I don't think we need to be looking for PCOS just because a mother 
presents with inability to produce a full supply. Insulin resistance in 
all of its forms (including Syndrome X--Metabolic Syndrome) are so 
common today that they alone account for many of the cases of 
insufficient supply that I see.

  This is even more complex when you consider leptin resistance, thyroid 
function (especially as it relates to iodine deficiency) and the 
relationship between the hypothalamus and the immune system and state 
control in the body--which then affects cortisol and in turn and in 
reciprocity, insulin.

  Much as I think we are seeing survival and reproduction among women 
who would not have been able to do so in the past, I think the issues 
above are more significant. Now that we are making such a strong case 
for exclusive bf'ing, we have so many women who cannot do so. What I 
think is worse is that we would have to acknowledge that this is in 
large part a reality of the choices we make in our lives (diet, 
exercise, stress, etc), not only environmental issues genetics or 
choices our parents made. Our DNA is in constant relationship with our 
environment and is in no way fixed. We in the US at least do not like 
to be responsible for our own outcomes nor do we as a culture like to 
make health choices that are not easy. In the bigger scheme of things, 
many of these syndromes are about our ecology as human beings--how we 
live with the world around us.

  I am currently having conversations with several other practitioners 
on this topic and I am always working with my clients with these issues 
in mind.
 Jennifer Tow, IBCLC, CT, USA


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