Part 4: PCOS and Menopause
What are common symptoms of PCOS? Weight gain or trouble losing weight, irregular menstrual cycle or fertility issues, blood sugar imbalances, ovarian cysts, oily skin and acne, increased facial or body hair (hirsutism), hair loss from the head, mid-cycle spotting, heavy menstrual bleeding, heavy menstrual cramps, low sex drive, and chronic fatigue. Note- not all women have the same symptoms, as symptoms depend on the root cause of the condition! There are 4 main types of PCOS:
1. Insulin Resistant PCOS (includes Androgen dominance): With insulin resistance PCOS, the body becomes resistant to the hormone insulin. This means that the body is unable to utilize carbohydrates for energy sufficiently, which can result in weight gain, hormonal imbalances, blood sugar dysregulation, and inflammation. When you have elevated blood sugar, this causes your pancreas to secrete more and more insulin. This is an attempt for your body to get your blood sugar levels back down to normal. However, if insulin can’t do its job, blood glucose remains elevated, and the pancreas continues to output insulin. The extra insulin plus the high levels of blood sugar lead to hormonal and metabolic chaos in your body. This causes inflammation along with abnormal fat and glucose metabolism, which contributes to weight gain, fertility issues, the development of Type 2 diabetes, as well as cardiovascular disease.
A few suggestions for helping to increase insulin sensitivity and making sure to follow the overall PCOS suggestions include: Stay Active: Incorporate weight training and moderate intensity cardio into your life at least three times a week. This will enhance insulin sensitivity in your body, specifically by increasing the amount of GLUT4 receptors (what helps glucose enter your cells) in your cells and number of mitochondria. What does this mean for you? Help with insulin sensitivity, fuel utilization, and a happy metabolism. Fix your diet: Avoiding refined carbohydrates, added sugars, processed vegetable oils, and trans fats. Pay attention to what foods you are eating and focus on filling up your plate with ½ fruits and vegetables at each meal, the other ¼ complex carbohydrates, and then ¼ lean sources of protein. Strive to follow a whole foods, anti-inflammatory diet. Balance your blood sugar: This is essential to help regulate your blood sugar and insulin levels. To do this, make sure to always pair a carbohydrate with a good source of protein (about 15 g) and/or a fat (about 10 g). A great smart snack idea would be half of a banana with 1.5 tbsp almond butter, or 3 oz berries with ½ cup low fat Greek yogurt. Find foods that you enjoy and that make you feel good. Try to eat every 4 hours unless you practice a specific type of intermittent fasting. Supplement smartly: My favorite supplements for blood sugar include Myoinositol (6 g/day), Berberine (500-1000 mg/day), Magnesium (300-400 mg/day), Chromium (200-400 mg/day), Zinc (20 mg/day), Alpha lipoic acid (100-200 mg/day), Vitamin D (2000-5000 IU/day) and Gymnema Sylvestre (500-1000 mg/day) ****Remember to work with a healthcare practitioner***. Many companies make “glucose disposal agents” that incorporate insulin sensitizing herbs and dietary ingredients that may help the body to use glucose. These can be helpful and some are clinically effective. Supplements, especially those that enhance insulin sensitivity, can have undesired side effects, including gastrointestinal upset, headaches, fatigue, and may cause low blood sugar.
2. Post- Pill PCOS: Step 1- Replenishment: This includes replenishing the micronutrients that are commonly depleted by hormonal birth control. This includes: Zinc, Magnesium, B6, Vitamin C, and Folate. An anti-inflammatory diet with sufficient energy intake is imperative, as under-eating (i.e. dieting) for many can hinder your cycle from returning. A great way to replenish is to take a prenatal supplement (with methylated folate which is more readily absorbed) and to optimize your diet with plentiful (and a variety of) fruits and vegetables. Step 2- Removal: This is where you want to focus on removing the synthetic estrogens and/or progestins within your BC. Natural foods that help enhance liver detoxification include: cruciferous vegetables, garlic, onions, raw carrots, berries, citrus fruits, leafy greens, flaxseed, walnuts, beets, green tea, and apples. Herbs can be powerful aids as well, including milk thistle, rosemary, fennel, turmeric (active component is curcumin), parsley, ginger, dandelion root, mustard seeds, goldenseal, artichoke, chicory, and wormwood. Again, please speak with a healthcare professional before starting any new supplement. You also want to focus on removing your specific food intolerances as well as endocrine disruptors from your environment. Endocrine disruptors include: BHA, BHT, BPA, parabens, phthalates, fragrances, sulfates, sulfites, plastics, and dioxins.
3. Adrenal PCOS: this dysfunction can result from either high cortisol, low cortisol, or a combination of the two, called adaptive cortisol. Symptoms of adrenal dysregulation include: trouble falling or staying asleep, feeling “tired but wired” at night, chronic and constant fatigue, blood sugar crashes, mood swings, body fat concentrated around your abdomen, and constant salt or sugar cravings. In general, addressing stress, ensuring adequate sleep, prioritizing your diet, and balancing your blood sugar can be critical in helping bring cortisol levels back to a healthier place. Using adaptogens can also be extremely helpful, however you can not “out-adaptogen” or out-supplement adrenal dysfunction. You have to make sufficient dietary and lifestyle changes.
4. Inflammatory PCOS: In this case, inflammation is the root cause of your menstrual cycle irregularities. Inflammation can come from the diet via: poor micronutrient intake, inflammatory foods (such as processed vegetable oils, fried foods, excess added sugars, processed meats, too much saturated fat), intake of individual food intolerances (or supplement intolerances- yes they exist!), or excessive food intake. Inflammation can also come from gut dysbiosis or infection, as well as your environment, endocrine disruptors, heavy metals, mold, pollution/exhaust, and excess minerals such as fluoride, calcium, or iron. Infections or viruses, especially stealth infection like Epstein Barr or Lyme disease, can cause underlying low-grade systemic inflammation. Commonly, inflammation does not have one sole root cause. Inflammation is like a little cup that will continue to fill up, then produce havoc and symptoms when the cup overflows. The key is to reduce what you can from adding into your cup. The treatment for inflammation depends on the source. However, it’s also important to follow an anti-inflammatory diet, focus on stress management, ensure adequate sleep, balance your blood sugar, and use exercise to help instead of harm your body (as inflammation can be from overtraining or under-recovering). Helpful supplements for lowering inflammation include: curcumin, omega-3s, N-acetyl-cysteine, glutathione, bromelain, ginger, alpha-lipoic acid, resveratrol, Boswellia (frankincense), cat’s claw, vitamin E, and pycnogenol. Having low levels of vitamin D and magnesium may also contribute to inflammation
Menopause:
Peri menopause is referred to by many women as “the years of hell.” From mood swings, hot flashes, and difficulty sleeping, to chronic fatigue, the symptoms can be quite crippling. Diet also plays a huge role, and ensuring to eat an anti-inflammatory diet with a focus on reducing added sugars and processed vegetable oils can help to reduce inflammation, which can exacerbate symptoms. Focusing on nutrients such as omega-3s, B-vitamins, zinc, magnesium, and vitamin E is also important. The author found in practice that some women also benefit from a moderate to low-carb diet as estrogen levels drop because low estrogen decreases your body’s ability to utilize glucose. Remember the roles of both estrogen and progesterone in your body beyond their functions for reproduction? Estrogen is powerful in preserving bone mineral density and reducing the risk of cardiovascular disease. Progesterone increases your metabolism, helps your body use fat for energy, and enhances your sex drive. Losing the power of these two hormones naturally results in an increased risk of cardiovascular disease and osteoporosis, which estrogen levels protect during reproductive years, as well as an increased risk of endometrial cancers and reduced metabolic rate, which result from the reductions in your progesterone levels. Additional changes common during menopause include increased levels of abdominal body fat, loss of lean muscle mass, increased levels of cholesterol, higher blood pressure, increased occurrence of UTIs (urinary tract infections), and urinary incontinence.
