological differences, but that health systems historically have fallen short in considering those differences. The inequities worsen when factoring in groups including women of colour, women with low socioeconomic status and women living in rural or remote areas.

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Research has often evaded complexities of menstrual cycles, pregnancy

Heart disease is the leading cause of premature death in Canadian women, said Dr. Kara Nerenberg, a clinician-scientist at the University of Calgary Cumming School of Medicine whose work focuses on preventing heart disease and stroke in younger women.

She said in the past, much cardiovascular research specific to women has been excluded by researchers to avoid dealing with the complexities of menstrual cycles or pregnancies in their studies.

That means some treatments developed to treat heart disease that work well in men don’t work for women, Nerenberg said.

“That’s potentially because of a different biology, the hormonal changes and how it affects drug metabolism, or even just the dosing of medications,” Nerenberg said, adding women are underdiagnosed when it comes to heart disease.

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“We know that even in Alberta, women receive fewer cardiac tests and fewer cardiac medications.”

  1. Dr. Anmol Kapoor, a Cardiologist, and Founder & CEO of CardiAI, is shown in a company supplied photo. Calgary-based CardiAI is using artificial intelligence to detect the signs of heart disease more accurately and sooner than the current methods.

    Nelson: Calgary doctor pushes AI boundaries in heart disease

  2. The University of Calgary.

    U of C has widest gender pay gap among Canadian universities

  3. Dr. Paul Fedak is a cardiovascular surgeon in Calgary and a professor and head of the department of cardiac sciences and director at the Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary.

    Opinion: Our suffering health-care system can be resuscitated, but let’s make it personal

Women can experience different symptoms than men

Some conditions of pregnancy can increase risk of cardiovascular disease, Nerenberg said, underlining a need for better and more regular screenings for women.

She said health-care providers, as well as women, should be aware of different ways that heart disease presents itself between men and women.

“We do know that a lot of women will have the same symptoms of men of heart disease — chest pain, shortness of breath. But women also commonly experience different symptoms, like fatigue or different types of pain, and they may not describe it the same way as men,” she said.

“As a society as a whole, we need to put more attention to signs in our own bodies, and that’s male or female. I think too many times, we put things off because life is busy, but we have to pay attention to ourselves,” Stuwe said.

jherring@postmedia.com

Twitter: @jasonfherring

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Ultra-Processed Foods May Be Linked to Increased Risk of Cancer

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Summary: High consumption of ultra-processed foods, including soda, chips, and some white bread products, was associated with an increased risk of developing and dying from certain kinds of cancer, including brain cancer.

Source: Imperial College London

Higher consumption of ultra-processed foods may be linked to an increased risk of developing and dying from cancer, an Imperial College London-led observational study suggests.

Researchers from Imperial’s School of Public Health have produced the most comprehensive assessment to date of the association between ultra-processed foods and the risk of developing cancers.

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Ultra-processed foods are food items which have been heavily processed during their production, such as fizzy drinks, mass-produced packaged breads, many ready meals and most breakfast cereals.

Ultra-processed foods are often relatively cheap, convenient, and heavily marketed, often as healthy options. But these foods are also generally higher in salt, fat, sugar, and contain artificial additives. It is now well documented that they are linked with a range of poor health outcomes including obesity, type 2 diabetes and cardiovascular disease.

The first UK study of its kind used UK Biobank records to collect information on the diets of 200,000 middle-aged adult participants. Researchers monitored participants’ health over a 10-year period, looking at the risk of developing any cancer overall as well as the specific risk of developing 34 types of cancer. They also looked at the risk of people dying from cancer.

The study found that higher consumption of ultra-processed foods was associated with a greater risk of developing cancer overall, and specifically with ovarian and brain cancers. It was also associated with an increased risk of dying from cancer, most notably with ovarian and breast cancers.

For every 10 percent increase in ultra-processed food in a person’s diet, there was an increased incidence of 2 percent for cancer overall, and a 19 percent increase for ovarian cancer specifically.

Each 10 percent increase in ultra-processed food consumption was also associated with increased mortality for cancer overall by 6 percent, alongside a 16 percent increase for breast cancer and a 30 percent increase for ovarian cancer.

These links remained after adjusting for a range of socio-economic, behavioral and dietary factors, such as smoking status, physical activity and body mass index (BMI).

The Imperial team carried out the study, which is published in eClinicalMedicine, in collaboration with researchers from the International Agency for Research on Cancer (IARC), University of São Paulo, and NOVA University Lisbon.

Previous research from the team reported the levels of consumption of ultra-processed foods in the UK, which are the highest in Europe for both adults and children. The team also found that higher consumption of ultra-processed foods was associated with a greater risk of developing obesity and type 2 diabetes in UK adults, and a greater weight gain in UK children extending from childhood to young adulthood.

Dr. Eszter Vamos, lead senior author for the study, from Imperial College London’s School of Public Health, said, “This study adds to the growing evidence that ultra-processed foods are likely to negatively impact our health including our risk for cancer. Given the high levels of consumption in UK adults and children, this has important implications for future health outcomes.

“Although our study cannot prove causation, other available evidence shows that reducing ultra-processed foods in our diet could provide important health benefits. Further research is needed to confirm these findings and understand the best public health strategies to reduce the widespread presence and harms of ultra-processed foods in our diet.”

Dr. Kiara Chang, first author for the study, from Imperial College London’s School of Public Health, said, “The average person in the UK consumes more than half of their daily energy intake from ultra-processed foods.

“This is exceptionally high and concerning as ultra-processed foods are produced with industrially derived ingredients and often use food additives to adjust color, flavor, consistency, texture, or extend shelf life.

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The study found that higher consumption of ultra-processed foods was associated with a greater risk of developing cancer overall, and specifically with ovarian and brain cancers. Image is in the public domain

“Our bodies may not react the same way to these ultra-processed ingredients and additives as they do to fresh and nutritious minimally processed foods. However, ultra-processed foods are everywhere and highly marketed with cheap price and attractive packaging to promote consumption. This shows our food environment needs urgent reform to protect the population from ultra-processed foods.”

The World Health Organization and the United Nations’ Food and Agriculture Organization has previously recommended restricting ultra-processed foods as part of a healthy sustainable diet.

There are ongoing efforts to reduce ultra-processed food consumption around the world, with countries such as Brazil, France and Canada updating their national dietary guidelines with recommendations to limit such foods. Brazil has also banned the marketing of ultra-processed foods in schools. There are currently no similar measures to tackle ultra-processed foods in the UK.

Dr. Chang added, “We need clear front of pack warning labels for ultra-processed foods to aid consumer choices, and our sugar tax should be extended to cover ultra-processed fizzy drinks, fruit-based and milk-based drinks, as well as other ultra-processed products.

“Lower income households are particularly vulnerable to these cheap and unhealthy ultra-processed foods. Minimally processed and freshly prepared meals should be subsidized to ensure everyone has access to healthy, nutritious and affordable options.”

The researchers note that their study is observational, so does not show a causal link between ultra-processed foods and cancer due to the observational nature of the research. More work is needed in this area to establish a causal link.

About this diet and brain cancer research news

Author: Press Office
Source: Imperial College London
Contact: Press Office – Imperial College London
Image: The image is in the public domain

Original Research: The findings will appear in eClinicalMedicine

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