Keto Study Club: Session 43

Added: 2026-05-27

[00:00:26]Hello. Hello. Hello. Man, it's been a while since I've watched that intro.

[00:00:32]>> I know. It has been a hot minute.

[00:00:34]>> Yeah, it seems like forever and a day since we've we've done this and uh so I think we should do some catchup and uh because it has been quite a while. Like we're trying to figure out like I mean it may have been January. I don't know. But you guys confirmed it was before we before I moved. So I don't know if you know. So this is my front yard. That's awesome. This is Yeah. Now, it doesn't show all the mountains and all the, you know, the trees, but this is this was this is my front yard. So, and uh this was the very first deer that came wandering through. Now, we have deer constantly now, but I was so excited to actually have a deer in my front yard that I uh had to go out and take a picture. So, >> I love it. Yeah.

[00:01:18]>> Oh, that looks so peaceful.

[00:01:21]>> It's amazing.

[00:01:23]Yeah. It's like every day I look out and I like, "Oh my goodness, it's just so different than living in the suburbs and looking out and just seeing your neighbors, >> right?"

[00:01:32]>> Yeah. And not that we don't have a couple neighbors that we see, but it's mostly nature.

[00:01:38]>> It's at a distance.

[00:01:39]>> More at a distance. Exactly. And Yeah.

[00:01:43]And then just, you know, when it's a clear day, we got snow cap mountains and it's just lovely. I love it. So, >> I am so happy for you. That is awesome.

[00:01:55]>> Yeah. And so we've got the uh you know, I did one before video of the house and I've been dragging my feet on getting a getting get an update video out there because I've been so busy with the nutrition network course and healing humanity. And we went and you know went to meet stock and showed the documentary there for the first time to a huge audience. It looks we got a couple people here. Manda, nice to see you, Amanda.

[00:02:26]Awesome.

[00:02:28]Wow. Oh, yes. We I love my yard, too.

[00:02:31]Yes. It's amazing. But, uh, yeah, so we got to show the documentary at Meatstock, and I happen to know, um, Renee, that um, one of the people who's going to be looks like hosting a showing is Laura Stath. Oh, yay. Maybe we can make it up there. neck of the woods.

[00:02:52]Yes.

[00:02:53]>> Oh, wow.

[00:02:54]>> Yeah. So, Bill's here. That's awesome.

[00:02:57]Yeah. And so, we have the um the world premiere, the official hometown world premiere at at Montello on June 6th. And so, Dave and I are flying out for that.

[00:03:13]But our baby granddaughter is due just after that. So, if for some reason she's, you know, my daughter goes into labor early, then we would be canceling our trip out to Montel.

[00:03:28]But she's she's >> And what was that date again?

[00:03:32]>> The which date?

[00:03:33]>> The date that the the future like the at Montello?

[00:03:38]>> June 6th.

[00:03:39]>> June 6th. Okay, gotcha.

[00:03:41]>> Yeah. Yeah. So, it's just in a couple weeks.

[00:03:45]Yeah. So, it's a Yeah. So, that's exciting. So, we've got that whole trip planned. It's going to be kind of a big turnaround trip and um because we don't want to be there too long because we want to get home because my daughter's going to be due and uh yeah, so it's exciting. So, we've got all the floors in in our house.

[00:04:03]We've got our, you know, a most probably 90 99% of the painting done. Um, we've replaced we've the whoever built the house, the guy who built the house did not apparently they did not like doorork knob like handles and knobs on cabinets >> because we have had to put h handles and knobs on everything.

[00:04:26]>> And so that was one of the little projects that we did. We replaced >> pretty much all the light fixtures and we're currently getting the apartment um ready to have be an Airbnb.

[00:04:39]Yeah. So, that's what's going on in my life. Plus, almost July, I'll be done with the nutrition network coaching course. And so, yeah, I'll officially be a nutrition network uh coach.

[00:04:52]>> Oh, that is fabulous.

[00:04:53]>> Yeah. So, that's what's going on in my life. What's going on with you, Carrie?

[00:04:57]>> Well, I had flooring, new floors, engineered hardwood. It's the color is legacy oak. And I had been saving money forever. And then I think maybe the last time we talked, I said that I went ahead and scheduled it, but I had scheduled it a couple months out so that I would have time to get things ready. So I went through all of this purging stuff and, you know, I got rid of a ton of stuff. I got rid of a little bit of furniture.

[00:05:27]Um, but I'm I did most of the work myself. My kids helped me move a couple of big things and a friend took um like a big huge dresser out and a a desk out.

[00:05:39]You know, they they wanted it. They knew somebody who wanted it. So that those things were gone. But anyway, got the floors put in. Finally got everything settled back in. And then I sort of like while I was moving stuff to the back shed, you know, temporarily, I walked past and I know this sounds crazy, but like there's a there's a like little closet outside my kitchen. Like there's a patio and then the right over here.

[00:06:07]>> And I kind of glanced over and there were these two huge cracks in the brick.

[00:06:12]And I had never noticed them before. And there's a big crack in the patio. So >> needless to say, I had foundation issues. So I just had foundation work done, too.

[00:06:26]>> Oh, wow.

[00:06:27]>> So yeah. So it's it's just been Then they've got to come back and do a little finishing up on the back patio. Um they drilled these holes and then they put they also had put installed pillars like at the edge of the house and then on part of the the patio slab and then of course oh and then they had to of course somebody had to move my heat and air unit which luckily my son knew somebody who owns a HVAC company.

[00:06:56]I'm like because I really didn't have anybody that I regularly used. I mean, it was sort of we had a family friend and he retired. But anyway, so needless to say, all of that was a lot of arranging and coordinating and everything, but I think it's finally starting to calm down. So, >> yeah, not good having foundation issues.

[00:07:17]My goodness.

[00:07:18]>> Yeah. Thankfully, it wasn't terrible. I mean, like there was a And now you can't even tell that it was ever cracked there. I mean, like the cracks, you know, you can't even tell.

[00:07:31]>> Um, >> but I wanted to fix it. They told me it wasn't that bad and that it was good that I went ahead and took care of it.

[00:07:39]But, you know, getting bids and then just Oh my gosh.

[00:07:43]>> Oh, yeah. Can totally relate. Like when there's work that needs to be done and you can't do it yourself, it's like Yeah. It's a kind of a pain.

[00:07:51]>> So, wow.

[00:07:51]>> So, thankfully that that's all done and I smile every time I see these floors. I wish I could show them to you. They're just beautiful. So, >> did you get did you get like uh M MVP?

[00:08:04]>> It's it's MVP. What is it called?

[00:08:06]>> Engineered hardwood.

[00:08:08]>> Yeah. Yeah. I don't know why I keep calling it MVP. That's most valuable person.

[00:08:13]>> The the stuff. Yeah.

[00:08:15]>> Yeah. Yeah. You know, so every all even including inside closets, everything even the little bathroom downstairs. I did not do the ba bathroom upstairs because, you know, of the shower and and mo, you know, trapped moisture kind of thing. So, that's going to be a whole another project. I don't even know what I want to do with that bathroom, but I'm not in there enough to worry about, you know, I mean, I'm in there briefly, so it's like, >> yeah, >> but I'm just so happy with the rest of the floors. So, >> it's been exciting and and busy, but I think it's calming down a little bit now.

[00:08:52]Good. All right, Renee, what's new with you?

[00:08:58]I have nothing great to talk about, so life's been a little bit rough for us this year.

[00:09:06]>> Um, just working and >> trying to get through every day.

[00:09:11]>> Yeah. And I know that's why we've been not meeting because we've been, you know, Rene's been going through some stuff so we don't get into it. But yeah, we're glad that you're at least okay and you can join us today and you know, really hope that life settles down. And you know, it's it's amazing how sometimes it seems like I go through periods of time where it's like, my gosh, can life quit throwing stuff at me?

[00:09:35]>> Yeah.

[00:09:36]>> You know, the only thing I'm grateful for is my health is still right where it needs to be. And >> good, >> you know, so we can, you know, we sit on the back and we watch the sunset and I'm representing.

[00:09:46]>> Oh, good.

[00:09:48]We sit on the back porch and we are grateful every night for what we have and I agree with you. We live out in the middle of nowhere and I don't have any neighbors and it's totally amazing and you know so I'm grateful for what we have and I'm grateful every single day that I can walk and that I'm not in pain. So I mean I try to hold on to that.

[00:10:06]>> Yes. Well, and considering all of the stressful times you've been through, to be able to still feel pretty good, that's really says something because a lot of times a relapse will happen.

[00:10:17]>> Oh, yeah.

[00:10:19]>> Yeah. And I have I mean, I just I'm continually getting better. Um start a new workout program. Um you know, it Yeah. So, I have to be grateful for that.

[00:10:29]>> Yeah. I love it. That's good. Well, >> and that's motivation too to others, the fact that you're still able to continue with your plan and you've got a new workout plan and you know because life is going to happen and >> you know we're all human and you know we can relapse if we're not careful. So >> yeah, I'm grateful for my meat every single day.

[00:10:54]>> Oh yeah.

[00:10:55]>> Very good. And sometimes we can't control whether or not, you know, we have a flare up because it's like, you know, it's stress happens and how our bodies handle it. Sometimes it seems like it's just our body has a mind of its own and it's going to decide I'm going to flare up.

[00:11:12]>> So it says something that you were able to manage and get through flare. So that's >> I really have had to dial in and I had to go back to eating only meat. Um I because you know you you worry and there are days that I was like ooh maybe I should not be eating anything else. So I'm back to just beef and chicken.

[00:11:36]>> But I'm okay with that.

[00:11:38]>> Yeah. Yeah. That's good. Bill said just share with some of Kilta's coaches.

[00:11:43]Excellent. Yeah. We we go through this slow but we're getting through it.

[00:11:51]>> All right. Very good. And it looks like Manda's going to be at the Montello showing. So that's awesome. Get a chance to meet her there. It's great. So, okay.

[00:12:00]So, for anyone who's listening to this now or later and has not joined in and doesn't know what on earth are we doing.

[00:12:06]We are going through which I can't really get it on. I'll let you guys get on the camera. This textbook, it is a medical textbook. It's called ketogenic, the science of therapeutic carbohydrate restriction in human health. is actually put out by the Nut Nutrition Network, which is where I'm getting my coaching certification.

[00:12:25]And unlike a book club where we read ahead, we do not do that. We are science nerds and we like to learn and we're reading and discussing as we go. We are currently in still in chapter 3, page 155, and we're getting started on the section on polycystic ovarian syndrome and infertility.

[00:12:47]I heard they have ch recently changed the name to metab it's metabolic. Do you know what it is?

[00:12:58]>> I know it has the word metabolic in it.

[00:13:00]>> Metabolic in it. Hang on, let me look this up.

[00:13:01]>> Oh wow.

[00:13:02]>> Yes, they have changed.

[00:13:04]>> It's a great thing because really they're finally acknowledging that it's a metabolic issue. I mean it's not >> Yes.

[00:13:13]>> Yeah. Let me see if I can find um there was a post on our nutrition network platform about this.

[00:13:26]Oh, okay. Here we go.

[00:13:27]>> Polyendocrine metabolic syndrome.

[00:13:30]>> Yes. Polyendocrine metabolic ovarian syndrome. So, P Mos.

[00:13:37]>> Wow.

[00:13:38]>> Yes.

[00:13:40]And Yeah. So, that's good. also fatty liver disease. They're they're changing the terminology.

[00:13:48]Um is it fatty liver disease? It's the it's the uh >> nld.

[00:13:56]Yes. Is now >> mld I believe.

[00:14:01]Mafold metabolic dysfunction associated fatty liver disease.

[00:14:08]>> Oh wow.

[00:14:10]>> Wow. That is incredible. Did you ever think you'd live to see the day?

[00:14:14]Honestly, >> no. And this is the actual uh the the governing agency for the liver, the the ASLD, the American Association of the for the studies of liver disease that is changing the acronym and the the terminology around this. So, they're actually acknowledging the underlying metabolic dysfunction in both of these conditions.

[00:14:41]So to me that's huge.

[00:14:43]>> That is because I'm telling you back like in oh gosh I guess I started all this >> like in 2014 roughly and I mean back then I mean it was just the status quo.

[00:14:57]It was low fat. It was and there was just no hope of like people knew because of experience and whatever but I mean it was always anecdotal and >> and it was just so discouraging because every you know whenever the new dietary guidelines would come out it would be the same old thing and >> and you know it was just you know you're a conspiracy theorist or whatever and so it's just amazing that this has happened. I got diagnosed with PCOS when I was well very early early to mid 90s you know and uh they didn't really know that much about it just put them on a birth control pill and then later I remember the doctor saying oh there's a new thing we're treating with we're doing some treatment with metformin >> and you'd think that it would be obvious like okay if it's helping and metformin is known to help with insulin become you become more insulin sensitive.

[00:15:57]>> You think that that would have been a clue, right?

[00:16:00]>> But >> you would think >> 30ome years later they're finally bringing in the metabolic component of it, but it is what it is. So, we're >> Yeah. But I'm just amazed and I'm just so thankful that finally, you know, it's starting that the big ship is starting to turn around, you know.

[00:16:18]>> Yeah.

[00:16:18]>> Awesome. Yeah. So, all righty. Well, let's see. I don't even remember who read last.

[00:16:27]>> I'll go ahead and go first.

[00:16:28]>> Okay, sounds good.

[00:16:30]>> All right, we are on page 154.

[00:16:33]>> Hopefully, there won't be nearly as many big words with this one, but we'll see.

[00:16:39]>> All right, I'm still gonna because I don't remember what the um acronym for the new term is, we'll just say PCOS.

[00:16:47]>> Yes.

[00:16:48]>> All right, introduction. Polycystic ovarian syndrome is the most common reproductive disorder in the world. It affects an estimated 8 to 20% well that's a big range 8 to 20% of women of reproductive age globally depending upon the specific diagnostic criteria used.

[00:17:10]40% of patients diagnosed with PCOS suffer from infertility and 90 to 95% of women in infertility clinics who cannot conceive due to lack of ovulation suffer from PCOS.

[00:17:26]History PCOS conceived as a disease of modernity is actually ancient h originally described as a gynecological curiosity. It is now the most common endocrine disorder in young women involving multiple organ systems.

[00:17:45]Early definitions PCOS was recognized as early as Hypocrates who defined it as women whose ministration is less than 3 days or is meager or robust with a healthy complexion and a masculine appearance. Yet they are not concerned about bearing children nor do they become pregnant. Okay, I've got to take a little issue with that definition because whose menstruation is less than three days or is meager that is we know and of course this was they said this was 460 to 377 BC was hypocrisy. So, it's like, okay, I'll cut him a little bit of slack. But I had one period that lasted 11 months. That was not a meager. I mean, I realized it wasn't super super heavy, but I I had very, very heavy, lengthy periods. Even when they lasted seven, eight days, which is longer than a normal period should last, >> they were so so heavy and so so painful.

[00:18:54]I I definitely take issue with his definition. I have a feeling back then he didn't necessarily talk to a ton.

[00:19:00]Maybe maybe the women weren't quite as you know maybe >> open the way I was experiencing it. I don't know. Maybe because I live in an era where we're exposed to all sorts of other >> you know toxins and chemicals and environmental you know and seed oils.

[00:19:16]Maybe I experienced it different than the women back then. But who knows?

[00:19:22]>> It's just interesting. I I never thought of it being known, you know, or a condition even if and I imagine that there are um like various types like even within like maybe the type he knew was like the meager, but then other types are around too and maybe it just wasn't >> Yeah. documented or like or maybe the women just really didn't share that much >> and not everybody gains weight. Um, >> so >> yeah. Well, I think I might have had it, but I was never diagnosed with it, but my periods were terrible.

[00:20:05]>> It was awful.

[00:20:06]>> Um, my dad would have to I mean, it was like clockwork. I mean, we only had one car and luckily my dad worked close to home and like he'd come pick me up from school and take me home. I mean, just about once a month like clockwork unless it happened to be on a weekend. I mean, it was bad.

[00:20:25]>> Yeah.

[00:20:26]>> So, but anyway, all right. Well, this is interesting. The ancient Greek gynecologist Saranus of Ephesus and this was circa let's see 98 to 138 AD made a similar observation French obstitrician Ambrose Pere from 1510 to 1590 corroborated that these women were manly and became bearded >> Italian herutism growing of facial hair, male pattern facial hair.

[00:21:03]>> Yeah.

[00:21:05]H interesting.

[00:21:08]Italian scientist Antonio Valis Valiseri connected these features into a single disease when he described several young infertile women whose ovaries were white, shiny, and the size of pigeon eggs. How did he know?

[00:21:29]Good question.

[00:21:32]>> He described several young infertile women whose ovaries were white, shiny, and the size of pigeon eggs.

[00:21:40]>> I imag them.

[00:21:48]>> Holy moly.

[00:21:51]>> Okay. In 1921, French doctors Emil Charles Ashard and Joseph Tears described a syndrome that included masculinizing features and type 2 diabetes. Further cases in 1928 cemented the link between what is now called PCOS and type 2 diabetes and these were described in the article diabetes of bearded women.

[00:22:17]Careful observation had revealed to these clinicians common pathology beneath menstrual irregularities, infertility, masculine features, and obesity coupled type 2 diabetes. The only feature differing from the modern definition of PCOS was the ovarian cysts, which were understandably missed due to a lack of non-invasive imaging.

[00:22:40]Well, apparently dude on back, he saw the white shiny ones, so I don't know. So, I wonder if the a lot of the bearded women that were in the circus early on had PCOS.

[00:22:53]>> Oh, that's a good question. I bet they did.

[00:22:57]>> Maybe.

[00:22:58]>> Yep. Wow. Okay. Clinical presentation.

[00:23:04]The PCOS spectrum. What PCOS PCOS is and is not. To confirm a diagnosis of PCOS, clinicians must confirm the presence of two of three of the following conditions: hyperandrogenism, menstrual irregularities, and polycystic ovaries. Because some women will present with all three criteria and others will only have two, PCOS represents a spectrum of disease. The Roderdam criteria recognized this continuum and grouped patients into four different phenotypes.

[00:23:40]Frank or classic polycystic ovary PCOS chronic and ovulation hyperandrogenism and polycystic ovaries three of three criteria classic nonpolycic ovary PCOS which is chronic anovvulation hyperandrogenism and normal ovaries non-classic ovary PCOS regular menstrual cycles hyperandrogen ISM and polycystic ovaries and non-classic mild PCOS with chronic inobulation normal androgens and polycystic ovaries.

[00:24:21]H the frank phenotype represents the most severe disease and is associated with metabolic diseases like obesity and type two diabetes with cardiovascular risk factors like high blood pressure and triglyceride concentration.

[00:24:37]In contrast, women with non-classic mild PCOS are at the lowest risk of metabolic disease. Why some women with PCOS present with hyperandrogenism as opposed to anobularary cycles is unknown.

[00:24:55]H it makes me wonder with with me because you know they talk about anovulatory cycles meaning you you know you don't ovulate right?

[00:25:08]Like how did they how back then? How did they know that?

[00:25:13]You know, I like I didn't know whether or not I was ovulating most of the time.

[00:25:19]Like how did how did they know that? I didn't track. So, >> right, >> you know, only I only knew that when I got cysts, and I would get the cysts for sure because I could, you know, and especially when we were doing fertility treatments, they would um beforehand, you know, I had different ultrasounds and stuff and they'd see the cysts inside my ovaries. I could feel them because they would grow, but then they don't release, you know. So, it's not like you don't have the eggs. You do.

[00:25:51]they just don't release from the ovary and so that they would get big and that's why they call it polycystic. So you get more than one they get big but then they kind of reabsorb into the tissues of the ovary and so they get to a certain point and they shrink. But I could tell for sure when they were getting big because it would really hurt.

[00:26:13]>> It was really painful. But I just assumed that every month I didn't release any of them because I was never able to get pregnant.

[00:26:25]>> No.

[00:26:26]>> Yeah.

[00:26:27]>> Even when we were doing fertility treatments, I still wasn't able to get pregnant.

[00:26:32]>> Yeah. That's I think maybe because of the the new or or not new, but it it seems to me in reading this that that the um like not releasing the the um the eggs.

[00:26:53]I think that's a later >> discovery >> addition to the criteria. It seems to me like one of the first ones was the >> um >> the beards.

[00:27:05]>> Yeah. The hyperandrogynism and the menstrual reg irregularities. And with the exception of the guy who must have cut some women open up there. Um I don't think that the last part was really >> Yeah. until later.

[00:27:23]>> Yeah.

[00:27:23]>> Yeah.

[00:27:24]>> Yep.

[00:27:25]>> Wow. This is wild. Okay.

[00:27:29]The Frank phenotype represents the most severe disease and is associated with metabolic diseases like okay well we'll just reread this um like obesity and type two diabetes with cardiovascular risk factors like high blood pressure triglyceride and triglyceride concentration. In contrast women with non-classic mild PCOS are at the lowest risk of metabolic disease. Why some women with PCOS present with hyperandrogenism as opposed to an ovillary uh cycles is unknown. So hyperandrogenism male sex hormones called and androgens are normally present in both w men and women but the normal concentrations for men are f far higher than for women.

[00:28:15]Testosterone is best known is the best known androgen and contributes to many of the physical factors that distinguish men from women. It is produced in the testes of men and in the ovaries of women. Small amounts are also produced in the adrenal glands that sit above the kidneys. Testosterone helps regulate sex drive, fat distribution, and bone mass.

[00:28:41]More than 80% of women who present with symptoms of hyperand hyperandrogenism will eventually be diagnosed with PCOS.

[00:28:51]Hm. Common features of hyperandrogenism include increased facial and body hair growth or >> cursetism, male pattern baldness, acne, lower tone of voice, menstrual irregularities and clitorol enlargement in severe cases.

[00:29:16]The menstrual irregularities, irregular, absent, or rare menstrual cycles are all common symptoms of PCOS.

[00:29:24]An estimated 85% of women with PCOS suffer menstrual irregularities. During the normal menstrual cycle, the human egg develops from the primordial follicle. It grows during the first half of the menstrual cycle and is then released into the fallopian tubes to be carried to the uterus where it awaits fertilization by the sperm. Ovulation is the release of the egg inside the ovary.

[00:29:51]Irregular menstrual cycles are caused by failure of ovulation.

[00:29:57]H in PCOS the main menstrual problems are an ovulation and ugly ovulation.

[00:30:06]And ovulation means a complete lack of ovulation. And ugly ovulation refers to a lower than normal rate of ovulation.

[00:30:18]>> When normal ovulation does not occur, menstrual cycles may be completely absent aminora or may last longer than usual. Aglominia.

[00:30:29]>> Maybe that was me.

[00:30:30]>> Mhm.

[00:30:33]>> Than usual. Yep. Mhm.

[00:30:37]However, having a regular cycle does not mean that ovulation has occurred normally, especially in women with other evidence of hyperandrogenism.

[00:30:46]Of note, 20 to 50% of women with signs of excess testosterone in regular periods still have evidence of an ovulation. This lack of ovulation will result in difficulty conceiving and infertility. PCOS is associated with recurrent miscarriages and is the most common cause of infertility in industrialized nations.

[00:31:11]>> You know, it's interesting when I was 15 and up to that point. So, I got my first period when I was 11.

[00:31:19]>> When I was 15, I had the for the first time an abnormality. I had a period that lasted a whole month.

[00:31:28]And my mom took me to a doctor, but it was all military.

[00:31:35]>> And so we went to the military base and I saw a Air Force doctor because it was the Air Force base. And this doctor did nothing. Like literally just said, "Oh, that happens sometimes." And sent me away. Didn't do any blood work, didn't check my hormone levels, nothing.

[00:31:55]>> Wow.

[00:31:56]>> Yeah. So, I'm just it was just kind of curiosity me. I mean, I wasn't I was only 15, so I wasn't delighted about going and seeing a male doctor. I didn't have any choice about what doctor to see because this was the military, right?

[00:32:09]So, >> um I was glad that he didn't examine me, >> right?

[00:32:17]>> So, here I was at 15. I was like, got away scot-free on that one. But looking back, you know, to at least do some blood work >> might have been helpful, you know.

[00:32:30]>> Yeah.

[00:32:31]>> But no, nothing was ever done. So, >> wow. I mean, that that is that is bad because that's Well, that happens sometimes maybe, but it's not normal.

[00:32:43]So, you should look into it, you know. Um, just because it happens sometimes doesn't mean that it's you know, um there's not something wrong, >> right? Well, and I mean that was in the was it the like early kind of early to mid80s. I I don't know how it was with women getting medical care back then, but there was definitely this, you know, and there's such a lag when it comes to getting good medical care for women anyways because it's like, you know, even a lot of the studies that have been done on nutrition, they're all done on men, right?

[00:33:22]>> Yeah. You know, >> and men and women are different.

[00:33:26]>> We are different. Yep.

[00:33:28]>> We are different.

[00:33:30]>> Yep. So, >> wow.

[00:33:34]>> Okay, let's see.

[00:33:36]>> Do you want me to read?

[00:33:39]>> Yeah, you can go ahead.

[00:33:40]>> I just figured it would be nice to have somebody else besides just you to do it.

[00:33:45]>> Okay.

[00:33:46]>> Polycystic ovaries.

[00:33:48]Follicles are collections of cells in the ovary. During normal menration, many follicles begin to develop and one eventually becomes the human egg that is released into the uterus at the time of ovulation. The other follicles usually shrivel up and are reabsorbed into the body. When these follicles fail to shrivel up, they become cystic and show up on an ultrasound of ovarian cysts.

[00:34:09]The Roderdam criteria define polycystic ovaries as being the presence of 12 or more follicles measuring 2 to 9 millime in diameter in each ovary. Two main factors influence the number of cysts.

[00:34:23]Small 2 to 5 millimeter follicles are related to the serum androgen concentration and larger 6 to 9 millimeter follicles are related to both serum testosterone and fasting insulin concentration.

[00:34:38]Of note, 20 to 30% of otherwise normal women may have multiple cysts on their ovaries. Consequently, the mere presence of cysts is not enough to make the diagnosis of PCOS. Additionally, there is no correlation between the number of cysts and the severity of PCOS.

[00:34:55]>> And so, one thing that's interesting to note too is that it it did say otherwise normal women may have multiple cysts on their ovaries.

[00:35:07]It's in their ovaries. It's like there's definitely a difference between PCOS cysts and an ovarian cyst that's that's actually on the ovary. Like those are ones that need to go and be surgically removed.

[00:35:22]>> Y >> these are actual follicles that don't release and like it says they will break down and absorb reabsorb back into the ovary. So it's definitely they're different because I know a lot of people used to say oh like you have to get those removed. No, because you can't.

[00:35:40]>> Right. Exactly. Because they are inside the ovary as opposed to attached and growing on the ovary.

[00:35:49]>> Yeah, >> that's a that's a good distinction to make there.

[00:35:56]>> Okay. Investigations differential diagnosis.

[00:35:59]Hyperandrinism and polycystic o ovaries are not exclusive to PCOS. Thus other diagnos other di diseases that mimic PCOS must be excluded by history or by physical or laboratory examination before the diagnosis can be confirmed.

[00:36:14]While most of these conditions are rare, there may be serious they may be serious and require entirely different treatments which makes the distinction important. The list of similar conditions include pregnancy, hyper prolactinmia, prolactin excess, thyroid disorders, non-classic congenital adrenal hyperplasia, NCA, Cusheen syndrome, and hyperandrogenmia, androgen excess tumor drug induced.

[00:36:50]Health risks associated with polycystic ovarian syndrome. If PCOS were just about acne and a few missing periods, then it would not be so bad.

[00:36:58]Unfortunately, PCOS is associated with many health health concerns, reproductive as well as general. The reproductive issues include an I how do you say that Lynn?

[00:37:10]>> An ovulatory ovulatory. This should it should make sense. Cycles, infertility, disorders of pregnancy, and fetal concerns. Other significant health concerns include CBD.

[00:37:25]I I don't know what NAFldD is.

[00:37:28]>> Non-alcoholic fatty liver disease.

[00:37:30]>> Oh, we were just talking about that.

[00:37:32]>> Yeah, it's not MLDD.

[00:37:35]>> Interesting.

[00:37:36]>> Um, sleep apnea, anxiety and depression, cancer, type 2 diabetes, and METS, >> metabolic syndrome. These these are some of the deadliest conditions in the world, including the top two causes of death in America, cardiovascular disease and cancer. PCOS is not merely a nuisance. It is an important warning of risk. For this reason, it's worth taking a closer look at each of these conditions in more detail to try to understand their link with PCOS, which is quite interesting because now they're since they changed the name of it, they're looking at it's not causing metabolic syndrome. metabolic syndrome could be causing the PCOS. So, it's quite simple chapters kind of gotten turned upside down with the new research.

[00:38:22]>> Oh, yeah. Exactly. And it's like are these these are probably more associations because you have somebody with an underlying metabolic problem and these all these issues come with the underlying metabolic problem and PCOS just happens to be one of them. Mhm.

[00:38:44]Mhm.

[00:38:45]>> Right. It's quite interesting how that all of that research that just came out is going to change the landscape of PCOS.

[00:38:53]>> Oh yeah. It's going to change the approach because it'll it'll it'll tackle all these at the same time.

[00:39:00]>> It'll be amazing.

[00:39:01]>> Yeah.

[00:39:02]>> Understanding the link between polycystic ovarian syndrome and its associated risks. PCOS must be considered more than merely a disorder of excess facial hair, acne, and abnormal reproduction. Patients with PCOS have double the chance of being hospitalized compared with those without the disease. The United States spent an estimated $4 billion in 2004 on health care related to treating PCOS, an amount equal to the entire gross domestic product of Barbados.

[00:39:32]Much of this cost, 40.4%, 4% is due to the associated type 2 diabetes.

[00:39:38]>> Even more sobering, this number likely underestimates the true costs because it takes into account only the reproductive years and not the associated health risks such as type 2 diabetes, heart attack, strokes, and cancer that may arise in the future. These diseases typically occur in a woman's post-menopausal years and are many, many times more expensive than treating than simply treating PCOS.

[00:40:02]Furthermore, PCOS is one of the leading causes of infertility and in vitro fertilization, which it is its own multi-billion dollar industry. And as we've seen, women with PCOS who do get who do become pregnant are at increased risk of obstetrical complications such as gestational diabetes, pregnancy induced hypertension, and preeacclampsia.

[00:40:25]Though they are not part of the formal definition of PCOS, obesity leading to metabolic syndrome and insulin resistance leading to type 2 diabetes have been frequently noted in patients and affect an estimated 50 to 70% of women with PCOS.

[00:40:42]The close link between obesity and type 2 diabetes suggests that all three conditions have the same underlying root cause. All three are now understood as metabolic diseases, putting women with PCOS at high risk later in life for cardiovascular disease, strokes, and cancer.

[00:41:00]Perhaps the most important associated disease is a history of weight gain that often precedes the diagnosis of PCOS. Of the obese women referred to one clinic, 28.3 were diagnosed with PCOS. PCOS can be more common as severity of obesity increases. But more importantly, weight loss has also been proven to reduce testosterone, improve type 2 diabetes, and decrease here.

[00:41:26]You're the only one that can say that word, Lynn.

[00:41:27]>> Hersudism.

[00:41:28]>> Herudism. More on this later.

[00:41:31]>> Whoever decided to name it that, I just really question them. It does not roll off the tongue.

[00:41:37]>> No, it doesn't.

[00:41:39]>> No, not at all. But you know I I know that with me I started having um at the same time I started gaining weight and I also started having twice a month periods and yeah like literally it was the same time is and so but it was also following a few really stressful years where I had a tremendous amount of stress and then I had also gone away to college. I was a junior, got away to college, and my eating was terrible.

[00:42:14]>> Yeah, it was awful. It was pretty much completely carbs and not good.

[00:42:20]>> Yeah.

[00:42:20]>> So, I'm sure that had both of those components had something to do with it hitting because I mean, I don't think I was predestined to have PCOS.

[00:42:32]Yeah. I think it's just >> Yeah. I I think it happened because of what I was exposed to as far as food and stress, >> right?

[00:42:42]>> Yeah. Probably could have avoided it.

[00:42:45]>> Yeah. Yeah. It makes you think there's so much I think that could be avoided, you know. I mean, if we only knew, right? I mean, that kind of gets back to like, you know, for example, feeding my cat kibble. I mean, I didn't know, you know, I just thought, "Oh, they sell it in the store. it must be safe for him to eat. I mean, you know, it's just something that you never really thought of >> and then only later you know better.

[00:43:13]>> So, yeah, >> hindsight.

[00:43:15]>> Yeah, it's always 2020, isn't it?

[00:43:18]>> Yes, it is.

[00:43:20]>> Very true. All right. You want me to read?

[00:43:24]>> Sure.

[00:43:25]>> All right. So, pathophysiology.

[00:43:28]Well, there is a genetic predisposition to developing PCOS. Endocrine factors or insulin in response to diet, carbohydrates, and eating can determine who develops PCOS and who does not.

[00:43:40]That's just what I basically just said.

[00:43:42]>> Yeah, we were just talking about that.

[00:43:44]>> Yes.

[00:43:44]>> And no, we didn't read ahead.

[00:43:46]>> Yes. It has to do with like epigenetics, right? Just because you have the genetic tendency doesn't mean that it's going to express. There's certain things that have to be fall into place in order for that to happen.

[00:43:57]>> Okay. So insulin the storage the energy storage and energy use hormone. The body's set weight or BSW sets an ideal body fat percentage that it defends just like our house thermostat. Below this set point, the body attempts to gain weight. Above this set point, the body attempts to lose weight. The body seeks homeostasis, which is why counting calories is futile. The body can burn more or fewer calories depending on the situation.

[00:44:28]The hormone insulin instructs the body to gain body fat. If you keep feeding the body, it will continue to gain body fat. Insulin will keep directing the body to convert the food energy to glycogen and body fat. This is the reason that snacking continuously leads to weight gain. It is also the reason that insulin injections lead to weight gain. Your body has no mechanism to count calories.

[00:44:56]So basically there's a there's a diagram here that basically says high insulin is basically the root cause of all these other things. So >> um so so insulin is the common link. So given that obesity is a hormonal imbalance that results in the gradual increase of the body uh set weight. I got to remember that BSW body set weight thermostat over time it is likely that that the root cause of PCOS is also hormonal.

[00:45:28]But is insulin the other factor? In the study of a disease the most crucial piece of information is its ideology? If you know that a virus causes hepatitis C, you can prescribe an antiviral that kills the virus and cures the disease.

[00:45:43]If you understand that smoking causes lung cancer, you can prevent much of this disease by introducing smoking sessation programs. We can get a hint of PCOS's ideology by looking at its associated conditions. So, insulin and hyperandrogenism.

[00:46:00]Excessive insulin causes both. Number one, overp production of testosterone.

[00:46:05]And number two, increased decreased sorry, decreased sex hormone binding globulin concentration that leads to increased testosterone effect.

[00:46:16]The striking correlation between blood glucose blood concentrations of insulin and testosterone was noted as far back as 1980. When ovarian cells are purified and bathed in insulin, they increase testosterone production significantly.

[00:46:33]Insulin is the major regulator of sex binding uh sex hormone binding globbulin or SHBG production in the liver.

[00:46:44]The higher the insulin, the lower the sex hormone binding globbulin production. This relationship holds true not just in women but also in men.

[00:46:53]Decreasing insulin concentrations through weight loss increases sex hormone binding globbulin.

[00:47:01]Interesting. So the lower you have the lower uh sex hormone binding globbulin you end up having higher testosterone. Is that what I'm getting out of this?

[00:47:16]>> That's how I read it.

[00:47:17]>> Yeah. And so, yeah, so the higher your insulin, the lower your sex binding, sex hormone binding globbulin is going to be, which means then you're going to have higher testosterone.

[00:47:31]That's interesting because what about these guys who end up going on a carnivore diet? They reverse their insulin resistance and their testosterone goes up. Yeah, it's almost opposite of that because I was just thinking that um because my husband had that, you know, I mean like the testosterone levels like tripled, >> right, >> just on carnivore. So >> maybe it's because they're men though and it should >> maybe. I don't know. Hard to say, you know, because I mean their bodies react, you know, our bodies react differently.

[00:48:07]though to other things.

[00:48:10]>> I wonder if it has to do with the um where where it the testosterone is being produced.

[00:48:19]>> Yeah, that could be because it was talking about like uh bathing the ovaries in insulin. So if it if that happens then you know in women then that's understandable that it would cause you to have too much of the testosterone as a you know as a woman which women aren't supposed to have that much. But then if men in turn like >> but the men when they lower their insulin their testosterone >> I'm confused. Well >> I am kind of confused but >> it's not clear. answered. Let's see if it gets answered. Sometimes it does and ends up getting answered later.

[00:49:00]Okay, so the next section is the surprising link between insulin and reproduction. The ovary itself is particularly rich in insulin receptors, which seems rather strange at first glands because insulin is most commonly associated with digestion, blood, glucose, and body fat. Why would the ovaries carry insulin receptors? In fact, the pathway that the pathways that link reproductive function and metabolism are seen in virtually every living animal from fruit flies to roundorms to human beings. Why? The answer is that all animals need to know that food is available before committing to reproduction. Raising children requires a good deal of resources, including adequate food supplies for both the expectant mother and the developing baby. We can therefore conclude that a high insulin concentration is the primary factor stimulating excessive ovarian production of testosterone and that this increased androgen or hyper andro hyperandrogenism is responsible for the masculinizing features of PCOS including acne and heretism.

[00:50:12]Hyperinsulinemia is the root cause of hyperendrogenism.

[00:50:17]Too much insulin causes too much testosterone.

[00:50:21]Is insulin responsible for the lack of ovulation and polycystic ovaries too? In 1982, it was first observed that the ovaries of women with PCOS contain two to three times the number of small primary follicles measuring 2 to 5 millime.

[00:50:40]More recent studies suggest up to six times the usual number. The small ovarian follicles are rich in testosterone receptors. And it was determined that high testosterone concentration was forcing too many primordial follicule follicles from the resting phase to become primary follicles.

[00:51:02]Hyperinsulinemia causes premature response to luteinizing hormone which stops further follicular development.

[00:51:11]In PCOS, the many small follicles do not mature to become eggs that can be pushed out to the uterus for fertilization.

[00:51:19]This failure failure of ovulation causes an ovulatory cycles of menstrual irregularities and the excessive numbers of small follicles fill with fluid and are visible as polycystic ovaries.

[00:51:35]So, that didn't really answer the question. Should I check?

[00:51:41]Let me see what chat GP say. He says, "Why uh does high insulin lead to high testosterone in women, but lowering insulin often increases testosterone in men."

[00:52:11]Okay, let's see. Okay, so what do we suggest?

[00:52:15]So suspected this comes down to how insulin interacts with different tissues, hormones, and metabolic states in men versus women. The short version is that insulin is not a testosterone hormone by itself. It changes the hormonal environment around the testes or ovaries and the effects differ between male and female physiology.

[00:52:39]In women, high insulin often raises testosterone. This is especially common in polycystic ovarian syndrome. High insulin can increase testosterone in women through several mechanisms. One, insulin directly stimulates the ovaries.

[00:52:53]The ovarian thea cells respond to insulin. When insulin is chronically elevated, the ovaries are pushed to produce more an androgens including testosterone. Insulin also amplifies the effect of luteinizing hormone which further drives androgen production.

[00:53:08]Um, two, this is the one they talked about. Insulin lowers the sex hormone binding globbulin. So, we already read about that. And then hyperinsulinemia disrupts ovulation. So, when ovulation becomes irregular, progesterone tends to fall and the hormone balance shifts towards excess androgens.

[00:53:28]Um so in many women lowering insulin through car carbohydrate restriction weight loss or improve metabolic health reduces ovarian androgen production and raises sex hormone binding globbulin lowering free testosterone. So that's women which is kind of we talked about that. So it says in men high insulin often lowers testosterone.

[00:53:51]So in men chronic hyperinsulinemia is usually associated with lower testosterone not higher. This happens through several pathways. Insulin resistance impairs testicular function.

[00:54:04]Now that makes sense. The testes require a healthy metabolic environment. So chronic inflammation, fatty liver, elevated triglycerides, and insulin resistance impair le cell functions which lowers testosterone production.

[00:54:20]And then obesity increases aromatization in men with insulin resistance. Excess visceral fat converts testosterone into estrogen through the enzyme aromatase.

[00:54:33]So more body fat equals more estrogen which equals more suppression of the hypothalmic pituitary gonodal axis that that can reduce testosterone production further. High insulin also suppresses the te the sex hormone binding globbulin in men too.

[00:54:50]Um it may initially increase free testosterone slightly but over uh time total testosterone often drops enough that total free total and free testosterone become low and then yeah the metabolic syndrome suppresses the brain test signaling access which reduces testosterone production. So it was definitely true. It's like changes. Yeah. In men versus women.

[00:55:17]So >> that's incredible. Yeah. Interesting. We should probably stop here. I But my brother actually just tried to call me and I never hear from him. So, I'm just wondering if there's something wrong.

[00:55:30]>> Yeah. So, should probably call him back.

[00:55:34]>> All right.

[00:55:35]>> So, but awesome. Well, I'm glad we had a chance to meet and um hopefully we'll be able to meet again and next week pick this up because it's been >> I know the week of the 15th I'm going to be out of town though. I'm going to be on vacation. So, >> okay, sounds good. We'll just keep keep you posted and I may not remember that, but just let me know.

[00:55:57]>> Okay.

[00:55:59]Theo for who joined in and and glad to see we had people here, which was awesome.

[00:56:04]>> Yes.

[00:56:04]>> Yeah. So, we'll see you guys next time.

[00:56:07]>> All right. Find