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E14 Your PCOS Breakdown with Ariella Weinstein, RD
81 Plays2 years ago
Excited to have this WEALTH of knowledge on the show today! We chatted all things PCOS - from the range of symptom pictures, diagnostic criteria, interventions, outcomes, and unnecessary dietary recommendations. Spoiler: PCOS does NOT have to mean restrictive and rigid diets!
I honestly learned SO much in this conversation and can't wait to share with you!
Ariella Weinstein is a Registered Dietitian based out of Las Vegas, NV. After completing her Dietetic Internship at Memorial Sloan Kettering Cancer Center in NY, she went on to complete her Master's in Clinical Nutrition at NYU. She has been practicing as a dietitian for five years now, working in both inpatient and outpatient clinical settings. After going through her own journey with PCOS and infertility, she decided to delve deeper into the research behind nutrition and PCOS. She has since started a private practice specializing in helping women with PCOS optimize their health and fertility without unnecessary restrictive dieting. She lives in Las Vegas with her husband and two kiddos.
Find Ariella:
Instagram: https://www.instagram.com/pcos.dietitian.ariella/
Please remember nothing you hear on the Eating Between the Lines Podcast should be taken as medical advice. Please always consult your practitioner prior to making changes with your health.
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Transcript
Introduction to Podcast and Guests
00:00:01
Speaker
Hello and welcome to Eating Between the Lines. I am your host, Therese Martinez, and I am so happy to have you here. If you want to untangle yourself from diet culture conditioning and get appropriate, actionable options to nourish your unique life and body, I'm going to dive deep into the nuanced spectrum of health to help you figure out what to prioritize in your journey
00:00:25
Speaker
without getting trapped in the extreme ideology of health optimization or total complacency. I am here to help you apply the science effectively, not rigidly, and get you feeling better in your body and mind. Here is how to eat between the lines.
00:00:47
Speaker
Hello, hello, welcome back everyone. Very excited for my guest today. We have Ariella. She is a registered dietitian based out of Las Vegas, Nevada.
00:01:03
Speaker
After completing her dietetic internship at Memorial Sloan Kettering Cancer Center in New York, she went on to complete her master's in clinical nutrition at NYU. She has been practicing as a dietician for five years now, working in both inpatient and outpatient clinical settings. After going through her own journey with PCOS and infertility, she decided to delve deeper into the research behind nutrition and PCOS.
00:01:31
Speaker
She has since started a private practice specializing in helping women with PCOS optimize their health and fertility without unnecessary restrictive dieting. We love that here.
Understanding PCOS: Misconceptions and Clarity
00:01:43
Speaker
She lives in Las Vegas with her husband and two kiddos. Welcome. Welcome. How are you? I'm good. Thanks so much for having me today. I'm so honored to be here. Absolutely.
00:01:56
Speaker
If the bio wasn't concrete enough, I really wanted to have Ariella on here to talk about PCOS. I find that there are a lot of misconceptions, a lot of misunderstandings around diagnoses, what it means, what treatment protocols are.
00:02:18
Speaker
Um, there's a lot of confusion around just it being sort of like an umbrella diagnosis.
Ariella's Personal PCOS Journey
00:02:25
Speaker
I see a lot of commonalities with people coming in believing they have PCOS, like they come in feeling like they have IBS and not really a direction of where to go with it because of just the variance in diagnostic components. And so.
00:02:43
Speaker
I am so excited to have you on here to dive into the nitty gritty of some of this while creating clarity and with that approach that is, like you mentioned, unrestricted and all-encompassing too.
00:03:00
Speaker
To start off here, why don't you kind of walk us through a little bit around your own journey and what that has looked like with how you got into this interest.
00:03:14
Speaker
Yeah, absolutely. So growing up PCOS was something that I had heard of, but didn't really understand a lot about, and that's because my mom actually had PCOS, but the way it impacted her didn't seem to relate to anything that I was experiencing at the time.
00:03:31
Speaker
When I was going through puberty, early adolescence, when I got married, trying to have kids, we didn't have any of the same type of situation. And what I really mean by that is my mom did not struggle to conceive at all. My sister was born, let's just say, about 10 months after their wedding.
00:03:48
Speaker
And so my experience wasn't like that at all. What led me to feel like I may have this type of condition was because A, my mom had it. So it was just in my mind as a condition that affected hormonal health. And when my husband and I were looking, trying to conceive, I was like, Hey, I don't have a cycle. That's
00:04:12
Speaker
not normal. I had all my friends saying that I was lucky, that I didn't have a cycle. And for the most part, I felt like there were some benefits to that. I didn't have a lot of that, any crazy hormonal shifts, feeling like I was having major mood swings. So that was really nice and pleasant. But at the same time, there's a reason why our period is now being more coined as our fifth vital sign, because it really gives us a good indication of what's going on in our body.
00:04:39
Speaker
And so several months into my journey with trying to conceive, I said, you know, this, this isn't working. I'm not having a cycle. So clearly I'm not ovulating. So there's no issue with us, you know, maybe timing everything improperly. Let me just go to my OB and see what's up. So I went to my OB, got tested, low and behold, I have PCOS.
Navigating Medical Advice and PCOS Diagnosis
00:05:01
Speaker
And I was like, Hey, that makes a lot of sense. Now I know kind of maybe where to go from there, but.
00:05:07
Speaker
I actually had no idea where to go from there. At that point, I was prescribed metformin, which is definitely one of the more common medications to help with PCOS, specifically someone in my situation where birth control was the last thing I needed because I was trying to conceive.
00:05:23
Speaker
So I was put on the metformin, didn't really understand what that role was going to play with my PCOS because at that point in time, I was in my master's for clinical nutrition at NYU. I had heard of metformin as a drug to help with diabetes. And I was like, I don't have diabetes. So I did some research, found out insulin resistance is very commonly an underlying root cause of PCOS.
00:05:47
Speaker
And I had very similar symptoms or symptoms consistent with insulin resistance. I could gain weight just like that. I had a lot of more abdominal weight gain. But again, at that point, I was at what was considered or was considered a normal BMI. So I was still kind of confused what that role was serving for me at that point. My hemoglobin A1C was normal. So then I tried to do some further testing with my PCP. And again, this is
00:06:14
Speaker
something where I have a background in healthcare, in clinical nutrition. So I have the tools to really try to delve deeper because I didn't have the information that I needed to really understand what was going on in my body. And in the meantime, the metformin was giving me horrible GI side effects. So this is also really why I was trying to understand how it was actually helping me because if a hemoglobin A1C is normal and hemoglobin A1C, for those who might not know,
00:06:43
Speaker
is your three-month measure of blood glucose control. So if your blood sugar is under control, maybe there isn't insulin resistance or so I thought. So I went to my PCP, you know, mentioned I have PCOS.
00:06:58
Speaker
I said I'd like to get an oral glucose tolerance test to maybe see if there is an issue with my glucose spikes, my ability to tolerate glucose and carbs, that maybe I could see through that type of test. And at that point in time, she said to me,
00:07:15
Speaker
Oh, just lose five to 10% of your weight and your PCOS should be fine and your cycles will come back. And in the meantime, yeah, magic weight loss is just the magic answer to everything. Um, and I say that sarcastically, of course, but at that point, again, that was also not what I was coming for. I was really coming to say, Hey, can we run this test? Can you help me get this done? Not looking for that type of advice.
00:07:38
Speaker
And with my background in nutrition, I had also been exploring intuitive eating recently. I was exploring the health at every size movement. So my resilience was pretty high up there in terms of being able to tolerate that type of comment.
00:07:54
Speaker
But that type of comment can be very, very damaging to women with PCOS because what we know about insulin resistance, which we'll also talk about perhaps a little bit later, is that it makes it extremely challenging to lose weight. So that advice is probably the least helpful advice. And if anything, shows the weight stigma and bias in medical care where you assume someone at a higher BMI or even someone at a normal BMI.
00:08:21
Speaker
is lazy and maybe just not trying hard enough to lose weight. And weight loss, again, being this magical cure all for all types of conditions. But again, in reality, there were changes I certainly could have been making to my diet, supplements I could have been trying, but weight was certainly not a factor that I needed to address.
00:08:43
Speaker
So that was definitely a little disheartening. But in the meantime, I still didn't quite get the answers that I needed. And at that point, I was pretty impatient for looking for answers for trying to conceive. So on my own, I went to a reproductive endocrinologist, got some hormone testing done. We found that we had some mild male factor infertility. So at that point, our doctor had mentioned, it's likely going to be the best option for us to do some sort of stronger intervention.
00:09:11
Speaker
So we tried out Clomid, that didn't work for us, unfortunately. And then we basically jumped straight to IVF. And that was definitely a mistake on my part. I mean, again, anyone who is going through the journey of trying to conceive knows that patience is definitely very hard at that point, especially when you try for a while before you go to a doctor, go to a doctor, wait for answers, try a treatment that doesn't work. At that point, you're kind of like,
00:09:38
Speaker
I just want this baby. Let's see what happens. So my journey ended with IVF, which thankfully was successful for us. We did have to go through a failed transfer first, but one benefit of PCOS is usually the egg retrieval process is fairly successful because usually we actually have higher AMH levels, which shows a higher
00:10:00
Speaker
usually a higher ovarian reserve. So we usually have no trouble with retrieving a nice amount of eggs. Not everyone is as successful at making it to embryos. And of course, knowing that every person is going to be different, but that typically is not as much of a problem with PCOS. So that is how I ended up with my first daughter and that was wonderful and great. But after that, that's when I really started digging a lot deeper. Now that I had my patients was,
00:10:26
Speaker
You know, paid off. I got my baby, which is what I needed, but I still was looking for some answers of how to improve my health and make sure I didn't have to go through this again. Yeah. Okay. Oh man. So much to unpack there. Um, I want to, I want to back it up a little bit, like first kind of in a defining factor of like what PCOS is, I realized we have not actually identified that.
00:10:52
Speaker
And so can you kind of talk about what that is? Um, you know, and then also in relation to like your mom's symptom picture versus like maybe the spectrum of what symptoms can look like with it.
00:11:06
Speaker
Right, absolutely. So, PCOS stands for polycystic ovarian syndrome, and syndrome meaning it encompasses a wide range of symptoms. Right now, there is something called the Rotterdam criteria, which is how doctors will diagnose PCOS, and it requires that a woman or menstruating person
00:11:27
Speaker
meets two out of the three criteria. The three criteria being irregular cycles or anovulatory cycles or absence of cycles, which would be irregular also. The second is polycystic ovaries, which you would see on an ultrasound. So a pelvic ultrasound, you would look and see those cysts on your ovaries.
00:11:48
Speaker
And then the third one is clinical or biochemical science of hyperandrogenism. So what that means is lab markers that would indicate high androgen levels, androgens being testosterone, androcynidione, and another one called DHEAS.
00:12:05
Speaker
or signs of it which would include hirsutism or excessive growth of hair in unwanted areas. So the facial hair growth at the breast, the belly, hair loss, topical hair loss. So we have both ends of the spectrum. So hair loss where you want hair, hair growth where you don't want hair.
00:12:27
Speaker
acne, unintentional weight gain, those would be some of the main signs of those hyperandrogens. So that's really the diagnostic criteria. You
Approaches to PCOS Treatment: Diet and Lifestyle
00:12:38
Speaker
really only need two out of three. There's definitely a lot of controversy with these criteria because it could lead to a lot of diagnoses that don't really need to be there. But right now that's kind of the gold standard for PCOS diagnosis.
00:12:53
Speaker
Okay, so I'm kind of picturing like being someone that gets diagnosed with this. Like, first of all, you're coming in with some symptoms, potentially, I imagine, and then you get this diagnosis. And what does it mean? Like what I think what I would be curious around is like, okay, so either it means that now there's something defining my symptoms, and hopefully there's a resolution to the symptoms and the symptom picture,
00:13:22
Speaker
And or what else does that mean downstream like if this doesn't go treated if there is you know. If it's really delayed and diagnosis or something like that to what may be ramifications of that if they if they do kind of exist in a tangible fashion.
00:13:41
Speaker
Yeah, that's a great question. So I think someone asked me on my Instagram saying, what's the harm with PCOS going undiagnosed or what would happen if I got diagnosed later in life? And again, a lot of people have a wide range of symptoms and a wide range of what their PCOS picture looks like, specifically also with lab levels.
00:14:02
Speaker
So one of the more common ramifications is not having a regular cycle, either completely absent or irregular cycles, meaning that they're spanning maybe six to 12 months in between cycles, could increase the risk of endometrial hyperplasia, so extreme thickening of the endometrial lining, which could put you at risk for endometrial cancer.
00:14:24
Speaker
So that's why birth control is one of the more commonly prescribed medications, even though again there's also controversy with birth control if there is such a thing as post pill PCOS where people may develop signs or symptoms of PCOS as they come off the birth control pill.
00:14:42
Speaker
But really the birth control is a medication that is often prescribed for PCOS because it does shut off your hormones. So it is a little bit of a band-aid because we're not working on maybe the underlying root causes of the symptoms. But in the meantime, it does provide symptom relief in that people who are experiencing the acne, the facial hair, and the irregular cycles are having symptom relief for that.
00:15:08
Speaker
And more importantly, having the regular cycles is allowing them to have that shutting of the lining monthly, which is significantly decreasing their risk for endometrial cancer. So that is a big win. But when it comes to trying to conceive, that's where it starts to pose a problem of
00:15:26
Speaker
you know, this is a little bit more of a band-aid and when you're coming off of it, now we're maybe needing that 12 to 24 months for your cycle to regulate with the more maybe, with the maybe less conventional treatments for PCOS, which include maybe some nutrition and supplementation to address those root causes that are now, you know, coming back when coming off the pill because the pill was that band-aid.
00:15:52
Speaker
Gotcha. Okay. Interesting. So what would some of those treatments look like? And I guess also because of the multifaceted nature of the diagnostic criteria, right? So if a person has insulin resistance, but maybe they, and they have like
00:16:10
Speaker
I don't know, a androgen that's higher, like maybe a high testosterone or something like that. I feel like I've seen patients come in with doctors like diagnosing them with PCOS in that circumstance. And to me, I'm not sure if like
00:16:27
Speaker
I don't know, like plugging that diagnosis is the most beneficial thing for them versus kind of trying to peel apart maybe some of the isolated conditions like insulin resistance and potentially the high testosterone, but can they be treated separately or do you usually treat it on a whole with comparable interventions? What does that look like?
00:16:52
Speaker
So when a client is diagnosed with PCOS because of high testosterone, it usually might mean that they have the criteria to be diagnosed with PCOS because testosterone would be their higher androgen. They likely would have the symptoms of the hyperandrogenism. So that's
00:17:08
Speaker
together that criteria. And then really the other piece would be seeing if they do have a regular cycle. So if they don't have that and they just have the testosterone, maybe that would be an issue with just addressing the insulin resistance, but likely it
00:17:24
Speaker
It both will happen, because what we do know is that elevated testosterone levels is going to suppress ovulation. So maybe they are having regular cycles or semi regular cycles, but are they testing for if they're ovulating because if they're having regular cycles but not ovulating.
00:17:42
Speaker
that would also again be meeting their criteria for PCOS. So it could be that if they're not doing an ovulation kit or trying to conceive, but they just have that one criteria, it could still mean they have PCOS. But it is entirely possible that it could be something else. It would really be hard to know. It's one of those conditions that requires a lot of teasing out that there's a lot of work being done on the side of advocacy.
00:18:12
Speaker
to do a lot more research to maybe change the criteria a little bit more so that there is a little bit more targeted treatment and not as many people walking around with completely different symptoms. And then doctors are kind of confused with where to go because each case has been so completely different. Right. Right. Okay.
00:18:31
Speaker
it seems like cis would also be in like part like like I don't know imperative as part of the diagnostic criteria but um I also feel like I've seen patients that come in that like are that don't test positive or they at least are not seen and I know that there's there can be limitations to ultrasounds too sometimes and so um do you consider that to be a make or break as well?
00:18:56
Speaker
I mean, I'm not a diagnostician so I wouldn't be the one to say that that makes or breaks somebody but I have, I know people who have ultrasounds where they have cysts on their ovaries but don't have PCOS. That's again why there's a lot trying to be done to maybe change the name.
00:19:12
Speaker
because you can have PCOS without cysts on your ovaries if you meet those first two criteria of the hyperandrogenism and irregular cycles. And usually those really are the main two that we want to see to diagnose PCOS, or at least from what I've heard in the doctor's office.
00:19:29
Speaker
But that third piece can just, you know, be more of a confirmation that that's what's going on. But again, there are plenty of people who have cysts on their ovaries and don't have PCOS. Cysts are really just a sign of an immature follicle. So that's often present with PCOS because you're not ovulating.
00:19:47
Speaker
you're having irregular ratios of your LH or luteinizing hormone to your FSH. So that could contribute to, again, those cysts versus mature follicles leading to ovulation. So those are some things that impact the cyst piece, but again, why they're trying to move away from that because it's not currently required as a criteria if someone meets the other two. And again, people can have cysts on their ovaries without having PCOS.
00:20:13
Speaker
Gotcha. Okay. Okay. So helpful. So helpful. So in terms of like treatment, then someone comes in to see you diagnose the PCOS. What's the approach?
00:20:25
Speaker
Yeah, so great question. So typically there are several factors that contribute or are some of what we call the underlying root causes of PCOS. And the three main ones are insulin resistance, that's it comprises about 70 to 85% of women with PCOS have insulin resistance, inflammation, and also adrenal issues or HPA access dysfunction.
00:20:51
Speaker
Some other signs or things that we might want to work on or underlying root causes could be issues with their thyroid hormones, gut issues, which could also, a lot of them play a very, you know, synchronous role. So a lot of them cause each other, worsen each other, but really the three main ones are going to be adrenal dysfunction, inflammation, insulin resistance.
00:21:15
Speaker
So what I typically work towards first is addressing the insulin resistance piece since that is the more common underlying root cause. So I take a look at someone's glucose labs. I really like to make sure my clients get a fasting insulin done
00:21:31
Speaker
because that's going to be one of the more accurate ways to test for insulin resistance versus a hemoglobin A1c or an oral glucose tolerance test, which is what one of my main mistakes was when I was working through my own PCOS diagnosis was not getting a fasting insulin done as a more accurate picture of what insulin resistance looked like for me.
00:21:53
Speaker
The second thing would be addressing inflammation, so trying to make sure that we're addressing any additional causes of inflammation. That could be through some food sensitivities, through a lack of fiber, lack of omega-3 fatty acids in their diet, a more pro-inflammatory diet with certain food choices, but I always try to take the approach of what can we add to your diet versus what we need to take away, because what we do know
00:22:21
Speaker
About diet and nutrition with PCOS is a lot of those small changes can make a big difference. There's no need for any major restriction to really see big differences in cycle regularity and symptom relief with PCOS, but those are usually the two that I try to address from a nutrition standpoint. The adrenal issue is more about stress resilience and incorporating
00:22:43
Speaker
making sure that my clients are sleeping well, managing their stress and engaging in stress management practices, maybe some additional supplements that could help with stress resilience, but that's going to be less a piece of the nutritional ways that we're going to manage the PCOS.
00:23:01
Speaker
The insulin resistance piece can also affect things like cortisol, which is a hormone produced by the adrenal gland. So people who are skipping meals a lot, who are not fueling themselves properly after workouts, who might be deficient in some minerals. So things like magnesium that might impact insulin sensitivity and adrenal dysfunction. So those are some things where there's definitely a lot connected. I will say there's definitely a lot out there where it's kind of like
00:23:30
Speaker
Is this, is a super legit or research base, um, is adrenal fatigue really, you know, uh, a medically sound term, not really. Um, but there, there definitely are nutritional implications with HPA access dysfunction, but a lot of those things that we work on with instant resistance are kind of in line with that, but that, you know, regulating the HPA, HPA access dysfunction. Okay.
00:23:56
Speaker
Cool, I love that because I also do believe there's so much connectivity amongst the body, right? It's really hard to just isolate certain organs or like certain functions within the body that are not somehow connected to nutrients and also just the overall functioning. And so I definitely like to create the connection but also shed light on the fact that
00:24:23
Speaker
know many times we cannot just treat that individually and it cannot just be targeted like that too.
Factors Influencing PCOS and Management Strategies
00:24:30
Speaker
So okay so I wanted to see like when when folks come in to see you and you know while recognizing the the individuality of every single person and the nuance that goes into evaluating
00:24:47
Speaker
each individual. I am kind of curious if there are commonalities around certain dietary habits that you may see, like you had mentioned, you kind of mentioned pro-inflammatory food or, you know, things that can be like that lack in their diet. Are there specifics that you can take note of here?
00:25:10
Speaker
Yeah, absolutely. So I will say that one of the more common eating patterns or dietary habits I see with the women I work with is the irregular eating pattern. So a lot of skipping breakfast, maybe also skipping lunch, dinner is out of control, and then the snacking after dinner is out of control too. And part of that is the blood sugar balance piece, because what we do know is
00:25:37
Speaker
when you're not eating, especially when you have a degree of insulin resistance, it's going to cause a whole cascade of hormonal shifts, blood sugar release with a hormone called glucagon that's going to help bring those blood sugar levels up. And it's because of the insulin resistance that sugar release might not be as regulated if somebody is making sure that they're eating adequately throughout the day.
00:26:03
Speaker
and controlling the amount of carbs and how they're pairing those carbs throughout the day so making sure that they're having meals that prioritize protein fiber rich carbs and healthy fats, whereas that glucagon release is going to just be
00:26:19
Speaker
you know, major sugar release, and again, without the insulin receptors working well, which is often, again, one of those root causes of PCOS, not just because of someone's diet over time, but sometimes on a genetic level, you know, inherited from mom's DNA, as a result of exposure to high androgen or high sugar levels and utero,
00:26:40
Speaker
that could be this missing connection here where we're not able to process that sugar as efficiently. So skipping meals is probably one of the worst things you can do for PCOS, but is often one of the main things I see women with PCOS do. And sometimes it's because of the busy lifestyle, the needs and demands that we have as women.
00:27:01
Speaker
No just general busyness of a work schedule, but it's that's one of the main habits that I see women with PCS do and a very basic shift that I work on with the women I work with that makes a big impact on their blood sugar levels, which again is.
00:27:18
Speaker
you know, it's a whole cascade effect. So when we lower insulin, we actually lower testosterone. So I didn't talk about that before, but that's really a huge piece that, again, I wasn't told when I was diagnosed, not a lot, not a lot of women with PCOS know,
00:27:34
Speaker
But the reason why we wanna focus on dietary interventions that target the insulin resistance is that when we have high insulin levels, what it does is insulin goes then to cells on our uterus called theca cells and signals them to release testosterone. So that's why insulin resistance is a huge underlying root cause for many with PCS specifically if they have that elevated testosterone and why blood sugar management is so crucial for helping
00:28:03
Speaker
promote ovulation and regular cycles.
00:28:07
Speaker
Wow. Fascinating. Yeah. Oh my word. I just keep thinking about this like perfect storm that is set up for folks in this society with the, the lack of sleep, the go, go, go, just like the stress in and of itself in this kind of hustle culture. And especially if we're like women and moms and, you know, working, busy,
00:28:34
Speaker
women. And then in addition to that, like the push for exercise and potentially like an intermittent fasting and these things that like are actually compounding to create more stress on the body. And then, you know, creating additional underlying issues that can really provoke again, this perfect storm and create problems downstream. So yeah.
00:29:03
Speaker
I wanted to also touch base like, are there, is there a pretty large genetic component and like it to have they defined, like, I don't know, more
00:29:19
Speaker
are causal factors defined and what does that look like? Yeah so it's still there aren't really any well-established causes unfortunately but there are a lot of associations correlations that have been established so it's thought that again those high androgen levels in utero
00:29:40
Speaker
a lot of exposure to plastics or BPA is in utero. So think about, you know, microwaving a lot of plastics, use of a lot of those endocrine disrupting chemicals. So the tallades, BPAs, parabens, a lot of pollution, tobacco, smoking, all of those things can change the baby's DNA in utero and affect
00:30:07
Speaker
their ability to withstand inflammation, their insulin resistance. So it's thought that those are the things that could be impacted in utero specifically, not necessarily just genetic. There could be some genetic factors as well. So we know there's a very strong genetic component with things like type 2 diabetes and similarly with insulin resistance. So somebody could
00:30:30
Speaker
be on the road to develop type 2 diabetes, but along the way, they first have the insulin resistance that maybe worsens over time, either through environmental toxins, diet choices that then maybe when they're in their mid-20s and trying to conceive, they're seeing the effects of that in their cycle regularity, ability to conceive, and then maybe in early adulthood, that's when they develop the type 2 diabetes. If they're not catching that early and making the appropriate
00:30:59
Speaker
changes to their diet. Yeah. Hmm. Are there any thoughts around, um, like use of IUDs and the effect and of, I don't know how that affects symptom pictures with PCOS because you don't necessarily have the understanding of when your cycle really is.
00:31:21
Speaker
my understanding my personal experience having an IED for as long as I did and then also just you know recognizing other folks that do not highly get periods anymore so they don't have that variable so then they would only have the other symptom pictures right and so what are considerations around
00:31:42
Speaker
use of IUDs and how to kind of navigate what that might look like at the PCOS diagnosis or what to consider.
00:31:53
Speaker
Yes, that's a great question. So from my understanding, and I'm still kind of learning a little bit more about the different hormonal treatments for contraceptives and for PCOS. But from my understanding, IUDs could be an effective method of contraception for women with PCOS who don't want to go on the pill because with the IUD, they're still able to produce progesterone. So it's not that they're
00:32:19
Speaker
Technically it's blocking conception from occurring, but technically they're still able to ovulate.
00:32:25
Speaker
So it's blocking that from what I understood and continuing to understand and learn more about. And again, I could be speaking correctly, but from what I understand, that's one of the benefits of choosing that type of method of contraception is that you're still allowing your body to naturally produce that progesterone to ovulate.
Exploring Alternatives to Metformin
00:32:47
Speaker
Again, the downside is that we don't know what your cycle would regularly look like.
00:32:53
Speaker
But you could be still getting your hormone tests and seeing that natural rise in progesterone at what you would assume would be your ovulatory phase. So there are some benefits from choosing an IUD over the pill, specifically for PCOS.
00:33:12
Speaker
And can't, so in terms of success rate, like what does it even look like to heal from PCOS tend to be reversed or like, what is, what's the prognosis? Yeah. So unfortunately there's no real way to reverse PCOS, but there is a way to reverse PCOS symptoms with diet and lifestyle changes. So I've seen clients have great successes with lessening their acne, regulating cycles to the point of being able to conceive.
00:33:40
Speaker
by addressing a lot of those underlying root causes. And we didn't really talk about it so much before, but I had mentioned earlier that I was put on Metformin. And Metformin is one of those drugs that specifically, again, targets one of the underlying root causes of PCOS, which is the insulin resistance. So for a lot of people, Metformin could be a very effective treatment.
00:34:00
Speaker
for helping conceive with PCOS. There are studies showing that it has been successful metformin plus Clomid. Metformin alone has been helpful to reduce androgens, but what I always like to tell clients is that it's not your only option because unfortunately if you're in the same boat as me and you have the very difficult GI side effects from a drug like metformin, it kind of feels like where am I to go now besides maybe making
00:34:26
Speaker
Major shifts to your diet to target insulin resistance, especially if you're in that period of trying to conceive and want to see those changes immediately. You know, it feels like you have to go low carb, solo carbon, solo sugar. And again, that's not sustainable for most people. So, but I always like to, you know,
00:34:42
Speaker
recommend and part of what I do with clients is that individualized supplement recommendation. Because there are supplements like enositol and berberine that have actually been studied in comparison to metformin for women with PCLS. So we do have some good data that these are supplements without the harsh side effects of metformin, but that can be equally as helpful for
00:35:06
Speaker
specifically targeting that insulin resistance piece and potentially even without insulin resistance, helping improve egg quality and improve ovulation and regulating cycles. So those are the two that I often recommend paired with a variety of others. So there are often a lot of other nutrient deficiencies with PCOS like vitamin D. B12 is a common deficiency I see related to
00:35:30
Speaker
the pill and metformin, both depleting B12. So those are some things that I always work on addressing with clients as a way of where to go besides for the medications. If they're trying to conceive and birth control is now no longer an option for their next steps, or if they have experienced those side effects from the metformin, and again, maybe the low energy related to that B12 deficiency, that's maybe now
00:35:55
Speaker
causing those carb cravings because what we know is when we're tired, we're fatigued, we're going to crave those carbs. And that's kind of like, is the metformin actually helping me here if I'm, you know, experiencing those fatigues symptoms from the metformin?
00:36:09
Speaker
Right, right. Oh man, so quite a multifaceted condition and just a lot of things to kind of consider. So it sounds like, you know, if we back the track up a little bit here, symptom picture wise, like if people are curious that they have PCOS, they're looking at irregularity of their periods,
00:36:32
Speaker
Certain, maybe like also symptoms around periods to do like today is their experiences with like severe cramping and heavy flow like just kind of any, any indication of a regularity is that what you are like another part of it.
00:36:47
Speaker
No, not really. That could be an issue with something else that's common with more like sometimes endometriosis, the heavy flow and painful periods with PCOS painful periods are not a symptom. So if you have that, that should be being investigated further.
00:37:04
Speaker
It could be a sign of other hormonal imbalances. It's not to say that someone can't have PCOS in that, but it doesn't mean that that's the, you know, one of the criteria. It's irregular cycles. We talk about, you know, really long gaps in between cycles, very unpredictable cycles. And again, that lack of ovulation or complete absence of cycles.
00:37:24
Speaker
Okay. Okay. So, um, kind of maybe pillar number one to take a look at second one would be symptoms from high androgen, but you kind of mentioned with facial hair or, uh, like hair and like chin hair. Um, and.
00:37:39
Speaker
places that you don't want loss of hair in places that you do. Um, and then, uh, what we're seeing. Yeah. Acne also. Yes. Okay. Yeah. Um, very intense carb cravings could be a symptom of insulin resistance. So that's something you'd want to pay attention to, but specifically the androgens are mainly going to be, excuse me, the hair loss, um, acne and the hirsutism.
00:38:03
Speaker
Okay. The second pillar, third one cysts present on the ovaries and then other, and then insulin resistance. And insulin resistance is not a criteria, but if you do have signs of insulin resistance, it could be a good indication that you have PCOS and it's worth, you know, going to OB or reproductive endocrinologist to get that tested. But again, not a main criteria. Okay. Okay. Got it. Got it.
00:38:29
Speaker
Okay. And insulin resistance would be discovered, any symptom pictures that you can mention for folks with insulin resistance, or is that more lab value related? Yeah. I mean, there are plenty of people who have all of the symptoms of insulin resistance without it being reflected on their labs because maybe they're trying to take care of themselves and their health and very conscious about their health, but they might still be experiencing it. So that was the case with me in college. I had very intense carb cravings, could gain weight like that.
00:38:59
Speaker
Anytime I did gain weight, it was in my abdomen. I could get very hangry very quickly. So I had to be very careful about making sure I was feeling myself throughout the day. So those would be some of the more common signs of insulin resistance. Of course, labs are going to be the best indicator of what's there, but you know your own body really well. And if you're having those symptoms, it could be that there's some underlying insulin resistance there.
00:39:24
Speaker
Okay. Got it. Got it. And then potentially just a reflection on your own level of stress in your life might just be another reason to go get, go get kind of checked out.
00:39:35
Speaker
All right, Ariella, I know you need to jet, so thank you so, so much. You are a wealth of information. This was very, very helpful, and I think that definitely provided a lot of clarity on options and, you know, curiosities of how to move forward for many people.
00:39:56
Speaker
Um, where can people find you? Yeah.
Conclusion and Call to Action
00:40:01
Speaker
So right now, the best way to find me is on Instagram at PCOS.dietician.arela working on my website. It should be launching very, very shortly, but that is right now the best way to reach out. If you have any questions.
00:40:18
Speaker
Wonderful. All righty. Well, thanks again. And, um, we'll talk to you soon. All right. Awesome. Thanks. Thank you so much for listening today. If you found this information valuable, please share this episode and give it a review. They truly help a ton. If you want additional support and information, you can head over to my website, teresemartinezrd.com.
00:40:43
Speaker
where you can snag my free guide on how to improve your hunger signals, get on my email list for regular juicy content, or apply for the next round of my signature program, restoring nutrition intuition. Otherwise, Instagram at teresmartinasrd or my Facebook group fed fit and fad free nutrition with teres are always places for more content and support. Until next time.