Polycystic Ovarian Syndrome (PCOS) is said to impact as many as 1 in 5 women. With 50% of sufferers unaware that they even have it. Unfortunately, PCOS is a lifelong condition impacting – and disrupting – our hormonal balance. It can also impact fertility. There is no ‘cure’, however, thankfully modern science shows that the symptoms and effects can be controlled and vastly reduced with diet and lifestyle. The key (as always) is to know where to look! So in this piece, we take a look at seven key areas where research suggests we can make a real difference: 

• Insulin resistance
• The Gut microbiome
• Inositol
• Chronic Inflammation
• Vitamin D
• Adaptogens
• Berberine 

The often missed condition: do you have PCOS?! 

As usual – awareness is half the battle. Because PCOS can have wildly varying symptoms (some people may just have irregular periods/lack of ovulation vs others who can have the whole range) it can go undetected. Particularly in those who are not actively trying to conceive. The reality is you may have some, one, or all of the below common symptoms:

• Ovarian cysts (visible on ultrasound) 
• Irregular periods/long cycles (plus 35 days)
• Lack of ovulation
• Acne
• Excess hair growth
• Weight gain/high BMI (with weight particularly around mid section)
• Insulin resistance
• Elevated LH/AMH and LH/FSH ratio
• Oily Skin
• Mood issues: anxiety/depression/irritability

The only way to figure out if you have it is to see your doctor who will do a blood test (looking for high AMH/distorted LH/FSH ratio/insulin resistance) and an ultrasound to detect any ovarian cysts.

The good news – lots of things can clinically improve the symptoms of PCOS and help with getting pregnant. We try to get to the root: 

70% of PCOS sufferers have Insulin Resistance:  

Insulin resistance (which can progress to Diabetes) is an increasing phenomenon of modern life. Thanks in part to our diet and lifestyles. We know that PCOS is a complex condition which relates (often) to substantial hormonal imbalance. Insulin Resistance is the most common. 

What is insulin resistance and why does it matter for ttc? 

In a nutshell this is where the cells of the body don’t react as they should to the hormone insulin (which is responsible for ‘letting in’ the energy – glucose – from food into your cells). The result = the body produces more and more insulin in order to get sugar into our cells (which our cells increasingly fail to react to).

Hence the term ‘insulin resistance’ ie. the cells are resistant to the effect of insulin.

Some symptoms that you may have it and are worth investigating: 

• Higher BMI
• Trouble losing weight
• craving sweets after meals
• large appetite
• fatigue after eating
• feeling very thirsty and frequent urination
• acne/skin tags and skin pigmentation 

Insulin Resistance has all sorts of effects on the body. However, one of which is that it can cause the ovaries to produce more of the ‘male’ hormones: testosterone. This can cause some of the common symptoms of PCOS: excess hair growth, mood issues and lack of ovulation and many others. 

Treating the root cause of insulin resistance? 

We know that diet and lifestyle is currently a clinically proven way to reduce insulin resistance. Specifically a Mediterranean diet (full of whole foods, vegetable and lean proteins, oily fish, whole grains and healthy fats) and avoiding high fat/high sugar Western Diets. But why does this seem to work?

The latest science actually reveals some interesting things here…

Does it relate to an imbalance in our gut bacteria? If so, can this help us treat one of the root causes?

Research around the impact of the collection of bacteria, viruses and even fungi in our digestive tracts (the gut microbiome) has exploded in recent years. We now realise that ‘the gut’ does a whole lot more than simply breaking down our food. In fact, the latest science points to imbalances here being one of the root causes of hormonal issues like insulin resistance and PCOS. 

For much more detail on this topic click here . In short we have learnt the following: 

• Major bodies such as the National Institute of Health, American Endocrine Society and European Endocrine Society have now made the connection between metabolic issues and a ’disrupted’ microbiome. 
• We know that people with diabetes generally have less of certain types of bacteria in their guts: specifically lower Firmicutes and Clostridium. 
• We have also seen that by adding Bifidobacteria and Lactobacillus we get less obesity, cholesterol, increased SHBG (the carrier for testosterone which can be low in PCOS) and reduced chronic inflammation. 

In fact, in one experiment that transferred gut bacteria from mice with PCOS into healthy mice we saw that the healthy mice developed classic symptoms of PCOS: increased insulin resistance, cysts, higher testosterone and LH and had fewer pups!

So how do we ‘balance’ our gut bacteria to help PCOS?

Based on our current understanding these can help pretty quickly: 

• A broad/diverse range of whole foods this can generally help in as little as 24 hours
• Avoiding processed foods, refined sugars and high amounts of industrially produced animal products which may have been treated with antibiotics/hormones/steroids. 
• Adding in Pre and Probiotic foods. These feed the good bacteria we have and add in good bacteria. Click here for much more. 
• Moderate regular exercise
• Meat stock/bone broth. 

For more of the ‘how to’ click here. 

Inositol: another key in the PCOS battle: 

In a nutshell this is part of the B family of vitamins and is produced by the body itself as well as being found in nuts, whole grains, citrus and beans. 

Research has shown that this can have several positive effects in the fight against PCOS:

• Improving insulin resistance: once again we know the higher insulin/insulin resistance can cause the ovaries to overproduce androgen hormones like testosterone. 
• Helping with the production of Sex Hormone Binding Globulin (SHBG) which is a ‘carrier’ for testosterone making sure it gets to where it ‘should’ in the body. People with PCOS often do not have enough. 

Research has shown six months of Myoinositol can have the following effects: 

• Reduction in blood plasma LH
• Reduction in free testosterone
• Improved Insulin profile
• Better follicular development
• Even activation of serotonin receptors (key for mood which can be an issue for those with PCOS). 

For much more detail click here. 

The evidence increasingly shows that this is a supplement worth chatting to your doctor about. 

Chronic inflammation and PCOS: 

Inflammation in the right setting is a good thing. It’s the body’s defence system. The trouble is when they body’s defence system is constantly ‘fighting’ at low level. This is known as Chronic Inflammation and can cause tissue damage. Some women with PCOS – particularly those with a higher BMI can suffer from it. Click here for much more. 

A few ways to tackle it ( you may notice a common theme!):

• Avoiding extremes of exercise (too much/none at all) plus
• Physical stressors on the body (toxins/pollutants/plastics/pesticides)
• Mental stress
• Processed foods high in salt/saturated and trans fats
• excessive alcohol 
• blood sugar spikes
• promoting good gut health and healthy BMI
• prioritising sleep
• whole foods/Mediterranean diet 
• DHA/EPA (also known as Omega 3s) 
• more spices: turmeric/garlic/rosemary/ginger

For much more on the how to improve inflammation – click here. 

Vitamin D and PCOS: 

We know that Vitamin D is much more than just ‘a vitamin’. It is in fact a steroid hormone and research shows it plays a huge role in the body including reproduction and immune health. As above, some people with PCOS struggle with immune. In fact, in some women with PCOS there has been an imbalance noted (between Th1/Th2) that can even impact egg quality. 

So what do we do? Just more vitamin D?

There has been a huge amount of research around the connection between Vitamin D, the immune system and PCOS. Frankly at this stage it remains conflicting. However, we do know that whilst having enough may not ‘boost’ fertility and resolve symptoms – having a deficiency can certainly make it all worse. 

Your vitamin D status varies depending on your ethnicity, lifestyle and even your genetics so it is always best to test and see your own individual level rather than jumping wildly in. However, for reference the recommended intake for a pregnant woman is 400iu/day minimum. A quick blood test will tell you all you need to know. 

For much more click here. 

Adaptogens: helping the body balance hormones: 

At it’s core – PCOS is an imbalance in the body’s hormones. Adaptogens are worth considering as a tool. 

What are they? 

“a … class of metabolic regulators which increase the ability of an organism to adapt to environmental factors and avoid damage from such factors.”

In English: they help the body balance itself. 

The criteria? Turns out – pretty strict!

• must cause only minimal disorders in the body’s physiological functions
• Must increase the body’s resistance to adverse influences not by a specific action but by a wide range of physical, chemical, and biochemical factors
• Must have an overall normalizing effect, improving all kinds of conditions and aggravating none.

Two that meet the relatively strict criteria are Maca and Ashwagandha. In particularly Ashwagandha has been shown to reduce the body’s production of the stress hormone Cortisol. Click here for more. However as always it is imperative to chat to your doctor before taking these particularly if you are taking other medication/undergoing fertility treatment. They are also not to be taken if you think you may be pregnant. However, in the right circumstances they can certainly give your body a helping hand. 

Berberine: another supplement worth considering for PCOS: 

Research has shown that Berberine activates an enzyme within cells (known as AMPK). This is common to fatty acid oxidation, glucose generation and once again our friend: insulin resistance. Even better, Berberine has been shown to target this with very few significant side effects. 

Similarly, it has shown benefit reducing visceral fat (think that belly fat that can accumulate with PCOS) and also improves ovulation. 

So, once again, worth a chat to your doctor about. 

Click here for much more. 

Good luck!

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