I’m talking today about PCOS. There is a relationship between this condition and Hashimoto’s so it is a good subject to cover. 

What is PCOS or polycystic ovary syndrome? 

It is a metabolic disorder that causes irregular periods or no ovulation, excess testosterone levels and polycystic ovaries. The criteria for diagnosing this condition is to have 2 of the three of the characteristics just mentioned. 

Signs and symptoms of PCOS: 

• Acne

• Hirstuism- excessive hair growth on face, back or chest for example

• Hair loss

• Obesity or trouble losing weight

• Infertility

• Low libido

It is thought that as many as 1 in 5 women suffers from this condition which has risk factors for diabetes of any kind and 50-70% of women with PCOS have insulin resistance. You don’t have to be overweight or obese to have insulin resistance with PCOS either. 

Other chronic conditions affecting those with PCOS can include metabolic syndrome, high blood pressure, cholesterol issues, sugar intolerance, higher calcification of coronary arteries, depression, anxiety, bipolar and binge eating. 

The standard of care for PCOS in conventional medicine is to put you on birth control pills, drugs to control the excess testosterone, infertility treatments if you want to get pregnant and metformin to control blood sugar issues/insulin resistance. 

The cyst in this condition develops when/if ovulation doesn’t take place, there is no surge in luteinizing hormone, estrogen doesn’t peak and the egg doesn’t get released for ovulation so it continues to grow as a follicle creating a cyst which continues to make more testosterone and cause low progesterone and create insulin resistance. It is an unruptured follicle at the antrum stage of creating an egg for release. This, keep in mind, is a very simplified version of what happens. 

The insulin resistance through a variety of processes leads to anovulation or lack of ovulation- no egg released and insulin resistance also keeps eggs from being produced. 

High insulin will cause high testosterone levels in women with PCOS but also, high testosterone causes insulin resistance. 

What else is common in PCOS?

Liver issues- Non alcoholic fatty liver disease is a common issue. So common that it is safe to assume if you have PCOS you probably have some degree of fatty liver. Fatty liver leads to insulin resistance and visceral fat accumulation which leads to obesity which leads to inflammation with leads to accumulation of fat in the liver which leads to fatty liver. Fatty liver decreases sex hormone binding globulin which leads to more testosterone which leads to insulin resistance. 

GI issues- gut dysbiosis, leaky gut, gram negative bacteria- interferes with insulin receptors driving up insulin and screwing up egg development. Gut dysbiosis all by itself can contribute to all of the three criteria mentioned for diagnosing PCOS. One study showed that women with PCOS had higher zonulin levels which is the compound that causes the tight junctions in the small intestine to open- causing permeability or leaky gut. It is also more common for women with PCOS to have higher incidence of H. Pylori infections. 

Other hormone issues- lean women with PCOS will get excess testosterone from their adrenal glands whereas obese women will get it from their ovaries. I don’t know why this is but if you have high DHEA and PCOS it is likely because DHEA is making testosterone

Environmental toxins- BPA tends to be higher in women with PCOS- glass, stainless steel should be in your cupboards. One study suggests that BPA affects fertility. It increases testosterone production in both women and men. BPA also lowers one detoxification pathway in the liver- creating another vicious cycle of excess BPA in the body- the body is not able to get rid of it so it just circulates in the blood. Prenatal exposure to endocrine disrupting chemicals can cause a change in genetics for a fetus leading to PCOS or other health issues. 

Immune system dysfunction- discussed later

Inflammation- just having PCOS can lead to inflammation in the body creating a vicious cycle and wreaking havoc on the central nervous system. 

Oxidative stress- PCOS will often cause you to have less antioxidant status which means more oxidative stress, especially when dealing with insulin resistance too. One study showed those women who were also infertile had even more oxidative stress than PCOS women who were not infertile but had insulin resistance. Bottom line is the more insulin resistance, the more oxidative stress there will be and the greater the infertility the more oxidative stress there will be. There also seems to be more of a deficiency in glutathione levels, the master antioxidant, in PCOS. Supplementing with glutathione is tricky- oral supplements are not effective unless they are acetylated but you could also potentially take things like N-Acetyl-Cysteine to boost glutathione levels. Resveratrol also might be helpful. 

Nutrient deficiency- Deficiency in B12 and folate were common in PCOS women and also not eating enough can drive this condition. Maybe higher copper, low selenium, low zinc, high or low magnesium and more. Again- don’t just start taking one of these minerals. Know what you need. 

Glucose dysregulation- Mood or behavior issues due to reactive hypoglycemia can be a common symptom and a feeling of being tired but wired. 

Low cortisol can be a problem in this condition as well. Women with PCOS tend to have more of an enzyme that breaks down and degrades cortisol so you get rid of cortisol faster eventually leading to low levels. Morning cortisol tends to be lower and evening cortisol higher which means you maybe struggle to get out of bed in the morning and get that evening second wind. 

The thyroid connection. 

Women with PCOS had a much higher chance of having thyroglobulin antibodies. Low progesterone in PCOS causes the immune system to be overstimulated which produced more estrogen and lead to higher anti-nuclear antibodies, anti-thyroid antibodies and a bunch more antibodies against various tissues. 

It turns out perception may also have something to do with it. There was a study done on PCOS where women were given an MRI and shown pictures of a high-calorie food, low-calorie food, or some kind of control, and the high-calorie food picture increased insulin resistance. Crazy to think our brain has that much power. 

There is also the idea that insulin resistance is a protective mechanism for survival. We have increased glucose which the brain can use to stay alert, increase in blood pressure and blood coagulation for wound protection and obesity so you can survive a famine. Increased inflammation can prepare the body for trauma. All this is very primal and our brain and our physiology is still very primal and will lead to infertility or a bigger delay between pregnancies so there are less babies to feed and higher survival rate for mom and existing babies. The study this came from is called The molecular genetic basis of functional hyperandrogenism and the polycystic ovary syndrome. 

The best thing you can do with this condition either alone or combined with Hashimoto’s is to take a good hard look at your diet, then do some exercise. Get rid of the sugar and refined carbs and get moving. Exercise will help you get rid of excess glucose. 

You have to be careful with what you supplement with because not every one of you will need the same thing. I feel like a broken record saying that but it is sooo true. There are certain compounds called insulin secretagogue’s- they increase insulin in your body. If you have high blood sugar or hyperglycemia and high c-peptide then you don’t want to take compounds that will increase insulin secretion- things like Gymnema or bitter melon will raise insulin even further. 

If you have hypoglycemic tendencies you may be able to take something like licorice root or take fish oil, to stimulate proper use of glucose in the body. The thing is you don’t know what you need until you work with a qualified professional to help you figure out what your body is doing. 

Using a sauna as often as you can be helpful in the detoxification of toxins. Toxin levels measured as normal or negligible in urine and blood can be found in sweat. Sweating via exercise is good too. 

You also want to address inflammation, gut function, make sure your liver is able to do its job of detoxification of all the things, address oxidative stress, nutrient deficiencies, and fatty liver. 

That is it for today. Thanks so much for listening. If you like what you hear, please leave me a rating and review on Apple Podcasts. If you don’t like what you hear, please reach out to me and let me know what you don’t like. 

All my best to all of you! I am grateful you chose me! 

References: 

Arora, Sheetal, Kiran Sinha, Sachin Kolte, and Ashish Mandal. 2016. “Endocrinal and Autoimmune Linkage: Evidences from a Controlled Study of Subjects with Polycystic Ovarian Syndrome.” Journal of Human Reproductive Sciences

Blumenfeld, Z., Kaidar, G., Zuckerman-Levin, N., Dumin, E., Knopf, C., & Hochberg, Z. (2016). Cortisol-Metabolizing Enzymes in Polycystic Ovary Syndrome. Clinical medicine insights. Reproductive health, 10, 9–13.

Rutkowska, A. Z., & Diamanti-Kandarakis, E. (2016). Polycystic ovary syndrome and environmental toxins. Fertility and sterility, 106(4), 948–958.

Palioura, E., & Diamanti-Kandarakis, E. (2015). Polycystic ovary syndrome (PCOS) and endocrine disrupting chemicals (EDCs). Reviews in endocrine & metabolic disorders, 16(4), 365–371. 

Duleba, A. J., & Dokras, A. (2012). Is PCOS an inflammatory process?. Fertility and sterility, 97(1), 7–12.

Kurdoglu, Z., Ozkol, H., Tuluce, Y., & Koyuncu, I. (2012). Oxidative status and its relation with insulin resistance in young non-obese women with polycystic ovary syndrome. Journal of endocrinological investigation, 35(3), 317–321.

Sam, S., Vellanki, P., Yalamanchi, S. K., Bergman, R. N., & Dunaif, A. (2017). Exaggerated glucagon responses to hypoglycemia in women with polycystic ovary syndrome. Metabolism: clinical and experimental, 71, 125–131.