January 18, 2025 • 42 mins
In this episode, Juhi explores Polycystic Ovarian Syndrome (PCOS), a common endocrine disorder affecting reproductive-age women. She discusses its impact on cardiovascular, metabolic, and mental health, highlighting the complex hormonal imbalances involved. PCOS is often misdiagnosed, so understanding its symptoms and the diagnostic process is key.
The episode covers the role of insulin resistance, elevated androgens, and how obesity can worsen symptoms. Juhi also dives into practical solutions, focusing on lifestyle changes like balanced exercise, stress management, and sleep. Diet plays a crucial role in managing PCOS, and she provides specific recommendations, including the benefits of high-quality proteins, healthy fats, and reducing processed foods.
She also explores supplements and herbs that can support PCOS management, like Inositol, N-acetyl-cysteine, Cinnamon, and Spearmint, all known for their positive effects on insulin sensitivity and hormone balance.
This episode empowers women with actionable insights to take control of their health and manage PCOS symptoms holistically. Tune in for expert tips and guidance on balancing hormones and improving overall well-being!
For more information and to subscribe – https://wellnessandbeyond.es
Disclaimer: We are not licensed medical practitioners. The information offered on this platform and the resources available for download are for educational and informational purposes only and not intended as, and shall not be understood or construed as, diagnosis, treatment, medical, or health advice.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:30):
Hi guys, sorry to be out of sight for so long because we are learning so much and trying
to incorporate this new knowledge, not just in our consciousness, I guess, but definitely
(00:50):
on in practice as well.
And we are extremely happy to restart this podcast again.
And specifically today I wanted to touch upon the most hyped topic on social media, which
is also one of the most common endocrine disorders of the reproductive woman is polycystic ovidian
(01:16):
syndrome PCOS.
And this it's common, it's complex metabolic condition, also known as Stein-Leventhal syndrome
due to its association with the formation of multiple cysts within the ovaries.
(01:37):
So let me come back to this in a minute.
But with PCOS, it significantly impacts your cardiovascular endocrine and metabolic health.
In fact, in the US in 2004, around 4.36 billion dollars was spent on PCOS and its related
(02:00):
complications with over 40% of this cost attributed to treating reproductive dysfunction, be it
infertility, menstrual dysfunction, and a further 40% was attributed to PCOS related
diabetes.
And why is that?
(02:21):
Because its underlying mechanism relates to insulin resistance, which is a metabolic syndrome.
And it actually increases androgen levels resulting in diverse collection of signs and
symptoms rather than a defined disease.
(02:41):
And I would say not all of the women with PCOS will express all of the symptoms associated
with the disorder such as obesity, erratic ovulation, which is oligominoid, menstrual
dysfunction and infertility.
Now when we look at the diagnosis, it's furthermore one of exclusion because once certain other
(03:13):
pathologies like thyroid dysfunction, whether your prolactin is excess, adrenal hyperplasia,
which is also misdiagnosed as PCOS, as 9% of the times where you have abnormally high
17 hydroxy progesterone levels to make larger than normal male sex hormones.
(03:42):
Also I mean another pathology is Cushing's syndrome, even adrenal adenocarcinoma, which
is the cancer of the adrenal glands that has to be ruled out as well.
So interestingly PCOS gets its name from the changes in the ovary.
(04:04):
However, not all women with PCOS will have polycystic ovaries on their ultrasound suggesting
that they're not necessarily part of the pathology.
The cysts in polycystic ovaries are not true cysts, but rather antral follicles that have
(04:27):
been arrested in the development due to hormonal fluctuations.
So let's talk about some of the symptoms that one can face with PCOS.
Something like irregular missing periods.
This is the start of your menstrual cycle, menarche, you may have noticed that your periods
(04:48):
have been unpredictable or even absent at times.
Unwanted hair growth.
Now PCOS can cause hirsutism, which means you might see extra hair growing in places
like your upper lip, chin, area around the nipples and also along the lower abdomen,
(05:13):
which is called as linear alba.
Other symptoms would be like weight issues because about half of the women with PCOS
tend to be overweight or obese.
Now this often includes that central weight gain where the weight is carried around the
(05:33):
midsection leading to a higher waist to hip ratio and an apple-shaped body.
But PCOS and obesity are sort of like forward feeding each other as obesity and weight gain
can make the symptoms of PCOS worse and can have a negative impact on how your body handles
(05:56):
insulin.
So women with PCOS often deal with insulin resistance at its base, which means that their
body is not responding well to the insulin, which is a hormone that's been produced and
excreted by pancreas.
It's a hormone that actually controls blood sugar levels.
(06:21):
Now this insulin resistance can be due to PCOS itself, but when combined with extra
weight, especially around the abdomen, it can get worse.
So being overweight can play a role in causing or worsening PCOS, creating a cycle where
(06:45):
insulin resistance leads to more fat storage, particularly in the belly area, which we just
talked about, which then throws off other hormones even further.
This is why losing weight is often an important part of managing PCOS.
(07:08):
We have to break this cycle.
We have to improve insulin sensitivity, reduce the fat storage and balance our hormones.
But then we also have another symptom, which is hair thinning.
You might notice that thinning hair or hair loss, particularly following a pattern which
(07:35):
is also similar to male pattern baldness, which can be distressing.
So in short, PCOS can affect your ability to also be fertile, to be juicy.
Some women with PCOS find it difficult to get pregnant naturally due to irregular ovulation
(07:59):
and there may be a higher chances of miscarriage.
But then there are some women who can have PCOS and still become pregnant.
And if you do become pregnant, there's a higher risk of developing gestational diabetes.
(08:20):
So it's important to get screened for this earlier in your pregnancy, typically before
20 weeks.
And also another very important factor is that it can play a havoc on your mental health
as well.
Because whether it's due to the physical symptoms that you've been facing, the irregular menstrual
(08:44):
cycle, fertility concerns or associated weight and metabolic issues, anxiety and depression
are actually very common in women with PCOS.
So you might also notice darker thicker patches of skin, particularly in areas like your armpits,
(09:07):
under your breasts and on the neck.
And this condition is known as acanthosis nigricans, which is often linked to insulin
resistance, which is also a common issue in PCOS.
Another common issue is obstructive sleep apnea, OSA.
(09:31):
And this is even common because it happens when the muscles in your throat, they relax
during sleep, temporarily blocking your airway and disrupting your rest.
So OSA is actually been linked to insulin resistance.
(09:52):
And I would say that insulin is a bit of a shape shifter.
It doesn't look the same for everyone.
Now some women might have just a couple of symptoms, while others might experience a
whole bunch and the intensity can also vary widely.
(10:12):
Think of it as PCOS having different personalities or phenotypes.
Each one is a unique blend of symptoms and clinical features.
And what's even more interesting is that these phenotypes can change depending on where you
are in your life, your genetics, your ethnicity and even your lifestyle choices, including
(10:37):
your body weight, which is of bad amount importance.
I would say.
So whether it's subtle or strong, PCOS shows up differently for every woman, making each
journey with the condition truly one of a kind.
Don't you guys think that?
(10:59):
And not just that it can further have downstream health issues, because as I told you about
with insulin resistance, it can have or it may culminate into type 2 diabetes, especially
high for those who experience irregular ovulation, elevated androgen levels and are also obese.
(11:25):
Even a heightened risk of cardiovascular issues such as endothelial dysfunction, increased
carotid artery thickness and even coronary artery calcification.
In fact, endometrial hyperplasia can also occur due to prolonged exposure of elevated
(11:51):
estrogen due to anovulation.
So all this said, I know it can feel a bit distressing and disturbing because it's really
disturbing the quality of your life.
But I think we all at the end of the day have to make progress in the right direction.
(12:15):
Don't we?
So don't worry.
I won't be leaving this podcast without giving out some solutions, which definitely can be
employed on the spot for dealing effectively with the ongoing symptoms that many of you
are facing.
So do not fret over it.
(12:36):
Let's just get over it.
But before delving into that, I have to mention about the pathophysiology or the functional
changes of PCOS because it's creating this hormonal soup dance.
For instance, in non-obese PCOS women, there is a dysregulation of enzymes which regulate
(13:04):
the steroid synthesis within the ovarian follicle, thus leading to excessive androgen production
with an increase in LH secretion and on the other hand, this is for sort of like a lean
PCOS issue where there's a dysregulation with the enzymes.
(13:27):
But with obese women, LH levels are normal as insulin sensitizes the theca cells in the
ovaries to LH, thus increasing the androgen production.
So elevated insulin levels, I would also say that it enhances the 5-alpha reductase activity,
(13:54):
which actually converts your testosterone to DHT, which is dehydrotestosterone and thereby
potentiating androgenic activity, but it doesn't limit there because with insulin resistance,
your sex hormone binding globulin is reduced or suppressed, which actually binds to sex
(14:19):
hormones in general, which are your estrogen, testosterone, testosterone, DHT, thus leaving
more androgenic effect in the end in the bloodstream.
So in fact, in obese women, also another factor that's been noted is that there is aromatization
(14:44):
that's happening in the adipose tissue, which means that there is conversion of testosterone
into estrogen and specifically estrone.
So you can see the interplay of hormones affecting each other and creating a Vickshi cycle in
(15:05):
and of itself to be sufficiently diagnosed as hormonal imbalance.
Though seriously, I would be mentioning a few supplements and herbs, but before doing
that you have to understand that PCOS is mostly a lifestyle disease where metabolic syndrome,
(15:26):
you're balancing blood sugar like a pro, calming down those stress levels, giving your HPA
access some much needed TLC, making sure you're catching your quality sleep and also keeping
your gut healthy, dodging those pesky environmental hormones like the endocrine disruptors, which
(15:54):
are there in the environment, and giving your body's detox system a big thumbs up.
So another factor is that insulin resistance is decreasing the activity of T3, which is
your active thyroid hormone.
(16:16):
So with estrogen, with too much of estrogen, too much of DHT, it's also affecting your
T3 and your T3 hormone receptor function that can further cause sluggish thyroid and sluggish
(16:37):
thyroid also reduces your metabolic rate plus you have insulin resistance.
So when you're trying to lose weight, you can't do that because you have both the things
going on right now.
And further downstream effects of sluggish thyroid is that dry skin, fatigue, weak nails,
(17:04):
thinning of eyebrows, a lot of weight gain, stubborn weight gain.
But those are these hormonal interplay that's happening.
But we also have to look how can we actually handle this because I know it's pretty overwhelming
(17:28):
for all of you all, but it's all about getting to the root cause of the issue with the total
wellness makeover.
Think of it like this.
You're balancing blood sugar.
You're keeping your gut healthy.
You are taking care that you're not taking in any of the environmental toxins.
(17:52):
You're detoxing well.
So things like exercising.
I know as cliched may sound, but exercise is very, very crucial to control and manage
PCOS.
It can reduce insulin resistance and make cells more sensitive to insulin.
(18:14):
Additionally, women who exercise regularly can increase their chances of conception.
So I advise that exercising for at least 150 minutes a week with resistance training and
a minimum of 90 minutes of aerobic exercise.
(18:37):
However, be aware of the negative impact of over exercising, which can affect your sex
hormone production and balance.
So if necessary, some cardio sessions can also be alternated for something more like
for restorative yoga or with Pilates or even brisk walks in nature.
(19:06):
And also you can do another thing.
You can add two tablespoons of ground flaxseed to your daily diet because it's got those
lignans and they attach to the estrogen receptors.
So and it can have a less hormonal impact than what estrogen would directly have on
(19:31):
your body.
And it would also help to lengthen your luteal phase, which actually goes down enormously
if you have PCOS.
And in fact, it would also help improve ovulation and reduce your testosterone levels.
(19:53):
And another great one, I really like this one, it's sesame seeds.
They are also a great addition for PCOS and they can actually reduce your elevated androgen
levels by improving DHEAS and sex hormone binding globulin levels.
(20:14):
Other nutrients which have been immensely helpful for many women is inositol in the
form of D-chiro and myo-inositol, which really helps in reducing the insulin resistance,
testosterone and AMH levels.
(20:34):
Thus restoring your ovulation, improving fertility, egg quality and as well pregnancy rates.
So it's also helpful for anxiety and you can take around 600 milligrams per day.
Another great supplement is NAC, which is N-acetylcysteine and this one is like the
(20:58):
natural sidekick to metformin.
And in fact, in one study, NAC was just as good at lowering insulin levels, taming those
androgens and helping to keep your periods on track.
So around 600 milligrams three times per day.
(21:19):
I think it's great.
And let's not forget about mineral deficiency like selenium.
This little powerhouse when taken daily for at least eight weeks can work wonders for
your insulin metabolism.
(21:41):
So around 200 micrograms per day is sufficient enough.
Even another supplement that I would suggest over here is chromium picolinate.
And even this one has actually beneficial effects in decreasing your BMI, body mass
(22:03):
index, even your fasting insulin and free testosterone, especially in PCOS patients.
So around 200 mcg three times a day would also be great.
Now typically coming to the diet, what we are aiming here is for low carbohydrates.
(22:25):
See carbohydrates is not bad.
Everyone needs it.
And you cannot go on with your life just having like 50 grams of carbohydrates per day.
That's not healthy at all.
So around 250-300 grams per day with sufficient amount of good quality protein around 150
(22:46):
grams per day and hitting good fats at around 50 to 60 grams per day is a good place to
start.
But also understand that these figures are not set in stone.
They are just a guiding light to your plan or do you plan your meals and so just take
(23:09):
it as a template and from there on you can work your way the way you would like it to.
And also keep in mind that adding in around high amount of pulses around 30 to 50 grams
is amazing because a lot of fiber can actually increase the level of sex hormone binding
(23:34):
globulin.
Even oily fish that is rich in omega-3 fats three to four times weekly.
However I wouldn't say do more than that because of potential contamination with heavy metals.
(23:55):
But I think it's a good start.
Alternatively since I did mention about flax seeds you can also do some chia seeds or hemp
seeds even they provide rich vegetarian sources of omega-3 fatty acids.
And also remembering our vegetables and fruits since they are rainbow of phytonutrients.
(24:20):
So a lot of green leafy vegetables if you are not oxalate sensitive.
And obviously it's as you all know like you don't have to have processed or refined carbohydrates
that's not really great.
And also keeping your dairy low or even dairy free due to high levels of IGF-1 and the effects
(24:51):
it has on human insulin levels and also the androgens.
Plus taking care that you know since you are avoiding processed foods it contains a lot
of refined sugar.
So eliminating that as well.
Very low alcohol because it would be putting a lot of burden on your liver to process everything.
(25:16):
And apart from that actually incorporating more fermented foods around 1 fourth cup daily
that would be great.
And minimizing plastic packaging because there's a growing body of evidence that plastics and
certain chemicals can have negative health implications in women and negatively affect
(25:43):
their hormonal balance.
And as you know also that skin is a larger organ and chemicals are directly absorbed
into the bloodstream and they can act as endocrine disruptors.
So women should actually try to avoid cosmetics and toiletries with chemicals such as parabens,
(26:09):
sodium lauryl sulfate, pallates and talc.
In fact apart from this modern mass produced food and farming methods that are highly chemicalized
we should be also avoiding those.
(26:33):
As I just told you know anything that's processed or these the way the nowadays food is cultivated
it's fully pesticide laden.
So we have to stop all of these things we have to stop our plastic packaging and also
(26:56):
you know BPA free plastics and reduce as much of endocrine burden off from our body as we
can and actually get on to something more natural alternative because women with PCOS
they are more susceptible to these endocrine disruptors and therefore should minimize their
(27:23):
contact with them.
And one more point is actually also limiting your caffeinated drinks to no more than one
daily so that we also are easing the pressure on the adrenals.
(27:44):
And as an herbalist I think these are just some of the lifestyle practices that I would
be highly encouraging all of you all to follow but the favorite part of talking about herbs
can also be effectively utilized for this condition.
(28:07):
And since we know that PCOS has been partly plagued due to blood sugar imbalances like
insulin resistance concentrating on certain herbs like cinnamon, gymnema and fennel is
prudent over here.
So with cinnamon the first herb it's our household kitchen herb which can be sprinkled over food
(28:30):
for blood sugar spike and even in hypoglycemic cases.
So just I think whenever cinnamon comes up it always reminds me of stewed apples with
half a teaspoon of cinnamon sprinkled along with some cardamom.
(28:52):
Yummy!
I think my thoughts are getting me salivating over here but I have to hold my horses for
some time.
But the next one the second one is fenugreek and although fenugreek may not be the top
of mind for many it has special culinary uses and moments in history marking various cultures
(29:20):
reverence towards it as a food medicine and for other utilitarian and cultural values.
So Tutankhamun the Egyptian pharaoh was entombed with fenugreek seeds alluding to the importance
that fenugreek was used in the past as food and medicine.
(29:49):
Even breads imbued with the spice are still enjoyed as a traditional Egyptian cuisine.
So it's a very stimulating and moving herb and as you know it was definitely used historically
and even in modern medical herbalism use of fenugreek has been definitely incorporated
(30:14):
in chronic conditions for immediate therapeutic effects especially on blood glucose and glucose
intolerance and also insulin levels.
So fenugreek actually increases the number of insulin binding sites in humans and also
(30:36):
increasing the ability of muscle tissue to respond to insulin.
So making your cells more insulin sensitive and as well at the same time it helps to lower
cholesterol and tricholesteroid levels wherein there was a study done on patients with mild
(31:01):
non insulin dependent diabetes.
But be careful of the safety considerations with this herb as it can act as an additive
when it's used with drugs having similar effects.
So just be careful over there and but I would say around 2 grams of the whole seed powder
(31:30):
or the seed tea is alright to use but if you want to increase your dosage then I think
it's best to be done under the guidance of a practitioner or your physician.
The next herb which is amazing is gymnema and this is a clinically effective herb for
(31:52):
blood sugar balancing or stabilizing because it helps control diabetes by improving insulin
sensitivity very similar to fenugreek and even this one actually increases the number
of insulin producing pancreatic beta cells.
(32:12):
So gymnema is often recommended for people who are obese or suffer from sugar cravings
as its peptide gurmarin interferes with the ability of the tongue taste buds to detect
sweet or bitter flavors.
(32:32):
So gymnema has been used for its laxative, diuretic and cuff suppressant effects but
these may be undesirable when using this herb for its blood sugar lowering effects.
So you can start slow around 200 milligrams or twice a day and go up to 400 milligrams
(32:58):
two to three times a day but under supervision once again.
Caution over there.
The next one is many people's favorite is spearmint mentha spicata and this can be an
essential herb when it comes to its anti-androgenic effects.
(33:24):
In fact a randomized control 30-day trial with 42 patients study found out that drinking
spearmint herbal tea twice a day significantly reduce three and total testosterone levels
suggesting that it may actually be useful as a treatment for hirsutism with extended
(33:50):
use.
So using around seven grams of dried leaves in eight to twelve fluid ounces or water twice
per day is sufficient.
The fifth herb that we've come to know is saw palmetto and this one is actually thought
(34:11):
to exert its hormone balancing effects in part by decreasing excess androgen such as
testosterone and is therefore utilized by modern herbalists for conditions characterized
by androgen excess including BPH benign prostrate and as well as male pattern baldness PCOS
(34:39):
as well obviously that's why I'm talking about it and menstrual cycle irregularities.
So the lipid soluble content which is 65% free fatty acids and di tri-anseskyterpenes
which are responsible for hormonal balance.
(35:03):
I think it's amazing to use it as a grounded powder either sprinkled over meals though
it's unappetizing but if you can also take it with some fat for absorption I think that's
great.
So saw palmetto has been shown to reduce the conversion of testosterone into its active
(35:29):
form which is DHT through inhibition of the enzyme 5-alpha reductase that I did mention
about it before.
So using around 2-3 grams every day would be sufficient.
And let me reiterate that in PCOS, progesterone is often low due to failure to ovulate and
(35:58):
there is often elevated luteinizing hormone in comparison to FSH and characteristically
high testosterone levels.
So herbs like peony which contains the constituent peony florin which in one study has been shown
(36:23):
to significantly again decrease testosterone production from the ovaries.
So it has shown to increase low progesterone levels and also modulate estrogen and prolactin
levels.
And another herb which is licorice.
(36:45):
It's beneficial as an adaptogen to restore the adrenal function and hormonal balance
as well and it may assist with the reduction of body mass.
So therefore it is reducing your insulin resistance in women with PCOS as well as decreasing the
testosterone levels in non-PCOS women.
(37:10):
However care must be taken with licorice as high doses have the potential to raise blood
pressure.
So it's important to regularly monitor blood pressure levels when you're taking licorice.
Alternatively deglycerizinated licorice DGL may be used that will not affect your blood
(37:35):
pressure levels.
And in fact there is a combination of peony and licorice which is used in Japanese formula
for women actually for PCOS and it's called shakuyaku kanzotto.
And in a small uncontrolled trial infertile women with PCOS were given this combination
(38:01):
which actually decreased their testosterone levels inducing ovulation and increasing the
pregnancy rates.
So if you are going to use this formula then you can do 1 is to 1 fluid extract 3 ml of
licorice along with peony 1 is to 2 tincture around 7 ml.
(38:26):
So this can be taken once daily but then be careful with licorice as I told you all above.
The next thing that we can actually definitely focus on is optimizing and supporting your
liver because liver is something that we need to detoxify hormones and especially when it
(38:56):
comes to PCOS it becomes all the more important as we have to recycle these hormones and they
have to go through the liver through the intro hepatic system.
So things like milk thistle which is celebum marianum which has been traditionally used
(39:18):
to improve both phase 1 and phase 2 liver detoxification pathways and in fact a study
in women with PCOS found that the supplementation with silymarin a constituent of milk thistle
actually helped increasing for testosterone levels and also improving on insulin resistance.
(39:41):
So a strong tincture I would say around 1 is to 3 ratio with 70% alcohol it will be
around half to 1 teaspoon up to 4 times a day is a good start and if you are you have
to be careful over here because if you are on pharmaceuticals like cardiac glycosides
(40:02):
cyclosporin birth control metronidazole all these drugs are going to be metabolized via
cytochrome p450 pathway in the liver which milk thistle also uses therefore avoidance
(40:22):
is requested in that case.
So you have got to avoid if you are on these pharmaceutical drugs and I think these were
just a few things a person dealing with PCOS can incorporate in their life but at the end
of the day I think really it's important to realize that we have this knowledge and
(40:48):
knowledge is power when we know better we do better so at the end I would want to conclude
this podcast with hope and empowerment that this this ease can be managed with positive
lifestyle changes and we can put our symptoms into remission only if we want and ready to
(41:16):
put in the work.
So thank you everyone for listening to this podcast and if you like our content or have
some doubts either way please shoot us a message on our website and we would be happy to get
back to you.
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(41:36):
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(42:00):
So together let's unlock the full potential of your mind body and spirit and head over
to wellness and beyond because your best self is waiting for you.
Bye.
Hi guys, sorry to be out of sight for so long because we are learning so much and trying
to incorporate this new knowledge, not just in our consciousness, I guess, but definitely
(00:50):
on in practice as well.
And we are extremely happy to restart this podcast again.
And specifically today I wanted to touch upon the most hyped topic on social media, which
is also one of the most common endocrine disorders of the reproductive woman is polycystic ovidian
(01:16):
syndrome PCOS.
And this it's common, it's complex metabolic condition, also known as Stein-Leventhal syndrome
due to its association with the formation of multiple cysts within the ovaries.
(01:37):
So let me come back to this in a minute.
But with PCOS, it significantly impacts your cardiovascular endocrine and metabolic health.
In fact, in the US in 2004, around 4.36 billion dollars was spent on PCOS and its related
(02:00):
complications with over 40% of this cost attributed to treating reproductive dysfunction, be it
infertility, menstrual dysfunction, and a further 40% was attributed to PCOS related
diabetes.
And why is that?
(02:21):
Because its underlying mechanism relates to insulin resistance, which is a metabolic syndrome.
And it actually increases androgen levels resulting in diverse collection of signs and
symptoms rather than a defined disease.
(02:41):
And I would say not all of the women with PCOS will express all of the symptoms associated
with the disorder such as obesity, erratic ovulation, which is oligominoid, menstrual
dysfunction and infertility.
Now when we look at the diagnosis, it's furthermore one of exclusion because once certain other
(03:13):
pathologies like thyroid dysfunction, whether your prolactin is excess, adrenal hyperplasia,
which is also misdiagnosed as PCOS, as 9% of the times where you have abnormally high
17 hydroxy progesterone levels to make larger than normal male sex hormones.
(03:42):
Also I mean another pathology is Cushing's syndrome, even adrenal adenocarcinoma, which
is the cancer of the adrenal glands that has to be ruled out as well.
So interestingly PCOS gets its name from the changes in the ovary.
(04:04):
However, not all women with PCOS will have polycystic ovaries on their ultrasound suggesting
that they're not necessarily part of the pathology.
The cysts in polycystic ovaries are not true cysts, but rather antral follicles that have
(04:27):
been arrested in the development due to hormonal fluctuations.
So let's talk about some of the symptoms that one can face with PCOS.
Something like irregular missing periods.
This is the start of your menstrual cycle, menarche, you may have noticed that your periods
(04:48):
have been unpredictable or even absent at times.
Unwanted hair growth.
Now PCOS can cause hirsutism, which means you might see extra hair growing in places
like your upper lip, chin, area around the nipples and also along the lower abdomen,
(05:13):
which is called as linear alba.
Other symptoms would be like weight issues because about half of the women with PCOS
tend to be overweight or obese.
Now this often includes that central weight gain where the weight is carried around the
(05:33):
midsection leading to a higher waist to hip ratio and an apple-shaped body.
But PCOS and obesity are sort of like forward feeding each other as obesity and weight gain
can make the symptoms of PCOS worse and can have a negative impact on how your body handles
(05:56):
insulin.
So women with PCOS often deal with insulin resistance at its base, which means that their
body is not responding well to the insulin, which is a hormone that's been produced and
excreted by pancreas.
It's a hormone that actually controls blood sugar levels.
(06:21):
Now this insulin resistance can be due to PCOS itself, but when combined with extra
weight, especially around the abdomen, it can get worse.
So being overweight can play a role in causing or worsening PCOS, creating a cycle where
(06:45):
insulin resistance leads to more fat storage, particularly in the belly area, which we just
talked about, which then throws off other hormones even further.
This is why losing weight is often an important part of managing PCOS.
(07:08):
We have to break this cycle.
We have to improve insulin sensitivity, reduce the fat storage and balance our hormones.
But then we also have another symptom, which is hair thinning.
You might notice that thinning hair or hair loss, particularly following a pattern which
(07:35):
is also similar to male pattern baldness, which can be distressing.
So in short, PCOS can affect your ability to also be fertile, to be juicy.
Some women with PCOS find it difficult to get pregnant naturally due to irregular ovulation
(07:59):
and there may be a higher chances of miscarriage.
But then there are some women who can have PCOS and still become pregnant.
And if you do become pregnant, there's a higher risk of developing gestational diabetes.
(08:20):
So it's important to get screened for this earlier in your pregnancy, typically before
20 weeks.
And also another very important factor is that it can play a havoc on your mental health
as well.
Because whether it's due to the physical symptoms that you've been facing, the irregular menstrual
(08:44):
cycle, fertility concerns or associated weight and metabolic issues, anxiety and depression
are actually very common in women with PCOS.
So you might also notice darker thicker patches of skin, particularly in areas like your armpits,
(09:07):
under your breasts and on the neck.
And this condition is known as acanthosis nigricans, which is often linked to insulin
resistance, which is also a common issue in PCOS.
Another common issue is obstructive sleep apnea, OSA.
(09:31):
And this is even common because it happens when the muscles in your throat, they relax
during sleep, temporarily blocking your airway and disrupting your rest.
So OSA is actually been linked to insulin resistance.
(09:52):
And I would say that insulin is a bit of a shape shifter.
It doesn't look the same for everyone.
Now some women might have just a couple of symptoms, while others might experience a
whole bunch and the intensity can also vary widely.
(10:12):
Think of it as PCOS having different personalities or phenotypes.
Each one is a unique blend of symptoms and clinical features.
And what's even more interesting is that these phenotypes can change depending on where you
are in your life, your genetics, your ethnicity and even your lifestyle choices, including
(10:37):
your body weight, which is of bad amount importance.
I would say.
So whether it's subtle or strong, PCOS shows up differently for every woman, making each
journey with the condition truly one of a kind.
Don't you guys think that?
(10:59):
And not just that it can further have downstream health issues, because as I told you about
with insulin resistance, it can have or it may culminate into type 2 diabetes, especially
high for those who experience irregular ovulation, elevated androgen levels and are also obese.
(11:25):
Even a heightened risk of cardiovascular issues such as endothelial dysfunction, increased
carotid artery thickness and even coronary artery calcification.
In fact, endometrial hyperplasia can also occur due to prolonged exposure of elevated
(11:51):
estrogen due to anovulation.
So all this said, I know it can feel a bit distressing and disturbing because it's really
disturbing the quality of your life.
But I think we all at the end of the day have to make progress in the right direction.
(12:15):
Don't we?
So don't worry.
I won't be leaving this podcast without giving out some solutions, which definitely can be
employed on the spot for dealing effectively with the ongoing symptoms that many of you
are facing.
So do not fret over it.
(12:36):
Let's just get over it.
But before delving into that, I have to mention about the pathophysiology or the functional
changes of PCOS because it's creating this hormonal soup dance.
For instance, in non-obese PCOS women, there is a dysregulation of enzymes which regulate
(13:04):
the steroid synthesis within the ovarian follicle, thus leading to excessive androgen production
with an increase in LH secretion and on the other hand, this is for sort of like a lean
PCOS issue where there's a dysregulation with the enzymes.
(13:27):
But with obese women, LH levels are normal as insulin sensitizes the theca cells in the
ovaries to LH, thus increasing the androgen production.
So elevated insulin levels, I would also say that it enhances the 5-alpha reductase activity,
(13:54):
which actually converts your testosterone to DHT, which is dehydrotestosterone and thereby
potentiating androgenic activity, but it doesn't limit there because with insulin resistance,
your sex hormone binding globulin is reduced or suppressed, which actually binds to sex
(14:19):
hormones in general, which are your estrogen, testosterone, testosterone, DHT, thus leaving
more androgenic effect in the end in the bloodstream.
So in fact, in obese women, also another factor that's been noted is that there is aromatization
(14:44):
that's happening in the adipose tissue, which means that there is conversion of testosterone
into estrogen and specifically estrone.
So you can see the interplay of hormones affecting each other and creating a Vickshi cycle in
(15:05):
and of itself to be sufficiently diagnosed as hormonal imbalance.
Though seriously, I would be mentioning a few supplements and herbs, but before doing
that you have to understand that PCOS is mostly a lifestyle disease where metabolic syndrome,
(15:26):
you're balancing blood sugar like a pro, calming down those stress levels, giving your HPA
access some much needed TLC, making sure you're catching your quality sleep and also keeping
your gut healthy, dodging those pesky environmental hormones like the endocrine disruptors, which
(15:54):
are there in the environment, and giving your body's detox system a big thumbs up.
So another factor is that insulin resistance is decreasing the activity of T3, which is
your active thyroid hormone.
(16:16):
So with estrogen, with too much of estrogen, too much of DHT, it's also affecting your
T3 and your T3 hormone receptor function that can further cause sluggish thyroid and sluggish
(16:37):
thyroid also reduces your metabolic rate plus you have insulin resistance.
So when you're trying to lose weight, you can't do that because you have both the things
going on right now.
And further downstream effects of sluggish thyroid is that dry skin, fatigue, weak nails,
(17:04):
thinning of eyebrows, a lot of weight gain, stubborn weight gain.
But those are these hormonal interplay that's happening.
But we also have to look how can we actually handle this because I know it's pretty overwhelming
(17:28):
for all of you all, but it's all about getting to the root cause of the issue with the total
wellness makeover.
Think of it like this.
You're balancing blood sugar.
You're keeping your gut healthy.
You are taking care that you're not taking in any of the environmental toxins.
(17:52):
You're detoxing well.
So things like exercising.
I know as cliched may sound, but exercise is very, very crucial to control and manage
PCOS.
It can reduce insulin resistance and make cells more sensitive to insulin.
(18:14):
Additionally, women who exercise regularly can increase their chances of conception.
So I advise that exercising for at least 150 minutes a week with resistance training and
a minimum of 90 minutes of aerobic exercise.
(18:37):
However, be aware of the negative impact of over exercising, which can affect your sex
hormone production and balance.
So if necessary, some cardio sessions can also be alternated for something more like
for restorative yoga or with Pilates or even brisk walks in nature.
(19:06):
And also you can do another thing.
You can add two tablespoons of ground flaxseed to your daily diet because it's got those
lignans and they attach to the estrogen receptors.
So and it can have a less hormonal impact than what estrogen would directly have on
(19:31):
your body.
And it would also help to lengthen your luteal phase, which actually goes down enormously
if you have PCOS.
And in fact, it would also help improve ovulation and reduce your testosterone levels.
(19:53):
And another great one, I really like this one, it's sesame seeds.
They are also a great addition for PCOS and they can actually reduce your elevated androgen
levels by improving DHEAS and sex hormone binding globulin levels.
(20:14):
Other nutrients which have been immensely helpful for many women is inositol in the
form of D-chiro and myo-inositol, which really helps in reducing the insulin resistance,
testosterone and AMH levels.
(20:34):
Thus restoring your ovulation, improving fertility, egg quality and as well pregnancy rates.
So it's also helpful for anxiety and you can take around 600 milligrams per day.
Another great supplement is NAC, which is N-acetylcysteine and this one is like the
(20:58):
natural sidekick to metformin.
And in fact, in one study, NAC was just as good at lowering insulin levels, taming those
androgens and helping to keep your periods on track.
So around 600 milligrams three times per day.
(21:19):
I think it's great.
And let's not forget about mineral deficiency like selenium.
This little powerhouse when taken daily for at least eight weeks can work wonders for
your insulin metabolism.
(21:41):
So around 200 micrograms per day is sufficient enough.
Even another supplement that I would suggest over here is chromium picolinate.
And even this one has actually beneficial effects in decreasing your BMI, body mass
(22:03):
index, even your fasting insulin and free testosterone, especially in PCOS patients.
So around 200 mcg three times a day would also be great.
Now typically coming to the diet, what we are aiming here is for low carbohydrates.
(22:25):
See carbohydrates is not bad.
Everyone needs it.
And you cannot go on with your life just having like 50 grams of carbohydrates per day.
That's not healthy at all.
So around 250-300 grams per day with sufficient amount of good quality protein around 150
(22:46):
grams per day and hitting good fats at around 50 to 60 grams per day is a good place to
start.
But also understand that these figures are not set in stone.
They are just a guiding light to your plan or do you plan your meals and so just take
(23:09):
it as a template and from there on you can work your way the way you would like it to.
And also keep in mind that adding in around high amount of pulses around 30 to 50 grams
is amazing because a lot of fiber can actually increase the level of sex hormone binding
(23:34):
globulin.
Even oily fish that is rich in omega-3 fats three to four times weekly.
However I wouldn't say do more than that because of potential contamination with heavy metals.
(23:55):
But I think it's a good start.
Alternatively since I did mention about flax seeds you can also do some chia seeds or hemp
seeds even they provide rich vegetarian sources of omega-3 fatty acids.
And also remembering our vegetables and fruits since they are rainbow of phytonutrients.
(24:20):
So a lot of green leafy vegetables if you are not oxalate sensitive.
And obviously it's as you all know like you don't have to have processed or refined carbohydrates
that's not really great.
And also keeping your dairy low or even dairy free due to high levels of IGF-1 and the effects
(24:51):
it has on human insulin levels and also the androgens.
Plus taking care that you know since you are avoiding processed foods it contains a lot
of refined sugar.
So eliminating that as well.
Very low alcohol because it would be putting a lot of burden on your liver to process everything.
(25:16):
And apart from that actually incorporating more fermented foods around 1 fourth cup daily
that would be great.
And minimizing plastic packaging because there's a growing body of evidence that plastics and
certain chemicals can have negative health implications in women and negatively affect
(25:43):
their hormonal balance.
And as you know also that skin is a larger organ and chemicals are directly absorbed
into the bloodstream and they can act as endocrine disruptors.
So women should actually try to avoid cosmetics and toiletries with chemicals such as parabens,
(26:09):
sodium lauryl sulfate, pallates and talc.
In fact apart from this modern mass produced food and farming methods that are highly chemicalized
we should be also avoiding those.
(26:33):
As I just told you know anything that's processed or these the way the nowadays food is cultivated
it's fully pesticide laden.
So we have to stop all of these things we have to stop our plastic packaging and also
(26:56):
you know BPA free plastics and reduce as much of endocrine burden off from our body as we
can and actually get on to something more natural alternative because women with PCOS
they are more susceptible to these endocrine disruptors and therefore should minimize their
(27:23):
contact with them.
And one more point is actually also limiting your caffeinated drinks to no more than one
daily so that we also are easing the pressure on the adrenals.
(27:44):
And as an herbalist I think these are just some of the lifestyle practices that I would
be highly encouraging all of you all to follow but the favorite part of talking about herbs
can also be effectively utilized for this condition.
(28:07):
And since we know that PCOS has been partly plagued due to blood sugar imbalances like
insulin resistance concentrating on certain herbs like cinnamon, gymnema and fennel is
prudent over here.
So with cinnamon the first herb it's our household kitchen herb which can be sprinkled over food
(28:30):
for blood sugar spike and even in hypoglycemic cases.
So just I think whenever cinnamon comes up it always reminds me of stewed apples with
half a teaspoon of cinnamon sprinkled along with some cardamom.
(28:52):
Yummy!
I think my thoughts are getting me salivating over here but I have to hold my horses for
some time.
But the next one the second one is fenugreek and although fenugreek may not be the top
of mind for many it has special culinary uses and moments in history marking various cultures
(29:20):
reverence towards it as a food medicine and for other utilitarian and cultural values.
So Tutankhamun the Egyptian pharaoh was entombed with fenugreek seeds alluding to the importance
that fenugreek was used in the past as food and medicine.
(29:49):
Even breads imbued with the spice are still enjoyed as a traditional Egyptian cuisine.
So it's a very stimulating and moving herb and as you know it was definitely used historically
and even in modern medical herbalism use of fenugreek has been definitely incorporated
(30:14):
in chronic conditions for immediate therapeutic effects especially on blood glucose and glucose
intolerance and also insulin levels.
So fenugreek actually increases the number of insulin binding sites in humans and also
(30:36):
increasing the ability of muscle tissue to respond to insulin.
So making your cells more insulin sensitive and as well at the same time it helps to lower
cholesterol and tricholesteroid levels wherein there was a study done on patients with mild
(31:01):
non insulin dependent diabetes.
But be careful of the safety considerations with this herb as it can act as an additive
when it's used with drugs having similar effects.
So just be careful over there and but I would say around 2 grams of the whole seed powder
(31:30):
or the seed tea is alright to use but if you want to increase your dosage then I think
it's best to be done under the guidance of a practitioner or your physician.
The next herb which is amazing is gymnema and this is a clinically effective herb for
(31:52):
blood sugar balancing or stabilizing because it helps control diabetes by improving insulin
sensitivity very similar to fenugreek and even this one actually increases the number
of insulin producing pancreatic beta cells.
(32:12):
So gymnema is often recommended for people who are obese or suffer from sugar cravings
as its peptide gurmarin interferes with the ability of the tongue taste buds to detect
sweet or bitter flavors.
(32:32):
So gymnema has been used for its laxative, diuretic and cuff suppressant effects but
these may be undesirable when using this herb for its blood sugar lowering effects.
So you can start slow around 200 milligrams or twice a day and go up to 400 milligrams
(32:58):
two to three times a day but under supervision once again.
Caution over there.
The next one is many people's favorite is spearmint mentha spicata and this can be an
essential herb when it comes to its anti-androgenic effects.
(33:24):
In fact a randomized control 30-day trial with 42 patients study found out that drinking
spearmint herbal tea twice a day significantly reduce three and total testosterone levels
suggesting that it may actually be useful as a treatment for hirsutism with extended
(33:50):
use.
So using around seven grams of dried leaves in eight to twelve fluid ounces or water twice
per day is sufficient.
The fifth herb that we've come to know is saw palmetto and this one is actually thought
(34:11):
to exert its hormone balancing effects in part by decreasing excess androgen such as
testosterone and is therefore utilized by modern herbalists for conditions characterized
by androgen excess including BPH benign prostrate and as well as male pattern baldness PCOS
(34:39):
as well obviously that's why I'm talking about it and menstrual cycle irregularities.
So the lipid soluble content which is 65% free fatty acids and di tri-anseskyterpenes
which are responsible for hormonal balance.
(35:03):
I think it's amazing to use it as a grounded powder either sprinkled over meals though
it's unappetizing but if you can also take it with some fat for absorption I think that's
great.
So saw palmetto has been shown to reduce the conversion of testosterone into its active
(35:29):
form which is DHT through inhibition of the enzyme 5-alpha reductase that I did mention
about it before.
So using around 2-3 grams every day would be sufficient.
And let me reiterate that in PCOS, progesterone is often low due to failure to ovulate and
(35:58):
there is often elevated luteinizing hormone in comparison to FSH and characteristically
high testosterone levels.
So herbs like peony which contains the constituent peony florin which in one study has been shown
(36:23):
to significantly again decrease testosterone production from the ovaries.
So it has shown to increase low progesterone levels and also modulate estrogen and prolactin
levels.
And another herb which is licorice.
(36:45):
It's beneficial as an adaptogen to restore the adrenal function and hormonal balance
as well and it may assist with the reduction of body mass.
So therefore it is reducing your insulin resistance in women with PCOS as well as decreasing the
testosterone levels in non-PCOS women.
(37:10):
However care must be taken with licorice as high doses have the potential to raise blood
pressure.
So it's important to regularly monitor blood pressure levels when you're taking licorice.
Alternatively deglycerizinated licorice DGL may be used that will not affect your blood
(37:35):
pressure levels.
And in fact there is a combination of peony and licorice which is used in Japanese formula
for women actually for PCOS and it's called shakuyaku kanzotto.
And in a small uncontrolled trial infertile women with PCOS were given this combination
(38:01):
which actually decreased their testosterone levels inducing ovulation and increasing the
pregnancy rates.
So if you are going to use this formula then you can do 1 is to 1 fluid extract 3 ml of
licorice along with peony 1 is to 2 tincture around 7 ml.
(38:26):
So this can be taken once daily but then be careful with licorice as I told you all above.
The next thing that we can actually definitely focus on is optimizing and supporting your
liver because liver is something that we need to detoxify hormones and especially when it
(38:56):
comes to PCOS it becomes all the more important as we have to recycle these hormones and they
have to go through the liver through the intro hepatic system.
So things like milk thistle which is celebum marianum which has been traditionally used
(39:18):
to improve both phase 1 and phase 2 liver detoxification pathways and in fact a study
in women with PCOS found that the supplementation with silymarin a constituent of milk thistle
actually helped increasing for testosterone levels and also improving on insulin resistance.
(39:41):
So a strong tincture I would say around 1 is to 3 ratio with 70% alcohol it will be
around half to 1 teaspoon up to 4 times a day is a good start and if you are you have
to be careful over here because if you are on pharmaceuticals like cardiac glycosides
(40:02):
cyclosporin birth control metronidazole all these drugs are going to be metabolized via
cytochrome p450 pathway in the liver which milk thistle also uses therefore avoidance
(40:22):
is requested in that case.
So you have got to avoid if you are on these pharmaceutical drugs and I think these were
just a few things a person dealing with PCOS can incorporate in their life but at the end
of the day I think really it's important to realize that we have this knowledge and
(40:48):
knowledge is power when we know better we do better so at the end I would want to conclude
this podcast with hope and empowerment that this this ease can be managed with positive
lifestyle changes and we can put our symptoms into remission only if we want and ready to
(41:16):
put in the work.
So thank you everyone for listening to this podcast and if you like our content or have
some doubts either way please shoot us a message on our website and we would be happy to get
back to you.
If you are ready to take your health journey to the next level I invite you to explore
(41:36):
our wellness and beyond subscription platform this is where we share all our knowledge insights
wisdom without holding back anything.
You will be equipped empowered and enlightened with the tools and understanding you need
to truly elevate your well-being.
(42:00):
So together let's unlock the full potential of your mind body and spirit and head over
to wellness and beyond because your best self is waiting for you.
Bye.
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