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.



Sleep: How It Impacts Your Life, Your Looks, and Your Health!

For as long as I can remember, I have been a good sleeper.  I would be that friend at sleepovers that would sleep so long that my friends would go to church and come back and I’d still be in bed!  For a long time, my parents wouldn’t call me before noon because otherwise there was a wrath to follow.  I’m happy to say that I still love sleep, but I am up before noon. ;)  Last weekend, I sat in on a presentation by a former Navy Seal named Dr. Parsley and listened to all the things he was doing in his clinic to keep patients healthy, beautiful, and free from hormone imbalance.  You want to know what his secret is?  SLEEP!

We tend to see sleep as a luxury in the US because you can sleep when you’re dead, right?  However, many cultures value sleep, build naps into their schedule of working, and see it for what it is: a requirement for normal hormone function.  Losing hours of sleep mimics the aging process in so many ways.  Not only does it make you look older, it makes you hang on to excess weight, become cranky, and slows down your nervous system’s ability to adapt.  REM sleep specifically is when your brain converts short term memory into long term memory and without REM, you may feel as though you need to be told the same thing over and over again or read the same page in your book over and over again.  This decrease in memory and cognitive function isn’t just for the elderly, its for anyone at any age that isn’t getting enough zzz’s.

Lack of sleep also decreases your thyroid function by about 30 %.  When you have decreased thyroid function, you also have lowered cognitive capability and tend to lose your ability to react to stressful situations without being overly emotional.  Can we say “middle age sob-fest?!”  If I see anything in practice becoming a huge concern, it’s hypothyroidism.  There are thyroid receptors on every single cell in your body.  If you’re not making enough, you could experience things like anxiety, constipation, cold intolerance, skin issues, and a complete lack of energy.  I won’t go off on a tangent, but the normal ranges for TSH these days are NOT normal.  If this sounds like you, have someone take a closer look with you….please.

For all of you out there trying to fight the aging process, decreased sleep decreases your collagen, elastin, and keratin production in your skin which results in wrinkles, dull skin, and brittle hair.  UGH.  Who knew that you could bypass all those appointments with the dermatologist by just getting more sleep!?  Have you ever wondered what actually makes people look their age?  Think about it.  How do you know someone is 20 vs 28?  20 vs 35?  puppy vs dog?  It’s hard to pinpoint how you KNOW someone is around a certain age when it’s not due to grey hair or wrinkles, but we usually know approximately what age someone is.  It’s actually because of fat pad distribution.  You have fat pads above and below your eyes which open them up and a fat pad behind the eye that pushes your eye forward.  As that fat decreases, your eyes sink in ever so slightly and you continue to age.  Many people get BOTOX to look younger, but according to Dr. Parsley, it makes your muscles atrophy and you ultimately end up looking older because as your fat pads redistribute and muscles harden, you get something he calls “skeleton face.”

As if beauty, cognitive function, and thyroid production wasn’t enough, lack of sleep also decreases your testosterone production and insulin sensitivity by about 30%!  Tons of people are flocking to get testosterone replacement to stay youthful and lean; it is HUGE for what your body looks like.  Lowered testosterone also contributes to sex drive in both men and women!  Decreased sleep results in lack of sex drive, getting pudgy, and developing signs of diabetes!  Man, if only we just valued sleep, we could avoid being dumb, fat, ugly, and slow, and possibly diabetic!  Let me put sprinkles on the cake here and say that if you are an athlete, REM sleep is when your body rebuilds by producing anabolic hormones. So, yes, even the young, lean, athletes require sleep.

EVERYONE NEEDS SLEEP!  Aim for 8 hours a night and anything less is building a sleep debt. If you have trouble sleeping regardless of all your attempts, you may have something bigger going on and should consider testing; your health relies on it. We can’t escape aging but we can age well, age gracefully, and be a badass at any age!