Lorne Brown:

Welcome to another episode of the Conscious Fertility Podcast, and today we have Sandro Graca with us and he’s a colleague and actually a really good friend. So I’m looking forward to this conversation around PCOS polycystic ovarian syndrome. So Sandro is a lecturer and a published researcher in the field of menstrual and reproductive health. He’s a fellow of the acupuncture and TCM Board of Reproductive Medicine. The ABORM is also one of the directors at Evidence-based acupuncture. And Sandro, it was one of your posts I saw from evidence-based acupuncture. That reminded me. Hey, I got to interview you because you’re always reviewing research and posting and there’s so many things I want to talk about. Like you had a post a couple of days ago about the mechanism, what they’re seen in the brain when you do acupuncture for dysmenorrhea painful periods. But today we’re going to talk about PCOS.

Now Sandro, you should know a little bit about Sandro. He’s originally from Portugal, but he lives in Ireland because he obtained his license in TCM at the Irish College of TCM in Dublin. He’s also gone and studied at the Beijing University of Chinese Medicine. He completed his master’s science in Advanced Oriental Medicine Research and Practice at the Northern College of Acupuncture, the NCA. And that’s in conjunction with Middlesex University where his focus was on acupuncture for polycystic ovarian syndrome. He’s a lecturer on the online Master’s of Science program at the NCA in York, UK and he’s one of the researchers on the Cochrane Review Group for acupuncture, for dysmenorrhea and for assisted reproductive technology. I’ll also share that Sandro has spoken on Healthy Seminars at one of the integrated fertility symposiums. He had a group lecture and he talked about PCOS and we worked together on one of my other companies called Healthy Seminars way back when, and we’ve traveled to conferences to attend and to support them and to lecture at them. So we have traveled the world together. And so Sandro, it is a pleasure to have you as a guest on the Conscious Fertility Podcast.

Sandro Graca:

It’s a pleasure to be here. It’s just another one of our normal chats that we have. We just chat about these things.

Lorne Brown:

It’s true. We do get together and talk shop and now we’re going to record it and let everybody listen to us. So often the topics here are around the mind, body side of it, the consciousness and the mind body of fertility and health and wellness. And today we’re going to get into a lot of the body of the mind when it comes to reproductive health and wellbeing. However, polycystic ovarian syndrome does have that mind component. There is some emotional anxiety research that hopefully we’ll get into. But let’s just start with, can you tell us what is polycystic ovarian syndrome and how does this affect

Sandra Graca:

Health? It’s really interesting the way that you introduced it because it was actually how it got me really interested into it was how little, obviously the people when they’re diagnosed, how little they know about it and even how long it might take even to get a diagnosis per se. And the diagnosis itself. When you hear the words and you think about polycystic ovary syndrome, what does that mean? What is it? So is it just in my ovaries? Do I need to do something about it? So if you break down the term and the polycystic, so multiple cysts on the ovary and it’s a syndrome. So there’s multiple things at play here and there is a lot of controversy, but you’ve asked me not to be controversial today, so I won’t go into that about the name itself. Well,

Lorne Brown:

Let’s go into it because we’ve already had some listeners that are probably like, oh, I have no cyst. I ovaries, this isn’t for me. And in my practice, almost the majority of the women diagnosed with PCOS do not have cystic ovaries. So this is our chance to demystify Dr. Google that’s out there and really let those that are trying to conceive or those that have weird cycles know that they may have PCOS and how they can diagnose it and why they want to deal with it because there’s health risks. So be controversial, what it means and how we test for it and we’ll get into why. And also the risk factors if you have this metabolic disorder.

Sandro Graca:

So at that baseline, if you want to take it with a name first multi, I don’t even mention the word cyst, to try and stay away from that. So I always call it a multi follicular ovary or ovaries because it could be just on one side. And that’s what was kind of like the first thing that was known about PCOS was to see it the way that we got to a point in our history where you can now see inside the body and you would see that the ovary or the ovaries would have those cysts and that’s where it got that first name. But to be honest, they could be just follicles that stopped developing. And as you said, some people might not have any of that part of the name itself. So another thing that you mentioned that’s really interesting is in terms of what is it, is that a lot of the times women find out about this, and this happened in our clinic, we spoke about this before when they’re trying to get pregnant and before that they might not even have noticed that there was something, let’s call it wrong, but they didn’t notice anything until they’re told you have PCOS.

And that could be because their cycles are long or they’re absent, completely absent or they might’ve been on the pill, for example, and not even know that they had an issue with their menstrual cycle. But in terms of the definition, if you want to start there, then would be the long or absent menstrual cycles, they would have that presence of multi follicular or maybe even cyst in one or multiple ovaries. And then there’s the hyperandrogenism, so that’s the excess androgens in their body as well. The other side that is just tagged along, and again adds to that controversy because of the name is that there is a big, really huge component when it comes to insulin resistance. And that’s where there’s that metabolic aspect to this syndrome that it’s not just specifically to do with the reproductive system like with the ovaries or with trying to get pregnant. It’s also to do with the metabolic aspect.

Lorne Brown:

And you talked about the high androgens because you and I both, you’ve met Dr. Jalen Pryor, she’s a retired endocrinologist here and she uses the name a e, I think it’s Anor androgen access. So can you share with us what that means and how would somebody know based on physical signs that they may have this hormonal imbalance?

Sandro Graca:

Yeah, that is part of the mystery of it all is how do you actually find out and where do you draw the line about? Is it excess androgens or not? So when it comes to that balance between hormones, between what it’s normally called, and I know it’s not the right term for it, but let’s just make it black and white now, the male hormones versus female hormones, and then there’s that whole balance that we all have them anyway, but there’s a certain balance that needs to exist to make sure that your body functions continue accordingly. And one of the, I guess the telltale signs of for a woman to know that they should just get checked would be something like acne for example, or excess body hair. Those would be probably the main ones that you would be picking up on and say, this is going for a little bit long. I’m just not happy with what’s going on here. Let’s just get checked. But then word of caution, just be careful with what’s normal, what’s excess. And remember this is a syndrome, so you don’t diagnose this just with one particular excess androgens, for example. You would have to go and see, ask questions about their menstrual cycle, has it been irregular? Is it long? Is it happening at all? And so then when you put those pieces of the puzzle together, then you say, okay, this could be something else. And then you start investigating.

Lorne Brown:

And for those that are trying to grow their family, often they’ll come into a practitioner like yourself and they have delayed mens or no mens. So there’s an auditor dysfunction happening because of this syndrome and they have gone through or been suggested to auditor drugs like Clomid or Letrozole. In the research that you have published and that you obviously have to read through, is there an order, should you be going right into to force ovulation or an IVF or do you want to do some preconception care? I think of one of IVF docs in our town in a lecture. She said garbage in, garbage out When it comes to IVF, she’s a fan of doing a little bit of, depending on your situation age, but some preconception care to get the egg and sperm to their peak fertility potential before you do an IVF garbage and garbage out, right wants the best quality. I think of that for PCOS. People diagnosed with that or have PCOS like symptoms think that it’s beneficial to do some work to resolve this imbalance, but I’m wondering if that’s your strategy and what’s the research saying how to approach this?

Sandro Graca:

Yeah, absolutely. So that’s actually how I really got into it was because of working with a fertility clinic and seeing these patients coming in and now they were diagnosed with PCOS and then now we can’t just jump into treatment straight away. And that’s what made me read more into it. And you’re absolutely spot on. Again, everyone is different if you’re younger, if your body’s been super healthy and if you can just start treatment or cut something that you shouldn’t be doing. And all of a sudden, yes, you get pregnant even though you were diagnosed or you were told that you have PCOS, ideally from what I see in the clinic, and I don’t just want to say that it’s my gut feeling because I would say get yourself in a better position because something wasn’t working right for X amount of months, years, maybe. Is that really your best choice to go into pregnancy, like a so special time of your life knowing that something wasn’t quite right, just like the cycle before.

Lorne Brown:

Aren’t there risk factors if you get pregnant with this condition? What are some of the risk factors to the mom to be and the child? What are some of those?

Sandro Graca:

Yeah, so that’s even more, this is really interesting because now you’re getting into the metabolic side of things and that insulin resistance aspect and albeit some of those you just can’t avoid because it is who you are and just have to mitigate those risk factors. But you’re absolutely spot on PCOS. I’m sure that there’s going to be loads of people listening to this and going, getting pregnant wasn’t really the main issue that I had. And I was like, yeah, it wasn’t A lot of the times it’s the staying pregnant a lot of the times, the carrying all the way through. And a lot of the risks actually with those people that get pregnant and get towards the end of pregnancy is how then that birth is going to be, and the complications tend to be towards the end of pregnancy.

Lorne Brown:

So can we unpack that a little bit? Yeah. So there was the difficulty of getting pregnant. And so with this syndrome there’s an issue with egg quality because you’re talking about the high androgens, the male hormones or the insulin resistance or the hormonal imbalances, like really long follicular, lots of estrogen, short progesterone, so all that can impact egg quality. So not getting pregnant or if they’re miscarrying, there’s egg quality, but also the uterine environment, that high androgenic environment is not so receptive for implantation. And then are you thinking of gestational diabetes and high blood pressure with this condition later on? Yeah,

Sandro Graca:

Absolutely. Again, especially towards the end of pregnancy. But if I can bring you back then to the start and to the trying, so you have that aspect of the egg quality because the cycles might have been long, how long were those follicles a part of the ovaries now that you’re actually getting to, no disrespect to the medication, but the medication is going to flare for you to try and get to release those eggs, but how long have they been there for? Are they good quality? And think about the lining as well. If your cycle was long, how long is that lining there for? So what’s that soil? You talk about the soil all the time because you listened to the podcast. How good is it? So that’s that preparation that goes into it to say yes, it could be talking about the quality, but you could actually have, one of the things that comes up all the time is the anovulatory infertility where you’re just, you’re not getting pregnant because you’re not ovulating, you’re not getting a release, you’re not getting a menstrual cycle per

Lorne Brown:

Se. I want to share a story and I want to highlight how there are things that you can do to shift things, right? And to get your ovulation back to see your hormonal profile. Do you have a story where somebody is not ovulating, maybe even done some auditory drugs and with your, because you’re practicing with diet and acupuncture and Chinese herbs and supplements, do you have a story to share? Because I know listeners like to hear this, I have many. One of my favorite things to see is polycystic ovarian syndrome. Why I think Chinese medicine and naturopathic medicine, their tools are really effective when it comes to that and we’re seeing more and more research on that. When you do well in something, you tend to like it. So that’s why I like to see it. But I do have my favorite case. It was a difficult case that worked out well, but I wanted to see if you had any stories you wanted to share just to let our listeners know that it’s possible.

Sandro Graca:

I always think about PCOS when I have to talk about how passionate I am about it and how patients made me look at things differently. I always think about one thing that I was thinking before coming on the podcast with you that maybe your audience is going to be way younger to remember this, Lorne, but when we started in clinic, there were no mobile phones and there was very little computer stuff going on and definitely no apps to track your cycle. And I remember one particular patient in my clinic that was probably one of the first few times that consciously I was thinking about treating someone that had been diagnosed with PCOS and remember the charts that used to be like they had 40 days. That’s as much as you can put in one day. Oh, you’re talking

Lorne Brown:

About those body temperatures, the chart? Yeah, that’s right. So yeah, it could only go so long unless you started taping them together

Sandro Graca:

Because that’s as much as you can put in one page. And I remember at one time, and this is vivid in my memory, where she had one, two and a little bit of the third page, that was her cycle. Right now I know that again, this doesn’t happen anymore because everyone uses their app and it’s not as visual anymore. But that’s one of the times when I think about someone coming in and saying, here’s my cycle. And I thought, wow, one page is already 40 days old. That would be a long cycle. This person is living with this and this is two pages and a half. And if you take that in very early days of me being in clinic and thinking, okay, I need to learn a lot more about this because I want to help these people coming in. And one of the things that really warms my heart, so although I don’t have one specific story, it’s probably the group of people, and I could be biased because I love it, but it’s the group of people coming into the clinic that actually sit and really want to learn from you.

And this happens because they have this experience. And you asked about research, we actually know this from research that takes two to three years, two to three, sometimes even three to four different medical people to be seen for them to get a diagnosis. So when someone sits in front of them and we have a conversation about, tell me about your symptoms, rather than just looking at a piece of paper and go, your hormones look normal, it’s the group of people that I really enjoy to sit down and learn and go through the digging on. And then I have this symptom and then I have that symptom and look at what happened. And now they bring the apps and then it’s like, look at what happened here and I had a symptom here, and then maybe that was ovulation. Things are changing in my body. So that’s what really, really inspires me is that this is actually a group of people coming in that are so willing to listen and learn because a lot of the time we are the ones who did that to them for the first time.

Lorne Brown:

It’s true. And they’re motivated to learn. They want to get pregnant and have a healthy baby. I want to talk about some of the tools like acupuncture, herbal lifestyle. I still want to talk about the research around that as well. The health risk. We know that there’s some cardiovascular risk. So there are some diseases that later on in life if you have this, you’re at higher risk for. So it’s motivation to manage this syndrome so you have less risk of developing these cardiovascular diseases, diabetes, and also for the health of the baby and pregnancy. So that’s usually motivation. So those are things that we kind of touched on, but I want to talk about the research that you’ve done and I want to share a story, but I’m going to do a really abridged, people hear me say this because it’s my favorite one for PCOS.

I often shared this one, but we do have many, it was just one of those cases where she’d come after she had done IVF, so in vitro fertilization because she had PCOS and she didn’t respond to the ovulation drugs. So she’s never had her own period. The only time she has a period is sometimes with a progesterone withdrawal. But she, even the ovulation drugs didn’t result in an ovulation. So they did an IVF cycle and her first cycle did not work and the second one was positive and then miscarried all from the same IVF cycle. So she had a frozen embryo left and she’d come to the clinic to help us prepare her lining for the frozen embryo transfer. She wanted to increase the chances of it. And in that education that you were talking about, Sandro is about educating them. I shared how the embryo quality may be issued because of her egg quality, because of the syndrome she’s had.

And so we can prepare the lining, but if there’s an embryo issue, we can’t change that. But the work we’re going to do together with diet and movement and mind body stuff, and I’d use the low level laser and I use my acupuncture, my herbal supplements, all that stuff that’s going to help balance your hormone and manage these high androgens that she had and insulin resistance. If it does what it’s supposed to do for uni receptivity, it would also help with your hormonal profiling, your egg quality. So you may actually try to conceive naturally, but she says, I never ovulate. I go, no, but if this is successful, you may start to ovulate again. And it was after four months of our treatment and she came regularly, this is the downfall, she was coming two to four times a week and her SM she said shifted.

She lost weight, her mood improved and her acne went away. So she was really happy about that and she conceived naturally and had that baby. So here’s somebody that went through IVF already had two transfers, and then by doing that preconception work, she was able to reverse some of this and she was able to conceive naturally she never ovulated before on her own. And that’s what I want to emphasize just to the listeners, is that these tools like IVF and ovulation drugs were big in integration. You and I, we love that. What I’m sharing is I think the diet and the lifestyle and the mind body stuff, and if you have access to it, the acupuncture, herbs and low level laser therapy and supplements, I would encourage that’s what you start with. And then you move into an ovulation drug or IVF if they’re not resulting in change after three or four months, that’s congruent with your thoughts. Oh

Sandro Graca:

Yeah, absolutely. Yeah. If you think about it, people sometimes ask me that even students go like, what’s the typical PCOS coming in the clinic? And I’ll be like, okay, it has changed. And I’m sure you’ve seen this in the clinic as well. Typical idea of the PCOS would be someone who is either obese or borderline obese, has problems with weight, and you have that herm type. 10 years ago I would have a completely different picture, but nowadays actually I end up seeing more of the what’s called the lean PCOS type in the clinic same than

Lorne Brown:

Anything else. Thin and dry to call them, right? Thin and dry type A. Yeah,

Sandro Graca:

Absolutely. Yeah. And again, it is just the way that we talk about things in our own terminology that we use for our own medical system. We just go like, oh, these are the liver stressed people because this, it’s what happened to the world. And always, again, as I was saying to you that sitting down with a person and having the conversation is a lot of the time I say, Hey, let’s have a very open conversation here right now and say, are you ready for this pregnancy? Do you feel ready to be pregnant? Let’s think it’s tomorrow.

Lorne Brown:

How do they answer that for you? Because for me, ready or not, they want this pregnancy. So they want to do anything. And that’s why I think they jump into the ovulation drugs or IVF very quickly because ready or not, they’re ready as in because they wanted to have this baby a long time ago. I think it’s the education part though, when you’re saying ready, is your body ready to get pregnant? Hold this pregnancy and her goal is a healthy baby, right? And I think that may be a different answer, but for me, if I say, are you ready to get pregnant? They’re like, hell yes. Why do you think I’m sitting in front of you here?

Sandro Graca:

No, absolutely. So me, I’m very visual. So at that point I’ll go with, okay, so let’s go at the pros and cons. So have you thought about this? Have you thought about that? And you mentioned those risks that are there. So I’m always very open and I look, I don’t want you to be here with me if you don’t want to be here with me, and I’m going to be, I’m not wishing any of this and I’m not going to be talking about it because I want it to happen, but I want the two of us to be clear about what we’re getting ourselves into. And the ready is this could happen and everything that we’re going to do is to minimize the possibility for this to happen. And I might even go to the point where I say, just like what you said, here’s the scenario treatment itself, the approach that you see from the guidelines now. And I worked on the update for the guidelines, which would be out soon enough this year. Still lifestyle. That’s the approach. Lifestyle is what you need to do.

Lorne Brown:

What do you define as lifestyle? So what fits under lifestyle?

Sandro Graca:

You name it, I’ll

Lorne Brown:

Throw it out and you tell me. I’m assuming your diet is a lifestyle. Okay. Yeah, movement, exercise, sleep. Yep. Rest. Yes. Stress reduction.

Sandro Graca:

Absolutely. I’ve got mindfulness. Yeah.

 

Lorne Brown:

Do they bring in community and stuff like that? I’m curious. I know that’s starting to be, we’ve learned from Covid when we isolated how that was not good for our health and they’re starting to show connections with family and friends and community. I don’t know if that’s in there. Yeah. Are they saying you should smoke and drink a lot of alcohol? Right?

Sandro Graca:

No,

 

Lorne Brown:

Not really. I just want to see if you’re just saying yes to everything, go

 

Sandro Graca:

Out with your friends and have a few drinks. It’s just one time. Yeah. So it’s really interesting because the question that you asked is the question in everyone’s mind, what does lifestyle mean to you? What does lifestyle mean to someone else? Right? And that’s part of what I always say about readiness. It’s like, are you ready for this now? It’s a complete change of lifestyle when you are pregnant. I know we’ve had this conversation before, but I’ll share it here. And I always say, you are not pregnant. The moment that you get your positive pregnancy test, you were pregnant a few weeks before and that lining was there for even more weeks ago and that egg was inside that follicle for even more weeks before that months. So you don’t just go and flick a switch and say, Ooh, now it shows that I’m pregnant. I’m going to change my lifestyle. Now

Lorne Brown:

You said something that I think I want to highlight for our listeners, and I like this. You weren’t pregnant, the pregnancy didn’t start when you got the positive pregnancy test. So when you said it started two weeks before because you had ovulation, so there’s fertilization, but you said something that how many days before that, the quality of that egg that’s going to become the embryo baby, how many days before that ovulation, is it being impacted by your diet and lifestyle? Do you remember?

 

Sandro Graca:

And even think about the fact that that egg was already inside that follicle from the cycles before that egg was inside your ovaries, Lorne right inside you, you’re keeping it in what environment?

 

Lorne Brown:

Those eggs were inside that ovary when you were in your mother for the daughters, right, exactly. So this is where we get into the whole epigenetics and why what you’re doing now is going to even impact future generations. And so we could go on and on in this because it just shows you that what you’re doing now is impacting not just your child, but future generations. And that time period is on average a hundred days seems to be really important before you even ovulate or do your IVF or your ovulation drug is when you’re really impacting the fertility potential of that egg. And for men of that sperm, what’s the research thing? We are talking about diet and lifestyle. More and more people are very aware of the ovulation drugs like Rozo clone and IVF, what we offer the acupuncture, we do the diet and lifestyle, but the acupuncture and the herbal medicine and the supplements, which I shared with my story, that’s what we did.

And here’s somebody that did IVF that didn’t work after ovulation drugs and that made the big shift for her. You’re involved in research and you’re reviewing the research. So number one, what does the research say about acupuncture? And because of your work with the evidence-based acupuncture group, the EBA, what are some of the mechanisms? Because I’m seeing you posting about the brain and peripheral nervous system and inflammation and insulin resistance. So can you, in a distinct and short way, I know you’ve gone through lots of paper and research, what’s the research saying about acupuncture for conditions like PCOS and what’s the mechanism that they think is happening?

 

Sandro Graca:

So one of the key aspects where you can really benefit from acupuncture and everything else that you mentioned that comes with TCM as well is because of that metabolic aspect. So part of it, because of the hormones, because your listeners are used to hearing this from you as well about regulating the self-regulating. So there’s that aspect where you can use acupuncture to help with the hormones as well. But then really a big part of it is going to come down to the metabolic system. And that’s why being more technical, when you look at the acupuncture points that are used, they’re not just to do with the ovaries reproductive system. They’re also to do with the metabolic system that’s going to help with that insulin resistance aspect of it. And it’s also going to help with your own metabolic system, the way that you’re processing things, again, in and out of your body.

If you think about what we were saying about the delayed long or absent cycles, it’s almost like there’s that friction. Your ovaries and your uterus were designed to do that. Some of those hormones are there, but something is not working. So if you can get there and think about that process going again, you achieve that point where now you’re more, let’s use the imbalance like your balance. Now that’s going to help. And that’s the real benefit from acupuncture is that you don’t need to take anything because remember one of the cautions that I always say about other practitioners would ask me, what about herbs? What about other things that you’ve heard recently the metabolism for these people are not, they’re not great to start with. So maybe that’s not the first thing. Start with acupuncture. First start with the lifestyle. Get them to go to a point where things are now shifting, things are now moving, then you can go with the stuff that goes inside.

And I would just put a very, very strong aside here, which is that letrozole is fantastic if what you are trying to achieve is to ovulate, but that’s all it does. Ovulation is not the end of your issues and there’s the side effects that come with that. So every time that you put something inside you, what are the side effects? And from research you asked me, a lot of the time, unfortunately for these people, they do report that this, even from starting with Clomid can be a bit strong in your stomach. It could be a bit uncomfortable to take. Same thing with Letrozole with the hot flashes and stuff like that. So do you have the time? Are you ready to give acupuncture a little bit of time? Give TCMA a little bit of time to get you going, to get these systems balanced again and remember doing what your body would normally do anyway. We’re not trying to do anything like we’re taking medication to chemically induce something to happen. We’re just asking your body to let’s go and do the stuff that you were actually designed to do.

 

Lorne Brown:

I often find that the brain is the best pharmacy in the world. And so you’re using the acupuncture to engage that in a pharmacy. Is the research using electrical acupuncture often in the research? What I do for my PCOS patients, is that what you see mainly? Although you could do a lot of manual stimulating the points with your hands, is that the main research?

 

Sandro Graca:

Yeah, so it’s interesting you mentioned that about how many times per week the treatment was because something that you do see for these types of conditions, like these stuck stubborn conditions. So again, something that should be happening is not happening. So you want to encourage the body to do it. Electro acupuncture, definitely. Yes. Especially for those with long or completely absent ovulation because that would be great. And if you, again, I know because you’re a practitioner, so you’re in clinic all the time, it’s around that area, belly button area around the phos pubis, that’s really when you want to stimulate blood flow and get things moving in very simple terms to explain what you’re trying to do, you’re trying to get everything that is stuck there to just move a little bit more. So acupuncture is great for that for a few reasons. One, and I know a common question is, is it because it’s stronger. No, it’s just because it means that instead of you being there stimulating those needles all the time, you could just press the button and go, Hey, do this for a few minutes because I really want to stimulate things there. So it’s not because of intensity, it’s more because of prolonged effect. And that would be, again, you asked me about research. The main thing that you see from PCOS research in terms of dealing again in particular with the menstrual cycle scenario is you really want to be doing two to three times a week treatment

 

Lorne Brown:

And electrical acupuncture. And you sound like you’d like to start with acupuncture. I kind of do. Not quite a kitchen sink, but I kind of started it all. So they’re doing the diet, the lifestyle, we’ll do the acupuncture, I’ll do Chinese herbs and I’ll do supplements as well. I just started all at the same time. Do you have any supplements that you like and that you have read in the literature that seem to either may or have confirmed support in improving the metabolic factors with PCOS?

Sandro Graca:

Yeah, for sure. Everyone heard about acetals and how they can help. I can tell you that in the next while you’ll hear more about it because they are being included in the PCOS guidelines as well. That will be out soon. So I won’t say too much. But yeah, pay attention to it. And it seems to be the one that there’s the most confidence in terms of using it and really we can see the difference. And it’s interesting that here we are talking about a supplement and we talk about acetol and we go, Hey, that’s more metabolic than anything to do with reproductive. And it’s this balance that we have to have with this particular condition. And it ties in nicely with what you were saying about how you do it one way. It’s interesting that this could also be a regional thing where you are and the type of people that you’re seeing in your clinic might be completely different from someone else in a warmer, colder, different lifestyle as well. So that could change in terms of how you approach it. And just to clarify, the reason why I said about acupuncture first is I’m big into the lifestyle, not just because of PCOS, because of everything. So I don’t want to overload that lifestyle thing. I want to go at things that they’re already doing a little bit or doing too much of and then I’ll introduce the other stuff.

Lorne Brown:

Gotcha. Everybody has their own style, but I want to know when you introduce that other stuff, what are some of the things you like to introduce? So the inositol, there’s the myo-inositol, then there’s the 40:1 myo-inositol and d-chiro-inositol. I know we have those friends that have their product. How do you say it? Ovasitol?

 

Sandro Graca:

Yeah.

 

Lorne Brown:

Really good product as well. I’ll have to get them to sponsor this now that we mention them. But they do have a good product. There are logics on that. And there’s many other companies doing this 40 to one ratio beyond what we want to talk about today. But some of those supplements are being researched. And you said that one is the nasals are being included in your guidelines that you’ve been reviewing.

 

Sandro Graca:

So that was something that was introduced for the first time because it wasn’t there for the previous release of the guidelines. And this is something that, I’ll just put the plug here now for everyone from the patient side, this is what’s amazing. It’s a condition that we need from the research point of view. We need so much input from the people that are dealing with this condition day to day that happened because of patients. And it’s the fact that the patients are taking it, the patients are finding the benefit from it, and it’s like why wasn’t even looking at it for the guidelines. So then it’s like, okay, we need to do this. So we need to look at what evidence is there. And just opening a little bit, and again, I can’t say too much, but it’s interesting the link with acupuncture, because we’ve been there from that generation that we know this happened with acupuncture, that there is very little research and RCTs are very small and whatever. But at the end of that look at the results. These people are getting results from this.

 

Lorne Brown:

And that’s usually what encourages research. When you start to hear enough stories, then they’ll study it, and get a bigger population. So the nasals, I’m going to share some of the things I like and I want to know if you’re using any of these or if there’s research that you’ve come across. But usually when it comes to PCOS at the clinic, we’ll do some functional medicine testing. So we’ll look for deficiencies or out of balance if there’s a microbiome issue, the probiotics and just going after the microbiome to support it. But in general, and I’m going to just add a caveat here that we’re not telling you our listeners to take these because Sandro, and although we’re practitioners, we’re not seeing you right now. We’re not having this one-on-one conversation. So I will say, you want to have a one-on-one conversation with your healthcare provider, and we’re giving you information as education so you can go and talk to them about it.

So I tend to like the acetals, NAC, acetylcysteine I like. If somebody has PCOS or PCOS like symptoms and vitamin D, they’re usually those three that they’re all getting. And then there’s the essential fatty acids. There’s other things depending on what’s going on. But if you said you got three and I don’t know anything about the patient, I just know that she has PCOS, I would probably be doing the acetol. Is vitamin D and NAC agree or disagree or is there anything you like in your top three or you have anything else that you tend to go to? We have our favorites and you have the luxury where you are immersed in research on a regular basis either doing the research publishing or you’re reviewing research. So what else can you share with me and our listeners?

Sandro Graca:

It’s interesting that you mentioned, so it was when I said about the different regions and the different types of population coming into your clinic. I was actually thinking about the vitamin D was the word that was in

Lorne Brown:

My head. That’s right. You’re in Dublin and I’m in Vancouver. Yeah, we need vitamin D over here. Yeah,

 

Sandro Graca:

Absolutely. Yeah. It’s a little bit like we could be having this conversation with a colleague that works, say in Italy or Cyprus or whatever, and they go like, no, we don’t need that here. Normally their values are great for that. And I’m like, yeah, of course they are.

Lorne Brown:

Right, right, exactly.

 

Sandro Graca:

They see the sun, right? So yes, that is a very good point. And there is a main reason why I don’t normally say, Hey, there’s a top three, but you mentioned a top three. That would be something that at some level, even just for maintaining health and thinking about that process of this is someone that wants to go into a pregnancy, that they want to be as healthy as possible. So if they need and if they can be doing something that will be helpful in terms of maintaining their own levels in going into pregnancy. For sure. Those would definitely be in my top three. The thing that I would say to you is that as I was explaining, why do I stay away from trying this, try that without talking to the person and without, as you said, being in front of me is that this is a metabolic condition. This is a syndrome. You can have two people that were diagnosed with PCOS and look and have completely different symptoms altogether. That

 

Lorne Brown:

Is so important. We got to say that again. So you could have two people both have the diagnosis of PCOS, but it’s a syndrome. They’re very different. For example, you could have somebody who looks at a muffin and gains 10 pounds and is overweight. And you could have somebody that is thin, super thin and can’t gain weight.

 

Sandro Graca:

And if you take that to the level of someone that can take, let’s say for example, this has happened in your clinic, and I’m sure you can think of a lot of them because I can’t too that, oh, the clinic gave me X amount of clot, but I was really nauseous after taking, I just couldn’t take it at all. And someone else that takes it and goes like, oh, it was great. From the moment I started taking K Clomid, everything was so much better. And you’re like, but it’s the same medication. How is this possible? It is possible because the syndrome is different and it affects people differently. And especially because this one in particular involves its metabolic. So the way that stuff goes in and the way that your body processes it is completely different.

 

Lorne Brown:

And that’s the individualized type of medicine that you and I practice because it actually says, don’t treat the disease, treat the individual, take the disease into consideration. But then you have to differentiate based on that individual. And that’s why when we get the calls, can I have your Chinese herbal formula for PCOS? My girlfriend has it. You’ve treated two of them and it worked. They’re not aware that they had different Chinese herbal formulas because we individualized it. It wasn’t like a one-time fits all. Now, when we do nutraceuticals, often that’s based on the condition like the AOL and vitamin D. But when it comes to the Chinese herbal medicine, it is a different recipe usually based on the individual. Yeah,

 

Sandro Graca:

Absolutely. And think about anyone that is listening to this and that has gone through the experience, think of even with pregnancy, no pregnancy is the same. You might’ve had one pregnancy where things happen this way and you’re thinking about planning your next pregnancy and go, this was so cool. It’s going to be the same thing again. It might not be. Everything is different and our bodies change. We get older, we go through different things, different levels of hormones. So be very, very, especially with these in terms of metabolism and even with the way that you would approach something like exercise, I know a lot of people now use the word movement because exercise kind of makes you think about, I have to go to the gym, I have to sweat, I have to be uncomfortable. It has to hurt. No, that’s just going to add.

If you think about that, doing something that you don’t like and thinking about all the other things that we mentioned about the stress of life, there’s your prolactin going up straight away. You’re stressed about it, you don’t want to go to the gym and you don’t like it. Well walk. Is there a possibility of doing something else? Because although this works for someone, it worked for your friend, it worked for your colleague at work that got the same exact same label, you are different. So what works for you? And this is what I was saying about the lifestyle and say, okay, we can work with that. Let’s see what works for you and let’s build on that. And

 

Lorne Brown:

With this being the Conscious Fertility podcast, and we talk a lot about emotions here, is that also connected to the syndrome? What is one of the symptoms around the emotions that they are starting to now observe and document when it comes to this syndrome?

 

Sandro Graca:

Yeah, it’s really interesting. So it was actually when I got into research that I had to look at this into more detail because in our clinics we were seeing obviously these people that were coming in were more likely to be trying to get pregnant. So being of a certain age, but actually PCOS has a huge burden on teenagers and adolescents. And at that point, if you can think about things like acne, the herm, so the excess body hair, if they are in that category where metabolically, they’re finding it really difficult to lose weight, it’s really, really impacting on their life and the way that they see themselves, the way that depression, the way that they even look at the world and how are other people looking at them. So when you look at that age group, I do acknowledge this could happen in any age group to be clear, but especially at those teenage years, if you have to deal with irregular cycles, pain, difficulty with menstruation, and then those visible signs where you have herm, so the excess body hair and the acne, that really, really impacts on these girls developing.

 

Lorne Brown:

Thanks for sharing that. And to kind of put it together, there are things, proactive things, activities that you can do to help reverse or manage the syndrome. Yes.

 

Sandro Graca:

Yeah, absolutely.

 

Lorne Brown:

Yeah. And in your guidelines, you’re talking about the lifestyle, you’re talking about diet, I’ll put a plug that there’s the free acubalance fertility diet that is a low glycemic index, anti-inflammatory diet that you can download from acubalance.ca. So there’s lifestyle, there’s diet, then there’s supplements that we talked about. There’s acupuncture and Chinese herbal medicine that can also be shown to be beneficial. And then there’s also the ovulation drugs and even IVF. So there’s lots of interventions and integration that works really well that are available to these people, and it takes some time. Like the story I shared, that was over four months of regular treatment of her diet, lifestyle, acupuncture, herbs, and low level laser therapy. It’s not like doing this for two weeks. There is some time involved.

Sandro Graca:

Unfortunately, there’s no silver bullet.

 

Lorne Brown:

Yeah, there’s no silver bullet. It’s a syndrome and it requires a multidisciplinary approach. Did I miss anything? Kind of what you’re thinking about your guidelines, but just in general of your approach. There’s research which is limited because of time, space, money, and then there’s what we do in the clinic. So clinically, the lifestyle and the diet, stress reduction, herbs, acupuncture, supplements. I like to use low level laser therapy. There’s research showing that it can be beneficial. Is that kind of your style as well in your practice?

 

Sandro Graca:

Yeah, absolutely. Yeah. So to bring something a little bit more modern than just talking about acupuncture, combining the low level laser therapy, that’s amazing because again, especially for those who are having difficulties with long or absent menstruation, the impact that that can have is huge. And I always see it as a little bit like Jenga, right? There’s going to be one piece that’s going to make the whole thing move. And I know that in Jenga that it collapses badly, but in this case, you actually want something to move. And the stuff that you can add on that is going to help you, it’s going to have an impact on the conditions, on the symptoms that you’re having, but you’re also improving your health. And that’s major, and that’s something that we touched upon for the pregnancy. And what happens then with pregnancy, if you can get into that pregnancy as healthy as possible, you’re minimizing those risks of gestational diabetes, the type two diabetes. Then later in life, which I will add, Lorne, that we were talking about, the adolescents. BCOS doesn’t end when you hit the menopause.

Lorne Brown:

There

 

Sandro Graca:

Are problems after the cardiovascular situation, the type two diabetes. All of these are more likely to happen later in life. If you had PCOS and the symptoms were left untreated or manageable to a point where you weren’t really, let’s call it fixing the problem. So I would say, when you say, did you miss anything, I would say, please do go and get checked if you think that something’s not a hundred percent right. Because the longer you leave it, the longer the risks.

 

Lorne Brown:

And so if you have hair where you just don’t think it should be, if you get a lot of acne, male pattern baldness, your cycles are delayed or you’re not having cycles. So auditory disorders, infertility, these are things to consider. Thank you, Sandro. I want to have people be able to find you, so we’ll put in the show notes as well, but what’s the best way to find you? Do you want us to put the other things there? Like the evidence-based acupuncture and the The That stands for what? 

 

Sandro Graca:

Obstetrical Acupuncture Association.

Lorne Brown:

Yeah, I should know that since I’m a member of it, as you are as well. Some things are for practitioners. We do have practitioners that listen to this and some for the public. But can you kind of list out how people can contact you and which ones are more for the public? Which ones are more for practitioners?

 

Sandro Graca:

I love the time when we could say this, that the best way to find me and to find us would be somewhere around the world traveling, going to conferences and learning together. But that’s changed a little bit in the last while.

 

Lorne Brown:

Yes.

 

Sandro Graca:

But yeah, even with the Obstetrical Acupuncture Association and the evidence-based acupuncture, it does have that strong component towards the practitioners. We make the point of making in a language that is accessible to the public as well. And this is to promote this engagement and to talk about things like we said about someone coming into the clinic, sit down and have the time to talk to us. Being able to talk to them rather than just looking at pieces of paper with different ranges of hormones and thinking that, oh, this says normal. That says, okay, we want to have a conversation with you. And that’s the magic and the beauty of our medicine is that we can do that, and we do that all the time. So we do promote that with those, what’s

Lorne Brown:

Your website?

 

Sandro Graca:

Yeah, Sandro Graca. So S-A-N-D-R-O-G-R-A-C-A.com.

 

Lorn Brown:

Okay. So that’s how they can find you. And then I’ll get you to send me, if you have your Instagram or if you have your podcast, I know you’ve done the podcast, so the evidence-based, we’ll put those things in the show notes. But I guess the best way is to start off with, because then you can contact Sandro, go to his sandrograca.com website, and then there’s lots of jumping off from there.

 

Sandro Graca:

And on social media, as you said, I try to post in a way that it’s to educate the public, also educate my colleagues and thank you. And you’re seeing them and you’re reading the stuff as well. But just try to put it in a way that people can use that and go, huh, I never thought about this before. Maybe I should talk to my own clinician, maybe get this communication going and help as many people as we can.

 

Lorne Brown:

I want to thank our listeners for tuning into this episode, and I want to thank you, Sandro, for sharing your clinical and your research that’s involved in PCOS. Much appreciated.

 

Sandro Graca:

Thank you.