This is a guest blog written by registered dietician, Kaely McDougall
Disclaimer: the information in this article is for educational purposes only and is not designed to replace individualized recommendations from a practitioner. Always check with your doctor before adding supplements or making changes to your treatment plan.
Prior to going into private practice, I helped start a nutrition program for a large OBGYN practice based in Long Beach, California. I had the pleasure of working with women from the ages of 15-70 on a wide array of women’s health issues but one that came up with more and more frequency was the issue of PCOS. The diagnosis of PCOS has repercussions across the lifespan – for a teen it may mean things like acne, hair loss, weight gain (and very difficult time losing weight) and irregular periods, and later in life it can mean difficulty with conception, infertility and increased likelihood of type 2 diabetes. Even though this condition is increasingly common, there is a lot of misinformation and confusion out there leaving women feeling trapped with their diagnosis and feeling reliant on a lifetime of birth control pills and other medications.
The goal of this post is for you to understand what PCOS is, what might be causing it and how to apply the latest research of real food as medicine, lifestyle and supplement options. YOU are in control of your health, not just along for the ride.
According to the DHHS, PCOS affects 1 in 10 women of childbearing age and is one of the most common causes of infertility.
WHAT IS PCOS?
PCOS stands for polycystic ovarian syndrome. So if you have cysts on your ovaries (as identified by an ultrasound) you have PCOS, right? Actually, no. PCOS is not a physical, ovarian condition of the presence of cysts but rather it is a HORMONAL condition. There are a few different “varieties” but the end result is irregular or absent periods, high androgen levels (testosterone and DHEA) and typically insulin resistance. The name is a little confusing and leads to many false positive and false negative diagnoses.
- Irregular or absent periods
- Hirsutism (hair growth on face)
- Loss of scalp hair
- Weight gain and/or difficulty losing weight
- Elevated androgens
- Signs of insulin resistance: elevated fasting insulin levels, fatigue after meals, carb cravings, increased waist circumference
The conventional treatment for PCOS typically involves birth control pills, metformin, or a combination of the two.
Birth control pills are prescribed to “regulate” irregular cycles but if you’ve been on this blog before, you already know that hormonal BCPs actually shut down ovarian function. This is arguably making the issue of PCOS worse even if it masks external symptoms.
Metformin is a drug typically given to Type 2 Diabetics that addresses the insulin resistance side of PCOS. It is a biguinide, meaning it works by reducing the amount of sugar in the bloodstream by decreasing liver output and increasing muscle insulin sensitivity. Metformin has documented benefits for the PCOS population; however, as with all prescription drugs it does not come without side effects and repercussions for your body. Fortunately there have been a handful of studies comparing Metformin alongside more natural alternatives that indicate some of these holistic approaches may be more effective. I’ll get into those below.
WHAT CAUSES PCOS?:
So if PCOS isn’t an ovarian condition, what exactly is going on? Essentially:
Blood sugar issues + inflammation + genetic susceptibility = ovaries begin to produce large amounts of androgens
Blood sugar issues are a key part of PCOS. When blood sugar levels rise from the digestion of carbs our pancreas releases a hormone called insulin who’s job is to grab the glucose and let it into our cells to be used for fuel or stored for later. If this system gets overworked due to an overabundance of simple carbs in the diet, a deficiency of micronutrients needed to produce effective insulin or a sedentary lifestyle it can begin to break down. When this happens, insulin isn’t able to let glucose into cells as easily anymore and so it stays in the blood. This is called insulin resistance – our body quite literally becomes resistant to the action of insulin, leaving both insulin and glucose in the blood where it does not belong. We could talk all day about the problems with insulin resistance but for the purposes of this post just know that elevated insulin levels communicates directly with the ovaries and causes the overproduction of androgens or male sex hormones. It is the excess of androgens that produces the symptoms of irregular cycles, hirsutism, hair loss and acne.
Inflammation is the next common issue in PCOS. This can occur as a result of insulin resistance, damaged gut health or poor dietary choices. Inflammation on its own can decrease the body’s sensitivity to insulin, perpetuating insulin resistance. It is also taxing to the immune and adrenal systems which can raise cortisol levels and further elevate androgens. If the gut is not healthy, we also lose out on the ability to detoxify toxic compounds as well as hormones that we don’t need.
As you can see, the onset of PCOS has nothing to do with your ovaries but everything to do with blood sugar regulation, inflammation and stress on the body. The genetic component comes into play in how your ovaries respond to insulin resistance/inflammation/stress. Obviously not everyone with insulin resistance or diabetes automatically gets PCOS and the same can be said for individuals with inflammation. Some of us just have more “sensitive” ovaries that respond to the impaired hormonal environment by cranking out excess androgens.
FUNCTIONAL NUTRITION APPROACH TO PCOS:
- Real food strategies –
- The first step is to improve the quality of your food choices. Remove inflammatory oils, added sugars, processed carbohydrates and chemical/artificial additives and replace them with whole, real food.
- Reduce the consumption of simple, high-fructose carbohydrates and take inventory of your total carbohydrate load throughout the day. The goal is to eat sufficient carbohydrate to promote ovulation while focusing on whole, real-food sources like starchy veggies (potatoes, beets, squash, corn), whole fruit (keeping to 1-3 whole pieces per day) and unprocessed whole-grains and legumes if tolerated (like rice, oats, beans and lentils).
- If insulin resistance and weight gain is significant, consider the use of a therapeutic VLCD (very low carb diet) approach and possible intermittent fasting (12-16 hrs) to restore insulin sensitivity. This can be used initially but should not require a lifetime of eating this way. I highly recommend working with a practitioner on this to ensure safe execution and carb reintroduction plan.
- Maintain adequate calorie intake (even a mild calorie deficit is a stress on the body) and aim for balance across the macronutrients: protein, healthy fats, carbs.
- Focus on gut-nourishing foods like bone broth, probiotics from fermented foods and cultured products and prebiotics from fiber-rich plant foods.
- Lifestyle –
- Exercise is a crucial tool in repairing insulin sensitivity and managing blood sugar levels. Focus first on increasing daily movement (try tracking your steps). Next, consider adding in resistance training and short, HIIT style workouts as these show the most metabolic improvements. In general, avoid long duration cardio on a regular basis as this can be stressful on the body.
- Stress management is a KEY piece of hormonal balance since adrenal health has the ability to impact the function of your sex hormones. Evaluate your sources of stress, reduce what you can and build in stress-relieving activities daily. A few solid options include meditation, journaling, massage, acupuncture and gentle exercise.
- Sleep! Even one night of insufficient sleep will impair insulin sensitivity. Aim for 7-9 hours every. single. night.
- Targeted supplementation (see FullScript below for high quality brands)
- vitamin D – plays an essential role in hormone and immune health
- fish oil – these omega 3 fatty acids help to reduce inflammation and provide raw materials for building hormones
- B vitamins – in particular B6 plays a large role in hormone balance and preventing common PMS symptoms
- berberine – great for improving insulin sensitivity and healing the gut
- myo-inositol and d-chiro-inositol – helps to improve insulin sensitivity, reduce androgens and promote ovulation
- curcumin – the potent anti-inflammatory compound in turmeric
- adaptogens like Ashwaghanda help your adrenal glands respond more effectively to stress and can help calm a taxed HPA axis
- herbs – Vitex (or Chasteberry), Peony and Licorice can all be helpful in PCOS but it is recommended you work with a practitioner to determine what is the right fit in your specific case based on your lab work.
- Lab Testing – this is an important part of determining what treatment options will work best for your body
- To request from your doctor:
- blood sugar regulation: fasting glucose, fasting insulin, hemoglobin A1c, triglycerides
- hormones: testosterone, DHEA-S, LH, FSH, estrogen, progesterone (day ~21 ideally)
- inflammation: c-reactive protein
- nutrients: vitamin D, RBC magnesium, iron, ferritin, B12, zinc
- Speciality labs:
- DUTCH test for a VERY in-depth look at hormone production/metabolism/detoxification, cortisol production and rhythm throughout the day, oxidative stress and key organic acids to assess nutrient and neurotransmitters
- CardioMetabolic Test for an advanced assessment of blood sugar control, cardiovascular disease risk, inflammation and omega 3/6 fatty acid balance
- Micronutrient Test to check on the functional levels of 34 vitamins, minerals and antioxidants
- MRT testing to assess for food and chemical based sources of inflammation
- for more info on any of this testing, click here.
- To request from your doctor:
Whew! That should about do it. Hopefully you now understand what PCOS is/is not and have a few ideas about what you can do to overcome it. As always, please feel free to comment below or send me emails with questions.
González, F. (2012). Inflammation in Polycystic Ovary Syndrome: Underpinning of insulin resistance and ovarian dysfunction. Steroids,77(4), 300-305.
Laganà, A. S., Rossetti, P., Sapia, F., Chiofalo, B., Buscema, M., Valenti, G., . . . Vitale, S. G. (2017). Evidence-Based and Patient-Oriented Inositol Treatment in Polycystic Ovary Syndrome: Changing the Perspective of the Disease. International Journal of Endocrinology and Metabolism,15(1).
Pal, L., Zhang, H., Williams, J., Santoro, N. F., Diamond, M. P., Schlaff, W. D., . . . Legro, R. S. (2016). Vitamin D Status Relates to Reproductive Outcome in Women With Polycystic Ovary Syndrome: Secondary Analysis of a Multicenter Randomized Controlled Trial. The Journal of Clinical Endocrinology & Metabolism,101(8), 3027-3035.
Saleem, F., & Rizvi, S. W. (2017). New Therapeutic Approaches in Obesity and Metabolic Syndrome Associated with Polycystic Ovary Syndrome. Cureus.
Unfer, V., Facchinetti, F., Orrù, B., Giordani, B., & Nestler, J. (2017). Myo-inositol effects in women with PCOS: A meta-analysis of randomized controlled trials. Endocrine Connections,6(8), 647-658.
Wei, W., Zhao, H., Wang, A., Sui, M., Liang, K., Deng, H., . . . Guan, Y. (2011). A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome. European Journal of Endocrinology,166(1), 99-105.