Testicles Forever?

A recent report on possible therapeutic uses of testicular stem cells helps to highlight the level of confusion and lack of focus
in stem cell biology today. Sources of stem cells such as embryos, testicles and ovaries are technically difficult to manipulate and have worrying, potentially malignant properties should they ever be transplanted to a human being. These stem cells also carry significant moral, ethical, legal and religious objections to their creation and use. UK researchers have been given the go-ahead to investigate the potential of human testicle stem cells to develop into other types of body tissue. The Human Fertilization and Embryology Authority (HFEA) has licensed the team, based at the Hammersmith Hospital in London, to
study the cells in order to find out if they are as versatile as stem cells isolated from early embryos. The scientists hope that the work may eventually lead to new therapies for conditions such as heart disease, Parkinson's disease and spinal injury.
Last year, German researchers isolated cells from adult mouse testicles that share some of the characteristics of embryonic stem (ES) cells. The team isolated stem cells that normally grow into sperm, and coaxed them into producing many different types of body cell. The researchers, based at the Georg-August-University of Goettingen, published their findings in the journal Nature. However, at the time, other scientists cautioned that stem cells from human testes might not behave in the same way as their mouse counterparts. The Gottingen team used genetically altered mice in which the sperm stem cells were permanently 'tagged' with a fluorescent protein, to enable them to isolate the elusive cells from mouse testes. They then grew the cells in the laboratory, and found that some of them resembled ES cells. These cells, which they dubbed multipotent adult germline stem cells (maGSCs), were able to grow into several different types of body cell - including heart, brain, liver and skin. The scientists also found that the maGSCs were able to form different tissues and organs when injected into mouse embryos. The ongoing controversy surrounding research into human ES cells in Germany, where such work is banned, and many other countries, has lead several groups to seek alternative sources of cells that can potentially develop into a wide range of different tissues. Even in countries where ES cell research is permitted, it hinges on the availability of donated human eggs.

There is another source of stem cells which is hardly ever mentioned in the news and is currently being discarded on a daily
basis. It has no moral, ethical, legal or religious objections to use and it has been transplanted safely over 6,000 times to date to treat 45 different diseases. This source of stem cells is human umbilical cord blood. Cord blood can be collected at every birth with no risk or pain to the mother or baby. Once collected cord blood is processed using tried and tested technology and can be frozen in liquid nitrogen for many years. Current applications of these stem cells are in the treatment
of leukemia, related blood disorders and the repair of the bone marrow following high dose chemotherapy for cancer. Perhaps the most important aspect of cord blood is that it contains mesenchymal stem cells capable of producing many cell types including neuronal and muscle tissue. These cells have an availability and potential far greater than embryonic or testicular stem cells and we must focus our time, energy, resources and expertise on the full utilization of these priceless stem cells. Cord blood stem cells are currently being assessed in a clinical trial in Canada in the treatment of multiple sclerosis. The umbilical cord itself also contains stem cells capable of producing a range of tissue types, most
notably bone tissue. If stem cell biology is to advance we must begin to collect, store and carry out research on as much cord blood as possible. According to advocates of umbilical cord blood banking, we have a readily available source of stem cells with massive potential which is currently, for whatever reason, being ignored by researchers, media and politicians alike. “We must stop talking about esoteric sources of stem cells and focus on cord blood stem cells as the source of stem cells for current therapeutic applications and ground breaking therapies of the future.”

Commenting on the planned research at Hammersmith Hospital, stem cell expert Professor Harry Moore, of Sheffield University, said: 'In this country, the ethical issues of obtaining stem cells from cloned embryos are really covered by the
HFEA, but there is still the major problem of where do you get eggs that are high enough quality and in sufficient quantity. The advantage of this work on human testicular cells is that it avoids both of these issues'. If testicular stem cells prove to be as versatile as their embryonic counterparts, it may be possible for men to bank testicular tissue early in life, and later use it to repair damaged or diseased areas of the body. Such tissue could also potentially be used to provide cell-based therapies for any men who share the same tissue type. Professor Chris Barratt, of the Birmingham Women's Hospital told the Guardian newspaper: “There are a lot of testicles around and you don't need a staggering number to have enough variety to match nearly all of the population”. In India, we have much larger numbers.

Asymmetrical People make Jealous Lovers & Handsome Men have the best Sperm!

Asymmetry could account for a fifth of the variation in romantic jealousy from person to person, says a Canadian researcher. Just about everyone is lopsided to some extent. But in recent years, a series of animal and human studies have suggested that the implications of asymmetry go far beyond struggling to find shoes that fit both feet. It seems that people who are more symmetrical are not only healthier, more fertile and perhaps even smarter - they are also more attractive. This led William Brown at Dalhousie University in Halifax, Nova Scotia, to wonder about jealousy. "If jealousy is a strategy to retain your mate, then the individual more likely to be philandered on is more likely to be jealous," he speculated. And if people who are less symmetrical are less desirable, they are more likely to be cheated on. To test his theory, Brown looked at 50 men and women in various kinds of heterosexual relationships, comparing the sizes of paired features such as feet, ears and fingers. The volunteers then filled in a questionnaire already used in other studies to assess romantic jealousy. He found a strong link between asymmetry and romantic jealousy. Asymmetry could account for over a fifth of the variation in romantic jealousy from person to person, he says. To make sure less symmetrical people are not simply cursed with more jealous personalities, Brown also assessed their propensity to be jealous outside the relationship, in the workplace for example. But the less symmetrical people were no more likely to be jealous in general, he found, than more symmetrical folk.
A separate study by UK researchers has revealed that women with the most alluring voices have the most attractive faces. Sarah Collins and Caroline Missing, at the University of Nottingham, played recordings of 30 young women to men who later saw their photos. The men judged women with attractive voices as the best looking, reveals the study published in the latest Animal Behaviour.
Beauty really is in the eye of the beholder. Rather than always chasing the best-looking members of the opposite sex, some animals prefer mates that the majority find decidedly unattractive. Studies of how birds, fish and people choose mates have found that members of the same species tend to find the same things attractive. For instance, peahens prefer to mate with brightly colored, long-tailed peacocks, while women prefer tall men. Those attractive traits are supposed to signal beneficial characteristics such as an increased chance that any offspring will survive. Male lions with long, dark manes are more attractive to females and more intimidating to rivals, US research involving dummy animals shows. Manes vary from light blond to black and can be up to foot long. The research team planted pairs of life-sized toy lions with different types of mane near males and females in the Serengeti National Park in Tanzania, and monitored the lions reactions to the 'intruders'. In all cases, males preferred to approach dummies with lighter, less shaggy manes. But females did the opposite. They preferred to approach darker males, suggesting they are a better bet as a mate. Next, the team examined data on blood samples from several dozen males that had been sedated. They found a strong correlation between blood testosterone levels and mane color.
According to a recent news story in the New Scientist, 'handsome men have the best sperm'. And how do we know this? Because researchers recruited 66 women in Valencia, Spain, who looked at the faces of 66 male students and happened to identify as the most handsome those men who also have the best sperm. The authors of the study conclude: 'Our study has shown that women are able to recognize reproductively fit males on the basis of their facial appearance alone.'
It's difficult to see how they could come to such a conclusion. In the study, 66 women made a subjective assessment of the attractiveness of 66 men; and the men they judged to be most good looking happened to have more motile and more morphologically normal sperm. All the research shows, therefore, is that in a small sample of young men, good looks seems to correlate with good sperm. What we don't know from the New Scientist story is other information that might be relevant, such as how much the men smoke or drink. Intriguingly, the study doesn't show a correlation between good looks and a good sperm count - a measurement often used as an indicator of male fertility.
Studies such as these are becoming increasingly common in the media today. But why we are so interested in them? Perhaps drawing grand conclusions from such research findings fulfils a need in us to find causes for our behavior that are not the result of our own free will and for which, consequently, we don't have to take responsibility. In this case, our search for causes of human behavior that are beyond our control leads us to conclude that women are attracted to handsome men for sound biological reasons. It can't possibly be that we are simply driven by such shallow reasons as the desire to be surrounded by beautiful things, can it?

The Great Verna Promotion from Hyundai Motors

I recently became a sucker to full page advertisement promotions by Hyundai Motors India Limited. Let me tell you this interesting story. In fact it will be more readable as I take you along-with two letters that I wrote to the "customer relations" of Hundai motors & am yet to receive any feedback. Letter 1 - "I am a gynecologist practicing in the city of Mumbai. I have
previously owned cars from the Maruti Co., Honda as well as the Mercedes Benz. On May 16, I booked the Verna CRDi Sx model from Jayabharat Automobiles. I was told that the waiting period is two weeks but if I make a complete down-payment for the car, I would probably get the car within 10 days. I gave them the full payment by check on May 16, 2007. The car was booked in my personal name. No one contacted me till I went to the dealership myself after 6/7 phone- calls in the first week of June 2007. Everytime I would make a call, someone would promise me they would call back and never did call. The car was finally delivered on June 13, 2007. The dealership is a shame on your company. The attitude of the staff is like a Government of India office ten years ago. No one is driven or is customer attentive- the whole atmosphere is Babu-like!
My car has two major problems. The auto function of the Climate-Controlled A/C is not working and the polyglass covering the Milometer-Odometer panel is defective (opaque in parts like some chemical has corroded parts of it. I wonder how did it get past the quality checks. Never before for any of my previous 8-9 cars did I ever have a problem in a brand new purchase.
I do not want to get any services or trouble-shooting done with Jayabharat. Please recommend another dealer/workshop where I can send my vehicle for the rectification of problems.
I hope your customer care is not like the dealership:(
I look forward to hearing from you.
Sincerely yours,
GNA"
I got a reply that someone from Jayabharat would contact me. The story continues thus-I wrote again to the "customer relations" cell - Letter2 -
"I got a call from the Jayabharat workshop and had visited the same. Mr Ashokan there was extremely courteous and receptive to the complaints. He mentioned that the polyglass is not available separately and the entire milometer/odometer assembly needs to be ordered from Chennai and he would write to the factory. I have not heard from them again.
The "automatic" climate control problem could not be solved! He made me speak to a Hyundai Motors representative who explained that the A/C was not defective but was set to European standards & nothing canbe done about it. Let me explain again what the problem is to me &possibly to all end-users. Till 21 degrees Celcius, the A/C works as an automatic climate controlled A/C and automatically adjusts the blower speed to reach the preset temperature between 17-21 degrees Celcius. The moment we set the temperature to 22 degrees or more, the Automatic Function is disabled automatically & the A/C moves automatically to the Fresh-air mode and starts pulling in air from the outside! Imagine driving in Mumbai with the temperature set to 22 degrees and getting Diesel & Petrol fumes being sucked in. This is very unfair to the customer. I was explained by the Hyundai representative, that after 21 degrees, I could very well move to a manual function!
Sir, the only reason I paid some extra money for the CRDi Sx model was the climate controlled A/C. If I wanted to use the regular car A/C, I would have bought your regular diesel Verna. I drive other vehicles like the Honda CRV, Honda Accord, Mercedes Benz C 220 CDi -all with automatic climate controlled A/Cs, but none of these A/Cs switch to a manual mode after 21 degrees Celcius! Please give me a satisfactory explanation. I'm sure your engineers can set the problem right. There is no other vehicle on the Indian roads with a malfunctioning automatic climate controlled A/C such as in the Verna CRDi Sx model if the above explanation is true. I look forward to your response."
I have since written twice more to their "customer-relations" cell, but there is no response. The company believes in no customer-relations. Their existence is only till the great Indian customer reads their color ads in National dailies & color hoardings in the city and buys one of their cars. Post sale, there are only suckers like me writing letters to the motor company, blogs & letters-to-the editors of National dailies, hoping someone exposes the mighty Koreans.

Stem cells: Miracle postponed?

In the light of the Korean stem-cell scandal, many big claims about stem cells are looking decidedly doubtful. Hyeoni Kim believed that the miracle cure for his paraplegia was around the corner. He had been paralyzed at just 8 years old when he was hit by a car on his way home from school. So when South Korea's science superstar, Woo Suk Hwang, asked if his team could take skin cells from Kim and use them to obtain stem cells that might one day provide a cure, Kim and his family were delighted. When Hwang visited him in hospital in April 2003, the boy, then 9, asked him if he would walk again. "I promise," Hwang replied. That promise became immortalized in a Korean postage stamp showing a man rising from his wheelchair. But it was always highly questionable. Even if Hwang had managed to derive cloned embryonic stem cells (ESCs) from the skin cells of Kim and 10 others - as he claimed in May 2005 - he would still have been a long way from mending Kim's paraplegia.
Stem cell science has been hailed as modern medicine's best hope - to treat the untreatable, to keep us fit in old age and even, perhaps, to help the severely disabled to walk again. But scandal in South Korea has rocked this science - with one of its leading proponents labeled a fraud, and as the scientists reflect on the ethics of their work and its practical limits, where does this leave all of us, the potential patients?
Stem cells, unlike ordinary cells, have the unique power to re-create themselves when they divide. There are two types: the first, adult stem cells, are cued up to become particular cell types - say nerve, blood, bone or heart. These can carry out valuable repairs - but only in their specialist part of the body. The second group is embryonic stem cells. Found in the early human embryo, these are highly sought after because they can re-create themselves indefinitely. Also, since they are not yet switched to become specific cell types, they have the potential to repair damaged and diseased organs anywhere in the body.
Dr Hwang claimed to have created 11 stem cell lines from human embryos, cloned so that the cells exactly matched an individual patient - the Holy Grail of stem cell science. It turned out much of his work was fake, and crucially that he'd had to use far more human eggs than he'd said. The challenge now, for embryonic stem cell scientists at least, is to find ways to make stem cells without using vast quantities of human eggs - in short supply and, for some, ethically questionable. Until now, scientists have relied on creating stem cells from left over embryos from IVF. Before the Hwang expose, researchers had hoped to join the elite club of scientists using cloning to study the cellular processes behind disease. Now, to avoid using up human eggs on an uncertain technique, most workers have a plan for a new - and potentially controversial - way around that: cloned human-animal hybrids. Researchers now would like to use non-human eggs - for instance rabbit eggs. But therapies are at least 10 years away. A team at the University of Cambridge has another plan. Roger Pedersen, director of the centre for stem cell research at the university, told us about a plan that avoids cloning, and fresh human eggs, and relies instead on off-the-shelf matches from a bank of stem cell lines from selected donors. Then there's the man with a third way to avoid the need for human eggs. Mohammed Taranissi runs one of the UK's most successful fertility clinics. He's promoting what he calls "stem-brid" technology, which uses the stem cell line itself as a surrogate egg. But there's a new realism now among embryonic stem cell scientists about how long it will be before they can help people.
That leaves their counterparts working on adult stem cells. They now expect to deliver treatments much sooner. One team, at the London Chest Hospital, is using adult stem cells taken from a patient's own bone marrow to try to repair the damage caused by a heart attack. Dr Anthony Mathur is the cardiologist in charge of the trial - the largest of its kind in the world. He is quoted as saying: "My passionate feeling here is that this type of therapy, cellular therapy, is going to revolutionize the way we practice medicine." Half the patients are treated with stem cells and half with just the fluid, or growth factor in which the cells are found. Neither Dr Mathur nor the patients know who's getting what but that's crucial in order to gather definitive, scientifically controlled data. Across London, another adult stem cell trial could yield results within months. At the Institute of Neurology, they hope to use unique adult stem cells from the lining of a patient's own nose to treat nerve and spinal cord injury. Professor Geoffrey Raisman, who's leading this research was quoted on BBC: "The interest in embryonic stem cells has led to adult stem cells being very much neglected. And whereas I think for embryonic stem cells we're talking about a long time ahead before these cells are going to be in use, in our case we're thinking of clinical trials within this year." It would seem a safe bet that adult stem cells will deliver first - but the enthusiasm for this science as a whole is still there, despite the reality check brought about by Dr Hwang.
I agree completely with Prof. Roger Pedersen from Cambridge who says: “We hope that discoveries that are made quietly and without the glare of lights... will ultimately change the way we treat diseases”.

Cytoplasmic Transfer

It was recently reported in the journal "Human Reproduction" that cytoplasmic transfer could be used to transfer healthy mitochondria (small structures that power the cell) into certain infertile women's eggs. This has resulted in 30 healthy children that were "born from three parents". This pioneering work into fertility treatment was conducted at Institute for Reproductive Medicine and Science of St Barnabas, in New Jersey. The 30 children born were actually the first human babies ever whose genetic makeup has been artificially altered. Even though the babies were born healthy (and without this novel technique would not have existed at all), the cytoplasmic transfer technique was condemned as unethical by some opponents, who said it amounted to human cloning (BBC). However, cytoplasmic transfer and nuclear transfer are NOT the same thing, and the genetic makeup of mitochondria does not govern key aspects of the child's development, like intelligence, personality or physical form. These things are predominately determined by nuclear genes, and these genes were not altered in the children. Cytoplasmic transfer is certainly not cloning, as has been suggested, but it is a useful fertility technology for certain women affected with mitochondrial diseases. Cytoplasmic transfer is a logical extension of assisted reproduction, a procedure that represents a hybrid between in vitro fertilization in its traditional form and IVF using donated oocytes. As the IVF procedure has improved, several groups of patients continue to pose huge challenges. One such group is characterized by normal FSH levels and normal responses to stimulation. Patients have lots of follicles when stimulated and high estradiol levels, but poor subsequent embryo development. For years these women, after numerous failed cycles, had no alternative but to discontinue treatment. Oocyte donation, now a common procedure, offered these women a viable procedure, one with a high pregnancy rate. Unfortunately, oocyte donation includes the disadvantage of losing the mother's genetic link to the child, as the genes of the donor are passed on to the child born through the procedure.
Two potential reasons account for poor embryo development. Studies of the genetic component of many of the eggs in women with persistent poor embryo development showed that eggs with abnormal chromosomes often made poor embryos. However, this was not always true. Many eggs with normal chromosomes also developed poorly. Logically, the reason may lie in the cytoplasm, the area within the shell of the egg that lies outside of the nucleus, outside of the region that contains the genetic material or DNA. The cytoplasm includes several components. One component is mitochondria which provide energy to the cell, fuel for many of its functions including, presumably, cell division. In theory, a deficiency in mitochondria may leave a cell without the necessary fuel to power its own division after fertilization, resulting in abnormal division. This abnormal division then results in an accumulation of fragments from the dividing cells and a poor chance of further development after embryo transfer.
Another important component of the cytoplasm is the spindle apparatus, a sort of railroad track within the cell, along which the chromosomes separate. The steps in cell division include the duplication of the chromosomes and the subsequent distribution of the genes equally between the two daughter cells. If an egg contained normal chromosomes but had inadequate mitochondria to power cell division or a defective railroad track system for the chromosomes to divide, would this not result in poor embryo formation? And if the cause of the egg problem was in the cytoplasm, then why not replace just the cytoplasm instead of the whole egg, thus keeping the mother's own genetic contribution to the pregnancy? This is the premise behind the development of cytoplasm transfer by Jacques Cohen & his group from St. Barnabas, New Jersey, USA. But the journey from good idea to actual pregnancies has been long and complex. As in many of the procedures in assisted reproduction, much of the initial research came from our colleagues in veterinary medicine. Two methods of cytoplasm transfer were developed, one which transfers a small amount of cytoplasm by tiny needle from the donor to the recipient egg, the other transfers a larger amount of cytoplasm which is then fused to the recipient cytoplasm with electrical impulses.
As a step forward in the refinement of assisted reproduction it is a huge step, and presently, only a relatively small group of people will benefit from it. As the process of cytoplasmic transfer is further refined it will help many others. Important questions need to be clarified. What we most want to know is how will this technique work with the poorer responders? Can cytoplasm transfer affect the poor results we consistently see in patients with elevated FSH levels? And what exactly is in the cytoplasm that might make the eggs "better?" Can we someday hope to find a source of that substance that does not
require the expensive and cumbersome process of using a donor's eggs? For now, we can only give the unsatisfying answer that we'll have these answers sometime in the future. For those of us struggling with the frustrations of infertility now , we can only hope that the future is sooner rather than later.

Cloning: New high-tech and ancient morality

Ethical discussions of cloning and other high-flown technologies don’t seem to get to the heart of things; they tend to be too fine-grained. When Dolly first became known to the world in 1997, people at large began naturally enough to speculate on human cloning. Several medical doctors and at least one physicist are already planning to offer a clinical service. One well known professor said he would like to be cloned out of curiosity, as if this was justification enough, and another said that human cloning “raises no new questions of ethics”.
At present, cloned human beings exist only in science fiction, lurid tabloids and in the boastful and bogus claims of sham scientists and cult kooks. For now, the only destiny for cloned human cells is to help scientists understand and cure diseases. The reason to clone embryos is that the resulting cells and tissues will have the same genetic makeup as the person they come from. Therefore, they can be transplanted back to the person without fear of rejection. The reason that adult stem cells do not offer an equally valuable alternative is that embryonic cells are the only cells capable of turning into all the various types of cells that are needed to fight disease, disability and death. And no one has figured out yet how to get adult stem cells to revert back into this omnipotent state.
If your child is dying, you want all research avenues pursued and that includes both embryonic and adult stem cell research. The bottom line is that cloning for cures has the potential to do enormous good by saving the lives of millions of people and ending agony for millions more. These human beings and their loved ones aren’t interested in pieties and abstractions and science fiction. They are desperately seeking help for their ailments and they need to have medical scientists free to pursue those answers and cures. Banning all human cloning would be a highly unethical thing to do. The needs of children confined to wheelchairs, of parents dependent on oxygen tanks to breathe and of friends imprisoned by the creeping paralysis of Parkinson’s far outweigh the moral status of cloned cells that will never leave the Petri dish. Myths should not be the basis for public policy when cures hang in the balance.
The latent totipotency of adult mammalian nuclei suggests that it may be feasible to reprogram adult human cells for use in the treatment of disease. Thus, investigators may be able to develop strategies to facilitate the repair and regeneration of human tissues. Nucleo-cytoplasmic interactions that restore potency to differentiated cells are an important research focus with great potential in treating diseases such as cancer, diabetes and neurodegeneration.
Another potential application of mammalian cloning is the production of clones of genetically-engineered domestic animals, such as sheep, pigs and cattle. For example, bovine nuclei could be engineered so that medically-significant proteins would be selectively secreted into the milk of cattle produced by nuclear transplantation. Presently, the Indian Council for Medical Research(ICMR) has banned all forms of human cloning while the USA and Israel have put a moratorium for four years on research in human cloning. Cloning is a difficult topic, fraught with empirical uncertainties and uncertain moral boundaries. Indeed, we agree with those countries who would impose a moratorium on cloning – only we wish the ICMR would impose a moratorium, and not a ban, on all cloning, keeping the debate open on all of its possible applications.

Polycystic Ovary Syndrome: Lessons learnt from Atkins Diet & Alternative Medicine

PCOS is a common condition that affects up to 10% of all women of reproductive age. It is characterized by enlargement of the ovaries, irregular menstrual cycle, failure to ovulate, obesity, high levels of insulin in the blood and insulin resistance, excessive hair growth (due to increased testosterone), and infertility. More than 50% of all women with PCOS have high insulin levels, which may be a risk factor for diabetes, high blood pressure, blood clots, and heart disease.
Simply following a low carbohydrate diet can offer effective relief from distressing symptoms. In a report to the Endocrine Society 2005 meeting, Dr James Hays demonstrated that polycystic ovary syndrome (PCOS) is linked to a phenomenon called insulin resistance, which can be successfully reversed by reducing carbohydrate intake. Continually eating high carbohydrate meals and snacks can make your body's cells become less sensitive to insulin, so that more and more is required to do the job. Having a high level of insulin in your bloodstream eventually makes your ovaries and adrenal glands over-produce male sex hormones. These high levels of male hormones can cause the symptoms of extra body hair, acne and moodiness and increase your risk of heart disease. They also interfere with the normal release of hormones from the pituitary gland in your brain, which regulate the process of ovulation and the production of female sex hormones in your ovaries. This can cause absent or irregular periods and infertility.
The first step one should take to relieve symptoms of polycystic ovary syndrome (PCOS) should involve cutting down on carbohydrates. Doing so will mean that your insulin levels will naturally fall and other hormones in your body will gradually begin to balance out again. In his book, Dr Atkins' New Diet Revolution, Dr Atkins identifies a low carbohydrate diet as being central to the natural treatment of polycystic ovary syndrome (PCOS). He says, "It all goes back to lesson one in don't cause your metabolism to struggle incessantly with high insulin levels, weight gain and looming health tragedies". So remove all refined sugar products from your diet, such as cakes, confectionery, sweet drinks, honey and starchy foods such as bread, pasta, rice and potatoes. The good news is that you won't feel hungry since you can eat all the chicken, fish, seafood, omelettes, rich creamy sauces, crisp salads and green vegetables you want. Just make sure that you drink at least 2 liters of water a day, to flush away harmful toxins that will be released as your body breaks down fat. Dr Atkins also views nutritional supplements as an essential part of his diet plan, particularly in the treatment of polycystic ovary syndrome (PCOS). One that has recently proved its worth is N-acetyl cysteine, or NAC. Women with polycystic ovary syndrome (PCOS) and high insulin levels who took between 1.8 and 3 grams of NAC a day for five to six weeks, were found to have a significant reduction in their insulin levels and improved insulin sensitivity (Fertility and Sterility 2002; 77: 1128-35). Dr Atkins also recommends the amino-acid glutamine to prevent sugar cravings. Animal studies have shown that it helps combat insulin resistance too. Researchers at Vanderbilt University in the US found that glutamine improved blood sugar control so dramatically that they concluded "glutamine has potential benefit as a nutrient adjuvant during clinical situations associated with insulin resistance" (J. Nutr. 1996; 126: 273-79). A daily dose of 500mg is recommended. Chromium is a very important mineral if you have polycystic ovary syndrome (PCOS), since it encourages your liver to produce a substance called glucose tolerance factor (GTF), which increases the effectiveness of insulin. Chromium deficiency has been shown to produce symptoms of insulin resistance and diabetes (Health and Nutrition Breakthroughs, Sept 1998). In one study, chromium supplements combined with an exercise program reduced insulin and cholesterol levels (J Nutr Biochem 1998; 9: 471-475). Take 200mg to 400mg of chromium picolinate a day. The B vitamins are also important in helping to correct the symptoms of polycystic ovary syndrome (PCOS). B3 is a component of glucose tolerance factor (mentioned above), B5 helps to control fat metabolism and B6 balances hormone levels. A relative of the B vitamins, called d-chiro-inositol, increases the effectiveness of insulin in patients with polycystic ovary syndrome (PCOS), reduces male hormone levels and restores normal periods (NEJM 1999; 340: 1314-20). This compound is not available yet in the west as a nutritional supplement, but it is present in soya lecithin. Dr Atkins advises patients to take a B-complex supplement and one tablespoon of lecithin granules a day. In India, a traditional Indian ayurvedic drug being advocated for hyperinsulinemia in PCOS called Hyponiid (Charak Pharmaceuticals, India) also contains large amounts of D-chiro-inositol and could be used as a supplement.
There is no cure for PCOS, but doctors often recommend birth control pills, which help decrease the levels of testosterone, estrogen, and progesterone, thereby reducing hair growth and shrinking the cysts in the ovaries. However, birth control pills have not been shown to improve insulin resistance. N-acetyl cysteine may be useful in picking up where birth control pills leave off, by increasing insulin sensitivity. While it is possible that birth control pills and NAC could work in conjunction with one another, the interaction between the two treatments is unknown.
In this preliminary study, 31 women with PCOS were given 1.8 to 3 grams per day of NAC for five to six weeks. Blood measurements for glucose and insulin were taken before and after a glucose tolerance test, both at the start of the study and at the end of the treatment period. No dietary modifications were made during the study.
Initial measurements showed that 14 of the 31 women had normal insulin levels, while the remaining 17 had abnormally high levels of insulin. Women with high initial insulin levels who took NAC had a significant reduction in insulin levels following the glucose tolerance test and also showed improved insulin sensitivity. On the other hand, those with initially normal insulin levels had no improvement in any measurement. This suggests the benefit of NAC in women with PCOS may be restricted to only those women who already have high insulin levels to begin with.
NAC is an amino acid that has commonly been used as a treatment to break up mucus in the lungs. It is also a precursor to glutathione, a powerful antioxidant in the body, which has been shown in other studies to improve insulin sensitivity. Although glutathione levels were not measured in this study, the improvement in insulin resistance seen in the group taking NAC may have been due to increased amounts of glutathione; however, future studies will need to clarify this issue.
Some physicians recommend taking NAC on an empty stomach, so it does not compete with other amino acids in food for absorption. People taking single amino acids should also make sure they eat adequate amounts of protein, to prevent upsetting the balance of amino acids in the body. In addition, some doctors recommend that long-term supplementation of NAC (more than a few weeks) be accompanied by 15 mg of zinc and 2 mg of copper per day, because preliminary evidence suggests that NAC might deplete these minerals.
N-Acetyl Cysteine (NAC), an antioxidant with insulin-sensitizing properties, may boost the effectiveness of other pharmaceutical treatments for polycystic ovary syndrome (PCOS), according to a new placebo-controlled, double-blind, randomized trial (Fertil Steril. 2005 Feb;83(2):367-70). Researchers studied 150 women who suffered from PCOS that was resistant to clomiphene citrate, one of the drugs used to treat this condition. The subjects, ages 18-39 years, were all undergoing therapy for infertility. The researchers randomly assigned the patients to receive either 1.2 grams of NAC per day or a placebo. Each of the two groups also consumed 100 mg per day of clomiphene citrate for 5 days starting at day 3 of the cycle. The combination of clomiphene citrate and NAC significantly increased both ovulation rate and the pregnancy rate in women with clomiphene citrate-resistant PCOS. The NAC-treated subjects experienced a 49.3% increase in ovulation compared to only a 1.3% increase in placebo-treated subjects. The NAC treated subjects also experienced a 21.3% pregnancy rate whereas none of the placebo-treated subjects were able to conceive. Two of the NAC-treated patients who were able to conceive, however, did eventually miscarry. Although agents that stimulate the ovaries sometimes cause ovarian hyperstimulation syndrome (OHSS), a serious condition that causes pain and potentially life-threatening consequences, no cases of ovarian hyperstimulation syndrome were reported in the NAC group. The researchers concluded that NAC is safe and well tolerated.
Even in the West & the rest of the developed world, researchers & doctors & health authorities are looking at alternative medicine with an open mind. Dr HS Palep is presently lecturing American Universities on the benefits of Ayurveda. I wonder why such draconian laws have been passed in a country like India against Gynecologists using traditional Indian medicine!