The Functional Nutrition Approach to PCOS

PCOS Causes

Polycystic ovary syndrome or PCOS is an endocrine and metabolic condition that creates a hormonal imbalance.  PCOS is the most common form of hormonal imbalance in women of reproductive age, affecting from 5-15% of women.  While some people develop cysts on their ovaries as a result of PCOS, many people do not. Some of the main hormones disrupted in PCOS are androgens, which regulate the development of male characteristics and reproductive activity, like testosterone.  While androgens are called “male hormones,” females also make androgens. However, with PCOS, androgen levels are higher than normal. An excess of testosterone and lack of estrogen means that the body does not go through regular ovulation. The backup of eggs, from not being released, may cause swelling and form cysts around the ovaries.  

Because the body’s estrogen receptors are not working correctly, the body’s whole metabolic system can be thrown off, affecting insulin processing. The body becomes less responsive to insulin, leading to elevated blood glucose levels, which causes the body to make more insulin and produce more androgens.  

Diagnosing PCOS

While no one single test exists to diagnosis PCOS, healthcare providers rely on identifying symptoms, blood tests to measure hormone levels, a physical exam, and sometimes a pelvic ultrasound to get a closer look at the ovaries. Diagnosing PCOS relies on identifying androgen levels, ovary dysfunction, and irregular menstrual cycles.  Symptoms may begin shortly after puberty but can also develop in later teen or early adult years. Symptoms may go unnoticed, and PCOS may be undiagnosed for years. A wide range of symptoms is associated with PCOS, with the most common being challenging to manage weight, weight gain, unpredictable periods, adult acne and insulin resistance.  A physical exam is done to determine if other signs of PCOS are occurring. These include skin tags, darkened skin, and unwanted hair growth on the face, arms, back, chest, and abdomen are due to changes in androgen hormones. Along with these physical and hormonal symptoms, having PCOS elevates the risk for Type 2 diabetes, cardiovascular disease, mood disorders, and sleep apnea.  

What Contributes to PCOS Symptoms 

Stress 

Stress and PCOS share an interconnected relationship as the condition itself can cause stress, but stress can also exacerbate PCOS.  The burden of PCOS contributes to higher levels of anxiety and depression. The hypothalamus in the brain stimulates the pituitary gland to secrete adrenocorticotropic hormone (ACTH) in response to stress. Constant stress creates sequences of nerve cell firing and releasing chemicals like adrenaline, noradrenaline, and cortisol into the bloodstream.  ACTH stimulates production of the adrenal androgen hormones, contributing to PCOS symptoms.  

Medications

Conventional treatment for PCOS symptoms often includes the use of birth control.  The estrogen and progesterone in birth control override the body’s standard hormonal control of the menstrual cycle and ovulation.  Birth control turns off the ovaries, reducing testosterone production. The birth control pill increases the body’s production of sex hormone-binding globulin (SHBG), binding testosterone in the blood and reducing the symptoms of excess testosterone.  However, using birth control can also worsen insulin resistance and increase the risk of type 2 diabetes.  

Another medication used is Metformin.  Used in type 2 diabetes treatment, Metformin is prescribed to improve insulin sensitivity.  It also helps to reduce androgen levels and improve ovulation. Metformin has some unpleasant side effects, which include gastrointestinal issues like nausea, stomach discomfort, and abdominal pain, and bloating.  Metformin also depletes vitamin B12, which is vital to energy levels, methylation and mood.

Food 

Foods that spike blood sugar, increase inflammation, and cause weight gain are not recommended with PCOS.  These include refined carbs like white bread, regular pasta, and white rice. Beverages and foods high in sugar contribute to weight gain and fluctuations in blood sugar.  Saturated and trans fats are pro-inflammatory and can cause problems in the gut. Dairy is often avoided to help control hormonal symptoms, especially if there are gut issues linked to dairy intolerance. 

Environmental Toxins

Environmental toxins are chemical pollutants in the environment that may cause adverse effects on the body. Contaminants can be inhaled, absorbed through skin and mucous membranes, or ingested.  Recent studies have shown that these can harm reproductive health, including PCOS and symptoms related. Chemicals that are particularly harmful to reproductive health are endocrine-disrupting chemicals (EDCs).  These chemicals show up in groundwater, food, air, and everyday household products and have been associated with PCOS. Many of these chemicals have been banned for use in the US. However, whenever possible limiting exposure to chemicals by purchasing organic foods, choosing alternatives to plastic, and keeping harmful chemicals out of the household is beneficial to overall health.  

The Right Meal Plan for PCOS 

Diet is critical in managing PCOS and getting to the underlying issues causing the symptoms.  Focusing on whole food options to improve blood sugar control, maintain a healthy weight, and reduce inflammation is the way to treat PCOS from the inside out.  Increasing fiber comes with many benefits such as lowering insulin levels and feeding good bacteria in the gut. High fiber foods like seeds, legumes, berries, and whole grains are rich in prebiotics, which feed the probiotics and nourish the gut microbiome.  Lean protein sources like those found in fish, chicken and plant-based protein options keep you feeling fuller longer and help with weight loss. Boosting antioxidant levels in the body by increasing fruit, vegetable, and whole grains combat inflammation. Choosing berries like raspberries, strawberries, and green leafy vegetables will provide antioxidant power and promote more gut microbiota diversity.  Healthy, unsaturated fat sources like nuts, olive oil, and avocado also contribute to reducing inflammation.  

Processed foods and refined carbohydrates are nutrient-void, so limiting or avoiding these foods can lead to weight loss and help decrease androgen levels, which contribute to many PCOS symptoms.  These foods also create inflammation and wreck the beneficial bacteria in the gut. Dairy can be problematic in PCOS, so choose alternatives to milk, yogurt, and cheese.  

Recommended Meal Plans:  EvoBalance or KetoBolic Diet from INEVO Body

Natural Ingredients to Help with PCOS

There are many natural alternatives to treat symptoms of PCOS while getting to the root cause.  Improving diet, lifestyle factors like increasing exercise, and getting a good night’s sleep are all pieces to the puzzle of treating PCOS.  Adding in specific nutrients through supplementation can help with naturally lowering blood sugar and decreasing inflammation to improve PCOS symptoms.  Some effective natural ingredient choices for PCOS include: 

Myo-Inositol – Inositol are members of the B-vitamins and is found in fruits, beans, grains and is made in the body.  Myo-inositol act as messengers relaying signals in insulin regulation. With PCOS, there is a defect in the body’s ability to convert myo-inositol into d-chiro inositol, which leads to infertility and insulin resistance.  Supplementing with myo-inositol decreases testosterone in the bloodstream, improving insulin sensitivity, ovulation, and egg quality, making this an excellent option for improving fertility.      

Chromium – Chromium is an essential mineral that helps the body regulate insulin and blood sugar levels.  Taking chromium has been associated with reducing insulin resistance and stimulating ovulation in PCOS.  Studies show that chromium can be as sufficient with treating insulin resistance as Metformin and is often better tolerated.  

CoQ10 – An antioxidant that the body produces naturally, CoQ10 is used by the cells for growth and maintenance.  CoQ10 is found in meat, fish, and whole grains, but the amounts found in foods aren’t enough to significantly increase levels in the body.  Supplementing with CoQ10 in PCOS shows marked improvement in fasting blood sugar and insulin resistance.  

Magnesium – Magnesium deficiency is common in those with PCOS and can be further depleted with the use of medications like birth control pills.  Magnesium plays a role in almost every significant process in the body, like in insulin and glucose signaling. Increasing magnesium to optimal levels in the body improves insulin resistance, alleviates anxiety and reduces blood pressure.  

DIM – Diindolylmethane (DIM) is a phytonutrient found in cruciferous vegetables like broccoli, kale, cabbage, and Brussel sprouts.  DIM helps the body metabolize excess hormones and is highly effective in those that struggle with estrogen dominance. 

Turmeric – Turmeric and its active ingredient curcumin have been used as a potent anti-inflammatory for years.  It has various health benefits and has been used to treat conditions such as heart disease, diabetes, hypertension and some types of cancer. Its use in PCOS stems from the ability to act in many beneficial ways, comparable to some prescription medications used to manage PCOS symptoms.  Turmeric stabilizes testosterone levels, restoring hormone levels while serving as an antioxidant and reducing oxidative stress.  

Recommended Lab Testing

• Estrogen
• Progesterone
• Testosterone
• Glucose
• Insulin
• Cortisol

Recommended Supplements by INEVO Body

EvoXCore – Supports PCOS, fertility, blood sugar metabolism and hormone detoxification

Fem Protx – Supports symptoms from perimenopause, menopause and PMS

Estrevo – Supports estrogen metabolism and detoxification

Progestevo Cream – Non-prescription progesterone cream

EvoBolix Shake – Go-to meal replacement shake supporting hormone balance and weight loss

Reference

Amooee, S., Parsanezhad, M. E., Ravanbod Shirazi, M., Alborzi, S., & Samsami, A. (2013). Metformin versus chromium picolinate in clomiphene citrate-resistant patients with PCOs: A double-blind, randomized clinical trial. Iranian journal of reproductive medicine, 11(8), 611–618.

Ashoush, S., Abou-Gamrah, A., Bayoumy, H., & Othman, N. (2015). Chromium picolinate reduces insulin resistance in polycystic ovary syndrome: Randomized controlled trial. Journal of Obstetrics and Gynaecology Research, 42(3), 279–285. doi:10.1111/jog.12907

Günalan, E., Yaba, A., & Yılmaz, B. (2018). The Effect of Nutrient Supplementation in Management of Polycystic Ovary Syndrome Associated Metabolic Dysfunctions: A Critical Review. Journal of the Turkish-German Gynecological Association. doi:10.4274/jtgga.2018.0077

Merkin, S. S., Phy, J. L., Sites, C. K., & Yang, D. (2016). Environmental determinants of polycystic ovary syndrome. Fertility and Sterility, 106(1), 16–24. doi:10.1016/j.fertnstert.2016.05.011

Izadi, A. (2018).  CoQ10 plus vitamin E improves metabolic profile in PCOS.  Journal of Clinical Endocrinology Metabolism, doi:10.1210/jc.2018-01221.

Reddy, P. S., Begum, N., Mutha, S., & Bakshi, V. (2016). Beneficial effect of Curcumin in Letrozole induced polycystic ovary syndrome. Asian Pacific Journal of Reproduction, 5(2), 116–122. doi:10.1016/j.apjr.2016.01.006

Regidor, P.-A., Schindler, A. E., Lesoine, B., & Druckman, R. (2018). Management of women with PCOS using myo-inositol and folic acid. New clinical data and review of the literature. Hormone Molecular Biology and Clinical Investigation, 0(0). doi:10.1515/hmbci-2017-0067