Polycystic ovarian syndrome is a debilitating hormonal condition which affects around 1 in 10 women in the UK. Those affected are faced with fertility complications, hormonal imbalances and hugely uncomfortable symptoms.
A genetic condition
PCOS is thought to be a genetic condition. Whilst the exact reason for PCOS is still unknown, it often runs in families. This means that If you have been diagnosed with it, you were most probably born with the gene.
Unfortunately, as it is genetic, there is no cure. However, there are effective ways of managing it and putting it into remission. PCOS is heavily directly influenced by blood sugar imbalances, more accurately - insulin resistance. If you can balance your blood sugar and reduce your insulin resistance, you can have great improvements in this condition.
There are also several triggers that can cause the condition to emerge, including smoking, excessive alcohol consumption, a sedentary lifestyle, type 1 or 2 diabetes, high birth weight, premature puberty and metabolic syndrome.
Having the PCOS gene doesn`t mean that you are going to develop the condition, it means that you are more likely to develop it if the environmental factors are right to 'switch it on'. Environmental factors are things like lifestyle, stress, sugar intake, diet, alcohol intake, poor gut health, hormonal birth control, environmental toxins and malnutrition.
Whilst this may sound a bit scary, the good news is that this means you can effectively 'switch off' the PCOS gene by altering these environmental factors and enjoy a life with less pain and suffering.
What is PCOS exactly?
We are born with a full stock of eggs in our ovaries. Every month the follicles that are little pockets that surround the ovum (eggs) begin to swell, ready to "pop out" an egg. These follicles compete with each other and the one that matures the quickest will be the successful follicle to release the egg. As the egg is released from the mature follicle, the other follicles subside and are reabsorbed by the body.
Someone who has PCOS isn`t able to release the egg from the mature follicle. Because the egg isn`t released, the ovary is left with an enlarged follicle each month, giving the ovary that typical bumpy image full of follicles that you may have seen on an ultrasound scan.
A genetic condition
PCOS is thought to be a genetic condition. Whilst the exact reason for PCOS is still unknown, it often runs in families. This means that If you have been diagnosed with it, you were most probably born with the gene.
Unfortunately, as it is genetic, there is no cure. However, there are effective ways of managing it and putting it into remission. PCOS is heavily directly influenced by blood sugar imbalances, more accurately - insulin resistance. If you can balance your blood sugar and reduce your insulin resistance, you can have great improvements in this condition.
There are also several triggers that can cause the condition to emerge, including smoking, excessive alcohol consumption, a sedentary lifestyle, type 1 or 2 diabetes, high birth weight, premature puberty and metabolic syndrome.
Having the PCOS gene doesn`t mean that you are going to develop the condition, it means that you are more likely to develop it if the environmental factors are right to 'switch it on'. Environmental factors are things like lifestyle, stress, sugar intake, diet, alcohol intake, poor gut health, hormonal birth control, environmental toxins and malnutrition.
Whilst this may sound a bit scary, the good news is that this means you can effectively 'switch off' the PCOS gene by altering these environmental factors and enjoy a life with less pain and suffering.
What is PCOS exactly?
We are born with a full stock of eggs in our ovaries. Every month the follicles that are little pockets that surround the ovum (eggs) begin to swell, ready to "pop out" an egg. These follicles compete with each other and the one that matures the quickest will be the successful follicle to release the egg. As the egg is released from the mature follicle, the other follicles subside and are reabsorbed by the body.
Someone who has PCOS isn`t able to release the egg from the mature follicle. Because the egg isn`t released, the ovary is left with an enlarged follicle each month, giving the ovary that typical bumpy image full of follicles that you may have seen on an ultrasound scan.
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As you can imagine, because the ovary struggles to release the egg, PCOS has huge implications on fertility.
PCOS is the leading cause of infertility, but it is reversible and many women go on to have successful pregnancies after addressing their insulin resistance through diet and lifestyle. What are the other symptoms of PCOS? People who suffer from PCOS will commonly (but not always) be affected by acne, greasy skin, excessive hair growth (hirsutism) usually on the face, back , chest or buttocks, hair loss or thinning on the head, weight gain, irregular, absent or missing periods and mood disturbances. Most of these symptoms are due to the body producing too many androgens (typical male sex hormones). PCOS also puts the individual at risk from developing type 2 diabetes and high cholesterol levels. |
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How do I know If I have PCOS?
PCOS is made by a clinical diagnosis by your healthcare provider. Generally, they will look for two out of these three criteria:
Insulin resistance and PCOS
In most cases, PCOS is directly linked to insulin resistance. A very small percentage of people suffer with PCOS caused by adrenal issues , but most are because of excess insulin in the blood.
Insulin resistance is where the cells in the liver, muscles and fat are not as sensitive to insulin so are less able to store the glucose away. Because of this, too much insulin is circulating in the blood stream. As a result, the pancreas makes and releases more insulin leaving the body with higher than normal circulating insulin. Women with PCOS can make insulin but they can`t use it effectively. Too much insulin is inflammatory and causes weight gain. It can cause type 2 diabetes and heart disease. It is also the cause of the uncomfortable symptoms of PCOS that you are all too familiar with.
When the blood has too much insulin in it, the insulin stimulates the ovaries to produce testosterone, leading to the excess androgen symptoms that were mentioned before. Not only this but high levels of insulin cause sex hormone binding globulin to lower. SHBG is a protein that attaches itself to excess circulating sex hormones that helps them to be eliminated. When SHBG is lowered, the excess sex hormones are left to circulate further, allowing testosterone to be circulating in higher levels than it should. High insulin is also responsible for impairing ovarian function and preventing the follicle from releasing the egg.
The other thing that can have a direct influence on raised insulin is stress. When we are stressed our adrenals secrete cortisol to help us cope. When the body has a high level of cortisol, it increases insulin.
So what can I do to help my PCOS?
The main thing to focus on in order to improving your symptoms of PCOS is to control your blood sugar and reduce insulin resistance.
Insulin resistance is not just for people who are overweight. You can be of average build and still be insulin resistant. It is something that every person with PCOS should focus on. Conventional treatment of PCOS is generally Metformin. This makes sense as it is a drug that is used to regulate blood sugar and insulin.
The best way to balance your blood sugar is through a complete overhaul of your diet. It`s not about restricting calories - it`s about changing the way you think about food.
PCOS is made by a clinical diagnosis by your healthcare provider. Generally, they will look for two out of these three criteria:
- Irregular periods
- Excess androgens
- Polycystic ovaries from a scan
Insulin resistance and PCOS
In most cases, PCOS is directly linked to insulin resistance. A very small percentage of people suffer with PCOS caused by adrenal issues , but most are because of excess insulin in the blood.
Insulin resistance is where the cells in the liver, muscles and fat are not as sensitive to insulin so are less able to store the glucose away. Because of this, too much insulin is circulating in the blood stream. As a result, the pancreas makes and releases more insulin leaving the body with higher than normal circulating insulin. Women with PCOS can make insulin but they can`t use it effectively. Too much insulin is inflammatory and causes weight gain. It can cause type 2 diabetes and heart disease. It is also the cause of the uncomfortable symptoms of PCOS that you are all too familiar with.
When the blood has too much insulin in it, the insulin stimulates the ovaries to produce testosterone, leading to the excess androgen symptoms that were mentioned before. Not only this but high levels of insulin cause sex hormone binding globulin to lower. SHBG is a protein that attaches itself to excess circulating sex hormones that helps them to be eliminated. When SHBG is lowered, the excess sex hormones are left to circulate further, allowing testosterone to be circulating in higher levels than it should. High insulin is also responsible for impairing ovarian function and preventing the follicle from releasing the egg.
The other thing that can have a direct influence on raised insulin is stress. When we are stressed our adrenals secrete cortisol to help us cope. When the body has a high level of cortisol, it increases insulin.
So what can I do to help my PCOS?
The main thing to focus on in order to improving your symptoms of PCOS is to control your blood sugar and reduce insulin resistance.
Insulin resistance is not just for people who are overweight. You can be of average build and still be insulin resistant. It is something that every person with PCOS should focus on. Conventional treatment of PCOS is generally Metformin. This makes sense as it is a drug that is used to regulate blood sugar and insulin.
The best way to balance your blood sugar is through a complete overhaul of your diet. It`s not about restricting calories - it`s about changing the way you think about food.
- It`s really important to familiarise yourself with the glycaemic index. The glycaemic index is a way of categorising foods and drinks according to their glucose content. It is something that most diabetic people will be familiar with as it is the same principle. Foods are categorised on the glycaemic index as high, medium or low G.I foods. It is important to avoid all the high G.I foods and try your hardest to keep to the low G.I foods with the occasional medium category foods once in a while. You can find the glycaemic index here
- One of the best ways to balance your blood sugar is to have a protein based breakfast within an hour of waking up. By doing this you are setting the tone of your blood sugar for the rest of the day. Protein and healthy fats slow down the process of any accompanying carbohydrates converting into glucose too quickly. You should throw away all those sugary breakfast cereals immediately and instead start to have eggs if you eat them or other good quality protein sources.
- Whilst we are talking about protein, it is important to add it to every meal you have. That doesn`t mean that you have to eat a diet heavy in meats, there`s lots of vegetable proteins you can use such as beans and lentils.
- Avoid ALL fructose. I`m talking about the type of fructose in fruit juice, deserts and soft drinks. These high dose fructose items overwhelm the normal processing pathways in the small intestine. The fructose can directly reach the liver, where it can generate inflammation and impair insulin sensitivity.
- It goes without saying that sugar HAS to go. It`s no good lessening it or dropping down a bit - if you have insulin resistance you most probably have a genetic variation on the cells in your pancreas that release insulin. Just the smallest amount will cause a huge release of insulin. It has to go. Full stop. Artificial sweeteners have to go as well. They still have an effect on insulin.
- It`s time to ditch refined carbohydrate foods. Anything made with white flour is a no-no. Refined flour converts to glucose very quickly. Swap to wholemeal items instead.
- Restrict the amount of starchy foods - breads, pastas etc. Even though I have just told you to swap to wholemeal, you should still really restrict the amount of these items you eat. A little wholemeal bread is ok every now and again, or with some eggs for breakfast, but that`s it! It still is higher up on the glycaemic index than you should be eating.
- Include an array of vegetables each day. Try to eat a rainbow of veggies and aim for 60% of two of your daily meals being made up of vegetables.
- Include plenty of cruciferous vegetables such as broccoli, cauliflower, cabbage and sprouts.
- Avoid all sweet fruits like grapes, bananas, peaches, pineapples and mangos etc. Stick to apples, pears, berries and citrus fruits.
- Eat only whole, fresh foods. If it came in a package and doesn`t resemble anything that grows naturally, it is not good for you and will cause more inflammation.
- Don`t allow yourself to go hungry. Keep a snack bag with you with healthy snacks such as berries, apples, nuts and seeds. Beware of "healthy" packaged snacks that contain dried fruits such as dates and raisins. Always check the sugar content as these kind of snacks are often high in fruit sugars which will cause your insulin to rise.
- Avoid dairy. When dairy is digested, a similar hormone to insulin is released called IGF-1. This is similar at a molecular level to human insulin. PCOS sufferers are more sensitive to IGF-1 and it will have the same testosterone triggering effect on the ovaries as insulin. Dairy also contains hormones that can imbalance the endocrine system further, complicating the balance of hormones.
- Cut out all alcohol. Alcohol is so high in sugar and will cause huge amounts of insulin to be released.
- Cut out all caffeine. Caffeine causes a stress response and stress = high cortisol and high insulin.
- Don`t eat after 7pm. Allowing your liver time to function without the pressures of glucose and insulin will help you become more balanced with your blood sugar in the long-run. This is often known as intermittent fasting. You can read more about this here
- Avoid dehydration - that means drinking between 1.5 and 2 litres of pure water every day. Dehydration effects the mineral content of the cell and causes losses of magnesium and potassium. Magnesium is needed for blood sugar control. Dehydration also causes a stress response which we know causes insulin to rise.
Lifestyle advice
As I mentioned before, stress causes further inflammation and rises in insulin. It is so important that you reduce the amount of stress that you encounter and therefor the amount of cortisol your adrenals need to make. You really need to nourish your adrenals.
As I mentioned before, stress causes further inflammation and rises in insulin. It is so important that you reduce the amount of stress that you encounter and therefor the amount of cortisol your adrenals need to make. You really need to nourish your adrenals.
- What can you do to reduce stress? Can you ask for help somewhere? do you need to move house? Seriously, even huge, life-changing decisions may be necessary for your long-term health.
- Improve your sleep routine. Lack of sleep is so inflammatory. It is a cause of high cortisol and will worsen your symptoms. Make sure you are in bed by 11pm each night and aim for 7 or 8 hours of sleep.
- Exercise is really great for blood sugar balance. The more muscle mass that you have, the more glucose you can store away. light resistant training is really good for muscle mass so a small set of weights can be a great addition to your health toolbox. A 20 minute walk each day is good for moving your muscles and your lymphatic system.
- If you already exercise, be careful that you don`t over-exercise and cause a stress response.
- Practice mindfulness or meditation as often as you can. This can be as simple as a spot of gardening, colouring, tapestry - anything that can take your mind off of your worries. There are some great guided meditations on youtube and some helpful apps you can download such as Headspace .
- Summary
PCOS is a common, hormonal condition with genetic traits that is associated with insulin resistance. It is imperative to control insulin balance and stress levels to improve PCOS. The great news is that studies have found that diet and lifestyle changes are shown to be better than metformin and clomid at regulating PCOS. https://www.sciencedirect.com/science/article/abs/pii/S0015028209005056
