Image of Vitamin C Deficiency list

Vitamin C Deficiency. What It’s Doing To You And How You Can Fix It.

Before you get into this article, if at anytime you want to speak to one of our Toronto Naturopathic Doctors about Vitamin C deficiency or Vitamin C IV Drip, we have a free consultation call available. Click here to book one.

What are some of the symptoms of Vitamin C deficiency?

Unfortunately, Vitamin C deficiency is quite common. On the flip side, severe forms of Vitamin C deficiency, like Scurvy, is quite rare.

Risk factors that can lead to vitamin C deficiency are a lack of fresh fruits & vegetables in your diet, excessive alcohol intake, smoking, individuals with eating disorders, restrictive diets, food allergies, type I diabetes, inflammatory bowel disease, and patients on hemodialysis.

You can see why it’s so common with the typical North American lifestyle!

Vitamin C deficiency is usually diagnosed based on clinical signs and symptoms as well as assessing any contributing risk factors.

If you are concerned about your vitamin C levels, make sure to book an appointment with a Toronto Naturopathic Doctor for a thorough assessment.

Here Are Your Top 5 Initial Signs Of Vitamin C Deficiency

  • Fatigue
  • Weakness
  • Irritability
  • Joint pain
  • Muscle pain

When you don’t address a Vitamin C Deficiency, you can start having some serious problems that can result in:

  • Poor wound healing
  • Problems fighting infections
  • Easy bruising
  • Dry splitting hair
  • Dry/rough skin
  • Bleeding gums and/or tooth loss

Why is Vitamin C so crucial for our bodies?

Vitamin C, also known as ascorbic acid, is a water-soluble vitamin that is essential for optimal health and wellness. Humans are unable to synthesize vitamin C endogenously, meaning we have to get our vitamin C through diet and supplementation.

Since vitamin C is a water-soluble vitamin, very little can be stored in the body, therefore daily intake is very important to avoid deficiency. Vitamin C also tends to be depleted in instances of intense stress, trauma, burns, surgery, fever, inflammation, diarrhea, iron deficiency, and chronic infections so the need is even further increased during these times.

Our body also needs vitamin C to form and maintain blood vessels, cartilage, collagen, and bones.

Vitamin C acts as a highly effective antioxidant, plays an essential role in maintaining proper immune function, and facilitates the absorption of iron.

It’s probably one of the most important vitamins you need to keep on top of for overall health and wellbeing.

You can do this through diet, supplementation and when you’re really depleted or want to experience the benefits of high dose Vitamin C, you can try a Vitamin C Intravenous Vitamin Therapy, or IV drip.

What is IV Drip Therapy for Vitamin C Deficiency?

Intravenous (IV) therapy also know as an IV Drip, is the practice of infusing fluids directly into the bloodstream. Vitamins, minerals, amino acids, and other natural substances are administered directly into the veins allowing them to bypass the digestive system and go directly into the bloodstream where they are immediately available to the cells, muscles, and tissues that require them.

Since IV therapy skips the digestive process, it allows us to use much higher doses of natural substances than we can ingest orally. For instance, high dose IV Therapy for Vitamin C can be delivered in significantly greater amounts intravenously than can be taken orally and has a stronger therapeutic effect. IV vitamin C is only about 15 percent bioavailable (actively used by the body) when taken orally in high doses, but it is 100 percent bioavailable when administered intravenously, providing significantly higher peak plasma concentrations.

As IV vitamin C is one of the most popular and effective nutrients used in intravenous therapy, this next part is going to specifically focus on the many therapeutic uses of IV vitamin C and how it can potentially benefit you!

What are the benefits of IV Drip Vitamin C Therapy?

Intravenous vitamin therapy , or IV Drip , is an efficient and bioavailable way to replenish your body when you’re vitamin C deficient.

Vitamin C acts as a strong antioxidant, accelerates collagen production, aids in the development of a robust, healthy immune system, can provide patients with more energy, and guards against chronic diseases.

Since oral high doses of vitamin C are not well absorbed and can also result in gastrointestinal discomfort, the best way to administer high doses of vitamin C is through IV therapy.

 IV vitamin C is commonly used to treat many conditions including:

  • Chronic infections
  • Fatigue and low energy
  • Joint pain
  • Mononucleosis
  • Fibromyalgia and Chronic fatigue syndrome
  • Shingles
  • Side effects of chemotherapy and radiation
  • Hypertension
  • Allergies
  • Asthma
  • Common cold and flu
  • Sinusitis
  • Migraines
  • Inflammatory bowel disease

IV vitamin C Antioxidant properties

Stress, alcohol consumption, and smoking can all cause oxidative stress. Oxidative stress results in the formation of damaging molecules called free radicals that can build up and harm our bodies.

Many diseases are caused by, or at least linked to, oxidative damage. Vitamin C is a physiological antioxidant that protects the body against oxidative stress and has been demonstrated to replenish other antioxidants in the body.

According to population studies, those who consume high doses of vitamin C have a lower risk of developing a variety of chronic diseases, such as heart disease, cancer, eye diseases, and neurodegenerative conditions.

Due to poor intestinal absorption and ready excretion from the body, high doses of vitamin C are needed to effectively act as an antioxidant, and IV vitamin C is the most optimal route for administration.

IV vitamin C for Collagen production

Collagen is the primary structural protein found in connective tissue and vitamin C is essential for collagen formation. Collagen is vital for healthy skin, teeth, bones, tendons, cartilage, blood vessels, and cardiovascular health. A lack of collagen can result in weakened blood vessels, ligaments, tendons, and bones and therefore, IV vitamin C is an excellent way to support our bodies’ need for collagen formation.

IV vitamin C for Immune Support

Infections have a major impact on decreasing vitamin C levels due to the increased inflammation and metabolic demands. A deficiency in vitamin C also lowers immunity and makes us more susceptible to infections. Vitamin C supplementation has been used in both the prevention and treatment of respiratory and systemic infections. High doses of IV vitamin C have been shown in research to be effective in managing difficult infections, such as Epstein Bar Virus, by reducing disease duration and amount of viral antibody levels. If you tend to get sick often or start to feel under the weather, an IV vitamin C treatment may be the boost your immune system needs.

 IV vitamin C  to help with Antihistamine effects

Histamine is known to play an important role in the development of atopic diseases, such as allergies and asthma. Vitamin C acts as a natural antihistamine and can decrease inflammation and swelling related to allergic conditions. Research has shown that IV vitamin C can reduce histamine levels in patients and reduce allergy symptoms such as sneezing, runny nose, and itchiness. Do you suffer from seasonal allergies? IV vitamin C may be a great option for you.

IV vitamin C  for Energy

Fatigue is one of the most common symptoms individuals experience in day-to-day life. A lack of vitamin C can result in feelings of fatigue or depression as vitamin C is one of the many important nutrients required for proper energy production. Research has shown that high doses of IV vitamin C can reduce symptoms of fatigue so it may be just what you need for that energy boost!

How can a Toronto Naturopathic Clinic help?

Our Toronto Naturopaths at Higher Health are certified for IV drips that include IV vitamin C.  Your naturopathic doctor will run all the required blood work to ensure proper screening takes place before beginning any IV therapy treatments. In Ontario, Naturopathic Doctors receive additional training to become licensed in intravenous therapy.

IV vitamin C can also be combined with a variety of other vitamins and nutrients tailored to meet your specific health concerns. A naturopathic doctor will individualize each IV treatment with the nutrients you require, the proper dosages, and number of IV sessions necessary to reach your health goals.

If you are interested in discussing how IV Therapy for Vitamin C can help you, book a free consultation with on of our Naturopathic Doctors.

References:

https://pubmed.ncbi.nlm.nih.gov/29864039

https://pubmed.ncbi.nlm.nih.gov/17884994/

https://www.ncbi.nlm.nih.gov/books/NBK493187/

https://dermnetnz.org/topics/scurvy/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898816/

https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/#en1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015650/

https://pubmed.ncbi.nlm.nih.gov/29099763/https://link.springer.com/article/10.1186/1475-2891-11-7

https://pubmed.ncbi.nlm.nih.gov/12134712/

How Do Your Hormones Affect Your Weight and What You Can Do

How Do Your Hormones Affect Your Weight and What You Can Do.

How Do Your Hormones Affect Your Weight and What You Can Do

Before you get into this article, if at anytime you want to speak to one of our Naturopathic Doctors about PCOS, we have a free consultation call available. Click here to book one.

“I can’t lose weight, no matter what I do!” As Toronto Naturopaths, we work with clients every day who have struggled with their weight.  They come to us having invested countless dollars, tried every diet, over exercised, and the weight still won’t come off.

Sounds familiar? Chances are that your hormones are out of balance.

When they are, no amount of diet or exercise is going to help you lose the weight long term until your hormones are back on track.

This blog does get a little technical, but it will explain which hormones are affecting your weight and why.

Insulin resistance, and keeping a stable blood sugar level is key for weight loss.

 When it comes to how hormones affect your weight, our body secretes insulin in response to higher levels of blood glucose. This is to bring blood glucose levels down, and allow glucose (sugar) entry into our cells.

When your blood sugar is fluctuating frequently, this influences the production of insulin, and promotes fat production.

In addition, blood sugar fluctuations provoke sugar cravings, further exacerbating the blood sugar insulin roller coaster.

When our body has a blood sugar issue like insulin resistance, it demands more sugar which can cause you to crave those sweet, calorically dense, nutrient void foods.

The more frequently your blood sugar level spikes, the more your body produces insulin, and this can increase the risk of insulin resistance leading to further problems including inflammation and hormonal chaos.

Dealing with cortisol is often one of the very first steps when addressing weight loss.

Stress hormones affect your weight more than you think.

“I’m not that stressed”, says the full time working mom running around on fumes all day. Often, we are expected to do it all; work life, cooking, cleaning, parenting, errands and a social life in between.

We somehow accept that feeling tired, overworked, and burnt out is normal.  Some symptoms that may indicate your stress levels may be higher than you think, and on the verge of burnout include: feeling tired, either all day or that afternoon slump in the afternoon, you feel you never have enough time in the time to complete the things you need to get done, you feel overwhelmed, you find you are snapping at things or people you wouldn’t otherwise have, and you feel you are constantly on overdrive.

When hormones affect your weight this is your sympathetic nervous system working overtime, that fight or flight mode that is only supposed to be used in emergencies to help keep us alive.

Our adrenal glands which sit on top of our kidneys, secrete a hormone called cortisol which responds to these periods of stress. In short bursts or acute situations, our body’s response to cortisol is necessary and warranted.

However, over prolonged periods of sympathetic activation, stress, and cortisol secretion we see blood glucose spikes, insulin resistance, weight gain around the abdomen, brain fog, decreased mental and physical performance, amongst other things.

What does this look like?

You may get hit with some serious cravings for foods you know aren’t nutritious for you, but the cravings are so powerful you can’t control them.

Next your body is going to send signals to eat more high sugary foods, because it think it’s in danger or there is a threat, so it thinks it needs more glucose (energy) fast.

In addition, under chronic stress our body decreases muscle mass. Decreased muscle mass also means less mitochondria (energy powerhouses of the cell), which further slows down our metabolism, meaning we burn less calories.

In addition, elevated levels of cortisol start affecting other hormones like insulin, thyroid hormones, and our reproductive hormones which only leads to further problems.  You can see how your hormones affect your weight.

Nutrient repletion, adrenal support, and a Natuorpathic assessment can help give your adrenals the T.L.C. they most likely need and help you on your way towards your health goals.

How Do Your Thyroid Hormones Affect Your Weight

Our thyroid is one of the master glands which controls our metabolism. It controls the way our body uses energy for a variety of functions throughout the body.

For those that have been diagnosed with a thyroid condition, either “hyper” or “hypo”, this indicates that your thyroid is demonstrating signs of dysfunction.  In a “hypo” state, the thyroid gland is under functioning.

It is not producing enough thyroid hormone to drive our metabolism and use energy efficiently. This may include signs of weight gain, slowed heart rate, hair loss, brittle nails, dry skin, fatigue, constipation, and brain fog to name a few.

In a “hyper” state, we typically see the opposite. Our thyroid gland is producing too much thyroid hormone, causing the body’s metabolism to run in overdrive with additional energy expenditure.

This may look like increased sweating, anxiety, diarrhea, feeling wired but tired, unintentional weight loss, and more. In terms of how hormones affect your weight, one of the major complaints we hear is weight gain despite doing all the things “right” or the frustration associated with the inability to lose weight. This can be maddening for individuals because despite every diet or exercise routine, the reading on the scale just won’t budge.

Could it be your thyroid? Your doctor told you your TSH level was fine, so therefore your thyroid was fine. Unfortunately, it’s not as simple as that.

Our Toronto Naturopathic Doctors at Higher Health are trained to look at a more comprehensive approach when assessing thyroid health and function. This includes a full thyroid panel, nutrients needed to optimize thyroid function, assessing any food intolerances and gut disturbances,  and of course stress levels.

We know that chronic stress takes a toll on the thyroid, and hits it hard. Stress also depletes magnesium and selenium, essential nutrients needed for optimal thyroid function. The core foundations of thyroid health include optimizing digestion, sleep, stress, diet, exercise, and correcting deficiencies.

How Do Your Leptin Hormones Affect Your Weight?

Leptin is a wonderful hormone secreted by our fat cells to communicate to the brain that you are full and should stop eating.  It says to our brains that okay, we have enough fat stored, we don’t need to continue to eat, and we can burn calories at a stable rate.

Leptin sounds great right? The issue is that when we gain weight we have higher circulating levels of leptin.

Higher levels of circulating leptin can lead to something we call leptin resistance, which basically means your brain doesn’t respond to the signals leptin is trying to send. When your brain doesn’t receive or can’t respond to leptin’s signal, it thinks your body is starving.

As a response, your brain thinks that you must eat more in order to prevent starvation, and in an effort to conserve energy it reduces energy expenditure and slows down your metabolism.

A variety of potential mechanisms have been proposed with leptin resistance including inflammation, having elevated free fatty acids in the blood stream, and as mentioned having high circulating levels of leptin.

A lot of times the reason yo-yo diets fail is due to fluctuating levels of leptin and its consequences on hunger and metabolism.

How Do Your Estrogen Hormones Affect Your Weight?

Estrogen levels that are either too high or too low can both cause weight gain. Low levels of estrogen can be the driving factors behind very stubborn hormonal weight gain, often around the abdomen, and especially for women during perimenopause/ menopausal years.

As ovarian estrogen levels decline, it turns to other cells to produce estrogen including our adipose tissue. In an attempt to balance this demand, our body starts converting extra energy sources into fat, which can lead to hormonal weight gain especially around midline.

On the other hand, estrogen levels that are too high can irritate the cells in our body that produce insulin, our beta cells located in the pancreas. This can lead to insulin resistance, causing blood sugar levels to rise and subsequent weight gain.

In addition, higher levels of estrogen can impact thyroid function, which we know is one of the master glands regulating metabolism. Symptoms of estrogen dominance may include PMS, painful periods, breast tenderness, brain fog, lowered libido and weight gain.

Luckily, our Toronto Naturopathic Doctors have training and advanced testing to assess estrogen levels!

When your hormones are in check you should feel like you have infinite energy, balanced moods, your cravings will disappear, and you can start hitting those weight loss goals.

You can book a free call to speak to with a Naturopathic Doctor today to help you determine if hormonal imbalances may be the root issue preventing you from losing that stubborn weight! Click here to book one now!

 

References:

https://pubmed.ncbi.nlm.nih.gov/34262799/

https://pubmed.ncbi.nlm.nih.gov/34224398/

https://pubmed.ncbi.nlm.nih.gov/34267323/

https://www.healthline.com/health/leptin-diet

https://www.yourhormones.info/hormones/leptin/

https://www.webmd.com/menopause/guide/menopause-weight-gain-and-exercise-tips

PCOS Symptoms

What Are PCOS Symptoms And What You Can Do About It!

How To Know Your PCOS Symptoms Before you get into this article, if at anytime you want to speak to one of our Naturopathic Doctors about PCOS, we have a free consultation call available. Click here to book one. Have you ever felt like something with your hormones and menstrual cycles are “off” and may be wondering what could be going on? Could you have symptoms of PCOS? Or, maybe you’ve been newly diagnosed with PCOS and are wondering, now what? Either way this blog post is for you, as we discuss the most common hormonal disorder in women of reproductive age- PCOS, also known as Polycystic Ovary Syndrome. PCOS is a complex hormonal and metabolic disorder. Despite its name, it goes far beyond having polycystic ovaries; in fact, it is possible to have PCOS without having ovarian cysts (more to come on that later).

Did You Know Approximately 10% Of All Women Have PCOS. Some Will Never Know They Have It!

First and foremost, you are not to blame for your PCOS. The exact cause of PCOS has yet to be determined; however, we do know that many factors are believed to play a role. These range from genetics, androgens, AMH, insulin resistance and environmental endocrine disruptors. Although we have made profound progress with beginning to understand this illness, there is a lot we do not know, but we do know the symptoms of PCOS and what to look for so we can begin to help.

Top 10 Signs and Symptoms of PCOS

Moderate to Severe Acne, commonly along the jawline: Both insulin resistance and androgens can be to blame for acne in women with PCOS. Both insulin and IGF-1 can increase the production of androgens, and also decrease sex hormone binding globulin (SHBG), which further increases serum testosterone. In addition to increasing androgens, insulin resistance can trigger unregulated growth and keratinization of the skin cells which is a factor in acne. Androgens can cause excess sebum production, resulting in clogged pores and bacterial overgrowth.  Another red flag that may indicate PCOS is in patients whose acne did not fully respond to Accutane. Hair growth on the Chin, Upper Lip, Stomach, or Chest: Higher levels of androgens can cause excess hair growth in areas of the bodies where hair is typically not seen in women. These hairs can be coarse and dark, and is one of the keynote signs of hirsutism in women who have PCOS. Irregular periods: One of the major signs of PCOS is that your periods can be irregular including being far apart, or skipping periods altogether. Difficulty in Conceiving: Individuals with PCOS may have difficulty conceiving for a variety of reasons. As mentioned above, cycles can be either irregular or absent which also means that a woman may not be ovulating regularly. Identifying the fertile window can be difficult, and ovulation tests typically used (LH strips) are not reliable for those with PCOS since LH tends to be elevated throughout the cycle, resulting in false positives. In addition, less ovulatory cycles can equate to less fertile windows throughout the year. Furthermore, egg quality can become impaired due to the hormonal and inflammatory changes seen within the ovaries. It’s important to note that PCOS does not mean you can’t get pregnant; however, it can mean that more targeted treatment options may need to be explored to optimize conception and pregnancy outcomes. Hair Loss: Higher levels of androgens can also be the culprit of hair loss seen in those with PCOS. Testosterone gets converted into another androgen called DHT within the scalp. DHT does not play nice with hair follicles, causing damage and shrinkage which ultimately results in the hair to enter the telogen phase where they then fall out. Hair loss in PCOS is typically seen around the frontal area behind the hairline, but can also appear as overall thinning. Pigmentation in the folds of your skin: This is known as acanthosis nigricans, and results in the skin being very dark in colour, and velvety in texture. If present, it is commonly seen in the crease behind the neck, under the arms, or in the creases of the thighs. This occurs as a result of insulin resistance, and can typically be improved or reversed when insulin sensitivity is improved. Skin Tags: Small, flesh coloured tag-like growths that appear on the skin, and are related to insulin resistance. Ovarian Cysts: The cysts seen in PCOS are not typical ovarian cysts. They are actually partially developed follicles that have grown, but have stalled during the process of preparing for ovulation. This will be seen on ultrasound as what’s referenced as the “string of pearl” appearance. It is important to note that having polycystic ovaries is not a required factor in diagnosing PCOS. Weight Gain, or difficulty losing weight:  For some women with PCOS, they may tend to gain weight very easily, or may have difficulty losing weight. This can be related to both insulin and leptin resistance. Insulin resistance causes our bodies to store fat more easily since glucose cannot enter the cells as readily, it is also associated with gaining weight around the midline and abdominal area. Leptin resistance has also been discovered as a factor in PCOS, and can make our brain think we are in starvation mode, which ultimately messes with our hunger and fullness signals. Depression and Anxiety: Women with PCOS have higher rates of both depression and anxiety. These changes in mood can be related to a variety of factors including inflammation, hormonal imbalances, and the stress associated with dealing with the symptoms of PCOS. It is important to screen for mental health disorders in patients with PCOS and offer additional support where needed.

How To Assess If You Have PCOS

Typically the diagnostic criteria for PCOS is having 2 out of the 3 present:
  • A pelvic ultrasound indicating the presence of cysts, or multiple immature follicles
  • History of oligo (irregular) or anovulation
  • Hyperandrogenism assessed via physical exams and/or lab work
Additionally, your Toronto Naturopathic Doctor may consider all or some of the following lab work in order to develop an individual and comprehensive treatment plan for you:
  • Hormones
    • Day 3 FSH- stimulates follicles to grow in the ovaries
    • Day 3 LH – triggers ovulation and can often be 2-3x higher than FSH in individuals with PCOS (LH:FSH ratio).
    • Day 3 Estradiol – to ensure you can build a uterine lining, also plays a role in ovulation
    • Testosterone – an androgen that is often elevated in patients with PCOS
    • DHEA-S – an androgen secreted by the adrenal glands that can also be elevated in patients with PCOS. Of note, this androgen is often elevated in those with “lean” PCOS
    • Progesterone- 5-7 days after suspected ovulation to confirm of ovulation did occur
  • Metabolic
    • Fasting Insulin + Fasting glucose to measure insulin resistance
    • HbA1C to rule out diabetes
    • Lipid Panel – to monitor cardiovascular risk associated with PCOS
  • Inflammatory
    • Hs-CRP – often elevated in PCOS due to chronic low grade inflammation
    • ESR – a measure of general inflammation
    • Vitamin D- typically low for individual with PCOS. Vitamin D is very important for proper immune functioning, reducing inflammation, hormone regulation, and overall health
  • Ruling out other conditions
    • Thyroid panel – women with PCOS have higher rates of Hashimoto’s thyroiditis, thyroid dysfunction can also contribute to weight gain and hair loss
    • 17’OH – to rule out a condition called NCCAH that signs and symptoms can mimic PCOS
    • Prolactin – elevated levels can also cause irregular cycles
    • AM cortisol – to rule out Cushing’s disease, but can also be a factor in PCOS

How Naturopathic Medicine Can Help Your PCOS Symptoms

Nutrition The overall goal with targeting nutrition in those with PCOS is to regulate blood sugar, improve insulin resistance, and reduce inflammation. There have been many studies looking at the impact of diet on outcomes for those with PCOS and some of the most important strategies are around reducing glycemic load, managing caloric intake, improving food quality, and increasing healthy fats. Nutrition is something that is individual to each person, and recommendations are made so that they are realistic and sustainable for the person to optimize success. Overly restrictive diets (for example very low carb, diary free, gluten free) do not result in better outcomes, and can further exacerbate stress and declining mental health in those with PCOS. Exercise Overall the goal with exercise is to promote movement, ideally a minimum of 120 minutes a week. Different types of exercise have been studied with PCOS including resistance training, HIIT training, yoga, and aerobic exercise. Ultimately, the most important factor is choosing a form of exercise that you enjoy doing, that you can commit to doing on a regular basis and that will help you reach your movement targets. Your Naturopathic Doctor can dive into this further with you and help make specific recommendations that meet your health goals. Targeted Supplementation There are some key supplements that have been studied to improve health outcomes and symptoms in those with PCOS. Some of these include:
  • Myo-Inositol: Can help to improve insulin receptor activity, and improve insulin resistance. It has also been found to improve ovulation, and decrease excess androgens.
  • NAC: Can help to improve insulin resistance, lower testosterone levels, regulate ovulation and menstruation, and improve fertility.
  • Berberine: An herb that can improve insulin sensitivity, increase rates of ovulation, decrease androgens and also decrease unhealthy cholesterol.
  • Vitamin D: A deficiency is common amongst those with PCOS and can lead to more intense PCOS symptoms. Optimizing Vitamin D levels can help to improve insulin resistance, ovulation, menstrual irregularities, infertility and reduce androgens.
  • Zinc: A mineral that can have a positive effect on PCOS symptoms like acne, hair growth, and hair loss.
This is not an exhaustive list by any means. Our Toronto Naturopathic Doctors at Higher Health have extensive experience in treating and helping individuals manage their PCOS, and will target supplementation on an individual basis. Think you could be suffering from PCOS, or have been recently diagnosed? Reach out to one of our Toronto Naturopathic Doctors and book a free consultation today! References: https://www.pennmedicine.org/updates/blogs/fertility-blog/2020/march/five-myths-about-pcos https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos https://www.jogc.com/article/S1701-2163(16)32915-2/pdf https://cwhn.ca/en/node/44804 https://pubmed.ncbi.nlm.nih.gov/31749393/ https://pubmed.ncbi.nlm.nih.gov/18097891/ https://pubmed.ncbi.nlm.nih.gov/33260918/