PCOS: Where to Start

Polycystic Ovary Syndrome, commonly termed “PCOS,” is something I am seeing more and more in my practice.  Often times, women have no clue this is an issue until they try to become pregnant.  Since infertility is one of the negative repercussions of such condition, trouble conceiving is often the red flag.  However, many women may notice something isn’t right before that and not associate it to PCOS.  For example, common symptoms of PCOS include things like:

  • Weight loss resistance
  • Blood sugar regulation issues
  • Increased hair growth in all the wrong places
  • Depression
  • Decreased hair in all the right places
  • Irregular periods
  • Sometimes high blood pressure
  • Pelvic pains that come and go
  • Often times high LDL levels

How’s that for a good time?  Overweight, with acne and facial hair, not knowing when you’re going to get your period, and depressed.  Then you feel like you can’t even do something as basic as get pregnant.  You know how many people get pregnant and don’t even try?!  This is the PCOS story.

What do doctors traditionally do about it?

They usually prescribe birth control pills and metformin (diabetes drug).  Since PCOS is an issue of hormone regulation, the birth control is supposed to put someone on a normal cycle with “normal” hormone levels.  The thought is also that the reason this occurs is due to blood sugar issues, which is why women often improve with diabetes medications.  This sounds great until you start asking why it started in the first place.  Not only does Metformin not address the issue, but it depletes your body of B vitamins and CoQ10, so you may even have decreased energy. If your blood sugar issues started it, why wouldn’t you change the habits associated with poor blood sugar?  Instead, those continue and everything associated with those is still taking place.  Your body is making too many androgens, which is what you can thank for those hair growth patterns and acne.  Taking a pill with estrogen does not remove the inappropriate hormone production patterns.  This treatment protocol is likened to adding green food coloring to water and to make someone think it’s juiced vegetables.  You may make things APPEAR differently, but once you look (or taste) further, you notice it doesn’t taste like green juice, it doesn’t have benefits of green juice, and it may be even worse because we had to add chemicals to the water just to make it APPEAR differently. Wouldn’t it be easier, and better, if we just made some green juice?!

What SHOULD your labs look like?  What should be the goal?

  • A1C should be 5.4 or less
  • fasting glucose should be 75 or less
  • Insulin should be 6
  • Homocysteine should be 6-8

Insulin levels are often not tested because we tend to test glucose more often; however, insulin decreases something called sex hormone binding globulin (SHBG).  The point of SHBG is to bind free hormones and if it’s ability to do so is impaired, we see elevated testosterone levels.  Testosterone is one of the androgens we touched on earlier.  This is why adding estrogen via a birth control pill can sometimes make your body APPEAR improved, but we are really just creating that appearance by adding green food coloring. Inside, we still have the issue of it just being dyed water.

Why does this even matter?  Is it that big of a deal?

For women who desperately want children, YES.  That can be a huge deal.  For the rest that don’t mind the childless lifestyle, having PCOS increases your risk for heart disease, hormone driven cancer, blood pressure issues, and if you have irregular periods, you are 7 times more likely to develop diabetes.  We don’t want to go down the rabbit hole of diabetes, but think diabetic neuropathy, limbs removed, eye sight issues, and a huge stealer of quality of life.

What things can we do from a lifestyle perspective?

  • Eat balanced macros with a focus on protein and healthy fats (this will help regulate blood sugar)
  • Increase fiber intake (think around 30g/day) (this helps bind hormones and cholesterol)
  • Avoid sugar and processed foods (this impairs normal blood sugar)
  • Avoid caffeine (this can drive androgens)
  • Decrease stress (stress drives cortisol and disrupts your hormone production)
  • Clean up your beauty products (these are often endocrine disruptors meaning they damage receptor capabilities for hormones)
  • Exercise (this sensitizes cells to normal blood sugar responses)
  • Drink spearmint tea (this decreases testosterone)

That’s great Dr. Angela, but I’m in deep.  Will I need more than just lifestyle changes?

This could be the case and often is by the time someone sees me.  THIS IS NOT MEDICAL ADVICE, and each patient is different, but I want to share some things that are often common with improvement.

  • Essential Fatty Acids-consider a good fish oil, cod liver oil, or fatty acid blend
  • Antioxidants- consider taking a spectrum of antioxidants because studies show one single antioxidant does not work the same
  • Detox- sometimes increasing detoxification pathways can be helpful
  • Herbs- Inositol, Fenugreek, Cinnamon, Vitex, Black Cohosh, Nettles, Green Tea, Licorice, Spearmint
  • Saw Palmetto-240-260mg 2x’s/day-lowers testosterone
  • Progesterone- day 14-25 days of the cycle taking 20mg transdermal or 110-130 mg oral (this should be started low and slow and directed by your health care provider who is testing)
  • Berberine-200mg 2x’s/day for those who also have high LDL levels

The take away message here is that cysts on the ovaries are a sign that something is going wrong with hormones and blood sugar regulation inside.  Taking medications for these issues acts like a bandaid and doesn’t address the underlying mechanisms.  I encourage you to take lifestyle changes seriously and find a knowledgeable practitioner who will talk to you about solutions to CORRECT the issue and not jump to birth control or metformin.  This is not a life sentence, and many women address these issues naturally.



Carb Challenge Part 3: White Rice

Catch up with what this is all about. How may your body respond differently to the same amount of net carbs, but from different sources? Would it effect your blood sugar the same? The answer is “probably not.” I set out to experiment on myself, so you guys can see a personal experience of the differences! Having said that, unless you test yourself, you won’t know if you fit the same profile as myself.

First test: 50g net carbs from Oats
Second test: 50g net carbs from banana

Third test: 50g net carbs from white rice

Why white rice?
Rice is a gluten free grain that I consume on occasion, especially with sushi. Consuming white rice vs. brown rice means there is no bran present, which means it’s not high in nutrients or fiber, but it also doesn’t need to be soaked for safe consumption. That makes it a quick, easy, and safe starch for those that handle it well. Since it wasn’t a high fiber carb source, I only had to consume 1.14cups to get 50g net carbs. This made me happy because if you read my experience with oats, eating over 2 cups was hard and unpleasant. I did prepare the rice with bone broth as opposed to water because I would normally prepare it as such.

How did I feel with white rice?

It was super easy to eat this amount of rice! I may even say easier than banana. I didn’t feel full and wanted to eat more. I didn’t feel shaky or nauseous or any other reason to call it a negative reaction. I was ready to eat again fairy shortly though, and found myself staring at the clock waiting for the 2 hours until I could take my blood sugar.

What were the results?
My 2 hour post-prandial reading was 99. If you recall, oats was 122, and banana was 84. The one major difference in my opinion was I decided to do it on a Sunday as opposed to a work day. That means that I didn’t do it quite as early in the morning, and therefore my blood sugar prior to eating it was higher than the other challenges. For oats, my blood sugar prior to eating was 74. Banana fasted blood sugar was 69. This time, I started at 90. So, to have 99 means even though it wasn’t as low as the banana, it came much closer to the fasting level prior to consuming the carbs within that 2 hour window.
Oats: pre# 74- post# 122= 48
banana: pre#69- post# 84= 15
Rice: pre# 90- post# 99= 9

So, oats have still had by far the worst response in my body, but I can’t really determine which was ‘better” between rice and banana because while the blood sugar value was better with banana, the ability to come close to my fasting number was better with rice.

What does this mean for me?

I will honestly probably start incorporating more white rice in my days that I have intense workouts. I like rice. I can use it as an amazing way to get bone broth into my diet, and I know that my body responds nicely to it.

What’s next?
I will likely do a vegetable next. Maybe a potato or sweet potato. Potatoes are probably one of my go-to carb sources, so I’ll be interested to see how they stack up to rice. The one downfall to choosing sweet potato is the volume I have to consume on that one. ;( This is also a testament to which carbs are easiest to ingest in certain quantities. If you are a sedentary person that wants to feel full but not consume too many carbs, then go with those that are less refined. However, if you are trying to build mass or recover and have the need or double or triple the amount of carbs as an average person, then choosing those easy to consume without as much volume may be much better options to comfortably fit your macros.