Interview: Dr Sabine Wünschmann - The Link Between PCOS And Blood Sugar

Sync team
Sync team
September 13, 2021

This is an episode from our series of interviews with Health professionals and specialists on how people can improve their metabolic health. You can watch the episode in video on our YouTube channel.

Dr Sabine Wünschmann is a holistic Gynaecologist and Obstetrician in private practice with over 30 years serving women internationally. She also is the founder of Hormone Harmony program(R) , helping women worldwide in Menopause and Perimenopause heal naturally from symptoms related to hormonal imbalances by addressing the root cause.‍

Daphne Karnezis (Sync): [00:00:00] so my guest today is Dr. Sabine Wünschmann. She's an obstetrician gynecologist specializing in hormonal health for women, and I'm going to be finding out about, you know, the important link between polycystic ovarian syndrome, PCRs and insulin resistance and how managing blood sugar through our diet can help us.

So hi, Sabine. I mean, last time I met you around this time last year, and we were talk ing about your career and your practice and the importance that you play. It's just not, you know, not just on treating. You know, the acute symptoms that many women might come to you for, but also the wider factors, the underlying things that are so, so important, like diet and lifestyle, to make sure that symptoms don't reemerge.

And I know that one of the things that you see in a lot of your patients is hormonal imbalance. And so today I wanted to focus on a specific condition or syndrome, rather that's polycystic ovarian syndrome, PCOS that is essentially an imbalance of certain hormones. And as with, you know, all of the discussions that we have here on, on the channel, it's also linked to our metabolic health and how insulin sensitivity or insensitivity can cause various problems and, and how that's linked to how we process our blood sugar in the body.

So let's get straight to it. I mean, it's amazing that polycystic ovarian syndrome is one of the leading sort of causes of infertility in women. I mean, correct me if I'm wrong, but I think it's one in 10 women who suffer from it and it often does go undiagnosed because maybe they don't pick up on certain symptoms.

So I guess let's start with what PCRs is and defining it. And why we so often hear it as one of the causes of infertility in women.

Dr Sabine Wünschmann: [00:01:41] Yeah, thank you very much, Daphne. I'm really glad to be here. It's it's always, you know, wonderful to support, you know Actions and , you know and, and initiatives that really help women, how to connect the dots and, help them really, you know, become,   the actual driver of their own health and not just, you know, running after symptoms.

And I think that is so important that we're here also today that women really start to learn about their health In a very lightweight, you know, we don't want to become too medical and to be exhausting, but it's important to actually understand the concept of having symptoms and to understand the concept of what to do with them.

So, you know, we do not have just symptoms and order to get annoyed. We have symptoms because it's a sign of an imbalance. And as you very clearly and rightly say, you know, polycystic ovarian syndrome is something that is extremely common. It's it's a condition, you know, that you're, that you're born with.

It's not something that you pick up because you you know, you were unlucky. It's just something that is also , geographically more common in the, in the Southern European hemispheres  in the Mediterranean countries like Greece and turkey and Spain and Italy is much more common than, than in the North European countries.

And it's a condition that the ovaries are actually you know, equipped  with a large amount of eggs. I mean, I need to maybe. Make a small excursion in order to explain what, you know, what the ovaries are actually consisting of. And we as women, which is one of the big differences between men and women, but, you know, amongst, you know, social differences, the medical differences that we as women were born on the day of our birth with the amount of eggs that we do have in our ovaries. So we have like 350 - 450 thousand ovaries in our eggs and our ovaries and these ovaries they're kind of sleeping hibernating through childhood. And then, the puberty starts and, you know, the, the hierarchy system, the signaling from the brain, from the hypothalamus and the pituitary gland start.

And, you know, we got started you know,  on our way to reproductive age, you know, every month that we have a cycle, one or two  ovaries eggs will, will be activated. So we have this hibernating pool of eggs. And then, you know, through the release of hormones that we would, that get released through the, through the brain axis one or two or three or four eggs get activated to become the dominating egg of the month.

One of them usually progresses to become the leading follicle. And then when the follicle, reaches maturity, which is usually in the middle of the cycle of a woman, anything between day 10 and day 14, the follicle burst, the egg will released and so forth. And this happens again and again. So in the, in the course of our reproductive life, every month,  we lose a certain amount of eggs.

And the way the ovaries are supposed to react  to the instructions by basically by the brain, in order to release the growth of one egg, it needs a certain amount of risk receptors on the surface of the ovary, so that  the hormones that are released into the bloodstream, they hook onto the surface of the ovary.

And then the ovary gets the information we need to prepare the egg, release, the egg. And then, you know, the whole process starts. These preceptors in policy, cystic ovaries, they are quite different. So these receptors in the Polycistic ovarian syndrome, there are you know, I would say lazier, so it's much more difficult for the ovaries to actually get instruction to ovulate.

That's why the cycles traditionally are usually long, women with polycystic ovaries they have very long cycles. So ovulation really gets delayed you know, instead of ovulating on day 12 day, 13 day 14, they sometimes ovulate day 25 day 30, or they don't even ovulate when, when it really becomes into an ambulatory cycles.

And this is something that, you know, is very classical problem with the polycystic ovaries that, you know, you do not really. Get the trigger to ovulate ovulation gets delayed and then, you know, the quality of the egg that gets released eventually is much less. And so comes, come see, you know, the, the whole infertility issue.

The infertility issue insists you know, primarily of slow, delayed release of the eggs from the follicle and this, you know, will then result in, in non fertilizing or not good quality eggs. So that is the pathology of infertility with polycystic ovary. I don't know. Is that, is that understood?

Daphne Karnezis (Sync): [00:06:55] No understand the link. Yeah. I think we're link within fertility. I'm just curious to find out what, what are some of the symptoms that manifest themselves? That was, you know, how might a woman realized that she has this.

Dr Sabine Wünschmann: [00:07:07] Yeah. So  the difficulty really is in infertility that you, you know, you obviously, when ovulation doesn't happen in a timely manner, your cycles become prolonged.

So you would, you would experience as a woman, you would experience very long cycles. You would have like, you know, a cycle from 30 days and upwards, you know, 30 days, 40 days, 50 days even sometimes skip a months extremely long and  irregular cycles. As a result of that you also experience usually extra hair growth or you have a condition that we call hirsutism, which can present itself with facial hair, with hair growth around the nipples, in the decollete on the back.

So you have extra body and facial hair. You have usually very oily skin. You have a tendency to be to be rather obese, you know, you have, you've been more on the chubby side, so it's very much more difficult to  have your weight, on a steady level. You need to really struggle constantly with losing weight, it's very difficult to lose weight, and that's where all the you know, your great effort comes in because these ovaries that tend to who also helps with the tendency towards insulin resistance. So it's not only that they have delayed over you know, ovulation.

They also have you know, increased testosterone, they have a very  high LH level on blood tests, and I think one big difference that we should also differentiate because, you know, we don't want women to be scared when they get diagnosed with polycystic ovaries, because very often it creates a great deal of, of fear. You know, you you're diagnosed with polycystic ovary and then, the traditional approaches that they put on the pill.

And with the use of contraceptive pill, you just take externally your. Your tablet every day. And then you have like a fake period in a way, because you just, when you stop your period, you get a withdrawal bleed. But of course, this is not really addressing the issue of polycystic ovaries. And I want to make very clear that there's a big difference between.

Polycystic ovarian syndrome and polycystic ovaries on the ultrasound. So you have very often you have a multicystic polycystic, that's actually a Greek word. You know, Polly in Greek means many and cystic assists. So if you look at the and the ultrasound of a woman with polycystic ovaries, they look almost like a Swiss cheese and they have this, what we call like a necklace sign, like Pearl, you know, a chain of Pearl that we wear.

The, you know, in the sense of the policies, the policies stick ovarian syndrome is really when all, all the things that I said earlier are I have the picture on the edge. You have very irregular cycles and long. You are you struggling with your weight, your hairy, and and you're not ovulating regularly in that case, women usually have an increased insulin level.

They have you know, they have a poor sugar balance. They have increased LH and increased testosterone. So it's a bit I think it's very important to differentiate, you know, do I have the policy cystic ovarian syndrome, which then also will give me great difficulties to fall pregnant? And if I'm pregnant, even, you know, it gives me an increased risk for miscarriages or do I only have the polycystic appearance on the ultrasound, but I have regular cycles and I'm just a little bit more prone to possibly, you know develop symptoms  of insulin resistance. So it's a, it's a big difference  in diagnosing. And I think, you know, there's no panic, you know, you understanding the pathology  and the way that polycystic ovaries are working, there's a lot you can do with managing your blood sugar.

Daphne Karnezis (Sync): [00:11:17] Exactly yeah. So our aim is to keep our insulin levels in check, right? Therefore keeping our blood sugar relatively stable. We should be doing that through our diet I presume?

Dr Sabine Wünschmann: [00:11:30] Yeah. I mean, one of the key, you know, one of the key things that are usually recommended when patients appear with, you know, all the symptoms that we have said earlier is really to adjust the diets.

You know, you know, you can just start with a low-glycemic index diet, you know, measure your, your blood sugar levels, make sure that you do not really go towards insulin resistance that you make sure  that your diet is very balanced in that sense that you exercise regularly, that you, you know, really help the metabolization of the nutrients that are  put into your, into your system are really wisely chosen. And then in that sense a lot of women that they even you know, they don't have any problems in terms of symptoms.

I think one of the reasons that it's so important and so exciting that we're here today is really to make sure that people do understand that there's a lot they can do themselves about, you know, dealing with a diagnosis of polycystic ovaries,  which means that you take care of your, of your diet. You make sure that you're, your sugar levels are balanced, that you don't really have any ups and downs of your insulin curve. That you're, that you r diet is conscious of that, and it can be managed beautifully in that sense.

And doesn't need to be any concern for wellbeing because  the severeness of the Polycystic ovaries is definitely the young age, because you know, when you're young, you have lots of eggs. Like we said earlier, you know, we are born with the amount of eggs when the time of our own birth.

So clearly, the earlier we don't allow our body to slip into this mode of insulin resistance, the better, because the problem is also that, you know, you do not have significant symptoms of that. I mean, other than, you know, weight gain, and it's just something that is usually you know, very subtle and it's not from one day to the next you you know, experienced horrendous symptoms. So it needs awareness and it needs really a conscious approach. And  one thing that would really help wonderfully is really to measure your, your blood sugar levels.

So that would be, you know direct paradigm of seeing where do I stand and what am I doing with what I'm eating? Am I doing the right thing? You know, paying say all door, I'm eat very healthy. I have every day, you know, my, my little biscuit and I have my coffee and I'll have a glass of milk.

And people think that they're really eating healthy, so healthy eat mopping your body is also something that you know, would, would need a lot of education  will assist patients to do know what them dig.

Daphne Karnezis (Sync): [00:14:27] Yeah, no, I was just going to say that each of us reacts differently. But as sort of a general measure in general advice, we should really be avoiding sugar and refined carbohydrates, right? And starch essentially to keep our insulin in check.

Dr Sabine Wünschmann: [00:14:42] Absolutely. Yeah, but there, we also, you know, that's where we also victims of our advertising industry around us because, you know, we get suggestive you know, I cons everywhere or if it's in, in newspapers or in, you know, in advertisement between entertainment problems on television, you know, we always get suggested that, you know, eating processed carbohydrates is a good thing. And it's definitely not because it's really like a, it's like a sugar tsunami on your poor pancreas, because if we want to say, you know, what is insulin resistance?

It's something that maybe all of you not aware of. It just basically means, you know, that the, the fat cells, the muscle cells and the liver cells, they are not responding to the insulin as much as they should. Insulin is a hormone that gets released from the pancreas and it's responsible for the uptake of sugar into the cells in order to produce energy for our body. So if I have like, you know a sugar load of processed carbohydrates coming in, and my cells can actually not respond to the insulin, that means you have all these sugar circulating in your bloodstream and you know, this is happening on a continuous long-term basis. You will end up with increased sugar levels and, you know, pre-diabetes and diabetes. And this is something that is totally avoidable If you, you know, take your measures and time.

Daphne Karnezis (Sync): [00:16:15] Definitely. And just as a final question Sabine, and I just wanted to ask you, you know, we, we said that polycystic ovarian syndrome is essentially a metabolic condition. A lot of people think about metabolism and they just think it's about, how quickly or efficiently we, we burn calories and in a way it is, but metabolic health is so much more than that. What does metabolic health, you know, mean mean to you? And everything that we've just talked about in this, in this context and the context of insulin resistance.

Dr Sabine Wünschmann: [00:16:46] I mean, metabolic health is just so much more than just burning the calories. And I think you know, this is really probably the, the building block of our level of health is our metabolic health.

And, you know, a lot of people they're actually suffering from a metabolic syndrome already, you know, which means that they have hydrate glyceride levels or they have reduced good HDL cholesterol, they have increased blood pressure. You know, they have a large waves and they have elevated fasting blood sugar.

So, it's a team playing convention of, of multifactorial events, you know, metabolism is and, and, you know, burning the calories is just a tiny little break of this whole castle of you , which is called metabolic health.

And if you do invest and look after your metabolic health you're just really taking your measures to step away way from all these diseases that can be avoided like high blood pressure, high cholesterol  pre-diabetes diabetes and  [00:18:00] obesity. So metabolic health is really  the symphony orchestra of all of our hormones' health: if my insulin is playing up and is not really doing well, we are suffering from so many diseases.

Me as an obstetrician, I see also the increasing incidents of women that's, you know, as a, as a underlying basic strategy has, a condition called homeostasis.

It's also the timing of what you eat when you eat, how fast you eat, et cetera. They can find themselves in a situation of gestational diabetes, which means that they present with, with diabetes in pregnancy, which is very detrimental to the imprint of the cells of the pancreas of the oven babies.

So if I'm diabetic in pregnancy, and I'm not really taking care of that, you know, the chances of the baby to become diabetic in life is very, very high. And there's definitely a big increase with the women that present with gestational diabetes. They, you know, as soon as they deliver the normal incident is usually that they don't come out of the diabetes and they become normal again, even though in many cases of, you know, sort of later in life, they go back to diabetes.

So I always say it's like the sugar in the carbohydrates support, processed carbohydrates, there is this tsunami often attack on our, on our vibrant health, really. And it needs, you know, a lot of it needs a lot of effort and awareness. And, if you had the means and measure to measure your blood sugar on a regular basis on a daily basis, that would be wonderful because you have an immediate feedback of what you're doing, or you just don't wait, wait for your checkup with your doctor, which is once a year, maybe twice a year at the most to see then, you know, what's happening. You can see every day what you're doing and then, you know adjust and remodel and reinvent yourself accordingly.

Daphne Karnezis (Sync): [00:20:06] Great. Thank you so much for your time.

Dr Sabine Wünschmann: [00:20:10] Thank you very much for having me. Thank you. Bye.

This is an episode from our series of interviews with Health professionals and specialists on how people can improve their metabolic health. You can watch the episode in video on our YouTube channel.

Dr Sabine Wünschmann is a holistic Gynaecologist and Obstetrician in private practice with over 30 years serving women internationally. She also is the founder of Hormone Harmony program(R) , helping women worldwide in Menopause and Perimenopause heal naturally from symptoms related to hormonal imbalances by addressing the root cause.‍

Daphne Karnezis (Sync): [00:00:00] so my guest today is Dr. Sabine Wünschmann. She's an obstetrician gynecologist specializing in hormonal health for women, and I'm going to be finding out about, you know, the important link between polycystic ovarian syndrome, PCRs and insulin resistance and how managing blood sugar through our diet can help us.

So hi, Sabine. I mean, last time I met you around this time last year, and we were talk ing about your career and your practice and the importance that you play. It's just not, you know, not just on treating. You know, the acute symptoms that many women might come to you for, but also the wider factors, the underlying things that are so, so important, like diet and lifestyle, to make sure that symptoms don't reemerge.

And I know that one of the things that you see in a lot of your patients is hormonal imbalance. And so today I wanted to focus on a specific condition or syndrome, rather that's polycystic ovarian syndrome, PCOS that is essentially an imbalance of certain hormones. And as with, you know, all of the discussions that we have here on, on the channel, it's also linked to our metabolic health and how insulin sensitivity or insensitivity can cause various problems and, and how that's linked to how we process our blood sugar in the body.

So let's get straight to it. I mean, it's amazing that polycystic ovarian syndrome is one of the leading sort of causes of infertility in women. I mean, correct me if I'm wrong, but I think it's one in 10 women who suffer from it and it often does go undiagnosed because maybe they don't pick up on certain symptoms.

So I guess let's start with what PCRs is and defining it. And why we so often hear it as one of the causes of infertility in women.

Dr Sabine Wünschmann: [00:01:41] Yeah, thank you very much, Daphne. I'm really glad to be here. It's it's always, you know, wonderful to support, you know Actions and , you know and, and initiatives that really help women, how to connect the dots and, help them really, you know, become,   the actual driver of their own health and not just, you know, running after symptoms.

And I think that is so important that we're here also today that women really start to learn about their health In a very lightweight, you know, we don't want to become too medical and to be exhausting, but it's important to actually understand the concept of having symptoms and to understand the concept of what to do with them.

So, you know, we do not have just symptoms and order to get annoyed. We have symptoms because it's a sign of an imbalance. And as you very clearly and rightly say, you know, polycystic ovarian syndrome is something that is extremely common. It's it's a condition, you know, that you're, that you're born with.

It's not something that you pick up because you you know, you were unlucky. It's just something that is also , geographically more common in the, in the Southern European hemispheres  in the Mediterranean countries like Greece and turkey and Spain and Italy is much more common than, than in the North European countries.

And it's a condition that the ovaries are actually you know, equipped  with a large amount of eggs. I mean, I need to maybe. Make a small excursion in order to explain what, you know, what the ovaries are actually consisting of. And we as women, which is one of the big differences between men and women, but, you know, amongst, you know, social differences, the medical differences that we as women were born on the day of our birth with the amount of eggs that we do have in our ovaries. So we have like 350 - 450 thousand ovaries in our eggs and our ovaries and these ovaries they're kind of sleeping hibernating through childhood. And then, the puberty starts and, you know, the, the hierarchy system, the signaling from the brain, from the hypothalamus and the pituitary gland start.

And, you know, we got started you know,  on our way to reproductive age, you know, every month that we have a cycle, one or two  ovaries eggs will, will be activated. So we have this hibernating pool of eggs. And then, you know, through the release of hormones that we would, that get released through the, through the brain axis one or two or three or four eggs get activated to become the dominating egg of the month.

One of them usually progresses to become the leading follicle. And then when the follicle, reaches maturity, which is usually in the middle of the cycle of a woman, anything between day 10 and day 14, the follicle burst, the egg will released and so forth. And this happens again and again. So in the, in the course of our reproductive life, every month,  we lose a certain amount of eggs.

And the way the ovaries are supposed to react  to the instructions by basically by the brain, in order to release the growth of one egg, it needs a certain amount of risk receptors on the surface of the ovary, so that  the hormones that are released into the bloodstream, they hook onto the surface of the ovary.

And then the ovary gets the information we need to prepare the egg, release, the egg. And then, you know, the whole process starts. These preceptors in policy, cystic ovaries, they are quite different. So these receptors in the Polycistic ovarian syndrome, there are you know, I would say lazier, so it's much more difficult for the ovaries to actually get instruction to ovulate.

That's why the cycles traditionally are usually long, women with polycystic ovaries they have very long cycles. So ovulation really gets delayed you know, instead of ovulating on day 12 day, 13 day 14, they sometimes ovulate day 25 day 30, or they don't even ovulate when, when it really becomes into an ambulatory cycles.

And this is something that, you know, is very classical problem with the polycystic ovaries that, you know, you do not really. Get the trigger to ovulate ovulation gets delayed and then, you know, the quality of the egg that gets released eventually is much less. And so comes, come see, you know, the, the whole infertility issue.

The infertility issue insists you know, primarily of slow, delayed release of the eggs from the follicle and this, you know, will then result in, in non fertilizing or not good quality eggs. So that is the pathology of infertility with polycystic ovary. I don't know. Is that, is that understood?

Daphne Karnezis (Sync): [00:06:55] No understand the link. Yeah. I think we're link within fertility. I'm just curious to find out what, what are some of the symptoms that manifest themselves? That was, you know, how might a woman realized that she has this.

Dr Sabine Wünschmann: [00:07:07] Yeah. So  the difficulty really is in infertility that you, you know, you obviously, when ovulation doesn't happen in a timely manner, your cycles become prolonged.

So you would, you would experience as a woman, you would experience very long cycles. You would have like, you know, a cycle from 30 days and upwards, you know, 30 days, 40 days, 50 days even sometimes skip a months extremely long and  irregular cycles. As a result of that you also experience usually extra hair growth or you have a condition that we call hirsutism, which can present itself with facial hair, with hair growth around the nipples, in the decollete on the back.

So you have extra body and facial hair. You have usually very oily skin. You have a tendency to be to be rather obese, you know, you have, you've been more on the chubby side, so it's very much more difficult to  have your weight, on a steady level. You need to really struggle constantly with losing weight, it's very difficult to lose weight, and that's where all the you know, your great effort comes in because these ovaries that tend to who also helps with the tendency towards insulin resistance. So it's not only that they have delayed over you know, ovulation.

They also have you know, increased testosterone, they have a very  high LH level on blood tests, and I think one big difference that we should also differentiate because, you know, we don't want women to be scared when they get diagnosed with polycystic ovaries, because very often it creates a great deal of, of fear. You know, you you're diagnosed with polycystic ovary and then, the traditional approaches that they put on the pill.

And with the use of contraceptive pill, you just take externally your. Your tablet every day. And then you have like a fake period in a way, because you just, when you stop your period, you get a withdrawal bleed. But of course, this is not really addressing the issue of polycystic ovaries. And I want to make very clear that there's a big difference between.

Polycystic ovarian syndrome and polycystic ovaries on the ultrasound. So you have very often you have a multicystic polycystic, that's actually a Greek word. You know, Polly in Greek means many and cystic assists. So if you look at the and the ultrasound of a woman with polycystic ovaries, they look almost like a Swiss cheese and they have this, what we call like a necklace sign, like Pearl, you know, a chain of Pearl that we wear.

The, you know, in the sense of the policies, the policies stick ovarian syndrome is really when all, all the things that I said earlier are I have the picture on the edge. You have very irregular cycles and long. You are you struggling with your weight, your hairy, and and you're not ovulating regularly in that case, women usually have an increased insulin level.

They have you know, they have a poor sugar balance. They have increased LH and increased testosterone. So it's a bit I think it's very important to differentiate, you know, do I have the policy cystic ovarian syndrome, which then also will give me great difficulties to fall pregnant? And if I'm pregnant, even, you know, it gives me an increased risk for miscarriages or do I only have the polycystic appearance on the ultrasound, but I have regular cycles and I'm just a little bit more prone to possibly, you know develop symptoms  of insulin resistance. So it's a, it's a big difference  in diagnosing. And I think, you know, there's no panic, you know, you understanding the pathology  and the way that polycystic ovaries are working, there's a lot you can do with managing your blood sugar.

Daphne Karnezis (Sync): [00:11:17] Exactly yeah. So our aim is to keep our insulin levels in check, right? Therefore keeping our blood sugar relatively stable. We should be doing that through our diet I presume?

Dr Sabine Wünschmann: [00:11:30] Yeah. I mean, one of the key, you know, one of the key things that are usually recommended when patients appear with, you know, all the symptoms that we have said earlier is really to adjust the diets.

You know, you know, you can just start with a low-glycemic index diet, you know, measure your, your blood sugar levels, make sure that you do not really go towards insulin resistance that you make sure  that your diet is very balanced in that sense that you exercise regularly, that you, you know, really help the metabolization of the nutrients that are  put into your, into your system are really wisely chosen. And then in that sense a lot of women that they even you know, they don't have any problems in terms of symptoms.

I think one of the reasons that it's so important and so exciting that we're here today is really to make sure that people do understand that there's a lot they can do themselves about, you know, dealing with a diagnosis of polycystic ovaries,  which means that you take care of your, of your diet. You make sure that you're, your sugar levels are balanced, that you don't really have any ups and downs of your insulin curve. That you're, that you r diet is conscious of that, and it can be managed beautifully in that sense.

And doesn't need to be any concern for wellbeing because  the severeness of the Polycystic ovaries is definitely the young age, because you know, when you're young, you have lots of eggs. Like we said earlier, you know, we are born with the amount of eggs when the time of our own birth.

So clearly, the earlier we don't allow our body to slip into this mode of insulin resistance, the better, because the problem is also that, you know, you do not have significant symptoms of that. I mean, other than, you know, weight gain, and it's just something that is usually you know, very subtle and it's not from one day to the next you you know, experienced horrendous symptoms. So it needs awareness and it needs really a conscious approach. And  one thing that would really help wonderfully is really to measure your, your blood sugar levels.

So that would be, you know direct paradigm of seeing where do I stand and what am I doing with what I'm eating? Am I doing the right thing? You know, paying say all door, I'm eat very healthy. I have every day, you know, my, my little biscuit and I have my coffee and I'll have a glass of milk.

And people think that they're really eating healthy, so healthy eat mopping your body is also something that you know, would, would need a lot of education  will assist patients to do know what them dig.

Daphne Karnezis (Sync): [00:14:27] Yeah, no, I was just going to say that each of us reacts differently. But as sort of a general measure in general advice, we should really be avoiding sugar and refined carbohydrates, right? And starch essentially to keep our insulin in check.

Dr Sabine Wünschmann: [00:14:42] Absolutely. Yeah, but there, we also, you know, that's where we also victims of our advertising industry around us because, you know, we get suggestive you know, I cons everywhere or if it's in, in newspapers or in, you know, in advertisement between entertainment problems on television, you know, we always get suggested that, you know, eating processed carbohydrates is a good thing. And it's definitely not because it's really like a, it's like a sugar tsunami on your poor pancreas, because if we want to say, you know, what is insulin resistance?

It's something that maybe all of you not aware of. It just basically means, you know, that the, the fat cells, the muscle cells and the liver cells, they are not responding to the insulin as much as they should. Insulin is a hormone that gets released from the pancreas and it's responsible for the uptake of sugar into the cells in order to produce energy for our body. So if I have like, you know a sugar load of processed carbohydrates coming in, and my cells can actually not respond to the insulin, that means you have all these sugar circulating in your bloodstream and you know, this is happening on a continuous long-term basis. You will end up with increased sugar levels and, you know, pre-diabetes and diabetes. And this is something that is totally avoidable If you, you know, take your measures and time.

Daphne Karnezis (Sync): [00:16:15] Definitely. And just as a final question Sabine, and I just wanted to ask you, you know, we, we said that polycystic ovarian syndrome is essentially a metabolic condition. A lot of people think about metabolism and they just think it's about, how quickly or efficiently we, we burn calories and in a way it is, but metabolic health is so much more than that. What does metabolic health, you know, mean mean to you? And everything that we've just talked about in this, in this context and the context of insulin resistance.

Dr Sabine Wünschmann: [00:16:46] I mean, metabolic health is just so much more than just burning the calories. And I think you know, this is really probably the, the building block of our level of health is our metabolic health.

And, you know, a lot of people they're actually suffering from a metabolic syndrome already, you know, which means that they have hydrate glyceride levels or they have reduced good HDL cholesterol, they have increased blood pressure. You know, they have a large waves and they have elevated fasting blood sugar.

So, it's a team playing convention of, of multifactorial events, you know, metabolism is and, and, you know, burning the calories is just a tiny little break of this whole castle of you , which is called metabolic health.

And if you do invest and look after your metabolic health you're just really taking your measures to step away way from all these diseases that can be avoided like high blood pressure, high cholesterol  pre-diabetes diabetes and  [00:18:00] obesity. So metabolic health is really  the symphony orchestra of all of our hormones' health: if my insulin is playing up and is not really doing well, we are suffering from so many diseases.

Me as an obstetrician, I see also the increasing incidents of women that's, you know, as a, as a underlying basic strategy has, a condition called homeostasis.

It's also the timing of what you eat when you eat, how fast you eat, et cetera. They can find themselves in a situation of gestational diabetes, which means that they present with, with diabetes in pregnancy, which is very detrimental to the imprint of the cells of the pancreas of the oven babies.

So if I'm diabetic in pregnancy, and I'm not really taking care of that, you know, the chances of the baby to become diabetic in life is very, very high. And there's definitely a big increase with the women that present with gestational diabetes. They, you know, as soon as they deliver the normal incident is usually that they don't come out of the diabetes and they become normal again, even though in many cases of, you know, sort of later in life, they go back to diabetes.

So I always say it's like the sugar in the carbohydrates support, processed carbohydrates, there is this tsunami often attack on our, on our vibrant health, really. And it needs, you know, a lot of it needs a lot of effort and awareness. And, if you had the means and measure to measure your blood sugar on a regular basis on a daily basis, that would be wonderful because you have an immediate feedback of what you're doing, or you just don't wait, wait for your checkup with your doctor, which is once a year, maybe twice a year at the most to see then, you know, what's happening. You can see every day what you're doing and then, you know adjust and remodel and reinvent yourself accordingly.

Daphne Karnezis (Sync): [00:20:06] Great. Thank you so much for your time.

Dr Sabine Wünschmann: [00:20:10] Thank you very much for having me. Thank you. Bye.