PCOS – or Polycystic Ovarian Syndrome – affects over 5 million women in the US alone, that’s 1 in 10 women. It is the most common cause of female infertility and the most common endocrine disorder in women today.
Elevated levels of androgens and insulin have been targeted as the primary cause of PCOS. The associated symptoms can affect women all the way through menopause. However, diet and lifestyle changes can reduce and eliminate many of the symptoms. Preventing us from having to deal with these symptoms for years!
Symptoms associated with PCOS:
Infertility – or difficulty in getting pregnant
Infrequent/absent/irregular periods
Hirsutism – increased hair growth in the wrong places – on the face, chest or other areas of the body.
Acne or oily skin
Male pattern baldness or thinning hair
Obesity and weight gain, especially around the waste
Skin tags – excess tags of skin under the arms or around the neck
Acanthosis nigrans– dark pigmented patches on the skin in the areas of the nape of the neck, inner thighs, and arms
Anxiety/depression – even times of rage due to the high levels of testosterone
The main reason for the name: more than 12 cysts in one ovary on an ultrasound
To be “diagnosed” with PCOS, you may only present with a few of these symptoms. As we delve deeper into this syndrome, we start seeing some of the same symptoms present with blood sugar dysregulation. In fact, metabolic syndrome and insulin resistance (hyperinsulinemia) are now seen as one of the main factors causing PCOS.
Let’s walk through how an increase in insulin affects the sex hormones and ultimately creates these symptoms.
Hormones
First, let’s discuss hormones. Hormones are chemical messengers used in the body to tell your organs what to do. Think of them as the boss telling the organ to send this out or stop making that. They are generally produced by glands but can be made by organs as well. These messengers control most of the major bodily functions, from simple basic things like whether you are hungry to complex systems like reproduction. Even emotions and moods are controlled by hormone messengers.
A feedback system in the body is used to monitor hormone levels, when they get to a certain amount in the body a mechanism is triggered to turn them off and on. Similar to an air conditioner, once your house reaches a certain desired temperature the air condition turns off and if it gets too warm the air conditioner turns on.
Insulin
Insulin is a hormone that tells our body to store sugar (or glucose). This glucose gets stored in your adipose tissue as fat. The food we eat, specifically the carbohydrates, is converted through our digestive processes to glucose. This glucose is used as a fast-easy way to get energy. But when there is too much, your body wants to store it for later use.
Our bodies were really made to deal with an under-abundance of food. Therefore, in times of abundance it has several mechanisms to make sure that we store fat. These days, we generally have access to food all of the time. However, our bodies don’t recognize this abundance, and simply continue to store, just in case. With the overabundance, insulin is consistently being sent out to tell the cells to store the excess glucose. Over time, the insulin feedback mechanism becomes disrupted. Essentially, the thermostat controlling your insulin levels breaks.
Hyperinsulinemia
Insulin doesn’t get turned off, and now too much insulin is present in the blood. Eventually, the cells stop listening to what insulin is trying to get them to do, which results in insulin resistance. You become tired because the energy source is not getting into your cells where your body can use it. Ultimately, the pancreas just stops producing insulin and this is what we call Type 2 Diabetes.
This happens over years, and the trigger point when the pancreas turns off insulin production, is different in every individual. This is where intervention before getting a Diabetes diagnosis can really reverse the trajectory. Preventing that diagnosis from ever happening.
Sex Hormone Connection
The pathway to PCOS is complicated, as all hormone pathways are, but let’s try to simplify it.
As insulin continues to increase in the bloodstream with the overabundance of carbohydrates, it starts to signal to other organs in the body. Insulin now starts to deliver a message to the ovaries to change the amounts of sex hormones it is producing. The high levels of insulin stimulate an increase in the production of androgens.
Androgens
Androgens are hormones that give women a healthy libido. They are also the precursor to estrogen in the hormone production pathway. The major androgen is testosterone. Increased androgens are a central factor in PCOS: they stall ovulation and create hirsutism, acne, and hair loss. This increase in testosterone is another reason we see male pattern baldness in women that have PCOS.
Insulin resistance impairs the body’s ability to ovulate. Making some women struggle with irregular or absent periods, and infertility. It does this by creating excess Luteinizing Hormone (LH). This is one of the main hormones normally involved in ovulation. When LH is out of balance with Follicle Stimulating Hormone (FSH), it prevents ovulation from occurring. High insulin also impairs the ovaries ability to create estrogen and progesterone, which are essential for healthy cycles and hormone balance throughout a woman’s lifespan.
Digestion
Think of digestion as the first entry point for nutrients, with a healthy gut being foundational. New research is showing the problems controlling blood sugar could start in the gut. Gut hormones play a role in insulin signaling. This makes having a healthy gut just as important as blood sugar regulation, and important for those women struggling with PCOS.
Studies have found that women with PCOS also have an increased likelihood of having Irritable Bowel Syndrome (IBS). Which has also been correlated with a higher body mass index and body fat percentage. Research has now shown that intestinal impermeability or “leaky gut” is likely the underlying factor in many IBS cases.
5 steps to addressing PCOS
1. Nutrient-dense whole foods diet that is high in healthy fats and moderate high-quality protein and lower in carbohydrates
Foundational to any healing protocol is diet. Introducing a diet focused on lower carbohydrates is going to be absolutely necessary for turning PCOS around. Adding in high quality fats and proteins will help balance blood sugar levels. A good start is to remove packaged foods. These are highly inflammatory and high in carbohydrates that convert to sugar/glucose.
Focus on a diet high in vegetables with lots of fiber and fruit that is low on the glycemic load index like berries. Meats that are high-quality, grass-fed or pastured, will help satiate hunger. Healthy fats such as nuts, avocados, animal fats, ghee, and butter will help provide long lasting energy. Vegetable oils that are highly processed should be eliminated.
2. Intermittent Fasting
Studies have shown that giving your digestion a break can start to help insulin sensitivity. Break-fast was actually a meal that we used to break a fast, even an overnight fast can help. Try to incorporate 12 hours of not eating, so eat at 7:00pm and then don’t eat again until 7:00am the next morning.
3. Movement
Walking just 20 minutes a day can help your metabolism and digestion. Try to incorporate a little movement every day.
4. Gut Healing
If you are struggling with cravings or changing your diet, there could be an underlying issue. In addition to digestion affecting insulin, an imbalance in your gut microbiome could be driving what you eat. For instance, if you have an overgrowth of yeast in your gut, you may be craving sweets. This is because sugar actually feeds yeast your gut and the overgrowth in yeast has now taken control of your body, getting you to reach for more sugary foods to feed them. Without addressing this imbalance, it will be difficult to manage your cravings.
5. Supplements
Licorice – Great for balancing blood sugar, but also reducing androgens.
Peony – Helps increase progesterone and lower androgens (like testosterone). This also helps to regulate the LH:FSH ratio.
Chaste Tree – Helps the body increases progesterone levels.
Spearmint Tea – Helps to lower the androgens in the body.
Read this article about how one of our own, Jordan Hoefing, struggled with this syndrome.