WHAT IS PCOS?
Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects up to 15 percent of women. Even though this is the most common form of hormone imbalance, conventional medicine has had little success in treating it. Why? Because it isn’t a bug that is susceptible to an antibiotic, it is a syndrome. This means that the exact cause is not always known with each individual, but those who suffer from it have signs and symptoms in common.
The main hormone disruption that we’re seeing in PCOS, is higher-than-normal levels of androgens in women. You can think of androgens as the “male hormones.” These are things like testosterone, DHEA, and these hormones are responsible for giving some of the male characteristics. Women normally have these hormones, but in PCOS they tend to see higher levels of the androgens causing a hormonal imbalance. Whenever men start getting too much estrogen, or women start getting too much testosterone, it isn’t good. Men can get what is often referred to as “moobs”, and women can start to see more facial hair.
In order for a physician to diagnose PCOS, they are looking for high levels of testosterone, irregular or missed periods, and high blood sugar. For the young woman, too often this simply means fatigue and infertility. Unfortunately, conventional medicine really struggles with syndromes in general. An example of why that is can be seen by looking at irritable bowel syndrome. With IBS, you can go to the doctor and describe your symptoms, they in turn give you a diagnosis that essentially summarizes your symptoms, your “bowel is irritable”, so you have irritable bowel syndrome. Then the treatments are all oriented around managing those symptoms. If there is pain, you might have an analgesic. If there is constipation, you might get a promotility drug, if there is diarrhea, you might get an anti-diarrheal, and that the basic approach.
In Functional Medicine, we’re trying to address the root causes and the underlying mechanisms that contribute, so to talk about that in the context of PCOS, the best way of addressing the root causes is to understand the biology of the person, not just a list of their symptoms.
UNDERLYING THE MECHANISMS OF PCOS
There are 43 Genes involved with PCOS, and according to the literature, “the role of genetic factors in PCOS is strongly supported” .
Unfortunately most healthcare providers aren’t even looking in this direction with the thought that “genes cannot be changed so why should we care.” Here are Balanced Health Care, we have found great success in working with the genetic strengths and weaknesses an individual comes in with to help their body express real health.
When it comes to PCOS, we want to look at those genes that regulate and control the function of the adrenal glands, insulin sensitivity, inflammation turning on and off at proper times, etc .
Dr. Evelyn M. Reid once said, “genes load the gun, the environment pulls the trigger” . When it comes to our environment, there is an ever increasing threat of endocrine disruptors (ED), or in other words, drinking from that plastic water bottle might be causing you more harm than you realize. A recent study looked at some of these EDs in relation to PCOS. After an extensive questionnaire about their environment and habitation, and the resulting fasting blood test, they found the following results.
“PCOS patients were more frequent than the controls in eating plastic-packaged food, contacting pesticides, eating fruit with pericarp, living beside a garbage heap, working at an acid plant, taking chinese patent drugs, smoking, and drinking alcohol. However, PCOS patients were less likely to use kitchen ventilators, eat canned food, contact decorated materials, use skin care products, and cosmetics” .
This article summed up their findings with this sentence. “The existence of an association between (endocrine disruptors) EDs and PCOS was proved. Plastic-packaged food, fruit with pericarp and drinking alcohol should be avoided as possible as we can” .
Diet and Lifestyle:
One of the main concerns with PCOS is higher than normal levels of insulin, and this often goes along with insulin resistance. High blood sugar and the associated insulin resistance has devastating effects on the hormonal pathways! This is why most women with a PCOS diagnosis are prescribed the drug Metformin in a bandaid type approach to care. One of the problems with this therapy, as with most other pharmaceutical based approaches, is that trying to cover up a problem, often causes another. In this case Metformin tends to cause a vitamin B12 deficiency . This in turn causes a further lack of estrogen in these already testosterone overdosed women 
Most women are also told to “go on a diet” or to “lose weight”, but are not given much more guidance beyond that. Then these poor ladies, who are already stressed out, take on this additional stress of figuring out what diet to try without the support that a real healthcare program would provide. Afterall, who trusts the food pyramid, now called My Plate, anyway?
According to the literature, a paleo or keto diet would offer a great benefit. Health coaches here make all the difference! One of our patients reported the other day that while living a keto lifestyle this last year, she has dropped over 50 lbs, stopped her thyroid medication and balanced out her hormones. Because in the end, let’s not forget that estrogen and progesterone do come from cholesterol.
One interesting thing about PCOS, is that usually there really aren’t cysts on the ovaries. Technically, they aren’t ovarian cysts, they’re actually follicles that were seen on an ultrasound. The sad thing is, these follicles are inflamed which makes them painful, especially during certain times, thus they are not acting like they normally would by producing an egg during ovulation. This is one of the main reasons for infertility. This is also why it is not uncommon for a diagnosis of PCOS to be given without even looking at the ovaries!
THERE’S A SOLUTION!
With Functional Medicine, our goal is to identify the problem mechanisms for the individual we are working with, and that are causing their specific problems. Afterall, every person is unique. Our job is NOT to diagnose and then follow the medical standard of care. For us, that standard is too low. Functional Medicine is just a way of looking at things. It’s a systems approach, instead of a traditional symptoms approach. The primary tenet of Functional Medicine is to look for the root causes of disease, then go into the scientific literature and ask, “Is there any research to support what I see?”. For example, is there research that links the HPA axis dysfunction to any of the mechanisms that we suspect cause PCOS? Looking at things that way, there is a lot of research. That’s what the whole paradigm is based off of. It’s an important paradigm shift. We have to be continually revising our way of talking and thinking about health and healthcare. Instead of a three minute focus on the disease, so different patients with the same disease get the same treatment, Functional Medicine focuses on treating the patient rather than the disease.
Beyond dietary recommendations and support, it’s important to look at a comprehensive blood panel checking on vitamins, iron, thyroid, blood sugar, insulin, cholesterol, liver enzymes, etc. We may also want to look at gastrointestinal testing (stool, SIBO) because of the deep correlation between the gut and hormones. It might also be wise to consider a toxicity panel to look for heavy metals and endocrine disruptors (hormone disruptors).
We have seen many times that correcting thyroid and adrenal issues improves menstrual cycles and improves those symptoms that are otherwise consistent with PCOS. There is a clear connection in the research connecting high and dysregulated cortisol with insulin and thyroid resistance in the cells.
We also want to check those high androgens, so again, those sex hormones like testosterone and DHEA. Also, checking anovulation, and again this is why we tend to see irregular menstrual cycles. Something that needs to be understood is that a normal menstrual cycle can actually be anywhere from about 21 to 35 days. We have a lot of women who come in and say, “Yes, I have irregular cycles.” They are 24 to 30 days. That’s completely normal. Most women are not clockwork 28 days.
With this information in hand, we are able to treat each of our PCOS patients differently based on their individual physiology.
We will sometimes hear “Oh, I have some degree of adrenal dysregulation, therefore I shouldn’t exercise.” This is only partly true. You should be exercising, and slowly trying to build yourself up. As you do, you will most likely see improvements in how you feel overall and specifically with your PCOS.
Another thing that can be very beneficial is intermittent fasting. It helps to improve insulin sensitivity and also improves the lipid profile.
- Magnesium Glycinate – 400 milligrams daily with dinner
- Metabolic Stimulator – This has two forms of inositol, myo-inositol and D-chiro-inositol, both of which can help with blood sugar metabolism and insulin.
- Vitamin D – The dosage will depend on lab results.
- Zinc – This is another nutrient that has a really interesting role in both men and women, but we see a lot of zinc deficiency in women. 30 milligrams of zinc is a safe place to start. Zinc plays a really important role in ovarian follicle development. One of the primary issues with PCOS is that we don’t see normal follicle development, and that’s how you get production of the egg and ability to conceive. On a side note, oral contraceptive pills can deplete zinc as well.
- Berberine – Another favorite to support sugar metabolism.
- Vitamin B12 – Depending on lab results, active forms of B12 or folate can help support metabolism and the detoxification process.
- Pritam Kumar Panda, Riya Rane, Rahul Ravichandran, Shrinkhla Singh, Hetalkumar Panchal. Genetics of PCOS: A systematic bioinformatics approach to unveil the proteins responsible for PCOS. Genom Data. 2016 Jun; 8: 52–60. Published online 2016 Mar 31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832036/
- N Prapas, A Karkanaki, I Prapas, I Kalogiannidis, I Katsikis, and D Panidis. Genetics of Polycystic Ovary Syndrome. Hippokratia. 2009 Oct-Dec; 13(4): 216–223. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776334/
- Dr. Evelyn M. Reid, Director, Kornblum Institute, School of Education, Webster University. Genes Load the Gun, the Environment Pulls the Trigger: Obesity among Children and Adolescents in U.S. Schools. http://forumonpublicpolicy.com/archivespring08/reid.pdf
- Zhang J1, Liu XF1, Liu Y1, Xu LZ1, Zhou LL1, Tang LL1, Zhuang J1, Li TT1, Guo WQ2, Hu R3, Qiu DS3, Han DW3. Environmental risk factors for women with polycystic ovary syndrome in china: a population-based case-control study. J Biol Regul Homeost Agents. 2014 Apr-Jun;28(2):203-11. https://www.ncbi.nlm.nih.gov/pubmed/25001653
- Bell DS1. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy. South Med J. 2010 Mar;103(3):265-7. doi: 10.1097/SMJ.0b013e3181ce0e4d. https://www.ncbi.nlm.nih.gov/pubmed/20134380
- Palmas W1. Effects of short-term supplementation with ascorbate, folate, and vitamins B6 and B12 on inflammatory factors and estrogen levels in obese postmenopausal women. Int J Vitam Nutr Res. 2006 Jan;76(1):34-8. https://www.ncbi.nlm.nih.gov/pubmed/16711655