Why PCOS IS Now PMOS (What It Means In Practical Terms)
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
No question/request too big or small 😎
❝Is there anything that’s actually changed with PCOS now being PMOS, or is it just a name change?❞
Yes and yes! That is to say:
- Yes, it is technically just a name change
- Yes, there are expected positive knock-on effects of this change
First, let’s quickly recap what the name change actually is, so that we can talk about why the change was made and what we can expect to see in the category of positive effects resulting from this change:
The name was: polycystic ovary syndrome (PCOS)
The name is now: polyendocrine metabolic ovarian syndrome (PMOS)
The old name is a little bit misleading, since not only are ovarian cysts not a required symptom, but there isn’t even, on average, an increase in abnormal ovarian cysts.
The new name, in contrast, de-emphasizes that aspect and instead brings attention to the endocrine and metabolic aspects.
This was talked about before, for example in this guest article on our own site: PCOS affects 1 in 8 women worldwide, yet it’s often misunderstood. A name change might help
This is important, because PMOS is linked to infertility, pregnancy complications, acne, excess hair growth, depression, anxiety, eating disorders, Type 2 diabetes, heart disease, and reduced quality of life, with metabolic complications occurring earlier and more frequently than in people without the condition.
Almost all of these things have far more to do with the hormonal and metabolic side of things, rather than being anything to do with cysts (which, when they do occur, are also a result of those things, being characterized by disrupted follicle development caused by hormonal signalling disturbances).
As for how this change is expected to help, advocates hope the new terminology will reduce stigma, improve understanding among physicians, encourage more whole-body treatment approaches, and ensure patients with varying symptoms receive better long-term support.
Of these things, probably the “whole-body treatment approaches” are going to have the biggest positive impact on people’s lives.
Want to learn more?
If you will kindly overlook that these articles were written with the old name, then do check out:
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How Gluconolactone Restores Immune Regulation In Lupus
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Let’s be clear up front: this will not cure lupus.
However, it will interrupt the pathology of lupus in such a way as to, as the title says, restore immune regulation—so that your body stops attacking itself, or at the very least, attacks itself significantly less.
What is gluconolactone anyway?
Gluconolactone (also called glucono-δ-lactone) an oxidized derivative of glucose, when glucose is exposed to oxygen and a certain enzyme (glucose oxidase). It’s used in various food-related fermentation processes, and also helps such foods to have a tangy flavor.
It’s also known as E575, showing that E-numbers need not always be scary 🙂
How does it work?
First, a recap on how lupus works: lupus is an autoimmune disease where the immune system attacks its own tissues, causing inflammation and organ damage (to oversimplify it in very few words).
Next, how lupus is currently treated: mostly with immunosuppressant drugs, which reduce symptoms but have significant side effects, not least of all the fact that your immune system will be suppressed, leaving you vulnerable to infections, cancer, aging, and the like. So, there’s really a “damned if you do, damned if you don’t” aspect here (because untreated lupus will run your immune system into the ground with its chronic inflammation, which will also leave you vulnerable to the aforementioned things).
See also: How to Prevent (or Reduce) Inflammation
Now, how gluconolactone works: it increases the number of regulatory T-cells (also called “Tregs” by scientists who don’t want to have to say/write “regulatory T-cells” many times per day), which are the ones that tell the rest of your immune system what not to attack. It also inhibits pro-inflammatory T-helper-cells that are otherwise involved in autoimmune dysfunction.
Where is the science for this?
It’s a shiny new paper that covers three angles:
- In lupus-suffering mouse in vivo studies, it improved Treg function and reduced inflammatory skin rashes
- In human cell culture in vitro studies (with cell cultures from human lupus patients), it bolstered Treg count and improved immune regulation
- In human patient in vivo studies, a gluconolactone cream controlled skin inflammation and improved the clinical and histologic appearance of the skin lesions within 2 weeks
❝These results suggest that gluconolactone could be a targeted treatment option with fewer side effects for autoimmune diseases such as lupus.
Gluconolactone acts like a ‘power food’ for regulatory T cells—a real win-win situation for immune regulation❞
~ Dr. Antonios Kolios
You can find the paper itself here:
Where can I get gluconolactone?
At the moment, this is still in the clinical trials phase, so it’s not something you can get a prescription for yet, alas.
But definitely keep an eye out for it!
We would hypothesize that eating foods fermented with E575 (it’s sometimes used in feta cheese, hence today’s featured image, and it’s also often used as a pickling agent) may well help, but that’s just our hypothesis as it isn’t what was tested in the above studies.
Want to learn more?
In the meantime, if you’d like to learn more about lupus, we recommend this very comprehensive book:
*The “et al.” are: Jemima Albayda, MD; Divya Angra, MD; Alan N. Baer, MD; Sasha Bernatsky, MD, PhD; George Bertsias, MD, PhD; Ashira D. Blazer, MD; Ian Bruce, MD; Jill Buyon, MD; Yashaar Chaichian, MD; Maria Chou, MD; Sharon Christie, Esq; Angelique N. Collamer, MD; Ashté Collins, MD; Caitlin O. Cruz, MD; Mark M. Cruz, MD; Dana DiRenzo, MD; Jess D. Edison, MD; Titilola Falasinnu, PhD; Andrea Fava, MD; Cheri Frey, MD; Neda F. Gould, PhD; Nishant Gupta, MD; Sarthak Gupta, MD; Sarfaraz Hasni, MD; David Hunt, MD; Mariana J. Kaplan, MD; Alfred Kim, MD; Deborah Lyu Kim, DO; Rukmini Konatalapalli, MD; Fotios Koumpouras, MD; Vasileios C. Kyttaris, MD; Jerik Leung, MPH; Hector A. Medina, MD; Timothy Niewold, MD; Julie Nusbaum, MD; Ginette Okoye, MD; Sarah L. Patterson, MD; Ziv Paz, MD; Darryn Potosky, MD; Rachel C. Robbins, MD; Neha S. Shah, MD; Matthew A. Sherman, MD; Yevgeniy Sheyn, MD; Julia F. Simard, ScD; Jonathan Solomon, MD; Rodger Stitt, MD; George Stojan, MD; Sangeeta Sule, MD; Barbara Taylor, CPPM, CRHC; George Tsokos, MD; Ian Ward, MD; Emma Weeding, MD; Arthur Weinstein, MD; Sean A. Whelton, MD
The reason we mention this is to render it clear that this isn’t one man’s opinions (as happens with many books about certain topics), but rather, a panel of that many doctors all agreeing that this is correct and good, evidence-based, up-to-date (as of the publication of this latest revised edition) information.
Take care!
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What is a ‘vaginal birth after caesarean’ or VBAC?
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A vaginal birth after caesarean (known as a VBAC) is when a woman who has had a caesarean has a vaginal birth down the track.
In Australia, about 12% of women have a vaginal birth for a subsequent baby after a caesarean. A VBAC is much more common in some other countries, including in several Scandinavian ones, where 45-55% of women have one.
So what’s involved? What are the risks? And who’s most likely to give birth vaginally the next time round?
MVelishchuk/Shutterstock What happens? What are the risks?
When a woman chooses a VBAC she is cared for much like she would during a planned vaginal birth.
However, an induction of labour is avoided as much as possible, due to the slightly increased risk of the caesarean scar opening up (known as uterine rupture). This is because the medication used in inductions can stimulate strong contractions that put a greater strain on the scar.
In fact, one of the main reasons women may be recommended to have a repeat caesarean over a vaginal birth is due to an increased chance of her caesarean scar rupturing.
This is when layers of the uterus (womb) separate and an emergency caesarean is needed to deliver the baby and repair the uterus.
Uterine rupture is rare. It occurs in about 0.2-0.7% of women with a history of a previous caesarean. A uterine rupture can also happen without a previous caesarean, but this is even rarer.
However, uterine rupture is a medical emergency. A large European study found 13% of babies died after a uterine rupture and 10% of women needed to have their uterus removed.
The risk of uterine rupture increases if women have what’s known as complicated or classical caesarean scars, and for women who have had more than two previous caesareans.
Most care providers recommend you avoid getting pregnant again for around 12 months after a caesarean, to allow full healing of the scar and to reduce the risk of the scar rupturing.
National guidelines recommend women attempt a VBAC in hospital in case emergency care is needed after uterine rupture.
During a VBAC, recommendations are for closer monitoring of the baby’s heart rate and vigilance for abnormal pain that could indicate a rupture is happening.
If labour is not progressing, a caesarean would then usually be advised.
Giving birth in hospital is recommended for a vaginal birth after a caesarean. christinarosepix/Shutterstock Why avoid multiple caesareans?
There are also risks with repeat caesareans. These include slower recovery, increased risks of the placenta growing abnormally in subsequent pregnancies (placenta accreta), or low in front of the cervix (placenta praevia), and being readmitted to hospital for infection.
Women reported birth trauma and post-traumatic stress more commonly after a caesarean than a vaginal birth, especially if the caesarean was not planned.
Women who had a traumatic caesarean or disrespectful care in their previous birth may choose a VBAC to prevent re-traumatisation and to try to regain control over their birth.
We looked at what happened to women
The most common reason for a caesarean section in Australia is a repeat caesarean. Our new research looked at what this means for VBAC.
We analysed data about 172,000 low-risk women who gave birth for the first time in New South Wales between 2001 and 2016.
We found women who had an initial spontaneous vaginal birth had a 91.3% chance of having subsequent vaginal births. However, if they had a caesarean, their probability of having a VBAC was 4.6% after an elective caesarean and 9% after an emergency one.
We also confirmed what national data and previous studies have shown – there are lower VBAC rates (meaning higher rates of repeat caesareans) in private hospitals compared to public hospitals.
We found the probability of subsequent elective caesarean births was higher in private hospitals (84.9%) compared to public hospitals (76.9%).
Our study did not specifically address why this might be the case. However, we know that in private hospitals women access private obstetric care and experience higher caesarean rates overall.
What increases the chance of success?
When women plan a VBAC there is a 60-80% chance of having a vaginal birth in the next birth.
The success rates are higher for women who are younger, have a lower body mass index, have had a previous vaginal birth, give birth in a home-like environment or with midwife-led care.
For instance, an Australian study found women who accessed continuity of care with a midwife were more likely to have a successful VBAC compared to having no continuity of care and seeing different care providers each time.
An Australian national survey we conducted found having continuity of care with a midwife when planning a VBAC can increase women’s sense of control and confidence, increase their chance to be upright and active in labour and result in a better relationship with their health-care provider.
Seeing the same midwife throughout your maternity care can help. Tyler Olson/Shutterstock Why is this important?
With the rise of caesareans globally, including in Australia, it is more important than ever to value vaginal birth and support women to have a VBAC if this is what they choose.
Our research is also a reminder that how a woman gives birth the first time greatly influences how she gives birth after that. For too many women, this can lead to multiple caesareans, not all of them needed.
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University; Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University, and Lilian Peters, Adjunct Research Fellow, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Wasting Your Vitamins?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Are you flushing away your vitamins?
Most likely…but you don’t have to.
We all know what a wasteful expense supplements can sometimes be, but you can optimise your intake to get more bang for your buck!
Top Tips for Getting Your Money’s Worth:
- Liquids are better than tablets—the body can’t absorb nutrients from tablets anywhere as easily as it can from liquids, with some saying as low as a 50% absorption rate for tablets, so if your supplement can come in drinkable form, take it that way!
- Capsules are better than tablets—capsules, depending on the kind, contain either a powder (true capsules) or a liquid (softgels). Once the capsule/softgel is broken down in the stomach, it releases its contents, which will now be absorbed as though you took it as a drink.
- Stay hydrated—on that note, your body can only make use of nutrients that it can easily transport, and if you’re dehydrated, the process is sluggish! Having a big glass of water with your supplements will go a long way to helping your body get them where they’re needed.
- Take with black pepper—studies disagree on exactly how much black pepper improves absorption of nutrients. Some say it improves it by 50%, others say as much as 7x better. The truth is probably that it varies from one nutrient to the next, but what is (almost) universally accepted is that black pepper helps you absorb many nutrients you take orally.
- Take with a meal—bonus if you seasoned it with black pepper! But also: many nutrients are best absorbed alongside food, and many are specifically fat-soluble (so you want to take a little fat around the same time for maximum absorption)
- Consider split doses—a lot of nutrients are best absorbed when spread out a bit. Why? Your body can often only absorb so much at once, and what it couldn’t absorb can, depending on the nutrient, pass right through you. So better to space out the doses—breakfast and dinner make for great times to take them.
- Consider cycling—no, not the two-wheeled kind, though feel free to do that too! What cycling means when it comes to supplements is to understand that your body can build a tolerance to some supplements, so you’ll get gradually less effect for the same dose. Combat this by scheduling a break—five days on, two days off is a common schedule—allowing your body to optimise itself in the process!
- Check Medications—and, as is always safe, make sure you check whether any medications you take can interrupt your supplement absorption!
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Do You Struggle To Comfortably Sit Cross-Legged? Here’s How To Fix That
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Are you sitting comfortably? No? Then let’s begin…
Let’s get down to it
Difficulty comfortably sitting cross-legged is very common usually reflects limited hip mobility, rather than any particularly advanced flexibility problem. It’s not like one is trying and failing to sit in the lotus position, or with one’s feet behind one’s ears or something. So, why is such difficulty so common?
Simply, the body adapts to what we do with it (or not), and so a lack of habituation quickly becomes a lack of mobility. Multiply that by decades of life, and if the last time you sat cross-legged was in kindergarten, then there’s the reason. Fortunately, it’s not too tricky to fix.
First, do a self-check: sit cross-legged and notice (dis)comfort, knee height, and whether one hip feels markedly stiffer than the other.
Next, to get your hips used to being opened more: lean back on your hands, place your feet together, and actively open one hip at a time by shifting your weight from side to side. You can also do the butterfly option, and bring both feet together (soles touching each other) and gently bounce your knees to encourage hip opening. On which note…
With regard to knee height: use controlled effort to guide each knee closer to the floor and compare sides, rather than simply hoping for them to drop passively due to gravity. Because, yes, you can and should work with gravity on this, but you can’t rely on it entirely, since the body will only adapt to what’s done with it, so if it’s easier for the body for the knees to stay higher, then higher is where the knees will stay. So, gently pushing them down is important here, and the best way to do this is to place your elbows against your knees and press dowwards to open your hips without holding on.
Also! Do note that the perceived symmetry of sitting cross-legged is an optical illusion—one leg is, after all, in front of the other. So, do regularly change which leg is in front, to balance mobility between sides.
For more on all of this plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
How to Sit On Your Heels (Seiza For Everyone)
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How we diagnose and define obesity is set to change – here’s why, and what it means for treatment
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Obesity is linked to many common diseases, such as type 2 diabetes, heart disease, fatty liver disease and knee osteoarthritis.
Obesity is currently defined using a person’s body mass index, or BMI. This is calculated as weight (in kilograms) divided by the square of height (in metres). In people of European descent, the BMI for obesity is 30 kg/m² and over.
But the risk to health and wellbeing is not determined by weight – and therefore BMI – alone. We’ve been part of a global collaboration that has spent the past two years discussing how this should change. Today we publish how we think obesity should be defined and why.
As we outline in The Lancet, having a larger body shouldn’t mean you’re diagnosed with “clinical obesity”. Such a diagnosis should depend on the level and location of body fat – and whether there are associated health problems.
World Obesity Federation What’s wrong with BMI?
The risk of ill health depends on the relative percentage of fat, bone and muscle making up a person’s body weight, as well as where the fat is distributed.
Athletes with a relatively high muscle mass, for example, may have a higher BMI. Even when that athlete has a BMI over 30 kg/m², their higher weight is due to excess muscle rather than excess fatty tissue.
Some athletes have a BMI in the obesity category. Tima Miroshnichenko/Pexels People who carry their excess fatty tissue around their waist are at greatest risk of the health problems associated with obesity.
Fat stored deep in the abdomen and around the internal organs can release damaging molecules into the blood. These can then cause problems in other parts of the body.
But BMI alone does not tell us whether a person has health problems related to excess body fat. People with excess body fat don’t always have a BMI over 30, meaning they are not investigated for health problems associated with excess body fat. This might occur in a very tall person or in someone who tends to store body fat in the abdomen but who is of a “healthy” weight.
On the other hand, others who aren’t athletes but have excess fat may have a high BMI but no associated health problems.
BMI is therefore an imperfect tool to help us diagnose obesity.
What is the new definition?
The goal of the Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity was to develop an approach to this definition and diagnosis. The commission, established in 2022 and led from King’s College London, has brought together 56 experts on aspects of obesity, including people with lived experience.
The commission’s definition and new diagnostic criteria shifts the focus from BMI alone. It incorporates other measurements, such as waist circumference, to confirm an excess or unhealthy distribution of body fat.
We define two categories of obesity based on objective signs and symptoms of poor health due to excess body fat.
1. Clinical obesity
A person with clinical obesity has signs and symptoms of ongoing organ dysfunction and/or difficulty with day-to-day activities of daily living (such as bathing, going to the toilet or dressing).
There are 18 diagnostic criteria for clinical obesity in adults and 13 in children and adolescents. These include:
- breathlessness caused by the effect of obesity on the lungs
- obesity-induced heart failure
- raised blood pressure
- fatty liver disease
- abnormalities in bones and joints that limit movement in children.
2. Pre-clinical obesity
A person with pre-clinical obesity has high levels of body fat that are not causing any illness.
People with pre-clinical obesity do not have any evidence of reduced tissue or organ function due to obesity and can complete day-to-day activities unhindered.
However, people with pre-clinical obesity are generally at higher risk of developing diseases such as heart disease, some cancers and type 2 diabetes.
What does this mean for obesity treatment?
Clinical obesity is a disease requiring access to effective health care.
For those with clinical obesity, the focus of health care should be on improving the health problems caused by obesity. People should be offered evidence-based treatment options after discussion with their health-care practitioner.
Treatment will include management of obesity-associated complications and may include specific obesity treatment aiming at decreasing fat mass, such as:
- support for behaviour change around diet, physical activity, sleep and screen use
- obesity-management medications to reduce appetite, lower weight and improve health outcomes such as blood glucose (sugar) and blood pressure
- metabolic bariatric surgery to treat obesity or reduce weight-related health complications.
Treatment for clinical obesity may include support for behaviour change. Shutterstock/shurkin_son Should pre-clinical obesity be treated?
For those with pre-clinical obesity, health care should be about risk-reduction and prevention of health problems related to obesity.
This may require health counselling, including support for health behaviour change, and monitoring over time.
Depending on the person’s individual risk – such as a family history of disease, level of body fat and changes over time – they may opt for one of the obesity treatments above.
Distinguishing people who don’t have illness from those who already have ongoing illness will enable personalised approaches to obesity prevention, management and treatment with more appropriate and cost-effective allocation of resources.
What happens next?
These new criteria for the diagnosis of clinical obesity will need to be adopted into national and international clinical practice guidelines and a range of obesity strategies.
Once adopted, training health professionals and health service managers, and educating the general public, will be vital.
Reframing the narrative of obesity may help eradicate misconceptions that contribute to stigma, including making false assumptions about the health status of people in larger bodies. A better understanding of the biology and health effects of obesity should also mean people in larger bodies are not blamed for their condition.
People with obesity or who have larger bodies should expect personalised, evidence-based assessments and advice, free of stigma and blame.
Louise Baur, Professor, Discipline of Child and Adolescent Health, University of Sydney; John B. Dixon, Adjunct Professor, Iverson Health Innovation Research Institute, Swinburne University of Technology; Priya Sumithran, Head of the Obesity and Metabolic Medicine Group in the Department of Surgery, School of Translational Medicine, Monash University, and Wendy A. Brown, Professor and Chair, Monash University Department of Surgery, School of Translational Medicine, Alfred Health, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Apple vs Gooseberries – Which is Healthier?
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Our Verdict
When comparing apple to gooseberries, we picked the apple.
Why?
These two fruits are popular contenders for losing most head-to-head contests on here, but…
In terms of macros, gooseberries have more than 2x the fiber, scoring them a first-round win.
When it comes to vitamins, apples are not higher in any vitamins, while gooseberries are higher in vitamins A, B1, B2, B3, B5, B6, B7, B9, C, E, and K, sweeping this category.
Looking at minerals, apples are not higher in any minerals, while gooseberries have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, winning overwhelmingly again.
Adding up the sections makes for a clear overall win for gooseberries, but by all means enjoy either or both, as diversity is best!
Want to learn more?
You might like:
Are You Getting The Right Kinds Of Flavonoids? ← while both of these fruits today are quite modest in their polyphenol content, they have different ones, which is another reason to get a variety
Enjoy!
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