Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / PCOS Without Knowing It? What Is PCOS in Women, How It’s Diagnosed and Why 70 Percent Miss It
Transcript
- [00:00:00] Before we dive in, I just wanna say how much I enjoy hearing from you guys every week. Your [00:00:05] dms on Instagram remind me of why I started Whole Plus in the first place to [00:00:10] make health simple, human and personal again. If you're listening right now [00:00:15] and something from this show hits home, please send me a message at Dr. [00:00:20] Taaz md. Your stories inspire what we talk about next, who we bring on, [00:00:25] and what we wanna dive into. Alright, let's get started with today's episode. In this [00:00:30] next episode we are about to talk about a syndrome that is impacting millions of [00:00:35] women worldwide but is still misdiagnosed in the exam [00:00:40] room every single day We're actually gonna spend the next few minutes talking about [00:00:45] PCOS or polycystic ovarian syndrome now I have a very deep personal [00:00:50] connection to this particular diagnosis It is actually the diagnosis that led [00:00:55] me to this entire field of holistic integrative and functional medicine back in my twenties [00:01:00] I was actually getting sicker and sicker as the years went by and experiencing all [00:01:05] kinds of strange symptoms Everything from acne to hair loss weird [00:01:10] weight gain and ultimately just Achy not being able [00:01:15] to think clearly and honestly just a shadow version of who I originally [00:01:20] was It took a lot of coaxing for me to get into the doctor's office but when I finally [00:01:25] did no one Could diagnose me now That was over 25 years [00:01:30] ago And as we sit today in our clinics at Whole Plus unfortunately it's the story [00:01:35] that many of you tell us as well the story of having symptoms that no one [00:01:40] can put together Being told that you don't have PCOS because you [00:01:45] don't have cyst on your ovaries and nothing Could be further from the truth I could [00:01:50] probably spend the entire episode telling you patient stories and how they were told [00:01:55] they would never get pregnant that there was nothing wrong with them that they were simply anxious or [00:02:00] depressed and they needed to take a particular medication And at the end of that story They [00:02:05] left our clinics with a diagnosis of PCOS So needless to say this is a really [00:02:10] important topic and one that I feel strongly we all need to understand and [00:02:15] start to peel the layers back a little bit more easily Now when we look at the [00:02:20] hard stats right when we just go to the literature and we look at What is the rate of PCOS? [00:02:25] At first it's like why is she making such a big deal about this? One in 10 [00:02:30] women are diagnosed with PCOS but here's the here's the trick [00:02:35] Almost 70% of women go undiagnosed When it comes to [00:02:40] PCOS so while one in 10 maybe get the official diagnosis we have a huge [00:02:45] population millions of women across the world who walk around not [00:02:50] knowing that this is actually what's happening with their bodies the misdiagnosis of [00:02:55] PCOS is rooted in a number of different issues First of all PCOS was [00:03:00] originally thought of as a purely GYN issue An issue [00:03:05] that comes up if you're trying to get pregnant but is not related to anything else [00:03:10] And this is a problem we have in medicine in general right where we don't understand that everything is [00:03:15] interconnected and a hormone doesn't live in isolation but actually [00:03:20] interacts with other hormones Now traditionally the diagnosis of PCOS [00:03:25] was established by something called the Rotterdam criteria The Rotterdam criteria was [00:03:30] established by different physician groups and essentially said you had to have two of three [00:03:35] particular characteristics to have a diagnosis of PCOS One of [00:03:40] them was that you had cyst on your ovaries Kind of a no brainer The second one was that [00:03:45] you had an overproduction of something called androgens Now androgens are those hormones [00:03:50] like DHT free testosterone D-H-E-A-S These are the [00:03:55] hormones that we traditionally associate with something like PCOS And then the [00:04:00] third was that you were having an issue getting your periods or anovulation where you were skipping [00:04:05] periods or not getting a period And if you had two of those three then yes you got the check [00:04:10] mark for you got PCOS Unfortunately the Rotterdam [00:04:15] criteria have fallen short and researchers and clinicians today [00:04:20] both are actually in agreement that we need to find a better way For [00:04:25] example in this particular study this is from 2024 so recent right? [00:04:30] Evidence-based common standardized guidelines for PCOS diagnosis and treatment are [00:04:35] urgently needed There is a problem understanding how [00:04:40] women's health is getting impacted by this disease and that's in a study as [00:04:45] recent as just a few months ago So we have a lot to learn when it comes to PCOS [00:04:50] and we have a lot to dig into and we need to start widening our ability to [00:04:55] diagnose this disease And that's what we're gonna talk about a little bit here today and hopefully it's gonna be helpful for [00:05:00] you or for somebody that you love When we think about PCOS what [00:05:05] most of the research and I'll quote some of it for you shortly but what most of the research [00:05:10] seems to be pointing to is that PCOS is actually an [00:05:15] autoimmune disease and not just an autoimmune disease It's a disease of your [00:05:20] metabolic health Your metabolic health is closely tied to what is [00:05:25] happening with PCOS and the roots of it Go all the way back to your [00:05:30] prenatal environment I want you guys to think about that for a second This is not [00:05:35] your fault In fact today even getting ready for this shoot the woman doing my [00:05:40] hair said wait what are you talking about You're talking about PCOS What do we do about it? [00:05:45] I have PCOS I feel like I can't go anywhere without having a conversation [00:05:50] about this disorder because so there's just so much confusion around it But PCOS at [00:05:55] the end of the day needs to be rethought and rediagnosed In a much [00:06:00] different framework Let's look at what the research is starting to say And I feel bad for so many of [00:06:05] you out there struggling to get answers because this is such new research And what happens with research [00:06:10] is it often doesn't translate into the exam room for another decade or even [00:06:15] sometimes for another 20 years Here's another article And I'm again I'm just gonna read it [00:06:20] and I I know that's probably boring but I'm just gonna read it out loud to you so that you understand what the research is saying So [00:06:25] this is from the Journal of Assisted Re Reproduction and Genetics And [00:06:30] essentially it's saying hyperandrogenism remember that's the overproduction of those hormones that I was [00:06:35] talking about which was an which was a part of the initial Rotterdam criteria [00:06:40] hyperandrogenism Hyperandrogenism Causes insulin resistance and [00:06:45] hyperglycemia high blood sugar And then that in turn leads to and I'm gonna use a lot of [00:06:50] big words but these are the things we dig into and practice day in and day out It [00:06:55] leads to oxidative stress which is the ability of your cells to [00:07:00] withstand the environment other things that they're getting exposed to But [00:07:05] hyperandrogenism leads to more oxidative stress It leads to Belly fat and [00:07:10] abdominal adiposity and it leads to and here's the big word [00:07:15] inflammation And over time those particular very functional medicine [00:07:20] ideas right of inflammation oxidative stress uh belly fat all of these [00:07:25] things Lead to disease So there's a link for example between PCOS [00:07:30] and many different diseases including mental health disorders cardiovascular [00:07:35] disorders autoimmune disease having additional autoimmune disease and of course cancer[00:07:40] It's all connected It's all linked up together So when we look at the research and when we [00:07:45] look in the exam room and when we look at traditionally what's been happening we know [00:07:50] that there has to be a new way to diagnose and understand [00:07:55] PCOS and simply using the Rotterdam criteria is not enough and being [00:08:00] told that you don't have cyst on your ovaries therefore you don't have PCOS [00:08:05] is not the answer Moving forward Let's dig a little bit now into [00:08:10] what we do need to do to get a better understanding of PCOS When we look [00:08:15] critically at PCOS statistics and we understand that it is very underdiagnosed and that [00:08:20] so many women today are walking around with PCOS and are unaware of it even though the [00:08:25] stats have risen and they say one in 10 women today maybe one in 20 have a [00:08:30] true in the exam room diagnosis of PCOS we need to understand a little [00:08:35] bit better about why the rates of PCOS Are increasing I get asked [00:08:40] this all the time What's happening? Why are we seeing so much PCOS? Is it simply [00:08:45] because we're more aware of it? And the answer is no Here is what's happening in [00:08:50] the exam room and also in research what we're actually seeing day in and day out [00:08:55] PCOS is increasing for a number of reasons When I turn to the research [00:09:00] it's fascinating It's talking about the prenatal environment and how the [00:09:05] prenatal environment If for example your mom had high androgens or high [00:09:10] insulin you're predisposed to PCOS when you hit puberty But [00:09:15] here's the even more interesting piece of the puzzle Prescription medication [00:09:20] usage is tied to the development of PCOS They're finding that [00:09:25] antidepressants anti-anxiety medications anti-seizure [00:09:30] medications are all linked to the development of PCOS because they are changing [00:09:35] the prenatal environment that maybe you or your child or your loved one was [00:09:40] exposed to right from concept Yeah this is mind [00:09:45] blowing to me right? Because for so long it's like oh we're stressed or we're eating bad food or [00:09:50] you know we're doing all these other behaviors and that's why we have PCOS But it's [00:09:55] winding all the way back to what is happening in your mother's [00:10:00] environment And that's just the start As those androgens [00:10:05] continue to build and you're exposed to androgens not just prenatally but now as you [00:10:10] go through life and you get them from processed food from the environment [00:10:15] again we've got studies talking about how BPA endocrine disruptors [00:10:20] phthalates increase the amount of androgens circulating in the bloodstream[00:10:25] We now need to think about this idea of the cumulative load right? I've talked about it in [00:10:30] reference to other conditions and Other diseases I talk to patients about it all the time [00:10:35] and I think one of the biggest challenges we're having in medicine and that's why this holistic approach I think is so [00:10:40] important is that oftentimes it's not a singular hit that is causing a singular [00:10:45] problem It is a cumulative load that eventually is leading people down a [00:10:50] particular path And same is true for PCOS So we've talked about the prenatal [00:10:55] environment we've talked about toxins exposed prenatally androgens exposed prenatally [00:11:00] high cortisol If your mom was stressed or if that stress continued [00:11:05] through your childhood home and as you entered puberty you're more predisposed [00:11:10] to PCOS We've talked about medication usage and one of the things we know for sure [00:11:15] is that the prescription medication usage amongst all of us has gone up over the last [00:11:20] 50 years Young children today are put on many antibiotics right? They're put on asthma [00:11:25] medications They're put on A DD and A DHD medications All of these are [00:11:30] changing the microbiology and the environment of the cell and in turn [00:11:35] making the body more androgenic We miss out on the opportunity to [00:11:40] catch this because We don't check these things in childhood right? We might check some of these [00:11:45] numbers in a woman trying to get pregnant and we can start to understand if someone's got a very [00:11:50] high A MH for example or the high DHT or the high free testosterone [00:11:55] Sure they're predisposed to PCOS but we're not checking it in children before they hit [00:12:00] puberty so that we can prep them to maybe avoid A-P-C-O-S [00:12:05] journey Then we enter puberty and into puberty we go and there are all kinds of challenges [00:12:10] once we hit puberty But what we are seeing now finally in puberty is the [00:12:15] overexpression of these androgens And they look different They look like severe acne [00:12:20] They can look like body hair in places where we don't expect it They can look like hair [00:12:25] loss but here are some of the other manifestations that we are missing even [00:12:30] in our teens PCOS is associated with mood disorders We have [00:12:35] studies again that show how the androgens and the cortisol in turn work [00:12:40] together to trigger things like depression bipolar disease and severe [00:12:45] anxiety We even know that it's connected to a DD and A DHD And if [00:12:50] you have a child with a DD or A DHD I challenge you to observe [00:12:55] them watch them see if their focus is different Especially in your girls it's a little bit more easy to [00:13:00] catch if their focus is different at different points in their cycle And I [00:13:05] bet your answer's gonna be yes I see that right here in our own home that again the two weeks [00:13:10] where estrogen is higher and those androgens can't be over expressed We [00:13:15] see better focus But the second two weeks especially as the cycle approaches [00:13:20] and those androgens are allowed to over express focus and concentration [00:13:25] weakens So again there are all these different manifestations of PCOS and [00:13:30] there are all these different reasons why PCOS has become the epidemic [00:13:35] that it is today We have to acknowledge that the environment has changed [00:13:40] toxins and your toxic load has increased the prenatal environment has [00:13:45] changed and then for our teens and for our young women in their twenties [00:13:50] Talk about stress and cortisol It's at a completely different level than it was even [00:13:55] 50 years ago We now have the added stress of connectivity and blue light [00:14:00] that actually triggers an inflammatory load in the body And when we take that [00:14:05] inflammatory load and we combine it with all the hormones and all the environmental toxins and [00:14:10] all the epigenetic changes that's why PCOS is an [00:14:15] epidemic today And unfortunately our medical models have not caught [00:14:20] up to what's actually happening to the chemistry in our bodies So [00:14:25] PCOS is rising It is an epidemic and it is something that we need to think [00:14:30] differently about And sticking to old fashioned criteria like the Rotterdam criteria [00:14:35] is no longer gonna be sufficient What we are going to have to do instead is [00:14:40] screen for PCOS from early childhood through the history of our hormonal [00:14:45] life because it actually presents in different ways at different stages So what does that mean [00:14:50] tactically? Let's break that down for just a second So let's hopefully you're taking notes and hopefully you're saying [00:14:55] okay I agree with you but now what do I do? Right? We need to make this tactical Here's what we [00:15:00] need to be thinking about If we're gonna change this conversation around PCOS and we're gonna [00:15:05] succeed in diagnosing PCOS earlier and being able to be maybe more [00:15:10] proactive around it and preventing stories like mine or so many of my patients [00:15:15] then we really need a holistic approach and a holistic diagnostic approach We can [00:15:20] also use the word a functional approach or an integrative approach Bottom line we need a new approach [00:15:25] So what I would like to see happen is a couple of things no matter where you [00:15:30] are in your time span right? Whether you're a mom taking care of a child whether you're a young [00:15:35] woman really trying to get pregnant or you're just not feeling right or whether you're in your thirties and [00:15:40] forties and you're noticing hormone changes associated with PCOS or even if [00:15:45] you're in menopause because there is a version of PCOS for each of these stages [00:15:50] Let's first review the symptoms to make sure you know what to dial into [00:15:55] Typically the most common loud you know speaker friendly symptoms are gonna be the [00:16:00] acne right the cystic acne that's typically on the jawline and usually on the neck [00:16:05] and often on the back High androgen symptom you can't miss it That one's super [00:16:10] obvious Symptom number two is the hair loss That's the one that got me and it's called [00:16:15] androgenetic alopecia And in that particular symptom you're losing hair but the way you [00:16:20] lose hair is very unique and that's where you can diagnose it differently from other forms of hair [00:16:25] loss When it's PCOS androgenetic hair loss here's what's actually [00:16:30] happening The hair is getting thinner and more brittle It's not coming straight out [00:16:35] It actually gets thinner and more brittle and it's almost like crunchy You can hear like paper sort of crunching in [00:16:40] your fingers when you go to rub it and that is because the hair follicle is narrowing [00:16:45] because of the androgen exposure And over time that hair then falls out [00:16:50] So hair loss is a symptom but that particular type of hair loss where the [00:16:55] diameter of the hair thins it falls over time It's almost not noticeable [00:17:00] until next thing you know you have this wide gap or part that you've never had before and that's exactly [00:17:05] what happened to me when I was dealing with PCOS in my twenties All right Those are two very obvious symptoms The [00:17:10] third is you're skipping periods or you're not getting a period Another I would still put in [00:17:15] maybe the more obvious bucket of PCOS but let's talk about some of the other ones Gaining [00:17:20] weight excessively especially around the abdomen belly fat is often [00:17:25] a sign of PCOS and here's why especially if you're having some of the hormone issues that go with [00:17:30] it Because with PCOS there is this issue As the androgens go up the insulin goes up [00:17:35] and we store fat and we typically will first see that fat storage right [00:17:40] around the belly Maybe around the arms maybe around the back Those are classic hallmark [00:17:45] places where PCOS fast storage occurs So that's another way you can tell [00:17:50] Here's another symptom that we just talked about but it's the rise and fall of your mood and [00:17:55] emotions if you are having extremes of depression or anxiety [00:18:00] especially as your cycle approaches it's another sort of whisper a soft [00:18:05] sign that you may have PCOS And I'm gonna give you one more skin sign and here's what [00:18:10] that one is If you've got this velvety texture to the back of your skin that's called [00:18:15] acanthosis Nigra cans Fancy word I know I'm sorry but that's actually a sign [00:18:20] that you might be insulin resistant And in turn if it's coupled with hormone [00:18:25] imbalances you may have PCOS So that's a way to dial into your body and get a [00:18:30] sense of what's going on Now when we flip the switch a little bit and we talk about looking [00:18:35] at it from the vantage point of other systems of medicine right? If we're really gonna take this holistic [00:18:40] approach in Chinese medicine here's what they would actually say about PCOS They didn't [00:18:45] diagnose it as PCOS right? But here's what They did do They would talk about it as [00:18:50] liver qi stagnation meaning your liver for whatever reason is [00:18:55] not able to do the work your hormones needed to do So here's what you would see You would [00:19:00] see the dark circles right under the eye If You stuck your tongue out and looked at it in the mirror [00:19:05] you would see that darkening kind of that Purple purplish sort of reflection of the tongue [00:19:10] That's liver cheese stagnation The other pattern of PCOS was actually a gut [00:19:15] pattern believe it or not They had already connected the fact that the gut and the [00:19:20] hormones are interconnected and if we ignore that connection then in turn we're gonna have [00:19:25] issues with overall balance in the body So the way you tell that this [00:19:30] time if your face was red or ruddy or you were getting a lot of rashes or you were itching a [00:19:35] lot and then your tongue had a coating whether it was a white coating or a yellow coating [00:19:40] you again should be thinking about something like PCOS So again these are [00:19:45] self-diagnostic tools that you can use I would almost you know take a second to check in with [00:19:50] your body look at your face What's happening with your face? Do you have circles under the eyes? Do you [00:19:55] have a coating to your tongue or is your tongue kind of that purplish color that we were just talking [00:20:00] about? Do you have a lot of cystic acne or is there acne on the neck? Do you have hair loss or something that we [00:20:05] need to be thinking about there? Do you have other rashes on your skin or your back your [00:20:10] legs your arms? All of these are a way to check in with your body Before you [00:20:15] even hit an exam room and start to understand that there is a connection between what your [00:20:20] hormones are doing and those androgens and maybe or maybe not your [00:20:25] ability or your risk I should say for having PCOS So that's a quick diagnostic [00:20:30] Tests that you can do Now what we do in the exam room is a little bit different If we [00:20:35] are suspicious of a patient having PCOS then there are a number of things that we actually [00:20:40] wanna look at Once we've passed a physical exam Here's where we really start to [00:20:45] test and I hope you guys have you know this is a resource that you can use and even take into the [00:20:50] exam room with you but you should be testing and I've mentioned it a few times in this particular episode we [00:20:55] should be testing A DHT an AMH A free testosterone [00:21:00] a total testosterone A DHEAS and even a 17 [00:21:05] hydroxy pregnenolone Why? These are all androgens And again in pulling the [00:21:10] literature they talk over and over again about how a high a MH is [00:21:15] connected to having PCOS So when we look at all the androgens [00:21:20] together that's how we make the decision Simply looking at a total testosterone And many of you have [00:21:25] said this back to us in the exam rooms that well you know my testosterone is fine so I can't have [00:21:30] PCOS That is not enough We have to look deeper and that's just the [00:21:35] androgen part of the conversation Remember PCOS is a metabolic [00:21:40] autoimmune disease so we have to check the metabolic markers too And what I'm talking about [00:21:45] here are things like a fasting insulin your triglycerides your lipids [00:21:50] even your blood pressure matters in this scenario because PCOS is impacted [00:21:55] by your metabolic state and your metabolic state is impacting PCOS[00:22:00] In a particular study looking at PCOS they talked about something called advanced [00:22:05] glycation end products Alright big words again What am I talking about? I'm [00:22:10] talking about foods behaviors Toxins [00:22:15] emotions that at the end of the day increase these molecules that [00:22:20] are basically high sugar or high glucose molecules and That's right Everything I just [00:22:25] mentioned can cause that So when we're thinking about PCOS looking at the metabolic markers as [00:22:30] just as important as looking as the at the hormonal markers they're [00:22:35] intertwined Now there's one more set of markers that we like to look at before we put the whole puzzle [00:22:40] together and that's looking at inflammation markers So if you have a high [00:22:45] CRPA high SED rate a high TGF alpha a high interleukin six [00:22:50] these are all inflammatory markers that clue us into the fact that you are [00:22:55] dealing with something like PCOS because it's not just a hormone but it's the hormone [00:23:00] symphony that ultimately impacts you at the end of the day So the holistic [00:23:05] approach the functional approach to diagnosing PCOS involves looking at all the [00:23:10] hormones looking at all the androgens in their derivatives looking at inflammation markers and [00:23:15] understanding what those markers are and then also looking deeply at all the [00:23:20] different metabolic markers and putting that puzzle piece together Because what was missing [00:23:25] in those Rotterdam criteria is the fact that PCOS is a [00:23:30] metabolic disease is an inflammatory disease and is a disease of oxidative stress [00:23:35] influenced by the environment toxins prenatal environment and so [00:23:40] much more As we dive deeply into PCOS and how to think about it and how do we reposition [00:23:45] it in the exam room so so many women don't walk around undiagnosed There's one [00:23:50] caveat that we're also not talking about today but the research is evolving and we are seeing [00:23:55] it partly in the exam room as well One of the things that we understand about [00:24:00] PCOS is that there's actually a different presentation of PCOS depending [00:24:05] on your race I'm gonna say that again Your race matters when it comes to what [00:24:10] PCOS will look like Caucasians have a different presentation of [00:24:15] PCOS than South Asians South Asians have a different presentation of PCOS than [00:24:20] traditional Asians And they have a different presentation of PCOS when compared to Hispanics [00:24:25] or when compared to blacks And each of them have to be evaluated [00:24:30] a little bit differently and honestly treated differently as well Let me tell you what I mean Here In the [00:24:35] Caucasian population we actually do see what the Rotterdam criteria initially talked about [00:24:40] skipping of cycles more cyst on the ovaries higher androgen levels [00:24:45] However when it comes to the Southeast Asian population Those [00:24:50] criteria often don't apply and instead many of those folks are actually dealing with more of the [00:24:55] acne or the hair loss component of it So checking their androgens becomes critical [00:25:00] to understanding what's happening in their version of PCOS When we talk [00:25:05] about Hispanics and blacks we see a huge preponderance of the metabolic [00:25:10] component of it In fact blacks have actually higher triglyceride levels when it comes to [00:25:15] their version of PCOS than maybe a Hispanic Caucasian or southeast Asian patient [00:25:20] Blacks also have a higher level of blood pressure They have more hypertension when it comes to [00:25:25] PCOS and They have more issues with weight Whereas a Hispanic patient [00:25:30] instead may have more problems with something called hirsutism which is where you have a lot of body hair or facial [00:25:35] hair or hair in places where you really don't want it So there is a racial [00:25:40] component to PCOS when it comes to presentation and that's another reason why [00:25:45] globally PCOS is often missed because the initial research was done mainly on a [00:25:50] Caucasian population not really paying attention to many of these other races [00:25:55] In fact when we look at India for example in people of Indian descent which of course I am as well [00:26:00] there is some talk that the incidence of PCOS among Indian women may be [00:26:05] closer to 70% So if you're Indian and you're watching this particular [00:26:10] episode it's not if you have PCOS it's more like you probably do have [00:26:15] PCOS and how do we treat it and how do we try to understand it? So again there is [00:26:20] a racial undertone when it comes to PCOS and this is something that we do need to [00:26:25] dive more deeply into as we move forward Now as we've talked about PCOS and [00:26:30] talked about the diagnosis conventional diagnosis the holistic diagnosis now we understand the [00:26:35] racial component to this as well We need to understand that it's looking different when it walks [00:26:40] into the exam room So some people may be walking in with new onset [00:26:45] weight gain They can't explain that weight gain They've got belly fat They've got maybe [00:26:50] more more heaviness in general than they've ever experienced before and that's why PCOS [00:26:55] is not just a disorder of women trying to get pregnant Again there's the childhood [00:27:00] version If a child has high androgens and high insulin you are gonna see the distribution of [00:27:05] fat exactly the way we've been describing it For somebody with high insulin Fat around the [00:27:10] belly fat around the chest fat in the back fat in the arms If a teen has this [00:27:15] issue with metabolic syndrome right maybe you're seeing somebody who is African [00:27:20] American or a Hispanic teen is having issues with weight gain We need to be thinking about [00:27:25] PCOS because again that midsection weight gain is tied to this [00:27:30] hormonal imbalance Now what often happens people will sail through childhood and maybe [00:27:35] through their teen years just fine and they'll even get through their twenties okay And not [00:27:40] realize that they're having an issue with PCOS until they try to get pregnant and then they go on an [00:27:45] infertility journey that can be devastating and heart wrenching Whereas at the end of the day this was a metabolic [00:27:50] issue and it's really about the insulin and the blood sugar And if they could correct that [00:27:55] and those n glycation products then in turn they would improve their hormone profile [00:28:00] But sometimes people sail through that too and they hit [00:28:05] perimenopause and menopause but they actually have PCOS so they have A-P-C-O-S version of [00:28:10] this Let me explain When you hit perimenopause and menopause and [00:28:15] estrogen levels decline guess what happens if you have undiagnosed PCOS? [00:28:20] Your androgens are allowed to overexpress themselves and [00:28:25] remember high androgens high insulin It means two things For a woman [00:28:30] in perimenopause and menopause it means that now suddenly they're going through a second puberty They're like [00:28:35] what just happened? They're getting acne They're experiencing hair loss [00:28:40] Many women as they go further into menopause will get that classic male pattern [00:28:45] baldness because they're having overexpression of androgens From undiagnosed [00:28:50] PCOS They also are gaining weight much more rapidly than their [00:28:55] counterparts If you take A-P-C-O-S woman and a non PCOS woman and put [00:29:00] them both through perimenopause and menopause those with PCOS are going [00:29:05] to struggle with weight gain and belly fat much more dramatically than those that [00:29:10] don't have Because again remember those androgens are going up because [00:29:15] estrogen is going down insulin is being overexpressed or we're having an issue with [00:29:20] hyperinsulinemia and that in turn makes weight loss so so [00:29:25] difficult And women in turn starve overexercise do everything they can do [00:29:30] but don't seem to see a difference So understanding the [00:29:35] racial undertones and how that's presenting in each of these cases of PCOS is so [00:29:40] important and how the metabolic the hormonal and the inflammatory part work [00:29:45] together is critical in putting the whole puzzle together for any particular patient so [00:29:50] that they are not just having success hormonally but they're having success with their overall [00:29:55] health So now that we understand that PCOS is a truly autoimmune [00:30:00] Metabolic syndrome not a hormone disorder We can actually build a holistic [00:30:05] plan and here's what's exciting and encouraging that we can actually do something about all of [00:30:10] this And here's where we really need to start Once we've done the right testing and the [00:30:15] lab work and we can really nail the pattern then we can build a protocol around it [00:30:20] And the fundamentals of that protocol While they are nuanced for every particular patient because [00:30:25] personalization does matter there are some general principles that work and I'm so [00:30:30] excited to share some of those with you In all forms of PCOS whether we are [00:30:35] dealing just with the androgens with the inflammation or with the metabolic component we have to [00:30:40] start with the gut the gut is ground zero of health And managing that [00:30:45] microbiome and helping those gut bacteria metabolize hormones reduce [00:30:50] inflammation and even help regulate blood sugar is a win that allows the [00:30:55] rest of your health to come back together So when we're talking about the gut with PCOS there's [00:31:00] some basic rules that you guys have heard before but I'm gonna reiterate 'em because they're so [00:31:05] important when it comes to this disorder An anti-inflammatory diet right? Bringing [00:31:10] in lots of plant-based foods Clean foods and when you have a choice [00:31:15] choosing real food over processed food wins every single time We've talked [00:31:20] about that toxic load and how it helps accumulate and drive the body [00:31:25] towards this sort of high insulin high androgen state So the gut is the first place to start [00:31:30] If you don't know where to start that's where we begin And changing your diet helps and [00:31:35] changes the microbiome but also supporting the gut helps too And this is where doing things like [00:31:40] taking digestive enzymes that help you metabolize your fats better adding in a [00:31:45] probiotic that's broad spectrum and has things like lactobacillus bifidobacteria bacillus [00:31:50] bacteria in it can help support the hormones In addition to that [00:31:55] helping rebuild the integrity of that gut lining I love using glutamine Some [00:32:00] people like collagen but these are things that make a difference when it comes to PCOS [00:32:05] And sometimes over time if you just work on the gut the [00:32:10] body starts to repair itself and the hormone profile starts to get better as well [00:32:15] I can share my own story with this right? A part of my journey was not [00:32:20] knowing that I had a gluten issue and the minute I took gluten outta my diet it's almost like [00:32:25] everything kind of fell into place Why? Because the integrity of my gut lining was right where it [00:32:30] needed to be the bacteria got rebalanced and my hormones started to behave [00:32:35] and that's one way of bringing those androgens down If we move on from the [00:32:40] gut the next place to go when we think about a holistic approach to PCOS is looking at the liver [00:32:45] The liver is ground zero for your health and you want to make sure you're supporting the [00:32:50] liver cleaning the liver just like you would clean a room in your house the [00:32:55] way to do that is increasing your consumption of leafy greens herbs [00:33:00] like parsley and cilantro and oregano which help liver to detox very naturally [00:33:05] And in addition to that Adding things like dandelion tea or taking something called [00:33:10] milk thistle which helps the liver to flush clean rinse and repeat and do what [00:33:15] it needs to do We also know that the liver benefits when we reduce its chemical [00:33:20] exposure So again back to the food we eat but even thinking about substances [00:33:25] like alcohol medications or even excessive supplementation [00:33:30] all of these are hard on the liver and make it difficult for the liver to do its [00:33:35] job to move bad hormones out and really regulate blood sugar the [00:33:40] way it needs to be The gut and liver are ground zero and that's why those Chinese [00:33:45] medicine and Ayurvedic medicine concepts of liver cheese stagnation or excessive yang [00:33:50] or too much PDA apply to something like PCOS Now moving on from the [00:33:55] gut and liver where would we go next? Well once we're sure we've tackled that then [00:34:00] we have to decide This is where the road may diverge a little bit So if you have high [00:34:05] androgens our first response is to put you on an androgen blocker There are some [00:34:10] natural androgen blockers that work beautifully Saw Palmetto for example is one of my favorites [00:34:15] Anatol is another one that works beautifully to help bring that androgen load down [00:34:20] Or you may be someone who the metabolic component is the strongest and biggest [00:34:25] component And in that case thinking through things like berberine which regulates blood [00:34:30] sugar adding in a good probiotic that also helps both the gut and the blood [00:34:35] sugar component of it And here I'm talking about something called akkermansia which we found is connected [00:34:40] to how the body uses blood sugar That's another way of helping and really [00:34:45] beginning a holistic approach to PCOS And then finally if you have an [00:34:50] inflammatory piece that really needs to be managed then we love bringing in high dose [00:34:55] Omega-3 curcumin boswellia These are things that we have seen work in practice[00:35:00] But sometimes you need a medication and medications aren't bad But what we don't wanna do is [00:35:05] the bandaid approach that you've got PCOS here's your birth control and your spironolactone and boom you're done [00:35:10] What we wanna do instead is kind of build this plan so the body isn't necessarily always [00:35:15] dependent on this particular prescription medication So this is where we've prescribed [00:35:20] as well spironolactone in very low doses and we're able to get away with low [00:35:25] doses because we've done all this other work So you may only need 12 and a half to 25 [00:35:30] maybe 50 milligrams of spironolactone in this particular scenario If you [00:35:35] have high androgens we've done oral minoxidil to help with the hair loss and it makes a [00:35:40] difference And then we've also done the medications like Metformin and even I'm [00:35:45] gonna say it even GLP one medications because they in turn help to [00:35:50] regulate the blood sugar and the hyperinsulinemia that's associated with PCOS [00:35:55] And all of this is then in turn influencing [00:36:00] weight gain adiposity hormone balance fertility [00:36:05] mood and so much more So again when you take this holistic approach [00:36:10] you're not band-aiding a myriad of different symptoms right? When I went on my journey I was [00:36:15] handed an anxiety medication at one point a depression medication at another point a birth control [00:36:20] pill I was given spironolactone That's actually the medication which I had a very bad reaction to [00:36:25] but it was a lot about just band-aiding every symptom We wanna flip the switch really [00:36:30] when we think about how to care for our bodies and think about stacking and building it sequentially [00:36:35] starting with the gut moving to the liver moving to nutrients that optimize all the different [00:36:40] hormones and all the different cells of our body providing it with QE and energy that we [00:36:45] need to actually reproduce and to maintain our hormonal cycle And then from there [00:36:50] moving into understanding that we have to regulate blood sugar And there are so many different ways to [00:36:55] regulate it There are some natural remedies that work but if it's not working [00:37:00] then we move on and that's the point of whole plus is that we have to move on some time and move [00:37:05] into medications that work but we can microdose medications and we can use less [00:37:10] of them for less period of time when we've done this work So that's the holistic approach [00:37:15] Now I've left one really critical piece out of this entire equation [00:37:20] and I did so on purpose because one other thing that we have to talk about that I've alluded [00:37:25] to as we've talked about PCOS is the impact of cortisol and stress Right [00:37:30] Cortisol is the stress hormone and as cortisol ramps up right? Should I be [00:37:35] surprised that mine expressed itself after you know years of med school and residency and night [00:37:40] shifts and all that stuff? Probably not But as cortisol ramps up and we [00:37:45] go into high cortisol states We overproduce androgens and we overproduce insulin [00:37:50] and the body goes into this metabolic mode of PCOS So managing [00:37:55] cortisol is really important too and there are a number of different ways to do that And I have so many [00:38:00] episodes and videos where we talk about that But in the context of PCOS [00:38:05] I wanna remind you all to have a plan to bring your cortisol down [00:38:10] because that hum of cortisol that's coming from the pituitary and the hypothalamus is [00:38:15] influencing your hormones So whether you do acupuncture Or yoga or [00:38:20] massage or you meditate or you go on a retreat or you sleep whatever it is you [00:38:25] have to have a consistent plan to start to calm those cortisol levels down [00:38:30] And if you find yourself in a position like I was in my twenties where I didn't really have control [00:38:35] right? I had to do night shifts you know I had to do residency These were not optional [00:38:40] Then you have to have a recovery plan that really works hard on bringing the cortisol [00:38:45] way down And in that way you are protecting your hormones but [00:38:50] ultimately you're protecting your long-term health because every time these symptoms go [00:38:55] unchecked it's more inflammation It's more metabolic disease it's more [00:39:00] hormone disruption And even though you may check off the goal Hey I got pregnant Hey I [00:39:05] lost weight Hey my mental health issues are stable It's not over [00:39:10] until these things are balanced So a holistic approach to PCOS serves you well through your [00:39:15] decades and through your lifespan And avoiding doing this work only leads only leads [00:39:20] to more heartache more medications more disease burden and [00:39:25] ultimately a you That's simply not you I hope this episode gave you something valuable [00:39:30] to think about or to even try this week. If it did, please leave a short review on your [00:39:35] podcast app. It really helps us grow the whole plus community and reach more people [00:39:40] who need to hear this message. You can also connect with me directly on Instagram at Dr. [00:39:45] TAs md. Send me a DM and tell me what you'd love to hear about next.