Category: Science


PCOS – Focus on Cause Not Just Symptoms

PCOS, or polycystic ovary syndrome, is becoming increasingly common. The syndrome is characterized by a multitude of factures, including irregular or total loss of menstrual periods, heavy periods, acne, increased facial hair, ovarian cysts and metabolic issues related to insulin sensitivity and blood sugar regulation. It is the most common endocrine disorder of women in America, and affects an incredible 5% to 10% of women between ages 18-44.

Interestingly, as we move forward in our understanding of PCOS, it appears that, despite the name, ovarian cysts are certainly not required to make the diagnosis. That is to say that the cysts are a consequence of the underlying disease process, not the fundamental player.

What PCOS represents is primarily a metabolic disorder closely akin to type 2 diabetes in which the body becomes resistant to the effects of the hormone insulin.

For those of you following my blogs, you’ll recognize that this issue with insulin seems to be a recurrent theme related to brain disorders, immune issues, and now PCOS, an ever more common situation with women that is described as having “no cure.”

Many of the manifestations of PCOS, like the acne and increased facial hair, as well as the menstrual changes, are a consequence of higher levels of male related hormones called androgens. As such, pharmaceutical intervention for PCOS often involves hormone therapy designed to re-establish balance between so called male and female hormones. In addition, the diabetes medicine metformin is frequently used to help regulate blood sugar.

And as it is with the more than 26 million diabetics in America, the first choice in PCOS, as it relates to elevated blood sugar and loss of insulin sensitivity, focuses on drug intervention and not lifestyle manifestation. But please recognize that the metabolic issue related to elevated insulin is absolutely a central issue in PCOS, not something that just appears along with the rest of the symptoms.

It turns out that the elevated level of insulin actually has a direct effect when it comes to the primary hormonal issues of PCOS. As described in this report from the Medical College of Virginia, elevated insulin stimulates the ovaries to increase their production of androgens, upsetting the male/female ratio of hormones and leading to the many downstream manifestations of PCOS.

With this understanding of the central role of insulin elevation in terms of directing the rest of the symptoms of PCOS, it truly shines a light to the importance of lifestyle issues that are directed at not only the treatment of type 2 diabetes, but perhaps even more importantly, its prevention.

The diet of Americans is anything but ideal. And as it relates to young women at risk for PCOS, the profound exposure of young women to sugars and carbohydrate rich foods, because of their role in increasing insulin, is clearly related to tipping their hormonal balance in favor of masculinizing androgen hormones, a fundamental feature of PCOS.

I believe PCOS is a preventable situation with diet and lifestyle well-deserving of our attention. As is so often the case in Western medicine, the focus seems to be on fixing problems with drugs long after the cow has already left the barn. We need to focus on keeping the barn door closed in the first place, a metaphor for changing our focus to prevention, as opposed to treating issues once they have arisen.

In upcoming blogs I will explore other ideas now emerging that may relate to PCOS including environmental toxins as well as changes in the microbiome. So stay tuned.

  • Ri

    excellent discussion! can you please delve into the topic of birth control and the effect of excess estrogen on weight gain as well as increasingly common aneurysms that birth control may have contributed to due to blood clots. This is important information for those of us who have been on the pill long term.

  • Ri

    Further do you believe in eating for your body type? ie. pear shape, apple shape..as there are metabolic differences between individuals. I have been doing some research about this and Dr Eric Berg uses this diet approach to help his patients. Even Dr Oz discusses how eating specific foods that work best fsor your body type will help you lose weight and prevent disease. I am curious what Dr Perlmutter’s thoughts are.

  • Janknitz

    There is a hereditary form of PCOS in my family. My mother had it, I have it, and now my 14 year old has it. We were all thin for a very long time–my weight didn’t come on until we started monkeying with my hormones to try to conceive my first child via IVF. My second child was a very wonderful “surprise” when I was eating LCHF and taking Metformin–age 41!. She is the one with PCOS as well, currently her BMR is 18% but she has a very high insulin level and other symptoms of PCOS (severe acne, amenorrhea, etc.) At 14 she’s all about the pizza and doughnuts (though not in our home) and unwilling to avoid grains or limit carbs very much but someday it will be important to her. I second Ri’s request for some info on birth control pills–I’ve so far resisted letting them put her on BCP’s (she is on Metformin) but the endo will insist if she gets to 15 1/2 or 16 without menses. It seems to me that BCP’s are counter-productive in insulin resistant PCOS. Also, I’m menopausal now and my HMO has told me that I don’t need to “worry” about PCOS anymore since I’m not trying to conceive. How about preventing diabetes, dear health MAINTENANCE organization????

    • Lynn Dell

      They have tunnel vision because they don’t consider that root causes of many disease processes are similar. The axe works best at the root of the tree to cut it down, not on individual branches.

    • See my post that I just did: I suggest that you try Lugol solution.

  • Donna Trautman Paige

    I don’t understand why they don’t treat the hormonal problems with natural bioidentical hormones, why the pill, it is a drug, can’t be good.

    • Opine2u

      I’d assume that they prescribe the pharmaceutical version because many MDs don’t know the advantages of bioidenticals, also because insurance will only pay for the Big Pharma version. We are on our own for covering the cost of bioidenticals. Not cheap, but well worth the cost, imo. I wonder if one could get a bioidentical version in the same content and strength that is being prescribed as a pharmaceutical. I would imagine a compounding pharmacy could make anything that’s required.

  • SL

    Thanks so much for addressing this! I completely agree that prevention needs to be the focus, but, unfortunately people (including doctors!) are so woefully under educated about this condition! Most women don’t even know that they have it – and most doctors don’t see a need to go to the trouble of diagnosing unless a woman is trying to conceive. This is not just about infertility! Women need to know, and they need to learn how to manage the associated risks that come along with this disease. I am blessed to have found a doctor who has pcos herself, and so she understands and is willing to answer my questions and tell me the truth – but wow I went to a few that had no clue.
    Thanks so much, Dr. Purlmutter, for addressing this. Would you please discuss your thoughts about metformin and birth control pills, as these seem to be the most common treatments in addition to lifestyle changes. I have also been hearing about supplementing with inositols. How does a woman with pcos – who did not have access to information to be able to prevent the disease, overcome the profound insulin resistance to be able to lose weight and improve outcomes? Thank you!

  • napleskb

    I have PCOS. Been seeing a nutritionist (a VERY good one) for years. I have also been eating clean since 2008. Unfortunately, the symptoms have been getting worse. My last resort is medication. And I finally broke down. Now, I’m on 3 different mess and am sick as a dog. As a weightlifter, My biggest concern was losing my strength. I just don’t know what to do anymore about it.

    • Kim

      Does your nutritionist have you on dairy? My symptoms made a huge improvement when I got off dairy and started taking inositol. Theres a lot of research on how inositol helps with insulin resistance in PCOS which is the first domino in triggering the rest of the PCOS symptoms. This site was a great resource. http://www.pcosdietsupport.com

      • Isabel

        Can inositol be taken if you are taking vitex?

    • Kim

      Forgot to say that all dairy has a hormone called IGF or insulin growth factor that stimulates insulin. High insulin is the cause of most PCOS symptoms via the domino effect. Excess insulin stimulates ovaries and throws your hormones out of balance…thus PCOS. My symptoms come back with a vengeance by the next day if I cheat and eat dairy or aren’t watching my sugar or carbs. Hope this info helps.

      • napleskb

        No dairy since 2008. No gluten. Nothing with a commercial. Very rarely do I have fruit due to the sugars. I don’t drink alcohol either. Been doing this clean eating thing for a long time

    • Halley Holloway

      Perhaps you would benefit from a food sensitivity test like LEAP. I’m a LEAP dietitian and have read that there can be an association between food sensitivities and PCOS.

    • Tania

      read please the book of Dr.Lee “What your doctor may not tell you about premenopause” and check the webside of Dr.Lam about Adrenal Fatigue. Plus Alisa Vitti has the “Woman Code” book and website about how to cure PCOS.

  • Heidi Holden

    I have PCOS and once I went on a gluten-free diet, I was able to get off of Metformin completely. I do have to ensure that I exercise or the weight will come back on. My doctor is amazed at the results and asked what the change was and when I told her she was amazed.

    • Elizabeth Lavet

      What specifically did you not eat on gluten free. Did you give up all grains or just those considered gluten, and if so, which did you consider these to be. Thank you ahead of time for your answer.

      • Heidi Holden

        Elizabeth: I went totally gluten free. I gave up everything gluten — the grains; the caramel coloring; the preservatives; the processed food (like soups in the stores — tuna fish unless it specifically stated gluten free) — all of my food must state gluten free or I don’t buy and even then I read the labels. I bought the book “The Grain Brain” and he has 2 pages worth of additional “ingredients” that are considered to be gluten or code for gluten i.e. brown rice syrup; caramel color; dextrin; yeast extract (which is in most soups); soy protein; maltodextrin; natural flavoring; modified food starch, etc. So I read the labels very carefully if I’m going to buy a processed food item. I try to stick to only non-processed foods and do very well. I’ve been off Metformin for almost a year.

        • Elizabeth Lavet

          Thank you.

  • Rick Bailey

    Is there a specific name of the stool test that Larry Smarr used to test the health of his microbiom.

  • My wife had benign cysts in her breasts for 20 years, then did an ortomolecular treatment with daily dosis of 2 drops of Lugol 2% and the cysts went away in 6 months. Lugol is named after Dr Lugol who cured many in his time (he died in 1851). Many doctors wrongly think that Iodine is only used by the thyroid gland, but the thyroid only needs 50 mg, while the whole body needs 1500 mg. All glands, liver, stomach, esophagus and skin need Iodine. Lugol is solution made of potassium iodide and iodine. Some glands need one form of the iodine and some need the other, but the ovarium and mamma need both.

  • Anna Downunder

    I have PCOS and gave up sugar, grains and processed carbs. I lost 129 pounds … my cycle is now back with a vengeance (every 3-4 weeks) but no relief from male pattern hair loss or facial hair growth. I’m in my early 50s (Mom didn’t go through menopause until 55 so I may have a few more years of this). Maybe I need to consider hormonal treatment, or is it too late now?

  • Ebs Gordon

    There is also a big chance pcos is linked to thyroid problems so when grain free low sugar dairy free diets aren’t fully working get an Integrative Dr to check your thyroid as I was diagnosed with pcos aged 24 but tested for hypothyroid several times a year for over 20 years my GP’S wouldn’t treat me because my test results were ‘normal’ so I was left to suffer I’m now being treated thankfully and I’ve been told my pcos is likely to go when my NDT starts to kick in. Good luck ladies.

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