PCOS: Research Updates and Treatment Strategies
We recently had the opportunity to connect with Fiona McCulloch, leading expert on PCOS (Polycystic Ovarian Syndrome) and author of best-selling book 8 Steps to Reverse Your PCOS: A Proven Program to Reset Your Hormones, Repair Your Metabolism, and Restore Your Fertility and wanted to share recent research updates and tips!
PCOS is a condition that causes hormonal imbalance in 1 out of 10 women of childbearing age. Signs include:
Irregular or Absent Menstrual Cycles or Anovulation *
Weight Gain or Difficulty Losing Weight
Androgen Excess *
Excess hair growth on face and chest and/or male pattern balding
Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
Higher than normal blood levels of androgens
Multiple cysts on one or both ovaries with imaging *
A diagnosis is reached when someone exhibits two of the above * signs.
Beyond challenges getting pregnant due to irregular cycles, PCOS puts women at greater risk of miscarriage, heart disease, diabetes, sleep apnea, endometrial cancer, and depression and anxiety. It is for this reason that it is important to implement strategies to manage the condition and optimize health ongoing.
What causes it? While research is continually evolving, the consensus is that the root of PCOS is three-fold: increased androgens (primarily testosterone), inflammation and fat tissue dysfunction, and insulin resistance. Insulin resistance is present in most women with PCOS and is the body’s way of preventing the overload of glucose into the cells by blocking insulin receptors leading to increased glucose and insulin in the blood stream. Insulin resistance is correlated with increased body fat, particularly around the abdomen. In a recent study, waist to height ratio was an indicator of insulin resistance 70% of the time. Fat is an endocrine organ that releases hormones and if healthy secretes beneficial compounds that assist metabolism. However, when fat cells become enlarged (from insulin resistance), their circulation becomes compromised leading to tissue death. In response to this and in attempt to rid the body of any toxicity, our immune system creates inflammation. This inflammation is a good thing when we have an infection, but not so good when it is chronic and ongoing.
So what if I am thin? 75% those women with “lean” PCOS still have a tendency to carry weight in their mid-section and most still have some level of insulin resistance. The other 25% may have normal insulin levels but have insulin hypersensitivity (presents as reactive hypoglycemia- crash in blood sugar and intense hunger with shakiness when they haven’t eaten in awhile.).
OK so we know that losing weight and abdominal fat can be helpful to manage PCOS, but losing weight is often easier said than done given the hormonal terrain and inflammation we just talked about. Women with PCOS store more fat and their body is constantly secreting insulin making it very difficult to lose weight. So what can be done?
The first thing to keep in mind is that losing just 5% of your weight can help to improve reproductive outcomes and hormone balance while reducing inflammation.
Insulin is a response to eating so diet is the most important piece of the puzzle. There has been a movement from just looking at the glycemic index of foods to an insulin index to prevent the pattern of spiking insulin and hypoglycemia. Keeping blood sugar stable is key! Reducing carbs and increasing fat has been shown to reduce insulin levels.
Carbohydrates make blood sugar go up and then crash by 300 minutes.
Fat or Protein reduces the crash over the 300 minutes
By eating both fat and protein together you get a more sustained, stable blood sugar over the 300 minutes
Adding fiber offers even more support while being beneficial to the microbiome. Eating a wide variety of vegetables, stems, and leaves.
For a free download of Dr Fiona’s Food Insulin Demand Handout, go to: https://drfionand.com/food-insulin-demand/
No dairy? From a Chinese medicine perspective, we typically recommend removing dairy from the diet as it can contribute to phlegm/damp accumulation in the body and aggravate PCOS symptoms. Dr Fiona offered evidence that this may be important on many levels as it too can contribute to insulin resistance. Dairy products are high in branch chain amino acids and have been associated with insulin resistance. Dairy is a food designed for baby animals to grow and trigger the release of massive amounts of insulin so limit your intake!
What about exercise? Building muscle can improve the health of our mitochondria (the energy center of our cells- also important for egg quality!) and reduce insulin resistance. Studies have shown that strength training as little as three times per week can reduce testosterone levels and waist circumference. And here is an interesting one- vigorous exercise at 75 minutes per week was shown to be superior than 150 minutes of moderate exercise in improving metabolic parameters!
Let’s take a look at some of the current research on supplements for PCOS:
Inositol- considered the cornerstone supplement in the management of PCOS. There are two forms that can be beneficial in the treatment of PCOS- MYO inositol (good for insulin resistance, regulating menstrual cycles, reducing androgens, and improving egg quality) and D-Chiro inositol (further improvement of insulin resistance). We recommend a combination of the two as you get the benefit of both at a ratio similar to what occurs naturally in the body. Ideal dosage of a combination supplement is 2000mg of MYO inositol and 50 mg D-Chiro inositol twice daily.
N-Acetyl Cysteine- may improve oocyte (egg) quality in women with PCOS undergoing IVF.
Omega 3 combined with Vitamin E may improve depression and anxiety in women with PCOS and improve insulin resistance and reduce testosterone levels.
Vitamin D- we recommend having your levels tested as optimal dosage can vary. When levels are optimal there can be improvement in glucose metabolism and lipid profiles. A baseline in Wisconsin winters is likely between 2000IU-4000IU, but again if you are deficient, you may need more so beneficial to have your levels tested!
Chromium picolinate (200mg) can reduce fasting glucose and insulin, reduce triglycerides, and improve antioxidant capacity.
CoQ10 can reduce inflammation and improve lipid metabolism (and is good for egg quality;)
Multi-mineral (magnesium, zinc, calcium) can help support overall health, improve deficiencies, and reduce unwanted hair growth.
Probiotics- profound benefits for the immune system and encourage a healthy microbiome.
Green tea extract taken by women with a high BMI and PCOS can assist with weight loss while reducing insulin and testosterone.
We hope that you have found some of this information helpful! It can be hard to know where to start, so we are here to help! Also, Dr Fiona’s book is a wonderful resource!
In good health,