Until I started practicing Nutritional Therapy I really had no idea how common Polycystic Ovary Syndrome was, it is the most prevalent endocrine (hormonal) disorder in women of reproductive age and is the most common cause of infertility. Around 1 in 10 suffer with PCOS and is a condition that conventional medicine is failing us on, so something that we really need to be informing ourselves on better.
Because of this and my own past experience of trying to get to the bottom or hormonal issues, I suffered with amenorrhea (absence of menstruation) for around 4 and half years with most trips to the doctors resulting in more confusion and no more advice than to take the pill, I wanted to cover some important points on what action we can take ourselves to support hormonal imbalances behind issues such as PCOS.
The conventional approach (or replacement model), of giving synthetic hormones to replace those that are low or out of balance can seem perfectly sensible at first glance but there are many reasons why it is far from a perfect solution;
- It does not seek out an underlying cause or try to understand why the hormones are out of whack in the first place, it’s only masking a symptom.
- Synthetic hormones disrupt and down-regulate the natural production and effectiveness of our own hormones, contributing to imbalances in the long run. We can also become less sensitive to the synthetic hormones and their effects which is why women often change pills after a period of time.
- They come with side effects….headaches, emotional outburst, bloating, fatigue, cranky….all signs your body is giving to show that something is not right for you yet we put up with it as the ‘norm’.
A functional medicine approach on the other hand, the model I use when working with clients, is concerned with finding out the source of the imbalance and addressing the underlying cause. Much of the time hormones take care of themselves once basic systems in the body, required for proper hormone production are supported and functioning well. There are different types of PCOS and different causes, these can not be solved by taking a pill.
Imbalanced hormones are not the problem but instead are a symptom of systems not working properly, or in harmony with each other. Below I will cover the systems that should all be looked at TOGETHER when dealing with PCOS.
5 critical systems to focus on
Blood sugar regulation
If blood sugar levels are continually spiking up high, from processed carbohydrates, sugary foods, too much caffeine, or chronic stress for example, then more and more of the blood sugar regulating hormone; insulin, is produced in response to bring this back down. Over time this can lead to insulin resistance (a more extreme case of insulin resistance being diabetes).
This can lead to PCOS due to the knock on effect on the sex hormones, for women causing an increased production of testosterone which can cause symptoms such as hair thinning or loss, facial hair, weight gain, or low mood. Disrupted blood sugar levels can also increase estrogen levels (estrogen dominance) which suppresses FSH (follicle stimulating hormone) and can lead to fertility issues.
A lower carbohydrate higher fat diet can be very helpful in this case, to help re-balance the blood sugar levels and prevent the roller coaster effect. A ketogenic (very low carb, moderate protein, high fat) diet has been found to help manage or reverse PCOS by reversing the insulin resistance, but I would only recommend this to clients when chronic stress is not an issue as it can lead to burn out. The most important steps would be to take out, or reduce as much as possible, any refined carbohydrates/sugars, grains, tropical fruits, low fat products, and processed foods in general, and base your meals on quality protein, healthy fats, and plenty of vegetables. To further support blood sugar levels it’s important to get moving! Weight/strength training and/or HIIT (High intense interval training), meaning short bursts of high energy and effort, would be most effective.
Adrenal function/ fatigue
After insulin resistance from too much processed sugar/carbs the next major player in PCOS and other hormonal imbalances is STRESS. Stress is a survival mechanism; your flight or fight response. It is not a bad thing short term, the problem is that many of us as exposed to chronic stress all day everyday from work, studies, finances, family, lack of sleep, inflammatory foods, travel, or overexercising, and these are often not well balanced with rest. Unfortunately we tend to get through stressful situations by sleeping less, drinking more coffee and/or alcohol, and using sugar, in an attempt to get more done in the day, instead of ensuring we get proper rest and recovery time. Hello viscous cycle!
The reason this interferes with the female sex hormones…..it’s a case of priorities. As I mentioned stress is a survival mechanism (if we’re running for our lives from a charging bull it would be a life saver!), when the body feels under threat, as it does during a stress response to any of the above, reproduction is the least of it’s worries, putting energy and resources towards producing the hormones needed for a healthy cycle and fertility are not as important as dealing with stress and pumping out cortisol and adrenaline (our stress hormones).
A lot of the time we cant simply get rid of stress, so if this is you then it is more about managing stressors and ensuring you spend enough time in a state of rest and relaxation. For this you need to find something that works for you; walks outdoors, stretching or yoga, small acts of pampering, a good chilled out bedtime routine, laughing with friends, listening to music, meditation, deep breathing, baths, maybe even a spot of healthy baking 😉
The gut has been labelled the second brain for a very good reason; it has a lot of control and say over what goes on in the body, you can’t optimise all other systems without looking after gut health at the same time. As well as the vital role of breaking down and absorbing nutrients necessary for making hormones, such as fatty acids or vitamin D, it also has a role in the production of the hormones and the functioning of associated organs such as adrenal glands and the ovaries.
Fungal overgrowth, parasites, leaky gut, or an imbalance in the good and bad bacteria (dysbiosis) through the digestive tract are far more common than we think, often missed, and all cause inflammation that influence the role of the gut in hormonal balance.
All of the above can be looked into through testing and/or working with a practitioner, but other steps to support gut health include; removing foods which commonly damage our digestive system such as gluten, refined sugar/carbohydrates, artificial sweeteners, and, low quality dairy, and including beneficial probiotic foods (see my top choices in this article) and prebiotic rich foods (cabbage, onions, garlic, asparagus, leeks, artichokes, chicory, bananas, and apples are all great examples). Bone broth and/or collagen protein powder are also beneficial for healing and supporting the gut lining.
Detoxifying isn’t only for junk food, alcohol, sugar, etc, we also detoxify hormones; they get broken down and eliminated too. The liver and gall bladder have a key role in clearing out excess hormones, when these are not functioning properly detoxification pathways are compromised and these hormones can only be partially metabolised (broken down). They can then recirculate back into the bloodstream, getting in the way of active hormones doing their job and disrupting messages sent to the brain about whether we need more or less of a certain hormone.
The liver is constantly burdened with toxins to clear out, from pesticides, food additives, refined sugar, environmental pollutants, chemicals in cleaning products, cosmetics, plastic food or water containers, tap water, alcohol, caffeine…..In other words its got it’s work cut out!
While trying to address PCOS give some thought to where you can limit toxins you are exposed to daily; Could you cut back on the alcohol and coffee? How about investing in a water filter? can you afford to switch to organic produce (or if not avoid the dirty dozen)? Could you gradually replace cleaning and beauty products with natural alternatives? Many products also contain xenoestrogens, a chemical compound which mimics oestrogen in the body so can contribute to hormonal imbalances.
Fatty acid balance
A diet lacking in essential fats, including cholesterol (which is critical for hormone production) can lead to a lack of proper hormone production. We can’t expect them to all be in balance and work properly if we are not giving them enough fuel to do so in the first place..
A good balance of omega 3 to omega 6 fats is important, for overall health and avoiding inflammatory issues/conditions, as well as supporting our hormones, but EPA and DHA (longer chain omega 3 fatty acids) have also been found to help improve insulin sensitivity and glucose tolerance, especially important if PCOS was triggered by issues with blood sugar.
The best way to get more omega 3 fats and avoid too much omega 6 is through eating oily fish, wild caught salmon and tinned sardines being my top suggestions, 3-4 times per week
REMEMBER; All these systems work together, if one is not functioning properly others can be negatively effected, and on the other hand by looking after one area others will be better supported. When it comes to PCOS it’s important to find out the triggers, look at all of the above systems together, and identify what areas you can work on to re-balance hormones.