What Is PCOS?
PCOS is the intersection where hormonal, metabolic and gut health meet. Essentially, PCOS is a hormonal condition that is characterized by dysregulated menstrual cycles, infertility, and insulin resistance. Its impact reaches beyond sex hormone regulation and includes a wide range of impacts to our metabolic and hormonal health. Symptoms include hyperandrogenism, which means an overabundance of androgens like testosterone. This results in physical symptoms like unwanted facial hair growth, male pattern hair loss, and acne. Other symptoms include irregular, missing and/or painful periods, gut dysbiosis, and increased likelihood to also be affected by Metabolic syndrome and Type 2 Diabetes.
While pcos is characterized by imbalance hormones, irregular periods, gut dysbiosis and poor metabolic health, the two primary drivers of the hormonal and metabolic dysregulation that cause and progress the symptoms are thought to be insulin resistance and low omega 3 to omega 6 ratio. We’ll go over this in more detail shortly.
How can we help our body heal?
Hormones rule over the systems most affected by PCOS, so the best way to help our body heal is to support our hormonal health. Polyunsaturated fats like olive oil, flax oil, walnut oil and other omega 3 fats like wild salmon, avocado, pumpkin seeds, and hemp hearts can help lower testosterone levels in women. The body also uses these fats to support health cholesterol levels, which is important because the body uses cholesterol to make all of our hormones.
We can balance our hormones by:
Good rules of thumb to help hit these benchmarks are to aim for 8 hours of sleep with a bedtime around 10pm (or earlier), take regular walks, stretch often, and incorporate some moderate aerobic exercise and strength training 2-4x/wk. It would also be beneficial to always buy organic, wild, pasture raise and hormone free animal products as well as organic produce. You can follow the Environmental Working Group’s (EWG) Clean 15 & Dirty Dozen – recommendations on the cleanest fruits and veggies and the top 12 produce items that need to be purchased organic. Artificial scents are known to be endocrine disruptors as are chemicals like BPA, phthalates, PFAs, and other toxins. The EWG, www.ewg.org, has valuable information on how you can avoid endocrine disrupting chemicals. You can also find helpful resources at www.endocrine.org or reach out to us for more information.
Diving in a little deeper to nutrition, there are several factors we can address to help support recovery from PCOS.
Starting here is important because if we have gut inflammation, leaky gut, or dysbiosis, we will not be able to reap the benefits of an improved diet or excellent supplement regime.
Because cortisol is so closely linked to inflammation, digestion and general gut health, good nutrition and stress management practices are vital to lower inflammation and restore gut health. Embodied movement like dance, tai chi, martial arts, and yoga, as well as regular play (physical play or creative idea play) are the best ways to lower stress and improve overall well being in my opinion. Any restorative practice is also excellent, such as hiking, sitting on a beach, getting a massage, having a great conversation with a friend over coffee, a sincere deep belly laugh, a moment of awe and appreciation.
Foods that help to lower inflammation are dark leafy greens; cilantro, parsley, celery, ginger, garlic, deeply colored berries and other plants like beets and bell peppers; fiber rich plant foods like lentils, broccoli, onion, asparagus, leeks, cabbage, artichoke, beans, oats, sweet potatoes; and omega 3 rich foods. Which leads us so nicely towards our next point…
The literature clearly shows a strong relationship between omega 3 intake and PCOS risk. Omega 3 fatty acids are a driving factor in our hormonal and metabolic health which understandably makes them key to resolving PCOS.
Do your best to incorporate at least 1-2 servings a day of the following foods to support omega 3 levels: wild salmon, sardines, herring, anchovy, mackerel, olives/olive oil, walnuts/walnut oil, flax seeds/flax oil, avocado/avocado oil, pumpkin seeds, hemp hearts, 100% grass fed beef and bison.
Eating more vegetables and less grains and processed foods will support omega 3 levels by lowering omega 6s in the diet. Omega 6 fatty acids are abundant in vegetable oils and some nuts and seeds. Cook with the oils listed above and do your best to eliminate or avoid industrial seed oils, which promote inflammatory responses in the body. Many processed foods also contain endocrine disrupting compounds.
First, what is insulin resistance and why does insulin matter so much in my reproductive health you might be asking?
Insulin resistance is when your cells aren’t easily able to take in glucose from the blood so they stop responding to insulin. We could think of it sort of like the cells stop answering the door when insulin knocks. Over time this causes a build up of glucose in the blood which raises our risk of diabetes, heart disease, stroke, obesity, cancer and more.
Eating too much sugar, eating too much food and or eating too often can all contribute to insulin resistance. Blood glucose also rises when we are stressed, so chronically high cortisol levels can lead to insulin resistance as well.
The ovaries are actually quite sensitive to insulin hormone which makes sense if you think about it because insulin levels are essentially a direct result of how well we’re eating and our levels of actual and perceived stress. If we are not eating well and are under extreme stress, our ovaries get the message it is not an ideal time to get pregnant and respond accordingly. This is a factor in how changes in stress can result in early, late or missed periods. In addition, Cortisol and DHEA balance is essential for healthy ovulation.
We can prevent insulin resistance by eating a balanced diet, managing stress and getting appropriate exercise. Try to fill half your plate with veggies and ¼ of your plate with protein and healthy fats every time you eat. If you would benefit from weight loss, adopting the following habits will greatly support your efforts. Limit processed foods, limit or avoid added sugars, try not to eat after 8pm if possible, get adequate sleep, start your day with a high protein meal, engage in a breathwork or walking practice, and try to sweat regularly.
It can be really easy to get overwhelmed by the multitude of nutrients, supplements and lifestyle modifications involved in resolving PCOS symptoms. However, the beautiful thing about the body is that making one change will create a cascade of positive changes. If we can increase omega 3 rich foods in our diet and eat 1-2 pounds of vegetables a day we will naturally raise vitamin D levels and balance our omega 3:6 ratio and blood glucose levels. By eating a variety of plants each day we will also naturally help to increase good gut bacteria, balance gut flora, and get the benefits of fiber, inositol, folate, vitamin E, and the other necessary nutrients needed to support our hormonal health.
Some supplements that are beneficial for women with PCOS are:
L-Methyl-folate may be very beneficial as recent research has shown that methylation issues may be associated with PCOS etiology. mFolate, in concert with myo-inositol can help to regulate insulin activity as it increases peripheral insulin sensitivity.
The inositols are found in fruits and beans and have the same molecular formula as glucose. Myo-inositol is what we call an insulin-sensitizing agent as it helps to make the cells more responsive to insulin. It also is used as a messenger for many hormones including insulin and follicle-stimulating hormone (FSH).
FSH impacts ovulation and there is a relationship between a women’s LH:FSH ratio and risk of PCOS. A healthy FSH:LH ratio is between 1-2. As FSH:LH ratio rises (as high as 2 or 3), ovulation stops.
Peony helps to regulate and optimize ovarian function and ovulation. Licorice can help mitigate the effects of stress and help to modulate adrenal hormones. This supplement can be very helpful in returning consistency to the menstrual cycle.
Each patient is an individual and may need only part of this complex regimen for healing. The best plan is to find a provider who will test your vitamin and hormone levels.
* Vitanica OvaBlend
Chromium and NAC (N-Acetyl-L-Cysteine) promote healthy glucose tolerance levels and insulin response
Cinnamon supports regular menses and a healthy metabolic response
Nettles root and Green tea; flax meal may also be supportive
Saw palmetto promotes healthy testosterone levels
Sarsaparilla promotes a progesterone-like effect
* Fem Balance by Premier Research labs:
Organic Chaste Tree (Fruit) 600 mg / *
Ultra Fem Support Blend™ 116 mg / *Organic Alfalfa (herb) (Medicago sativa)‚ Organic Chinese Salvia (root) (Salvia miltiorrhiza)‚ Aquamin® F Mineralized Red Algae (whole) (Lithothamnion sp.)‚ Milk Thistle (seed) Extract (Silybum marianum)‚ Organic Turmeric (rhizome) (Curcuma longa).
If you are struggling with PCOS and would like more information or would like to work with us, please don’t hesitate to reach out. You can contact us here on our website or email firstname.lastname@example.org.
All the best,
Kate Godly, MS, PA-C