Understanding & Holistically Managing PCOS

PCOS has become extremely common amongst women, and is a leading cause of infertility in reproductive-aged women, affecting approximately 5 million in the US alone. Seventy percent of women with PCOS go undiagnosed. But, what's even more common is the confusion of what to do after receiving the diagnosis.

This guide will help you:

• Understand what PCOS actually is (and isn't)

• Identify Your Type of PCOS

• Review Common Medical Treatment + Medications

• Teach You How to Manage Your PCOS Holistically

What is PCOS?

PCOS (PolyCystic Ovarian Syndrome) is a group of symptoms that affects the ovaries and ovulation. It is a hormonal imbalance that is caused by a high level of androgens (male hormones in the body responsible for the development of male characteristics) such as testosterone and DHT. Normally, testosterone gets converted to estrogen, so if there are high levels of testosterone present, it can also contribute to high levels of estrogen.

This is why when these hormones(androgens) are higher than they should be, it is common to see signs of acne, excess hair growth (often around the chin), ovulation and fertility issues, as well as irregular periods.

Other Common Signs and Symptoms of PCOS:

• Oily skin and hair

• Excess hair growth on the face and body

• Hair thinning or loss on the head

• Weight gain or trouble losing weight

• Darkened skin patches

• Irregular periods or no periods

• Delayed ovulation

• Skin problems including skin tags, darkening skin

Risk Factors associated with having PCOS:

• Diabetes

• High Cholesterol

• Heart Disease

Explaining What the "Cysts" are:

Hearing the word "cyst" can be scary. Even scarier, hearing "cysts on my ovaries" as a woman can cause unnecessary stress. The cysts in this particular case are better known as an increased number of "follicles". They are not true cysts in the majority of the cases. These can even be seen in women that do not have PCOS and also can be absent in women with PCOS.

Testing that determines PCOS and the type:

• Ultrasound (2 ovarian cysts)

• High HbA1C Glucose (above 5.4)

• Belly fat,apple shape

• High glucose levels (above 90)

• High insulin levels (Fasting glucose) (above 15)

• Hunger after eating a meal

• Tiredness after eating a meal

• Cravings for sugar and processed carbs

• High Androgens

Traditional Treatment of PCOS

• Birth control pills to regulate ovulation

• Diabetes drugs, such as metformin, to improve insulin levels

• Medications to treat symptoms such as acne or hair growth

Nutritionist Note: These signs and symptoms can be seen in other common hormone imbalances (like Cushing's, Congenital adrenal hyperplasia), so after receiving a diagnosis of PCOS it is important to follow up with "What is the underlying reason for my PCOS?" and rule others out so you can start taking the right steps to manage it or reversing it (yes, I said to reverse it!) You can do this by understanding which "type" of PCOS you have.

Before reading on, if you aren't sure of what your type may be, take the "What’s Your PCOS Type?" Quiz here to get more clarity: Take the quiz here

Blood sugar dysregulation is the key driver of PCOS, so no matter what type of PCOS you may have, blood sugar has to be addressed. Lifestyle, nutrition, and mindset changes are the tools we will look at to provide natural solutions later on in the article.

The 4 Types of PCOS

1.Insulin Resistant PCOS

This type is the most common. Insulin resistance occurs when there are such high levels of insulin in the body, that the body literally becomes "resistant" to it and shuts off the receptors that would normally respond. Insulins main job is to carry glucose (the fuel we get from the food we eat) into our cells to help us have clarity and energy throughout the day. That is why they say "food is fuel".

Well now that the body is resisting insulin's effort to bring in more glucose, the pancreas stresses out, flooding in more insulin to try and "break down the door". Overall this insulin causes inflammation throughout the entire body.

What does this look like in real life? If you have this type of PCOS, weight gain around the abdomen may seem like it doesn't want to budge, you might experience more brain fog or fatigue (because that fuel isn't getting to the brain or your muscles). Because insulin can't properly deliver glucose to the cells, it might feel like you have to constantly eat for energy or crave sweets (because that glucose gets delivered much more quickly).

These high levels of insulin, increase those androgen hormones we mentioned earlier, resulting in excess hair growth, hair loss, and acne.

2. Adrenal Dysfunction Type

This type of PCOS is due to abnormal stress response and affects around 10% of those diagnosed. Typically DHEA-S (another type of androgen from the adrenal glands) will be elevated alone, and high levels of testosterone and androstenedione are not seen. In order for this to be tested or diagnosed, you'd have to go through an endocrinologist or other specialist.

What does this look like in real life? Having barely enough energy to get up, irritability, anxiety, fatigue, and feeling like you should work out and eat less.

If this is your primary type, be sure to address your stress first. Check-in on how you're responding and what positive outlets you've created or need to create to handle stress better. See below for specific supplements, diet, and lifestyle recommendations.

3. Inflammatory Type

As you may have heard, inflammation is the root of all diseases. In this type of PCOS, chronic inflammation causes the ovaries to make excess testosterone. This predisposition to inflammation comes from a contribution to metabolically active fat cells that secrete inflammatory agents. These agents will typically result in a production of high C-reactive protein (CRP above 5) and IL-6 on your bloodwork.

What does this type look like in real life? You may notice more pain in your joints, headaches (also associated with cycle fluctuations), skin issues like eczema, fatigue, and bowel discomfort, or IBS-like symptoms. Think bloating, cystic acne, hair loss, moodiness!

If this is your primary type, reducing inflammation and improving your gut health (because toxins leaking from our gut into the bloodstream cause more inflammation) is a priority. Removing specific foods that trigger inflammation (see list below) and incorporating anti-inflammatories such as turmeric, omega-3's, NAC, and blood sugar regulation may help in supporting this type.

4. Post-Birth Control Type

In this type of PCOS, after stopping oral- contraceptives (approx. 3-6 months), the ovaries become overexcited and create more androgens. When this happens, you may see irregular periods and excess hair growth. This type does not typically involve insulin resistance, but having balanced nutrition, being mindful of your cycle, and lifestyle wellness can help support this type.

How to Holistically Treat PCOS

Nutrition

Your diet can make a huge impact on your PCOS symptoms. Maintaining healthy blood sugar is first and foremost in every aspect of hormone balance.

Start here:

• Reduce and eliminate gluten and dairy, and swap for whole foods or minimal ingredient gluten-free options (Try for 30 days and see how you feel). Gluten can trigger chronic inflammation and symptoms like fatigue, bloating, and weight gain. Dairy can spike insulin levels, and promote symptoms like cystic acne.

• Increase lean protein (or vegan protein) intake (ground turkey or grass-fed beef). A high-protein breakfast (around 35g) is a great start to the day!

• Eat high, quality fats and eliminate inflammatory ones. Check out the guide on fats and oils in the wellness library!

• Swap processed foods (where a lot of sugars, bad oils, and toxins hide that contribute to insulin resistance, (and make you feel hungry all the time) and inflammation for whole foods!

• Reduce or eliminate added sugars and replace if necessary with monk fruit.

• Practice eating an overall balanced plate for blood sugar control. You can check out the Mealspiration section in the wellness library or learn how to create a balanced bowl aka the "Nourish 5" bowl. The Nourish 5 handout also gives you examples of different, proteins, greens, and healthy fats.

Sample Meal Plan:

• Breakfast: Green Protein Smoothie with hemp or plant-based protein powder (no-whey) or oatmeal with collagen protein, almond butter, & berries.

• Lunch: Kale or spinach salad with hummus & pumpkin seeds or sweet potato, grilled chicken or turkey burger, and asparagus.

• Snack: Guacamole and Siete chips (pair carbs with a protein or healthy fat)

• Dinner: Cooked greens (like collards or mustard) with ground turkey or chicken + quinoa

Supplements

Always consult with your practitioner before beginning new supplements. Always work with a nutritionist or naturopath to help figure out which supplements are best for you. Supplements that support anti-inflammation, hormone balance, and insulin resistance are:

• Ovasitol: Myo-Inositol reduces androgens, restores ovary function, and increases sensitivity to insulin and d-Chiro-Inositol reduces androgens.

• Omega-3 Fish Oil: Reduces inflammation, supports hormones.

• B Complex: Supports hormone production and nourishes the adrenals.

• Adaptogenic herbs: Supports adrenal health and stress response.

• Vitamin D3: Supports immune system, hormones, and gut health.

• Vitex (Chaste tree berry): Promotes healthy progesterone levels.

• NAC: Powerful antioxidant to combat free radicals and excess estrogen.

Exercise + Lifestyle

• Light Strength training, Yoga, and Pilates are great. These forms of gentle exercise can still build muscle, reduce stress, and sensitize your body to insulin. Avoid high-intensity training at first like cardio and HIIT as it can create a stress response (to your adrenals), and lead to more hormonal imbalance.

• My absolute favorite app to assist with this type of exercise and lifestyle change is the Asana Rebel App!

• To help naturally increase energy: turn off screens before bed, try getting to sleep around 11:00 pm- 7:00 am, and avoid intense workouts.

You can also find affirmations and yoga stretches in the community coming soon!

Have any questions or PCOS wins? Drop a comment below or send a message!

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Sources:

1. Rosenfield RL. Ovarian and adrenal function in polycystic ovary syndrome. Endocrinol Metab Clin North Am. 1999. 28(2). 265.

2. González F. Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids. 2012. 77(4). 300-5.

3. https://www.emilyjensennutrition.com/blog/4-types-of-pcos-and-how-to-know-which-one-you-have

4. Overcoming Estrogen Dominance, Magdalena Wszelaki.

5. Integrative Women’s Health, Maizes and Low Dog