Episode #101: The PCOS Plate: A Closer Look at Nutrition’s Role in Polycystic Ovary Syndrome

Hello, hello. It’s Ashlene again on the PCOS Repair podcast. This week, I’m really excited to review an article called The Pathophysiology and Nutritional Approaches in Polycystic Ovarian Syndrome, PCOS: A Comprehensive Review. This is an interesting study because everything that I work with women is primarily around nutrition, although we include all lifestyle aspects. Before we dive in today, when we think about the four different root causes in my terms, these aren’t necessarily globally used terms, but the insulin effect, inflammation, hormone, and nutritional dysregulation or disturbances, and stress responses. I lump them into these three areas, and they have differing aspects. So not all of those are nutritionally related, although they may sound nutritionally related. They do come down to a couple of core concepts, which this article looks into from a nutrition standpoint. So while we’re not looking at some of the other lifestyle factors such as stress management, sleep, exercise, self-care mindset, and so forth, we’re focusing on the nutrition standpoint. Nutrition can touch all four of those root causes. It touches them all slightly differently. All four of those root causes touch the insulin diabetic component of PCOS. They touch the inflammatory component of PCOS.

Some of them, it’s like, what came first, the chicken or the egg, but they all get into those core functions of PCOS. They also sometimes go beyond that, to where even as we fix those, and we see this in more of a hormone and nutritional dysregulation or disturbance type of PCOS is that we start to see that even as we fix some of those root causes, our body is so used to being out of whack, so to speak. It has a hard time finding that rhythm again. Even as we restore our nutritional balance and make sure we don’t have any deficiencies, and as we make sure that we are balancing those hormones, they don’t always bounce back into action. Definitely, there’s places where this goes further, but since today we’re focusing on a research article, I just want to give this broad picture of where everything lands with the different root causes of PCOS. They are vast, they are unique to each person, there’s many intricacies around them and for this research article, to try and figure out what nutritional approaches are appropriate for PCOS, I just want to set the stage by saying there is still not a one size fits all but I think some of the information found in this article and looked at in this article are very helpful to start continuing the questions that we ask of what is going on with PCOS and how can we take a lifestyle approach to improve our symptoms, improve our health, how we feel, and ultimately, how our body functions. So In that mindset, let’s dive into this research article.

You’re listening to the PCOS Repair podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally with a little medical help sprinkled in. Hi, I’m Ashlene Korcek, and with many years of medical and personal experience with polycystic ovarian syndrome, it is my joy to watch women reverse their PCOS as they learn to nourish their body in a whole new way. With the power of our beliefs, our mindset, and our environment, and the understanding of our genetics, we can heal at the root cause.

The way this research article was conducted, or this research was conducted, was that they looked at previous studies. This wasn’t a specific study that was done. They looked at different studies. They did a Medline search, and They did a database search that was accessible through Pubmed for articles that were published up until the year 2023. You have to put a stop point. We’re doing all the way up until this point. They used different keywords to screen and identify what studies they were going to include in this particular research analysis. They used either polycystic ovary syndrome or diagnosis or polycystic ovary syndrome diet therapy and so forth. I’ll include the link and you can read the full article if you want but there’s a whole list of different key phrases they use to conduct their search and how to include different research studies to look at. Basically, for the pathophysiology, which is a very fancy word for just saying, how does the disease process work in the human body when it comes to PCOS? I love how they defined that PCOS is a multifactorial syndrome in which genetic and environmental factors contribute, and I’m reading right from the research article here, factors contribute to uncontrolled ovarian steroidogenesis, which is basically just me adding in here, that’s the androgen production.

[00:05:15.450] – Speaker 1
So an uncontrolled ovarian androgen production, apparent insulin signaling, so our insulin signaling is impaired, and excessive oxidative stress. An intrinsic defect in the theca cell could partially explain the hyperandrogenemia in PCOS patients, women with PCOS. Indeed, present theca cell, which despite the absence of trophic factors, can secrete high levels of androgens due to intrinsic activation of steroidogenesis. They basically go on with a lot of continually difficult words to get my tongue wrapped around and really complex conversations here but essentially what they’re trying to say is that while there are some factors that seemed and had traditionally been thought of as this theca cell defect was the reason we had excess androgens, but now what we’re seeing is that it has a lot more to do there. There’s a lot more factors at play and they have to do with this cycle of spiraling upward or downward with contributing factors from the environment being things like nutrition, exercise, sleep, stress management, stressors on the body, and so forth. A lot of things in play here where the PCOS body is essentially primed to have sensitivities to its environment. When we present an overload of these less healthy choices, like not exercising or eating too many processed packaged sugar foods, our body doesn’t function well.

Basically, this study looked at what is going on in regards to how does PCOS respond to different diets. The two things that they really looked at, if you read the whole article, it goes into a lot of different interesting things on PCOS insulin resistance and sex hormone binding globulin, as well as the DHEA and FSH and LH and estrogen production. It really goes into all the hormones, but essentially it is just going through and explaining things that we’ve talked about on other episodes of the podcast. Really the takeaway from this particular article, we’re going to jump down to where it’s talking about the dietary models and PCOS. Now, first of all, I don’t think that there is a one size fits all. When they talk about a dietary model, for the purpose of the study, they needed something that was really well defined. Now, when I think about how you approach nutrition, I don’t think we need to define it as this is the only way to eat it, eat for PCOS. I think that we can take the knowledge of what worked in this diet and what worked over here in this diet, and we can weave them in and out, as well as creating a little bit of softness to make it sustainable in a lifestyle. Keep that in mind because I’m not telling you to go out and eat in these two different models, but they were very interesting from a point of view of studying how nutrition affects PCOS. I just wanted to make that clarification.

The two different dietary approaches that this study looked at was keto and the Mediterranean diet. They were looking to see what was the best for the therapeutic option Okay, so let’s start with the Mediterranean diet. The Mediterranean diet is the gold standard dietary model in preventative medicine due to its anti-inflammatory and antioxidant properties, as well as having a nice combination of carbohydrates, fats, and proteins. I think it’s one of the reasons why it has become the gold standard is that nutritionists feel good about getting behind this diet. We’re not leading out any food groups. We’re getting a good array of nutrients as well as healthy fats and proteins and carbs through whole grains as well as vegetables. It doesn’t have to be that you eat Greek food, but the Mediterranean diet is a very well balanced diet. The carbohydrates that we see in the Mediterranean diet tend to be lower in the glycemic index, and they tend to be very high in antioxidants and vitamins.

That’s where we like to see nutrition in general. This is a nice way of categorizing it into a type of diet that people understand and have heard about before. The other thing that we have behind the Mediterranean diet, which makes it a gold standard diet, is that we have data through research articles and research that’s been conducted, it decreases the risk or the prevalence in individuals of heart disease as well as type 2 diabetes, as well as improving non-alcoholic fatty liver disease. These are all things that the Mediterranean diet has going for it. However, However, that doesn’t necessarily mean that we have to eat foods that are flavored in the Mediterranean diet. However, we do want to take the concepts of what exactly is comprising the Mediterranean diet and replicate that throughout our efforts to eat healthy. Now, the interesting thing was that this is contrasted with the ketogenic diet. Now, the ketogenic diet, if you haven’t heard, is a high fat, low carbohydrate diet that puts your body into a state of ketosis. Now, this is not something that is a sustainable Even people that follow a ketogenic lifestyle cycle in and out of being truly in ketosis or following a strict ketogenic diet, and they will carb cycle and so forth because this diet is not sustainable for the body or healthy to sustain.

The thing, though, that was interesting in this one is that following a ketogenic diet had a faster and more aggressive as well as more substantial improvement in improving the insulin effect or insulin resistance and improving insulin sensitivity, which in addition, it had an improvement in the hormonal picture of the FSH-LH ratio. Now, completely aside from this study, and this has not been said. This is my own just observation, is that while this can be really helpful in the short term, leaning into the nutrition piece and really using the nutrition to help restore some of these root cause hormones to balance, The issue comes into play with, are we getting a proper well-rounded nutritional approach? Otherwise, we’re still going to have some hormones that, although they may be closer in balance, aren’t becoming cyclical, and we’re not seeing the fertility piece return, and so we’re not seeing that period repair itself. We’re not seeing women get pregnant necessarily by just doing this piece. Now, some people do. Some people have a harder time, and we have to take to the next step. Just an FYI there that while it sounds really great and we do see some amazing metabolic changes with things when it comes to strict nutrition with the ketogenic diet, it’s not as magic as it sounds right at the beginning, it takes a little more nuancing than just that.

The study also talks on being able to improve our profile even with supplementation. When our nutrients are in question, some things can be improved through taking in certain supplements as well as just making sure that even if we didn’t change a thing in our diet and we ate completely as we do now, if we just carved out some of our daily calories to include certain vegetables, that people actually were seeing a huge improvement in their PCOS health just by bringing in some of the nutrients that were lacking. I think that’s also a very important point is that our American standardized diet, which has become more popular globally and which isn’t a good thing necessarily, but that particular diet is fairly void of nutrition on a daily basis. When you think about what nutrients you are actually consuming, we do tend to have a fairly nutrient-void diet if you’re following the American standard diet. When we think about a hamburger, yes, you got some protein, and protein is amazing. Outside of that, you had a white bun, maybe a small, pathetic, I call them anemic tomatoes because they just don’t look like they have any It’s vibrant.

When the vegetable doesn’t look like it’s vibrant, I just question how much of its nutrients has been leached out through the process of how it’s been stored, prepared, package, shipped. Was it picked too early? Who knows? Then one little tomato on a small piece of wilted lettuce does not even equal a serving of vegetables and so, yes, you got some protein, but you filled up on things that were otherwise void of nutrition. If you had it with fries, technically, there’s some potassium in those fries and the potatoes, but you also ate a ton of inflammatory oils as well as really didn’t get any nutrition from the potatoes. That’s an example of a classic American meal and a very classic example of a fairly void of nutrient meal. If we eat that long term, we’re going to lead to a whole bunch of deficiencies. The takeaway here from this particular research article is really that when the discussion that was used towards the end of the article, and again, I will link the full article in the show notes but the thing that I really liked about this article is that it broke down two different, fairly extreme diets.

I mean, the Mediterranean, it followed exactly, is a very healthy, clean, anti-inheritian inflammatory diet that doesn’t lean in quite as hard to insulin sensitivity repair, but it does address that. People will see that their diabetes improves if they follow a Mediterranean diet for any length of time. Then we have the ketogenic diet, which is a much more extreme diet, also has a lot more quick results on some big, heavy-hitter metabolic hormones but in my experience, there’s definitely some finessing that needs to go about if you choose to take a more drastic approach with the ketogenic diet to see the results that we want in fertility and period repair for women. That’s just a little bit more of a delicate process but the thing that’s really cool is, as we look at these two well-understood, well-researched outside of PCOS ways of eating. Then we start to look at different studies that talk about how they impact the hormones that are involved in PCOS. It’s really interesting to see how heavily this research article points to our nutrition having such a impact and crucial role in managing our PCOS symptoms. I wanted to bring that one to your attention, and I will link it in the show notes below.

Now, I know this is going to bring up a lot of questions on what you should be eating and how we should be eating for our PCOS. Like I I mentioned before, and I will continually say, there is not one way that we need to eat for our PCOS. Ultimately, it comes down to finding the right calorie intake, the right macro ratio, and the right amount of carbohydrates that include really nutrient dense foods for you and your body, and finding to what degree you can also include the other foods that you enjoy eating. Basically, we eat to nourish first, and then we can fit the other things in in the edges. We may have to have a strong longer healing phase where we get our body back on track to where we want to be. Then we have more of the lifestyle phase where we’re in maintenance, so to speak. While this particular research article is looking at two specific ways of eating, it’s doing that for purpose of being able to compare apples to apples in a research study and is not meant to suggest that those are the only ways that you can eat for PCOS.

But I do think it really sheds some light on how important and impactful our nutrition is to being able to manage our PCOS and reverse the symptoms and heal from the root cause. From there, I would love to answer any specific questions you have that come up over on Instagram. You can find me @Nourishedtohealthy. Until next time, bye for now.