I remember in my early training that the first question to ask a patient with polycystic ovary syndrome was: "Are you trying to get pregnant?" If no, hand them the birth control pill. If yes, choose between clomid, a fertility drug, and metformin, an insulin sensitizer. No questions related to lifestyle, stress, nutrition, total toxic burden – there were 29 more patients to get to that day.
It turns out, many lifestyle changes have been shown to pull someone out of the metabolic chaos of PCOS, therefore decreasing their chances of developing comorbidities such as diabetes, heart disease, hypertension, sleep apnea, anxiety, depression and infertility. Insulin resistance is one of the root physiological imbalances in most, if not all, PCOS. This is where your pancreas needs to pump out more and more insulin in response to high blood sugar levels. Insulin lowers the blood sugar by storing the glucose in cells. The cells become resistant to the constant insulin and need more to be signaled to lower the blood sugar. When this resistance goes on for a while, you have high insulin and high blood sugar. Incidentally, insulin is a fat storage hormone, concentrating fat in the belly region. High insulin levels can tell the ovaries to make more testosterone. That's why some women with PCOS have symptoms of excess androgens, like dark hairs on the face and belly.
Ask for a fasting insulin and fasting glucose level to be drawn, along with a HgbA1C (an average of blood sugars for the past 12 months). Shoot for an insulin level under 10, and if you're really a perfectionist, under 5. Fasting glucose should be under 90 or so.
The most common contributor to insulin resistance is a high refined carb/processed food diet. If you eat cereal – yes, cereal – for breakfast, a sandwich for lunch and pasta for dinner, with maybe a glass of wine because you deserve it at the end of your long day, the insulin receptors on the cells become numb to the insulin, and your pancreas has to work overtime to produce more and more. Another important contributor is stress – whether it's working 80 hours a week at a job you hate, not allowing enough sleep to rest and repair, being overcommitted (and having overcommitted kids) or internal stress such as chronic infections, eating foods that react with your immune system or high toxic load. It seems most Americans have some, if not all, of these stressors. These things tell your brain to send a signal for cortisol, the stress hormone, to be released from the adrenal glands. If cortisol is being overproduced on a regular basis, it can lead to insulin resistance.
So what can you do to restore insulin sensitivity? Does it make sense that only taking a birth control pill to control the downstream effects of this underlying process is more like a Band-Aid than a cure? Depending on how long you've had these issues, simple lifestyle changes may be all you need to make a significant difference in your symptoms. There's a large subset of women with PCOS who will thrive on a low grain or grain-free food plan – similar to a paleo way of eating. At least start with a JERF (Just Eat Real Food) diet, a term I love coined by nutritional podcaster and entrepreneur Sean Croxton. Exercise is a terrific insulin sensitizer, decreasing the amount of insulin needed to signal cells to decrease blood sugar. Be careful of excessive exercise, the definition of which is very individual. This may increase the demand on your adrenal glands, which can cause more problems. Rather, moderate exercise such as burst/interval training and yoga are perfect.
So if you've been told you have PCOS and you want to correct the metabolic imbalance at the root, try ditching the bread and milk, and go for a hike. And if you want to take a deeper dive into your specific risk factors, schedule an appointment with an integrative or functional medicine practitioner.
PCOS: Is the Pill the Only Answer? was originally published on U.S. New & World Report.
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