Episode #116: The Pyramid of PCOS: Breaking Down the Root Causes for Better Health

Perhaps you’ve had some of these similar questions that I have been getting asked over and over in the last couple of weeks. I seem to have all of the PCOS root causes. How do I know which one I really have? Or, I’m thin, therefore I must have thin type PCOS. Is that a thing? Or, I was told by my doctor that I don’t have any insulin problems, but on the quiz, I got insulin effect PCOS. I don’t know what’s going on. Or some variation of these questions. But in the month of September, over the next few weeks, we’re going to dive into the PCOS root causes, what they are, how they work together, and try to answer as many of these questions that I’ve been getting to help you really understand what is going on with your PCOS. Without further ado, let’s dive in.

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.

Welcome back to the PCOS Repair podcast, where I want to start by just introducing the four PCOS root causes. I’m going to start by clarifying that these are my definitions of these root causes. I talk about them very differently than other individuals that help women with their PCOS. I definitely talk about them different than your doctors will tell them. The reason is because I’m really talking about them from a lifestyle perspective. There is a ton of science that we will go over in the next couple of weeks as we go through each of the root causes. But in today’s episode, I want to give an overview of the root causes and also introduce the fact that this is not how other people talk about them. This is my podcast, this is the way I work with clients, and the verbiage we use is more to help us understand what is going on than to try to match some scientific journal that was written for one purpose in medical literature. While I use all the research from medicine and the practical applications from years of working with women and from having a body myself that has PCOS and having dealt with many of the different root causes myself, as well as all the women that I’ve worked with, the verbiage is really just a matter of having a conversation.

Don’t get tripped up why everyone’s actually going to talk about it differently. When you’re on social media or you’re on Google or you’re trying to talk to your doctor, don’t get hung up on the terminology because everyone’s going to use certain terms a little different. I’ll explain what I mean as we go along today.

Okay, so first of all, I want you to think about a hormone pyramid. The tip of the iceberg, so that tip of the pyramid, is where all of our symptoms of PCOS reside. So hair problems, facial hair, male pattern, balding, irregular periods, not ovulating, infertility, weight gain, mood swings, irritability, anxieties, depression, fatigue, the list goes on and on but all of those symptoms that make up the picture that then gets you labeled with the diagnosis of PCOS. That is at the very, very top of the pyramid. We could basically sum that up into hormone dysregulation. That’s our problem. We are frustrated by having an irregular period. We’re not ovulating, we can’t get pregnant. We don’t understand why we’re doing all the “right things” to lose weight, and we seem to be gaining weight. This is where we get frustrated, but the root causes are deeper than that.

All of these problems at the tip of the pyramid, this hormone dysregulation, if you will, are symptoms of basically having extra androgens. Where are those extra androgens, elevated androgen response comes from is various root causes, and these root causes are all interconnected. We’re going to zoom all the way down to the base of this pyramid. If you think of a pyramid in your head, the very base of the pyramid comes from a hormone called cortisol. This is your stress hormone. We’re going to get into each one of these in a separate episode, so we can just focus on that one. But think about this base pyramid as your base root cause. This cortisol and stress, they’re going to increase your androgen production, so those top of pyramid symptoms, in two ways. First of all, just having that stress response, that adrenal response, can create excess androgens right from your adrenal glands. Your adrenal glands are the glands, these little things that sit on top of your kidneys, and they’re responsible for your stress hormone and your stress response. When your adrenals are receiving the message that we’re stressed, then excess androgens can be released directly from your adrenals.

The other way that this happens is that having high levels of circulating cortisol, so when we’re stressed and we have that on edge, it can almost feel like adrenaline. We can almost feel like we’re having a caffeine high, and maybe we’re drinking extra fat caffeine because we have all these deadlines or we’re feeling anxious, all of these different Maybe you’re not drinking caffeine, but you’re anxious. Maybe you’re drinking caffeine because you have all these deadlines, so you’re really feeling energized and these deadlines are causing stress. Or maybe you have strife in a relationship. Maybe there’s stressful things going on in your life. This stress creates cortisol circulating your system. This excess cortisol, cortisol is not bad. We’ll talk about that more when we get to this specific root cause in one of the upcoming episodes. But this excess stress increases insulin. That introduces the next rung in our pyramid. At the base, we have cortisol. Moving on up the pyramid, we have insulin. Insulin, also similar to cortisol, is not a bad hormone. Our bodies need it. It serves a very vital purpose for us. But when we have it in excess, and excess means several things.

We’re going to get into this in the episode that focuses on the insulin effect root cause. But just to look through our pyramid here, this hormone tells our ovaries to produce excess androgen. Then we move up to the next realm. This one is inflammation. Now, Being chronically stressed or being stressed frequently creates inflammation. Lack of sleep, possibly due to stress, creates inflammation. Having chronic inflammation in our bodies because we have PCOS, PCOS by itself this excess inflammation. That’s nice. Other inflammatory disorders such as asthma, eczema, psoriasis, and then all the autoimmune diseases, these also, especially if they are uncured for, create excess inflammation. Foods that we eat can create excess inflammation. Being chronically sleep-deprived or chronically fatigued for various reasons can cause excess inflammation. Toxins that we’re exposed to, endocrine disruptors that we’re exposed to many things in our lives can create this excess inflammation. That’s that next rung up on the pyramid. We start with the bottom of the pyramid because cortisol, insulin, inflammation. You can tell through what I’m saying here, too, that these are all intertwined. They create this spiral. The more stressed we are, the more insulin we have, the more inflammation we have.

The more inflammation we have, the more our body is struggling, the more insulin resistant we’re going to be. I don’t mean really developing insulin resistant like you’re going to show it on a lab test. I mean, in a short period of time, your body may be struggling a little bit more with its insulin. We’ll get into that more when we talk about insulin specifically. Anyway, these are all intertwined as one worsens, the other one worsens, and so forth to where all of these root causes create a problem. How are these specifically root causes and how do I talk about them? When we talk about stress, and we’ll get all into this one in the next episode, but for now, what I want you to realize is that stress is perceived stress and how our body perceives stress, not how your mind perceives stress, but how your body perceives stress. A really good example of this is, one, we can feel really stressed. I have this many things to do. I have this much time. I’m not going to get it done. That creates a stress in us. It’s this deadline at work and this needs to happen and I’m not going to get it done.

That can feel stressful. We can have interpersonal stress, such as we have the in-laws coming over, they’re difficult people to handle. I’m trying to get everything right so that everything goes smoothly. That creates an interpersonal stress. Then we have a third stress that goes completely unnoticed and unthought of when we think about stress and perceived stress on our body. This is where our body goes back in a very primal place, and this is going on all the time, and we don’t even know it. If we’re, say, restricting calories, we might think, Well, I’m just trying to lose some weight because that’ll be healthier, and I’m doing really well with it, and I’m actually feeling really good, and I feel like I’m being really successful, and the scale is starting to go down a little bit, and this is great. In our mind and in our body, what we’re perceiving emotionally is things are good. Maybe I’m a little hungry, but I’m really proud of myself, I’ve been really motivated and I’ve been really determined and I’ve been very disciplined. Everything’s great. What your body is perceiving is we’re starving. We must be in famine.

There may not be enough food around. We need to shut down all reproductive systems. We need to focus on survival. We may be dying soon because we’re not eating enough food. That’s a version of perceived stress. This is where when we get into thinking about the stress response, it’s not just about the stressor, it’s how our body is perceiving our environment. If our body perceives our environment as threatening, we release cortisol. We release it in larger or smaller quantities over short periods of time or long periods of time. All of that has an effect on our PCOS symptoms in our root cause health. But overall, this is why I label it the stress response. This can also come into play with things like toxins and other things that are stressing our body. Some of them are causing inflammation directly. Some of them are just making things harder on our body, and our body feels stressed, feels stretched, feels like it’s having a harder time doing what it’s supposed to be doing, and this creates stress in our bodies. The insulin effect. The reason I use the terminology the insulin effect is that simply having insulin circulating our system, even though it’s supposed to circulate our system, can create an insulin effect in that it tells our ovaries to produce excess androgens.

With the genetic tendency towards PCOS, we have certain genes that code for us doing this more easily than maybe somebody else. This is where it gets fuzzy is, is there a genetic component to PCOS? The reason is because pushed far enough in health decline, other women will start to also produce extra androgens based on having too much insulin. Maybe their health decline has happened early enough in life that we’re seeing diabetic tendencies or insulin resistance early on in their life, so they’re still in that reproductive stage. We’re seeing a PCOS without having necessarily a genetic tendency to it. Just excess weight, eating habits, lifestyle habits, have led them to developing insulin resistance early enough that that excess insulin in their system is telling their ovaries to produce extra androgens. They’re seeing this earlier than someone who is no longer in that phase of their life where they would have irregular periods and so forth. Oftentimes, we don’t see diabetes until ’60s plus. They’re postmenopausal, and so we have a very different picture. Whereas if we’re starting to see approaching diabetic tendencies in their health, maybe still insulin resistance, but we’re really getting bad insulin resistance towards our late ’30s, you may not have had any tendency toward PCOS in your ’20s, but now we’re seeing those symptoms.

Just the insulin effect in and of itself can be very complicated in how we divide out, well, are you just a normal insulin resistant diabetic? That’s really looking at it from a laboratory standpoint of at what point do we call your numbers? Do we look at your numbers and we’re like, Okay, you’re still in the fine number range. You’ve crossed over into the concerning insulin resistant number range. Now you’ve crossed over into the full diabetic must be on medication range. That’s only for lab determination and lab values and how do we, on a lab test, determine where you fall. When you think about the individual, it’s a continuum. As soon as you cross over into even starting to encroach on the insulin resistant or increasing your numbers on the healthy end of the spectrum, you’re already starting to decline in your insulin health. More importantly, even if your body is still completely and totally compensating for how you’re eating, if you’re constantly spiking your insulin, then you constantly have insulin being circulated in your system. If you’re eating foods that are creating a high spike in insulin, and you’re doing that repeatedly throughout the day, the magnitude of insulin that you had circulating your system compared to somebody who was eating foods that didn’t spike their insulin so high, and they didn’t spike their insulin very frequently throughout the day, the magnitude that they’re having is quite a bit less.

This is where the insulin effect terminology comes in, because really what we’re looking at is, are we pumping out enough insulin that it’s creating a response from our ovaries to excrete excess androgens and therefore increase our PCOS hormones or the problematic hormones and the hormone imbalances that are leading to the symptoms that are our concern? Every woman’s body is going to have a different threshold to how much insulin her body is happy with and at what point her ovaries start to produce excess androgens and to what volume they’re producing those excess androgens and which it’s going to lead to her symptom profile. It’s finding that sweet spot. But again, that’s why we talk about on the podcast here and why I talk about it with my clients and women that take my programs, that the insulin effect is not just about insulin resistance. It’s about how is your insulin hormone that’s circulating your body, which is normal and good, but is it crossing over into where now, instead of being normal and good, it’s creating a response through the ovaries to produce extra androgens that we don’t need, don’t want, that are creating the symptoms that we’re trying to improve.

Then as we move up to the inflammation, this is really just, and you can do lab markers and so forth, but really this is just about, is your body getting weighed down by this extra inflammation? It can be due to completely separate inflammatory reasons, so autoimmune, other disorders, the fact that you have PCOS, that you’re eating inflammatory packaged foods, that you’re being exposed to environmental things that are creating inflammation in your body. Or is it additional problem that’s creating its own cycle from having excess stress response, from having excess insulin effect? Again, they are all connected, but they also have different adding compounding factors that worsen these three main root causes. The fourth root cause that we’ll talk about individually as well is when all of these are working together fairly equally, and it creates a confusion of, Well, insulin doesn’t seem to be my problem more than stress, more than inflammation. Overall, I’m actually relatively healthy, so you’re not scoring super high on any one of these individually. You’re like, Well, I’m stressed. I have some stress in my life, but I wouldn’t say I’m excessively stressed. Well, maybe I have a little inflammation.

I could probably do a couple of things better. I do eat some pre-prepared foods. There’s a couple of things going on. I don’t always get great sleep, but I try. It’s this across the board struggle. Oftentimes, this is because of a specific event. Someone who has relatively good health, knows what they’re doing health-wise, has always put some effort into being healthy. But then they’ve been on birth control and they’ve been getting away with it, goes off of birth control, and now everything is a mess, but there’s not a clear reason why. This is where we get into what I call hormone and nutritional disturbances. That’s the fourth root cause. This one compiles the fact that everything is in chaos. There isn’t a clear, Oh, my gosh, it’s all because of stress, or it’s the fourth root cause. This one compiles the fact that everything is in chaos. There isn’t a clear, Oh, my gosh, it’s all because of stress, or it’s all because of stress, or it’s really inflammatory-driven. This is where there may be a fair amount of each of these, as well as there may have been some things like being on birth control for several years and now going off of it, where all of a sudden, your body is thrown into this state of chaos.

There are some root cause reasons. They’re there. They’re not prominent, but usually they’re all three showing up together. The way that we handle this is actually different than how we would handle if your primary root cause was stress, if your primary root cause was insulin or inflammation. The last thing I want to say in this episode before we move on to our The key focus of each root cause in the next future episode is that you can have more than one. This is a question I get very frequently. I think this is my main root cause, but I also think I have some of these other things going on. As humans, With or without PCOS, these are things that are going on in all of us. Now, with PCOS, we have specific genetics that create problems in these areas at a younger age. We see as our reproductive system starts to develop in our teen years, we start to see problems because our environment impacts these root causes a lot stronger at a lot younger age because our bodies are genetically wired for it. That’s why we have to learn how to manage them through lifestyle, because there’s not really a medication that can change it, at least not at this point in time.

It’s because our genetics are basically hyper-affected by the foods that we eat, the stress that we have, and so forth. How do you know if you have multiple of these going on? How do you know which one to focus on? Well, think of it like a three-legged stool between the three primary root causes, which is stress response, insulin effects, and inflammation. Basically, you want to get those three-legged stool as balanced as possible so that it’s not rocking. You’re going to try to, first of all, discover the one that is the most problematic. This is going to be the one that is, say, I don’t know which makes more sense for this analogy, but say it’s the shortest one. You want to lengthen it a little bit. Lengthen it to full health. But if you lengthen it too far to full health without addressing the other two, now you’re going to be imbalanced again. You’re constantly figuring out which one is the most out of balance, addressing that one, bringing it into balance with the other two, and then assessing, are the symptoms resolving enough? Do we still have some problems? Okay, what’s the next one that’s the most out of balance?

Then bringing that one into balance. But essentially, we all have all of these going on. Some of us may be really good at managing our stress, and that one’s hardly present at all. We may be really pretty good at managing our inflammation, and that one’s hardly present at all. But we really like sweet things. We love eating food and drinks and all sorts of things were going to really spike our insulin. That’s the one we need to work on. But maybe for someone else, it’s only slightly worse than the other two. We’re going to see that we have a little bit more of a combination. You can have a combination of any of these four root causes. Then, of course, once you figure out which combination or which primary root cause you have, then there are specific issues that you specifically want to address. Someone may be really frustrated with their acne. That’s going to be addressed slightly different. The root cause healing is the same. Then you may add some additional health benefits and lifestyle changes that are going to specifically address your acne. Most women that I work with, they either want to lose some weight and have it stop being this constant problem of dieting, losing, and then stop the diet, gain it back.

They want to just get on with their life. They want to lose the weight. They want to maintain the weight loss and they want to just enjoy living at the weight they want to be at. Other women, they want to recover their cycle, they want to improve their fertility, and they want to get pregnant. Of course, you address your root causes, you create health in those root causes and reverse the effects of those root causes. Then you also may need to do some cycle tracking, some additional work to get those cycles back into a rhythm because they’ve gone into chaos. So there may be some additional work. You may, if you’re trying to lose need to get that health and lifestyle changes going to address the root causes. But then you still need to look at what is the correct calorie deficit for me based on the root causes I have because certain root causes, we can be more aggressive, less aggressive with that calorie deficit exercise, and how do you create that structure that’s going to help you both lose the weight, and then how do you restructure it in the way that you’re going to then be able to maintain that weight loss over a long time I wanted to give this overview of what does it look like, because I’ve been getting a lot of questions of what does it look like to actually start to understand what’s going on in the root causes.

This is the overview. We could really get into the weeds of the hormones that we’re dealing with with these root causes, but this gives an overview of the scientific aspects as well as my terminology of how we talk about what’s going on in those root causes. I hope you find that helpful. If so, make sure you hit the subscribe button and make sure that you stay tuned because over the next four weeks, we’re going to go through each one of the four root causes, especially because September, at the time of this recording or the time that this is going to be aired, is PCOS Awareness Month. I really want to shed some light on what’s going on beneath the surface as we gain awareness and understanding of our PCOS health.

Until next time, if you have any questions or specific questions, about what’s going on in the root cause hormones of PCOS. You can find me over on Instagram. You’ll find me @Nourishedtohealthy. I welcome your DMs. I’ve been getting a ton of DMs lately, and sometimes they hide in my hidden folder. I apologize if it takes me a few days to get back to you, but I do try to search everywhere in my DMs to make sure I do get back to everyone once a week. So if it takes a few days, it’s not because your question is not important, it’s because my inbox over the last couple of weeks has become more and more and more busy, which I am excited about to welcome. Please feel free to come ask your questions over on Instagram. I love to hear from you over there. Until next time, bye for now.