The takeaways from the transcript…….

What exactly is PCOS?

If you're listening and you don't know, Poly Cystic Ovarian Syndrome was previously considered a gynecological problem diagnosed in the presence of ovarian cysts by ultrasound. And now, it's actually recognized as a complex endocrine disorder with multiple possible causes and clinical manifestations. And only one of those actually yields Polycystic Ovaries on an ultrasound. So, if you've been told that just because your ultrasound came back without the string of pearls that you don't have PCOS, that could be wildly incorrect.

Where did PCOS come from? 

In the intro you heard me mention in-utero and that it's more than likely that PCOS developed while your mother was carrying you in response to diet, and that it was a way to genetically protect you from famine or starvation. And that's all well and good if you're born into an area with famine or not enough food. But what happens when you're born into an area of feast like the United States, where everything is filled with corn syrup and you have insulin resistance that is related with PCOS? In a nut shell, you're basically a sitting duck waiting for Polycystic Ovarian syndrome to develop as a result of your capacity to not be able to handle carbohydrate load very well.

Oftentimes when a woman finds out later in life when she is trying to conceive that she has PCOS, she's devastated, she's kind of like, “how did this happen? I eat pretty healthy a lot of the time, I exercise.” Many of these women aren't like eating cupcakes every day and they're absolutely devastated and they're wondering, "How the heck do I have a problem with sugar?" When they begin to understand that it was likely a predisposition from their mother in-utero based on changes in the food supply, they can then have a little bit more grace and compassion with themselves, as well as motivation to try and stop it for the next generation. So if you understand that it was possibly somewhat genetic, it takes some of that burden off of you in terms of blame and shame, which can have other impacts on your fertility. I also want you to understand that your mom didn't know. Food was wildly changed in the fifties in the US, so if you were born, especially in the seventies and eighties, where there was a lot of processed food given, a lot of sugar and God forbid if you were in-utero in the nineties during the low-fat diet craze where everybody was fed a healthy diet of things like neutral sweet, it could absolutely affect your ability to process carbohydrates. I also want to remind you that just because you have a genetic predisposition for something doesn't mean that it's going to happen either. It just means that you have to work a little harder than somebody else that doesn't have it to make sure that it doesn't trigger on.

So how exactly is PCOS diagnosed?

PCOS is a clinical diagnosis and it is primarily diagnosed based on having some or all of the classic symptoms and having other medical conditions being ruled out. On testing the blood on day three of the menstrual cycle, looking at the ratio between LH, Luteinizing hormone and FSH, Follicle stimulating hormone, estradiol and testosterone can certainly be one of the ways we diagnose PCOS. We need to look at the symptoms too. Some women actually come back without abnormalities in the hormonal testing, meaning that they don't have that two to one ratio of LH, FSH, and it doesn't mean that you don't have the condition. You need a health care practitioner that is willing to exhaust all the different possibilities until they figure out what exactly is going on with you. And not everybody that has PCOS has multiple cysts in their ovaries like I said, and not everybody that has PCOS is overweight or has abnormal hair growth from excess testosterone, which does happen in one phenotype but not all. There are oftentimes when I'm sitting with a thin woman in my practice and I'm looking at her thinking, okay, she has all of these symptoms; she gets periods, maybe they go longer and sometimes she skips a cycle here and there thinking it’s from stress, she has plenty of cervical mucous but isn’t showing positive Ovulation tests midcycle and hasn’t fallen pregnant after months of trying. She's telling me she skips breakfast and if she does, she's Hangry, she's lived off of caffeine for a really long time, maybe through college or graduate school, maybe she's losing some hair on her head or she has some mood instability like alternating anxiety & depression. All of these things kind of clue me in and there might be some insulin resistance happening, even though she's not that traditional overweight phenotype of PCOS. You know, maybe she even over exercises to keep her body that thin. That's also very common, which is exactly why we can't just rely on our sight in one type of phenotype to diagnosis.

What are the symptoms of PCOS?

The symptoms of PCOS can include any of the following: infertility, irregular periods, lapses between periods for months at a time without being pregnant or breastfeeding, acne, weight gain, unwanted facial hair or hair in places where it doesn't traditionally grow like the nipples or below the belly button, hair thinning or hair loss, which oftentimes looks like male pattern baldness in PCOS. And then less commonly sometimes you can see darkening of the skin in the armpits, in the back of the neck, or the groin. The other aspect to consider is that women with PCOS are also more likely to suffer from depression and anxiety, they can have eating disorders, particularly binge eating. And this is for reasons that aren't very clear, we don't really understand if it's the chicken or egg, meaning did it come out of the blood sugar dysregulation and in turn worsen the problem, Or if you've got blood sugar imbalances, you know, you could have some serious ups and downs with anxiety and depression, or if you have insulin resistance and your dieting and you're not seeing weight come off, it can be maddening and upsetting to your emotional health. And if you have a moment of despair, it can kind of feel like all is lost and kick you into binge eating, especially if your blood sugar is low and you're feeling hungry or hangry.

It's kind of like this perfect storm, we don't really understand which came first, but we see them oftentimes coexisting. And this is important because those are the three major things that women are medicated for in the US: anxiety, depression and weight gain. And I feel like it's a huge disservice to women to just give them a pharmaceutical without looking at maybe what the underlying causes, maybe straightening out some of these blood sugar issues can have a huge effect on their anxiety or their depression and I see it all the time. It really shows itself in pregnancy if it isn’t corrected prior with symptoms of irritability, intense fatigue, increased nasuea sn dsevere headaches becasue the demand on the body for glucose is so prevelant during gestation. The other reason that this episode is super important is women with PCOS unregulated are more likely to experience pregnancy complications, they are twenty to forty percent more likely to experience a miscarriage due to insulin resistance and the hormonal problems that it creates. 

Oftentimes there is estrogen dominance and not enough progesterone to actually hold a healthy pregnancy and I just happen to observe a lot of chemical pregnancies or early stage miscarriage in women that have this kind of slight spectrum of PCOS but then after we do a little bit of deeper digging, we find that they've had these symptoms all along and that controlling their blood sugar dysregulation as well as her hormonal picture is quintessential to actually helping them get pregnant and stay pregnant. Diet becomes super important in these women. And I don't ever want anybody to have to go through the hurt of a miscarriage if we can prevent that.

The 5 routes to addressing possible root causes of PCOS.

  • Blood Sugar Stabilization- Reversal of Insulin Resistance

  • Adrenal Burnout or HPA ( Hypothalmus Pituitary Adrenal) Dysregulation

  • Gut Health

  • Cellular Energy Production

  • Toxicity


The first one is going to be blood sugar imbalance and I think that this is the most important to bring out because like I've noted, it's probable cause of most women with PCOS. It's the thing that has the most impact on your long term health and generationally those that come after you. It's not just that your hormones are whacked, it's that it has its roots in your body's ability to handle sugar and the biggest thing that you do have control over is your diet, because you have to eat every day, right? And this is this kind of like double-edged sword that can be great, and then oftentimes maddening, and especially if you buy into what society tells you about dieting. 

For instance, the other day I saw this picture on social media that was trying to say that the efficacy of using a Ketogenic diet, a paleo diet, or a Mediterranean diet when it came to treating PCOS, was the exact same as long as you had caloric restriction. WRONG! We've known for a long time that it's not necessarily a calculation of calories and calories burned off. While, yes, caloric constriction can help you to lose weight, there's one major issue where it doesn't help you lose weight and that is if you have adrenal burnout, which so many women with PCOS do have, and we're gonna talk about that in the second category. And I also think it's a huge disservice because you read that and you think, "I've tried all of these diets and I've restricted my calories and nothing's happening." That may be so much more than just calorie restriction that's holding you back from losing that five to ten percent of your body weight that can help to regulate your endocrine system. And we want that to happen, but we want you to do that in a way that is not self-defeating.

One of the things that I'll look out with a woman who's told me that she's had trouble losing that five to ten percent of her body mass and has done various diets that are recommended in PCOS is, I'll look at if there's maybe some food triggers where they're eating something that's inflammatory or taking a supplement like a probiotic with inflammatory strain that's causing havoc in their gut biome. And we're going to get into those because those are part of the routes to figuring out your supplements. And I feel like that that's super important to do that detective work because it can be maddening when you're doing everything "perfectly" and nothing's happening. Now, adrenal burnout, like I mentioned, if a woman has severe adrenal fatigue and you restrict her calories, you actually push her into a state of starvation. And if you've already got a genetic predisposition with PCOS pointing towards being insulin resistant for famine, you can see where this might not work, right? Do think that if you are run down and having any of the symptoms of adrenal burnout like we'll talked about in just a minute, it is super important that you eat enough calories, that you have breakfast and that you don't do intermittent fasting at first because this can actually make things worse. You have to control the blood sugar and re-sensitize the cells and its ability to break down insulin, and then you can do some things like experimenting with fasting. Otherwise, it just makes you more tired and more hungry, more irritable, and you are not going to lose weight.

In terms of the science behind diet for PCOS, low inflammatory, low glycemic Mediterranean diet or a modified ancestral diet meaning paleo with lots of vegetables in it, not just all meats, have been the two that have shown the most evidence to dramatically affect PCOS in terms of weight loss. And the bottom line is, is that most patients with PCOS will respond to a diet that is no more than eighty grams of carbohydrate a day and has about sixty to ninety grams of protein and the rest being good fat. So you can see that you are in fact getting carbohydrates. We are not limiting you down to fifteen grams like you would see in a Ketogenic diet. The majority of these carbohydrates, though, are coming from fiber-rich vegetables and fruits. And while fruits are high in sugar, you just want to balance that out with more vegetables, less fruit, think three to one ratio and that in your diet. And the aim for about a pound of vegetables a day is a really great goal, which I know sounds like a lot but for all you goal-oriented women out there, if you're slowly increasing your fruit and vegetable intake and vegetables on the high side and you're aiming for a pound a day, I can guarantee that you're going to make all the way less poor food choices. At the end of the day, you're going to be so full of fiber that you're not even going to want that cupcake or whatever is lying around tempting you.


In terms of blood sugar instability, there are a couple of supplements that can help you. One of them is vitamin D, it has been associated with insulin resistance in low amounts. Having your vitamin D tested to see whether your low is super easy and can be done by any of your physicians, you can also order a cash pay test on your own and then supplementation depends on how low you are; with two thousand to five thousand units a day being the kind of optimal range. What you want to do is you want to start with either of those depending on how low you are, and then retest again in thirty to sixty days to see if it's making a difference on the levels themselves.

One of the supplements that I use in my practice all the time, kind of, is a first line of defense when I think that there is an issue with insulin resistance, whether you're talking about a thin or overweight phenotype, is Inositol. Inositol comes in a couple of different forms, and a lot of the studies that have been done actually show that it's advantageous to have a combination of Myo-inositol and D-chiro-inositol, and that's at a ratio of forty to one of Myo-inositol to D-chiro. And the reason for that is that's how it's naturally occurring in the body is in that ratio. So you want to have the myo-inositol to come in somewhere around four grams a day and the D-chiro to come in around twelve hundred milligrams a day. Myo-inositol shows improvements in the Luteinizing hormone and the follicle-stimulating hormone ratio, as well as the free testosterone and prolactin levels. The D-Chiro has been shown to improve insulin sensitivity, to regulate ovulatory function and to decrease testosterone, high blood pressure and high triglycerides, which we often see in conjunction with the PCOS spectrum. Now you can see how these two supplements put together in the right concentration can affect the whole spectrum, the entire picture of PCOS. So it's affecting the hormones as well as the insulin part of the picture and even some of the cardiovascular effects. In one study, a combination of four grams of my myo-inositol plus four hundred micrograms of folic acid, significantly improved ovulation and conception in women with PCOS at a higher rate than fifteen hundred milligrams a day of metformin did. Now, as I mentioned before, metformin is that pharmaceutical that decreases blood insulin levels and is often prescribed to PCOS patients, it doesn't have any effect on the hormones though. And when you go off of it, your insulin levels oftentimes go back to how they were prior to the metformin. Diet wise, if you can tolerate beans, you can increase your intake of those garbanzo beans, kidney beans and non-genetically modified organic soy as they all contain high amounts of naturally occurring D-Chiro and myo-inositol, and they have the ability to improve glycemic regulation as well as reduce cardiovascular disease because they are so high in fiber. So you don't have to take these as a supplement if this is something that you tolerate well in your diet without bloating or fatigue or changes in bowels in a negative manner after you eat them. I highly encourage you to get them in your diet. 

Another herbal supplement that is used in blood sugar regulation is cinnamon. And we use this all the time in Chinese medicine. In fact, the main formula by which most others are based off of for treating PCOS in TCM is called Gui Zhi Fu Ling Wan. Gui Zhi is cinnamon root bark. In a 2008 pilot study that examined the effect of cinnamon extract in treating PCOS, participants who are assigned to either receive cinnamon or placebo daily over the course of eight weeks. And using fasting and oral glucose tolerance test, they showed statistically significant results seen in the cinnamon group compared to the placebo. Cinnamon is an excellent way to treat and lower your insulin resistance. It's also been shown to increase menstrual cycles. So, if you're one of these women that has erratic cycles taking cinnamon frequently can help with this. It's also a really versatile spice that you can manage to sneak in your diet most days if you cook for yourself. It's even good in drinks. So, if you are still taking in some coffee or tea, you can add it to that. But if you are one of these women that has adrenal burnout which, I promise, we're going to get to right now, I don't think that you should be using caffeine. It's one of those things that perpetuates it. It does not help it. 


So, this other category of adrenal burnout that I've referenced a couple of times, super important in treating PCOS. It's really known as HPA access dysregulation. What that is, is the hypothalamus, the pituitary and the adrenal access. Meaning, how they communicate together with their respective hormones has been interrupted. And one of the biggest things that you can do for yourself if you have experienced adrenal burnout or this feeling of being super, super exhausted or wired and tired is also another part of HPA dysregulation that happens. One of the things you can do to help yourself is to make sure that you get the proper amount of sleep. Rest becomes first line of defense that you have naturally without buying anything. You earn HPA access dysregulation through burning the candle at both ends, overstretching yourself, not getting enough rest and not getting enough proper relaxation. So, basically, you have your stress response turned on 24/7. That part of your nervous system, the sympathetic part that governs fight or flight gets stuck in some people that overdo, especially what we would refer to as type A. I'm raising my hand because I'm a recovering type A-er for the rest of my life. Maybe you'd like to control things. And as a result, you overextend yourself. 

Our bodies were only made to have this type of response fifteen percent of the time. But what's really common in HPA access dysregulation is to see a patient that is living there all the time. They have very few opportunities to turn on the relaxation response. They're kind of addicted to this chaotic over doing, over stressful life. And I empathize with this greatly because I suffered from adrenal burnout for about a decade, until I got control of it. And I understand how difficult it can be to change the patterns around overdoing and to help prevent it from getting kind of turned back on. It can, like I said, it can be addictive. You have this sense of control and just handling shit. But it comes in a huge price. I'll never forget when I had my blood work pulled and I did a twenty-four hour urine cortisol test and my functional nurse practitioner looked at me and was like, "Wow. You should be asleep right now. You have no cortisol. You're like a fifth year medical resident who has not slept in five years." And it was kind of true. I put myself through undergrad and graduate school and I definitely overworked. And it came in a huge price. But it didn't show up until later which is why I had a little bit of problem putting the two things together early on in my career before learning about functional medicine and all of it's glory. So, I mentioned sleep being super important. I am over-protective of my sleep. I actually have an alarm on my phone that tells me when it's time to start powering down, meaning no more screens, no more blue lights, things that will help my sleep hygiene, so to speak. And I actually start to get in bed around nine p.m. with the hopes of being asleep by eleven by reading or conversing with my husband and just kind of starting to power down. And if you can start to unwind around nine o'clock, I do think it is super important to not have screens on. So, not looking at your phone or your Kindle, making sure that you don't have any blue lights in your bedroom. Not even from clocks or computers because they affect a part of your cell called the mitochondria. And we're going to talk about the mitochondria in a couple minutes. But in order to get restful sleep, you actually need complete blackness. 

Mitochondria are pretty cool. They are really primitive parts of our nuclei. They're actually adapted bacteria. And they are amazing at sensing light, so much so that it's not-- they don't just work through your eyes. They actually can sense blue light through your skin. So, you have to make sure that your room is completely blacked out in order to get adequate restful sleep that actually helps restore and change adrenal burnout quicker. The other thing that you can do is to turn on your relaxation response as much as possible and as often as possible. Doing things like yoga and meditation or mini-mindful series in this podcast, actually help you flip from stress to relaxation response and to regulate your nervous system. You can't control stressors. But you can control your reaction to them. So, the more that you do these, the more aware you become of where you have been patterned and how to actually change that in your life. So, the first step is actually committing to doing some of these things and just being more aware of yourself in a non-judgmental way and turning them on when you can. I also want to stress the importance of not feeling like you have to be perfect and do all these things every day because it's quite impossible in our society. And that's the last thing I want is for you to apply this kind of over controlling rigid aspect to your self-care. We want you to meet your self-care with joy and not feel like it's a job. It should be the same way with your diet, too. So, like I said, the more that you can do these types of things and self regulate, the better chances you have of your nervous system not disrupting your endocrine system or your hormonal system. The main supplement to aid your mitochondria and your cellular energy is CoQ10 or Ubiquinol and both have been shown to be advantageous to fertility in men and women.

And in terms of supplements, there are a lot of things that you can take to help regulate your nervous system. Adaptogens are the greatest weapons that you have, so to speak. Adaptogens are these super interesting group of herbs. And what they do is they actually change the way your body perceives stress. So, I'll give you an example. It's a rat study, unfortunately. There are so many rat studies where these poor animals are seemingly tortured. But what they did in this study is they decided to put two groups of rats in it. One got adaptogens and one did not. And they needed to put them in the most stressful situation possible which, unfortunately, for them was to swim to their death. So, the one group that got adaptogens, what they found when they autopsy their brains at the end of this was not only did they out-swim the other rats by days. Not hours, days. They had statistically significant less brain damage. Meaning, that they were just going for a swim. They didn't perceive that they were fighting for their life. 

So, you can see how this changes your perception to stress when you take adaptogens. It actually changes your physiology and makes stress just a mental thing. Not something that immediately affects your physical body. So, some adaptogens that you might be familiar with are ginseng, rhodiola, ashwagandha, licorice, dang shen, also known as codonopsis in Chinese medicine, milky oats or schisandra, also known as Wu-Wei-Zi in traditional Chinese medicine. Oftentimes, if you pick up at adrenal axis formula or some that are even named HPA access formula, there's a great one over the counter BY Gaia that's named just that. You'll see a combination of these herbs. And I can tell you these herbs are instrumental in recovering from adrenal burnout. They were instrumental in my recovery and I still use them in stressful times to avoid sliding back into adrenal burnout because it can happen. Life can get hairy and you can overextend yourself. So, in those times, this is something that I absolutely employ most days. 

Now, the only adaptogen that has been specifically studied for PCOS is licorice. Licorice is great. It's in a ton of Chinese formulas because it has this unique ability to harmonize other herbs and reduce their toxicity. However, it does have one contraindication that I want you to be aware of and that's high blood pressure. So, if you have high blood pressure and licorice is not for you, it tends to raise the blood pressure. And you would want to avoid that. And another that I feel like is in so many supplements and people reach for because it's been kind of popularized is ginseng. And ginseng is a great adaptogen. Especially if there are some heart involvement. Meaning like you have palpitations, you feel your anxiety and stress in your chest. You get really nervous or wired and tired feeling. But energetically speaking, it's really, really hot. So, especially red ginseng. If you have a lot of symptoms of heat, like you're sweating at night. Maybe you're having hot flashes during the day as well. You've got red itchy skin, loose urgent bowels, ginseng is not the one for you. You would want to use something more cooling like Dang shen or codonopsis. It's oftentimes substituted for ginseng in some of these formulas. And any herbalist that is making a custom formula will take these things into consideration when prescribing for you. And if you're a thinner phenotype of PCOS, like the kind that's go go go, you can't gain weight, that I lovingly describe as a little butterfly kind of going from one thing to the next. The correct adaptogen for you would be ashwagandha. It nourishes the yin or the fluids of the body and it helps to calm you without being overly sedating and can actually help your fertility picture.

Now, the way that adaptogens actually work in the body, they're a mechanism of action is by regulating cortisol. So, I'm sure you've heard about cortisol. It's that nasty hormone that makes us gain weight around our midsection. And if you've had a recent weight gain there and you've noticed it's cropped up in your belly, you might be able to correlate that this happens six months post, very stressful time in your life. When I explain this to women, they can usually track it back and mark it and say, "Oh my God. I had this stressful event or I had this period of time when I was go go go.” And about six to nine months later is when I saw the physiological response in terms of the weight gain in the center. And I feel like this is important because it's really important to understand the effects of stress in your body. It's not just some mumbo jumbo that we're saying like, "Hey, your stress affects your fertility. You should meditate." When you can actually see how it's actually impacting the way your body stores fat, trying to protect you from a stressful situation by storing fat around your organs. Your body is super smart. It's trying to protect you. This helps you to see the impact of stress and how smart our bodies are and that they're not failing us. And in fact, they're trying to protect us from a lifestyle that we are not quite adapted to yet. 

Not only do adaptogens regulate the cortisol. But they also help to regulate blood sugar and insulin. And this is really important because when you're under stress, here's what happens: Your adrenals release the cortisol and then that induces an elevation in prolactin and increase androgen synthesis, which is testosterone and then this is what leads to dysregulation in your menstrual cycle, having those abnormal cycles or skipping them altogether. And it really leads to anovulation or not ovulating at all. Which are all characteristics of this PCOS spectrum, right? So, when this happens, it's because you're stressed. It's a kind of protective mechanism of the prolactin being raised, telling your body, "Hey, we have to be our own birth control. We have to make sure we don't ovulate because it's not safe out there. This is not a safe place to have a baby." I want you to understand this because, again, I think it's so important and cool to see how stress can affect your body and how your body is actually trying to protect you in terms of infertility when you're super stressed. So, if you feel like this is a category that you're listening to and all the bells are going off and you're like, "Oh my God, that's me. I'm in adrenal burnout." I did an entire episode on adaptogens and explain them in further terms, in terms of your best choices for fertility. Not only for females but for males, too. So, you can find that episode here and you can learn in even more depth about which one would be perfect for you or your partner. You might be listening to this thinking, "That's not me. But that is definitely my partner." And adaptogens can certainly help with sperm production. Also if it's really hard to lose weight and you're in fight or flight all the time and you know that losing that five to ten percent of the BMI would help to reset your endocrine system, but it's just not happening despite you taking steps in diet and exercise, I need you to take the stress response into consideration. This could be the very thing that is holding you back. 


The other part that is really important in terms of PCOS and especially when it comes to weight loss and maybe it not happening even though you've been following the diet is gut health. And you might be thinking, "What does my poop have to do with my fertility?" Just hear me out. If you just sit back and think about how everything is so compacted in your lower abdominal area, your intestines are basically sitting on top of your reproductive organs. If you have anything happening like leaky gut, your constipated and you're leaking toxins back into your body and around all of your reproductive organs. Just think about the fact that your ovaries are sitting in primordial goo for a hundred and twenty days to get that one egg from start to finish. And if they're sitting in this junk, they're not going to be very healthy. They're not going to be good quality eggs. And the other issue with your gut is that this is the last part of detoxification in the body. If you aren't properly eliminating these toxins in your bowel, they circle back around your liver which only lessens your liver's ability to get rid of excess hormones. If you have extra hormones in your body interrupts all these negative feedback loops and can wreak havoc. So, making sure that you're having daily bowel movements and detoxifying to the best of your own natural ability is super important. On the flip side, if your bowels are too loose and you're seeing undigested food, you're not absorbing everything that you should be from your food. I guarantee it. I also can guarantee that you probably have some type of vitamin or mineral deficiency which will often lead to things like PCOS triggering on. I mentioned previously low vitamin D levels are almost always seen in PCOS patient. B12 insufficiency is also a big contributor to infertility across the board in females and males. So, making sure that your vitamins are balanced is really important. And one way to tell that is by looking at the health of your bowel movements every day because you can tell so much what's happening internally just by observing your bowels. So, if you're not having a bowel movement daily, things that could help you go would be to increasing your fiber up to thirty grams a day by adding something like ground flax seeds or psyllium husks if you tolerate them or increasing your vegetables like we talked about earlier. Chia seeds are also another great food supplement for increasing bowel function. You can include them in smoothies, you can make chia seed pudding. They're also high in the good types of fat which also help insulin resistance as well as fertility across the board when you're increasing the good fats in your body. 

If constipation is your issue, there is another supplement that I typically recommend and I find most people are deficient in, especially if they're not eating enough fruits and vegetables (five to seven servings a day) and that is magnesium. You can take up to a thousand milligrams of magnesium citrate before bed to get your bowels moving. It can help move your bowels without having to use a strong purgative like xena or something that forces bowel peristalsis and actually increases bowel peristalsis by turning on the part of your nervous system known as rest and digest. So, it also helps you get more restful night of sleep. So, if I see somebody that's constipated, isn't eating great, maybe he's having a little bit of insomnia. This is one of the first things that I'll reach for.  

The other aspect of gut health is leaky gut. Leaky Gut is caused by all kinds of pharmaceuticals, over-the-counter medications, antibiotics, improper gut flora, improper diet, major abdominal surgeries including C-sections. You may want to find out if there's any inflammatory food triggers, i.e. anything that's causing gut thinning or permeability of your intestines. If you're intolerant to gluten or dairy and you're eating every day, this can build up and create a lot of inflammation that actually thins the lining of the gut causing toxins to leak into the bloodstream. If you suspect leaky gut based on your history or the symptoms of fatigue, bloating or negative changes in bowels after you eat, the way to heal that is with supplements and doing some combination of curcumin or turmeric which are the same thing, licorice, marshmallow root, zinc and L-glutamine, which is an amino acid that helps to heal the lining of the gut. Like I said before, if you have high blood pressure, licorice would not be the greatest for you. Curcumin or turmeric is amazing and there have been a ton of studies that show that it actually has a great effect on PCOS itself by way of the hormones. It's a superb anti-inflammatory. The only reason that you would not want to use it, is if you've had a diagnosis of Hashimoto's thyroiditis. I find that a lot of patients with Hashimoto's don't tolerate it so well and it doesn't have quite the anti-inflammatory effects that you would expect. So, again, if you're having leaky got issues, you could use some or a combination, oftentimes, you'll see in like an inflamed G.I. supplement, you'll see some combination of these things. Marshmallow root, zinc, L-glutamine, turmeric and licorice. I personally will use L-glutamine by itself all the time to heal the gut. And I'll use that in a dose of five grams a day, divided doses of two point five a day, if I can. It's a white powder. You can throw it in your smoothies. You can drink it in water. And usually you see effects within four weeks in terms of less bloating, better bowel function and less fatigue from toxicity.

The other important thing to consider when healing the gut is a probiotic and a prebiotic. And probiotics are strains that create gut diversity in the microbiome of our gut. And then prebiotics are the food that the strains and feed off both good and bad. You want to have strains of lactobacillus and bifidobacteria. Now, if you have high inflammation or something like histamine response or histamine intolerance or you know that you are gluten or dairy intolerant, there are a few strains that you want to avoid. Lactobacillus casei being one of them. It is, unfortunately, in many of the probiotics available on the market and it increases histamine response in the body and can make your inflammation picture worse. So, when using a probiotic, if you suspect those things, histamine intolerance, immunity issues or a gluten and dairy intolerance, then you want to try and take out the Lactobacillus casei. 

The other potential problematic strains if you're dealing with skin issues or histamine intolerance on top of PCOS are Lactobacillus reuteri and Lactobacillus bulgaricus. They are found in most yogurts and fermented foods, which if you do have histamine tolerance and you think you're having an immune response to sperm and you suspect that that's part of your infertility, you would want to avoid not only these strains in a probiotic, but also fermented foods across the board. You also want to include strains that will help degrade histamines if this sounds like you. If you have an overactive immune response, so to speak, and this strain would be Bifidobacterium infantis. This is found in breastmilk. Bifidobacterium longum and Lactobacillus plantarum. These are super helpful along with soil based organisms, meaning prebiotics, to help feed the good strains and probiotics to help increase your gut diversity in a safe way that won't increase inflammation and trigger your immune system. So, a little side note, not everybody with PCOS has any issue with histamine intolerance. But if your endocrine systems out of whack and your nervous system is out of whack, oftentimes, they see it's only a matter of time before your immune system is then triggered by something. So, if you're having mental fog, unexplained weight gain, swelling, changes in your bowel, hives, urticaria is a huge one, you might want to also look at aspects of your immune system as well. Now, if you don't have any of those problems with your digestion or suspected histamine intolerance, lacto fermented foods in your diet can actually be really cheap and easy way to regulate your digestion. So, using things like sauerkraut, yogurt, kombucha, as long as they don't bother you. And by bother, I mean you can usually see some type of allergic response whether it's in the skin or the nasal cavities, as well as bloating and digestion problems within seventy-two hours of consuming those foods. 


Now, the last category that needs to be considered when you're cleaning up or trying to reverse PCOS is environmental toxins and detoxification overload. You really want to understand what you're being exposed to on a daily basis. Oftentimes, this is happening through your skin and beauty products, as well as your foods that are genetically modified and cause what's called xeno estrogens or bad estrogens to dock in your hormonal receptors. They're huge endocrine dysregulators. As are things like BPA which is found in the linings of cans. So, all of those tuna and Lacroix is that you've been consuming, thinking that you're eating healthy, the BPA inside can actually be detrimental to your estrogen-testosterone balance. Ways that you can help to naturally detoxify is by increasing the vegetable group of cruciferous vegetables, like cauliflower, broccoli and brussel sprouts. Also, phytochemical rich foods like legumes and beans if you're not intolerant to those. And whole grains with lots of fiber if you aren't gluten sensitive. So, when I say whole grain, I mean the kind of bread that you can actually still see the grains and that has a hard crust. Flax seeds and Omega 3s are also very, very helpful in the detoxification process. Omega 3s help you detoxify in a calm way that don't really rock your body, including lots of herbs and spices into your cooking, can also help you detoxify slowly in a way that isn't super jarring to your physical and emotional self. When I see somebody go on a detox, oftentimes, they'll have emotional responses as well, which catches them off guard. They think that they're just detoxing their physical body. But in reality, oftentimes, we have some emotional symptoms that come up with that, too. So, something to keep in mind if you're doing a "detox." Much softer on your entire physical and mental, emotional being to do it through food in a daily way as opposed to really rocking your body hard core with supplements over thirty days. Spices like cinnamon, turmeric, that we mentioned earlier, rosemary, garlic, ginger, fennel, dill, cumin, thyme all help the body detoxify and were meant to be included in foods. In terms of supplements, you can use something like DIM or NAC. Those helped to increase detoxification slowly through the body by getting rid of xenoestrogens and helping estrogen metabolism regulate itself. The dosage for dim is one hundred to two hundred grams a day. And NAC or it's longer name N-acetylcysteine is also really helpful in the way that it is the precursor to the glutathione detoxification pathway in the liver, helping your body to do what it already does naturally. It helps with the ridding of extra estrogen, balancing the androgen levels or testosterone. And it also has an affinity for re-sealing the gut in the sinus issues. So, if you're somebody the suspects leaky gut or you have allergies, maybe you always have that sneezing, runny nose thing happening first thing in the morning. And you know that your estrogen-testosterone levels are out of whack, NAC is something that can be really, really beneficial for you. And the dosage would be six hundred grams in the morning and then twelve hundred grams at night. And I like to dose it that way, which seems kind of uneven at first blush because the twelve hundred grams at night, that's going to help your liver when it's actually the most active detoxifying itself at night between the hours of one and three a.m.. And this is a concept from traditional Chinese medicine. 

I know that this is a ton of information. You guys have stayed with me well over the hour. So, I'm going to make sure that's all worth your while by having a nice handy dandy chart that you can look at. And of course, like always, if you feel totally overwhelmed, I'm always happy to work with you and give you an evaluation and point you in the right direction for your specific situation. You can find links and other show notes to contact me for those opportunities as well. I hope this has been super helpful. And I look forward to hearing from you how this has changed your situation. Bye for now. 

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