In this episode, we sit down with Dr. Professor Marla Lujan from the division of Nutritional Sciences at Cornell University and discuss some of the biggest questions regarding PCOS. Thanks for listening uterinekind!
We’re continuing to celebrate PCOS Awareness month this week Uterinekind! For those living with PCOS, getting the condition under control and harmonized with your everyday life can seem impossible. That’s why we’re providing listeners with the best, up-to-date information from the top experts in the field to keep you connected with your body. Today we continue to bring you the best by bringing you into a wide-ranging interview with our brilliant guest, Dr. Professor Marla Lujan from the division of Nutritional Sciences at Cornell University.
Also known as the Lujan Laboratory, Dr. Lujan and her team investigate the link between nutrition, metabolism, and reproductive physiology in uterinekind. In this episode, Dr. Lujan shares some exciting information and studies coming from her team and answers some of the biggest questions regarding PCOS. What should you really be doing for your condition? And do we really know PCOS like we think we do?
Lastly, we end on a high note from Austria that is as sweet as honey! Reach out and do something nice for your neighbors and the Earth!
Thanks for listening, learning, and being you. And join us back here every Tuesday for all things uterus, in service to you, uterinekind.
Carol: Without research, without the data backed understanding of the root causes of conditions that impact those born with the uterus, we are screwed. I'm Carol Johnson and this is Hello uterus.
Today I joined Dr. Professor Marla Lujan and researcher in the division of Nutritional Sciences at Cornell University for a wide ranging discussion on P C O S during P C O S awareness month, but first uterus in the news.
Stacey Abrams clears up the nonsense around the fetal heartbeat at six weeks. It's impossible. Instead, the sound is caused by the ultrasound machine because heart chambers aren't a thing at six weeks. In fact, there's not even a heart within which to contain heart chambers. And none of it matters because people deserve to make healthcare decisions with the support of those who are, you know, actually doctors not forced to remain pregnant, not forced to carry a child in a child's body, not forced to leave your family and die in an operating table because you aren't sick enough to save.
You know, we don't dip our toe into the scalding waters of politics often here at Hello Uterus, but this election cycle is different. Arizona just passed a law that was developed in the 18 hundreds. How's that for progress? Before women had the right to vote even. Essentially when we were still owned by the man in our family, and this law, of course, is to ban abortion virtually in any situation, with the exception of the potential that the pregnant person may die like within the next six seconds, and that, that's probably your window to, to get an abortion.In Arizona, abortion and pretty much every medical decision and the right to body autonomy should have never become a political conversation, but the issue has been hijacked and turned into this fake morality issue in an attempt to secure votes. My mom was a single issue voter. Despite having eight children, she lacked the clinical understanding of the need for abortion care. She was easily conditioned to believe that abortion was murder and it's not. Abortion is healthcare, but it, it's wild for me to have witnessed a woman who is educated, had lived a, a pretty global life, had interacted with a wide range of people. She wasn't regularly tuning into general hospital. She was actually listening to news and she was reading and, you know, all these things right, while raising eight kids.And, and one would think that over, over the period of time. And she passed in at 90, about seven, eight years ago. That she would've connected the dots on abortion care and the need for it, and would've been able to make the distinction between what is a hijacked issue that was politicized and that which is proper healthcare.But she didn't, because of a very long, decades long process of conditioning people, especially super moms, right, that are in the Catholic church and that, you know, my mom went to church every morning, so there was no escaping it for. It's it. Although now I think that if she had been alive now, I feel like we could have had a productive conversation that would have resulted in her understanding that, that it is murder to allow a pregnant person to die on an operating room table because the lawyers say the doctors can't intervene because of a law that isn't based in any way on proper clinical evidence.
And because there's so much gray in the law and because it was not well thought out when it was forced down, our throats, doctors and, and the legal teams that now exist inside operating rooms, they're not gonna take any chances. Arizona's Law, which predates the State's founding , just seriously blows my mind.It includes a two to five year prison sentence for anyone who helps someone get an abortion. Nurses, doctors, anybody that's in the room. It's just crazy. Arizona, like several other Republican led states past legislation banning abortion after 15 weeks earlier this year so that it could be brought into effect after Roe v.Wade was overturned. But now in Arizona, it's unclear whether the 15 week ban or the near total ban will take precedence. Governor Arizona, Doug Ducey said it would be the 15 week ban, but his fellow Republican attorney General Markovich said it would be the older ban. Isn't that just so cute? Two dudes arguing over who can be more cruel over who can drag us back two centuries faster.Two dudes arguing over whether a mom should die on an operating table because of some religious doctrine. It is cruel. It is barbaric. It is also. Extremely evil when you factor in that. This rule is obviously, I welcome anybody on to debate with me on this. Happy to have a debate with you on it. This rule is obviously designed simply to control women and how they vote, so that a segment of the population that's currently in power can remain in power.
It's remarkable. Meanwhile, in productive news in a lab in Ithaca, New York, one woman and her talented team are using their precious time on this planet to help other humans by breaking the trail and P C O S research a short uterus in the news this week, because this interview. Crucial, and it's a little bit on the long side, but we think you're gonna love it. So after a break, we'll be right back with our expert guest, Dr. Marla Lujan.
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Carol: Dr. Marla Lujan received her Masters of science in Dr.Philosophy in physiology from Queens University Kingston, Ontario. She conducted her post-doctoral studies in obstetrics, gynecology and reproductive sciences at the University of Saskatchewan. Prior to joining the Division of Nutritional Sciences at Cornell University, the focus of her research relates to the interplay of nutrition and metabolic status with reproductive health.Thank you for being here, Dr. Lujan. We are so happy to have you on the Hello Uterus podcast classes in session. We have a professor in the house.
Dr.Lujan No pressure.
Carol: No pressure at all. No pressure. We're not, we're not gonna be graded on this. It's super great to talk to you because you are in a lab which also is named after you.Is it right? Isn't it? Like I saw online at the Lujan lab at Cornell.
Dr. Lujan: Oh really? Yeah. Call it the Lujan lab and. And it's, we call ourselves the Cornell OV Lab. If you're following us on Twitter, that's our handle. And, uh, we are also, uh, considered the Woman's Research Imaging Lab as well. So we, we've got a variety of names.I would say we're rarely called the Lujan Lab, but theoretically I am the lead, although I could tell you that, uh, my team is absolutely amazing and they take charge of the work that they do. So I'm very lucky. Yeah, to be in that.
Carol: That's terrific. So would you mind starting us off by sharing an overview of your research What are you focusing on now and what are you really excited about?
Dr. Lujan: We've come to build a program that is very translational in nature. And so what I mean by that is as we collect data, whether it's ultrasound, images of the ovary, whether it's blood samples that allow us to look at different types of hormones, whether it's data on physical activity, the diet, the types of foods, one. Are eating, uh, things that relate to an anthropometry, body composition, et cetera. What we're able to do is we're able to formulate questions that enable us to get at exactly how the ovaries work and how they confer health benefits, but also how we can leverage some of those data into tools that clinicians can use to better diagnose conditions, be it ovulatory disorders such as polycystic ovary syndrome or perhaps other conditions, uh, related to, um, abnormal ovarian function in which ultrasound images of the ovary, for example, have not yet been leveraged. And so those are sort of the, the main themes of our lab. And, uh, in terms of some of the more specific, again, we're working on tons of projects. And so, uh, if I had to. A couple that, uh, to share. We're certainly interested in how to best diagnose and identify polycystic ovary syndrome, which is a leading cause of anovulatory infertility, uh, but also a leading cause of cardio metabolic risk and disease. And so my group conducts both small scale and large scale studies to try to understand what does polycystic ovary syndrome. Look like, particularly at the ovarian level because we know that the ovary is a source of the disease, whether that be abnormal morphology, abnormal shape or size, as well as abnormal function, uh, be it different types of hormones that it produces.And so we've been working to try to understand how P C O S looks like in younger individuals versus midlife individuals versus older individuals. And. Does it change over time? And more recently, we've been starting to ask the question, is there a time during the reproductive lifespan where we can begin to identify individuals that are at risk for developing P C O S later in life? And so another exciting project that we're working on is called Ovarian Morphology in Girls, our OMG study where we're bringing in individuals during the earliest phases of reproductive life the first two years after they get their first menstrual period. And we're asking, how does the ovary change over that time? And are there any ovarian markers that might be able to identify, uh, individuals or girls that go on to have. Sustained reproductive dysfunction or differences in their metabolic status later in life. And so those are two exciting studies that are ongoing where we are leveraging the participation of adults as well as, uh, the participation of young adolescents and their families. And so those are two that I'll mention, but we've got some other excited stuff using artificial intelligence that we're also super
Carol: excited about too. Oh my gosh. It's a thrill. This, I have a feeling like the next five to 10 years, I guess it's kind of silly, you could say this in during any time period, but the next five to 10 years feel like a big wow moment in terms of using technology to further our understanding of conditions that have been tying us that technology is gonna help accelerate our understanding of these condit.
Dr. Lujan: And I think it's very much linked to data. I think there's never been a time in history where we've had so much data. And I think what's great is that as researchers we're beginning to see the power of pooling those data and working with individuals outside of our disciplines to help us use that data. And so things have definitely multidisciplinary more collaborative now than ever. And so that's super exciting. We face some challenges because oftentimes funding this type of research gets really challenging cuz you gotta bring all these individuals in, um, across the board. Studies don't take a year or two to conduct, They take decades, but our funding periods are quite limited in scope. Right? And that makes it really challenging to address questions when you only have two to five years to answer a question, right? And so, um, I think by pooling data and trying to find ways to leverage some of the existing information that we already have, may better position us to answer some of these questions.
Carol: You brought up funding and we, a couple weeks ago we had an episode on the nihs gender disparity and funding of conditions, and we were really pissed off to find out that they don't even have P C O S in their database of, I forget what's what it's called. It's like re something, but essentially the database that you search to find out what is being funded and P C O S as a condition was not in that database.
Dr. Lujan: You'd have to use a keyword search or something to find individuals like us .
Carol: I mean, that's just a little bit of, you know, lighting one's hair on fire. When you realize that it's, it's one of the most common conditions that people face and it's not like, Oh, it's just a bad period. I've interviewed people who have gone from having P C O S to having cervical cancer. This isn't just like a bad period. How do you deal with that? How do you deal with that environment and, and is it just bias and patriarchy or like, can we unwind it?
Dr. Lujan: That's, um, that's a great question. And so I've always been trained in the field of reproductive physiology, reproductive biology, reproductive medicine. And I can tell you that reproduction as a discipline is just low on the totem pole. It's often been viewed as something that you either wanna do or you don't wanna do. You know, it's, you know, funding for the privilege, et cetera. And so, from a hierarchical perspective, understanding how individuals reproduce has never, has just never garnered, um, the level of funding that it. Which is to me very shocking, right? Because , Cause I believe in evolution and I think it's a main driver. And yes, I understand that from an energetics perspective, right? When our bodies are struggling, the first thing that shut down is our ovaries, right? Or our, you know, or that portion of our brain that drives our ovaries and or our testis, right? Are going ads. I understand that. However, what I think is so fascinating and, and the hat that I've always worn, is this notion that these reproductive organs, right, and the hormones that they produce, Confer health benefits, right? Or, or or effect essentially every other physiologic system in the body, right? So that interconnection is what is so important. And so I've often said to my, my trainees, I don't really care about fertility . That's not what I study, right? I'm interested in why do individuals that report a life history, whether it be infertility or irregular menstrual periods or absent periods or dysfunctional uterine bleeding, Why do they have higher rates of cancer? Why do they have higher rates of cardiovascular disease? Why do we see stroke in these individuals? Poor bone health, depression, anxiety, altered cognitive function, right? That's, to me, one of the fascinating things about, um, about the reproductive system. And so I've always been fascinated in those, you know, about that interplay about. About those connections. And I think that's what we need to, um, ensure that the public is educated on right. And so ovaries, right, are hormones. They confer these benefits and, and having a menstrual period. Sure. That's linked to fertility and that may be very important to some individuals, but the other aspects of reproductive health and their interconnection with our other, uh, physiologic systems, that's important to all of us and to everyone.
Carol: And merits consideration and, and. Yeah, you've mentioned evolution. That is one of the things, you know, when you're lying in bed, not able to sleep at night, you start thinking about these things and it's, it is kind of crazy making, actually, it's the best way to put it, because we know that our reproductive organs are part of a system, right? They don't exist in a room. You know, isolated where you can just kind of shut the door and pull the room out of the body. , they're, they're completely integrated. And then the head goes to, Well, gee, we've been taking out the uterus and the ovaries for decades, upon decades, upon decades, without any thought to gee, how might this disrupt the communication system that exists in the body? Right? And so there's, there's all of these kinds of questions that you can, I ponder without the ability to actually do anything about it, because I'm not a researcher, so I just, you know, stay awake all night. But I understand your enthusiasm and your fascination with and passion about understanding how this communication system operates because it doesn't seem plausible that something that is so crucial.To the existence of the species is also disposable.
Dr. Lujan: Yeah, I agree with that. Right. But, but we can survive without them. So therefore it's not a critical organ survival.
Carol: Yes. But right when you take it out, and then can we survive? Because some people have increased complications or, or, uh, an increased likelihood of a variety of complications after having the uterus removed. I mean, yeah, we can survive, but there's something there, you know. Fascinating to think about it. So in that, you said something interesting. You said ovaries are hormones, they're in organ, but they are hormonally activated.
Dr. Lujan: Right? It's the source of the, the source of our, of our hormones, right? Not all of our hormones but you. But they respond to hormones that are produced by the brain and they in turn make hormones and those hormones that are produced by the ovary, in order for them to function, they have to interact with a receptor. They have to interact with those receptors on other organ systems. And essentially our body, like essentially those receptors for ovarian hormones are everywhere or everywhere in the body. And so that's why that communication, Between the ovaries, the hormones, and the other parts of the body. So
Carol: hormones are in every conversation around chronic uterine conditions, and as non-clinicians, we kind of get them, We know that they exist and we know that they're often weaponized. You know, like when someone says like, Why are you so hormonal? And, but I think we don't really understand, I guess, the relationship we need to have with our hormones, which, which will then get us into un talking about diet and exercise, which are kind of weaponized in a way. But let's start with the hormones. Like what do we need to unders. Stand about hormones to have a better relationship with them, to not feel like we have to fight against them, but that we can work with them.
Dr. Lujan: Sure. So hormones are essentially messengers, they're communicators. There are a way in which an organ can tell another organ, Act this way, or function this way. The interesting thing about hormones is that we tend to think of them as existing within a narrow and specific range. Right. And then once those hormones are low, or if they're too high, then we're in hormonal imbalance. And then inevitably right, that, uh, symptoms will arise and in, and in severe cases, disease will enue. And so our hormones again are those communicators and, and we are built to maintain our hormones and in these relatively narrow and fixed ranges. And I think what we should know is that that's okay. That's the way the system works. And, and it's been helpful because understanding those ranges have helped us to develop diagnostics to, And so when in an individual presents with different symptomology, right, you could look in the blood and try to decipher whether or not there's a system, an endocrine or a hormonal system that's out of balance. And so I think from a reproductive perspective, we're unique in that as it relates to ovarian function, our hormones fluctuate. That's really cool. And so at, in certain. Parts of the menstrual cycle. If we use that as an example, some of those hormones are low and at other times of the reproductive cycle, other hormones are high. And one of the really cool things about those distinct fluctuations is that those distinct fluctuations are what we think confer health benefits over time. And so having this dynamic changes in your hormones over time should confer health benefits. And so a good example of that would be something like estrogen and progesterone, which we know are very dynamic.They change over the menstrual cycle. They act at the level of the uterus to bring about changes in the endometrium or the lining of the uterus. And if you shed that uterine lining, to some degree, it may provide health benefits. However, not everybody responds favorably to those fluctuations in hormones.And unfortunately we don't have a grasp as to why that continuum exists and, and we don't have good baseline predictors to sort of be able. Let individuals know, you know, what, you're at risk for having these types of responses to these different, um, fluctuations.
Carol: That makes me go back to the word evolution. Do you have thoughts on the changes that are happening in our hormonal system, whether it's environmentally impacted or cuz it feels like, you know, trying to herd kittens all the way around. When you deal with, with hormones, it feels like hurting kittens because when a patient goes in and presents with symptoms and a physician says, We're gonna start you on some hormonal medications, Even that is like a trial and error experience and it, so it feels like we're constantly, you know, trying to like capture butterflies or whatever the, whatever the metaphor is. It's not like, Oh, you have this, like for instance, acid reflux. You have acid reflux and this is the medication that's going to suppress the acid or what have you, Like when it comes to hormones, it's just like, well, we'll give it a. That's sort of how it feels
Dr. Lujan: like. Yeah, and, and I think in part it's because of that, that narrow range, right? ,Like we're supposed to keep our hormones within this narrow range. And then the question becomes, and I, I think I had also said something related to understanding that narrow range is helpful because it helps to infer diagnostics. The main issue with our diagnostics, and this is true till this day, is that those diagnostics or those normative ranges are based on very limited data and often time those normative ranges, right, were developed decades ago in homogenous populations, et cetera. And then the additional layer or limitation is that it, it's one thing for there to be variation in levels of the norm, right? Norms exist on a spectrum, and so we're all individuals, we're gonna exist on that spectrum. The one thing that we don't have a good handle on and is incredibly difficult. To quantify is this notion of the sensitivity. Everybody's sensitivity to these hormones. As I mentioned, hormones need to interact with a receptor. Right? You know, what about the variability and how sensitive are these receptors or cross populations? That's a huge part of this trial and error notion that you mention, right? Because we're, we're trying to find a sweet spot for how this in specific individual may have a hormone mono imbalance and then we're trying to correct that imbalance based on norms that may not be representative to that individual in a context where we don't understand the sensitivity of that individual to, to that specific hormone, right? So while I think theoretically , it would make sense to a clinician to try to normalize, it's incredibly difficult and it is in fact trial and error. There's really no way around that. Part at this current time, to the best of my knowledge, I, I don't know how one figures that out.
Carol: So that's wild. That levels up the complication of this beyond my ability to actually parse it. I didn't even consider the fact that it's not just the hormones, it's the receptors too. And, and there could be some kind of a disruption at any point along that process. So you really are like, you're Nancy drew this thing, but you don't have a whole lot of reliable data that sort of helps you accelerate the, the solving of the mystery. It, it's like we're in this time period where, where we're using old ways of addressing, uh, condition because we don't yet have the new ways . It's in a way, I'm kind of really glad that you're pointing this out because sometimes I think we all feel bad that we feel like we're kind of ganging up on doctors. You know, we're like, diagnosis better, faster.
Dr. Lujan: It, it's difficult. It's difficult. We're we're individuals. Yeah. Right. And, and I think, you know, that's incredible. It's important. It's important for us to be individualized. And I think that's why this notion of precision medicine, personalized medicine, primarily precision medicine is so attractive. Right. Because we haven't even touched on the genetics yet. Right. You know, so we haven't even touched on the genetics and like you mentioned, environment. We all live in different environments, right? And so our exposures are going to be different, right? And so there's a long way to go, but at least we're starting to think about these things. ,And I think it's difficult to be a clinician. I I don't envy that challenge.
Carol: No, not at all. Yeah. Now we layer in the repeal of Roe and we look at conditions like P C O S and the increased chances of having a spontaneous abortion. And you know, what if that is not a complete spontaneous abortion, and now your physician is in a position where they can't do anything until you get really sick, and then maybe they can do something. I wouldn't be surprised if like, we pull back a curtain and we, you know, see this Wizard of Oz and they say, Well, I was sent here to try to make it as difficult as possible for you , you know, just on, in every possible way to make being a a gynecologist today hard. On segue into diet and exercise, cuz these are, are really polarizing difficult conversations. They have a lot of built in, you know, sore spots in them. You know, people would say across the board that these conversations are often handled, you know, really improperly and they lead to a lot of just it damaged self-esteem. And I think also maybe, you know, not feeling like you're a partner, it feels very parental, critical parental to be told that you need to lose weight. Right? And so it's like, Oh, P C O S you need to lose weight. Oh, cool. But you know what? P C O S causes weight gain, so how do we deal with that? Right?
Dr. Lujan: yeah. Just an uphill battle, right? Yeah. Mm-hmm. .
Carol: Yeah. So what, what are you discovering as far as diet is concerned? And I think what I'd like to try to get at is the. Why is diet an issue, right? Like, why can't we just eat whatever we want without, you know, eating 10,000 calories a day? Cuz we know that that calories and calories out. But why in this case is it so important? And then I think when we understand why it's so important, then it becomes easier for us to integrate these changes into our world because we can connect the why. So can give us some insight there.
Dr. Lujan: Yeah, that That's a great question. Yeah. And we've been trying to understand the impact of diet on P C O S for a long time, and we've used different approaches to understand, but one of the main challenges with the data that we've conducted to this point is that it's impossible. To get at a causal relationship bottom line. And so some of the approaches that we've taken over the years is to bring in individuals with P C O S and then bring in individuals that don't have P C O S. We match them for age, we match them for bmi, we match them for a variety of parameters, and then we, and then we ask them questions related to their dietary intake. And we use tools that we think are the most reliable because this type of research is fraught with challenges. There is no perfect tool. It's not that individuals lie so much as we forget what we eat. We forget to write things down if we're collecting things prospectively. Um, when we know people are gonna ask us what they eat, we eat in different ways, et cetera. So, Right. So we've always gotta take data, um, related to dietary intake with a grain of salt. Right. But when we. Individuals with P C O S about their food intake over a generalized period, right? Over a month or three months, et cetera. And then we contrast that with individuals that don't have P C O S. We really don't see any differences. Yes. And so that was somewhat shocking to us and colleagues of ours, um, in different parts of the world have even generated data that suggests that individuals with P C O S eat better than individuals without P C O S. And so there's different ways to look at diet. You can look at individual nutrients, you can look at different types of foods. You can score diet based on quality and whether or not dietary intake aligns with diets that we know in part, um, decreased risk for cardiovascular disease, cancer, et cetera. So we've tried all different ways of looking at diet and we don't see any major differences. And then over, and then more recently, we pool data across all of the studies that have ever looked at diet, looking at, um, over tens of thousands of individuals with P C O S. And we were able to identify subtle differences, et cetera, but not in the ways that would convince us. That individuals with P C O S are eating in diets or consuming foods that would sort of perpetuate this risk for obesity, um, overweight and obesity that we know exists. So that, that's one thing that I'd wanna mention. I think the, the other thing that should bear in mind about these types of studies is that typically we are asking individuals that already know that they have a diagnosis of P C O S. And so there's this notion of reverse causation. If I know I have a condition and everything that I've read on the internet, Interaction that I had with a clinician made me feel that I needed to eat better than the foods that they might, or the diets that they might be reporting are better than what they would've been eating at a time, let's say, when they were younger or didn't know they had a diagnosis. Right? And so having longitudinal data or early data, like in teens that go on to have P C O S later in like maybe better enable us to understand if there's any effective diet and programming of our metabolic systems that might lead to or perpetuate, uh, weight gain, um, risk of weight, regain. Over time. So these are certainly some of the challenges that we've faced and things that we've tried to better understand. And we've done the same thing related to physical activity. We don't see differences in physical activity across groups, whether or not we are asking individuals using questionnaires about their physical activity, the amount of physical activity, amount of sedentary time, the types of the intensity of their activity. We don't see any differences. And when we use devices like accelerometers, Fitbit type devices, watches, and we can quantitatively get at how much physical activity individuals are engaging in, we don't see any differences either. And so from those perspectives, it's been very difficult for us to identify where there might be differences or deficits, where we can better tailor treatments or interventions for individuals with P C O S based on these data.
That said, from a biological perspective, it makes sense that diet and exercise should be first line. Treatment, if you will, for individuals with excess weight and or cardiometabolic abnormalities in P C O S. Because we know that if individuals with P C O S or any individuals really that have these cardiometabolic defects, if they engage in these lifestyle changes, their benefits will be conferred. Right? And we've seen that across the board, irrespective of age, et cetera. One of the challenges that we face, however, is maintenance. There are very, very, or long term maintenance or long term adoption of lifestyle changes. And this is no different than what we see in other populations, right? It's really hard for. As individuals to, to make and sustain these changes over time.
Carol: Yeah, especially when you're dealing with the other complications that arise from being out of balance. Hormonally, it could be P C o S, it could be endo, whatever it is, it's, it's safe to say that at the root of those conditions, there's a hormonal imbalance. Is that accurate to say?
Dr. Lujan: Yes, certainly. And those hormones are known. Our earlier conversation, they're known to converge, right? Or there are those receptors for those abnormal hormones on systems that govern metabolism, and even the regions of our brain that regulate appetite and in the regions of our brain that regulate metabolic rate expenditure. And so we know that those interconnections exist. It's just been very difficult to provide concrete evidence that it's specific to P C O S and then quantitate just how those differences exist across populations, right? Because P C O S in itself exists as a spectrum, and that's made it very difficult to conduct this type of work.
Carol: It's not the same for each person. It's kind of an interesting perspective as you were describing the way in which our body communicates and that it's really, if I understand you correctly, it's, it's not really P C O S that's causing the weight gain that behind the P C O S. There's a disrupted system. And so you might be feeling it from an energy perspective, right? So that impacts your diet and your exercise. It impacts, you know, maybe you're eating for energy, but that's not really working and you can't exercise because you don't have the energy. And I think it's helpful. And that's just one example. I mean, it can, it, it would manifest in a wide variety of ways for people who are struggling with weight while they're dealing with these conditions. But when you remove the attachment to the condition, when you don't say you have P C O S, you need to lose weight and exercise more. When you take a step back and start talking about this, what we always refer to as an exquisite system. This system that you've said has this narrow range of optimal condition and that the idea is that we can't always live in that perfect range, but that if we are aware of the things that we can do that help us get to that range. That then can positively impact an existing condition like P C O S or perhaps get in front of it. Does that make sense? Like what I'm trying to get at is the, the psychology that's at play here, because losing weight, as you said, losing weight and exercising and incorporating it on a regular basis over a long period of time is really d.
Dr. Lujan: And it's difficult for all, and there's a lot of anecdotal evidence, and I'm sure you're familiar with this as well, is that individuals with P C O S say it's harder for them to lose weight. And from a biological perspective, one would agree with that because theoretically those mechanisms. I, If we think about the biology of P C O S and the biology of metabolism and energetics, yeah, it makes sense that it might be more difficult. However, when we look at the empirical evidence, that's where I would say that, that the data are lacking. So it's not to say that it's not the case, I'm just saying that that's where the data are lacking. And so some of the questions that we tried to address in my lab are, does that difference exist? And if so, what's the magnitude of that difference? If so, how? Like you said, how do we get in front of it? How do we empower individuals to get to a place where they can have realistic expectations? Right. Because I think what happens is you enter thinking that it's going to be hard, and then when it is hard, you think you, you have these feelings of inevitability, and we've reported this in some of the research that we've done as well, where individuals won't engage or they're more apt to, um, not adopt. Because I've got P C O S, it's inevitable, right? It's always gonna be harder for me. I'm only ever going, you know, So I think we've got to get in front of that. And I can tell you from some of the work that we do here on this campus, in which we use intensive approaches where individuals come to see us every other day or twice a week, and we put them on hypocaloric diets to look at the trajectory of change. I can tell you they have tremendous success. Women with B C O S or individuals with P C O S have tremendous success. With weight loss, especially that if that's their goal, because that doesn't necessarily have to be your goal either, right? Having these changes in body composition, it may be your main goal is, you know, improving your cardiometabolic health or improving how well you sleep at night, right? Because diet changes in diet and physical activity can propel that. Uh, but I can tell you that in our hands, using more intensive approaches where you're either interacting with research personnel or nutrition professionals, et cetera, where you can turn to someone to say, you know, this is the diet that I'm having right now and I don't feel like I'm losing weight or I don't like this diet, you know, how can I change? Right? If you've got someone there to facilitate when these barriers arrive, you can have tremendous success in a short period of time. And I think oftentimes, um, if you have that success right out of the gate, you feel motivated to continue. So I just wanted to provide that example so that you can. Get the feel for some of the other work that we do.
Carol: First of all, I wanna just like move, uh, Cornell Universities in Ithaca. And before we started recording today, we talked about how we share a history with Ithaca. Cuz I was went to school there as well, Not at Cornell. I went to the school for the not as smart people, Ithaca College. But the, I wanna go there because what I felt when you described that, the words that came into my brain in like a neon sign were self worth because the way your team interacted with those people. Typically, when a person goes into a gynecologist, and again, we're not vilifying anyone, it's the whole system is set up to be a challenge for everybody, right? So you have six minutes in front of your doctor. Your doctor's not gonna like, you know, let you rest your head on his shoulder and, and go through all this. But the message is, your body's broken. It's your fault. You need to go home and get your act together. That's how it feels. But what you described was, Hey, this is an opportunity. We're gonna look at what you're doing now and we're gonna see how we can adjust it, and we're gonna work together in this shared environment and we're gonna get you on a path to wellness. Right. And that to me is the difference between you are worthy and you are not worthy. You know? To me, I feel like a lot of it is psychological and then we still don't understand how hormones impact psychology. Right. Like, do we have any real understanding there? Because if they have. They impact everything else.
They must impact.
Dr. Lujan: They, they do. And um, and fun fact, we're starting to collaborate or currently collaborating with psychologists within the department because we're, again, our disciplines are often disconnected, right? Because we use these more invasive approaches, right? We draw blood, we do all sorts of things to our participant where, you know, we're in psychology, they don't necessarily do that, right? But I think that's where collaboration becomes really important, because like, yes, inevitably there's a connection between our hormones and our psych.
Carol: Yeah, absolutely. And so it's that fix is or not the fix. The way to look at this, I'm speaking to our listeners, is just recognize the situation that you're in and understand that it, it's environmental, right? So if you're in front of a physician who's heard 125 times that week about, you know, weight gain and, and P C O S and whatever, you're gonna get a response that's probably reflective of the frustration that they can't do anything either, you know, and, and it's like, you gotta lose the weight. I can't do it for you. You know, it's, it's just fraught with a lot of problems, but it's refreshing. I hope that you guys actually look at that program and then see if you can spin something out of it. I don't even know if that's legal, but see if you can spin something out of it, you know, even if it's. Just like a meditation or something where you talk to a person in a different way about their diet and their body and how to connect. Don't connect with the, I'm broken, I'm bad part, but connect with the, We're gonna work together, you exquisite system to try to create a more harmonious environment. I think one
Dr. Lujan: of the things that I have found frustrating. Sort of area that I work in is that we're still not clear on what are, in fact, the expectations of lifestyle intervention or, or weight loss, if you will, for for individuals with P C O S. And so I can tell you that yes, there's good evidence and, and I mentioned this earlier, that if you have P C O S and if you've got excess weight, if you reduce your weight, you'll have benefits at the level of cardiometabolic status, right? And that's no different than what we see in other disease states, um, irrespective of whether or not they're associated with hormonal imbalances. And so that's really promising and that's really important. Uh, what I find a bit more controversial is the notion that weight loss may lead to the resumption of regular ovulatory cycles and or this, um, or fertility, right? This could be incredibly damaging because if an individual comes in and is being advised that if you lose weight, your hormones, hormonal profiles do show some changes with weight loss, but it's not a complete reversal. We really haven't. Seen that. And I would say that that's why some of the research that we're doing trying to understand, is it really realistic to think that every individual or a vast majority of individuals with P C O S, if they lose X number of weight or bring their body mass down to this or their percent body fat down to that, that they're gonna have normal, regular menstrual cycles and that they can go on to have all the children that they've ever wanted because some individuals do want, um, fertility. I would say that that's not realistic and I wouldn't, and I would say that the empirical data are not there yet. It may be the case for some individuals with P C O S, but not all types of P C O S. There may be a type of P C O S that you could lose a tremendous amount of weight and still never have normal hormonal balance, if you will, or normal fertility per se. And I think that is incredibly important that individuals know.
Carol: Absolutely that. I'm so glad that you said that in the, in the way that you said it. You got to remember that there's a lot that we don't know. You mentioned a type of P C O S. There's four types of P C O S Unless that's changed. This can and will change over time because we really, it's like the wild west. We have very little data and, and it's just all, it's all a big learning environment, which is why it's so exciting except for the people who are suffering. Right. They're like, Well, exciting for you. Maybe , if you guys could hurry up, that'd be great. It's just, it's all changing and there is no, there are no black and white answers. You've made me think and I will let you go soon to get back to your world. I know I have a lot of questions for you, but I'm not gonna get to the mall today. Let's, can we talk about stress and environmental. Impact Because I wonder, you know, when you say like, diet isn't the, the be all, end all exercise is not the be all end all. We're not seeing in the data that we have that there's this dramatic reversal because of these two, you know, behavioral changes. What about stress? and environment, how do you feel that impacts a person's hormonal balance? And I, I'm assuming that we probably don't have a ton of data on it.
Dr. Lujan: Yeah, and so stress and or activation of the part of our nervous system called the sympathetic nervous system does seem to be altered in individuals with P C O S. And again, we think that hormonal imbalances, whether they're cardiometabolic or whether or not they are imbalances related to the ovary, again, seem to converge on that part of our nervous system. And so from a biological perspective, and there are some good, what we call preclinical studies and rodents, et cetera, that show that there's definitely a connection and there's also some emerging data. Acupuncture to target some of these systems that show that reduction of stress could help improve some of the symptoms and characteristics of P C O S. So there's definitely that interconnection in terms of environment that that's a loaded question. , Right? That's a loaded question. And environment can be defined in many different ways. One of the ways that I have found, one of the definitions for environment that I've been particularly fascinated by with is, is the notion of the, the prenatal environment or the gestational environment and how that ultimately can bring about a P C O S phenotype. Again, really incredible preclinical data in sheep and in monkey and in rodents that show that the prenatal environment can program a P C O S phenotype later in life. And so really, really cool stuff that we've known about for decades now. Really fascinating research that have, have helped us to understand the prenatal environment is so important, or the gestational
Carol: environment is so important. That's amazing. Um, I, I think I've heard something similar with Endo looking at it. Yeah. Whether or not it's in the preclinical. What was the term?
Dr. Lujan: So preclinical just means that the studies are conducted in either animal models or cell models, et cetera, but studies particularly during gestation, right? And so in in pregnant, in pregnant type animal models, you can see a programming of metabolic disease and A P C O S phenotype or programming of reproductive dysfunction. That can start as early as in. Wow. Right? And I, that, that's fascinating. That, that's really cool. Right? Yeah. And then that kinda helps to shift the blame a little bit too, right? For individuals that are absolutely, like, I did this to myself or whatever. And I'm not saying your parents did it to you. What I'm saying is we are, we've all been programmed in some capacity during, during a utero life.And so, you know, this is just part of the carts that were dealt, right? So now how do we manage, right? What do we do our best, Right. With the carts that we've been dealt. Yeah.
Carol: And I, I also, because I don't have a lab, I have no data on this, but I'm gonna state it as if I do, um, I, I feel like , like I researchers nightmare.I feel like, you know, just having. That actually I do have data cuz I personally had to go through this process and I think a lot of people do have to go through this process. Just having a more loving relationship with your body helps kind of relax it. And I've talked before about how, for the longest time I lived, only from my head up. I really did not actually connect with my body because there was a lot of body issues there. And you know, like I remember one time going to my doctor, my, we didn't have gynecologists as early as I think we should all have them. So I was still going to my, you know, it was my pediatrician who then became my primary care doctor and, you know, it was just a disaster of a situation. And I remember him feeling my breast tissue and saying, you know, if you lose weight, your breasts will be more firm. And he was commenting on how my breasts, you know, weren't firm. And I think I was probably like 13. And, and so obviously the fact that I can even remember that, Right. If you could see, if you could see her face right now, you would, you would, you probably are all making the same faces because it's gross. Right. Good. Come on. Breast tissue's, fatty tissue. Give me a break. They're not, you know, like, what, what are you talking about? You know, that, that the way that we're objectified or the way that we objectify ourselves or what, whatever the reasoning, I feel like if we can have a more loving relationship with our bodies in the state that they're in, and recognize sort of the unique nature of having this living electrical kind of being that we don't fully understand, you know, with eyeballs and a brain and stuff.I mean, it's crazy. Mm-hmm. , it's amazing. Right. And that we are not the cause of these conditions that we are still, we're still trying to understand. It's kind of like getting a car for the first time, but, But you had never seen a car before. Right? And you press the gas and the thing goes really fast and you're like, Wow, I didn't know that was gonna, I didn't know it was capable of that.Right. I didn't know that was possible by spending time. With our bodies and understanding how little changes can, can make a huge benefit. It's like, okay, now I'm in partnership with my body. I'm not fighting it. And I feel like that in and of itself is helpful.
Dr. Lujan: Oh, I agree. My non-scientific, No, I agree.
You know, I think one of the things that I've loved about the research that I do and and and its clinical nature are, is this opportunity to interact and hear everyone's stories. And, and like you said, it is data, right? It is data. We're not qualitative scientists, but we have collaborated with qualitative scientists over the years to, to get at some of these, um, perceptions, right? The, the way folks feel about whether it's their interactions with their healthcare providers or their social support, be that at home versus I in a healthcare setting, right? Because we're all individuals, right? We, we represent our social networks and, and how can we support our each other in a way that helps facilitate success? Cuz we only wanna be successful, but we, we've gotta step away from, from blaming ourselves for, for these disease.
Carol: Yep. And don't let anybody do that blaming for you either. Just, uh, definitely speak out. So the, the last question that I have for you is kind of like a little theory game. I don't know scientists will ever play the theory game because , I'm trying to hear it.I know. Well, just, it's really simple, but I just, I feel like that's always where I can sort of sense people saying like, Well, wait, I'm only supposed to talk about things. I have data to back up, you know, . But, but I really wanna know, like my most pressing questions are things around like how you think when you don't have to actually back up your statements with data.And so I'd like you to finish this statement. I wouldn't be surprised to find out that P C O S isYou're not gonna do it, are you ?
Dr. Lujan: Yeah. If you could see me now I'm literally scratching my head. Okay. Oh,
Carol: I know. Like she's, You can tell that her, that that sympathetic nervous system just got activated and it's like, Oh.
Dr. Lujan: Oh that's good question. You should sent me this one ahead of time so I could have thought about it.Right. And I taking a poll with myself. Okay. So I wouldn't be surprised if P C O S wasn't a, Oh this is a hard one. So glad this is gonna be edited cuz you guys can cut out this,
Carol: leaving this part in. We want you to know that even people with PhDs sometimes have to think about things.
Dr. Lujan: Yeah, we've gotta think about things.
Okay, I'm gonna go with, Okay. I wouldn't be surprised if P C O S isn't as broad of a spectrum as currently thought. Oh. So what I mean by that, and I know and, and I know you said not to think about my data, but okay. But, so I'm not thinking about the data that I've analyzed or quantified or whatever. And I wouldn't say that I'm the first person or the only person that thinks this either. But I think over time, working in this field, one of the things that I've been really frustrated by, but have come to accept and integrated my research, I'm a glass half full kind of person, is this huge spectrum that exists. Now, when we think about P C O S, you mentioned something about there being four phenotypes and yeah, technically there's these four phenotypes, but if you think about the criteria, there's probably about 12 different subtypes of P C O S and I, I have often not have been convinced that all of that is P C O S And I think from a biological perspective, I think there's, there's different mechanisms at play and I think that one of the adverse consequences of labeling everybody with P C O S is this confusion that we've alluded to, right? When we go and we do our research and we're asked to silo individuals, you know, into different, in, into having P C O S or not having P C O S, but the P C O S population has, you know, four to 12 different varie.In it and it's really hard to tease out, right, what's effective and what's not effective when we might not be studying the same condition. And, and I think that really slows our progress down. And if I was to use an example of this, I think in my work where we work with individuals with overweight and obesity and we try to understand what are in fact the benefits of weight loss in individuals, how quickly does it happen?What body compartments are actually changing with weight loss? Does this type of diet work? Is reproductive potential or fertility potential actually improving? Right? I can tell you that inevitably there will be responders in non-responders, right? And so does that mean that they're different conditions here, right at play and the biological mechanisms are different.And so individuals with obesity that. Tagged as having P C O S. They may just be seeing reproductive consequences of the obesity per se, and it could be readily reversible if they adopt lifestyle practices or psychological or behavioral practices, or they have the appropriate social support that helps them to facilitate weight loss or those metabolic changes, et cetera.Where like I mentioned earlier, there may be other individuals that lose much more wage, right? Or, or, or their metabolic system changes, you know, in magnitudes more than this other individuals, but they see, they don't see the same level of benefit maybe. I think that's P C O S, maybe. I think it's the severe one where maybe the endocrine abnormalities are so entrenched.Or maybe these were the ones that have a really strong genetic underpinning where maybe the other one. Maybe more environmental in nature. And I think in having labeled everyone, we've made it very difficult to tease out the actual biological mechanisms that play in what, in fact is efficacious or effective in our various patient populations.So I'm, I'm gonna go with that.
Carol: think you, without having any advanced notice of that question, I think you nailed it. That is really remarkable to just sit and ponder what the drawbacks are when the foundation that you're looking at is cracked. So if, if you're looking at, if you're calling all of it, P C O S, But some of it is in P C O S, then you're operating from a false premise.Is that the scientific way to say it? You know, that you're, Yeah.
Dr. Lujan: Like I, I, as I mentioned, I, I've come to embrace this larger definition only because it enables me to dissect out and code everybody in different ways and then sub stratify my data, look for confounding effects of phenotype or whatever. So, so we're we and other labs.My group is not the only group, but we are, we're using this as an opportunity to tease out what's P C O S and what's not P C O S. But at the level of practice, the argument is, the benefit of casting the net wide gives you the potential to intervene at earlier or less severe stages. That's the premise.But then how do we, I. , what are the tools? What's gonna work, What's not going work when we don't have, when, when it's a catch 22. Mm-hmm. , when you, when you don't ha how do you define the disease condition we're in to test your intervention. Right. To test your hypothesis. So it it's a catch 22. Yeah.
Carol: Yeah. And then, then that gets back to, you know, like medicating a hormonal affected condition with, with hormonal birth control pills and trial and error and herding kittens and butterflies.And, and it's, and we need like four more shows with you, but we need you also in the lab. So , we're not gonna co-op your entire existence. I'm just so grateful to have this time to speak with you. This has been really like, I have a dozen thoughts that I wanna go spend time just thinking about. And I'm so glad that we have the opportunity to have time with you and with other researchers because this is the stuff to me that makes our consultations with physicians.Um, more productive, even if we don't fully understand everything that you are studying or the conclusions that you're coming to, or, or we can't, you know, directly benefit from them because research takes years. Just having the knowledge and knowing that somebody is out there studying this stuff, it's not, you know, we're not flying in the wind is really amazing.So we're just grateful that you spent the time today to share this knowledge with us. Thank you.
Dr. Lujan: Yeah, you're welcome. I really enjoyed my time with you as well,
Carol: Carol. Excellent. We will be right back after this short break with ending on a high note.
Ending on a high note, we're about to get buzzed. I just, it's a terrible pun, but you'll understand when I tell you about the cool stuff going down in a meadow in Austria. So in Austria, there's this guy, his name is Yore, and he's a hobby beekeeper. He lives on his little plot of land and he's building his bee boxes and he's keeping his bees buzzing. You get the punt now. It's terrible, right? I told you it was terrible. And he's, you know, working his, his hardest to be able to grow a really significant bee population because it, it's one of the things that we have to do in order to be able to feed ourselves, . We don't have to make up a lot of crises on the planet because we already have some. So I love this ending on a high note because this is how we work together to solve a crisis. So Yoof is there raising his bees, doing his thing. And his neighbor decides that he wants to do something to help. He wants to help Yoof, but he also wants to help the planet. So he goes and turns one fifth of his land into a meadow for cre. Andre's bees and plants, 40 different blooming species that make up a perfect environment for the bees. Andre is blown away. The person who did this, his name is Franz Nigel, and Fran is, This isn't gonna be a surprise because it's already been published, but Franz is going to go one step further and he's going to expand this to make even more of his land be friendly.And so here you've got this situation where one guy is like, You know what? I think I wanna take up beekeeping and see how I can do on that. And then his neighbors inspired by that and it's like, Wow, I think I wanna do something cool too. I'm gonna turn my meadow into a wildflower meadow so I can make. The bees really happy. And then we'll share flowers and honey and have happy growing bees. I mean, this is how we can go from doing little things on a small scale to figuring out easy ways to create change on a massive scale. Like you know how it was a big deal to pay for the person behind you in the line at Starbucks when we all used to go to Starbucks for coffee? And I don't think anybody does that anymore. Well, maybe what we could do is call it like writing the planet and we do something great for the neighbor to our right that is also great for the planet, whatever that might be. Just something good. And I just love this little story and I wanna go meet these guys because it's, they sound like really awesome people. At a minimum. Let's see if we can get some pictures of this meadow, because that would be pretty spectacular. So congratulations. Yoof and Fran beekeeper and gardener extraordinaire, doing good things for the planet. Love it. And thank you to our guests today, Dr. Marla Lujan. Just amazing. I say it every time I interview someone. I have a million more questions. I have a million more questions. I'm really, really grateful to know that even though we, we understand the, the battle that we're up against in these times with the repeal of ROE and the legislating of the uterus and the disparity and gender funding and the just overall lack of, of care for, you know, half the population of the United States are government saying that we are. Not full citizens that we don't have the right to, uh, to be full citizens. You know, even with all of that going on, there's incredible stuff happening and I guess that that's sort of how it goes down, right? It's like a tipping point or a swing of a pendulum. They always say it's darkest before the dawn gets worse, before it gets better.Well, I hope that what we're doing here at Hello Uterus is bringing you the silver lining that's happening in research labs all across the country. as underfunded at the as they are, they're still doing it, and we're gonna help increase their funding and shine a light on the research that's going on and hopefully really create a lot of momentum behind the need for increased research, increased funding, and honestly just increased freaking respect. For the uterus, the ovaries, the cervix, the vagina, the, the hormone systems, the everything. Just respect our bodies. Respect the fact that we, we have just as much right to be here as anybody else. And you know, kudos to those people who chose to go into a business, whether it's research funding or it's being a gynecologist or a therapist or what have you, but to help uterine kind stay on a path of wellness.We're really grateful and, uh, we're gonna show our gratitude in that by making sure that, that people understand what all you guys are doing out there in the world and that we help do our best to, to drive funding dollars in your direction. So thank you. Thank you to Angel and Marielle for producing the podcast.And thank you to the team back at Uterine Kind. We are so grateful for your hours and hours and hours of work that you're putting out in order to build our app, and we will be back next week. We have an incredible interview with Dr. Marla, who is a minimally invasive gynecologic surgeon, and we're gonna get into surgical treatment of conditions that have historically just been medicated into into. And, uh, hear from, uh, Doctor fairly early on in her career who is speaking up and making change happen to benefit us. So we're really excited for that interview. So we will be back next week and until then, stay well.
Angel: The Hello Uterus Podcast is For Informational Use Only The content shared here is to not be used to diagnose or treat any medical condition. Please speak with a physician about your health condition and call 911 if it's an emergency. And thank you, Uterine kind for listening.