This is part 2 to the post on the 4 types of Polycystic Ovarian Syndrome (PCOS) and how to identify which you are dealing with.
If you missed it, give that one a read first by clicking here.
With the conventional approach to PCOS, there are limited treatment options that your doctor may have mentioned...
1. The birth control pill (to 'regulate' your menstrual cycle, when in actual fact it works by shutting down your own natural hormone production)
2. Lose weight by eating less and exercising more (even though this doesn't work for so many women....because HORMONES!)
3. Eat a low carb diet (even though this could make things much worse in some cases)
4. Take medications such as metformin and spironolactone (to reduce symptoms of excess androgens, but these often come with a long list of side effects)
5. Use harsh creams to control your acne and improve your facial hair growth by waxing/shaving/lasers (even though this isn't dealing with the root cause of the issue)
6. If you want to get pregnant, consider fertility drugs like Clomid or IVF (which work to override your body's natural mechanisms)
Don't get me wrong, if these recommendations worked long term for women, then I wouldn't have a problem, the problem is that they don't.
The women who come to see me have been working for years to try and rebalance their hormones, get clear skin, lose weight and have a baby.
They have taken all the medications, used all the creams and followed the lifestyle advice.
But they are still struggling.
The problem is that conventional doctors aren't typically aware of the different PCOS types.
They believe insulin resistance and/or genetics are the problem, hence why factors such as nutrient deficiencies, environmental toxin exposure and stress management aren't mentioned.
In this blog post, I will be covering the top nutrition and lifestyle recommendations, for each of the 4 PCOS types.
*Remember, this advice is meant for educational purposes only, and is not designed to replace that of your health practitioner*
Insulin Resistant PCOS
This is the most common and recognised driver of PCOS and it is thought that 70% of women with this condition, have some degree of insulin resistance. Insulin resistance occurs when our cells become 'numb' to the actions of insulin. This leads to elevated levels of insulin and glucose in the bloodstream, which stimulates the ovaries to produce testosterone and other androgens.
Avoid all refined and processed carbohydrates and sugars such as cakes, sweets, biscuits, flour, pasta and bread. This can all spike glucose and insulin levels, because of their high glycemic properties.
You may also need to limit your intake of 'healthy, complex carbohydrates', such as potatoes, bananas, wholegrains, dates and oats, however this depends on your degree of insulin resistance.
As a general guideline, I like women with blood markers or physical indicators of insulin resistance, to keep their carbohydrate intake to around 50-150 grams per day. You will need to track your intake for the first week or so, to see where you are at. I also recommend starting at the higher end of this range, then slowly reduce your intake, whilst monitoring how you feel and if any symptoms improve.
Timing your carbohydrate intake around exercise is also beneficial as your body is better able to utilise this glucose better during the pre/post workout window. Another easy hack is to consume a tablespoon of raw, unpasteurised apple cider vinegar in 200ml of water prior to eating as this helps with the uptake of glucose too!
Some women with severe insulin resistance do benefit from a short term ketogenic diet, however I don't recommend it for longer than a total of 3 months, or if they are also dealing with adrenal or thyroid based issues.
Ensure you are consuming a source of high quality protein, healthy fat and plant fibre at each meal in order to keep your blood glucose levels stable. I also advise against snacking as this can keep insulin levels elevated, which can further drive insulin resistance and energy storage.
Aim for 3 large, balanced meals per day with 4-6 hours between each. A gentle fast overnight at a minimum of 12 hours and up to 16 hours (depending on the health of your adrenal glands) is also another way to improve insulin sensitivity.
Work on stress management by learning to delegate tasks, say no more often and schedule in self care activities. High cortisol can raise blood glucose levels, therefore triggering insulin release, even when you aren't eating! Meditation, yoga, walking in nature, epsom salt baths, journalling and acupuncture are some of my favourite relaxation techniques.
Make sleep a priority, and aim for 7-9 hours of high quality sleep each night. Studies have shown that just one night of poor sleep can reduce insulin sensitivity by 33%! This means that your body is less able to utilise dietary carbohydrates, so imagine what damage several years (or even decades!) or sleep deprivation could have caused! To learn more about how to get high quality sleep click here , and to find out my number one sleep secret, read this post.
The best types of exercise for insulin resistant PCOS are strength training and high intensity interval training (HIIT). When we build muscle, this helps our body to uptake glucose from our bloodstream without the need for insulin! If you aren't dealing with adrenal issues, you can incorporate HIIT workings into your workout for 10-20 minutes, 2-3 times per week. Throughout the day, try to stay as active as possible and aim for 10,000 steps. Going for a 10 minute brisk walk after eating can really support your insulin sensitivity!
Adrenal PCOS is driven by stress, and often high levels of cortisol, which is our main stress hormone, produced by the adrenal glands. As well as managing our stress response, our adrenals can also produce androgens, just like our ovaries. Stress during childhood, around the time of puberty or in our current lifestyle, may elevate levels of DHEA-S, which is an androgen made uniquely by the adrenal glands. Elevated adrenal androgens can often be a driver (or the result of) the other PCOS types.
Work on your blood glucose control as spikes or crashes of glucose can lead to the production of stress hormones (and androgens), by our adrenals. Avoid long periods of fasting and you may need to eat every 3-4 hours to begin with, while you work on your adrenal health. I recommend listening to your body and eating when you are hungry, but always choosing a balanced snack or meal option.
Women with adrenal based PCOS often tolerate more carbohydrates (if they are not also dealing with signs of insulin resistance), therefore avoid restricting carbohydrates from your diet. Focus on starchy carbs like sweet potatoes, squash, beetroot, plantains, yucca and also gluten free grains like oats, rice, quinoa and buckwheat.
Increase your intake of foods rich in vitamin C (berries, kale, bell peppers, lemon, limes, acerola cherry, kiwi and broccoli) and vitamin B5 (mushrooms, salmon, avocado, poultry, red meat, sunflower seeds and sweet potatoes) as these are two nutrients that are required in high amounts to support the adrenal glands, especially when we have been under chronic stress.
Avoid coffee, at least until your symptoms are under control, as this can be too stimulating for your nervous system and adrenal glands. Swap to herbal teas, which can help to provide medicinal benefit at the same time as hydration. The best caffeinated herbal tea's for adrenal PCOS are tulsi (holy basil), chamomile, lemon balm, valerian and spearmint.
Focus on reducing stressors in your life, whether that is in your work environment, exercise routine, mindset or social circle. If you continue to live a very intense, non-stop lifestyle, then you can expect symptoms to remain. Learn to say no more often, stop over scheduling, be less critical of yourself and cut back on the intense exercise!
Over exercising (or under recovering) is a very common driver of adrenal PCOS, as is under eating or restricting certain food groups, such as carbohydrates. A lot of my clients with adrenal PCOS are type A personalities, who seem to be doing 'all the right things' such as eating 'clean', exercising daily and excelling in their careers.
The best ways to overcome adrenal based PCOS, are to slow down, nourish your body with a lot of nutrient dense foods, opt for lower intensity exercise such as walking, yoga or pilates and learn to manage mental stress. I recommend adding in 10-20 minutes of meditation in the morning as a way to start the day on a more relaxed note. I prefer guided meditation using apps like Calm, Headspace or Insight Timer, as it can be hard to calm the 'overactive monkey mind' in women with adrenal based PCOS.
One way to support the adrenal glands first thing in the morning, is to incorporate 'Sole Water' into your routine. This is pink Himalayan salt charged water which helps to provide your body with electrolytes and minerals, which are needed for optimal adrenal health. You can find a DIY tutorial on how to make Sole, here.
This is usually a temporary state of hormonal imbalance, that can occur after discontinuing hormonal birth control. Women with post-pill PCOS often develop symptoms such as amenorrhea (missing periods), issues with ovulation, cystic acne, oily skin, hair loss and the appearance of 'cysts' on the ovaries. This is because the body has to re-learn how to produce hormones and often times androgens are produced in much higher amounts, mimicking 'true' PCOS.
Hormonal birth control depletes us of so many nutrients that are needed for hormonal balance and fertility, including B vitamins, vitamin C, zinc, selenium and antioxidants. Therefore our diet should be rich in these nutrients, in order to replete deficient stores.
Increase your intake of certain foods such as grass fed red meat, organ meats, pastured eggs, grass-fed butter or ghee, dark green leafy vegetables, oily fish, herbs, spices and berries, as these are packed full of vitamins, minerals and phytochemicals.
Our gut health can also be negatively impacted by hormonal birth control, therefore our diet should be as 'gut friendly' as possible. Avoid inflammatory foods such as gluten, dairy, alcohol, refined sugar and corn, whilst increasing anti-inflammatory, gut healing foods like bone broth, collagen powders, oily fish, soups, marshmallow root, liquorice tea and fermented foods.
(Some individuals, myself included, don't tolerate fermented foods like sauerkraut and kefir, bone broth or collagen powders due to a histamine intolerance. If symptoms such as acne, anxiety, digestive issues or itchy skin worsen, then discontinue)
I think that having patience is probably one of the best tips I can give with this type of PCOS, as it can take several months for the brain to ovary communication, to fully reconnect. Try not to get too stressed about your experience during this time, as that will likely just make things worse!
Continue to work on your gut health by avoiding your exposure to certain medications (unless absolutely necessary), including antibiotics, antacids, painkillers and anti-histamines, as this negatively impact gut health and your hormones.
I also recommend you eat organic food as much as possible, so that you receive more nutrition from your food, plus you will be avoiding pesticide residue which act as a low-dose antibiotic in the gut, killing your good gut bugs. Stick with buying the 'dirty dozen' fruits and veggies organic if you cannot afford to upgrade everything.
Consider adding in some DHT blocking nutrients if your symptoms of androgen excess are really bothering you. Some examples are reishi mushroom, zinc, pumpkin seeds, stinging nettle and spearmint tea. You may also find that you need to use supplements in order to restore the many potential nutrient deficiencies caused by hormonal birth control, however I recommend you work with a practitioner who can customise a supplement protocol to your unique needs.
Inflammatory/'Hidden Cause' PCOS
This type of PCOS is often driven by environmental factors such as exposure to environmental toxins, heavy metals and plastics, and chronic inflammation driven by poor gut health, food sensitivities or hypothyroidism. Inflammation is the second biggest cause of PCOS, alongside insulin resistance.
Focus on an anti-inflammatory diet which eliminates your individual food sensitivities. In order to identify what they are, you may need to go on a 30-60 day food elimination diet such as the Whole 30 or Autoimmune Paleo Diet (AIP), which both cut out the most common food sensitivities. I find that most people do best on a gluten, dairy, refined sugar and alcohol free diet, however some people may need to restrict further depending on their levels of inflammation and unique health issues.
Always try to buy organic produce (to avoid environmental toxin exposure from pesticides), high quality pastured animal products and healthy fats that haven't been exposed to high temperatures or oxidation. Try to limit your intake of omega 6 rich fats (pro-inflammatory) and increase your intake of omega 3 (anti-inflammatory) fats, as the ratio between the two determines levels of inflammation within the body.
Omega 6 fats are found at high levels in industrialised seed oils (canola, corn, sunflower, soybean) and factory farmed animal products, whereas omega 3's are found primarily in oily fish (salmon, mackerel, anchovies, sardines). Aim for 2-3 servings of wild caught fish per week, and in some cases an extra boost from a high quality fish oil supplement can be beneficial at reducing inflammation.
Avoid exposure to environmental toxins such as plastics, endocrine disrupters in personal care products, pesticides from non-organic foods and heavy metals in a lot of tap water. These chemicals and substances can enter our body and disrupt a lot of processes, leading to hormonal imbalances and immune system dysfunction.
In your kitchen, swap the plastic tuppaware containers to glass, replace your Teflon, non-stick fry pan with cast iron and your plastic utensils with wood or stainless steel. Never reheat your food in plastic! Instead, pour the content into a saucepan and heat on the stove. Just avoid plastic in general, even the BPA free types, as these are often just as bad as the original products.
Choose skincare and beauty products that are non-toxic and free from ingredients such as parabens, SLS and phthalates. There are so many amazing 'green beauty' brands available these days, that are just as effective as the conventional products. I like to keep things simple, using ingredients such as facial oils, essential oils, raw manuka honey and yogurt to care for my skin.
I don't expect you to throw out all of your products overnight and buy new, but next time you finish a product, choose a better option. That being said, I do highly recommend you start by upgrading your deodorant and menstrual care products right away, as these are usually the most toxic. I personally love using a menstrual cup during my period, however if you aren't up for that just yet, make the switch to organic cotton tampons and pads.
I'd love for you to share this important information with other women, because it's likely we all know and love someone dealing with PCOS.
Remember that the body is very resilient and when we provide it with the right building blocks and environment, we are able to live our lives without symptoms such as acne, weight gain, anxiety, hair loss and crazy periods!
Got any questions about your type of PCOS? Leave them in the comments section below and I'll get back to you!
Sign up for a free 30 minute 'PCOS Troubleshooting' call here. We will discuss your health in more detail and I will share with you some of the next steps to take, in your journey to hormonal harmony.