PCOS Is Now PMOS: How Hormones, Insulin & Fertility Are Connected – with Dr.Mark Ratner

Mark Ratner 

Polycystic Ovary Syndrome doesn’t really describe it accurately. There has been a movement to rename the condition. And so the name they chose was Polyendocrine Metabolic Ovarian Syndrome. So arguably it is a more accurate description and my concern is that the name change doesn’t really do anything to change the way reproductive endocrinologists view these patients. They are not geared towards holistic approaches of lifelong issues that need to be followed up. They have a very tight focus on just the reproductive aspects.

Lorne Brown 

By listening to the Coherence Code Podcast, you agree to not use this podcast’s medical advice to treat any medical condition either in yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Welcome to the Coherence Code Podcast, where we explore how the mind and body work together so you can move from stress and inner conflict to clarity, calm, and a welcome. My name is Lorne Brown. I’m a doctor of traditional Chinese medicine and a clinical therapist. And through my work, I’ve seen that healing happens when we remove what gets in the way and allow the body and the nervous system to do what they’re designed to do to heal.

Lorne Brown 

Welcome back to the Coherence Code Podcast. Today I’m with Dr. Mark Ratner and I think he now gets the certificate or the award. I think he’s the only guest that I’ve had on three times on the Coherence Code podcast actually. So congratulations on that. If you’ve missed the other ones, we’ve done two other episodes thus far. Episode 142 was on fueling fertility with NAD and episode 143. The second episode was on resveratrol and IVF. And today we’re going to talk about male fertility and we’re going to talk about what used to be called PCOS, now called PMOS. And he’s going to define that and tell us what he likes about the new definition and not. And then obviously solutions and things that are available and basically for those that are looking to conceive. So it takes two, a sperm and an egg to make a baby.

So the underserved often dismissed part of the equation, the sperm. We’re going to talk about that today. And then we’re going to go into PCOS now, PMOS, because it’s one of the most common or the most common ovulatory disorder related to infertility. So our guest today, as I mentioned, is Dr. Mark Ratner. He is a board certified urologist, hence we’re going to talk about male fertility and the chief science officer of TheraLogix, which markets micronutrient supplements with a focus on reproductive health. Dr. Ratner did his undergraduate and graduate studies in nutrition at Cornell University, so he is qualified to talk about supplements. And he received his MD. He’s a medical doctor in his residence training at Tulane University School of Medicine. And back in the day pre – COVID, when I used to chair the Integrated Fertility Symposium, we ran that for five years. I had the great privilege of having Dr. Mark Ratner as one of our speakers at the conference as well.

Mark, welcome back.

Mark Ratner 

Thank you, Lorne. Nice to be back.

Lorne Brown 

You’re a three-timer.

Mark Ratner 

Yeah, I have to get a little badge or something.

Lorne Brown 

I got to get a badge for you. It’s not so much like Saturday Night Live where you get the green jacket, right? 

Mark Ratner 

The Five-timers.

Lorne Brown 

Five-timer, right? But I really enjoyed our conversations and people enjoyed the one on NAD, episode 142, now on resveratrol. And so you and I were chatting like, let’s talk about more things that can support the couple. I want to get into the male side, but I know it’s because it’s really current at the time of the recording. There’s a new definition. So can you define PCOS, PMOS, what has happened and why it’s important to A, to know about PMOS, but what you like and don’t like about the new definition?

Mark Ratner 

Sure. Okay, great. So back in the 1950s, there were two gynecologists, Dr. Stein and Dr. Leventhal, who first described a syndrome that they had noticed that they had diagnosed in many women that they were seeing in their practice. And it was at that point they named it Stein-Leventhal Syndrome. And the typical findings in Stein-Leventhal syndrome were very irregular menses. So sometimes the women would just not have a period for six or 12 months, or sometimes they would be just very irregular throughout the year. These women would have testosterone or androgenic effects in skin and hair. So things like women would lose hair on top of their head, what we call male pattern baldness. They could have unwanted excess hair on places where they normally have hair on their chin or on their arms. They would get acne. Those were all effects of too much testosterone.

And then the other thing that they found was that many of these women, not all, but many of the women on ultrasound, they could see they had abnormal cysts on their ovaries. So at first this was called Stein-Leventhal Syndrome, but then probably within about 10 or 15 years, there was a new name assigned to it and they ended up calling it polycystic ovarian or polycystic ovary syndrome. And that was abbreviated PCOS. And PCOS has long been sort of the redheaded stepchild as the expression goes of women’s health. There hasn’t even been good agreement on exactly how to make the diagnosis. There have been multiple agencies or authorities that have weighed in on how to make the diagnosis of what has been called up till now PCOS. You had the Rotterdam Conference, you had the NIH Consensus Conference, then the Androgen Excess Society weighed in, and they all had their own little versions of exactly how you need to make this diagnosis.

There were three components though that they all more or less used in different combinations. Irregular menses, polycystic ovaries, and androgenic side effects. Androgenic, the effect of too much testosterone.

Lorne Brown 

And I want to define just for the regular menstruation is the Oligomenorrhea or menorrhea. So delayed or no menses.

Mark Ratner 

Exactly. Yeah. So what effects does this have on women who are affected by it? Well, the first obvious thing is fertility. Because if you’re not getting your period, it means you’re not ovulating. And if you’re going to get your period and ovulate only once every three months or four months and without any kind of predictability, it’s extremely difficult to time intercourse. And as a result, these women have significant issues with fertility. And as you mentioned, it’s the number one cause of anovulatory or… There are different causes for female infertility, one of which is a failure to ovulate. And this is by far the most common cause of that type of female infertility. So you had all these different ways of possibly making the diagnosis. And for many years now, it’s been dramatically underdiagnosed. Now what do we mean by that? It’s been estimated that 60 to 70% of women who have PCOS or now called PMOS, which I’ll explain in a second, remain undiagnosed.

They have not yet been diagnosed. They don’t know that they have it. And another study showed that when women do finally get diagnosed, on average, they have seen three providers with these issues before they finally get the correct diagnosis provided to them. So there’s been a real problem with getting these women diagnosed and then treated.

Lorne Brown 

And when it comes into my clinic, because it’s outside my scope as a Chinese medicine doctor, our naturopathic doctors luckily can, but women come in and they got a lot of acne. Their cycles are delayed, so they’re every 45 to 60 days. A lot of them, textbook, easy to gain weight, they look at a muffin. I have to say in Vancouver, I see the thin dry type phenotype actually though in our practice. But they would come in and that two out of three criteria, they never would think of that they had PCOS, even if you heard of it, because they have this idea that they have to have all these cysts, which most of them would not have it. And I would just say you have to now go to your doctor to get your diagnosis, but we could start treating our clinic with diet, with exercise, with supplements, acupuncture, herbs.

Because we can see the presentation. I just want to share as you unpack this, Mark, this is Chinese medicines. Chinese medicine’s all syndromes. We never look at on symptom in isolation. It’s very rare that we have, we do have, but it’s rare to have a hallelujah symptom that you have this symptom, this is the Chinese medicine diagnosis. Every symptom’s like a piece of the puzzle, and you start to put the pieces. So you give me two pieces, I’m like, I don’t know what’s going on quite yet. Once I have enough pieces, even if I don’t have all the pieces, I can tell you what the picture’s going to be on the box. So PCOS for us, when they would come in, it was easy for us in Chinese medicine to see what’s going on and start to treat it from a Chinese medicine perspective because everything is a pattern or what you guys would call a syndrome in Western medicine.

Mark Ratner 

Well, what you’re saying is that you think holistically.

Lorne Brown 

Yes.

Mark Ratner 

Okay.

Lorne Brown 

Systems are connected.

Mark Ratner

Yes. And unfortunately, allopathic medicine tends to be very siloed where you just think about the main complaint that the patient’s coming in with and you focus exclusively on that. And actually you raised one important point that I forgot to mention in that along with the testosterone excess and the irregular menses, about 70 or 80% of women with PCOS have a high BMI, so they’re overweight. But there is a small percentage, what we call lean PCOS patients, like you just mentioned, where these are women who don’t have an elevated BMI and yet they’ve got many of the other symptoms. Okay.

Lorne Brown 

Which is why they’re often missed by their physician because they’re not typical. But again, in Chinese medicine, because we’re not looking at one symptom, it was just so easy to see it because I wasn’t waiting for somebody to have that one piece of the puzzle being overweight.

Mark Ratner 

Right. Okay. So because this is such a complex syndrome and because only a small, it’s not a small percentage, but the majority of these women don’t have the polycystic ovaries on ultrasound if they do an ultrasound to look at their pelvis. There has been a movement particularly in academic circles around the world for the past at least six or seven years to rename the condition. And the reason the rationale was polycystic ovary syndrome doesn’t really describe it accurately. Not everybody has polycystic ovaries and there’s all kinds of other metabolic impact and metabolic issues that come along with it. Excess testosterone, typically cholesterol and triglycerides will be elevated. These women are typically going to have insulin resistance. So they are oftentimes pre-diabetic or maybe even have type two diabetes. And so there’s been this movement to try and get rid of the PCOS name. The problem is that now I’m getting into my own personal opinion here.

There has been for the last 10, 12 years, an advocacy movement that has taken root. And it has been focused on trying to raise awareness of PCOS, not only trying to drive more research dollars to it, but raise awareness amongst the public because as a condition, it has really fallen through the cracks. Now why? So you’ve got the fertility community, you’ve got the IVF docs. A woman comes in and maybe she’s got PCOS. They’re focused just on getting her pregnant. They are not focused on the fact that PCOS a lifelong condition with increased cardiovascular risk because of all the metabolic abnormalities and diabetes. It requires a holistic approach. It requires a multidisciplinary approach for good treatment. The fertility community, understandably, they’re focused on the reproductive aspects. Once you’re pregnant, congratulations and come back when you want another. The OBGYN community, which is also going to be sort of first line for these patients, they’re primary care doctors who are moving oftentimes at the speed of light in their practice.

They’ll see 30 or 40 patients in the course of a eight, nine hour day. They just don’t have the bandwidth or do they have that holistic approach that’s necessary to recognize this as a syndrome and to apply… Sometimes it not only takes maybe a visit to an endocrinologist, but maybe a dermatologist, maybe people for removal of excess hair, I mean electrolysis. I mean, there’s all kinds of other disciplines that need to come together. So they have focused, the PCOS community over the past 10, 12 years has really focused on driving awareness and they have done a terrific job.

Lorne Brown 

I want to unpack something because you said something that I think is important to highlight. When it comes to reproductive treatments, the clinics are often very focused on getting you pregnant.

Lorne Brown 

Sure.

Lorne Brown 

And also, by the way, the women coming in are, get me pregnant. So they have a shared interest. What I wanted to highlight is when you have this syndrome, which is systemic, there’s things happening, high androgens, inflammation, metabolic disorders, all the things that you’re talking about here. There are repercussions to the mom because our goal is to have healthy baby and healthy mom. So you talked about one part. There’s these risk factors for the mother to be later on in life with this condition, whether it tries to conceive or not with the lipids, triglycerides, cardiovascular disease, metabolic diseases like diabetes. There’s also health risk factors for the baby. There’s gestational diabetes in pregnancy. There’s risk factors for the baby and –

Mark Ratner 

Triple the risk, triple the risk.

Lorne Brown 

And the other part that I always like to share with patients, I’m even going to give you a short anecdotal story here is when you have irregular cycles or oligomenorrhea like long cycles, you have a hormonal balance. You have definitely much more estrogen to progesterone. You’re not having a balance cycle. You’re not bleeding every 28 days, you’re bleeding every 60 days. You may have, like you talked about the high blood sugars, more inflammation. All of this is going to impact egg quality, which is your goal to get pregnant. So if we just force it with letrozole or clomid in ovulation or an IVF, that doesn’t mean we’ve made the best embryo, which will turn into a blastysis which turns into a live birth. Also, all those hormone dysregulation imbalances, inflammation, high androgens in the uterus can diminish uterine receptivity. So now we have more implantation failure.

So here’s my story because I know you’ll be able to tie this in and you have this in your clinical cases and probably through TheraLogix, things that you’ve helped women. So I had a woman that came to me because through her reading, she’d gone through IVF, first transfer chemical. So there’s the implantation issue. She did not stick. Second transfer, no pregnancy. She came because she heard through our clinic that the integrative approach that we can help balance her hormones, the inflammation, and levels, because she wanted to improve uterine receptivity. I shared with her that we actually cannot just focus on your ovaries. There’s the holistic part and everything we do, we can’t just focus on your uterus. So we’re looking for lots of changes. She came in overweight. She came in experiencing depression, which is common. Hopefully you’ll talk about this. She had hirsutism, so she had hair where she didn’t want it.

She had acne and she does not ovulate. She didn’t even ovulate on some withdrawal bleeds with progesterone. And the reason she did IVF is clomid letrozole would not force an ovulation for her. 

So that’s why she was what we call stubborn back in the day, PCOS. So we worked with her and over a four and a half month period, her acne went away. She shared that she noticed her hirsutism changed. She lost like 20 pounds and her mood changed. And that following month, she conceived naturally and had that baby. So she went through IVF, transfer one chemical, transfer to negative. We were working on uterine receptivity. I shared if what we do really balances things, you may start to ovulate again, which is when she laughs, says, “I don’t even ovulate with a progesterone withdrawal or with an ovulation drug.” And I said, “Well, more unlikely even this won’t do it, but if we can balance things, there’s a chance.” And then when we saw her skin, her weight, her mood, her gut health change, we were aware that her systems have changed. And we were curious if all of a sudden she would ovulate on her own, which did happen in that case. And so she was on supplements and you’re going to talk about myo-inositol and D-chiro emotions. And we did acupuncture, we did Chinese herbs. I’d love for you to bring in my little case study as you’re explaining what’s going on and why it can impact egg quality and uterine receptivity because you had shared, rightfully so, the health of the mom, but there’s a health of a baby issue.

And if you have this syndrome, it also can impact your chance of getting pregnant with IVF or with Clomid because it’s not addressing the underlying cause. It’s just forcing ovulation.

Mark Ratner 

Yeah. So it’s very interesting that you bring this up. We are actually in the very final stages of a clinical trial. We’re not doing the clinical trial. It’s being done at the University of Oklahoma by the reproductive endocrinologist there. They are randomizing women with PCOS to either letrozole plus placebo or letrozole plus ovasitol, our inositol supplement. And then over the course of six months they get, I think it’s up to four cycles of IUI. It’s about 150 women being randomized into these two arms. So letrozole alone or letrozole plus placebo versus letrozole plus inositols. And I think we’re very hopeful that what it’s going to show is that by correcting the metabolic abnormalities, letrozole or anything that’s going to just force you to ovulate the story you told, I mean it didn’t even work. That’s not going to get at the underlying metabolic issues.

Lorne Brown 

I wish you had a third arm just because of what I’ve seen clinically. I wish you had an arm because standard of care letrozole, right? I wish you had an arm just your myo-inositol with a D-chiro because there are women I have worked with that every time they do the letrozole or Clomid, their cycles actually get a little wonky. And when we have three to four months when they’re not on it, that’s when we’ve seen them conceive naturally, not when they’re on the letrozole. I’m not saying let people don’t get pregnant. I just like to see because you have this assumption that letrozole is benign and everybody responds great. I just had a talk on menopause the other day. Some women do not respond well to progesterone therapy in perimenopause. So same thing. It’s a small population, but clinically I’ve seen some women, it doesn’t do wonders when they’re on these ovulation drugs.

Mark Ratner 

So to be clear, we didn’t design the protocol or the study.

The University Of Oklahoma came to us and said, “Can you give us our product Ovasitol to use in one arm and make us matching placebo for the other?” And we did that. So they just enrolled their last subject and it’ll take another six months for that subject to go through the treatment and the protocol and then we’ll get some results. But we’re hopeful it’s going to be exciting. But your point is extremely well taken. I mean gestational diabetes, large birth weight, increased the risk of C-section because babies are so big when mothers have elevated blood sugar late in pregnancy. So there’s all kinds of ways that correcting PCOS helps both the mother and the baby. The problem is, and this is, I mean, listen, I was in clinical practice for many, many years working very closely with large IVF practice. It takes several months on, let’s say you use inositols.

It takes at least three months, maybe as long as six months of treatment with inositols to get a really good response in terms of these metabolic outcomes, getting blood sugars and insulin level, HbA1cs down, getting testosterone levels down. It takes a while. The thing about fertility practice is that every couple that comes into a fertility clinic essentially freaked out. They thought they were going to have no problem.

They wanted to be pregnant a year ago and now the bottom is falling out. And so if a provider says to them, okay, well, we can try a treatment that may take three to six months to restore better metabolic picture for you and restore ovulation more regularly, they’re worried, I’m talking about the provider, that couple’s going to walk down the street to their competition, to another practice that says, “Hey, we can get you pregnant in six weeks. We’ll just do IVF.” And IVF works in many instances for PCOS, but it’s not without cost and complications and risks.

Lorne Brown 

We got to start using the new name.

Mark Ratner

Yeah, I got to get to PMOS.

Lorne Brown 

Otherwise, data, so we got to start using the due name. We haven’t defined it. It doesn’t roll off the tongue-like polycystic ovarian syndrome. So what is the actual name? And I’m going to use the new name now.

Mark Ratner 

So what happened was this big group of academic endocrinologists and fertility docs, these are all professors from universities around the world. They formed a committee and somehow they were put in charge of choosing a new name. And so the name they chose was, I have to look at this, polyendocrine metabolic ovarian syndrome.

Lorne Brown

Doesn’t roll off the tongue. It does not roll off the tongue. But it does have meaning.

Mark Ratner 

Well, it does. Okay. So arguably, it is a more accurate description of the condition. Yes, it’s multiple endocrine issues at once. It’s not only reproductive hormones, it’s insulin, and it’s metabolic. It does involve the ovaries in most women. So that’s what they decided they would rename it. PMOS instead of PCOS. The problem is here in the States, the biggest organization that has driven advocacy and awareness is something called PCOS Challenge. They’ve been around for probably 10, 12 years and they’ve done a tremendous job of raising awareness about PCOS. And there’s a whole community outside of organized medicine that has grown up around this advocacy movement. There are influencers, there’s dieticians and PCOS. So if you’re a woman who’s been diagnosed in the past and now you hear something new, it’s called PMOS. The first question you have is, do I still have PCOS or do I now have PMOS?

So there’s confusion that way. And listen, I’ve heard a lot of physicians out in the community say that this change was driven primarily by the academic world because they want to see more research dollars come their way. And by making it arguably a more accurate term, even though it’s going to create confusion in the short term, that serves that purpose. So somebody said to me, “This is a change that will probably be more popular in conference rooms than exam rooms.”

Lorne Brown 

I know we already, in our blogs and stuff, we’re calling it PMOS/PCOS because short-term only is. And like you, I had to look. Every once in a while I go, “What’s it stand for? ” But it’s nice. Poly means many everybody. Endocrines, you’re saying many hormonal issues. You talked about the blood sugars, the androgens, male hormones. It’s in fact your progesterone estrogen because if you’re not ovulated, you’re not getting the progesterone. It’s a polyendocrine. And then they still talked about ovarian syndrome. So that part’s still there. Oh, metabolic. So again, there’s your metabolic dysregulation. There’s a lot of things we see in anti-aging general health issues as well as fertility. So 10 years from now, it will probably be grateful if the name sticks. But you’re right, a little bit of confusion, but it does make it better because I have to say majority of my patients do not have cystic ovaries like string of pearls.

And then they’re confused. I have a cyst or I have endometrioma. They think it’s that PCOS because you have a cyst or endometrioma, not. So actually it will help with that part of the… So there’s confusion, but it’s probably a better name than what we had before, but the patients are going to be confused, but they’ll help. Well,

Mark Ratner 

There was apparently amongst the people on this committee and all of the members of the PCOS community that they tried to interact with as they made this proposal, this decision, there was a movement or an attempt to try and find to keep the initials the same, keep using PCOS, but come up with different words that would represent. Look, personally, I think this is an example of perfect being the enemy of good. And we’ll see how it’s going to have to play out. Listen, if you go into PubMed and do research on reproductive issues, you’re going to have to continue to search for PCOS because for the past 30 years, that’s what it’s been called. And if you look –

Lorne Brown

I appreciate the academics, but again, entrepreneurs versus academics consultants, everything works in theory and the academics can have their coffee talks and make up things for us to implement. How is this impacting the treatment? What’s the issue here? We started talking about, but what is the issue if you have PMOS? And then what are you seeing as ways for people to help regulate this imbalance?

Mark Ratner 

So I think my suspicion and my concern is that the name change doesn’t really do anything to change the way reproductive endocrinologists view these patients. They are not geared towards holistic approaches of lifelong issues that need to be followed up. They have a very tight focus on just the reproductive aspects. It’s very interesting. At TheraLogix, we’ve got tens. We were the first company to come out with the 40 to one product inositol. It’s 40 to one myo-inositol to D-chiro-inositol. We launched that product 12 years ago. And at the time it was the only one. If you go to Amazon now, there’s probably 30 or 40 of them. So it’s become very popular. But the point is that those products and that approach requires a more holistic mindset. And both of the specialties that are rightfully should be there diagnosing these women and treating these women, they just don’t have the tools or the time.

And changing the name from PCOS to PMOS not going to change that. It really won’t. And so if we look at the underlying issue, and that is that most of the women with it have still not been diagnosed, they don’t know they have it. And for women that finally do get diagnosed, they have to see typically three different practitioners before they get the diagnosis. So how does the name change impact those two important problems? I don’t see how it does. So that’s my sense of it. And if OB-GYNs take it more seriously, it’s not that they don’t take it seriously, it’s that they just don’t have the time and the bandwidth to make the diagnosis. There’s also all this confusion about is it you got to have two out of the three? Which are the two that she have? Does she have cystic ovaries? Is she not?

It requires an ongoing educational process because it’s been a moving target over the past 20, 25 years. So That’s my take on it, that hopefully the name change won’t turn things in the opposite direction of what it’s intended to do.

Lorne Brown 

And then regardless of what it’s called, if somebody’s having delayed or no cycles, so oligomenorrhea or amenorrhea, they have the endocrine imbalances. So you’re seeing hirsutism, male pattern baldness, acne, they may have high so those are clinical high androgens or serum high androgens, they see it in blood, blood sugar. What is the approach from lifestyle, acupuncture, ovulation drugs, supplements? What are the things that you like for this group? Because listeners are… And I’ll remind everybody, this is for educational purposes only. Dr. Ratner is a doctor, but he’s not your doctor. You’ll have to talk to your healthcare provider.

Mark Ratner 

And keep in mind, I’m a board certified urologist, so I never actually treated a single patient with PCOS or PMOS, right?

Lorne Brown 

Perfectly. Yes.

Mark Ratner 

Okay. And this is probably a good way to segue into the male fertility part that I did treat

Lorne Brown 

That’s going to be our part too. But first, from the research you’re looking at, I know at TheraLogix, you see this, you’re very interested in this population and you create a product, you were the pioneer for the 40 to one ratio of myo-inositol to D-chiro. So what are some of the things that you’re interested in when it comes to supplements? So can you share some of the things you think from a supplement perspective? Can you comment on diet and lifestyle as well?

Mark Ratner 

To some degree, PCOS, PMOS, it’s a vicious cycle, as I say. The metabolic abnormalities, meaning the elevated blood sugar and hyperinsulinemia, too much insulin, those things make you gain weight. And then when you gain weight, then you’re even going to make those metabolic abnormalities worse. And so it’s sort of a vicious cycle. So the same things that you would recommend for somebody who has metabolic syndrome or type two diabetes. You want to meet with a dietician, you want to understand what constitutes healthy eating, avoiding simple carbs. There are some dieticians who basically forbid PCOS patients, PMOS patients to have dairy. They want them to have absolutely no dairy products at all. Exercise, absolutely important. I mean, all things that are targeting some weight loss. And then supplement-wise, the target from a supplement perspective is really reducing the hyperinsulinemia because the excess insulin, which is caused by insulin resistance, the cells become insulin resistant.

The reason they become insulin resistant in our periphery, in our muscles and fat is because the ratio between myoinositol and D-chiro-inositol is out of whack in those cells without getting too deeply into the biochemistry of it. The goal of inositol supplementation is to restore a normal balance, that 40 to one normal ratio, which will then help reduce the amount of excess insulin being produced, reduces the insulin resistance, and so the body makes less insulin. It’s actually the insulin that gets into the ovary and makes the ovary produce too much testosterone. So if you get at the underlying cause, reducing basically the excess insulin production, reducing the insulin resistance and the excess insulin production, and you can do that with healthier diet, weight loss, exercise, and something that reduces or improves insulin sensitivity. And that’s what the inositols do. Berberine does it also. The interesting thing that we have probably, I don’t know, tens of thousands of women who have been Ovasitol customers and still are Ovasitol customers getting regular shipments at this point.

We surveyed them about two years, three years ago. We sent out an email survey. I think we sent out 5,000 email surveys. And we wanted to know why are you taking inositols? And presumably obviously you have PCOS, but is your main concern or did you start the inositols because of fertility issues or because of the metabolic issues, because of the hair and skin and weight issues that come along with PCOS for most women? And it was a fifty fifty split. Half the women had started this supplement regimen because they were trying to get pregnant and the other half were not trying to get pregnant. They were just trying to deal with the effects of PCOS/PMOS. So it’s a complex issue, not only in making the diagnosis and finding the best treatment, but it’s also a mix of patients. It’s a mix of people who have different endpoints that they’re hoping for.

Lorne Brown

I’m going to contribute as well. I want to share with you on this. On the inositols, we had a podcast with Lara Briden, naturopathic doctor, and she talked about the Inositols. I think she has a book coming out on it as well of how many other things it does besides just that whole fertility side on it. And then Jerilynn Prior, who’s a retired but local endocrinologist here in the Vancouver area, she’s been on the Coherence Code podcast as well. She gave up, but she for decades tried to change the name to anovulatory androgen access. That was what she used to call it, AAE. Just try to give it a better name than PCOS. So for the listeners, they’d like some ideas here. So I’m going to share my approach integration. So the pillars that you mentioned, it’s always got to be about diet. So an anti-inflammatory diet, anti-inflammatory low-glycemic index diet.

We have a free diet on the Acubalance website, so you can go and download that, which has recipes for 21 days that help regulate blood sugar and regulate inflammation. Movement. So you got to move the body guys. Now the lean type, which we call the dry thin type in Chinese medicine, they’re less about they need exercise like big exercise. Movement’s always important. But exercise like to try and lose weight or really big sweat, probably for that type not as important, nor is the diet as important as nervous system dysregulation. In Chinese medicine, they often come with what we call, so for my colleagues, a liver cheese stagnation has nothing to do with the liver, a Chinese blood deficiency. So these are the ones that more stress reduction seems to help this group. We use acupuncture in our clinic, we use Chinese herbal medicine, low level laser therapy known as photobiomodulation.

And we like this because it increases blood flow. It regulates inflammation. It’s been shown to regulate blood sugar. If you can get it to the ovaries, improves mitochondrial function so there’s more cellular energy. It helps with the gut microbiome. So there’s an inflammatory component with PMOS and there’s research using low-level laser therapy. So we do a holistic approach, but you’re doing the diet, you’re eating well then, you’re moving your body, you’re getting sleep. If you’re not able to sleep, then we do treatments to let your body naturally find that sleep so it can sleep. And then stress reduction is probably the missing link that I’ve seen in my two decades plus of practice that when you have the nervous system dysregulated, when you’re constantly in this fight or flight stress, you’re not even aware of it, it’s just your normal. There’s a term called PNI, which now people call it PNEI, psychoneuroimmunology, psychoneuroendocrineology, meaning stress, your thoughts and feelings impact your nervous system, your endocrine system, and your hormonal and immune system.

So that’s why I address the mental emotional. We’re going to look at holistically whether they call you PMOS, PCOS, or just your name is Jane, whatever they call you. If you’re not ovulating regularly, we’re going to want to get you ovulating regularly regardless of what they’re going to call it. If you have PMS and menstrual pain, if you have acne, we’re going to address the pattern. I do want to share with you guys, we have several blogs on Acubalance on PMOS. We have several podcasts on the Coherence Core Podcast related to PMOS as well. And for my colleagues that are watching on healthyseminars.com, my other company that I get to moderate those lectures, we have several lectures on… They’re called PCOS because they were recorded before it changed to PMOS. Here’s the key thing, Mark, that I want to see if you agree with. Not everybody with a diagnosis of PMOS would get the same supplements.

There will be overlap where there’s the inositols, I bet for sure, and hopefully the NAC N-acetylcysteine. But then based on how you’re presenting, you’re always cold versus hot, you got constipation versus diarrhea. If insomnia versus sleep like a baby, you’re going to get probably different supplements. Can you comment on that?

Mark Ratner 

Yeah. I mean, in Europe, not so much in the United States, in Europe, they talk about phenotypes. They have very specific PCOS phenotypes, and that is an attempt to subcategorize patients who fall under the PMOS, PCOS, PMOS sort of roof into the various presentations as you put it. You’ve got lean, you’ve got high BMI, you’ve got high androgen, you’ve got an anovulatory. And so I think they’re making more progress that way in trying to stratify treatments depending on exactly what the derangement consists of because you’re exactly right. And this is part of the confusion. It’s not really one cohesive homogeneous syndrome always. As you pointed out, OBGYN sees a thin woman who comes in and she’s anovulatory. They probably don’t even think about PMOS because in their mind, in most people’s minds, it’s high BMI women. It’s overweight women or most of the PCOS patients.

So there’s different phenotypes, there’s different appearances or presentations. And that sort of way of looking at things has not really come into widespread practice in the United States as much as it’s used in Europe.

Lorne Brown 

But in Chinese medicine, what they call phenotypes, we call patterns or body types. But we call these pattern differential diagnosis. So if you see a Chinese medicine doctor, they treat you based on phenotypes

Lorne Brown 

2000

Lorne Brown 

Years. So just to share with the audience, I’m really appreciative of the supplements you’ve been creating because they’re evidence-based supplements. So you don’t have 15,000 products, but you do have a good selection of products that have research behind them. So I appreciate that, including products for PMOS.

Mark Ratner 

I’ll tell you real quickly, there’s some really interesting stuff coming out in the last several years about the influence of the vaginal microbiome on fertility.

Lorne Brown 

We talk about it all the time in Chinese medicine, but go ahead, bring it up.

Mark Ratner 

Okay. And it turns out that women who have dysbiosis, in other words, vaginal dysbiosis and PCOS women, PMOS women, old habits, hard to break, have a much higher risk of having dysbiosis. And if you correct it, you improve fertility. And so we’re coming out with, it’s basically a symbiotic. It’s pre, pro and postbiotics. A formulation it’s going to be called trabiome and it’s going to be sort of fertility-focused. It’s heavily obviously lactobacillus and bifidobacterium, certain strains that have been shown to be pro – fertility. So that’s a couple months away.

Lorne Brown

So you talk about the vaginal microbiome and there’s a uterine microbiome and a gut microbiome, there’s a mouth microbiome. So I’m hearing that there’s some data showing there’s a correlation between women diagnosed with PMOS, previously known as PCOS, and the vaginal microbiome having a dysbiosis being out of balance. That’s what I heard?

Lorne Brown

Yes.

Lorne Brown 

So in our practice, and I’m curious how your probiotic will work, will often address it with a vaginal probiotic. So it’s the inserted and an oral probiotic. And also there is a pelvic wand that we often will recommend as well that gives off red and infrared light. You can also use ultraviolet, the blue light. So if there’s really BV, bacterial vaginosis, you use that. Otherwise, just doing red and infrared and it’s inserted vaginally and it helps with the blood flow and it helps with the microbiome because low-level laser therapy photobiomodulation has been shown when it’s been placed on the gut through DNA sequencing to change the gut microbiome in a positive manner. And it was done in a Parkinson’s study because there has been some correlation between the gut microbiome in brain inflammation and Parkinson’s. So the study put the laser system on the gut, which we do in our clinic as well for just everybody.

And they did it on the back of the head towards the brain and they saw changes in signs and symptoms as well as looking at certain markers like dopamine, et cetera. So

Mark Ratner

I’m just curious to put laser on the gut, as you said, is it like endoscopy? You got to put a?

Lorne Brown 

No. So the gut one is it permeates through the skin. So the laser’s on the stomach because it will penetrate so many millimeters or centimeters and you need it to sit there for a while. So we have professional lines, systems that sit on the gut for anywhere for 10 to 20 minutes or longer.

Mark Ratner 

Fascinating.

Lorne Brown

They’re doing that. There’s still question whether LEDs versus laser diodes, which works. I know the laser diode has been shown in research to change it. Now, as you’re aware, your studies will get quoted, but they’ll talk about somebody else’s product, but the study was done on your product. So most people will say photobiomodulation helps gut microbiome, but not every system is the same. So I know laser diodes have been studied to change the gut microbiome. I don’t know if LED studies have been studied, but people who use red light therapy LEDs will say it’s good for the gut microbiome, but they’re piggybacking on research on a different system. So we have a system that does laser diodes. We also have systems that does erays on the belly. It’s LEDs that it’s a vaginal pelvic wand, so that’s inserted vaginally and it runs for 10 minutes and you can choose red or red and infrared light.

And that’s done. You don’t do it every day, but probably four to five times a week. And they have some data. We have a few of them at our clinic. We pretty much just send people to the Fringe Heals website to get their wand for that.  

Mark Ratner 

So this is home treatment. They do this at home.

Lorne Brown 

Yeah, we don’t do it in our clinic. It’s outside my scope to do it. Naturopathic doctors can do it. So if somebody has a home system, this is what’s happening with photobimodulation. The home systems are getting so much better. They’re still not probably good enough like the professional systems, but they’re getting better and more cost-effective. $600 is still not an easy price for people, but it is not like it was $7,000. And it’s a monthtime cost. There’s no membership. You buy it and now for months or years and we use in our clinic or recommend it because for perimenopausal or menopause, women that have vaginal dryness, because it brings a blood flow and circulation, people that have tears during the birth. So

Mark Ratner

This is sort of adjacent to what, I don’t know if they have it again, MonaLisa Touch. Have you heard of MonaLisa Touch?

Lorne Brown 

I’m familiar with that. And this one’s called the fringe heal and it’s a pelvic wand. But yeah, same idea. The reason this one, we recommend this one. There’s many on the market. So I’m recommending at this point in time, I’ve had them on my podcast so people can check out that podcast. One is the device was developed by women because here’s a man saying, “This is what a woman should use for her.”

Mark Ratner 

It’s a good selling point for sure.

Lorne Brown 

Women have developed it, the women have experienced it to say, “This is comfortable.” It’s medical grade. So for the cleaning purposes, medical grade, because you can overheat tissue. The lights cannot be the right wavelength. So third-party testing. So at least I always want safety, especially when it comes to medical practice, you want safety, do not harm. So I do like this group and what they have created. And so diet matters, everybody, exercise. Guess what? Stress can affect your microbiome.

So what did you do to change the microbiome? So probiotics is another one. So you have a probiotic. Now, is yours going to be oral only? Vaginal? So it’s oral?

Mark Ratner 

We’re a supplement company and a vaginal probiotic is technically a device. It falls into this very strange FDA category here in the States. It’s considered a medical device, believe it or not.

Lorne Brown 

There are supplement companies that have created the vaginal one. Oh, sure. When somebody does the uterine biopsy and it shows that you have the microbiome is off, that’s the treatment is vaginal probiotics.

Mark Ratner 

Sure. Yeah. No, there’s no question. Vaginal probiotics. So for instance, using oral or vaginal probiotics for UTI prevention, the studies are stronger for the vaginal suppositories by far than they are for oral probiotics. Yeah.

Lorne Brown 

Well, I’m glad we brought that up. And again, at our clinic, we have the vaginal suppositories. Looking forward to your probiotic coming out because again, nice holistic way and there’s so many other benefits. The mood, the skin, hormonal, the microbiome in the gut plays an important role. And now we have a healthier vaginal microbiome. So all good stuff there.

Lorne Brown 

Yep.

Lorne Brown 

Thank you on that one.

Lorne Brown 

Sure.

Lorne Brown 

People stay tuned. We’re going to break this up probably into a part one and part two. So we’re going to join us because we’re going to get ready to record part two, and we’re going to talk about male factor infertility and the sperm quality and how this is impacting unexplained infertility, infertility, miscarriages and what can be done. So go and check out part two with Dr. Mark Ratner on the mail on the sperm. Mark, thanks so much for talking with me on PMOS and don’t go anywhere because we’re going to go and start the next topic.

Mark Ratner 

Sounds good.

Lorne Brown 

Thank you for spending this time with us on the Coherence Code Podcast. I’m Dr. Lorne Brown and I will see you next week for another conversation on coherence and healing. If this conversation resonated with you, please like, subscribe, or follow the show and also share it with someone who might benefit from it as well. Remember to take a moment to breathe, reflect, and stay connected. Welcome to the Coherence Code Podcast.