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26/Jul/2022

What is PCOS?

Finding an effective treatment for Polycycstic ovarian syndrome (PCOS) is important to me for two distinct reasons. 5-10% of woman are impacted by PCOS in their lifetime making PCOS a common and treatable condition in my Naturopathic practice. The second reason is that it is a condition that my wife has struggled with for many years therefore making it a syndrome that hits close to home.

PCOS is a bit of a misnomer as it is a continuum of symptoms and doesn’t necessarily have to include ovarian cysts. It is however characterized by several common objective findings including irregular periods, infertility, shifts in hormone balance (DHEA, Testosterone, LH, FSH), hirsutism (hair growth on the lip, chin and abdomen), Hair loss (Male pattern head hair loss), acne (typically on the lower jaw), high levels of insulin due to insulin resistance, and unexplained weight gain (especially around the abdomen).

Although we still do not know all the mechanisms involved as to why some women develop PCOS, there does seem to be a genetic component. Environmental toxins such as BPA seem to play a role, and gastrointestinal dysbiosis (unfriendly bacteria in the gut) plays a role as well.

Conventional Treatment for PCOS

Some of the more common conventional treatments of PCOS include birth control pill (to regulate irregular periods and hormone levels), metformin (a insulin sensitizing drug that helps to control blood sugar levels commonly used in diabetes), and spironolactone (a diuretic that also has the ability to block a type of testosterone formation called DHT). While these treatments can be helpful in the short-term they do not always address the root cause of PCOS and therefore ultimately fail in the long term. Some of these causes include hormone disrupters in the environment and diet, and gastrointestinal dysbiosis (leading to the production of inflammatory compounds that compromise insulin function).

Holistic Treatment for PCOS

Luckily there are relatively easy and low cost solutions to many of the fundamental causes of PCOS. As a Naturopathic Doctor I have the privilege and ability to take a detailed medical history. Doing so can point me in the direction(s) as to where these foundational imbalances are occurring. For instance if the patient has a history of gastrointestinal concerns, (constipation, diarrhea, gastritis, colitis) that informs me to focus investigation on the gastrointestinal tract. If a patients main concern is infertility and irregular periods I will shift focus into hormone balance. It may also be the case that a patient has several concern at the same time, which is not uncommon in PCOS. Once I know where to focus we can run specialized tests such as comprehensive stool analysis, female hormone panels, nutrient level panels, food sensitivity testing and environmental toxins. This aids in narrowing down where to implement the bulk of the treatment protocol. There are some general recommendations that are sure to aid all women with PCOS such as exercise, reduced carbohydrate diets and lowering exposure to petrochemicals. However, the medical history and specialized testing can be a guide for more specific recommendations.

Functional Testing for PCOS

A nutrients panel test can help determine if there are specific nutritional deficiencies such as low levels of vitamin D, vitamin A and omega-3 fatty acids, which tend to be common in PCOS. A female hormone panel can determine if there are specific imbalances with sex hormones. These imbalances can potentially be corrected with dietary recommendations, bio-identical  hormone replacement, and nutraceutical supplements. Evidence of dysbiosis in gut from a stool analysis can be reversed with dietary recommendations that promote colonization of helpful butyrate producing bacteria. Nutraceuticals containing antibiotic herbs can preferentially kill harmful bacteria while protecting good bacteria. Probiotic supplements containing specific strains of bacteria and prebiotic fibre can be very effective. Food sensitivity testing can help confirm if there are specific foods in the diet that are activating an immune response, causing further inflammation in the gut. Environmental toxin analysis would shed light on high levels of exposure to particular toxins, most of which are known hormone disruptors. Even the simple testing of insulin levels and blood sugar can lead to recommendations for easily accessible compounds like inositol, L-carnitine and chromium which can effectively increase insulin sensitivity.

Conclusions

The take home message is that PCOS is an extremely common and often disruptive condition for a significant amount of women worldwide. The conventional treatment of PCOS often does not provide long term solutions and can have significant side effects. Simple and inexpensive solutions through dietary, supplement and lifestyle recommendations can address the root causes of PCOS and bring about significant symptom relief with long-term sustainability. I therefore encourage anyone suffering from PCOS who hasn’t found an effective solution to contact a local Naturopathic Doctor or Functional Medicine Doctor for an assessment. If you would like to contact me, you can do so through the appointment page by clicking the link in the menu bar. The sooner you start to address the root causes the easier and quicker long lasting symptom relief can be achieved. That being said, implementation of a functional medicine approach to PCOS will undoubtably be helpful at any stage and at any age.


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13/Oct/2015

Title: Reduction in symptoms associated with Fibromyalgia at six weeks using Intravenous Vitamins and Minerals (Myers Cocktail).

Running Header: Myers Cocktail for Fibromyalgia

Author: Dr. Shawn Meirovici N.D.

Physio-Logic 96 Scarsedale Road, Toronto, Ontario, M3B 2R7

Disclaimer: Patient consent was obtained

Key words: Intravenous, Vitamins, Minerals, Fibromyalgia

Abstract: Fibromyalgia is a musculoskeletal disorder characterized by widespread pain commonly with one or more coexisting symptoms. Treatment often includes both non-pharmacological and pharmacological therapy. Pharmacological therapy includes the use of antidepressants and GABA derivatives with varying success rates and often with unpleasant side effects. Micronutrient infusion is a newer approach with the majority of use in the field of alternative medicine. To date one placebo controlled pilot study has examined its use in fibromyalgia patients noting statistically significant effects on pain and fatigue. The following is a case study using a similar “cocktail” as the one used in the placebo controlled trial, for 4 treatments using the modified visual analogue scale of the fibromyalgia impact questionnaire (mVASFIQ) as an endpoint measure. Significant reduction in all parameters of the mVASFIQ was noted at 6 weeks, suggesting that micronutrient infusion should be further investigated as a treatment approach for fibromyalgia.

 

Background: I have a special interest in the treatment of chronic pain. Operating out of a rehabilitation clinic in Toronto, Canada has allowed me the opportunity to work with neurological conditions and traumatic injuries of which chronic pain is often a prevalent symptom. Fibromyalgia is characterized by chronic widespread pain and often involves disruption of many body systems including the gastrointestinal tract. While pharmaceutical intervention is focused on regulating the body’s response to pain, many alternative therapies are focused on restoring function to debilitated body systems. One such treatment is the Myers Cocktail: a intravenous micronutrient therapy that delivers vitamins and minerals directly into the blood stream thereby  bypassing the gastrointestinal tract. There is both a review and placebo controlled pilot study demonstrating intravenous micronutrient therapy as an effective treatment for symptom reduction in fibromyalgia. [1] [2]

 

Introduction: Fibromyalgia is characterized by chronic widespread pain, increased tenderness at specific sites known as “tender points,” un-refreshing sleep, fatigue and cognitive dysfunction not attributable to other disease states. While the etiology of fibromyalgia is not entirely clear, associations with trauma, adverse life events, impaired mood, anxiety, irritable bowel syndrome, cold intolerance, paresthesias and other medical conditions have been described. The pharmacologic treatment of fibromyalgia ranges from antidepressants to analgesics. Here we are commenting on a novel treatment involving the infusion of vitamins and minerals also known as a Myers Cocktail.

 

Case Presentation: J.M. is a 38-year old female who had been diagnosed with fibromyalgia in 2008. Her  symptoms started approximately 10 years ago after enduring a series of traumatic life events. Symptoms included: chronic widespread pain, non-restorative sleep, muscle weakness, morning stiffness, subjective swelling, multiple chemical sensitivities, frequent severe headaches, vestibular dysfunction, TMJ, paresthesia, chronic fatigue, dysmenorrhea, anxiety and irritable bowel syndrome. J.M. had tried a number of GABA derivatives, antidepressants and analgesics with varying degrees of relief but with significant adverse reactions including aphasia, depression and dyspepsia. At initial presentation, J.M. was taking Wellbutrin 300mg XL daily and Tylenol with Codeine as needed. She felt that she was starting to develop a tolerance to Wellbutrin. She was not taking any dietary supplements and was not on any type of specialized diet or exercise program.

J.M. was prescribed an intravenous infusion Myers Cocktail (B-complex 1ml, Dexpanthenol 250mg, Pyridoxine 100mg, Hydroxocobalamin 1mg, Ascorbic Acid 2000mg, Calcium Chlroide 100mg, Magnesium Chloride 1000mg and Sterile Water 46ml) via 60cc syringe with a 24 Gauge butterfly needle at the right median cubital vein, delivered over 15 minutes once per week for 4 infusion sessions. This patient completed a modified visual analogue scale of the fibromyalgia impact questionnaire (mVASFIQ) at initial consult (Image 1) and again after her final infusion (Image 2). She was also prescribed magnesium malate 1.5 grams per day, 1000iu vitamin D per day and 1mg melatonin at night 30 minutes before sleep. However, J.M. was admittedly not taking these supplements consistently during the 4 weeks of intravenous treatment.

The mVASFIQ score at treatment initiation was: (Fatigue 9.5, Insomnia 9.5, Depression 4.5, Anxiety 6.5, Rigidity 8.5, Pain 8.5, Difficulty with work 8.5) at four weeks the mVASFIQ score was: (Fatigue 3, Insomnia 5, Depression 1, Anxiety 3, Rigidity 3, Pain 3, Difficulty with work 3). Besides mild nausea and flushing during the first treatment no adverse effects were reported.

 

Discussion: Micronutrient infusion delivers vitamins and minerals involved in stress response, muscle contraction and nerve signaling, while able to bypass the need for gastrointestinal absorption. This is an effective delivery method for chronic conditions, such as fibromyalgia, where there is often gastrointestinal disruption as well as the potential for micronutrient deficiencies. The results of this case study demonstrate that micronutrient infusion Myers Cocktail may be an effective treatment for fibromyalgia related symptoms as indicated by a  decreased in symptoms score on mVASFIQ at 6 weeks post treatment. This joins the small collection of evidence for the validity of this treatment for fibromyalgia. More study into this treatment for fibromyalgia is warranted.

 

Confounding Factors: As was outlined in the treatment plan, J.M. received a few dietary supplements on initial consult; however, J.M. admitted to not taking these consistently throughout the 4 intravenous treatments. The patient received all 4 infusions by myself and was not blinded to the treatment. There was also no placebo control. Additionally, the patient may have been influenced by the doctor patient relationship or through placebo effect. However the significant improvement observed within a relatively short time helps to validate the results of this study.

[1] Intravenous Micronutrient Therapy (Myers’ Cocktail) for Fibromyalgia: A Placebo-Controlled Pilot Study, Ather et al., The Journal of Alternative and Complementary Medicine, Volume 15, Number 3, 2009, pp. 247-257

[2] Myers’ Cocktail, Dr. Alan Gaby M.D., Alternative Medicine Review, Volume 7, Number 5, 2002.

 Image 1

Table 1

mVASFIQ for J.M. on July 18th 2015 (patient incorrectly marked X in box rather than a check through the appropriate line, therefore, results have +/- 0.5 confidence interval.

Image 2

Table 2

mVASFIQ for J.M August 28th 2015.


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Patient focused integrative health care. Utilizing effective natural approaches designed to be used alone or to compliment conventional medical care.


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