In America, between 8 and 20 percent of women are affected by polycystic ovary syndrome (more commonly referred to as PCOS), making it one of the most common endocrine disorders among women of childbearing age—and one of the biggest contributors to infertility.
In order to be diagnosed with PCOS, you must display two out of these three main symptoms:
Irregular menstrual cycles
High levels of androgens, which can manifest as symptoms of excess facial hair and acne
Presence of ovarian cysts on ultrasound
I have all three of these - but you might not! So your symptoms could slightly vary, especially if you don’t have high androgens, and that will impact your treatment. So definitely connect with a doctor to develop an individualized plan for management!
Check out my video below where I talk about how many doctors missed my diagnosis, the frustration I felt, and the shame over my symptoms. In the second vlog I discuss how I finally found some peace and relief.
I talk in the video about my weight gain (+50 pounds) and loss (-35 pounds), you can see that down below. Literally I’m wearing the same dress (and have the same amazing guy by my side) and you can see how differently it fits (it literally grew 2 inches in length without being stretched). Left is feeling bloated, fatigued, and misunderstood (still finding some joy because of my amazing support system) whereas the right is feeling less anxious, stronger, and living more in alignment.
Key tenants that I live by for PCOS management:
Mostly gluten-free and dairy-free lifestyle. I am not mega-strict with this to the point where I avoid all sauces with gluten; for example, I eat soy sauce with sushi (yum). I also sometimes eat goat cheese. But overall, I avoid gluten and dairy as much as I can. I also avoid replacing gluten with gluten-free processed products - so I don’t simply buy GF pasta, GF bagels, GF waffles, etc. I try to choose naturally GF foods like rice, potatoes, beans, etc. And when I buy a processed food, I keep the label as clean as possible (minimal fillers or preservatives).
Lower-carb. I try to make 1/2 of my plate vegetables at lunch and dinner, and limit fruit (1-2 servings daily, sometimes 1 of those is simply the dates in a Larabar). I limit my GF grains (quinoa, rice, etc). I don’t eat many beans because of my IBS, not because of my PCOS. That’s one reason I eat so many paleo meals; they are GF, dairy-free, and avoid legumes that irritate my gut, so it’s a win-win-win for me.
Limit sugar. I am a sugar addict! I love it. I used to eat it by the spoonful as a child. I’ve learned that sugar is not only super inflammatory, but can exacerbate PCOS since it’s a metabolic/inflammatory condition. PCOS can lead to leptin resistance (the hormone that tells you when you’re full), meaning you don’t feel full after a meal and it can also lead to increased carbohydrate cravings. Keeping my sugar intake low keeps my cravings low and prevents my blood sugar from spiking (remember that diabetes risk?). It also helps me appreciate GF cookie dough and other desserts way more when I do have them!
Avoid additives. I don’t do any artificial sweeteners (I do use some stevia) and I avoid things like nitrites/nitrates used to preserve meats. I limit gums (guar gum, xanthan gum) although will sometimes use them in GF cooking or I will consume them in non-dairy milks (I try to buy brands that are just nuts, water, vanilla, and salt, but that’s not always possible). If the ingredient list for a processed food is super long and there’s a bunch of names that I recognize as preservatives (or added sugar, I see you brown rice syrup) I will just say no.
Mostly organic. We buy the Dirty Dozen organic almost always, and most of other food organic when possible (clean 15 sometimes being the exception). We buy grass-fed beef or bison, hormone-free/antibiotic free poultry, pasture-raised eggs, and wild-caught fish (or responsibly farmed). My grocery bill is outrageous because I am 100% all about my food. As a dietitian, I recognize just how important food is for a healthy life and healing, so I’m fine with spending more money on it. This is honestly my biggest expenditure. We try to keep it lower by buying in bulk, buying in-season, buying frozen, but it still ends up being expensive, and I’m fine with that. If organic raspberries are outrageously expensive, I won’t buy raspberries. I’ll check the price of frozen organic, or I’ll make due with a different fruit. I also save money by avoiding processed foods - rice and potatoes are certainly much cheaper than pre-made cauliflower crust or super fancy granola bars (although sometimes I treat myself).
As a side note, I don’t avoid soy. The research isn’t there to support the effect of phytoestrogens on hormonal systems. In fact, for women who are at risk of hormonal breast cancer (or survivors), whole-food organic soy may actually reduce their risk.
PHYSICAL ACTIVITY TO MANAGE PCOS
I frequently do yoga. In PCOS, we are often ‘wired and tired’ pumping ourselves full of caffeine while struggling with chronic fatigue. We exacerbate this issue when we run, do HIIT, and other intense exercises without giving ourselves proper time for rest and rejuvenation.
I walk a lot. Running may be great for you, but I absolutely hate it. I hated it when I ran cross country in high school, I hated it when I tried to do it for weight loss, I hated it when I trained for the Tough Mudder… I have literally never enjoyed a run. Ever. So I walk a lot, which bodes well for heart health, and it means I am more likely to stick with it (plus, it’s a bit easier on the joints!).
LIFESTYLE KEYS FOR HEALING PCOS
Sleep 7-8 hours every night. This is good for self-care, and allows your body time to rest. Our body does a lot of work during sleep, clearing out dead cells and repairing our skin and other organs. It’s critical!
Clean beauty care. Dealing with cystic acne is hard enough, so I try to support my skin any way I can. That means not using products with parabens, triclosan, fragrance, and phthalates. I swapped to natural deodorant to avoid aluminum as well. This category includes makeup, skincare and cleansers, shampoo, conditioner, and more.
Non-toxic products. I’m talking about organic laundry detergent, non-toxic vinegar-based cleaners, washing clothing before wearing (they spray it with a lot of chemicals while they make it!), etc. I use essential oils for making my own products at home, as well as for aromatherapy (although I have to be very careful since I have two cats at home).
Limit Alcohol. It’s best to avoid it all-together since it’s toxic to your liver and increases inflammation, but it’s also a big part of many people’s lives. I personally limit it as much as possible. It’s easier in AZ since there is a Zero-Tolerance law (so no happy hour & driving home under the law), but there’s still a lot of social drinking, especially since I’m still in my 20s. I politely decline much of the time, and stick to only drinking when I want to (~1-2x/month).
I don’t weigh myself daily. It’s effin’ stressful and it completely takes the focus away from my health. Yes, I absolutely wanted to lose weight. So I would weigh myself every 1-2 weeks to see where I was falling, and keep myself focused. I also got labs drawn every 3 months because health does not equal weight, and saw my doctor frequently. I looked at my side effects of my PCOS (+IBS) and measured how those were improving or not (cystic acne, fatigue, GI distress, etc) rather than the scale.
Maintain a normal weight (for me). I did not count calories at all to lose weight. In fact, when I tried to count them I got stressed out, and found myself moving toward disordered eating instead of health. Not good. I’m a believer in the intuitive eating movement, while also supporting nourishing your body with good nutrition (which is actually the 10th tenant of intuitive eating). You can’t intuitively eat Wendy’s every day (sorry). I am a huge supporter of balance - I don’t weigh myself every day, I don’t count calories, I enjoy gluten-free cookie dough every so often. But I also eat a ton of kale, cook with extra virgin olive oil, and buy organic coffee. Pick your battles, and find your balance (it won’t look the same as mine, and that’s okay!!).
Work-life balance. I actually ended up switching jobs because my stress was so out of control. I’m still in the process of finding what my perfect balance is (and what my dream job will be), but I know it’s important for me to have time to relax and decompress. I also value my PTO, and being able to take time off is very important to me (like my trip to Japan in the Fall). I have found that I need a consistent schedule - I cannot work varying shifts, otherwise my sleep schedule gets thrown off the wagon. It’s important to learn what you need from your job to find balance.
SUPPLEMENTS I’M TAKING FOR PCOS
Adaptogens. There are a few adaptogens I take irregularly (throwing them in lattes, my morning coffee, using Four Sigmatic’s line, etc) including
Maca for hormonal support and energy
Ashwagandha for anxiety relief and relaxation
Reishi for immune and liver support (to help prevent toxin build-up)
Chaga for fighting chronic inflammation
Collagen Protein. I use Vital Proteins since it is grass-fed and widely available - I do 5-10g daily for hair, skin, and nail support. The research is mostly anecdotal right now, but I have noticed a difference in my nails particularly (SO much stronger!). Note that it is not a complete protein, so you need other sources (i.e. animal products, spirulina, a clean protein powder, etc) to make sure you’re getting all 9 essential amino acids.
Berberine. I’ve been on this supplement since my PCOS diagnosis. It helps with blood sugar management (my HgA1c was 5.4, not pre-diabetic, when I started) and is extremely anti-inflammatory. Since taking it and implementing a healthier lifestyle, my HgA1c dropped to 4.9 (!) which is awesome and (fortunately) very far away from the pre-diabetic range.
Fish Oil. Although I eat fish 2x/week, my doctor still recommended an omega-3 supplement for the anti-inflammatory benefits.
Vitamin D. You wouldn’t think Vit D deficiency would be common in AZ, but I see it in almost all my patients. And I was found to be deficient after moving here! It’s hypothesized that it’s due to the weather being so hot, we stay indoors most of the summer, similar to how northerners stay inside most of the winter. We also are religious about sunscreen, which is great to avoid skin cancer, but makes it hard for our body to synthesize Vit D. This nutrient is critical for mood, energy, and more, so you definitely should have your levels checked and supplement according to your doctor.
Methylated B12. I found out that I have 1 of the 2 currently identified SNPs for the MTHFR mutation, meaning that I don’t methylate (or activate) B12 and folate as well as other people. My B12 was on the low end of normal (again, functional docs tend to operate in ‘optimal’ ranges instead of just what is considered normal) so my doctor wanted me to supplement to increase my level. I was feeling mega-fatigued, so she wanted to rule out this as a contributor.
(X) P.E.A. Complex. I was on this supplement, but am not anymore. I tried it to help with my abdominal pain (that is either associated with my PCOS or IBS, or maybe both). Unfortunately it didn’t help.
(X) CBD Oil. I was on this, but am not anymore. Again, tried this to help with abdominal pain, but didn’t notice a difference with regular intake. It didn’t help with my anxiety either. I’m glad it works so well for others, but I didn’t notice anything.
HABITS I’M WORKING ON
Journaling. I haven’t started this yet. I keep meaning to, and then my perfectionism gets in the way. I am also very scared to put my true thoughts to paper - I’m not sure why since nobody has ever read a previous journal or anything, but I’m just super nervous about it anyways.
Eliminating Coffee. “Working on” is a rough term here. I drink coffee daily still. It is part of my morning routine and my pour-over is delicious. I use organic, locally roasted to avoid mycotoxins (and for flavor, the stuff sitting ground on the shelves for months cannot match up!). I would like to switch to matcha, which I already love to drink, but I haven’t pulled the trigger yet. Coffee burns out our system, and for many of us with PCOS, our adrenal system is already stressed enough.
Go off birth control? Many PCOS women choose to do this, so that they can sync their hormones naturally and manage without any meds. Personally, I chose to stay on birth control. It’s actually recommended by many OB-GYNs to help manage the symptoms of PCOS, although it is mostly masking symptoms, not addressing the problem. Personal choice.
All of the things I mentioned above. I’m not perfect, so I’m still trying to increase my physical activity through more frequent yoga and walking. I am transitioning my beauty over to non-toxic products as I finish old products (replacing everything all at once is very expensive!). I have slowly accumulated many of these habits over time - I didn’t wake up January 1, 2018 and decide to change every single aspect of my life. It takes time!!
LABS I AM WATCHING FOR PCOS
This is an area that isn’t talked about enough in PCOS circles. I’m a raw data kind of gal - give me the numbers! Here are some labs that I’ve monitored/had checked and why.
Hormone Panel. This includes LH, FSH, estradiol, serum testosterone, DHT, serum pregnenolone, DHEA sulfate, and more. My doctor doesn’t test all of these every visit, but follows my Testosterone pretty consistently.
Blood Sugar. I have had my HgA1c checked, which is a 3 month marker of blood sugar, as well as circulating fasting glucose levels (which is a typical lab test). HgA1c isn’t usually checked in younger people, but Type 2 diabetes sneaks up faster and faster nowadays, and you want to catch it early (prediabetes if possible, or prevent it all together!). So I recommend getting these values tested. You can also get your insulin checked, which can help determine if you’re struggling with insulin resistance.
Celiac Disease. Absolutely get a celiac test - especially before you go GF for PCOS because then you’re test is invalid! You must be eating gluten in order for the immunoglobulins to show up in your blood test. This might be more indicated if you have GI issues, or any micronutrient deficiencies (indicated malabsorption) like I talked about in my PCOS Part 1 video.
Thyroid Panel. Again, check out my video above, but PCOS can mimic hypothyroidism. So you want a FULL thyroid panel (not just TSH!). This is another reason I recommend going to an integrative physician, because they will look at the functional ranges where your thyroid should be to function optimally (Hashimoto’s Thyroiditis often has normal values EXCEPT for TPO antibodies, hence a full panel recommendation, and it’s an autoimmune condition that can mimic PCOS).
Leptin. This is generally a functional medicine lab, and your doctor may or may not test you for it (and your insurance might put up a stink about it depending). The research is still in limbo with leptin being an actual marker of leptin resistance, but it could indicate systemic inflammation. It’s not necessary, but can be helpful (maybe in combination with CRP - C Reactive Protein - another inflammatory marker).
Cholesterol. I actually have high cholesterol - whether it’s genetics, the metabolic effects of PCOS, both, or something else, we are still watching it. It hasn’t decreased despite my weight loss (you can be healthy and unhealthy at many different sizes) so we are still tweaking to try to bring it down/monitoring it. I really want to avoid statins so I am trying to increase my fiber intake (which binds to cholesterol in the gut).
It may seem like I’m living this perfectly balanced life, but I’m still a work in progress! I’m trying to increase my walking and yoga, I’m trying to do less processed GF foods, I am trying to implement more self-care habits. So don’t compare my multi-year journey to your beginning, and know that everyone’s situation is different.
Please reach out to me on here, or on Instagram with more questions!! I would love to do a PCOS Q&A in the future for you.
Decode Your Period: Discussing Traditional Chinese Medicine (TCM) and it’s approaches to linking your period symptoms and where an organ deficiency may be hiding.
FLO Living on Natural MD Radio: Aviva Romm, one of my favorite integrative docs, interviews Author of WomanCode, Alisa Vitti.
Healing PCOS Naturally - Love this overview of treating the various symptoms of PCOS (and it’s by an RD!)
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