September was PCOS awareness month, and while I'm a little late in getting this post up, I wanted to make sure I published one, as I personally understand the struggles of this increasingly common and difficult female condition.
I was one of the 10% of women who suffer with PCOS (and its related complication of infertility), and as my recovery was entirely nutritionally based, writing this post was near and dear to my heart!
PCOS stands for PolyCystic Ovarian Syndrome and it's the term used in the medical community to refer to a variety of hormonal imbalances in a woman's body which often accompany and contribute to menstrual cycle irregularity and a state of infertility.
Often this condition includes the presence of ovarian cysts; however, the presence of ovarian cysts is not actually a requirement for a medical diagnosis of PCOS, which is primarily characterized by a slew of symptoms, mostly hormonal imbalances - and not just the reproductive hormones, like progesterone, estrogen, LH/FSH, androgens and testosterone - but also thyroid hormones and insulin, which regulate basal body temps, metabolism, blood sugar, fat storage, appetite, and other supporting factors indirectly involved in regulating female hormones. Thyroid and insulin functions provide indirect, but closely related, support for sex hormone production.
Other common symptoms of PCOS may include painful, irregular or absent periods, lack of ovulation, acne, abnormal or increased hair growth, thyroid conditions, irregular or inadequate hormone levels or ratios, and an excess or deficiency of body weight and/or body fat.
THE PRIMARY CAUSE OF PCOS: INSULIN RESISTANCE + CARB INTOLERANCE
PCOS is becoming alarmingly prevalent in the U.S. and other westernized countries with a diagnosis rate of 1 in 10 women, but it's a relatively "new" condition. The medical community admits that an in-depth understanding and successful treatment methodology for PCOS has not been fully developed. Current pharmaceutical treatments available for PCOS are not highly successful or adequate in scope to reverse the condition.
What is clear and undisputed in the current scientific and medical research is that PCOS is a highly complex issue and that women with PCOS almost always have some degree of blood sugar handling problems characterized by an excess of insulin (hyperinsulinemia) and carbohydrate intolerance -- be it the first stage of insulin resistance, a more advanced stage of pre-diabetes, or a full-fledged form of diabetes (usually type 2). This is why Metformin or Glucophage -- which are diabetes medications -- are frequently prescribed to women with PCOS, though the effectiveness of these medications on PCOS (even in combination with hormonal therapies and/or fertility promoting drugs) is not impressively high and is not considered a primary use of the drug.
Insulin resistance, which, in its advanced form presents as pre-diabetes and diabetes, is caused by the body's inability to properly process an excess of carbohydrates and sugar. In response to chronically high blood sugar levels, the body pumps out excess insulin. Insulin has two primary functions -- 1) regulating blood sugar levels by transporting blood glucose (sugar/carb in its most broken down form) into cells, 2) converting an excess of glucose energy into triglycerides (fat) for future use.
Like the female sex hormones, insulin is a hormone, and its production is managed by the HPA axis, the director of the endocrine system. Proper blood sugar management and insulin regulation/production, while not directly utilized in sex hormone production, must be in solid working order to allow ample back-up, support and resources to be available for sex hormone production, which relies heavily on sterols derived from healthy fats (cholesterol). In a state of insulin resistance, prediabetes or diabetes, a high intake of low-nutrient, low-fiber carbs and sugar (think breads, cereals, pastas, pizzas, desserts, crackers, chips, juice, soda, candy, sugar, sweetened food/drink, potato products, etc) has created a blood sugar level crisis that requires an overproduction of insulin to keep blood sugar levels stable. When this occurs, much of the endocrine system's resources are shifted away from sex hormone production and allocated instead to managing blood sugar, creating the state of mild to severe hormonal imbalance prevalent in PCOS.
PCOS + NUTRITION - THE PROBLEM IS THE SOLUTION
Nutritional is the biggest underlying cause of PCOS and its related in/fertility complications. Fortunately, nutrition is also the most easy, risk/side-effect-free, affordable, and effective solution for PCOS.
PCOS and its in/fertility complications can be resolved by nutrition + lifestyle changes alone. I can personally, professionally, and academically testify to this - and it's a major reason why I became a holistic nutritional therapy practitioner. I took artificial + bio-identical hormones, Metformin and Spironolactone for years to try to resolve my PCOS and infertility issues. Nothing worked and the side effects were awful. Eventually, I stopped and sought alternative treatments - nutrition was the only thing that worked for me.
And, as it turns out, I'm not the only one. The scientific research absolutely supports the effectiveness of nutritional therapy in reversing insulin resistance, PCOS, hormonal imbalances and infertility, specifically a whole-foods, low-carb diet.
When we look at the drastic rise in consumption of processed and refined carbohydrates and sugar over the last few decades, we see exactly how PCOS -- a condition of insulin resistance, carb/sugar intolerance, and nutrient deficiencies -- has become widespread right along with alarming increases in type 2 diabetes. Compound this with the energy and nutritional deficiencies resulting from a low intake of healthy, whole-food sources of carbs, fats and proteins, and we have the perfect setup and even greater propensity for PCOS and related in/fertility complications.
Because of this, most women (my former self included!) who have struggled with PCOS and related in/fertility complications are not consuming the right balance of macro (and micro!) nutrients to sustain stable blood sugar levels, stave off insulin resistance, and provide the right amount of energy + nutrients for their fertility needs. They need to readjust the type, amount and ratios of carbs, protein and fat they are consuming to better support their body and reduce insulin resistance.
NOTE: It's important to note that PCOS affects women of all sizes -- but the basic nutritional imbalances (usually a macronutrient profile too high in refined, low-nutrient, low-fiber carbohydrates and lacking in select types of protein and fat) are often similar for all women, despite size.
Fortunately, because nutrition is the problem, it is also the solution. There is real hope for PCOS reversal through sustained nutrition.
MACRO BALANCE: A FIRST STEP IN REVERSING pcos
The single most important change a woman can make to combat PCOS at home is to rebalance the ratios in which she consumes carbs, proteins, and fats so that she can decrease chronically elevated blood sugars and insulin resistance, while increasing hormone-supporting nutrients.
Most women who come into my office are consuming a diet too high in carbohydrates and too low in protein and/or fat - usually they're getting >50% of their daily calories from carbohydrates, and <20% from protein, and the rest from fats. If we want to support healthy female hormone production (not to mention healthy body weight and freedom from diabetes!) these ratios will just not do!
Women with PCOS need to go on a low(er)-carb diet that eliminates all sugar, processed and refined carbs at a minimum, including low-nutrient, low-fiber foods like breads, cereals, pastas, pizzas, desserts, crackers, granola bars, chips, juice, soda, candy, sugar, sweetened food/drink, dried fruit, potato products, etc. Depending on the woman's unique bioindividual nutrient profile, energy + nutrient needs, and severity of insulin resistance and carb intolerance, she may even need to be on a very low-carb diet, eliminating even healthier forms of grains. beans, rice, potatoes, starches and even fruit). Other women may be able to tolerate (or even need) some of these healthy carbs.
However, women should be careful not to go too low-carb, as it can have a undesired rebound effect in some women -- if a woman's body senses an energy shortage (or even just perceives the possibility of an energy shortage), it may go into starvation mode and shut down non-vital body functions, like thyroid and/or sex hormone production. It may not be able to get the energy or nutrients it needs.
It's important to remember that our human and metabolic bioindividuality makes the carb threshold different for different women. While a ketogenic diet might be right for one woman, it can be harmful for another. It's often helpful to work with a nutritional therapy practitioner to assess and determine this threshold -- and make sure the right number, ratio and type of carbs are consumed.
When we lower the percentage of carbs consumed, we naturally must increase the percentage intake of protein/fat -- and this is extremely helpful to sex hormone production, provided we're consuming nutrient-dense varieties. Sex hormones are manufactured from fats and proteins, and ample intake of both are crucial in restoring hormonal balance and in both supplying nutrients and assisting in their uptake. A woman who doesn't consume enough animal meat protein and healthy, whole-food fats (from olives, avocados, animal fats, raw nuts/seeds) will struggle with hormonal imbalance and insulin resistance, regardless of her size. Low-fat (<30%) and/or low-protein diets (<20%) are not supportive of hormone balance or PCOS recovery, and may perpetuate the condition. Most women need significantly higher intake ratios of protein and fat (and again, the exact figure will depend on her unique nutritional profile).
What's important to remember in adopting nutritional changes is that a state of chronically elevated blood sugars, insulin resistance (or pre-diabetes/diabetes), and nutrient deficiencies were not things that occurred overnight, as a result of one extra banana. Hormonal imbalance and insulin resistance occur over time -- and as such, we shouldn't expect the reversal of these conditions to happen instantly. It may take a few (or more likely, many) months to restore the proper sensitivity to insulin and rebuild nutrient stores enough to permit the body to consistently allocate resources to sex hormone production. But sticking with it will create a happier, healthier and better functioning female body.
(And remember -- as the heading of this section suggests -- rebalancing macros is only a first step in overcoming PCOS. Most women need additional, targeted nutrients support, which I hope to explore more in later posts.)
FINAL NOTE: PCOS + ABNORMAL FOOD BEHAVIORS
In my personal past and experience working in private practice of nutritional therapy, I find that women with hormonal imbalance, PCOS, and/or insulin resistance / pre-diabetes / diabetes very often have or had a disordered relationship with food/drink not limited to: undereating, overeating, binge eating, clinical eating disorders, years of chronic yo-yo dieting, and/or an addiction to exercise, alcohol, caffeine, sugar, carbs or other food/drink.
If you're one of these women (and rest assured, there are many of us, whether we've admitted to it or not), know that abnormal food behaviors are unfortunately not helping -- and could in fact be causing -- your hormonal imbalance, insulin resistance / pre-diabetes / diabetes, and PCOS. Seeking mental and nutritional therapies and support will be a necessary component in restoring your long-term health in mind and body.