How To Treat PCOS Naturally June 24, 2018 Jun 24 2018 It seems like every other month that I hear about a new polycystic ovarian syndrome (PCOS) diagnosis, whether it’s within my family, among friends or a new client. However, this should come as no surprise – PCOS is considered the most common endocrine (hormonal) disorder, with estimates of prevalence as high as 26.7%  PCOS is not to be taken lightly. I’ve witnessed too many people that have ‘learned to live with it’ or relied solely on medication – albeit with the best of intentions – only fully realizing the destructive impact of PCOS when faced with fertility problems. In fact, a 2015 study estimates that 70-80% of women with PCOS have fertility problems.  If you have PCOS, I want to tell you that it is possible to reverse PCOS naturally or reduce symptoms to a large extent. However, it requires commitment to a lifestyle change. Taking pills will only serve as a short-term solution and crutch; once the crutch is taken away the body will be left with the same root issues as before. What is PCOS? PCOS affects the ovaries, where hormones that regulate the menstrual cycle –estrogen and progesterone – are produced. A small amount of male hormones, known as androgens, are also produced in the ovaries. PCOS is classified as: Cysts in the ovaries High level of androgens Skipped periods If you have two out of these three characteristics, you will be diagnosed with PCOS by a doctor. However, lets paint a more comprehensive picture, in order to truly understand where things go wrong. The best way to understand PCOS is to compare a regular menstrual cycle with someone who has PCOS. Regular MENSTRUAL cycle Every month, the pituitary gland in the brain sends two hormones known as Follice Stimulating Hormone (FSH) and Luteinizing Hormone (LH) to the ovaries, in order to help eggs mature and prepare them for fertilization. Once the eggs are mature, they release estrogen into the bloodstream. Estrogen in the blood signals to the brain to release more LH (known as an LH surge), which triggers the most mature follicle to release. The release of this mature egg is known as ovulation. If the egg isn’t fertilized, it results in a period. PCOS MENSTRUAL cycle The pituitary gland in the brain sends too much LH to the ovaries, upsetting the natural balance of FSH and LH. This prevents eggs from maturing properly, and also prevents the LH surge from taking place. Hence, ovulation does not occur. Immature eggs become cysts in the ovaries, which leads to infertility Too much LH triggers excess androgen production, which is converted into a potent form of estrogen (estrone) in fat tissue, along with triggering facial hair growth. Since progesterone production is triggered by ovulation, the absence of ovulation in women with PCOS leads to a progesterone deficiency. THE SYMPTOMS OF PCOS If you have a combination of the following symptoms, be sure to visit the doctor to receive a properdiagnosis: Difficulty getting pregnant: due to hormonal imbalances and ovarian cysts Facial hair growth: due to excess androgen production Irregular periods: the absence of ovulation means that the uterine lining doesn’t shed every month. Heavy bleeding: the uterine lining builds up for a longer period of time, so periods are heavier Acne: male hormones make the skin oilier and result in more breakouts Weight gain: 80% of women with PCOS are overweight Headaches: hormonal imbalances can trigger headaches in some women THE LONg TERM EFFECTS OF PCOS Unfortunately, PCOS has serious long term effects if left untreated: Endometrial cancer: since the uterine lining builds up in women with PCOS, this increases the risk of endometrial cancer by 2.7 fold.  Increased risk of depression and anxiety: women with PCOS are at an increased risk of mental health issues  Diabetes: 40% of women have insulin resistance or overt Type 2 diabetes  Heart disease: markers of heart disease like C-reactive protein and homocysteine have found to be higher in women with PCOS  THE CAUSES OF PCOS While genetics and the environment play a role in whether or not you develop PCOS, this risk is greatly increased by insulin resistance and inflammation.  Insulin Resistance Insulin is a hormone that is made in the pancreas, and it’s main role is to deliver glucose from the bloodstream into the body’s cells. With insulin resistance, the cells fail to respond to insulin. (Visualize insulin as a postman knocking on the door to the cell’s home, but the cell won’t answer the door!) Since the cells don’t receive the delivery of glucose, the brain tells the pancreas to secrete even more glucose. This greater abundance of glucose in the bloodstream eventually leads to more fat storage. What does this have to do with PCOS? Turns out that 70 percent of women with PCOS have insulin resistance – that’s a pretty large number! In fact, PCOS is so intertwined with insulin resistance that it is recommended to treat both PCOS and insulin resistance together.  This is because insulin stimulates the production of androgens, which exacerbates PCOS. What’s more, fat tissue is an excellent place for androgens to convert into estrone (a potent form of estrogen), causing further hormonal imbalances. In order to address insulin resistance, these two key things have to be addressed: OBESITY An excess intake of carbohydrates and sugar, along with a sedentary lifestyle contribute to obesity and insulin resistance. Up to 80 percent of women with PCOS are overweight or obese.  Stress The stress hormone, cortisol, releases glucose to provide energy for stressful conditions. Yep, that’s right. More glucose, which worsens insulin resistance and obesity. What’s more, cortisol is made with the same raw materials as the female sex hormones estrogen and progesterone. If resources in the body are being diverted away from sex hormone production and towards making cortisol, that will create further hormonal imbalances. Inflammation Research has found a strong association between excess androgen production and chronic low-grade inflammation. The biggest culprit? Good old sugar.  Sugar, along with eating high levels of junk and processed food – which often contain inflammatory industrial seed oils – contribute to chronic inflammation. HOW PCOS IS TREATED CONVENTIONALLY The decision to use medication is between you and your doctor, and depends on the severity of your PCOS and overall medical history. That being said, I strongly believe that it should not be the first line of treatment, but used as a last resort. Improving diet and lifestyle has to come first in order to fix the underlying problems that contribute to PCOS. Medication provides a Band-aid solution; once the medication is taken away, the problems return. Birth control While estrogen and progestin can have attain hormonal balance and regulate ovulation, there are side effects to consider: nausea, headaches, abdominal cramping, breast tenderness, and an increase in vaginal discharge or decreased libido.  Metformin This is a drug that is used to treat Type 2 diabetes, and helps improve insulin levels in patients with PCOS . Side effects to consider are: weakness, diarrhea, low vitamin B12, nauea, vomting, abdominal pain, dizziness, constipation, heartburn, muscle pain, upper respiratory tract infection, bloating. HOW TO TREAT PCOS NATURALLY Since 80% of women with PCOS are overweight, the primary focus of natural treatment should be weight loss, and improving insulin resistance. Losing just 5-10% of your body weight can help regulate your menstrual cycle and improve PCOS symptoms [12, 13] This requires a 3-pronged approach: diet, exercise and stress management. Once these have been addressed, natural supplementation and improving your environment can be considered. Anti-Inflammatory, Low Sugar Diet Similar to any other weight loss regimen, focus on eating real, whole foods, and avoiding junk food, processed food and added sugar. Increase your intake of fibre, protein and good fat, while minimizing carbohydrates from grains and sugar. Eat more: Lean protein e.g. grass-fed beef, organic chicken, organic eggs, wild-caught salmon Legumes and beans e.g. lentils, kidney beans Unsalted and unroasted nuts and seeds Vegetables Bonus: High magnesium foods to help insulin resistance e.g. dark leafy greens, almonds, cashews Bonus: High iron foods to replete after heavy bleeding e.g. spinach, liver, grass-fed beef, quinoa, pumpkin seeds Avoid: Sugary treats e.g. candy, chocolate, ice-cream, milkshakes Refined carbohydrates e.g. muffins, cookies, biscuits, bagels, granola bars, fruit juice, sliced bread/toast Processed diary products e.g. milk, fruit yogurt (high in sugar and stimulate androgen production) Caffeine (this triggers the stress hormone and glucose production) Minimize: Grains – a low-carbohydrate diet or low glycemic index diet has been shown to be effective for regulating periods and losing weight in women with PCOS  For a comprehensive guide on healthy grocery shopping that tells you exactly what to eat and avoid, along with healthier alternatives, check out, How To Grocery Shop Like A Nutritionist. Exercise Research shows that just 30 minutes of moderate-intensity exercise at least three days a week can help women with PCOS lose weight, improve ovulation and insulin levels.  If you don’t exercise at all right now, here are some great ways to get started: A daily 20-minute walk Climbing stairs for 5-10 minutes Following a beginner’s 10-minute workout video on YouTube Signing up for a group class once per week (one that you enjoy, like dance or yoga!) Stress Management Self-care is a big part of recovering from PCOS. I’ve written an in-depth article on stress management here, but here are some of my favourite tips: Go for walk breaks at work, or long morning walks Meditate (try an app like Headspace, Muse, or Calm) Yoga Write in a gratitude journal every night for 5 minutes Get a colouring book Take out a few hours each week to enjoy a hobby or interest e.g. improv classes Take a weekly bath Go for a monthly massage Bonus: Supplements and Environment I call this a ‘bonus’ section because diet, exercise and managing stress need to come first. If you can visualize a pyramid, diet, exercise and stress management reprresent the bottom foundation. No amount of organic deodorant or herbal concoction is going to help if you’re eating pizza every night and getting zero exercise. Nail those first, please. Then, I would invite you to review this list of xenoestrogens in our environment that can worsen hormonal issues, and make appropriate swaps. And lastly, you can also consider the following supplements: Blood sugar balancing nutrients e.g. cinnamon, chromium, inositol Adaptogen herbs to combat stress e.g. holy basil, ashwagandha, astragalus, rhodiola Anti-inflammatories e.g. turmeric, fish oil, evening primrose oil Vitamin D; 67-85% of women with PCOS are deficient  Hormone balancing blends e.g. AOR Advanced PCOS Relief, Estro-Smart, Estro-Adapt Subscribe to my mailing list * indicates required Email Address * First Name Last Name About Alina I'm a Holistic Nutritionist based in Toronto, Canada and my official title is Certified Nutritional Practitioner (CNP). I received my diploma in Applied Holistic Nutrition from the Institute of Holistic Nutrition. I'm a coach and an educator. Follow Alina on Facebook, Twitter, Pinterest and Instagram for all of the latest updates.