PCOS stands for Polycystic Ovary Syndrome, which is both a metabolic and hormonal disorder that impacts up to 20% women of reproductive age and is currently one of the top causes of infertility in the US. 

In this newsletter we will cover:

• Signs & symptoms of PCOS
• The pathophysiology & Root Causes of behind PCOS
• How PCOS is diagnosed
• Initial evidenced-based diet & lifestyle strategies for PCOS

Signs and symptoms of PCOS

classic signs & symptoms associated with PCOS include:

• acne/oily skin
• long/irregular/ missing periods
• excess hair growth on chin, chest, or back (known as hirsutism)
• hair thinning or loss on head
• infertility

BUT What the heck is PCOS?

Researchers have not identified one thing that causes PCOS- rather its a combination of genetic, hormonal, and environmental factors that all lead to the development of PCOS. 

PCOS is a chronic condition- meaning that it can never be fully “cured”. However, it can absolutely be managed and put into “remission” (aka your labs and symptoms reflect normalization in hormones & ovulation) via diet and lifestyle strategies.

In the beginning of a normal healthy cycle many follicles are stimulated but the body only recruits one follicle, which contains the egg, to fully mature and ovulate (aka release its egg).

In PCOS what is occurring is that due to high androgens and LH there is a dysfunction in follicle recruitment which leads to issues with ovulation (thus, why PCOS is an “ovulatory” disorder). These follicles are recruited egg sacs, known as cysts. Due to the issues with follicle recruitment and lack of ovulation, this ultimately leads to many stimulated follicles which appear on ultrasounds as a “string of pearls” on the ovaries. This is where the name “PolyCYSTIC ovaries” comes from. 

Now that we understand what PCOS is …we need to chat about WHAT IS DRIVING IT!!!

This is my beef with conventional medicine- all the do is diagnose PCOS and then send you on your way with a script for brith control. This does NOTHING to address WHY you have PCOS in the first place.

And this is why with most women their PCOS diagnosis leads to more QUESTIONS than answers.

We need to investigate what is driving androgens to be elevatated and what is driving the ovulatory dysfunction.

Research has established that things that can drive PCOS include:

1. Insulin Resistance / Elevated glucose and/or Insulin

Hyperinsulinemia (which can be caused by insulin resistance/ poor diet) can exacerbate PCOS by stimulating the ovaries to produce more androgens and by reducing the liver’s production of sex hormone-binding globulin (SHBG), which normally binds to androgens and reduces their activity.

You may have insulin resistance if you have any of these signs or labs:

• Headaches
• Weight gain/weight loss resistance
• Irregular or missing periods
• Skin tags
• Patches of dark velvety skin called acanthosis nigricans
• Hair loss
• Chronic acne
• Sugar craving
• Afternoon 24pm crashed
• Chronic fatigue

Labs that suggest insulin resistance/glucose dysregulation:

• Fasting insulin > 6
• Fasting glucose > 88
• Hemoglobin A1C > 5.5
• Triglycerides > 90

1. Inflammation / Gut Dysbiosis / Infection

Systemic Inflammation: 

Women with PCOS often exhibit markers of chronic low-grade systemic inflammation. Elevated levels of inflammatory cytokines (such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP)) are commonly found in the bloodstream of women with PCOS.

A vicious cycle exists between inflammation & elevated adrogens. 

Inflammation can directly impact the ovarian theca cells by increasing their production of androgens . Elevated androgen levels can themselves can tehn contribute to inflammation by promoting the accumulation of visceral fat, which in turn secretes more inflammatory cytokines. These inflammatory cytokines then stimulate more androgens and the cycle continues. 

Inflammation also disrupts the the normal development of ovarian follicles, leading to the characteristic polycystic appearance of the ovaries and impaired ovulation.

Chronic inflammation can also contribute to insulin resistance, which as discussed above can lead to PCOS. Inflammatory cytokines interfere with insulin signaling pathways, reducing the ability of cells to respond to insulin. This leads to higher insulin levels (hyperinsulinemia), which can exacerbate androgen production and ovarian dysfunction.

Women with PCOS often exhibit gut dysbiosis, which is an imbalance in the composition of gut microbiota. This dysbiosis is characterized by a decrease in beneficial bacteria and an increase in harmful bacteria which can lead to inflammation and metabolic issues (ie inuslin resistance). 

Gut dysbiosis and increased intestinal permeability (leaky gut) can allow bacterial endotoxins like lipopolysaccharides (LPS) to enter the bloodstream, triggering systemic inflammation.

Thus, identifying what may be triggering inflammation in those with PCOS is of upmost importance.

Things that can increase inflammation:

• Infections (like Candida & H. Pylori have been shown to be associated with PCOS)
• Gut dysbiosis and intestinal permeability (“leaky gut”)
• Highly process foods/excess alcohol or caffeine intake
• Lack of sleep
• Low sunlight exposure, high artificial (blue light) light exposure
• Over exercising, under-fueling
• High toxic burden, poor ability to detox via the liver/gut
• Low antioxidant status
• Insulin resistance / high blood sugar and insulin
• Chronic stress
• Autoimmune diseases like Celiacs, Hashimotos, Lupus, etc

Tests I use to identify inflammation:

• hs-CRP > 1 mg/L
• ESR > 8 mm/hr
• homocysteine > 10 (this is debated, and I have seen other reference >15)
• uric acid 3.2-4.4 mg/dL
• billirubin <0.5
• Gamma-glutamyl Transferase (GGT) 10‐22 U/L
• GI Map stool test to identify infections or gut dysbiosis

1. Nutritional Factors

Studies have linked nutrient deficiencies including low iron, zinc, folate, B12, vitamin E, vitamin C, vitamin D, magnesium, and omega 3 fatty acids to PCOS.  These makes sense as nutrient deficiencies are associated with inflammation, insulin resistance, and can interfere with healthy ovulatory function.

Nutrients I assess via blood labs:

• ferritin > 30 ng/mL
• copper 95-105 ug/dL
• sodium, potassium
• magnesium
• Storage & active Vitamin D
  • Storage D (25(OH)) ~30 ng/mL
  • Active D (1,25(OH)2D3) ~40 pg/mL

Diagnosis of PCOS:

Diagnostic Criteria:

• The Rotterdam criteria are commonly used for diagnosing PCOS, which require at least two out of three of the following:
  • Irregular or absent menstrual cycles
  • Clinical and/or biochemical signs of hyperandrogenism (excess male hormone levels)
    • testosterone > 45
    • DHEAS > 250
  • Polycystic ovaries on ultrasound

WAYS TO LOWER ANDROGENS:

Improve Diet

• Replace refined carbohydrates (white flour & sugar like cereals, bread, soda, etc) with whole food carbohydrates like legumes, Ezekiel or sourdough bread, sweet potatoes, and fruit
• Significantly reduce ultra- processed foods
• Majorly reduce alcohol to less than 2 drinks per week
• Reduce caffeine to <200mg daily
• Increase monounsaturated fats – like avocados & extra virgin olive oil
• Wide variety of fruit & non-starchy veggies (>6 servings daily) to support micronutrients
• Increase foods that block aromatase (Aromatase is the enzyme that increases the activity of testosterone)– such as mushrooms, celery, carrots, spinach/kale, & berries (basically any plant food with flavonoids!).
• Increase fiber- nuts & seeds , fruit, non-starchy & starchy veggies, whole grains, legumes
• Incorporate green tea daily
• Incorporate fish weekly to get in omega-3 fatty acids

Support healthy blood sugar:

• Have 25% or more of your calories come from protein and 40% or less from carbohydrates
• Start your day with a breakfast with 25+g of protein or more
• Do not go more than 5 hour between meals
• 25+g of fiber per day

Improve Lifestyle

• Prioritize sleep!
• Consistent exercise routine!
  • While ANY exercise is beneficial, weight training may be more therapeutic for those with PCOS as it helps to build lean muscle mass which has favorable impacts of insulin resistance.
• Manage stress/ start implementing strategies to reduce stress
  • meditation/prayer
  • improving work/life balance
  • leaning into friendships/ high quality relationships

Possible supplements for PCOS

• Comprehensive Prenatal
  • to fill in nutrient gaps like zinc, magnesium, folate, and B12 that are commonly associated with PCOS
  • I personally love the brand Fullwell and recommend this to most clients (code; womenshealthrn for 10% off )
• Inositol
  • Improves insulin sensitivity, reduces hyperandrogenism, regulates menstrual cycles, and may enhance fertility.
  • Commonly recommended doses are 2-4 grams per day of myo-inositol or a combination of myo-inositol and D-chiro-inositol in a 40:1 ratio.
• Berberine
  • Improves insulin sensitivity, supports weight loss, supports healthy gut microbiome and may have similar effects to metformin.
  • Common dose is500 mg three times per day before meals.
• Magnesium
  • Improves insulin sensitivity, reduces inflammation, and supports overall metabolic health.
  • Common dose is200-400 mg per day, preferably in the form of magnesium  magnesium glycinate for better absorption.
    • In the Fullwell Prenatal there is already 300mg of magnesium
• Gut specific supplements like fiber, digestive support, probiotics
  • These are to balance any gut issues. I don’t suggest blindly supplementing here- rather I suggest working with a provider to get targeted testing (we run a GI Map stool test with out clients) done to figure what gut supplements would be best for you
• Supplements that impact inflammation like CoQ10, N-Acetyl Cysteine (NAC), Alpha lipoic acid
  • These can act as antioxidants, improve insulin sensitivity, and support ovulation.
  • A good supplement that has all 3 is Fullwells Fertility Booster! (code; womenshealthrn for 10% off )

Finding and addressing YOUR root cause of PCOS via your diet and lifestyle can be a daunting task.

How do I know this? From experience. 

When I was first diagnosed with PCOS the only solution offered to me (and is a story I hear over and over with clients) was birth control. 

Turns out, upon digger deeper with functional lab testing I found out that I:

• was struggling with Candida overgrowth and leaky gut
• had major nutrient deficiencies
• was not structuring my meals for optimal blood sugar balance
• was over exercising and under fueling

and guess what? By taking a functional approach to my PCOS not only have I been able to restore my fertility, clear my skin, and maintain a healthy weight- but I have now helped COUNTLESS women with PCOS do that same! 

Looking to work with my team to finally get to the root cause of your PCOS? We gotchu!

If you’re looking for more 1:1 coaching to get to the root cause + in depth support + functional lab testing, you can apply for  4 our Month 1:1 Coaching program here.​