Consequences of PCOS

The Serious Health Complications Of Unmanaged PCOS

Just like endometriosis, there is a lot of the information about PCOS, but it is more about the symptoms, time to diagnosis and future fertility outcomes.

While it is necessary to educate people about these things, nobody is really talking about the serious health complications of unmanaged PCOS.

There have been some big changes to the diagnosis of PCOS, but still it can often take up to 3 years or more to get a proper diagnosis. While it may not take as long as endometriosis to be diagnosed, it still means that many women are being missed and dismissed in those year before they are finally diagnosed.

Like Endometriosis, some women with PCOS are never diagnosed and some women do not have any symptoms and can have very regular cycles etc. Women can have PCOS and endometriosis together, alongside other issues such as adenomyosis as well.

There are serious health consequences with unmanaged PCOS

The main thing I am trying to bring to everyone’s attention is that it doesn’t matter what disease you have, if it is left unmanaged, or not managed properly, it can have some pretty serious consequences of ones fertility, and mental and physical health.

PCOS is not exception. While the symptoms of PCOS are not as bad as those suffered with endometriosis, or adenomyosis, women can still suffer in many other ways. The long-term consequences of unmanaged PCOS can be very serious and can also lead to early death (cardiovascular disease, stroke etc.) and also lead to certain cancers.

Risk factors

PCOS is thought to have a genetic component. People who have a mother or sister with PCOS are more likely to develop PCOS than someone whose relatives do not have the condition. This family link is the main risk factor.

Then there is the insulin resistance factor with PCOS as well. Insulin resistance is a primary driver of PCOS and there is now evidence to show that most, if not all, women with PCOS have insulin resistance by default. Again this appears to be through genetic or family links of someone having PCOS, or having diabetes in the family tree etc.

Excess insulin is thought to affect a woman’s ability to ovulate because of its effect on androgen production. Research has shown that women with PCOS have low-grade inflammation that stimulates polycystic ovaries to produce androgens.

This is why diet and lifestyle interventions are so important in the overall management of PCOS. It is because these changes help with the insulin resistance.

There are other risk factors such as obesity, stress, nutritional deficiencies and sedentary lifestyle. Have a look at my page about more information on PCOS and risk factors etc (Click Here)

The Common Symptoms of PCOS

It is important to know what the common symptoms of PCOS are, so that women and healthcare professionals alike know what to look for.

The common symptoms of PCOS include:

  • irregular menses
  • excess androgen levels
  • acne, oily skin, and dandruff
  • excessive facial and body hair growth, known as Hirsutism
  • female pattern balding
  • skin tags
  • acanthosis nigricans, or dark patches of skin
  • sleep apnea
  • high stress levels
  • depression and anxiety
  • high blood pressure
  • infertility
  • Increased risk of miscarriage
  • decreased libido
  • high cholesterol and triglycerides
  • fatigue
  • insulin resistance
  • type 2 diabetes
  • pelvic pain
  • weight management difficulties including weight gain or difficulty losing weight

Early Intervention and management is crucial

The causes of PCOS are unclear, but early intervention, early diagnosis and early management, can help relieve symptoms and reduce the risk of complications. Anyone who may have symptoms of PCOS should see their healthcare provider, women’s healthcare specialist, or PCOS expert.

Coping with the symptoms of PCOS and managing the treatments can be demanding ands sometimes stressful. But, to then learn there can be serious complications and added risks to your health from PCOS not being managed properly can be distressing.

Be educated and get proper help

Just like any disease state just being aware, and being educated there are added risks is an important first step. Once you have the common symptoms of PCOS under control then you can turn your mind to thinking about ways to prevent further complications.  The good news is that many of the treatments and management strategies you will use for your PCOS will also help to prevent many of the serious complications. A qualified healthcare professional, or a healthcare practitioner who is an expert in PCOS should be managing anyone with PCOS. Nobody should be trying to manage PCOS on their own without some form of professional help.

The serious complications of PCOS

Women with PCOS are thought to be at higher risk of having future heart disease or stroke. They are also at higher risk of diabetes, endometrial cancer and other cancers too.

What are the serious complications of unmanaged PCOS?

Besides the risk factors already mentioned, the serious complications of unmanaged PCOS are as follows:

  • Weight gain or obesity
  • Prediabetes
  • Type 2 diabetes
  • Cardiovascular disease
  • Metabolic syndrome (generally having at least two of high blood pressure, high cholesterol, obesity, high fasting blood glucose)
  • Endometrial cancer
  • Other cancers (breast, ovarian)
  • Sleep apnoea
  • Inflammation of the liver
  • Infertility
  • Increased Pregnancy induced hypertension and pre-eclampsia
  • Increased gestational diabetes
  • Increased risk of stroke
  • Increased risk of sudden death
  • Atherosclerosis
  • Psychological disorders
  • Mood disorders (anxiety, depression)

What you can do

If you are worried about the serious complications of unmanaged PCOS it is helpful to:

  • Get your symptoms of PCOS under control as a first step
  • Discuss any concerns with your healthcare practitioner, or women’s health/PCOS expert.
  • Learn about and understand your risks
  • Learn that early intervention and early healthcare management is the key to assisting any disease state.
  • Have your blood pressure, blood glucose and cholesterol checked regularly
  • Seek guidance and support to help with weight management and dietary and lifestyle management.
  • Remember that all body types can have PCOS, not just those who are overweight.
  • Do not try to manage the symptoms of PCOS on your own.

Final word

If you do need assistance with PCOS and would like my help, please call my friendly staff and found out how I may be able to assist you. There are options for online consultations and consultations in person.

As mentioned before the key to any disease is early intervention and early healthcare management and you taking the first steps to get the help you need. PCOS also needs a multimodality approach. There are many facets to it. Don’t put off your health. Just pick up the phone and make that appointment today. There can be some very serious consequences if you do, especially for some conditions such and PCOS.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicines

-The PCOS Experts

References
  1. Ehrmann D et al. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2006 Jan;91(1):48-53
  2. Meyer C et al. Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metab. 2005 Oct;90(10):5711-6
  3. McCartney CR, Marshall JC. Polycystic Ovary Syndrome. N Engl J Med 2016;375:54-64
  4. Hull MG. Epidemiology of infertility and polycystic ovarian disease: endocrinological and demographic studies. Gynecol Endocrinol. 1987;1:235–245. [PubMed] [Google Scholar]
  5. Balen AH, Conway GS, Kaltsas G, et al. Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum Reprod. 1995;10:2107–2111. [PubMed] [Google Scholar]
  6. Tian L, Shen H, Lu Q, Norman RJ, Wang J. Insulin resistance increases the risk of spontaneous abortion after assisted reproduction technology treatment. J Clin Endocrinol Metab. 2007;92(4):1430–1433. [PubMed] [Google Scholar]
  7. Jungheim ES, Lanzendorf SE, Odem RR, Moley KH, Chang AS, Ratts VS. Morbid obesity is associated with lower clinical pregnancy rates after in vitro fertilization in women with polycystic ovary syndrome. Fertil Steril. 2009;92(1):256–261. [PMC free article] [PubMed] [Google Scholar]
  8. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19–25. [PubMed] [Google Scholar]
  9. Palomba S, de Wilde MA, Falbo A, Koster MPH, La Sala GB, Fauser CJM. Pregnancy complications in women with polycystic ovary syndrome: new clinical and pathophysiological insights. Hum Reprod Update. 2015 Jun 27;:dmv029. [PubMed] [Google Scholar]
  10. Anderson SA, Barry JA, Hardiman PJ. Risk of coronary heart disease and risk of stroke in women with polycystic ovary syndrome: a systematic review and meta-analysis. Int J Cardiol. 2014;176(2):486–487. [PubMed] [Google Scholar]
  11. Hardiman P, Pillay OC, Atiomo W. Polycystic ovary syndrome and endometrial carcinoma. Lancet. 2003;361(9371):1810–1812. [PubMed] [Google Scholar]
  12. Genazzani AR, Gadducci A, Gambacciani M. Controversial issues in climacteric medicine II. Hormone replacement therapy and cancer. International Menopause Society Expert Workshop. Climacteric. 2001;4(3):181–193. [PubMed] [Google Scholar]
  13. Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(5):748–758. [PMC free article] [PubMed] [Google Scholar]
  14. Broekmans FJ, Knauff EAH, Valkenburg O, Laven JS, Eijkemans MJ, Fauser BCJM. PCOS according to the Rotterdam consensus criteria: change in prevalence among WHO-II anovulation and association with metabolic factors. BJOG. 2006;113(10):1210–1217. [PubMed] [Google Scholar]
  15. Haoula Z, Salman M, Atiomo W. Evaluating the association between endometrial cancer and polycystic ovary syndrome. Hum Reprod. 2012;27(5):1327–1331. [PubMed] [Google Scholar]
  16. Chittenden BG, Fullerton G, Maheshwari A, Bhattacharya S. Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reprod Biomed Online. 2009;19(3):398–405. [PubMed] [Google Scholar]
  17. Giovannucci E. Metabolic syndrome, hyperinsulinemia, and colon cancer: a review. Am J Clin Nutr. 2007;86(3):s836–s842. [PubMed] [Google Scholar]
healthy food

The Difference Between The Proper Way To Eat Versus Dieting

The word diet is often misused and people often use it in the context of weight loss and food restriction. In this latest post I talk about the difference between the word ‘Diet’, as in dieting, versus “Diet”- meaning the proper way to eat.

I also show people the wellness pyramid and explains what good nutrition is and that all carbs are not bad carbs. I also talk about waist size, body fat and the perception people have around weight and weight loss. Have a listen to my latest post to here this and so much more.

mediterranean style lemon chicken

Quick & Easy Mediterranean Style Lemon Chicken & Vegetables

Recently I did a post about healthy eating and showing people how to cook a big batch of bolognese sauce to make 20 meals. I also showed how easy it was and how inexpensive it was. I also mentioned that I would do a video to show people a quick and easy Mediterranean lemon chicken dish.

In this video blog I cook up a quick, easy and inexpensive chicken dish that feeds 4 people, or more. It takes 10 minutes to prepare and then about 30 minutes to cook and then you are done.

All up the dish cost around $12 AUS.

For the best results always use local produce and fresh herbs and vegetables. If not, then use what is available, as shown in the clip.

While you are waiting for it to cook, you could be off having a shower, getting out of your work clothes, relaxing on the couch, or better still… talking to your family. You could even do a workout in that time too.

Cooking good food for the family doesn’t need to be hard, and it does not need to be expensive either. Your health is the most important thing you have, so look after it with good foods. Bon Appetite

Regards

Andrew Orr

Bloating

Could Your Bloating Be Caused By Stress, Anxiety, or Your Busy Life?

Many people suffer from bloating very regularly and some suffer it daily as well. While the cause of bloating if often dietary or food related, many are unaware that stress, anxiety and their busy life can actually be causing their bloating too. In many cases, when food and dietary triggers have been ruled out, a big part of peoples bloating is actually stress and anxiety, or even being overly busy. For the sake of this post, I am going to put ‘busyness’ as the same category and stress and anxiety.

Stress, Anxiety and Busyness affects the whole body

Stress, anxiety and constant ‘busyness’ changes the body, not just the mind. Intense stress or anxiety can trigger stomach discomfort, including bloating. Some people may not realise that our mind and gut are linked. So with our busy, on-the-go lives, emotions we experience throughout the day, like stress, can affect our digestive system. As mentioned in a previous post, stress and anxiety can also cause and exacerbate pain in the entire body. (click here to read)

Stomach pain and bloating are more common in people who have stress as well as an underlying condition, such as irritable bowel syndrome (IBS), or other inflammatory gastrointestinal conditions such Crohn’s disease and Ulcerative Colitis. Bloating and abdominal pain is very common in women with endometriosis and is known as “Endo Belly”. This is very commonly exacerbated by stress and anxiety and also disruption to the microbiome.

While abdominal bloating is a widespread complaint, with many possible causes, unless the pain is intense or accompanied by other worrisome symptoms, it is usually safe to see if symptoms disappear on their own. But if you are ever worried, always consult with your healthcare practitioner as constant bloating can be a sign of serious health issues too.

How does stress and anxiety cause bloating?

There is now plenty of research and evidence that the brain and the gut communicate with each other via numerous systems (neural, hormonal and immunological) and do not function independently. Because of this interconnected relationship it means that if one system is ‘disturbed’, or ‘distressed ’it will result in the other system being ‘disturbed’ or ‘distressed also. In simplest terms if you have a busy day at work and it is stressful then mental stress at work = tummy upset. It really is that simple

When someone is feeling stressed and anxious, it may induce a variety of digestive issues and discomfort. Stress and anxiety produce an alteration in the contractility of the gut. This may then cause cramps or pain (increased contractility) and may influence bowel habits, which then causes constipation due to reduced GI contractions. This may then lead to someone being bloated. This could also lead to people also having loose bowels, or alternating bowel movements too.

Additionally bloating may occur without constipation and you could also experience increased heartburn as a result of your stress and anxiety. Decreased stomach emptying accompanied by increased oesophageal contractions may cause acid reflux. This increase stomach acid can then cause bloating and pain. It can also then lead to increase gut permeability and then further lead to leaky gut syndrome.

Reducing the effects of anxiety and stress on the gut

Thankfully, there are several things you can do to reduce the effects of anxiety and stress on your gut.  As I have often talked about, there is a direct link between our microbiota and our stress hormone system. Any alterations in our gut microbiota may lead to a heightened or suppressed hormonal response to stressful situations. I’ve talked about the effects of dysbiotic bacteria and bloating before. You can read one of my previous posts on this (click here)

This is why it is so important to do a proper microbiome restore, to not only to help with bloating and gastrointestinal issues, but to help with inflammation, the immune system and our emotions as well. Of course one still needs to look at their diet and what they are putting in their mouths too. Let’s not forget the impact of alcohol on our gut and digestive system too. I have done a post about this and to find out more (click here).

Identifying triggers

Besides a proper microbiome restore, the best approach would be to identify the ‘stress trigger’ or ‘anxiety trigger’ and try to remove it, or alter its impact, from your daily life, where possible. This can often be hard and will require the help of a qualified counsellor, or psychologist. It is important that people identify this and are real about needing help from a trained healthcare professional.

Use mindfulness and meditation practices

There are things people can do on their own to reduce stress and anxiety too. Mindfulness and meditation exercises can help to alleviate stress and anxiety and something people should practice daily.

Some examples could be the following. If you may get stressed by not being prepared for some activity at work like giving a presentation, just make sure that you allow plenty of time to adequately prepare and rehearse to prevent or reduce anxiety.

Another example could be that you might get stressed by travelling to work in overcrowded public transport. You could ride sharing to work, or give cycling to work a try.

If you feel yourself getting stressed out with any task make sure you take some time out from the activity. Go and sit quietly and just breathe and reassure yourself that everything is ok. You could make yourself a cup of tea, or listen to some soothing music. All these things can help but at the same time, may not always be applicable to all stressful scenario, or where you are anxious.

Final Word

There is more and more evidence now to suggest that many gut issues are affected by stress and anxiety. But, troubles with the gut can also cause stress and anxiety too. The gut-brain axis works both ways and we need for more people to know this.

This is why it is so important to look after our gut health more. We need to be managing our diets better, cut out inflammatory and refined foods, increasing pre and probiotics, managing allergies and intolerances, cutting back alcohol, managing stress and anxiety better, and avoiding foods that we know aggravate stomach issues and cause bloating and pain.

It is also important for people that experience bloating to realise that not all bloating issues are related to food, or their health condition. For many people, their daily bloating and pain is actually coming from either being overly busy, or from their high stress levels, or anxiety. It could be coming from all of these things combined too. If you do not know how to manage your bloating and stress and anxiety levels, it is best to book in a see a healthcare professional who can assist you deal with it properly.

If you do need assistance with bloating and abdominal pain, please call my friendly staff and find out how I may be able to assist you. You can also check out my posts on restoring the microbiome properly too. Something that could be very beneficial for all, especially after the Christmas and New Year festivities.

Regards

Andrew Orr

-No Stone Left Unturned

-Women and Men’s Health Expert

 

New Years Resolutions

Let’s be real and talk about your “New Year” resolutions

It is just about to be the end of a year, and also an end of a decade. With that comes a lot of memes about walking into the new year and new decade. Let’s face it, the last year was a bit of a shocker and many will be glad to see the end of it. But, is last year just the same as other years, and do we say the same thing every year?

Regardless of how the year ended and how the new decade is seen in, many are vowing to do better, or are wanting better for the year ahead.

But, in order for something to change, something needs to change, and that something is actually one’s self. If we want something to change, we need to change something. But are people really prepared to make the necessary changes, or are those posts and memes just empty words …. just like every other year?

If you are wanting change, and I mean true change, then what are you going to do to make those changes?

Let’s not make those posts and memes empty words. Let’s turn them into action and benefits from those words and actions for better health and a better life moving forward.

Have a listen to my video blog on this very topic

Regards

Andrew Orr

Christmas health tips

10 Health Tips for Surviving the Festive Season

Christmas and New Year is fast approach and while I was looking at how to survive and stay healthy during this period, I really should be looking at how to survive the lead up to Christmas as well. So instead I have done up 10 health tips for surviving the festive season.

It is such a busy time of year with schools finishing, Christmas shopping to get finish off, Christmas parties and lastly work is manic trying to finish off everything before Christmas. Sounds all a bit silly to have all that stress for just one day.

Every year people ask me how they can stay healthy during Christmas and New Year and every year I have to tell them the same thing.

Moderation is the key to staying healthy and also staying hydrated.

10 Health tips for surviving the festive season

So what can you do to survive the season and come out the other end actually feeling you have had a break, rather than feeling in desperate need of one?

I have compiled 10 top tips to ensure you get the most out of the festive season and make it through less stressed and maybe a little more healthier.

  1. Plan Ahead– Try and plan to have all your Christmas shopping and all your supplies for the silly season organised well in advance to save on the stress of doing things last minute. Pre-order foods online if you have to and get it delivered.
  2. Deflate the Expectations– Don’t try and make everything perfect because will only lead to stress and anxiety if things do not go to plan. The main thing is to have fun and enjoy the family and friends. Don’t get caught up in buying expensive gifts and trying to overdo everything as this can spoil all your fun and lead to disappointment. Remember it is the festive season, not the stress and disappointment season.
  3. Delegate– Don’t try and do everything yourself. On Christmas day or New Years Eve, get family or friends to bring a salad, or a dessert, or both. When people arrive if someone asks to help, let them. Many hands make light work. If nobody volunteers to help, make sure you ask. You deserve to enjoy yourself too. While you are preparing food a nice glass of wine will ease any stress.
  4. Don’t be on your own– Christmas is a time to be with loved ones, friends or people in your same situation. If you have nothing planned, plan a small party at your place, or go to a friends, or family members place. There is nothing worse than being on your own where depression can set in.
  5. Ditch the pasta and bread– Go with more Paleo/Primal eating for Christmas and eat healthy while enjoying good food. In Australia there is no need to use fillers like bread and pasta, when we have all this healthy beautiful food to fill up on. Replace the chips with nuts containing healthy oils. Go for pistachios etc that keep you busy shelling and they taste good too. Cut up veggie sticks to go in dips and have heaps of lean meats, prawns, salads and veggies to make Christmas healthy and enjoyable. Cut up heaps of fresh fruits for dessert. Lastly remember everything in moderation and the odd dessert isn’t going to kill you.
  6. Rehydrate before and after drinking– Most hang-over’s are caused by dehydration  and regularly hydrating while drinking will make your next day feel so much better on waking. Remember water alone will not keep you hydrated. You need to use electrolytes before and during your drinking session on Xmas and New Years Eve. You need to use a proper electrolyte because Gatorade and powerade are not electrolytes, they are cordials with a bit of salt. Getting some electrolytes into you before and after drinking alcohol will be the difference between waking up with a sore head or not. Have a read of my article on electrolytes
  7. Know your limit with alcohol– Let’s face it you don’t have to write yourself off and embarrass yourself to have a good time. Most people actually feel relaxed and jovial after only a few glasses of alcohol. After the first couple of glasses, limit your alcohol to one glass per hour and drink water and some electrolytes in between. Always eat food before drinking. You will feel better for spacing your drinks, eating food and staying hydrated.
  8. Detox and restore your microbiome after the festive season– After Christmas and New Year is over, your number one resolution should be detox and restore your microbiome with healthy bacteria. All that christmas cheer, over consumption of food, alcohol  and stress all reduce your good gut bacteria and increase your bad bacteria, so you need to restore your microbiome again. You can also find out more about my microbiome restore

Final Word

Christmas and New Year is all about having fun and not getting too stressed with everything. It’s about good food, good company and most importantly it’s about family and friends.  Make sure you enjoy yourself, share some love and remember that moderation is the key to anything to do with keeping healthy and safe during the festive season.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

Microbiome

The Importance Of Properly Restoring The Microbiome For Optimum Health

One of the things I teach my patients is the importance of properly restoring the microbiome for optimum health and also reducing inflammation in the body.

Many people’s daily bloating, fluid retention, gastrointestinal symptoms, health issues, chronic disease states are being exacerbated by an unhealthy balance in this unique ecosystem we call the microbiome.

The problem is that many people do not really understand the importance of the microbiome, and even many healthcare professionals do not fully understand how to help with proper microbiome repair and restore.

Many people are also led to believe that by just taking probiotics, that this is enough to restore the healthy bacteria in the gut/microbiome.

I wish it was that easy, but it isn’t and this is why many people continue to have gastrointestinal issues, inflammation and chronic health issues, despite thinking that are doing the right thing for their gut health.

What is the Microbiome?

The human gastrointestinal tract (GIT) is host to an extraordinary amount of microorganisms composed of bacteria, viruses and microbes, collectively known as the microbiome. The microbiome is the name given to all of the genes inside these microbial cells.

Every human being has anywhere between 10 trillion and 100 trillion microbial cells all working together in a symbiotic relationship. This benefits both the microbes and their hosts, as long as the body is in a healthy state.

Recent scientific advances in genetics mean that humans know a lot more about the microbes in the body. There has been lot of time and money put into researching the interactions within the human body’s ecosystem and their relevance to health and disease.

The two terms ‘microbiota’ and ‘microbiome’ are often used to mean the same thing and are used interchangeably. I will explain the differences between them and how both are being used and researched in modern medicine.

You exist in a symbiotic relationship with your bacterial ecosystem, and there is a two-way relationship that makes your health inseparable from that of your microbiome and vice versa.

The benefits of a healthy microbiome/microbiota

The benefits of a healthy microbiome/microbiota, extend beyond the gut and digestive system and has a significant systemic impact on some the following:

  • Nutrient metabolism
  • Body composition (weight)
  • Cardiovascular health,
  • Chronic disease states
  • Inflammation in the body
  • Pain pathways
  • Immunity
  • Mental Health
  • Neuroendocrine function
  • Gene Expression

What is the Microbiota

The gut microbiota used to be called the microflora of the gut. The importance of the microbiota has been known for a long time, but now medical science is discovering just how important it is, and it is now becoming a cornerstone of preventive medicine.

The gut microbiota contains over 3 million genes, making it 150 times more genetically varied than the human body. The gut microbiota of each individual is very unique and it has a major contribution to how a person fights disease, digests food, and even his or her mood and psychological processes.

This symbiotic relationship greatly benefits humans. The presence of this normal flora includes microorganisms that are so present in the environment that they can be found in practically all animals from the same habitat.

However, while there are good bacteria found within these native microbes, some of these microbes also include harmful bacteria that can overcome the body’s defences that separate them from vital systems and organs. There are beneficial bacteria in the gut, and there are harmful bacteria that can cross into wider systems and can cause local infections of the GI tract. These infections can then cause infection and inflammation and can also worsen disease states in the body.

What is dybiosis?

The microbiome plays an important role in resisting intestinal overgrowth of externally introduced populations that would otherwise cause disease. In our microbiome, the “good” bacteria compete with the “bad,” with some even releasing anti-inflammatory compounds.

Bacterial dysbiosis produces an endotoxin called lipopolysaccharide (LPS). It is one of the most inflammatory substances known. LPS is also major contributor to the inflammation, which then drives many chronic health conditions and disease states.

These bad bacteria are called dysbiotic bacteria and cause a process called ‘dysbiosis’.

Broadly speaking, dysbiosis indicates the existence of either the wrong microbiota (e.g. overgrowth of bacteria, fungi and/or parasites) and/or the wrong numbers of the right microbiota (imbalances in composition), or either, in the wrong place.

Dysbiosis causes increased gut and intestinal permeability, which can lead to what we call leaky gut, or leaky gut syndrome. Dysbiosis can also consequent lead to up-regulation of inflammatory pathways and lead to increased inflammation in the body.

Dybiosis is implicated in many chronic diseases

Dysbiosis is very common it the western culture and bacterial dysbiosis is now being linked to causing, or exacerbating many health conditions and disease states. Research has found links between bacterial populations, whether normal or disturbed, and the following diseases:

  • Endometriosis
  • Adenomyosis
  • PCOS
  • Asthma
  • Autism
  • Auto-immune conditions
  • Cancer
  • Celiac disease
  • Colitis
  • Inflammatory Bowel Disease
  • IBS
  • Crohn’s Disease
  • Diabetes
  • Eczema
  • Heart disease
  • Malnutrition
  • Multiple sclerosis
  • Arthritis
  • Obesity
  • Metabolic Syndrome

What Causes Dysbiosis?

There are many things that lead to bacterial overgrowth, which then leads to dysbiosis. This is why many people suffer bloating, reflux, nausea, constipation, inflammatory bowel symptoms, and many other gastrointestinal symptoms daily.

Day-to-day risk factors include a western-based diet, overly hygienic living (being too sterile), alcohol, certain medications, hormones and the use of antibiotics.

Mood disorders, stress and being overly busy are also a big factors with creating dysbiosis and something that many overlook, or do not even realise. Yes, stress is a big factor in many gastrointestinal symptoms people experience daily.

With all these factors it means that almost everyone will have some degree of dysbiosis at some point in their life.

Many constantly have dysbiosis and why they often have long-standing digestive symptoms such persistent pain and bloating, constipation, alternating diarrhoea or other digestive imbalances. We also commonly see this with endometriosis and the dreaded “endo belly”

Medications Cause Dysbiosis and Significantly Affect The Microbiome

As mention already, many medications and hormones actually have a toxic affect on the microbiome and can cause dysbiosis. It is crucial to for all of us to understand the consequences of medication use in the gut microbiome. I’ll talk about this in my next post.

The good news, however, is although medications can cause a dysfunctional microbiome quite rapidly, you can begin to restore a healthy microbiome just as quickly through strategic microbiome restore.

Proper Microbiome Restore Protocols

When it comes to proper microbiome restore,  it isn’t just as easy as taking any old probiotic, or a combination of probiotics. Microbiome restore requires and individualised and strain specific approach and it needs to be done in stages with antimicrobials, gut repair and prebiotics as well. Dysbiotic microbes can be hard to treat effectively because they have evolved and adapted to life inside human beings. Consequently, elimination of these organisms requires a similarly evolved and adapted approach. This is all part of the microbiome restore protocol I use with my patients.

A New Understanding

When it comes to the perfect microbiome, researchers have discovered there is no ‘one size fits all’ across various populations. It is important to recognise that not all strains are created equal when it comes to their ability to rebuild a healthy microbiome.

What is now known is that there are only certain types of good probiotic bacteria that have benefit for our gut and microbiome, and that some strains of probiotic bacteria have no benefit. These new finding mean that we need to adopt a strain specific approach when repairing and restoring the microbiome.

From recent investigations and research, the best results are gained by introducing strain specific influential probiotic that have beneficial functions. These specifically influential strains are able to restore each patient’s unique microbiome by promoting the growth of key commensal (symbiotic) groups, but also by improving overall GIT function.

The Importance of Prebiotics

In addition to prescribing a specific probiotic formulation, prebiotic therapy is needed to help support and encourage the establishment of healthy microbiota by significantly increasing the numbers of beneficial bacteria. Without prebiotics, the probiotic bacteria do not grow and this is why they are essential for microbiome restore. Prebiotics are not talked about enough and many people do not realise their importance and often wonder why their probiotics are not working effectively enough.

Prebiotics are also needed to promote the growth of healthy microbiota, begin refurbishment of gut mucosa and improve gastrointestinal immunity. Prebiotics also help with inflammation and also support the integrity of the intestinal barrier, provide healthy immune responses and promote intestinal microbiome balance.

Microbiome Restore Protocols

With emerging research now highlighting the significance of developing and maintaining a healthy microbiome, it is important that everyone knows the importance of appropriate probiotic and prebiotic combinations. By supporting the restoration and repair of our micriobiome, we can all optimise our health, improve treatment outcomes and also help with reducing the risk of many chronic disease states.

If you would like to find out how to restore your microbiome properly, please give my friendly staff a call and find out how I may be able to assist you. Online and in person consultations are available. Some conditions apply.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

References
  1. Walker A, et al. Phylogeny, culturing, and metagenomics of the human gut microbiota. Trends Microbiol. 2014;22:267–74.
  2. Collado MC, et al. Role of commercial probiotic strains against human pathogen adhesion to intestinal mucus. Lett Appl Microbiol. 2007;45(4):454-60.
  3. Leahy SC, et al. Getting better with bifidobacteria. J Appl Microbiol. 2005;98(6):1303-15.
  4. McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010;16(18):2202-22.
  5. Jahn HU, et al. Immunological and trophical effects of Saccharomyces boulardii on the small intestine in healthy human volunteers. Digestion. 1996;57(2):95-104.
  6. Jahn HU, et al. Immunological and trophical effects of Saccharomyces boulardii on the small intestine in healthy human volunteers. Digestion. 1996;57(2):95-104.
  7. Dahan S, et al. Saccharomyces boulardii interferes with enterohemorrhagic Escherichia coli induced signaling pathways in T84 cells. Infect Immun. 2003;71:766-773.
  8. Hsieh H. Versalovic J. The human microbiome and probiotics: Implications for pediatrics. Curr Probl Pediatr Adolesc Health Care. 2008;38(10):309–327.
  9. Lam EK, et al. Enhancement of gastric mucosal integrity by Lactobacillus rhamnosus GG. Life Sci. 2007;80(23):2128-36.
  10. Seth A, et al. Probiotics ameliorate the hydrogen peroxide-induced epithelial barrier disruption by a PKC- and MAP kinase-dependent mechanism. Am J Physiol Gastrointest Liver Physiol. 2008;294(4):G1060-9.
  11. Gibson GR. Roberford M. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr. 1995;125:1401-1412.
  12. Fastinger ND, et al. A novel resistant maltodextrin alters gastrointestinal tolerance factors, fecal characteristics, and fecal microbiota in healthy adult humans. J Am Coll Nutr. 2008;27(2):356-66.
  13. Raninen K, et al. Dietary fiber type reflects physiological functionality: comparison of grain fiber, inulin, and polydextrose. Nutr Rev. 2011;69(1):9-21.
  14. Robison LE. Reeves S. EpiCor® and its immune effects on gut health. Embria Health Sciences, LLC. [Online]. No date. Available from: http://www.embriahealth.com/upload/pdf/EpiCor%20Science%20%20EpiCor%20and%20its%20Immune%20Effects%20on%20Gut%20Health_FINAL.pdf [Cited 16/02/13].
  15. Jensen GS, et al. Antioxidant bioavailability and rapid immune-modulating effects after consumption of a single acute dose of a high-metabolite yeast immunogen: results of a placebo-controlled double-blinded crossover pilot study. J Med Food. 2011 Sep;14(9):1002-10.
  1. Bartoli, C., Frachon, L., Barret, M., Huard-Chauveau, C., Mayjonade, B., Zanchetta, C., … & Roux, F. (2018, May 30). In situ relationships between microbiota and potential pathobiota in Arabidopsis thaliana. The ISME Journal. Retrieved from https://www.nature.com/articles/s41396-018-0152-7#article-info
  2. Berg, R. D. (1996). The indigenous gastrointestinal microflora. Trends in Microbiology, 4(11), 430-435. Retrieved from https://www.sciencedirect.com/science/article/pii/0966842X96100573
  3. Carpenter, S. (2012, September). That gut feeling. Monitor on Psychology, 43(8), 50. Retrieved from http://www.apa.org/monitor/2012/09/gut-feeling.aspx
  4. Clapp, M., Aurora, N., Herrera, L., Bhatia, M., Wilen, E., & Wakefield, S. (2017, September 15). Gut microbiota’s effect on mental health: The gut-brain axis. Clinics and Practice, 7(4), 987. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641835/
  5. NIH Human Microbiome Project. (n.d.). Retrieved from https://hmpdacc.org/
  6. Shepherd, E. S., DeLoache, W. C., Pruss, K. M., Whitaker, W. R., & Sonnenburg, J. L. (2018, May 9). An exclusive metabolic niche enables strain engraftment in the gut microbiota [abstract]. Nature, 557, 434-438. Retrieved from https://www.nature.com/articles/s41586-018-0092-4
  7. The Human Microbiome Project Consortium. (2012, 14 June). Structure, function and diversity of the healthy human microbiome. Nature, 486, 207-214. Retrieved from https://www.nature.com/articles/nature11234
  8. Ursell, L. K., Metcalf, L., K., Wegener Parfry, L., Knight, R. (2012, August). Defining the human microbiome. Nutrition Reviews, 70(Suppl 1), S38-S44. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426293/
Chill Pill

A Special Kind of Pill for Better Health and Increased Fertility

Previously I have mentioned that I was going to talk to you all about a special medicine and a special kind of pill, that can not only help you with gynaecological and other healthy issues, but it can also help with fertility and being able to fall pregnant.

I was going to post this up straight away, but then I had to think more about it, because I know when you mention this subject, people can take a message with the intention of helping the wrong way.

So what is this special pill that I am talking about and not yet available on the market?

Well, it’s called a “Chill Pill” and many of us need to be taking it often, or learning to administer it often.

Now, before anyone gets all up in arms about this and what I am about to say, I need you to listen and take the personal out of this and just hear the reasons why.

I have been on the other end of stress, where it almost killed me, literally and I know how it then affected my health and then exacerbated pre-existing health complaints I had. So I am coming from a place of understanding, but also a place of wanting to help people through my own experienced personally, but also what I see in clinical practice daily. I was one of those people who kept saying that weren’t stressed, or that I don’t feel stressed, yet all the while my body signs were saying something different.

Like any change we need to make, the first part is admitting there may be something wrong in order to enact that change.

The sad fact is that 9 out of 10 people report being stressed and 41% of people feel they experience unhealthy levels of stress. Stress and the body’s response to it, can affect people in different ways. Small amounts of stress that are easily resolved can help to keep us motivated and achieve our goals.

The difference with long term or chronic stress is that it can affect the whole body in a negative way. It is the long grade, low grade stress (or busyness) that often creeps up on us and causes issues. Many people do not even know they are stressed, or that stress is a big factor in their current health issues, because they are either so used to it, or their health issues takes over and they cannot even begin to see the correlation.

The harsh reality of many problems in life is that we are ultimately responsible for our own well-being. Not all people will want to accept this, as it is so much easier to blame someone or something else for our dilemmas.

Nearly every problem we experience in life may have an element of stress to it bought on by ourselves and our busy lives, with many of us not consciously knowing it is at play. That means everything from a common cold to a long-standing illness. Everyone reading this will be by now squirming in his or her seats as the harsh reality of such a statement hits home. But the real problem with this is that it is true. I know I had to face this reality with my own health issues. We can and do cause many of our own health problems, or exacerbate them, either consciously, or subconsciously.

The problem with any health matter is getting people to become responsible for their own self. So much illness is completely preventable if we would just take responsibility for our own actions. It is so much easier to blame someone, or something else with comments such as “ I have tried everything”, “That didn’t work for me”, or “I’ve been everywhere and nothing can help me”.

The problem with many of these blanket statements is that they are all just excuses not to take responsibility for our actions. Maybe it isn’t that the methods you are trying aren’t working. Maybe it is simply a matter of nothing will ever work unless we make that all important change for ourselves first.

Sure, some disease states are hereditary, or someone have a predisposition for them, but even so, once the illness, or disease is expressed in the body, it is our responsibility to do what we can to control it.

Yes, sometimes it doesn’t seem fair, I get that, but sometimes you just have to admit there is an issue that isn’t going away in a hurry, or keeps being flared up, because you need to make some changes in your life to better manage this issue.

I know this is something I had to learn myself. Boy did I fight the reality of this in the beginning too. But, I also acknowledge that some people have seen some pretty shitty healthcare practitioners who have missed and dismissed their issues too. It all compounds and just makes everything seem so much worse. But, at the end of the day you can also find good practitioners who can help you too.

Stress is also a major factor in many couples not being able to conceive. Stress affects cortisol levels and the adrenals and this then has an effect on testicular and ovarian function.

Stress can affect both sperm and egg quality and high stress levels also affects our hormones and our immune system. Stress also has an effect on the uterine environment, which can affect implantation, affect circulation in the uterine lining, and also increase the risk of miscarriage. High stress levels also exacerbate, or fuel many gynaecological and men’s reproductive health issues too.

Looking for the ‘Off ’ Butt on

Stress can affect each of us differently. Perhaps you are suffering from anxiety, feeling worried, depressed or irritable; even feeling exhausted and overwhelmed can indicate you are under stress. As well as affecting your ability to cope, stress may also be causing a disruption to your health. When under stress for a length of time, you may be more susceptible to tension headaches, high blood pressure, frequent colds and flus, digestive disorders or a worsening of an existing condition.

So you can see, there are many reasons why it is so important to manage your stress now, take that “Chill Pill” before it starts impacting your health and wellbeing.

How Resilience Begins

Some people seem to deal with stress better than others. That doesn’t mean that the rest of us need to continue suffering. The ability to increase your resilience to stress is something that can be learned and helped with talking to a counsellor, or psychologist etc.

There are supplements, nutrients, and vitamins to support your body’s individual stress response system too. Many people are lacking key nutrients because of our highly processed diets now and we also know that gut health, and a healthy microbiome is integral to psychological wellbeing and our moods.

Taking a strain specific probiotic and a prebiotic daily can improve gut health and improve your immune system and psychological wellbeing. Omega 3 oils, multivitamins, melatonin, St John’s wort, passion flower, chamomile and many other herbs and nutrients can assist with coping with stress and its impact on the body.

Don’t buy vitamins or supplements off the shelf at the chemist or supermarket as these are so inferior and contain lots of fillers and additives that aren’t good for you. Always see a qualified healthcare practitioner to get proper advice on what nutrients and supplements are needed for your health complaint.

By the way, Dr Google is banned in my clinic. Dr Google is not a reliable way to find out about healthcare products and illnesses. Only a trained healthcare professional should be giving you that advice. But, in saying that, researching where to find a good practitioner is great and also developing and understanding of ones health issues is great too, as long as it doesn’t become an obsession and that is all you focus on. It is about a balance. There is nothing wrong with trying to be informed. But, trying to self diagnose, or self prescribe is not a good thing at all.

Some people may be in such a bad state that medication may be needed to get them over their first hurdles and develop some resilience and coping skills. This should always be done in conjunction with talk therapy as well. To be honest, most of us could do with talking to a good counsellor or psychologist to get some coping strategies to deal with work, business, health, or life better.

Lifestyle Tips to Help Manage Stress

Managing your stress is essential for long-term health and vitality. With proper support, a variety of stress relief techniques can be introduced, in conjunction with a

healthy eating plan to help assist you in stressing less. These may include:

  1. Exercise: Daily movement is essential for brain health. Aerobic exercise including running, swimming or walking is proven to decrease stress hormones. Resistance exercise is also great for stress relief, burning fats, increasing lean muscle and keeping you healthy.
  2. Enjoy the benefits of spending some time in the sun. Being in nature for 30 minutes per day can help reduce stress hormones and assist recovery after a stressful situation.
  3. Meditation and/or yoga can help to increase relaxation whilst benefiting not just the mind, but also the body. Learning to unwind is important for reducing stress.
  4. Favourite pastime: create time for YOU! Do something that you love, like listening to music, enjoying a candle lit bath, watching a movie, or starting a creative project – these fun activities can help you become more tolerant of everyday stress.
  5. Get creative and express yourself in as many different ways as feels good; singing, dancing, and art projects are but a few ways to do this.
  6. Eat seasonally, fresh and organic as much as possible. Include protein at every meal with a variety of fruit and vegetables.
  7. Include good fats such as omega 3s from fish, nuts and seeds, and olive oil to help with brain health and mood regulation.
  8. Drink plenty of water, a minimum of eight glasses per day and avoid excessive alcohol, caffeine, sugar and salt.
  9. See a counsellor, or psychologist to get some coping strategies in place.
  10. Acupuncture has been shown to be as effective as medications for stress and equal to the effects of talk therapy in several major studies.

Stress Less for Good Health

Our modern lifestyle is inescapable. The stress of it however, is manageable. This is why I mentioned the magic “Chill Pill”. All people have to do is take the advice and administer it often.

You aren’t born stressed and being stress isn’t a part of you. It is a learnt behaviour that can be changed. You can become more resilient to the symptoms and long term effects of stress through the aid of individualised lifestyle and dietary changes, together with nutrients, supplement and in some cases medicines that your healthcare providers can help you with.

Talk therapy such as counselling and psychology is an integral part of leaning to cope with stress and dealing with it better too. Mindfulness and meditation can also assist with stress.

Supporting a healthy stress response will allow you to feel more energised, resilient and ready to tackle life, so you can maintain the state of health and wellness that you deserve.

I hope that helps everyone and please remember to take off those superwoman/superman capes regularly, allow space to just breath and shut off the mind and just have some you time. It is OK to just sit there and not feel guilty about it. People need to learn to switch off the “busyness” and close down the 100 boxes they have open. It is Ok just to sit in peace and quietness and not feel guilty about it. Actually, your body needs to do this to maintain your inner health, but also your psychological health.

Every persons health, or disease state is different and while stress may not be the cause of ones particular issue, it can certainly exacerbate it. This is why it is so important to look at every aspect of ones life, not just a small isolated portion of it.

When was the last time you allowed yourself the space to just be, just take some quite time and let the world pass by for a little while without worrying about it?

Take care and relax and don’t work too hard. We work to live, not live to work.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

weight loss 2036966 1920

Being Overweight, or Underweight, Can Adversely Affect Fertility

As mentioned in previous posts about fertility and weight, it is important to have healthy weight and waist size when trying to conceive. It is important to address dietary and lifestyle issues in order to be in health weight and waist range before trying to conceive.

Healthy Waist Size

Healthy waist range for a woman is 80cm (from the belly button around)

Healthy waist range for a man is 94cm (from the belly button around)

If a woman’s waist size is about 88cm and a man’s waist size if above 102cm then they are in what we call “metabolic syndrome”

This increases their chances of diabetes, heart disease, depression, gynaecological conditions (PCOS, endometriosis etc), sperm issues, egg quality issues, reproductive issues, increased miscarriage, increased risk of certain cancers and of course…. infertility.

Body fat and how it affects fertility

Excess body fat (now known as obestrogens) can disrupt hormones and fertility and can have a negative effect on egg and sperm quality.

Similarly being underweight and low body fat can affect fertility outcomes too. Body fat has a regulatory role in reproduction and a moderate loss of fat, from 10% to 15% below normal weight for height, may delay the menstrual cycle, completely stop the menses altogether and inhibit ovulation. Both dieting and excessive exercise can reduce body fat below the minimum amount and lead to infertility. But this is reversible with weight gain, increased body fat and reduction of intensive exercise, or both.

A moderate reduction in body fat, not just weight, for those overweight, can increase fertility and chances of pregnancy exponentially. Similarly an increase in body fat for those that are underweight, and who don’t have enough body fat, can increase their fertility and chances of pregnancy as well.

This goes for men too. Increased body fat, or not enough body fat can affect hormone production and fertility and can affect sperm quality and sperm production.

This is why preconception care and healthy screening and weight and waist management is so important before trying to conceive. This should also be a part of any fertility program and is definitely part of my fertility program for all couples.

Are you in healthy waist range?

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine and Women’s Health Medicine

-Women’s and Men’s Health Advocate

01 Dr Andrew Orr 1

pregnancy 1410705 1920

Why Excess Body Fat and Obesity is The Enemy of Fertility

Excess body fat and obesity is the enemy of fertility and it is something that needs to be talked about. Despite what anyone tells you, being overweight, or being obese significant affect on fertility and it can also affect the future health of offspring. This is a fact and we need to talk about it more and bring more awareness to this subject. This is why I have been focusing on this very important subject a lot more lately.

At present up to 70% (or more) of Australians are either overweight, or obese, so we can no longer ignore what the consequences of these statistics mean. We know that excess weight and excess body fat is linked to serious health consequences, but we need to talk about how it affects fertility and decreases the chances of obtaining a live birth.

Overweight, or obese men and women have higher levels of body fat and higher levels of the hormones leptin. As I have mentioned in previous posts, this excess body fat is also now referred to as obestrogens, as they cause the same health consequences as environmental estrogens (known as endocrine disruptors). These excess body fats and higher levels of leptin do impair production of sex hormones and also reduces fertility. It can also lead to poorer sperm quality, poorer egg quality and can also increase the risk of miscarriage. The more excess body fat, the greater the risk of fertility difficulties a couple will have. This is a fact. Despite what your specialist, your doctor, Dr Google, or your own mind tells you, this is a fact and we need to start being real about it. It isn’t about fat shaming either. It is to help people who are struggling with fertility and to help them seek the help they need to have a baby.

Excess body fat, especially excess abdominal fat is also linked to insulin resistance, metabolic syndrome and other health issues. It also interferes with the regulation of sex hormones and sex hormone binding globulin (SHBG).  This can then increase the risk of irregular cycles, PCOS, endometriosis, sperm quality issues, miscarriage and other factors affecting fertility.

While the facts around excess body fat, excess weight and obesity are very real and can often seem overwhelming, there is some good news for couples that are overweight and obese.

Dietary and lifestyle changes and fat loss interventions which also includes exercise, can significantly improve fertility outcomes. It can also help with regular menstrual cycles, PCOS, endometriosis, sperm issues, egg quality, mental health and many other health issues. It definitely improves the chances of pregnancy and lessens the chances of miscarriage.

Research has shown that fat loss of up to 7%, for those that are overweight, achieved by diet, exercise and lifestyle changes, can improve overall health, fertility and improve chances of a successful live birth.

There is no fast track, or easy way to lose excess body fat and people need to face the facts, face reality and just get in a do it. The best ways to do this are as follows:

Seek the help of trained healthcare professionals that can help you with dietary and lifestyle changes and can help monitor you and support you rather than blaming and shaming. It also helps to hold you accountable and keep you motivated.

Do any dietary, exercise or lifestyle changes as a couple. It is much easier if you both do it and can support each other in any changes. You can also hold each other accountable and also see the changes in each other.

Set realistic goals and be realistic about how long things will take. It is no use setting unrealistic goals and having an unrealistic perception of how long things will take to change it your body. This will only set you up for failure and chances of rebounding. It is about one day at a time and one step at a time.

Seek the help of a trained healthcare professional to educate you on what good nutrition, good dietary and lifestyle habits are. The more educated you are about what a good diet is, the better your chances are of eating the right foods and achieving your fat loss goals

You need to exercise as well. Diet changes alone will only help to a point and you do need to do some form of resistance work to help burn fat. While walking is great, it doesn’t burn fat and increase lean muscle like resistance exercise (weights etc) can. You may even need to see a personal trainer to get yourself started and be held accountable.

Have access to fresh foods and means to increase your levels of physical activity. It is important to have access to good fresh foods and stay away from the processed and refined foods. You also need to have ways of exercising and keeping your body active and burning fat.

It is all about perception versus reality. You need to be real about your weight, your body fat and then set realistic goals to lose the excess body fats. Just remember it is about being proactive. Nobody is going to do this for you, but they can help encourage you to be healthy and make better dietary and lifestyle choices.

Lastly, men and women are twice as likely to achieve healthy weight and waist range and proper dietary and lifestyle choices if their partner does it too. The journey to having a baby requires a couple to do it and the same goes for weight loss and achieving healthy body fat and healthy waist range too.

Take care

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine and Women’s Health Medicine

-Women’s and Men’s Health Advocate

01 Dr Andrew Orr