Dr. Nadia Pateguana & Dr. Jason Fung - 'Polycystic Ovary Syndrome'

hello everyone just wanted to make sure that this is working and I see that it is good okay so as we were introduced I know most of you here at least had great many of you know of dr. Jason Fung and Megan Ramos very well I work with dr. Fung in and Megan at the IDM program intensive dietary management program and so today I wanted to tell you a little bit about how I ended up here so as I said most of you know of these two fantastic people but almost everyone here has no idea who this African born Canadian raised Portuguese speaking person in front of you so yeah I'll start with that because that sounds interesting right so I graduated from CCM that's the Canadian College of naturopathic medicine in 2004 and skipping ahead a few years I started working with Megan and Jason in 2016 so what happened sort of in between well basically when I graduated in 2004 I decided that I wanted to go back to my home country and that's Mozambique particularly Maputo which is the city that I was born in and Maputo is known as the pearl of the Indic ocean so my whole life I left Mozambique when I was one but my whole life I really just wanted to go back and work there and so I thought I would go to Mozambique and help starving people right like probably lots of people my age that were born in Africa that was my goal I thought I'm gonna go and help make Mozambique a better place but unfortunately this complicated politics didn't allow for that and so instead I it was recommended that I open a clinical private clinical practice instead which I did and so for ten years I was basically the only person in my city doing weight loss or weight management and so instead of helping starving people I was helping people very much like me and you people with metabolic syndrome that we're looking for help losing weights or fighting off diabetes and so I knew nothing about diet I'm gonna tell you that right off the bat I didn't learn weight loss diets and naturopathic college just like you've heard from many medical doctors and MD saying the same thing we learnt very little about how to help people lose weight so basically along those wonderful 10 years I was very busy I was the only person doing this in my city and surprisingly there was a whole lot of people looking to lose weight and reverse diabetes so I learned I had to learn through trial and error and also because Mozambican people are wonderful and very forgiving and they were great quote-unquote guinea pigs somewhere along the way of those 10 years I developed a reputation for helping women to get pregnant I have no idea or at least I didn't know why that was happening but what I knew was that for whatever reason when women started following a diet with me if they had been struggling to get pregnant somehow miraculously they got pregnant with a little help from the husband husbands of course but anyhow so in fact a lot of people didn't want to come to me because they thought that they would get pregnant if they followed my diet and so I'm a big believer in car my still I'm a big believer in karma little did I know that a few years later I myself would be going through the same issue and these wonderful people helped me to successfully conceive and learn a lot about my own health so how did how did this happen basically I was a tiny little child very very small very thin and I grew up into a very very thin adult now this had absolutely nothing to do with a healthy diet quite the opposite and I'll just go ahead here and move on to this picture and I'll tell you an aside here as I was putting together this presentation my husband said is this really necessary do you really have to put up this picture but I do because it illustrates a very important point then does not mean healthy and this certainly was the case for me so as a child I in and even into my 30s I never had a full proper meal never and my mother's actually here she can confirm this but basically I would eat very small meals and snack all day long but not on food on junk or whatever I could get my hands on whatever my family would allow me to eat so basically it was fruit and candy and bread and lattes with lots of sugar and lots of coca-cola my country is actually known for people drinking more coca-cola than water in Mozambique that's the case and I I did grow up that way unfortunately so I also suffered terribly from rebound hypoglycemia so basically I would eat all this sugar and then an hour or two later I would be shaking because of the hyperinsulinemic response that I was creating and again little did I know that I would develop metabolic syndrome because of this so fast-forward and this is me and Mozambique at about 28 29 years old and again I was very thin I'll also let you know that there was not an ounce of exercise that went into that body because I'm very lazy and I I disliked my body immensely because what I wanted was to gain weight I wanted to be you know fit the standard of what was considered a nice body and that definitely wasn't it so anyway around this time sometime after this maybe a year or two after this I my husband and I started trying to conceive and I stopped taking the pill and unfortunately about a year after that or a bit more than that I still hadn't successfully conceived but what did happen in the midst of that is that my acne that I'd had as an adolescent all came back in pretty pretty fierce I gained lots of weight very very quickly so by 2010 I had gained close to 30 pounds now mind you my BMI was still within the normal range because I was so thin to begin with but about this time I started to realize that I was losing lots of hair the acne was there the central obesity predominantly was there and and I knew enough to know that something was going on and I wasn't getting pregnant which ultimately was my goal that's all I wanted so I went to my doctor in South Africa and finally was diagnosed with PCOS I was totally dismissed by my doctor because I was thin and so none of these tests were done he never looked into this but then when he did surprisingly enough I fit all three diagnostic criteria for PCOS I had high levels of male hormones I had polycystic ovaries on ultrasound and I had basically stopped ovulating altogether so at this time the doctor prescribed clomiphene citrate which most of you know very well clomid it's first-line treatment for fertility and I went home desperate I it was I remember this very well and what did I know then I knew that for whatever reason women that came to see me got pregnant when they followed a very strict diet and lost weight so that's what I did I went home and I decided if that's what it takes to get pregnant that's what I'm going to do and I followed the strictest of the low-carb diets that I used to give to people at the time I used to call this a detox quote unquote and it was something I didn't recommend that people do very long for a very long time but it was a very strict low-carb diet and so that's what I did my motivation was super high and I did that and in the very first month I lost tons away close to six pounds my which for a book you know at the time what I weighed wasn't all that much that's a big percentage of weight loss my acne cleared up and I started to ovulate in the very next month I was pregnant and so my firstborn her name is Lindsay was born on November of 2010 now because I didn't know Lilly at the time the speaker just before me and I didn't get the great and wonderful advice that I think she's giving people I followed no diet during my pregnancy I basically went back to my very very very poor eating lots of candies lots of chocolate all day long sugar sugar sugar and just as Lily mentioned I did develop serious complications during my first pregnancy it's not that PCOS women are infertile PCOS women can get pregnant and they do just like I did but there as we will talk a little bit later at a much higher risk for many things and so not only did I cause myself further damage somebody already with metabolic syndrome but as Lily also said I also put my children at an increased risk for metabolic syndrome after Zindzi was born unfortunately I developed serious in severe postpartum depression and I was medicated for that so on top of my metabolic syndrome condition and the medication that I was on for a high blood pressure I also had to take this medication which caused me to gain 20 plus pounds and in a very short period of time maybe about three weeks and now let me tell you that the the the two years between or the two years post my first pregnancy were a blur I don't remember very much it was I was in a very bad place physically and mentally I was on medication and I had severe anxiety and depression and at this point I was overweight considered BMI considered overweight so two years after Zinzi was born I developed this large ovarian cyst and I had to have urgent surgical removal it was it grew to be seven centimeters and my doctor the same South African doctor said to me it's now or never you either try to have another baby now or you'll probably not have another child now remember that I was in a bad place and the thought of going through all that again was no it was not an easy thought he he prescribed clomid and I I was motivated I did want another child but I didn't I wasn't in a place mentally or and I didn't really know enough really at the time to follow any kind of diet I didn't go back to the low carb diet and so I took this medication and six months later still no baby and the prescription is only for six months as many of you know and then you can consider other things so shortly after that I went to see a friend of mine doctor Karolina she's a Mozambican OBGYN and she said this to me of course you won't get pregnant not even on clomid because you are insulin resistant and now I promise you this was my lightbulb moment because up until then I had no idea why women with fertility issues got pregnant once they followed a low-carb diet but that moment was key in my life because I put all these things together then everything made sense the insulin the PCOS the diet the metabolic syndrome so I walked away from my friends office and she did prescribed met Foreman so with the information that I had once again pregnant the very next month unfortunately same sort of thing no diet same pregnancy complications but my the joy of my life my little Zuri was born on October 8 2013 and so you can clearly see from that picture that there is a big difference just overall how I looked and how I felt between those two pictures in a very short period of time there's only a few years between these two pictures and so in 2013 I was at the very peak of metabolic syndrome and during my pregnancy my doctor did find a thyroid nodule which later developed into follicular carcinoma but when Surrey was born I was in a place to make a decision and at that time I finally decided to put all my information together and I decided then so that was about five years ago to follow a low-carb ketogenic diet and intermittent fasting and within just a few months three months maybe even less than that I was off all of my medication no more hypertension medication no more metformin no more antidepressants my weight went back to normal my blood glucose a1c even my insulin levels which I did tests were back to normal but better than all of that is that my mood in my sleep stabilized as well and so this is us now and shortly after Sri was born I met dr. Fung at a conference and I guess I harassed him enough that he let me come and work with him and Megan and I met Megan and started working in the clinics with her and this is my family now Zindzi is now eight and Zuri is five and my husband actually since I started working with dr. Fung and Megan has lost over 70 pounds because he is an avid avid faster the very first doctor Fung video that he watched he went really this is it nobody ever told me this and it's been it's been five years or four years since I guess he started and he looks good and so let's talk a little bit about signs and symptoms of PCOS so the central obesity and and many women generalized obesity the menstrual and avila Tory irregularities and then the expressions of hyperandrogenism so the high male hormones the acne the hirsutism the male pattern baldness in more extreme cases clitoral enlargement lower tone of voice a cantos is nigricans which is a dark velvety patch on skin folds which is also seen in other insulin-resistant conditions I'm going to quote dr. Fung here because I think his quotes are and many people think his quotes are hilarious but this is not a funny one it's a serious one and that he said in one of our blog posts if PCOS was just about acne and missing a few periods then it wouldn't be so bad and so women in premenopausal that have PCOS are prone to these reproductive issues in front of you and supposedly PCOS women post menopause are at a higher risk for these very serious conditions on the right side now I'll have you know that before the age of 40 I had all of the conditions in bold and so this is again if PCOS was just about acne and missing a few periods then it would not be so bad and here we have associated you know increased risk for cardiovascular disease non-alcoholic fatty liver disease sleep apnea depression anxiety cancer type 2 diabetes and probably many more Alzheimer's and etc etc so the diagnosis for PCOS is made one two out of the three criteria listed above hi Peru and Rajan ISM illegal or regular ovulation and polycystic ovaries on ultrasound this is a spectrum of disease meaning that not all symptoms would appear in all patients there are many expressions of PCOS and there we believe four phenotypes ranging from the mild phenotype to the franc PCOS phenotype which is what I had and when you have all three of the expressions and so as the gentleman said at the beginning my co-speaker needs no further introduction and I'll pass it over to dr. fine thank you thanks very much thanks very much so I admit before I met Nadia I really had not very much interest in PCOS it wasn't anything I dealt with so if you're in medicine you know that there's sort of silos so I was in the internal medicine silo and nephrology so that wasn't something that we dealt with as soon as the booby giy a hoobie gynecologist who would deal with PCOS but what was interesting was that as we started treating people a lot of people were getting pregnant and so Nadia came up to me and said well you know a lot of people are getting pregnant oh okay that's kind of interesting but then I started to look into PCOS because there's obviously a correlation to what I do talk about a lot which is insulin resistance hyperinsulinemia and as I sort of looked more into the pathophysiology of just sort of struck me how illogical the whole treatment was so I'm gonna try and go over some of the pathophysiology about PCOS so they can understand it and understand how changing the diet is going to improve it significantly so if you look at the three criteria so you have an ovulation as one of the big criteria you can see that there's a clear correlation between obesity and ovulation that is if you're the more weight you are the less chance of ovulation and that's one of the criteria for PCOS and again infertility is such a major part of PCOS so even if it's not dangerous in itself it puts you at high risk but also people are spending millions of dollars on infertility treatments when really we could be changing their diets and having an impact so you can see that at every point here whether you're sort of normal weight overweight or obese PCOS has way more infertility like 70s you know 80 percent and this is again peace u.s. you see this clear correlation with obesity so as you move from underway to obese you see that there's definitely a lot more so the same thing happens with type-2 diabetes so there's just a lot more insulin resistance impaired glucose tolerance as well as Frank took to diabetes in people with PCOS in the cost is not really insignificant because if you look at the economic burden of PCOS it's sort of huge right so this is the annual cost and millions of dollars so the total cost which is sort of staggering is like four point three seven billion dollars spends on treating a condition that I think is mostly not treated very well so the question is why so there's sort of those three criteria one of the big ones is this hyper androgen emia so basically people have too much testosterone and that's what causes the acne the facial hair and you know the bearded lady sort of pattern and the question is why do they develop too much testosterone and so if you look at the pathophysiology you can see that the testosterone which is the main androgen in the body is sort of produced by two places it's produced by the adrenal gland and it's produced by the ovaries so when they look at where people are producing too much of the testosterone it's clearly coming from the ovary so it's not an adrenal problem it's an ovarian problem and the other thing that is contributing to this hyper androgyny mia is the low sex hormone binding globulin which is made in the liver so what that is it's the binding protein to the testosterone so normally in the blood testosterone doesn't circulate very much as a free molecule so it's bound up with this sex hormone-binding globulin and when there's not enough of this sex hormone-binding globulin that you have more of the free testosterone which is free to sort of make its effect so it's just like if you think about you know if you're at a baseball game and everybody gets out and everybody wants to take a taxi and go home well if there's not enough taxis then everybody just kind of Mills around it's the same thing here so the testosterone should be bound to this binding globulin if there's not enough of it everything every all the testosterone is just sort of milling around and that's where you get the acne and all the other things so the question is why do you have too much testosterone and the answer is insulin so you can see from studies that they've done that the higher insulin you get the more testosterone you get and there's a effect on the liver as well that if you have more insulin you're gonna have lower levels of this binding globulin so if you look at it from a causal standpoint you've got too much insulin which leads to this hyperandrogenism which is both too much testosterone and not enough of this binding globulin which is leading to the masculine masculinizing features the second major criteria of polycystic ovarian syndrome is polycystic ovaries right so that on the picture on the left is a normal ovary on the right you have all these cysts and the question is why are these cysts developing so this is a picture of the normal sort of menstrual cycle so if you if you look at the normal ovaries that picture there what you can see is that over the normal menstrual cycle you have a development of you know the that the ovary develops the egg which is released at the end there and then it sort of involute okay so what the cysts are are they're follicular cyst so if you look at the polycystic ovary you see they haven't ovulated yet they're sort of stuck in that before ovulation and that's why all these cysts develop so because you're not ovulating you're not gonna get pregnant because that egg doesn't come out of the ovary it doesn't travel to the uterus where the sperm meets it so everything is stuck at that pre ovulation level and there's a lot of them so that's why you get the ovary that's why you get all those cysts in the ovary and the reason for that is something called follicular arrest so normally if you look at the a diagram what you get is sort of this developing follicle and then you get this surge of hormone which is LH and then you get a preovulatory follicle that's the normal development if you have too much insulin so if you look at the B section so under the influence of too much insulin these follicles actually become too sensitive to the hormone so before you get this LH surge they've already developed and then you get the wrath of the follicles in other words they're stopping at a level which is about 8 millimeters before they get to that stage where they're big enough to ovulate which is sort of 10 to 15 centimeters and this is the reason that you have all these follicles stuck at that preovulatory stage and the ultimate cause of course is too much insulin that's the bottom line too much insulin is causing the follicular arrest which is causing all the cysts in the polycystic ovaries so once again if you look at the pathophysiology of what's happening is that you've got the polycystic ovaries we just caused by too much insulin you've got the too much testosterone which is caused by too much insulin and the third thing is the analog via Tory cycles so and that's of course caused because if you have the follicular arrest you don't get the release so everything is caused by too much insulin so this obviously is really really important because it overlaps with everything that we see clinically which is that too much insulin or hyperinsulinemia is also very important for the development of obesity and type 2 diabetes which are huge health issues that are clearly correlated to the presence of PCOS and it's clear it's obvious to see why because they're all caused by the same underlying disease of hyperinsulinemia these are all diseases of too much insulin so what you see is that in PCOS so if we kind of go beyond the fertility issues and the sort of acne and so on what you see is that there's a huge spectrum of disease you know cardiovascular disease sleep apnea non-alcoholic fatty liver which is that picture of the liver insulin resistance type-2 diabetes and so on and all of them are really diseases of too much insulin and it's not like nobody knows this stuff so this is a review article from the New England Journal of Medicine and in a very nice fancy picture it shows you exactly what the problem is with PCOS so if you look at the picture the key is the hyperinsulinemia you can see that the hyperinsulinemia goes down to the ovary which tells it to you know produce more androgens it locks the sex hormone the shbg the sex hormone binding globulin on the left and it causes the obesity and so on but again this is pretty easy to understand that everything here is really a disease of too much insulin and this is the part that sort of logic just breaks down because in medical school you learn about all this stuff and it's like okay well if too much insulin causes everything that you see in PCOS then what's the treatment how about clomid it's like okay like did you not pay attention here too much insulin was the problem why are you giving clomid which stimulates the ovary to you know ovulate it's like how about an ovarian wedge resection it's like uh huh what what are you talking about right so ovarian wedge resection was this sort of old time treatment for PCOS where they'd actually slice a little wedge you know like a little piece of watermelon out of your ovary and that was a treatment for PCOS and why did it work because if you slice a little wedge here ovary your ovary cannot produce as much of the testosterone so a lot of the symptoms would get better but again you're not making the actual disease better because you never actually treated the hyperinsulinemia or you can go to other treatments like that Foreman sort of makes little sense but how about birth control pills is like is that going to reduce your insulin if it doesn't then what are you doing for this disease like you got to go back to the root cause of a disease and fix it if you want to fix this disease and the disease is so common and causes so much heartache that we treat it sort of in this crazy manner when we already know what the root cause of this disease is it's like it's too much insulin so let's produce insulin that's the only logical treatment which is why nadia works with patients and says oh hey all of them are getting pregnant and it's like it sort of makes sense why that is so everything ultimately comes down to it but if you look this is a sort of standard treatment guideline and again this is what they tell medical students and family doctors and everybody so here's the symptoms and if you look at the treatment it's fertility drugs right fertility drugs if you want birth control pills insulin-secreting medications like like glucophage so that's that's an old medication of sulfonylurea where you would sorry metformin which is sensitize you to the insulin which makes a little sense and IVF and stimulating drugs it's like okay we're in this all have you actually thought about the actual disease and what we're doing for this disease like obviously this is not the answer and again it's billions of dollars from the pockets of all these women and it's sort of heartbreaking to hear all these stories of women who want to get pregnant and can't get pregnant so they go to their the you know fertility specialist who says you have PCOS let me give you some IVF for you know ten thousand dollars out of cycle it's like come on like we can do better than this this is not what we went to medical school for right this is not science you got to understand the pathophysiology then you treat it how are you gonna treat it well obviously if insulin is too high then you got a lower insulin and there's no drug that really does a great job of doing that and that's why the drug treatments really are not that good but what is fantastic is that you don't need drugs for this condition right you need to understand the disease and then treat it so how are you gonna do it low carbohydrate diets ketogenic diets intermittent fasting all of them at their heart are reducing insulin they're just trying to lower the amount of insulin if you don't eat your insulin is gonna go down if you eat very low carbohydrate diets ketogenic diets your insulin is gonna go down and that's all it is it's so simple yet you know to say stuff like this you know you come across as some sort of really wacky guy that shouldn't be talking about women's health because hey you're a nephrologist right so you know I this was very eye-opening for me just to see that hey this is not something that is we shouldn't be siloed like this in medicine these are diseases that need treatment understand the cause and then you can come up with a rational treatment just like in cancer for example where igf-1 is gonna make a big difference well hey if insulin is a growth factor maybe we should think about lowering insulin a little bit like maybe that might help it's the same idea so this is why why conferences like this are really so important because it allows us to explore these ideas that sort of exist outside of the mainstream medicine but why they should exist outside the mainstream of medicine it really shouldn't be thank you very much [Applause]

Channel: Low Carb Down Under

Views: 186,534

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Denver 2019, #LowCarbDenver, Jason Fung, Nadia Pateguana, Intensive Dietary Management, Polycystic Ovarian Syndrome, PCOS, The Obesity Code, Intermittent Fasting, LCHF, Low Carb High Fat, Ketogenic Diet

Id: TaouRuqqEfY

Length: 33min 30sec (2010 seconds)

Published: Tue Apr 16 2019