Question for Dagmar Ehling on PCOS

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kwisgirda
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Joined: 05/27/2009
Question for Dagmar Ehling on PCOS

Hi Dagmar,

I took your PCOS webinar and want to make sure I understand your carb counting recommendations.
First, thank you so much for the great webinar! Your presentation was so generous and packed with clinically useful info!

This is what I understood for daily intake:
For most PCOS patients: 70 grams of carbs, not counting vegetables.
I assume you aren't including white potato but wonder about sweet potato and other starchy veg.
For lean, amenorrheic PCOS patients: 50 grams not counting veg.

You recommend that Paleo approach for 6 weeks and then have patients graduate to your OHS food pyramid. After the 6 weeks, do you modify the carb counting recommendations if all symptoms are vastly improved and stable? Or do you keep the non veggie carb count low longer term? I understand that individual needs and responses vary. Any insight into what benefits more patients is always a good starting place.

Also, regarding Readisorb versus Oxicell as sources of glutathione: When do you use one versus the other? Will you ever have patients apply Readisorb topically on the thyroid even though it is labelled for internal use?

Thank you, Kristin Wisgirda

Dagmar
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Joined: 04/01/2013

Hi Kristin,
Glad you liked the webinar. You are raising some great questions! I am including sweet, white potatoes in the carb counting as one can easily overdo on those and cause a glycemic reaction. For example, a woman may interpret the paleo diet to mean that it's ok to eat 2 sweet potatoes pay day. This will not work for her as the 6 wks strict paleo serves to resensitize their insulin receptors. After that you'll want to maintain that progress. After the six wks I may revise their carb counting method or increase their daily carbs grams. This depends on the following: was there a definite change in labs (A1c, trigs, uric acid); did the "fatigue after meals", "crave sugar after meals" subside; are we seeing improvements in energy, brain health, return of ovulation/menses, weight loss? These are some examples. In general, women with PCOS will likely need to keep counting carbs long-term since they likely have "reached their lifetime quota of sugar" by the time they develop the disease. They are often women who ate lots of sugar during childhood. Ultimately, you'll want regular ovulatory cycles with ample cervical fluid. Long-term you'll want to see the "string of pearls" disappear on ultrasound. ReadiSorp is best used orally; I never use it topically. They are both good sources and for those who have a tough time with RediSorp's flavor I will use Oxicell topically or AC Glutathione orally which Apex now manufactures. I use Oxicell primarily during pregnancy for those that have auto-immune disease to support their glutathione pathway while minimizing the amounts of supplements she's is on. Hope this answers your questions! Dagmar

Dagmar
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Joined: 04/01/2013

Hi Kristin,
Great questions! We are not including white potatoes since their glycemic index is much higher when compared to sweet potatoes. My recommendations re starchy veggies varies depending on how bad her IR is, how much in a hurry she is to conceive, and whether she is a slim PCOS vs an obese PCOS patient. You can glean all that information from her history and labs (menstrual frequency, ovulation history, hirsutism, and trigs, HbA1c, uric acid levels).

Your g f lean vs obese PCOS patients above are correct. Typically, after 6 wks of a pretty strict paleo diet I will graduate them to the OHS food pyramid UNLESS her symptoms are still showing significant IR. This is an example where the lean PCOS patient likely needs to stay longer on the paleo diet but you just have to gauge it on symptoms and repeat labs. I do continue the non-veggie carb count forever since they likely have reached their lifetime quota of sugar (:>) ). However, as the insulin receptors become more sensitive we can increase their daily carb count to 100 or 120 again depending on symptom & lab presentation. Long-term, I find having some non-veggie carbs in the diet is useful.

We never apply Readisorb topically; it's too expensive for that and it's not designed for topical application. I use Readisorp internally for all AI patients and if I've run a Genomics panel and found that he/she has all three glutathione-enzyme producing SNPs missing I will have patients take Readisorp 2-3 tsp daily for the rest of their lives since they just won't make sufficient glutathione on their own.
I use Oxicell during pregnancy for those women who have any AI disease and those that travel since Readisorp needs to be refrigerated.

Hope this clarifies things!

Dagmar Ehling

Dagmar
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Joined: 04/01/2013

Hi Kristin,
Glad you enjoyed the webinar.

Yes, your numbers above are about right. If a woman's triglycerides, HbA1c or uric acid levels are elevated she will need to be more strict for a longer period of time than 6 wks. In an ideal situation you'd recheck her blood work by 6-8 wks from the date of implementing the paleo diet if those values have normalized or are at least improved. If those values are not a problem at the initial intake then you'll have to go by signs & symptoms such as fatigue after meals, sugar cravings, overall energy level, brain function, and, of course, if her period returns.

She may need to be longer than 6 wks on the very restricted diet depending on whether the patient was completely amenorrheic or just had irregular periods with occasional anovulatory cycles. In order for her menses to be regular and ovulatory you'll need to have her do either BBT's or OPKs. In an ideal situation you'll want several normal cycles before beginning to allow her to modify the carb counting so that means around 12 wks or so. However, some women have such amazing results with this approach that they can begin to eat a few more carbs at the 6 wks mark. You'll just have to see. Slender PCOS patients generally need to be on this more restricted diet for a longer period of time.

Redisorp is never used externally; it's not intended to be. I use Redisorp if the patient doesn't appear to detoxify well, has a variety of immunological issues (auto-immune, allergies, frequent colds, digestive parasites, etc.) at 1 tsp per day, rarely more than that. Oxicell is used during pregnancy and its use is topical.

Hope that helps,
Dagmar

kwisgirda
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Joined: 05/27/2009

Hi Dagmar,

Thanks for the response. It helps to be able to give patients an idea of what to expect.

Just one more clarification: Are all starchy veg included in the carb count or just white potato?

Thanks again, Kristin Wisgirda

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