March 11, 2025 • 24 mins
PCOS is a complicated condition that affects up to 20% of all women of reproductive age. Its presentation can vary among individuals. Some women have classic symptoms and some women are shocked to be diagnosed with PCOS. There are lots of opinions out there, but in this episode, we explore:
- Possible causes of PCOS
- The internationally recognized diagnosing system for PCOS
- Why I think there are only two types of PCOS
- Nutritional strategies for both types
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Website: www.adriennewei.com
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Episode Transcript
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Speaker 1 (00:01):
Welcome to the Practically Fertile Podcast.
I'm Adrienne Wee, doctor ofacupuncture and Chinese medicine
, functional medicinepractitioner and functional
nutritionist.
I specialize in using anevidence-based method, blending
principles of East Asianmedicine and modern functional
medicine to help women optimizefertility and get pregnant.
(00:22):
I believe in a world whereevery woman who wants to be a
mother becomes one.
If you're tired of being toldthat you're infertile and you
want to take the right steps toget pregnant naturally and
quickly, this podcast is for you.
You know, it seems like foreverago when I was diagnosed with
(00:42):
PCOS.
At the time, my doctor told methat very little was known about
the condition and he didn'tknow if I could get pregnant in
the future.
And he told me to just takesome birth control pills, make
it go away and just wait and seewhat happens, because he didn't
know what to do to help me.
So I definitely had cysts on myovaries at the time and also
(01:06):
facial hair.
Till now, to be honest with you, I'm still struggling with
facial hair right above my chinand also right about my lip.
It's super annoying, but I waslucky enough that when I was
diagnosed I was actually inacupuncture school, so I was
able to get it under controlwith acupuncture and herbs.
(01:27):
I was able to regulate myperiod, never 28 days, but I was
finally getting a period on aregular basis, like every 38 to
40 days.
And then when I met my husband,we both got acupuncture six
months prior to trying toconceive.
So when we did actually try toconceive we didn't have a lot of
(01:50):
problems.
So my story is a little bitdifferent, because I had my
struggles before even thinkingabout having kids.
I knew that I had problemsbecause I never took the birth
control pill.
I do think that birth controlpills can mask over symptoms of
PCOS, which might be why a lotof people are shocked to hear
(02:11):
that they have PCOS aftergetting off the pill.
But there was so littleinformation about PCOS when I
was diagnosed and now we know somuch more.
We have more information, moreresearch data and we understand
this condition better and havebetter treatment options.
So here's a fun fact about PCOS.
(02:33):
It's actually not a newcondition.
Doctors Stein and Leventhalfirst described this condition
in 1935.
So it's been around since 1935.
It's important to note thatnowadays it's estimated PCOS
(02:53):
affects as many as 20% of womenof reproductive age.
Globally, it's one of the mostcommon ovulatory disorders that
cause infertility.
But it's also important to knowthat many women are still being
undiagnosed or misdiagnosed.
One of the reasons for thisincreased prevalence is because
(03:14):
of the updates to the diagnosticcriteria called the Rotterdam
criteria.
Based on the Rotterdam criteria, a woman needs to have two out
of the three characteristics ofPCOS to be diagnosed.
So these three characteristicsare hyperandrogenism, which is
(03:35):
an increased amount of malehormones.
Irregular or lack of ovulationthis is characterized by cycles
longer than 35 days or less thaneight cycles per year.
And also the third ispolycystic ovaries, with more
than 20 small follicles on eachovary.
This classification methodmeans that there could be
(03:59):
different types of PCOS.
Prior to this, the NationalInstitute of Health guideline
was used, which only includedthe hyperandrogenism and
irregular or lack of ovulation.
So the Rotterdam criteria wasexpanded based on that.
(04:20):
So now the international medicalcommunity recognizes four types
of PCOS Type 1, which issomeone who has all three of the
symptoms the hyperandrogenism,ovulation disorder and
polycystic ovaries.
This would be what we know tobe the classic type of PCOS.
Type 2 is someone with an ovarythat has no cysts but does have
(04:46):
the hyperandrogenism signs andalso ovulation irregularities.
Type 3 PCOS is someone with thehyperandrogenism and polycystic
ovaries but they ovulateregularly.
Type 4 PCOS is the mildest typeof PCOS, where someone will
(05:10):
present with polycystic ovariesand ovulation irregularities but
not a lot of thehyperandrogenism signs.
I've seen over the years manydifferent types of
interpretation on these fourtypes from functional medicine
perspectives, such as adrenaltype, inflammation type, insulin
resistance type.
(05:30):
I'm not knocking on thesetyping systems at all.
I want to share my perspectiveon this and talk about if it
really matters which type ofPCOS you have based on recent
evidence.
Pcos you have based on recentevidence.
Studies have found that,regardless of the type, body
(05:50):
weight and hormone panels, themajority of women with PCOS have
underlying insulin resistance.
In one study, in a group ofwomen who had PCOS but normal
weight, 83.3% were found to haveinsulin resistance and in the
overweight group, 91% of thewomen had insulin resistance.
(06:12):
So there's not a lot ofdifference between the women
with the normal weight versuswomen who were overweight.
And just for clarification,weight and just for
clarification.
This is not to say that youhave to have PCOS to be insulin
resistant.
In fact, you can have insulinresistance without having PCOS.
(06:34):
Anyone can become insulinresistant at any time.
But more on this in just alittle bit.
Insulin resistance I'm going tostart referring to it as IR.
Ir is the reason why metforminis commonly used as a treatment
for PCOS.
I think it's being prescribedway too much and way too often,
(06:56):
but I understand that if you'regoing to do IVF and you have to
get the IR under control veryquickly, that might be the best
option.
So, because IR is oftenassociated with chronic
inflammation, the majority ofwomen with PCOS will also have
inflammation.
And what about the adrenal typeof PCOS?
(07:17):
Yes, and what about the adrenaltype of PCOS?
I just think that anyone withPCOS or without PCOS, the
adrenals are going to beinvolved, because stress is
something that all of usexperience on a daily basis.
The adrenal glands arehyperactive and they're
(07:40):
overworked.
And similarly, in Chinesemedicine, even if your archetype
isn't water and kidneydeficiency isn't your main
pattern, the kidneys are stillworking in the background and
are still a huge part of overallfertility potential.
So I think adrenals areinvolved in every single case of
(08:01):
fertility.
So does it matter which one ofthese types of PCOS you have?
As far as management of thesymptoms and improving your
chances of getting pregnant?
Not really.
What we do know for sure is thatinsulin resistance and
inflammation are the two commonissues that all women with PCOS
(08:22):
have to deal with.
Managing the IR andinflammation is the key to
overcoming PCOS.
So, before we get into thedetails about how IR and
inflammation specifically affectPCOS, I want to share something
very interesting about theorigin of PCOS, because it's
(08:47):
still a mystery exactly howsomeone develops PCOS.
We know that genetics is a bigcomponent, and epigenetics, and
the latest research estimatesthat up to 70% of women with
PCOS have some type of gutdysbiosis.
So we're getting there.
We're getting closer todiscovering the reasons why
someone might develop PCOS.
(09:08):
But what we do know as of rightnow is that PCOS possibly was
developed because it was asurvival mechanism, and this
dates back to when we wereancient humans.
Less ovulation could mean lesschances of having children, and
(09:31):
that could actually increasesurvival.
And insulin resistance playsinto part of this survival
strategy as well, because it canlead to the development of PCOS
.
Because it can lead to thedevelopment of PCOS, and then
PCOS can lead to more IR.
(09:52):
So how do we become adapt todeveloping IR in the first place
?
So, like I said, ancient humanshad to deal with a lot of
stressors like food scarcity,running away from dangerous
predators, extreme weatherconditions, when you didn't know
where the next meal is going tocome from or when you'll get to
eat again.
Some humans were particularlygood at developing insulin
resistance.
An IR, by nature, is areversible condition, so that
(10:17):
makes sense that under stress,survival was the utmost
importance.
But when the stress triggerswere reversed, then you didn't
need to be insulin resistantanymore.
And there were some reasons forthis, of why insulin resistance
is good for survival.
(10:37):
First of all, our brains usealmost exclusively glucose, so,
to preserve the brain, insulinresistance prevents other
tissues from using glucose andwill save the glucose for the
brain.
Secondly, insulin resistancehelped the body to hold on to
fat.
(10:57):
This provides the nutrient andinsulation that can help to
increase your chances ofsurvival.
And lastly, becoming IR duringharsh conditions will allow your
body to adapt to alow-carbohydrate diet in times
when fruits and tuber vegetableswere not available, and that
(11:19):
will force the body to burn fatinstead for energy and preserve
the glycogen storage in the bodyin case a rapid escape is
needed for whatever reason.
So fast forward to present day,where we live in the modern
world.
Our environment has drasticallychanged, but our body and brain
(11:39):
haven't changed very much.
We still have the fire-flightresponse, we still have the
scarcity mentality.
That's why PCOS is described bysome researchers as this
mismatch between the environmentand the body and brain's
pre-programmed responses.
We rarely have food shortagesas a developed country.
(12:02):
We're not running away fromprehistoric predators, but when
we're running out the door torush to places, running on the
treadmill for two hours, thebody's reaction is the same,
which is to prioritize survivaleven though you weren't in any
danger.
So back to what I was sayingbefore about how anyone can
(12:22):
develop IR.
This is why, even if you don'thave PCOS, you can still be
insulin resistant.
In fact, 20% of women in atrial who didn't have PCOS were
found to have IR.
So more on IR for women withoutPCOS in another episode.
But let's get back to PCOS,okay.
(12:45):
Insulin resistance can lead toan increase in male hormones,
because insulin actually is partof the process of making
testosterone and that can leadto facial hair, oily skin,
multiple cysts from forming onthe ovaries.
That will prevent ovulation andit can cause inflammation,
(13:06):
weight gain, many other healthproblems.
In a nutshell, how IR producesinflammation is by affecting the
gut microbiome.
It causes a reduction in thenumber of good bacteria,
specifically bifidobacterium andlactobacillus, and causes an
increased number of bad bacteria.
(13:29):
So this imbalance leads toleaky gut where the intestinal
lining thins to a point wheretoxins can literally leak into
the bloodstream Toxins likelipopolysaccharides.
You can actually find out ifyou have gut dysbiosis through
(13:49):
the GI map test.
It's a stool test.
I run it all the time and wecan actually gather a lot of
interesting information,including bacterial imbalance,
parasites, h pylori, things likethat.
So I do think GI map is areally good tool to use if
you're just not sure if your gutmicrobiome is balanced or
(14:11):
imbalanced.
So how do we fix insulinresistance and inflammation?
For PCOS, the first line ofdefense is diet and lifestyle
changes.
This isn't just my two cents.
This is the general consensusin the international community,
backed by lots of research.
Okay, what has made a lot ofsense to me in treating PCOS the
(14:36):
last few years is to categorizeeach patient with PCOS,
regardless of the Rotterdam type, and group them into either
lean or overweight.
I realize this is hard to talkabout because weight is a
sensitive topic.
I'm not trying to shame anyone,but weight does affect your
(14:57):
treatment because the diet planis different for those that need
to lose weight and those thatdon't.
Insulin resistance tends tocause your body to hold on to
visceral fat, which is the badfat, and that is the type of fat
that leads to more insulinresistance and other metabolic
dysfunctions.
So even a weight loss of 5% to10% can dramatically improve
(15:20):
your chances of getting pregnant, because it improves the
insulin resistance and lowersthe testosterone levels, and
that will help to promoteovulation and increase fertility
.
But lean PCOS is not immune tothis.
Lean PCOS women also have ahigh percentage of visceral fat
compared to subcutaneous fat,even though they're not
(15:44):
overweight and their BMI isnormal.
I mean, have you ever had afriend who was very thin but
always had a larger than normalbelly?
That is most likely caused byIR.
And here's something you mightnot have realized A hidden sign
of IR is high LDL cholesterol.
I see this very often.
(16:04):
My patient tells me that theyhave a very healthy diet but the
LDL is abnormally high.
If this is you, I would suspectinsulin resistance.
What about from a Chinesemedicine perspective?
What is the TCM viewpoint onPCOS?
Everything we've just learned.
Cystic ovaries, long cycles,delayed ovulation, insulin
(16:27):
resistance, not able to loseweight these are most commonly
associated with the wood andearth archetypes.
Not to say that you can't beanother archetype and have PCOS,
but these are the two mostcommonly seen archetypes and it
makes a lot of sense.
Wood archetypes are prone toexperiencing cheese stagnation.
(16:51):
So imagine around ovulation,when the flow of this vital
energy is stuck.
That can cause the follicles togrow much, much more slowly and
might even prevent the folliclefrom growing past certain sides
.
G-stagnation can also preventit from rupturing.
That leads to lots of cystsforming on the ovaries.
(17:14):
The wood archetypes typicallyhave the lean type of PCOS.
With the earth archetypes theproblem isn't qi stagnation,
it's qi deficiency.
Earth archetypes willexperience lots of digestive
issues.
They're the ones that will havemore pronounced symptoms of
(17:34):
insulin resistance.
They'll most likely be moreoverweight compared to the wood
archetypes.
If there are cysts on theovaries and you're an earth
archetype, it's most likelycaused by accumulation of phlegm
and mucus.
Splinchy deficiency leads to asluggish metabolism which, in
(17:55):
Chinese medicine terms, causesyour body to process what it can
into useful energy and the restjust turns into some type of
slush that eventually becomesphlegm-like in consistency.
And phlegm accumulation doesn'tjust cause cysts to form on the
ovaries, it's responsible forall sorts of cysts, fibroids,
polyps that are found in theuterus and other nodules that
(18:20):
are found elsewhere in the bodyare also caused by phlegm
accumulation.
All right, so let's talk aboutnutritional approaches for lean
and overweight PCOS.
For lean, pcos, studies suggestthat weight management is still
important, meaning, even thoughthere's no need to lose weight,
(18:43):
maintenance of current weight toprevent future weight gain is
critical.
And that doesn't mean what youeat doesn't matter.
The quality and quantity stillmatters.
We want to prioritize leanprotein, fruits and vegetables
and healthy fats and minimizeinflammation-producing foods
(19:04):
like processed foods, snacks,fast food and sugary drinks.
Even if you're the lucky fewthat can eat whatever they want
and never gain a pound, this isstill very important for you to
follow.
The type of fat that you consumeis important, so let me just
talk about that for a minute.
Saturated fat is a contributingfactor to IR, but you shouldn't
(19:29):
be afraid of quality protein,like grass-fed beef or grass-fed
butter or clarified butter likeghee.
These types of foods, althoughthey contain saturated fat, the
majority is stearic acid, whichdoes not raise your LDL.
They can actually even help toraise HDL, which is actually
(19:51):
good for your cardiovascularhealth.
So eating grass-fed is not thesame as eating industrialized,
mass-produced grain-fed beef.
I know that red meat gets a lotof bad reps, so I just want to
make sure that you know that Foroverweight PCOS, weight loss is
the top priority.
(20:12):
This doesn't mean you exerciseuntil you can't walk anymore and
only eat an apple and a saladeach day.
This will likely cause yourbody to become more insulin
resistant and accumulate morefat, but calorie restrictions
might be necessary, or sometimesit could be that you're not
eating enough.
I do want to make sure that,regardless of whether you need
(20:37):
to lose weight or maintain yourweight, first thing to do is to
figure out how many calories aday is needed to accomplish your
goal.
There are many caloriecalculators out there, and the
amount required should bedifferent depending on your age,
current weight, height andactivity level.
Similar to lean PCOS protein,protein protein Protein is one
(21:02):
of the most importantmacronutrients.
Protein stabilizes blood sugar,it reduces the insulin spike and
also provide amino acids thatare needed for proper hormone
production and balance that areneeded for proper hormone
production and balance.
So I would like to recommendeveryone to skip the high-carb
breakfast items like cereal,oatmeal, fruit or smoothies and
(21:25):
instead go for eggs, sausage,protein pancakes and things like
that.
This way, you're starting theday off with lots of protein and
fat, you're less likely goingto be famished at lunchtime and
you're less likely going to befamished at lunchtime and you're
less likely going to grabwhatever you can, and you'll be
less likely to have thatafternoon slump and you'll have
(21:46):
more energy throughout the day,more steady energy throughout
the day.
There are two other nutrients Iwant to mention for PCOS that
you need to make sure thatyou're getting enough, and those
are vitamin D and omega-3 fishoil.
Deficient vitamin D has beenassociated with several features
of PCOS, like hair growth, ir,cardiovascular disease risk and
(22:09):
infertility.
And since we're all stayingindoors more often now and we're
using sunscreen more than ever,we're making less vitamin D
from the sun.
So if you're deficient invitamin D, definitely supplement
.
Omega-3 fish oil is anotherfavorite of mine.
I love that supplement Not tobe confused with DHA, which is
(22:32):
only one component of omega-3.
Omega-3 has DHA and EPA, so youneed to be taking the full
omega-3.
Omega-3 reduces theinflammation by balancing the
omega-3 and omega-6 ratio and italso has been shown to help
(22:53):
balance the estrogen andprogesterone and promote
ovulation for PCOS.
Let me switch gears for onesecond when it comes to using
Chinese medicine for these twotypes of PCOS.
The wood and the eartharchetypes would benefit from
different types of foods.
The earth archetypes digestionis likely weaker.
(23:15):
Therefore, foods that are blandand easy to digest will be best
versus for the wood archetypes,foods that are cooling in
nature would be very beneficial,like leafy greens.
Okay, one last thing before Iwrap up.
I do want to mention thatinisotol is considered to be one
(23:39):
of the best supplements forPCOS because it's very effective
at reversing insulin resistance.
I'm not going to get into toomuch detail on this episode
because I want to dive deeperinto insulin resistance and how
it affects fertility in general,not just for PCOS, and talk
(24:00):
about inisotol as well in afuture episode.
So stay tuned for that.
All right, fertile Friend.
That's all I have for today.
Thank you so much for tuning inand spending some time with me.
I hope that you have a betterunderstanding of PCOS, insulin
resistance and inflammation, andwhat your nutritional
(24:22):
approaches should be if you havelean PCOS or overweight PCOS.
So until next time, take careof your amazing self and
remember that you're one fertilecycle away from getting
pregnant.
Welcome to the Practically Fertile Podcast.
I'm Adrienne Wee, doctor ofacupuncture and Chinese medicine
, functional medicinepractitioner and functional
nutritionist.
I specialize in using anevidence-based method, blending
principles of East Asianmedicine and modern functional
medicine to help women optimizefertility and get pregnant.
(00:22):
I believe in a world whereevery woman who wants to be a
mother becomes one.
If you're tired of being toldthat you're infertile and you
want to take the right steps toget pregnant naturally and
quickly, this podcast is for you.
You know, it seems like foreverago when I was diagnosed with
(00:42):
PCOS.
At the time, my doctor told methat very little was known about
the condition and he didn'tknow if I could get pregnant in
the future.
And he told me to just takesome birth control pills, make
it go away and just wait and seewhat happens, because he didn't
know what to do to help me.
So I definitely had cysts on myovaries at the time and also
(01:06):
facial hair.
Till now, to be honest with you, I'm still struggling with
facial hair right above my chinand also right about my lip.
It's super annoying, but I waslucky enough that when I was
diagnosed I was actually inacupuncture school, so I was
able to get it under controlwith acupuncture and herbs.
(01:27):
I was able to regulate myperiod, never 28 days, but I was
finally getting a period on aregular basis, like every 38 to
40 days.
And then when I met my husband,we both got acupuncture six
months prior to trying toconceive.
So when we did actually try toconceive we didn't have a lot of
(01:50):
problems.
So my story is a little bitdifferent, because I had my
struggles before even thinkingabout having kids.
I knew that I had problemsbecause I never took the birth
control pill.
I do think that birth controlpills can mask over symptoms of
PCOS, which might be why a lotof people are shocked to hear
(02:11):
that they have PCOS aftergetting off the pill.
But there was so littleinformation about PCOS when I
was diagnosed and now we know somuch more.
We have more information, moreresearch data and we understand
this condition better and havebetter treatment options.
So here's a fun fact about PCOS.
(02:33):
It's actually not a newcondition.
Doctors Stein and Leventhalfirst described this condition
in 1935.
So it's been around since 1935.
It's important to note thatnowadays it's estimated PCOS
(02:53):
affects as many as 20% of womenof reproductive age.
Globally, it's one of the mostcommon ovulatory disorders that
cause infertility.
But it's also important to knowthat many women are still being
undiagnosed or misdiagnosed.
One of the reasons for thisincreased prevalence is because
(03:14):
of the updates to the diagnosticcriteria called the Rotterdam
criteria.
Based on the Rotterdam criteria, a woman needs to have two out
of the three characteristics ofPCOS to be diagnosed.
So these three characteristicsare hyperandrogenism, which is
(03:35):
an increased amount of malehormones.
Irregular or lack of ovulationthis is characterized by cycles
longer than 35 days or less thaneight cycles per year.
And also the third ispolycystic ovaries, with more
than 20 small follicles on eachovary.
This classification methodmeans that there could be
(03:59):
different types of PCOS.
Prior to this, the NationalInstitute of Health guideline
was used, which only includedthe hyperandrogenism and
irregular or lack of ovulation.
So the Rotterdam criteria wasexpanded based on that.
(04:20):
So now the international medicalcommunity recognizes four types
of PCOS Type 1, which issomeone who has all three of the
symptoms the hyperandrogenism,ovulation disorder and
polycystic ovaries.
This would be what we know tobe the classic type of PCOS.
Type 2 is someone with an ovarythat has no cysts but does have
(04:46):
the hyperandrogenism signs andalso ovulation irregularities.
Type 3 PCOS is someone with thehyperandrogenism and polycystic
ovaries but they ovulateregularly.
Type 4 PCOS is the mildest typeof PCOS, where someone will
(05:10):
present with polycystic ovariesand ovulation irregularities but
not a lot of thehyperandrogenism signs.
I've seen over the years manydifferent types of
interpretation on these fourtypes from functional medicine
perspectives, such as adrenaltype, inflammation type, insulin
resistance type.
(05:30):
I'm not knocking on thesetyping systems at all.
I want to share my perspectiveon this and talk about if it
really matters which type ofPCOS you have based on recent
evidence.
Pcos you have based on recentevidence.
Studies have found that,regardless of the type, body
(05:50):
weight and hormone panels, themajority of women with PCOS have
underlying insulin resistance.
In one study, in a group ofwomen who had PCOS but normal
weight, 83.3% were found to haveinsulin resistance and in the
overweight group, 91% of thewomen had insulin resistance.
(06:12):
So there's not a lot ofdifference between the women
with the normal weight versuswomen who were overweight.
And just for clarification,weight and just for
clarification.
This is not to say that youhave to have PCOS to be insulin
resistant.
In fact, you can have insulinresistance without having PCOS.
(06:34):
Anyone can become insulinresistant at any time.
But more on this in just alittle bit.
Insulin resistance I'm going tostart referring to it as IR.
Ir is the reason why metforminis commonly used as a treatment
for PCOS.
I think it's being prescribedway too much and way too often,
(06:56):
but I understand that if you'regoing to do IVF and you have to
get the IR under control veryquickly, that might be the best
option.
So, because IR is oftenassociated with chronic
inflammation, the majority ofwomen with PCOS will also have
inflammation.
And what about the adrenal typeof PCOS?
(07:17):
Yes, and what about the adrenaltype of PCOS?
I just think that anyone withPCOS or without PCOS, the
adrenals are going to beinvolved, because stress is
something that all of usexperience on a daily basis.
The adrenal glands arehyperactive and they're
(07:40):
overworked.
And similarly, in Chinesemedicine, even if your archetype
isn't water and kidneydeficiency isn't your main
pattern, the kidneys are stillworking in the background and
are still a huge part of overallfertility potential.
So I think adrenals areinvolved in every single case of
(08:01):
fertility.
So does it matter which one ofthese types of PCOS you have?
As far as management of thesymptoms and improving your
chances of getting pregnant?
Not really.
What we do know for sure is thatinsulin resistance and
inflammation are the two commonissues that all women with PCOS
(08:22):
have to deal with.
Managing the IR andinflammation is the key to
overcoming PCOS.
So, before we get into thedetails about how IR and
inflammation specifically affectPCOS, I want to share something
very interesting about theorigin of PCOS, because it's
(08:47):
still a mystery exactly howsomeone develops PCOS.
We know that genetics is a bigcomponent, and epigenetics, and
the latest research estimatesthat up to 70% of women with
PCOS have some type of gutdysbiosis.
So we're getting there.
We're getting closer todiscovering the reasons why
someone might develop PCOS.
(09:08):
But what we do know as of rightnow is that PCOS possibly was
developed because it was asurvival mechanism, and this
dates back to when we wereancient humans.
Less ovulation could mean lesschances of having children, and
(09:31):
that could actually increasesurvival.
And insulin resistance playsinto part of this survival
strategy as well, because it canlead to the development of PCOS
.
Because it can lead to thedevelopment of PCOS, and then
PCOS can lead to more IR.
(09:52):
So how do we become adapt todeveloping IR in the first place
?
So, like I said, ancient humanshad to deal with a lot of
stressors like food scarcity,running away from dangerous
predators, extreme weatherconditions, when you didn't know
where the next meal is going tocome from or when you'll get to
eat again.
Some humans were particularlygood at developing insulin
resistance.
An IR, by nature, is areversible condition, so that
(10:17):
makes sense that under stress,survival was the utmost
importance.
But when the stress triggerswere reversed, then you didn't
need to be insulin resistantanymore.
And there were some reasons forthis, of why insulin resistance
is good for survival.
(10:37):
First of all, our brains usealmost exclusively glucose, so,
to preserve the brain, insulinresistance prevents other
tissues from using glucose andwill save the glucose for the
brain.
Secondly, insulin resistancehelped the body to hold on to
fat.
(10:57):
This provides the nutrient andinsulation that can help to
increase your chances ofsurvival.
And lastly, becoming IR duringharsh conditions will allow your
body to adapt to alow-carbohydrate diet in times
when fruits and tuber vegetableswere not available, and that
(11:19):
will force the body to burn fatinstead for energy and preserve
the glycogen storage in the bodyin case a rapid escape is
needed for whatever reason.
So fast forward to present day,where we live in the modern
world.
Our environment has drasticallychanged, but our body and brain
(11:39):
haven't changed very much.
We still have the fire-flightresponse, we still have the
scarcity mentality.
That's why PCOS is described bysome researchers as this
mismatch between the environmentand the body and brain's
pre-programmed responses.
We rarely have food shortagesas a developed country.
(12:02):
We're not running away fromprehistoric predators, but when
we're running out the door torush to places, running on the
treadmill for two hours, thebody's reaction is the same,
which is to prioritize survivaleven though you weren't in any
danger.
So back to what I was sayingbefore about how anyone can
(12:22):
develop IR.
This is why, even if you don'thave PCOS, you can still be
insulin resistant.
In fact, 20% of women in atrial who didn't have PCOS were
found to have IR.
So more on IR for women withoutPCOS in another episode.
But let's get back to PCOS,okay.
(12:45):
Insulin resistance can lead toan increase in male hormones,
because insulin actually is partof the process of making
testosterone and that can leadto facial hair, oily skin,
multiple cysts from forming onthe ovaries.
That will prevent ovulation andit can cause inflammation,
(13:06):
weight gain, many other healthproblems.
In a nutshell, how IR producesinflammation is by affecting the
gut microbiome.
It causes a reduction in thenumber of good bacteria,
specifically bifidobacterium andlactobacillus, and causes an
increased number of bad bacteria.
(13:29):
So this imbalance leads toleaky gut where the intestinal
lining thins to a point wheretoxins can literally leak into
the bloodstream Toxins likelipopolysaccharides.
You can actually find out ifyou have gut dysbiosis through
(13:49):
the GI map test.
It's a stool test.
I run it all the time and wecan actually gather a lot of
interesting information,including bacterial imbalance,
parasites, h pylori, things likethat.
So I do think GI map is areally good tool to use if
you're just not sure if your gutmicrobiome is balanced or
(14:11):
imbalanced.
So how do we fix insulinresistance and inflammation?
For PCOS, the first line ofdefense is diet and lifestyle
changes.
This isn't just my two cents.
This is the general consensusin the international community,
backed by lots of research.
Okay, what has made a lot ofsense to me in treating PCOS the
(14:36):
last few years is to categorizeeach patient with PCOS,
regardless of the Rotterdam type, and group them into either
lean or overweight.
I realize this is hard to talkabout because weight is a
sensitive topic.
I'm not trying to shame anyone,but weight does affect your
(14:57):
treatment because the diet planis different for those that need
to lose weight and those thatdon't.
Insulin resistance tends tocause your body to hold on to
visceral fat, which is the badfat, and that is the type of fat
that leads to more insulinresistance and other metabolic
dysfunctions.
So even a weight loss of 5% to10% can dramatically improve
(15:20):
your chances of getting pregnant, because it improves the
insulin resistance and lowersthe testosterone levels, and
that will help to promoteovulation and increase fertility
.
But lean PCOS is not immune tothis.
Lean PCOS women also have ahigh percentage of visceral fat
compared to subcutaneous fat,even though they're not
(15:44):
overweight and their BMI isnormal.
I mean, have you ever had afriend who was very thin but
always had a larger than normalbelly?
That is most likely caused byIR.
And here's something you mightnot have realized A hidden sign
of IR is high LDL cholesterol.
I see this very often.
(16:04):
My patient tells me that theyhave a very healthy diet but the
LDL is abnormally high.
If this is you, I would suspectinsulin resistance.
What about from a Chinesemedicine perspective?
What is the TCM viewpoint onPCOS?
Everything we've just learned.
Cystic ovaries, long cycles,delayed ovulation, insulin
(16:27):
resistance, not able to loseweight these are most commonly
associated with the wood andearth archetypes.
Not to say that you can't beanother archetype and have PCOS,
but these are the two mostcommonly seen archetypes and it
makes a lot of sense.
Wood archetypes are prone toexperiencing cheese stagnation.
(16:51):
So imagine around ovulation,when the flow of this vital
energy is stuck.
That can cause the follicles togrow much, much more slowly and
might even prevent the folliclefrom growing past certain sides
.
G-stagnation can also preventit from rupturing.
That leads to lots of cystsforming on the ovaries.
(17:14):
The wood archetypes typicallyhave the lean type of PCOS.
With the earth archetypes theproblem isn't qi stagnation,
it's qi deficiency.
Earth archetypes willexperience lots of digestive
issues.
They're the ones that will havemore pronounced symptoms of
(17:34):
insulin resistance.
They'll most likely be moreoverweight compared to the wood
archetypes.
If there are cysts on theovaries and you're an earth
archetype, it's most likelycaused by accumulation of phlegm
and mucus.
Splinchy deficiency leads to asluggish metabolism which, in
(17:55):
Chinese medicine terms, causesyour body to process what it can
into useful energy and the restjust turns into some type of
slush that eventually becomesphlegm-like in consistency.
And phlegm accumulation doesn'tjust cause cysts to form on the
ovaries, it's responsible forall sorts of cysts, fibroids,
polyps that are found in theuterus and other nodules that
(18:20):
are found elsewhere in the bodyare also caused by phlegm
accumulation.
All right, so let's talk aboutnutritional approaches for lean
and overweight PCOS.
For lean, pcos, studies suggestthat weight management is still
important, meaning, even thoughthere's no need to lose weight,
(18:43):
maintenance of current weight toprevent future weight gain is
critical.
And that doesn't mean what youeat doesn't matter.
The quality and quantity stillmatters.
We want to prioritize leanprotein, fruits and vegetables
and healthy fats and minimizeinflammation-producing foods
(19:04):
like processed foods, snacks,fast food and sugary drinks.
Even if you're the lucky fewthat can eat whatever they want
and never gain a pound, this isstill very important for you to
follow.
The type of fat that you consumeis important, so let me just
talk about that for a minute.
Saturated fat is a contributingfactor to IR, but you shouldn't
(19:29):
be afraid of quality protein,like grass-fed beef or grass-fed
butter or clarified butter likeghee.
These types of foods, althoughthey contain saturated fat, the
majority is stearic acid, whichdoes not raise your LDL.
They can actually even help toraise HDL, which is actually
(19:51):
good for your cardiovascularhealth.
So eating grass-fed is not thesame as eating industrialized,
mass-produced grain-fed beef.
I know that red meat gets a lotof bad reps, so I just want to
make sure that you know that Foroverweight PCOS, weight loss is
the top priority.
(20:12):
This doesn't mean you exerciseuntil you can't walk anymore and
only eat an apple and a saladeach day.
This will likely cause yourbody to become more insulin
resistant and accumulate morefat, but calorie restrictions
might be necessary, or sometimesit could be that you're not
eating enough.
I do want to make sure that,regardless of whether you need
(20:37):
to lose weight or maintain yourweight, first thing to do is to
figure out how many calories aday is needed to accomplish your
goal.
There are many caloriecalculators out there, and the
amount required should bedifferent depending on your age,
current weight, height andactivity level.
Similar to lean PCOS protein,protein protein Protein is one
(21:02):
of the most importantmacronutrients.
Protein stabilizes blood sugar,it reduces the insulin spike and
also provide amino acids thatare needed for proper hormone
production and balance that areneeded for proper hormone
production and balance.
So I would like to recommendeveryone to skip the high-carb
breakfast items like cereal,oatmeal, fruit or smoothies and
(21:25):
instead go for eggs, sausage,protein pancakes and things like
that.
This way, you're starting theday off with lots of protein and
fat, you're less likely goingto be famished at lunchtime and
you're less likely going to befamished at lunchtime and you're
less likely going to grabwhatever you can, and you'll be
less likely to have thatafternoon slump and you'll have
(21:46):
more energy throughout the day,more steady energy throughout
the day.
There are two other nutrients Iwant to mention for PCOS that
you need to make sure thatyou're getting enough, and those
are vitamin D and omega-3 fishoil.
Deficient vitamin D has beenassociated with several features
of PCOS, like hair growth, ir,cardiovascular disease risk and
(22:09):
infertility.
And since we're all stayingindoors more often now and we're
using sunscreen more than ever,we're making less vitamin D
from the sun.
So if you're deficient invitamin D, definitely supplement
.
Omega-3 fish oil is anotherfavorite of mine.
I love that supplement Not tobe confused with DHA, which is
(22:32):
only one component of omega-3.
Omega-3 has DHA and EPA, so youneed to be taking the full
omega-3.
Omega-3 reduces theinflammation by balancing the
omega-3 and omega-6 ratio and italso has been shown to help
(22:53):
balance the estrogen andprogesterone and promote
ovulation for PCOS.
Let me switch gears for onesecond when it comes to using
Chinese medicine for these twotypes of PCOS.
The wood and the eartharchetypes would benefit from
different types of foods.
The earth archetypes digestionis likely weaker.
(23:15):
Therefore, foods that are blandand easy to digest will be best
versus for the wood archetypes,foods that are cooling in
nature would be very beneficial,like leafy greens.
Okay, one last thing before Iwrap up.
I do want to mention thatinisotol is considered to be one
(23:39):
of the best supplements forPCOS because it's very effective
at reversing insulin resistance.
I'm not going to get into toomuch detail on this episode
because I want to dive deeperinto insulin resistance and how
it affects fertility in general,not just for PCOS, and talk
(24:00):
about inisotol as well in afuture episode.
So stay tuned for that.
All right, fertile Friend.
That's all I have for today.
Thank you so much for tuning inand spending some time with me.
I hope that you have a betterunderstanding of PCOS, insulin
resistance and inflammation, andwhat your nutritional
(24:22):
approaches should be if you havelean PCOS or overweight PCOS.
So until next time, take careof your amazing self and
remember that you're one fertilecycle away from getting
pregnant.
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