What is PCOS?
Polycystic Ovarian Syndrome (or PCOS) is characterized by cysts on the ovaries and usually, insulin resistance. It’s the most common cause of infertility in women and estimated to affect 5-15% of menstruating women depending on the criterion used for diagnosis. Women with PCOS often have high levels of androgens, a class of hormone that includes testosterone and DHEA. Androgens control libido, mood, and self-confidence, but high levels in women block ovulation.
High levels of androgens are less common in women after menopause as ovarian production declines. Therefore, PCOS and high levels of testosterone are much more common in women of reproductive age. PCOS is also more common in overweight women than in lean women.
Symptoms of PCOS include irregular periods (when your cycles are longer than 35 days a part), fatigue after meals, acne, unwanted hair growth (on face/jaw, breasts, and chin) inability to lose weight and sugar cravings.
PCOS is diagnosed with the help of blood tests or by ultrasound that looks to see if you have cysts on your ovaries and if they are enlarged. Common blood tests include looking at testosterone and DHEA levels in the blood. They also include a test that confirms lack of ovulation by measuring levels of luteinizing hormone (LH). There is not one diagnostic test that confirms PCOS. It’s also important to realize that not all women with PCOS have elevated androgens.
PCOS and Insulin Resistance
It’s estimated that 50-80% of women with PCOS have high testosterone AND high insulin levels. Having high insulin levels is indicative of insulin resistance, when the cells of the body lose their sensitivity to insulin. This can increase your blood glucose levels and make weight loss difficult.
Insulin’s job is to store calories (especially those from carbohydrates) in our cells for later. Once our liver and muscle cells get enough, carbohydrates get converted into triglycerides and are packed away in our fat cells.
Insulin also tells the ovaries to produce more testosterone which contributes to excess androgens in the blood and more free testosterone.
Eating for PCOS
Reversing insulin resistance and regulating blood sugar levels are key goals for dietary maintenance of PCOS.
Eating a low glycemic diet may reduce androgen levels by up to 20%. It’s important to focus on eating enough fiber (we recommend at least 30 grams daily) to support gut and hormonal health/detoxification. Eating enough fiber helps to prevent recirculation of hormones by making sure they are eliminated through daily bowel movements.
It’s important to avoid high sugar/highly processed foods that convert to sugar quickly as they can worsen insulin resistance.
Regulating blood sugar levels with protein and healthy fats will help reverse insulin resistance, aid in weight loss and reduce ovarian production of testosterone.
Foods to eat every day: Eggs, Salmon, Avocado, Berries, Leafy greens, Flax seed, Walnuts, Almonds, Chickpeas, Olive oil
Foods to avoid eating every day: High glycemic/processed carbohydrates (pasta, white potatoes, white rice, crackers, chips, pretzels, cereals, etc.), Red meat, Cured/processed meats, Vegetable/Seed oils
Supplements for PCOS
What is on your plate can go a long way to helping with PCOS. However, sometimes some targeted supplemental therapies designed to improve insulin sensitivity and reduce inflammation can be helpful. Here are some of our favorites!
Chromium – A mineral shown to improve cellular response to insulin that can help reduce glucose and insulin levels in those with PCOS. We recommend trying 500 mg daily of chromium picolinate. Chromium is also found in foods like eggs, nuts, and broccoli!
Berberine – Berberine is an herbal supplement derived from the herbs barberry and goldenseal. Studies show berberine may even be more effective than Metformin in lowering blood sugar and both total and LDL cholesterol. Berberine may also help with weight loss in those with PCOS. It can also increase sex hormone binding globulin (SHBG) which can help reduce free testosterone. We recommend taking 500 mg of berberine 3x/day for 8 weeks.
Alpha-Lipoic Acid – Alpha lipoic acid (ALA) is an antioxidant that helps reduce oxidative damage and has been shown to improve blood sugar control and inflammatory markers. Because it is both fat and water soluble, ALA helps to improve the function of other antioxidants in the body as well. One study found that 400 mg of ALA daily for 12 weeks improved insulin sensitivity and decreased BMI and triglycerides. Alpha lipoic acid in combination with inositol shows promise in improving fertility as well. Women who supplemented for three months prior to an IVF cycle had more mature eggs and had better reproductive outcomes.
Inositol – Inositol is a member of the B vitamin family that is shown to be deficient in women with PCOS. Studies show promising results on its effect on insulin sensitivity, reduction in free testosterone levels, triglycerides and blood pressure after 8 weeks of use. Inositol is found in two forms: myo-inositol and D-chiro inositol. We recommend 2 grams daily of Myo-inositol and 600 mg daily of D-chiro inositol. Interestingly, the combination of inositol and alpha lipoic acid has been found to be more effective than metformin at reducing androgen and insulin levels and improving BMI.
Vitamin D – Vitamin D has been found to be deficient in many women with PCOS perhaps due to certain genetic variations. Vitamin D deficiency may worsen insulin resistance and contribute to the impairment of ovarian follicle development as well as progesterone production. Studies have been mixed on whether Vitamin D plays a causative role in the development of PCOS. However, because of the many roles Vitamin D plays in our heath (hormonal, metabolic, immune and brain health) we recommend testing your Vitamin D with a blood test and supplementing if levels are below 50.
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