PCOS SUMMARY

by
RAPHAEL RETTNER D.C.
Table of Contents
Chapter 1: Definition, History and Symptoms:....................................................... 3

Chapter 2: Lab Tests:............................................................................................ 4

Chapter 3: Related Medical Problems:.................................................................. 6

Chapter 4: Pathogenesis:...................................................................................... 8

Chapter 5: Diet:................................................................................................... 10

Chapter 6: Apex Supplements:............................................................................ 14

Bibliography:........................................................................................................ 16

Copyright © 2015 Raphael Rettner D.C. All Rights Reserved.Page 2

Chapter 1: Definition, History and Symptoms:
Definition of PCOS:
Polycystic ovary syndrome is characterized by a
tough, thickened, shiny white covering, overlying a
layer of many small cysts just under the ovarian
surface.
Symptoms:
1. Excessive male pattern hair growth (hirsutism)
2. Obesity
3. Irregular or no menstrual periods, heavy periods
and menstrual cycle disturbances leading to
infertility and trouble getting pregnant.
4. Excess body and facial hair
5. Acne
6. Pelvic pain
At a 1990 National Institute of Health conference,
PCOS experts concurred that the two consistent
components of PCOS were elevated male hormones
and a chronic lack of ovulation. Women with PCOS
may not be infertile or obese. There are often
abnormalties of insulin and sugar metabolism and a
propensity to develop diabetes. Even though the
name suggests that the ovaries are central to disease
pathology, cysts are a symptom instead of the cause
of the disease. Some symptoms of PCOS will persist
even if both ovaries are removed; the disease can
appear even if cysts are absent.

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Chapter 2: Lab Tests:

Every evaluation for PCOS should include a

determination of insulin resistance and exclude
diabetes.
1. Glucose-The American Diabetes Association has
designated individuals with fasting glucose levels
over 126 mg/dl as diabetic. Individuals with fasting
levels of 110-126 mg/dl as having impaired glucose
tolerance.
2. Glucose Tolerance Test-If there is obesity, a family
history of diabetes or other risk factors, a GTT
should be considered in the PCOS evaluation. The
American Diabetes association recommends a 2
hour screening after an intake of 75 grams of
glucose. A one hour 50-gram glucose test is used
in most obstetric practices. A glucose level of less
than 140 mg/dl after a 2 hour test is normal, a level
of 140-199 is impaired glucose tolerance and a
diagnosis of diabetes is made when the level is
over 200.
3. Insulin-There is a strong association between
PCOS and higher than normal insulin levels (insulin
resistance). Usually levels above 20 are associated
with insulin resistance and levels under 14 are
normal.
4. Lipid panel-The panel measures cholesterol,
triglycerides , HDL and LDL (the good and the bad
cholesterol). Individuals with PCOS have a
tendancy toward lipid abnormalities. When

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 abnormalities are found, treatment can be
prescribed which may alter the risk of heart attack
and stroke.
5. Thyroid panel-Thyroid disease is quite common
with PCOS.
6. LH to FSH ratio. LH is related to, if not diagnostic of
PCOS. A diagnosis of PCOS is made when the LH
to FSH ratio is over 3.
7. Total testosterone-Marked elevation of either total
or free testosterone warrants a thorough
investigation.
8. DHEAS, SHBG (Sex hormone binding globulin)
and Prolactin
9. Transvaginal ultrasound can help determine the
number and size of follicles. Finding greater than
eight to ten cystic structures, smaller than 10 mm in
either ovary meets the established ultrasound
criteria of polycystic ovaries.1

Diagnosis is based on two of the following three

findings:
1. No ovulation,
2. High androgen levels,
3. Ovarian cysts.[3] Cysts may be detectable by
ultrasound.

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Chapter 3: Related Medical Problems:

1. Insulin resistance leading to type 2 diabetes

2. Heart disease
3. Hypertension
4. Obesity
5. Gallbladder disease
6. Depression
7. Migraine headaches
8. Epilepsy
9. Autoimmune disease
10. Asthma
11. Liver and kidney disease
12. Mood disorders
13. Obstructive sleep apnea
14. Endometrial cancer
15. Chronic fatigue syndrome and fibromyalgia 1

Risk factors: Include obesity, not enough physical

exercise, and a family history of someone with PCOS.
the condition.[6]
Conditions that produce similar symptoms
include:
1. adrenal hyperplasia
2. hypothyroidism
3. hyperprolactinemia.[7]

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Differential diagnosis
Other causes of irregular or absent menstruation and
hirsutism, such as hypothyroidism, congenital adrenal
hyperplasia (21-hydroxylase deficiency), Cushing's
syndrome, hyperprolactinemia, androgen secreting
neoplasms, and other pituitary or adrenal disorders,
should be investigated.[11][37][44]

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Chapter 4: Pathogenesis:

Polycystic ovaries develop when the ovaries are

stimulated to produce excessive amounts of male
hormones (androgens), in particular testosterone, by
either one or a combination of the following [21]):
• The release of excessive luteinizing hormone
(LH) by the anterior pituitary gland..
• Through high levels of insulin in the blood
(hyperinsulinaemia) in women whose
ovaries are sensitive to this stimulus[13]
• Adipose tissue possesses aromatase, an
enzyme that converts androstenedione to
estrone and testosterone to estradiol. The
excess of adipose tissue in obese women
creates the paradox of having both excess
androgens (which are responsible for
hirsutism and virilization) and estrogens
(which inhibits FSH via negative
feedback).[53]
• PCOS may be associated with chronic
inflammation [13]
• PCOS may be worsened by environmental
impacts especially industrial endocrine
disruptors[27] such as bisphenol A (BPA )
which is found on the inside of many food
and beverage cans as well as water
bottles. Endocrine disruptors, like BPA can
distress neural circuits that regulate

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 feeding behavior, which has been
proposed to increase the risk of obesity.
[102]
BPA works by imitating the natural hormone 17B-
estradiol. Evidence indicates that it is a potent
mimicker.[103] When it binds to estrogen receptors it
triggers alternative estrogenic effects that begin
outside of the nucleus. This different path induced by
BPA has been shown to alter glucose and lipid
metabolism in animal studies.[104]

Copyright © 2015 Raphael Rettner D.C. All Rights Reserved.Page 9

Chapter 5: Diet:

This condition must be managed as a multi-syndrome

disorder
1. Insulin Resistance
a. Diet - modified diet to include complex
carbs, protein and beneficial fats.
b. Exercise - Imperative 3 - 5 days a week for
20 minutes, can start with walking.
c. Supplements - Glysen, OmegaCo3,
Adrenacalm, Adaptocrine, Protoglysen and
Fibromin.

2. Decrease androgens with Prosta-DHT- it has anti-

androgen properties.

Consider the following protocol, in layers:

1. LAYER 1 - Start with a 3 - 5 day fast. Make a drink
consisting of water, lemon and/or lime juice, green
tea (you can use tea bags soaked in the water) and
grade B maple syrup to taste. Drink continuously.
2. LAYER 2
a. Clearvite 21 day elimination program (See
below)
b. Supplements -
Glysen-2 - 4 capsules, 3 x day with meals
Protoglysen-2 capsules, 3 x day
Adaptocrine-2 - 3 capsules, 3 x day
Adrenacalm-Apply as directed, 3 x day
OmegaCo3-1 Tablespoon, 3 x day

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 Fibromin-2 capsules 3 x day
Prosta-DHT-DHT-2 capsules, 3 x day
3. LAYER 3 - continue with supplements, dietary
changes, exercise and re-introduce foods one at a
time.
Clearvite 21 day elimination program:
FOODS TO EAT/DRINK:
1. Fresh water (8-10 glasses a day), herbal teas,
green tea, fruit juices (no sugar added), vegetable
juices•
2. Grain foods made from rice, quinoa or tapioca•
3. Fresh fruits, vegetables,
4. Beans (navy, white, red, kidney, etc), peas (fresh,
split, snap)•
5. Fish** (not shellfish) and moderate amounts of
chicken, turkey, and lamb•
6. Olive oil (flaxseed oil in moderation)
FOODS TO AVOID:• Any food that you are allergic to
eg.: 1. Dairy (milk, cheese, yogurt, butter), eggs
2. Margarine, shortening•
3. Foods prepared with gluten-containing ingredients
like wheat, oats, rye, barley; those ingredients
normally found in bread, pasta etc•
4. Tomatoes and tomato sauces, corn•
5. Alcohol, caffeine (coffee, black tea, soda)•

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6. Soy or products made from soy, such as soy milk or
tofu• meat substitutes made from soy.
7. Peanuts or peanut butter•
8. Beef, pork, cold cuts, bacon, hot dogs, canned
meat, sausage and shellfish.
9. Days 1 to 7, use any of the foods in the FOODS TO
EAT/DRINK list above. Avoid all of the foods in the
FOODS TO AVOID list above.
10. Days 8 to 14, use any of the foods in the FOODS
TO EAT/DRINK list above, except eliminate all
animal products from the diet (fish, chicken, turkey,
and lamb).• Avoid all of the foods in the FOODS TO
AVOID list above.
11. Days 15 to 21, use any of the foods in the FOODS
TO EAT/DRINK list above, including the animal
products (fish,** chicken, turkey, and lamb).• Avoid
all of the foods in the FOODS TO AVOID list above.
Where PCOS is associated with overweight or
obesity, successful weight loss is the most effective
method of restoring normal ovulation/menstruation.
A scientific review in 2013 found similar decreases in
weight and body composition and improvements in
pregnancy rate, menstrual regularity, ovulation,
hyperandrogenism, insulin resistance, lipids, and
quality of life to occur with weight loss independent of
diet composition.[64] Still, a low Glycemic Index diet,
in which a significant part of total carbohydrates are
obtained from fruit, vegetables, and whole-grain

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sources, has resulted in greater menstrual regularity.
[64]
Vitamin D deficiency may play some role in the
development of the metabolic syndrome, so treatment
of any such deficiency is indicated.[65]2

Copyright © 2015 Raphael Rettner D.C. All Rights Reserved.Page 13

Chapter 6: Apex Supplements:

I. Blood Sugar Supplements:

1. Protoglysen™ helps support both the metabolism
and peripheral utilization of sugars with specially
selected phytonutrients.‡ Key ingredients include
extracts of maitake mushroom, bitter melon, and
Gymnema sylvestre.
2. Glysen-Get sleepy after eating? Glysen contains
key herbs, vitamins and minerals which help lower
blood sugar levels for people who are insulin
resistant.-$47
3. Fibromin™ helps support the colon, sugar
metabolism, and lipid metabolism by providing a
spectrum of insoluble fibers.‡ This formula's key
ingredients include guar gum and high-quality,
standardized flaxseed bran. Dietary fibers,
especially those that are water soluble, may lower
the glycemic index of dietary carbohydrates by
affecting the stomach's emptying, its rate of
carbohydrate digestion, and its absorption.
Insoluble fibers increase the bulk of stool,
facilitating the transportation of waste outside of the
body.
II. Adrenal Supplements:
1. Adaptocrine-adaptogenic herbs which help
maintain your energy, balance
overstimulated adrenal glands and decrease the
impact of stress on your body. $29

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2. Adrenacalm- A cream that contains calming herbs
and vitamins which help restore the strength to
overstimulated adrenal glands. It will help you relax
and allow you to have a deep restful sleep.
Provides support for memory, cognition and the
management of anxiety.$43
3. K7-Omega Co3-Provides essential fatty acids
which helps memory and brain function. Useful for
those with weak fat metabolism and insulin
resistance-$22
Androgen Reduction
1. Prosta-DHT-Supports the prostate and the male
endocrine system using targeted phytonutrients and
amino acids. Key ingredients include saw palmetto
berry and pygeum bark. Additionally, this product is an
excellent source of zinc and includes a blend of plant
enzymes for digestive support.

Copyright © 2015 Raphael Rettner D.C. All Rights Reserved.Page 15

Bibliography:
1.Thatcher, Samuel S. M.D., Ph.D., PCOS:The
Hidden Epidemic (Indianapolis: Perspectives
Press, 2000).
2.Wikipedia

Copyright © 2015 Raphael Rettner D.C. All Rights Reserved.Page 16