THE FOLLOWING RECOMMENDATIONS ARE INCLUDED IN MY PCOS PROTOCOL. KEEP IN MIND THAT YOUR UNIQUE GENETIC SITUATION AND RISK FACTORS MAY REQUIRE ADJUSTED DOSES AND/OR DIFFERENT INTERVENTIONS. PLEASE CONSULT YOUR HEALTHCARE PROVIDER AND WORK WITH A NUTRITION PROFESSIONAL YOU TRUST.

PCOS+nutrition+what+to+eat+insulin+resistance+genetics+stress.jpeg — Polycystic Ovarian Syndrome is the most common endocrine condition in women, and it has strong effects on metabolic function, mood, and fertility. It is diagnosed when you have **2 out of these 3** symptoms:
high levels of androgens
irregular or missed periods
cysts on your ovaries (which aren’t really cysts, but that’s what they’re called)

THERE IS ANOTHER CONDITION CALLED HYPOTHALAMIC AMENORRHEA THAT CAN ALSO PRESENT WITH IRREGULAR/NO PERIODS AND OVARIAN CYSTS. IT’S IMPORTANT TO GET AN ACCURATE DIAGNOSIS, AS NUTRITION THERAPY AND MEDICAL TREATMENT CAN DIFFER SIGNIFICANTLY.

If you have PCOS and you want to understand how to support your health with nutrition, this is the blog for you! Let’s dive into the underlying causes of PCOS so you can understand how my solutions will work in your body.

3 Underlying Causes of PCOS

PCOS is commonly misunderstood, but what we do know is that there’s not one single reason why people get PCOS. And, there are different types of PCOS, which means that treatment is not one-size-fits-all. Here are the most common causes and how they interact with each other.

1) GENETICS

Our genes have a strong effect on so many things about our bodies, included hair color and texture, height, weight, and disease tendencies. In my experience, most people view genetics as a problem that can be overcome with enough hard work (when it comes to disease), OR they view genes as an unchangeable facet of their bodies. The truth lies somewhere in the middle.

Some genetic traits, like hair color, eye color, skin color, and the shape of your nose are unchangeable. In the future, there will most certainly be ways to pick and choose these things for your offspring, but for now, we’re stuck with them. Heart health, addictive tendencies, body size, metabolic function, and immune issues often run in families because of a genetic component.

However, many MANY genes are highly influenced by external factors, such as stressful events, nutrition, balanced movement, and sleep quality. Most acquired chronic illnesses (not those you can be born with, like an enzyme dysfunction or a hole in your heart) occur because your had the right genes AND your environment activated those genes.

What’s interesting about PCOS and genetics is that researchers have identified an early genotype that resulted in women with superior physical strength, reduced thermogenesis, and lower pregnancy rates. It is likely that this genotype was passed down because these women were more likely to survive harsh conditions. And today, 20-40% of females with PCOS have a first-degree relative who also has it.

So if you blame genetics for your PCOS, you’re right! …sort of. Unfortunately, you got the short straw. That doesn’t mean that you were destined to have fertility problems. It does mean you’ll have to work harder to have a healthy cycle and metabolism.

2) INSULIN RESISTANCE

Insulin resistance occurs when your cells slow the acceptance of insulin during metabolism, and excessive insulin builds up as a result. Say you eat a donut or a bagel - your cells need insulin to properly process the carbohydrates. If your cells stop effectively responding to insulin, two problems occur: your blood sugar stays elevated and you have excessive insulin floating around.

Some people say that PCOS causes insulin resistance…and that’s true. But it is also true that insulin resistance causes a cascade of effects that can trigger or exacerbate androgen production, causing or worsening PCOS. It’s a “which came first, the chicken or the egg” situation. Some people don’t get insulin resistance until after they have PCOS for a while. Others start having the symptoms of PCOS a few months or years after they exhibit signs of insulin resistance. Either way, it is a major player in determining the severity of your symptoms.

Insulin stimulates ovaries to produce androgens, including testosterone. Excessive androgens keep your follicles from becoming mature eggs, which means they tend to stay on your ovaries instead of go through the process of ovulation. These dysfunctional follicles become the “cysts” on your ovaries. If your healthcare provider has determined that you have this symptom of PCOS, insulin resistance is the primary cause.

High insulin also leads to increased abdominal fat, raised triglycerides, and lowered HDL. Each of these symptoms play a role in creating increased risk of cardiovascular disease, diabetes, sleep apnea, and liver disease. If you have insulin resistance, you probably also have energy spikes and crashes because of your irregular blood sugar levels. So even if you don’t have ovarian cysts, it’s important to consider the impact that insulin resistance has on your health. In order to reduce your risk of morbidity (fancy word for disease), consider insulin resistance to be your primary foe.

3) STRESS

If you haven’t read my blog on stress and cortisol, go check it out! Cortisol is released when you experience emotional or physical stress, and cortisol increases the production of androgens (leading to insulin resistance and follicular cysts). It is often high in people with PCOS. This could be for a variety of reasons, but one theory is that stressful events, such as Adverse Childhood Experiences (ACEs) trigger the expression (activation) of the genes involved in PCOS. One large clinical study showed that women with PCOS were twice as likely to have more than 4 ACEs, and also had increased rates of depression, anxiety, and PTSD. This is SO important to consider when supporting your PCOS.

Increased production of cortisol can also cause the reduced production of progesterone, which tends to be low in people with PCOS. Progesterone influences mood and is an important hormone in the early stages of conception. Even if you ovulate just fine, if your progesterone is too low, you won’t be able to carry the pregnancy to term.

Finally, stress influences estrogen production. It can cause poor estrogen metabolism in the liver, leading to estrogen dominance and a host of not-fun symptoms. Estrogen dominance is related to oxidative stress, which is associated with cardiovascular disease and impaired metabolism. If stress is high for an extended period of time, it can cause estrogen to become too low, eliminating ovulation altogether.

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Ok, now for some good news.

How to optimize your genetic expression

The awesome thing about the genes influenced by external factors is that you can change some of those factors! Not everyone has the same access to these changes, so use compassion with yourself and others. Here’s the list of lifestyle factors that you can potentially use to your advantage:

Nutrition - targeted food and supplements that improve insulin sensitivity, improve androgen/estrogen/progesterone balance, reduce oxidative stress, and reduce risk of comorbidities
Movement - Resistance training, gentle cardio, and stretching all support normal insulin and androgen production.
Stress management - Anything that helps you feel happy or relaxed can improve hormone balance.
Sleep quality - Sleep affects insulin sensitivity big time. It can also make or break your movement and food routine.

If you’ve experienced any physical or psychological trauma, the after-effects are still causing symptoms in your body. That’s why it’s important to pursue mental health care as well as take practical physical steps to support hormone balance. I highly recommend working with a therapist who specializes in trauma, PCOS, or HAES. You can find some great ones here.

Now for the details:

5 nutrition solutions for PCOS

You can do a LOT with food to reduce insulin resistance and improve metabolic function. Here are some basic guidelines:

1) INCREASE INTAKE OF ANTIOXIDANTS

Insulin resistance is associated with increased oxidative stress, which can contribute to many symptoms of PCOS. Antioxidants help reduce oxidative stress and keep from getting out of control. Antioxidants help prevent tissue damage and hormone imbalances, as well as reduce delayed conception time and implantation. The easiest way to do this is increase your intake of veggies and berries, and consider taking a supergreen/superred powder or a superoxide dismutase supplement. Here’s my blog on the perfect smoothie and another one on cooking root veggies to give you a few ideas. I also love Oxylent’s effervescent multivitamin because it includes SOD, which has very strong antioxidant properties. #notanadd I just really like it!

2) CONSUME MORE VEGETABLE PROTEIN AND LESS ANIMAL PROTEIN

This will naturally increase your fiber intake, which reduces oxidative stress and improves insulin sensitivity. Fiber also helps eliminate excess cholesterol by binding to it and processing it through waste. Finally, fiber promotes satiety so over eating is less likely to occur, which also supports insulin and lowers cholesterol.

Try using black beans to make a burger patty, or increase your veggie-to-meat ratio in a stir fry or salad. I should also note that being vegan/vegetarian does not necessary work better for PCOS than being omnivore, as other genetic traits influence your body’s preference for/against meat. That’s why it’s important to listen to your body’s feedback when you try something new. One of my favorite veggie recipe blogs is Angela Liddon’s Oh She Glows. All the recipes are vegan, but you can add meat/dairy/eggs as needed to fit what your body needs.

3) REPLACE TRANS FATS, SATURATED FATS, AND PROCESSED/HYDROGENATED FATS

Monounsaturated fats and high quality polyunsaturated fats should make up the majority of your fat intake. These fats improve hormone production (they are literally the building blocks of your hormones), help you stay sane (reduce anxiety and depression rates), and improve exercise recovery (less cortisol production? Yes please!).

Fat quality is SO important when you have high internal levels of oxidative stress, because trans and hydrogenated fats have higher levels of oxidation already. This creates too much inflammation in your cells, making normal cellular function a challenge. The Omega 3 fats are especially helpful for prenatal health, as they improve blood flow to uterine arteries and can hep prevent miscarriage and postpartum depression. Click here to read more about fat types and how to cook with them. For the majority of my clients with PCOS, I recommend a high dose EPA omega 3 supplement like this one from Nordic Naturals (at least 1500 mg omega 3), or (if you really like fish) eat wild salmon 4 times per week.

4) REDUCE OR ELIMINATE CAFFEINE

I know. I love coffee too. The problem is, it changes follicular and adrenal function, contributing to changes in hormone production and normal cycles. It also acts as a diuretic, giving you less time to absorb nutrients before they are flushed out of your body. If you want to get the most nutrients out of your food intake and avoid unnecessary supplements, reducing caffeine is your best bet.

Caffeine can also make your pre-period symptoms (like mood swings, cramps and low energy) worse. Quantity of caffeine is directly correlated to pregnancy rates in women with PCOS, so it’s especially important to reduce or eliminate your intake in the 3 months prior to attempting to conceive. So what to drink instead? Here’s a blog exploring all sorts of teas (avoid licorice though). I also love Rasa (which has ingredients that support your hormones!) and mushroom golden milk or hot chocolate . Or just drink high quality decaf!

5) REDUCE OR ELIMINATE ALCOHOL

Another bummer if you’re one who enjoys a good drink with friends. Alcohol inhibits estrogen metabolism in the liver, leading to estrogen dominance. This can cause decreased follicular function and infertility. Alcohol also contributes to insulin resistance, alters liver processing of medications and supplements, and is terrible for sleep quality.

To get a better idea of what this would look like, log for one month how often you drink, what you drink, and how many drinks you have in one day. Notice patterns, like if you only drink on the weekends but you drink a lot of mixed drinks or liquor, or if you have a glass of wine every day after dinner. The frequency and the volume matter. Then see if you can cut your intake in half. So if you tend to have 2 drinks after dinner, just have one. Or if you drink 3-4 drinks both weekend days, only drink on one of those days. Then find other fun ways to celebrate your time! This company makes some fun alternatives to mixed drinks.

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Beyond the basics…

These 5 solutions are often just the beginning for my clients with PCOS, but they can make a big difference in how well other solutions (supplements, breath work, sleep hygiene, movement) work to resolve symptoms and improve health outcomes. If you’re just getting started in your wellness journey, start with these things first (after confirming with your doctor).

If you’re already consistent with these things and aren’t sure what to do next, consider investing in a nutrition professional who can help you navigate your specific version of PCOS and build a comprehensive plan to feel your best. Depending on where you live, that professional could be me! Send me a message and I’ll let you know if I can take clients in your state/country. If I’m not the right person to help you, I’ll recommend someone in your area.

TO HEALTH AND HAPPY HORMONES,

~ Sarah

5 NUTRITION SOLUTIONS FOR PCOS