I recently received this letter from a wonderful woman who follows my blog. It moved me so much that I decided to weave some of her story into this article, because it brings up a lot of good questions that many of you have probably faced if you are struggling with PCOS or wondering if you have it. It can be especially helpful to know what to do about PCOS if you are already trying to live a healthy lifestyle, eat a great diet, and you pay attention to your exposure to environmental toxins. We’ll talk about this in this article.
Dear Dr. Romm,
I know that you can’t possibly give a medical evaluation over email, but I thought I might ask a few questions that might help with any upcoming posts on PCOS. I’ve been following you for a while, and all of your posts about adrenal fatigue, thyroid issues, the thyroid/gut connection, etc., were really ringing bells.
I had a recent diagnosis of PCOS from my endocrinologist. I’ve always had to work at staying slim, but I’ve never had the difficulty I’m experiencing now. My symptoms also include fatigue, postpartum depression & anxiety, weight gain, and acne. I was tested for testosterone and one or two other hormones. I am waiting on the results. In the meanwhile, I was prescribed 1000 mg of Metformin daily, and advised to stop eating a high fat diet (eggs, grass fed ground beef, avocado) but that grain wasn’t something to avoid.
I eat a very healthy diet of whole foods, low in dairy, sugar and grains. I do high-intensity workouts for an hour 4-5 times per week and I trained for and ran a half marathon a few months ago. I’m super-careful about non-toxic household products and make most of my own.
Despite this, I have not lost a single pound. Even after running over 60 miles in one month, I didn’t lose a single pound. I worked with a naturopathic doctor without any results, and after feeling strongly about my research on thyroid/adrenal problems, I sought out an endocrinologist.
I guess my top questions would be as follows:
How do I approach this naturally?
How in the world do I reconcile a “PCOS Diet” with all the real/whole food eating I’ve been doing?
I want to have more children, and I am determined to lose weight before I get pregnant again (for my health, the health of my pregnancy, and the baby). Is that the safest choice?
Thank you, thank you, for the hard work you do on behalf of women and children. I could cry when I think about all of the help you have provided my family – from ear infection prevention to opening my eyes to the role stress plays in my physical health.
Thank you for using your knowledge to help others!
~ MC
What is PCOS, Really?
PCOS (Polycystic Ovary Syndrome) is a hormonal condition that is thought to affect more than 5 million women in the US alone. Nobody really knows what causes PCOS for sure, though there are many theories. Initially, PCOS was thought to be a condition caused by imbalances in the “sex hormones” (estrogen, progesterone, and testosterone) but now we know that the condition is due to insulin resistance (a condition whereby your cells don’t respond to the normal actions of insulin). Thus, PCOS is considered to be a harbinger of metabolic syndrome and Type 2 Diabetes, which makes it important to pay attention to and treat properly.
In fact, 50 to 70% of women with PCOS demonstrate measurable insulin resistance beyond that which would be expected by their body weight or degree of obesity. Insulin stimulates secretion of testosterone by the ovaries, and inhibits hepatic sex-hormone binding globulin (SHBG) production leading to increased circulating testosterone – this accounts for the acne, facial hair, and male-pattern hair loss in many women.
While there appears to be a strong genetic component that increases one’s risk of developing PCOS, this risk is modified by environmental and lifestyle factors such as diet and stress. In other words, your genetic history doesn’t dictate your destiny – but you may have to work a little harder to prevent insulin resistance if you come from a family that is overweight, diabetic, or have close relatives with PCOS.
How Do I Know if I Have PCOS?
PCOS is a clinical diagnosis. This means it is primarily diagnosed based on having some – or all – of the classical symptoms, with other medical conditions having been ruled out.
While testing can confirm PCOS, lack of abnormalities on hormonal testing including the typically checked LH, FSH, and testosterone does not mean that you don’t have this condition. Test results are very variable based on the time of the month tests were done in relationship to your period, your weight, and other factors. And not everyone with PCOS has abnormal hormone tests or multiple cysts on the ovaries when an ultrasound is done.
Symptoms of PCOS can include any of the following: infertility, irregular periods or lapses between periods for months at time (without being pregnant or breastfeeding), acne, weight gain, unwanted facial hair, hair thinning or hair loss, and less commonly, darkening of the skin in the armpits, back of the neck, or groin.
Women with PCOS are also more likely to suffer from depression and anxiety, and to have eating disorders, particularly binge eating. The reasons for this are unclear but likely have to do with blood sugar dysregulation, which may in turn worsen the problem.
Should I Be Concerned About Having PCOS?
PCOS should be taken seriously. Because PCOS is due to insulin resistance and is related to blood sugar problems, untreated, it carries with it all of the potential risks for diabetes, and with it, heart disease and stroke. Although obesity worsens PCOS and increases insulin resistance, not everyone with PCOS has obvious problems with weight or blood sugar, so just because you’re skinny, doesn’t mean you don’t have PCOS.
Women with PCOS are also more likely to experience pregnancy complications, for example, women with PCOS are 20-40% more likely to experience miscarriage, due to both the insulin resistance and hormonal problems it creates.
So What’s a Girl to Do? First, Look at the Root Causes…
When I think about the escalating rates of PCOS globally, and how they parallel skyrocketing rates for all kinds of inflammatory and hormonal conditions related to insulin resistance, particularly diabetes, my functional medicine brain kicks into gear looking for root causes.
The ones to think about are those that can have an impact on blood sugar and hormonal balance. Because PCOS is so complex, I’ve put the root solutions into a chart that you can also print out as a PDF.
One question you might have is how can a healthy woman who eats well and exercises, like our friend MC above, possibly have PCOS? In fact, this is super common and I treat women like MC in my practice often.
First of all, most of us didn’t grow up with moms who ate healthy during their pregnancy with us, and most of us of a certain age grew up on less-than-optimally healthy diets. So when you take genetics and add in a heaping dose of prenatal and childhood exposures that increase our lifetime risks for insulin resistance and inflammation, we’ve got a set up for developing conditions like PCOS.
Add this to our crazy-busy adult lifestyles that create chronic stress, which in turn impacts our food choices, sleep patterns, exercise, and adrenal stress, and you’ve got an even more jacked up blood sugar situation. All roads lead to insulin resistance.
And here’s something that might surprise you! Too much exercise can also send your adrenals into red alert and drive up inflammation, which can also make you insulin resistant. In fact, I’ve treated quite a number of athletic women for PCOS! Sometimes the answer is to exercise less intensely, and to sub in more restorative forms of exercise like yoga, or gentle hikes. That’s one important tip for our pal MC.
The Natural PCOS Prescription
A natural approach to PCOS means taking an approach to your lifestyle with the overall goals of keeping your blood sugar in balance, reducing stress and nourishing your adrenals, reducing your environmental hormone exposures, supporting your body’s natural detox pathways, and reducing inflammation.
One of the main goals of treatment for PCOS for women who are overweight is weight loss. Easier said than done, right? The good news is that the suggestions in this blog will help you to lose weight naturally, and the supplements for reducing insulin resistance will help if you’ve been weight loss resistant – meaning you’ve had trouble losing weight no matter what you’ve tried.
A number of supplements, including vitamins, minerals, and herbs, have been shown in scientific studies to have positive effects in reversing PCOS. The real benefits come from a combination of making the dietary and lifestyle changes it takes to prevent and reverse insulin resistance, along with taking the supplements. I recommend taking at least one from each category, and sticking with these for a minimum 3 months, ideally 6-12 months, while working on your diet and stress.
1. Balance Your Blood Sugar & Reduce Insulin Resistance
The main medication used to treat PCOS is metformin. The reason for this is completely logical. It helps to get the blood sugar under control and it acts as an anti-inflammatory. You can do this naturally with the dietary recommendations described in the chart below. You might also need the help of some additional supplements to reverse insulin resistance.
Eat only whole, real, fresh foods
Eat regular, blood sugar balanced meals that include good quality protein, health fats, and vegetables
Aim for a pound of fresh vegetables daily (yes, really!), and make sure to eat a rainbow of color of veggies from reds to greens to yellows, orange and blue-purple
Eat breakfast everyday and make sure breakfast includes protein
Don’t go hungry; keep an emergency food stash in your bag, your desk drawer, your glove compartment – wherever you might get hungry
Cut out sugar and white flour products, soda, and fruit juice. While you’re at it, do you really need potatoes and rice? Nah…
Dumping the dairy out of your diet can be beneficial in reducing insulin resistance and helping with hormonal problems
Don’t eat after 7 pm
Cut out the wine and other alcoholic drinks. These massively elevate blood sugar!
Supplements to Lower Insulin Resistance
A combination of 4 gm. of myo-inositol + 400 mcg of folic acid significantly improved ovulation and conception in women with PCOS, at a rate better than 1500 mg/day of metformin.
Alpha-lipoic acid, 200-400 mg/day reduces insulin resistance.
Chromium picolinate, up to 1000 mcg/day, improves insulin resistance.
Cinnamon improves insulin resistance. One small study looking specifically at its use in women with PCOS found that 1.5 gm/day improved menstrual regularity.
Vitamin D is essential for reducing insulin resistance; I recommend keeping blood levels between 50 and 80 for optimal health, and taking a daily supplement of 2000 units/day of Vitamin D3 if you’re struggling with PCOS.
D-chiro-inositol, at 1200 mg/day, has been shown improve insulin sensitivity and reduce serum testosterone levels in women with PCOS. Myo-inositol (up to 4 g/day) may be substituted, or a combination of the two may be used and may even be superior.
Legumes are also rich in inositol, so including garbanzo beans, kidney beans, and non-GMO organic soy in your diet can also increase your intake.
Pinitol, similar to d-chiro-inositol, at 600 mg twice daily for three months lowered blood glucose levels by 19%, lowered average glucose levels by 12% and significantly improved insulin resistance.
2. Nourish Your Adrenals
Our bodies read stress as a crisis. When this becomes our chronic state, we pump out too much cortisol on a regular basis, which increases blood sugar and puts a heavy demand on our bodies to produce insulin to manage this. Additionally, when we are under stress, we tend to crave more sugar, carbs, and fats, which further imbalance our blood sugar. Unchecked this eventually leads to insulin resistance, increased inflammation, downstream hormonal problems, and also affects our sleep which just adds to the vicious cycle of stress, fatigue, and sugar cravings. The chart below will teach you how to nourish your adrenals. Also see HERE, and HERE, for more information on adrenal health.
Practice meditation, even for just 5 minutes at a time, with a quick meditation in the morning, and a refresher to pick your energy back up without caffeine. See my friend Gabrielle Bernstein’s website for great meditation guidance that is easy to follow.
Reduce stress in your life to the extent you can and learn how to internally manage your emotions on the stressors you can’t remove
Practice getting good sleep
Over-exercise contributes to increased cortisol production and hormonal imbalances; dial back on your exercise if PCOS is a problem and you’re highly athletic.
Reduce or remove caffeine include coffee, tea, and if you are sensitive, chocolate; green tea is ok as it has great antioxidants but if you’re caffeine sensitive, skip it too.
Supplements to Nourish the Adrenals
Adaptogens including Ginseng, Schisandra, Ashwagandha, Rhodiola, Rhaponticum, and Maitake mushroom support adrenal function, regulate cortisol, and help to regulate blood sugar and insulin.
Maitake mushroom was specifically shown to induce ovulation in women with PCOS at a dose of 50 mg/day of extract.
3. Balance Your Hormones & Support Natural Hormone Detoxification
Just by improving your blood sugar balance and reducing insulin resistance your hormones will start to find their natural balance. In addition, we want to reduce our environmental hormonal exposure whenever possible by reducing our use of BPA-containing cans, food storage containers and water bottles, cosmetics, body products, household cleaners, and pesticides and herbicides in our foods. Making sure your diet is rich in antioxidant fresh vegetables, especially dark leafy greens like kale and broccoli, and berries like blueberries and raspberries, you’ll boost your own natural detoxification. Making sure you are having a daily bowel movement is essential for eliminating excess environmental estrogens. There are also a number of herbal supplements that can help along the way. These are in the chart below.
Make sure you are having a daily BM; if not, increase fiber up to 30 gm/day by adding in ground flax seed (1-2 TBS/day) or psyllium husk, take a daily probiotic with Lactobacillus and Bifidobacterium strains, and if needed, take magnesium citrate up to 1000 mg/day before bed to get your bowels moving.
Reduce stress (see above)
Eat only organic meats, and avoid dairy but if you must have it, use organic only
Use only environmentally friendly cosmetics, body products, and household cleaners – see the Environmental Working Group for the best options
Avoid exposure to excess environmental estrogens by drinking out of glass bottles and storing your food in glass containers instead of plastic; choose foods that are not in soft plastic wrap whenever possible
Supplements to Balance Hormones
Peony and Licorice Combination (Kan Herbs): reduced testosterone, increased ovulation, improved fertility in women with PCOS. If you cannot find this combination (Kan Herbs carries it and is a reliable company for Chinese herbs), you can use,
Vitex (also called Chaste Berry) Extract: regulates ovulation, increases fertility, and improves progesterone in women with PCOS.
Black cohosh Extract: Improves ovulation and reduces effects of excess androgens in women with PCOS. Dose: 20 mg daily.
NAC is a naturally occurring detox chemical in our bodies, and supplementation has also been shown to improve insulin resistance and reduce testosterone levels as well as hirsutism (unwanted facial hair) in women with PCOS, while improving menstrual regularity. The dose is 600 mg three times/day, for a minimum of 24 weeks.
Supplements that Boost Fertility Medication
CoQ10 taken with clomiphene significantly increases ovulation and pregnancy rates compared to clomiphene alone. Dose: 60 mg three times/day
L-Carnitine taken with clomiphene significantly increases ovulation and pregnancy rates compared to clomiphene alone, and also less to a reduction in miscarriage rates. Cholesterol levels were also improved, suggesting a role in reducing insulin resistance. Dose: 3 gm/day.
Here is a PDF summarizing all of the “natural prescriptions” in this article. I hope this article helps you to find your natural hormonal balance, improve your insulin resistance, and achieve your dream whether that is losing weight, feeling great, or getting pregnant!
To your fantastic health!
References
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Davis A, Christiansen M, Horowitz J, et al. Effect of pinitol treatment on insulin action in subjects with insulin resistance. Diabetes Care 2000;23:1000-1005.
Galletta M, Grasso S, Vaiarelli A, Roseff SJ. Bye-bye chiro-inositol – myo-inositol: true progress in the treatment of polycystic ovary syndrome and ovulation induction. Eur Rev Med Pharmacol Sci. 2011 Oct;15(10):1212-4.
Lydic M, McNurlan M, Bembo S, Mitchell L, Komaroff E, Gelato M. Chromium picolinate improves insulin sensitivity in obese subjects with polycystic ovary syndrome. Fertil Steril 2006;86:243-246.
Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. Nutr Metab (Lond). 2005;2:35.
Nestler J, Jakubowicz D, Reamer P, Gunn R, Allan G. Ovulatory and metabolic effects of d-chiro-inositol in the polycystic ovary syndrome. N Engl J Med. 1999; 340:1314-1320.
Nordio M, Proietti E. The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone. Eur Rev Med Pharmacol Sci. 2012;16(5):575-81.
Oner G, Muderris I. Clinical, endocrine and metabolic effects of metformin vs N-acteyl-cytseine in women with polycystic ovary syndrome. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2011;159:127-131.
Raghuramulu N, Raghunath M, Chandra S, et al. Vitamin D improves oral glucose tolerance and insulin secretion in human diabetes. J Clin Biochem Butr 1992;13:45-51.
Romm A. Botanical Medicine for Women’s Health. St. Louis, MO: Churchill Livingstone; 2010.
Thys-Jacobs S, Donovan D, Papadopoulos A, et al. Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Steroids 1999;64:430-435
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