Are you one of the 5-10% of women diagnosed with Polycystic Ovarian Syndrome (PCOS)? If so you are in good company, as this is by far the most common reproductive disorder I see in my nutrition practice.
So what is PCOS? First, it is not a disease but a syndrome - meaning there are several symptoms that tend to collect together to cause malfunction and imbalance for our reproduction. With PCOS, the most common symptoms are:
Menstrual Irregularities - this ranges from long, heavy periods to irregular and scant to no periods at all (amenorrhea). This can lead to fertility trouble when trying to conceive, as ovulation is typically absent as well. This is usually the reason women go to their OB-Gyns and start the process toward diagnosis.
Hormonal imbalance - Elevated levels of insulin, and androgens (male hormones) lead to high blood sugar levels, facial hair growth and acne.
Difficulty with weight - Let’s be real, weight loss is never easy. However PCOS ladies tend to have even more difficulty losing weight if overweight, and tend to collect fat around the belly at a faster rate than those without the disorder.
Ovarian cysts - as the name suggests, some women have cysts on their ovaries that can be small and painless, or large and painful and potentially dangerous. Not all women with PCOS actually have cysts, in fact most of my patients do not.
Getting to the root
Insulin resistance with high blood sugar is understood to be one of the main drivers of PCOS. Put simply, higher than normal levels of insulin causes a change to the way the ovaries secrete hormones. This irregular output of hormone levels - both too high and too low - then cause the symptoms listed above. So, to control this and improve ovarian function the typical lifestyle change is to limit carbohydrate intake, exercise and work on weight loss. Metformin is a diabetes drug that is commonly prescribed to bring down blood sugar and can help with weight loss as well. That’s typically all a newly diagnosed woman with PCOS will hear about lifestyle and dietary changes.
That’s cool, but…. let’s dig a little deeper. PCOS isn’t just about carbs. Why does one become insulin resistant in the first place? There are a few likely scenarios…
“Low grade inflammation” is at the heart of many chronic conditions (think heart disease, diabetes, cancer, etc) and PCOS is among those. We know this because women with PCOS tend to have high levels of certain blood tests that indicate chronic inflammation (CRP and ESR). Inflammation is the set of events that are triggered by some type of injury or insult to the body, with the ultimate goal of healing. If you cut your hand while cooking, your immune system “healer” cells travel to your injury to work on fixing it, and you may notice the typical signs of heat, redness, and puffiness to the affected area. Chronic / low grade inflammation is the same process, except on a less dramatic and visible scale. In chronic inflammation the injury to the body is constant but small, and the inflammatory response never turns off. Instead you stay in an inflamed state, but on a much smaller scale.
What types of injury contribute to this inflamed state? A bunch! Too much sugar and refined grains and oils, not enough colorful vegetables and omega-3 fats, smoking, excessive drinking, infections, obesity (especially around the middle), as well as the state of our digestion (see below). These habits and conditions generally lead to a state of unwell, and PCOS can start to brew.
Stress is an extremely under-appreciated element of wellness and health. When we are constantly worried, stressed, anxious we are releasing the stress hormone cortisol from our adrenal glands. This hormone is essential under acute stress (like running away from a tiger), but starts to cause havoc when elevated for too long. If your cortisol is elevated consistently for a long time, this leads to high blood pressure and blood sugar, weight gain around the middle, carbohydrate cravings, decreased libido and immunity. So this stress can drive the impaired immunity and insulin resistance related to both chronic inflammation and PCOS. We’ve come full circle.
It’s important to note here that stress doesn’t just mean feeling “stressed out.” Other habits also cause the body to be in a stressed state - most notably lack of sleep- measured in quality or quantity. When we aren’t getting enough hours (7-9 hours nightly) or those hours are very interrupted, we will also be in a state of chronic stress with the same symptoms outlined above. Similarly, excessive high volume and intensity exercise not balanced with enough restorative movement and sleep falls in this same category.
The gut microbiota (aka the “good” bacteria that reside in the large intestine) is a hot area of research and nutrition right now. Dysbiosis of the gut - too many “bad” bacteria and not enough “good” bacteria is usually caused by a low fiber diet and/or overuse of antibiotics. Not only can this lead to a lot of digestive symptoms, but also activate the immune system that regulates inflammation and contributes to the whole cycle of inflammation - insulin resistance - hormonal disruption.
Phew. That was a brain-full. So as you can see, PCOS is not just a “carbohydrate and hormone” problem. Your body requires an intricate balance of hormones, nutrients and rest to stay in balance and when one or more of these things are off, issues such as PCOS can start to brew.
Stay tuned for part 2 of this series where I discuss foods that help balance blood sugar and inflammation.
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About the Author:
Alison is a Registered Dietitian Nutritionist specializing in a functional nutrition approach to women’s reproductive health. She holds a Master of Public Health in Nutrition from UNC Chapel Hill and has worked with with many women and men to achieve wellness and correct imbalances via optimizing nutrition. She has a passion for helping women through fertility, pregnancy and postpartum struggles using a “food first” nourishing approach wellness and healing.
Duleba, A. J., & Dokras, A. (2012). Is PCOS an inflammatory process? Fertility and Sterility. doi:10.1016/j.fertnstert.2011.11.023
Tremellen, K., & Pearce, K. (2012). Dysbiosis of Gut Microbiota (DOGMA)--a novel theory for the development of Polycystic Ovarian Syndrome. Medical Hypotheses, 79(1), 104–12. doi:10.1016/j.mehy.2012.04.016
Prelevic, G. M., Wurzburger, M. I., & Balint-Peric, L. (1993). 24-hour serum cortisol profiles in women with polycystic ovary syndrome. Gynecological Endocrinology, 7(3), 179–184.