Food = Abuse?

Volume 3, Issue 1 Spring 2010

also:~A review of the documentary, “Scrambled”~PCOS on TV!~Artificial Sweeteners

From the Editor

Did I order a roller coaster?

Linda HarveyEditorlmharvey@pcosmagazine.com

Blank Page LLCLinda Harvey, member

Joshua R. Yates, member

EditorLinda Harvey

Contributing WritersHolly Amarandei

Angela GrassiGretchen Kubacky

Sasha OtteySuzy Reyes

Additional Content Courtesy of:

NewswisePR Newswire

Photography & ArtworkCourtesy of:

Morguefile.comDreamstime.com

The editorial content of PCOS Magazine is prepared in accor-

dance with the highest standards of journalistic accuracy. Readers

are cautioned, however, not to use information from the magazine

as a substitute for regular profes-sional health care.

Editorial Contact Information:

Phone: (417)942-1416E-mail: editor@

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PCOS Magazine is available online from:

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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 mar-ried 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.

PCOS NowJoslin Diabetes Center and dLife Form New Online Partnership

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Joslin.org, the Internet site for Harvard-affiliated Joslin Diabe-tes Center, the world’s preemi-nent diabetes research and clini-cal care organization, and dLife.com, the leading online commu-nity for people living with dia-betes, today announced a new online partnership. dLife will host a resource page on its web site featuring the clinical and re-search 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 rele-vant information on dLife.com.

“Joslin.org is centered around educating people with diabetes and their families and providing up-to-date information on diabe-tes treatment and research,” said Jeffrey Bright, Director of Com-munications at Joslin. “Partner-ing with dLife.com will enable us to offer visitors to Joslin.org easy access to a wide variety of excel-lent online diabetes resources.”

The two organizations believe Joslin’s deep clinical and re-search expertise and dLife’s vast online social communities can bring more accessible and cred-ible 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 profes-sional education publications.

Similarly, the dLife page on Joslin.org will link to the dLife site and will include links to dLife infor-mation, and the dLifeTV schedule. Joslin has already started hosting the popular, dLife-produced multi-media story about Joslin’s founder, Dr. Elliott P. Joslin.

“Partnering with Joslin, a leader in diabetes care, education and re-search 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 help-ing more people with diabetes live stronger and healthier lives.”

We Can Face It Campaign Launched

The We Can Face It campaign for women with unwanted facial hair (UFH) has been launched to-day at a celebrity-backed event held at the Sunbeam Studios in West London. Television person-alities Dr. Dawn Harper (Channel 4’s Embarrassing Bodies), Mica Paris (soul singer) and Jason Gar-diner (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 nega-tive or critical thoughts about their appearance due to facial hair and a third experience anxi-ety 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 im-pact of excess, unwanted facial hair; create a supportive commu-nity of like-minded women with the condition and to encourage women to feel confident when speaking with their doctor about management and treatment op-tions 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-

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PCOS NowObesity and Diabetes Study Weighs Influence of Genetics, Lifestyle

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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 lon-gest-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 Hu-man Services and the study’s principal inves-tigator. “This study is taking those necessary steps toward finding a way to protect people against the develop-ment 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 Investi-gation of Nutrition and Development.

A related study al-ready has shown that Pima Indians in Ari-zona—who have a diet and lifestyle similar to most Americans—have a much higher rate of diabetes than the national average: 38

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 simi-larities between the two groups of Pima Indians, along with the contrast in their lifestyles, provides an ideal setting to study the relationship between environmental circum-stances and diabetes.

The researchers returned in the fall after 15 years to the Mexican village to

study the relationship be-tween the Mexican Pima Indians’ increasingly “westernized” lifestyle and their genetic predis-position for obesity and diabetes.

“Since we were last there, the environmental cir-cumstances of the village have changed,” Schulz says, explaining how the electrical supply to the region has increased, cars have become more preva-lent and grocery stores have appeared.

She points out that this changing environment affects non-Pima Mexi-cans who also live in the village as much as it does the Mexican Pima Indi-ans 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 employ-ing 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 at-tempting 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 expect-ing to find an increase in Type 2 diabetes and obesity among the Mexi-can Pimas that parallels the changes in their life-style. It’s a pattern that has been documented in other countries undergo-ing dramatic industrial and economic develop-ment, like China, where diabetes prevalence has increased threefold over a 10-year period. Simi-lar findings have been recorded in India.

While this may seem like bad news for the devel-oping world, Schulz said there is hope in the impli-cation that diabetes can be prevented in popula-tions with a predisposi-tion for the condition.

PCOS Now WSU Analysis Shows Minorities Less Likely to Receive “Cornerstone” Diabetes Test

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Ethnic and racial minorities bear a disproportionate share of Ameri-ca’s diabetes epidemic but are sig-nificantly less likely than whites to receive a commonly used test to monitor control of blood glucose, according to Washington State Uni-versity researchers.

In a commentary for the current issue of “The Diabetes Educator,” Assistant Professor of Pharmaco-therapy 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 cor-nerstone,” providing a retrospec-tive snapshot of a patient’s blood-

Joshua Jon Neumiller, assistant professor of pharmaco-therapy, Washington State University

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 expen-ditures associated with diabetes,” Neumiller said.

The WSU researchers note that diabetes has become a global epi-demic 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 moni-toring, say the WSU researchers.

Earlier this year, the American Diabetes Association announced

guidelines encouraging use of the A1C test in both the monitoring and diagnosis of Type 2 diabetes, the most common form of the disease.

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New Reality SeriesProvides Resources for Women with PCOS

As part of its continuing mission to provide infor-mation and support re-sources for women with Polycystic Ovarian Syn-drome, 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 wom-en with the condition to live healthier and happier lives.

The women participat-ing in the series will re-ceive guidance from three main experts – a nutrition coach, fitness coach, and mental wellness coach.

The women will also re-ceive supplemental advice from other experts includ-ing a naturopathic physi-cian, acupuncturist, and Reproductive Endocrinol-ogist. As the participants compete in various fitness and healthy lifestyle chal-lenges, they will have an

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 on-line and offline commu-nity 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 Chal-lenge, 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 op-portunity to see how to practically apply the in-formation that they have

learned in the face of daily life challenges and how to make sustainable healthy lifestyle choices.” “Since its inception, PCOS Challenge, Inc. has been innovative in its program-

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 trac-tion so quickly and is able to keep people engaged,” says William R. Patter-son, CEO of The Baron Solution Group and Ex-ecutive Producer of the PCOS Challenge televi-sion show.

“It is our aim to bring greater attention and re-sources to the PCOS com-munity. With a condition that affects millions of lives and families world-

wide, we feel the program will be an important ve-hicle to get more people involved.”

The PCOS Challenge tele-vision show is scheduled to begin shooting in mid-

March and is cur-rently casting for 6-10 women with PCOS in the DC metropolitan area to participate in the 13-week series.

Participants will meet with the ex-perts 1-2 times per

week for the duration of the series and commit to changing their lifestyles to promote healthier liv-ing with PCOS.

The PCOS Challenge tele-vision show will air on various local cable sta-tions across the United States as well as stream online.

To become a participant, sponsor, or for more in-formation about the PCOS Challenge television show, visit http://www.pcos-challenge.com/events/pcos-challenge.

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?

Answer:

Sometimes feeling uncom-fortable is about not having enough knowledge or infor-

mation to feel like you can effec-tively communicate, but more of-ten 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 disor-der that you inherited, and/or that manifested as a result of a hormon-al imbalance that you couldn’t pos-sibly have known about until you were diagnosed. As long as you’re clear on that fact, you should be able to overcome any initial embar-rassment.

Getting educated about the condi-tion, and, in particular, how it af-fects 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:

why you need to adhere to a schedule for eating (especially important in some work set-tings) or exercising;why you need to dedicate a big-ger part of the family budget to medical appointments, supple-ments, or professional hair removal;why eating/exercising “nor-mally” 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 re-duction, and ensuring that you get plenty of sleep;

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LiveHappier

and Healthier

withPCOS

Dr. Gretchen Kubacky, Psy. D.

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 fam-ily 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 com-fortable, introduce the topic with friends, extended family, or per-haps 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 per-sonal 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 special-izes 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 re-prints must state, “Reprinted with permis-sion 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 writ-ten and reviewed by the author. Any errors should be brought to the attention of the author.

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issues should be prioritized, it will be dif-ficult 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 Vet-erans Affairs Healthcare System in Ann Arbor.

When a diabetic patient visits the doctor, the doctor is often con-cerned about the patient’s risk of long-term complications from high blood sugar or uncontrolled sugar such as heart disease or kidney dis-ease. The patient, however, might have more pressing issues, such as back pain or depression.

“Both sets of priorities are valid, however we know from previ-ous studies that issues like pain interfere with a person’s ability

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PCOS NowPatients with Diabetes Rank Health Concerns Differently than Their Doctors, Survey Shows

About 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 hyperten-sion 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. Pa-tients were also more likely to prioritize symptoms such as pain and depression.

The findings appear in the cur-rent issue of the Journal of Gen-eral Internal Medicine and may shed light on why some patients manage their diabetes so poorly.

“If a patient and their doctor do not agree on which of these

to manage their diabetes,” Zul-man 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 ad-dressing multiple complex condi-tions in a brief office visit.

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 stron-gest 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 barri-ers to care,” she said. “For these patients, symptomatic problems might be of utmost importance because they exacerbate their exist-ing 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 ac-count for 37 percent of all cases, according to the U.S. Centers for Disease Control and Prevention.

According to Keller preventing obesity in children is far easier than treating obesity. To success-fully reverse the obesity trend the entire family must embrace the treat-ment program with regular and suffi-cient levels of physi-cal activity coupled with a healthy diet and calorie count.

“More than 70 percent of parents incorrectly think their kids get enough physical activity. So it’s likely that your kid may not be get-ting enough physical activity either,” said Keller.

Keller cites recent research reported in the journal Pedi-atrics, which states

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PCOS Now Tackling Childhood Obesity is a Family Affair, Says Expert

Betsy Keller, Ithaca College

“We are at a crossroads, where the unfortunate reality is that the cur-rent generation of children is more likely to pre-decease their parents because of the development of early onset obesity and inactivity-related diseases, such as type II diabetes,” said Betsy Keller, profes-sor of exercise and sport sciences at Ithaca College.

Keller explained that the great-est risk for childhood obesity is an obese parent. Typically, chil-dren with obese parents learn and practice family eating and lifestyle behaviors that contribute to the development of obesity, instilling such behaviors early in life.

“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. fami-lies. 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.

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.

“We now have more than one gen-eration in which obesity has been highly prevalent. We have a gener-ation 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.

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 fam-ily 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 ben-efits for all.

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.

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PCOS NowWomen Underrepresented in Clinical Trials to Formulate Guidelines; Affected By Lack of Support After Heart Attack

A special themed issue of Circu-lation: Cardiovascular Quality and Outcomes highlights studies about women and cardiovas-cular disease. In an editorial, researchers wrote that the pool of data on the topic is still lim-ited and has left “more questions than answers.”

Researchers in one featured study found women are under-represented in research areas cited in the American Heart Association’s prevention guide-lines for women.

Another study found that after a heart attack, low social sup-port is tied to poorer health outcomes, particularly among women.

Women are substantially un-derrepresented in clinical tri-als 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 Circula-tion: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.

In an editorial, Viola Vaccarino, M.D., Ph.D., notes that sex-specific research has revealed important differences in the causes, symptoms and treatment of heart disease. But the pool of data is still limited and key ques-tions remain about the develop-ment, prevention and treatment of cardiovascular disease in

women.

“After at least a decade of renewed interest in women’s cardiovascular health, we are left with more ques-tions than answers,” wrote Vaccari-no, professor of medicine at Emory University School of Medicine in Atlanta.

Cardiovascular disease is the lead-ing 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 guide-lines 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 propor-tion that is strikingly higher than their representation in the trials

supporting the guidelines -- there-by underscoring the importance of having adequate representation of women in clinical trials to solidify the evidence base supporting prac-tice guidelines,” researchers wrote.

Among all the trials, women were most represented in those involv-ing 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 cho-lesterol and triglycerides in the bloodstream, (28 percent vs. 49 percent).

Furthermore, the studies’ enroll-ment of women varied among classes of therapies being tested, including aspirin, diabetes medica-tions or statins.

In a prospective study examining data from more than 2,400 male and female patients at 19 centers, researchers found that through-out 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.

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PCOS Now 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 dem-onstrate 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 associ-ate professor, Yale School of Medi-cine, New Haven, Conn.

When the researchers compared their data in men vs. women, the association between social sup-port and health in the first year of recovery was stronger for women, particularly for disease-specific quality of life, physical functioning and depression symptoms. Wom-en with low social support were more likely than their peers to be single and have a history of smok-ing and high cholesterol. Thirty-three 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 sup-port with other outcomes such as health status and symptoms of de-pression has not been well-studied. The findings are important, “be-cause interventions that increase social support may represent effective, non-invasive opportuni-ties to improve health outcomes within the first year of recovery, particularly for women,” said Erica Leifheit-Limson, M.Phil, lead au-thor and doctoral candidate, Yale University.

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 Administra-tion today approved Victoza (liraglu-tide), 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 diabe-tes 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 build-ing 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) oc-curred 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 con-firmed by blood tests. Victoza should be used with caution in people with a history of pancreatitis.

The most common side effects observed with Victoza were headache, nausea, and diarrhea. Other side effects included allergic-like reactions such as hives.

Victoza was not associ-ated 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-market-ing requirements under the Food and Drug Administration Amend-ments 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 popula-tion, 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 specifi-cally evaluate the risk of medullary thyroid cancer, the company is re-quired 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 ap-proved with a Risk Evaluation and Mitigation Strategy consisting of a Medication Guide and a Commu-nication Plan to help patients and providers understand the risks of Victoza and to ensure that the ben-efits 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.

FDA Approves New Drug Treatment for Type 2 Diabetes

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Junk food is often like an abu-sive, controlling lover. You know it is not good for you, yet you tell yourself that you cannot resist the sweet (or salty or greasy) tempta-tion. 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 mil-lion 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 work-ing very hard to shorten your life. It lies to you. It tells you that you

Are You in an

Abusive 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 en-ergy, and inflammation. If you take a break from your lover, it may even have some special rewards in store for you like explosive diar-rhea, stomach cramps and indiges-tion. Why on earth would you stay in such a relationship?

Much for the same reason as many women stay in unhealthy relation-ships with men. They think that they “deserve” to be treated badly. They lack self-respect and are vulnerable to predators. They be-lieve 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 com-fort in more healthy ways. Some-times 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

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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

Continued on page 14

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 lover’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 un-healthy relationship with food you may know more than you think about being in an abusive relation-ship.

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 acquain-tances, become friends, and even-tually you may fall in love with this new healthy fare and the more rewarding lifestyle that comes along with it. As your relation-ship 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 dis-tance 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

helping you reach your goals of being a healthy woman, and are not coping mechanisms for deal-ing with life’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 sabotag-ing your good efforts by eating junk food that only makes you crave more of it?

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 some-thing that has been a problem food for you in the past. Do not re-intro-duce this food when you are upset, sad, angry, bored or lonely. Plan to resume your healthy eating imme-diately 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

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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 im-portant to recognize these feelings if they come up for you. Take note of any negative or self-sabotag-ing 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-

“Abusive” RelationshipContinued from page XX

tally after eating the food and how eating it has affected your behav-ior. 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 un-healthy 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 temporar-ily 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 affec-tion and will not respect you. It is not a friend or confidante and is no substitute for human companion-ship. 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!

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PCOS Nowrimental effect on women’s physical and mental health, body image and self esteem. I am very pleased to be support-ing 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 high-lighted that the impact of UFH on a woman goes far beyond the superficial or physical appear-ance 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 fa-cial 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 re-ally helping to bring UFH out of the shadows and onto the pub-lic radar. It is shocking that so many women are not fully en-joying their social life or form-ing relationships because they are so concerned about their fa-

Campaign, con’t.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 sup-port 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 pro-fessional help from their GP, stat-ing reasons such as not wanting to waste the GP’s time, feeling em-barrassed or being concerned they won’t be taken seriously.

Anxiety is commonplace and wom-en also list other strong negative emotions such as embarrassment, depression and even stress, as a result of their facial hair. The neg-ative 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 highlight-ing the impact of UFH, more wom-en will be inspired to take steps to-wards 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 re-sults.

Are You A Writer?

is always looking fresh, new writers with interesting perspectives, and great story ideas!

Personal storiesNew research studiesWellness ideasPCOS managementDiabetes/IR managementInfertility/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

16

Research Tracks Possible Links to Products with Estrogen and Cancer

Professor Jerry Darsey

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-mimick-ing compounds found in many medications, food additives, and consumer products.

“The project is important be-cause 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 develop-ment 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 proj-ect. 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 mechani-cally calculated data and artificial intelligence and models developed using correlations to biological responses. The approach pro-vides the possibility of evaluating hundreds or thousands of poten-tial compounds in less time than it would take to evaluate a few compounds by more traditional methods.

Their method also would reduce the need for test animals, reducing costs and ethical con-cerns regarding the use of ani-mals in toxicol-ogy testing.

In the last 35 years, more than 40 studies of factors affecting the health and illness of women have been conducted examin-ing the risks of taking estrogen hormone replacement and de-veloping 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 pres-ent 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 stud-ies and screens during product development, regulatory, and ap-proval processes. Often, processes testing products result in thou-sands of publications in hundreds of journals each year.

“Very often, there are conflicting results which must be evaluated,” he said. “There has been consider-able 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.”

17

PCOS NowPatient-Physician Compatibility Increases Odds of Following Doctor’s Orders

Doctors and patients have vary-ing opinions on how much con-trol 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 evi-dence indicating that patient-physician 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 phy-sicians 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 as-sess 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 pres-sure 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 ad-here to their medication regimen if they were being treated by physi-cians who didn’t share this belief in strong patient control,” Chris-tensen 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, includ-ing filling refills.”

Christensen said the study high-lights a need to pair up doctors and patients with similar views – or, when that’s not possible, for doc-tors to tailor their approach to suit the patient’s expectations.

“There’s currently a movement to-ward patient-centered care, which gives patients the opportunity to be more involved. This is often a good thing, but it’s also important to re-member that one patient’s empow-erment 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

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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 Asso-ciation (PCOSA) where I found online chat groups of other women strug-gling 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 pro-gram where I would com-mit two years of my life to making this film.

And it made me nervous! Suddenly I was in the po-sition of talking with all my fellow students about PCOS—periods, fertility- having facial hair, being fat. I pushed myself to be honest, as I knew I want-ed to make a film that would show how hard it is to reveal these very per-

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 g r a d u a t e p r o g r a m 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 satis-faction. I began distribut-ing it online to women with PCOS (I made VHS copies at home) but I wanted to reach a larger audience- especially professionals. I signed on with a distribu-tion company and was no longer allowed to sell the film myself—and the film

didn’t sell very well. I was frus-trated and didn’t know what else to do with it. I was busy teaching, mak-ing another film and PCOS faded into the back-ground.

When I finally got the rights back from the dis-tributor I decided that I wanted to re-release the film and add more up-dated material to it. I be-gan interviewing people from a variety of healing modalities, and I felt like I was understanding PCOS in a broader context. I in-terviewed 3 women who generously shared with me their experiences with PCOS—and one was my sister! I was excited to share all this new infor-mation with people.

But still I had trouble

finishing the film. A

part of me must have

been nervous again about

revealing my-self and PCOS

publicly. Face-book would be a

great way to reach a u d i e n c e s — b u t

did I really want to tell all those people from my high school that I had PCOS? When I be-gan 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 doc-umentary, people I had known for years sudden-ly 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.

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Patient-Physician CompatibilityContinued from page 17

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 how much information patients want, and how involved they want to be in decision-making.

“It takes extra time up front, but the patients will be more satisfied and likely to follow treatment recommendations in the long run,” he said. “If a doctor can see that someone prefers an active role, even providing patients a seemingly trivial choice like whether to take a pill twice a day or the long-acting form once a day can make a big difference in how well the relationship works.”

The study was funded by a grant from the Department of Veterans Affairs Health Service Research Development Service. Co-authors of the paper are: M. Bryant Howren, Ph.D., Stephen Hillis, Ph.D., Peter Kaboli, M.D., Barry Carter,

or equal partner in making deci-sions about their health. Others would rather just have the doctor sift through the information and tell them what to do.”

Because pairing doctors and patients could be difficult in some cases -- for example, when only one specialist is available in a rural area -- Chris-tensen believes helping health care providers tailor their approach is a better way to boost patient satisfac-tion and adherence. The next step in his research is to develop a short questionnaire to assess patient pref-erences -- perhaps one that could be filled out in the waiting room along with routine health history forms -- and translate that information in a way that’s easy for providers to apply right there on the spot.

“Physicians, with few exceptions, say that they already attempt to tailor their approach. I don’t doubt that they do try, within the time con-straints they have and their ability to discern what the patient wants.

The cousin of my neigh-borhood friend and com-puter guru. The woman I took the bus with in high school who I admired for her youthful social jus-tice work. The daughter of a freelance client. The list goes on, but the de-tails fade into what has become my new normal awareness of something that had previously been hidden.

As I’ve become more pub-lic 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 of-fer 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 some-times returned, and I didn’t feel all that eager to finish the DVD and begin a public marketing cam-paign. I felt the drag of an unfinished project- and moved ahead very slowly.

I never could have imag-ined 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 au-thor, a distribution plan to create, and no funding. It wasn’t a massive amount of work, but it was hard to do alone.

But he helped me- watched interviews with me and discussed which sections to keep, which were irrelevant or unclear or repetitive. He helped me see connections be-tween the different inter-views. Although he wasn’t a film editor, he had a very literary mind that intui-tively understood the pro-cess. Even working long-distance—with his help I finished the edit. Friends helped me by taking time to watch everything and make corrections to sound, text and edit-ing mistakes. My family helped in many ways. A friend designed the DVD cover, others wrote the

text, and another friend’s financial contribution al-lowed me the time to do the work.

Since announcing the film I’ve received so much sup-port from people I know, and from the PCOS com-munity. I was on a radio show and written about in the PCOSA Newsletter. A woman I just met has of-fered incredible help in my distribution/outreach efforts. We will work to get the film to universities and community groups- and 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. Mak-ing this film —and having PCOS—has been in many ways a blessing in dis-guise- 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.pcos-documentary.com, for more information on Scrambled.

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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., An-gela provides in-person or phone

consultations. Visit her website at www.pcosnutrition.com.

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 (saccha-rin). 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 diabe-tes continue to be on the rise. Allison asks a very important question: How safe are artificial sweet-eners?

According to the National Cancer Institute, there’s no evidence showing that artificial sweeten-ers 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 TheMayo-Clinic.com, The Food and Drug Administra-tion (FDA) has approved the following low-calorie sweeteners for use in a variety of foods. The FDA has established an “ac-ceptable daily intake”

21

(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

Artificial sweetener ADI* Est. ADI equivalent** Aspartame 50 mg per kg 18-19 cans of diet cola

Saccharin 5 mg per kg 9-12 pkts. of sweetener

Acesulfame K 15 mg per kg 30-32 cans of diet lemon-lime soda***

Sucralose 5 mg per kg 6 cans of diet cola***

*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 small-est amount that might cause health concerns.

Despite its low-calorie content, some research-ers are speculating that some sugar substitutes, especially those found in diet sodas may actu-ally cause weight gain, interfere with metabo-lism, 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.

Dieting Alone May Not Help Stave Off Type 2 DiabetesFINDINGS:Sarcopenia — low skeletal muscle mass and strength — is often found in obese people and older adults; it has been hypothesized that sarcopenia puts indi-viduals at risk for devel-oping Type 2 diabetes.

To gauge the effect of sarcopenia on insulin re-sistance (the root cause of Type 2 diabetes) and blood glucose levels in both obese and non-obese people, UCLA researchers

p e r f o r m e d a cross-sec-tional analy-sis of data on 14,528 peo-ple from the National Health and Nutri-tion Examination Survey III.

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 un-der age 60, in whom sarco-

penia was associated with high levels of blood sugar in both obese and thin people, and with diabetes in obese individuals.

IMPACT:Dieting to be thin is on its own not enough to stave off diabetes. It is also impor-tant to be fit and, in partic-

ular, to have good muscle mass and strength.

AUTHORS:Preethi Srikanthan, An-drea L. Hevener and Arun S. Karlamangla of UCLA

JOURNAL:The study appears in the peer-reviewed journal PLoS One: http://dx.plos.o r g / 1 0 . 1 3 7 1 / j o u r n a l .pone.0010805.

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 tes-tosterone levels, as well as improved blood pressure, ovulation and weight loss.

A handful of studies were conducted on inositol and PCOS, but all showed favor-able 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 in-creases the action of insulin, thereby improving ovulation, decreasing testosterone, and lowering blood pressure and triglycerides.

Generally, inositol is toler-ated but can cause nausea, fatigue, headaches and diz-ziness. No interactions with herbs and supplements are known. There is concern that high consumption of inosi-tol might exacerbate bipolar disorder. Inositol is sold as myo-inositol or d-chiro-ino-sitol. Dosage is 200 to 2,000 mg daily. As always, check with your physician before starting inositol or any other dietary supplement.

PCOS Now

Sleep apnea may cause metabolic changes that increase insulin resis-tance, according to re-searchers from the Uni-versity of Pittsburgh Medical Center. The intermittent hypoxia associated with sleep apnea causes a distinct drop in insulin sensitiv-ity in mice, even though chronic hypoxia, such as that associated with high altitude, did not.

The research will be re-ported at the American Thoracic Society 2010 International Confer-

Sleep Apnea May Increase Insulin Resistance

ence in New Orleans.

To de-t e r m i n e whether in-termittent hypoxia (IH) and chron-ic hypoxia (CH) would have differ-

ent metabolic effects, Dr. Lee and colleagues fitted adult male mice with arte-rial 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 per-cent, and compared each treatment group to proto-col-matched controls.

When compared to the control group, the IH mice demonstrated impaired glucose tolerance and re-duced insulin sensitivity; the CH group, however, showed only a reduction in glucose tolerance but not insulin sensitivity compared to controls.

“Both intermittent hypox-ia and continuous hypox-ia exposed mice exhibited impaired glucose toler-ance, but only the inter-mittent hypoxia exposed animals demonstrated a reduction in insulin sen-sitivity,” said Euhan John Lee, M.D., a fellow at the Medical Center.

“The intermittent hy-poxia of sleep apnea and the continuous hypoxia of altitude are conditions of hypoxic stress that are known to modulate glucose and insulin ho-meostasis. Although both forms of hypoxia worsen glucose tolerance, this re-search demonstrated that the increase in insulin resistance that accompa-nies intermittent hypoxia, or sleep apnea, is greater than that seen with con-

tinuous hypoxia, or alti-tude,” explained Dr. Lee.

The specific finding that intermittent, but not con-tinuous, hypoxia induced insulin resistance was not expected.

Increased generation of reactive oxygen species, initiation of pro-inflam-matory pathways, elevat-ed sympathetic activity, or upregulation of insulin counter-regulatory hor-mones in IH may contrib-ute to the greater develop-ment of insulin resistance in those mice versus those exposed to continuous hy-poxia.

“As sleep apnea continues to rise with the rate of obe-sity, it will be increasingly important to understand both the independent and interactive effects of both morbidities on the de-velopment of metabolic disorders. This research demonstrated that inter-mittent hypoxic exposure can cause changes in insu-lin sensitivity and insulin secretion, which may have important consequences in metabolically vulner-able diabetic patients who present with co-morbid sleep apnea,” said Dr. Lee. “Future research will explore potential in-flammatory and lipotoxic pathways by which inter-mittent hypoxia disrupts glucose and insulin ho-meostasis.”

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PCOS NowInhaling Diabetes? Study Suggests Link Between Air Pollution and Type 2 Diabetes in WomenTraffic-related air pol-lution, known to raise the risk for cardiovas-cular disease, may also increase the risk of de-veloping type 2 diabetes in women. Low-grade inflammation may con-tribute to the higher in-cidence of type 2 diabe-tes in women exposed to air pollution, according to German researchers.

Published online May 27 in the peer-reviewed journal Environmen-tal Health Perspectives (EHP), the study com-prised German women living in highly polluted industrial areas and in rural regions with less pollution. The re-searchers analyzed data from 1,775 women who were 54 or 55 years old when they enrolled in the study in 1985. Be-tween 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 environ-mental agencies were used to estimate each woman’s average expo-sure levels.

Exposure to compo-nents of traffic pollution, particularly nitrogen di-oxide (NO2) and soot in ambient fine particulate matter (PM), was signif-

icantly associated with a higher risk of type 2 diabe-tes. An increase in NO2 or PM corresponding to the difference between expo-sure 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 dou-bled the diabetes risk.

Measurements of C3c, a blood protein and marker for subclinical inflam-mation, predicted the el-evated 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 pe-riod. 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 re-sponse, which in turn may make individuals more susceptible to developing diabetes.

Although the study fo-cuses only on women, study leader Wolfgang Rathmann says, “We have no reason to assume sex differences in the associa-tion between air pollution and diabetes risk, but we do not have data on this issue.”

To the authors’ knowl-

edge, this is the first p o p u l a t i o n - b a s e d study to reveal a sta-tistically significant association between traffic-related air pollution and type 2 diabetes. Previous epidemiologic re-search shows that city dwellers have a higher preva-lence of diabetes than do rural res-idents, especially in developing countries un-dergoing rapid industrializa-tion. Changes in diet and physical activ-ity 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-relat-ed air pollutants may be an unidentified environ-mental factor related to the development of type 2 diabetes.

Air pollutants can cause low-grade inflammation, insulin resistance, and impaired glucose metabo-lism. Additionally, C3c is a risk factor for diabetes, and C3c levels are higher in individuals living in highly polluted areas. The latest findings further sup-port the role of traffic air pollutants and low-grade inflammation in diabetes risk.

Authors of the study are Ursula Krämer, Chris-tian Herder, Dorothea Sugiri, Klaus Strassburg-er, Tamara Schikowski, and Ulrich Ranft. The full article, “Traffic-Re-lated Air Pollution and Incident Type 2 Diabetes: Results from the SALIA Cohort Study,” is avail-able on the EHP website at http://ehponline.org/article/info:doi/10.1289/ehp.0901689.

EHP is published by the National Institute of En-vironmental Health Sci-ences, part of the U.S. De-partment of Health and Human Services. EHP is an open-access journal. More information is avail-able online at http://www.ehponline.org/.

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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

Back to that ines-capable question… “When are you go-

ing to have a baby???”

Following my PCOS di-agnosis, this question be-came even more difficult to answer. After we got the news from the infer-tility specialist, my hus-band 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 “su-per sperm” vitamins (as we called them) recom-mended 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 op-tions came into play. Our doctor, the young and

handsome “Dr. H”, was undoubtedly convinced that he would be able to get me pregnant (OK, get your minds out of the gut-ter!) but we had to choose which route to take.

After reviewing our medi-cal histories and test results once again, he informed us that we ba-sically 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 op-tions, artificial insemina-tion, was the much less expensive, much less in-vasive 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 preg-nant as quickly and ef-ficiently as possible”, he told us. He let us know that he was willing to take us through the insemi-nation process as many times as we wanted or were necessary, but that with the PCOS and my history, our chances of conceiving through in-semination may be very slight. He also wanted us to be aware of the reality that although the insemi-nation process would in fact be less expensive and invasive than in vitro, we would most likely under-go similar emotional ex-periences 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 pur-sue the first option, and began the process to pre-pare for insemination.

We started with Clomid (Clomiphene), lots of Clo-mid, to induce ovulation. We tried Clomid by itself in small and then larger dosages, and even com-bined with so many oth-er things I felt like I was popping one pill or an-other 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 (gonadotro-pins).

While I don’t necessarily have a strong aversion to needles, the idea of hav-ing 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

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Baby?sorts of interesting (and sometimes possibly emas-culating) things to help and support me through-out 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 di-rections over and over, and chose just the right spot below my belly but-

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 cour-age to get to 3.

Finally, I just went for it, jab-bing 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 noth-

ing. 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 pro-active, 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

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 ac-tually become pregnant?” Compared to these ran-dom thoughts, the side ef-fects of the drugs, and the hormonal roller coaster I was on, giving myself the injections was a piece of cake!

Because of my polycystic ovaries, I had been start-ed on an extremely low dose of the medication, as a precautionary measure. I continued to use the in-jectables 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 overstimula-tion, 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 cov-er 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 prog-ress, but each night I continued to inject my-self with a slightly larger dose of the medication. This became increasingly frustrating, as well as ex-tremely costly. I even re-member crying one day after leaving the phar-macy with a single dose of medication so pricey it made me second-guess the entire process.

As I drove away from the

pharmacy with this one dose of medication that cost nearly half of our monthly rent, I was try-ing to justify the purchase I had just made. Had we made a huge mistake? I was emotionally and fi-nancially drained; I had gotten used to the fre-quent trips to the doctor’s office, the pills, and the shots, but was finding it harder and harder to ra-tionalize the cost of what we were doing. Luckily, at my appointment the next morning, the ultra-sound 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 insemi-nate!

The morning of the pro-cedure 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 guaran-tee anything. My husband held my hand throughout the procedure, which, al-though not painful, was uncomfortable.

When the nurse finally finished and left the of-fice, I laid back and wept. I knew at that moment that we were closer than we had ever been to be-coming parents. Even if it was not a success, it was, for the first time, some-thing.

At that point all that was left to do was wait, and as Tom Petty said, “the wait-ing is the hardest part”....

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the ASCO study, dis-c o v e r e d CA-125 and its predic-tive value of ovarian cancer re-currence . Since then, research-ers at MD Anderson and be-yond have been trying to determine its role in early disease de-tection. The marker, how-ever, 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 excite-ment over new markers and technologies in ovar-ian cancer,” said Lu, the trial’s principal investiga-tor. “I and other scientists in the gynecologic oncol-ogy 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 test-ing them head-to-head in strong, scientific studies, we found no marker bet-ter than CA125.”

According to the Ameri-can Cancer Society, 21,550

PCOS NowCA-125 Change Over Time Shows Promise as Screening Tool for Early Detection of Ovarian CancerEvaluating its change over time, CA-125, the protein long-rec-ognized for predict-ing ovarian cancer re-currence, now shows promise as a screening tool for early-stage dis-ease, according to re-searchers at The Uni-versity of Texas MD Anderson Cancer Cen-ter.

The findings were pre-sented by Karen Lu, M.D., professor in MD Anderson’s Depart-ment of Gynecologic Oncology, in advance of the American Soci-ety of Clinical Oncology (ASCO) annual meet-ing. If a larger study shows survival benefit, the simple blood test could offer a much-needed screening tool to detect ovarian cancer in it early stages - even in the most aggressive forms - in post-meno-pausal women at av-erage risk for the dis-ease.

MD Anderson has a long history in the re-search of the impor-tant biomarker. In the 1980s, Robert Bast, M.D., vice president for translational re-search at MD Anderson and co-investigator on

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 ear-ly 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 posi-tive predictive value, or the number of operations

required to detect a case of ovarian cancer.

Each woman received a baseline CA-125 blood-test. Using the Risk of Ovarian Cancer Algorithm (ROCA), a mathemati-cal model based on the patient’s age and CA-125 score, women were strati-fied to one of three risks groups, with the respec-tive follow-up: “low,” came back in a year for a follow-up blood test; “intermedi-ate,” further monitoring with repeat CA125 blood test in three months; and “high,” referred to receive transvaginal sonography (TVS) and to see a gyne-cologic oncologist.

Based on the women’s CA-125 change over time, the average annual rate of referral to the intermedi-ate and high groups were 6.8 percent and .9 per-cent, respectively. Cumu-latively, 85 women (2.6 percent) were determined to be high risk, and there-by received the TVS and

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were referred to a gyneco-logic oncologist. Of those women, eight underwent surgery: five were found to have ovarian cancer, three with invasive and two with borderline dis-ease; and three had be-nign tumors - a positive predictive value of 37.5 percent. Consequently, no more than three opera-tions 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 in-vasive 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 in-vasive disease were moni-tored at low risk for three years or more prior to a rising CA-125.

“CA-125 is shed by only 80 percent of ovarian cancers,” explained Bast. “At present, we are plan-ning a second trial that will evaluate a panel with four blood tests includ-ing 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.”

While encouraging, the findings are neither de-finitive, nor immedi-ately practice-changing, stressed Lu; who also said

a large, randomized pro-spective screening trial still needs to be conduct-ed. Such research is on-going in the United King-dom; results from more than 200,000 women should be known by 2015.

“As a clinician treating women with this disease for more than ten years, I’ve become an admitted skeptic of ovarian can-cer screening. Now, with these findings, I’m cau-tiously 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 dis-ease.”

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 In-stitute, and was a research project of MD Anderson’s ovarian cancer Special-ized 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. Ander-son is one of only 40 com-prehensive cancer centers designated by the Nation-al Cancer Institute.

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