Episode #125: Ava’s PCOS Healing Through Revisiting Her Root Causes

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 and this week, I’m really excited to bring you one of my client stories because this is one that I know a lot of people are going to find interesting. It really goes right along with a lot of the messages and conversations that I’ve been having with women over in my messages over on Instagram and so I get to share the story of Ava, a darling girl who was about 28 years old when I first started working with her and prior to that, she had always been relatively healthy, took care of herself. Health was a big priority for her. In a lot of ways, she had been managing her PCOS quite well. She was really frustrated when she first started listening to the podcast and she had taken the PCOS Root Class quiz. Then she had talked to her doctor and she had a bunch of lab work done. They told her, perhaps you’ve heard something similar, that her glucose and insulin levels all looked normal. She had a nice healthy weight. She probably had some thin type PCOS. Really, her best bet was to start. They had offered her some metformin and letrozole.

She just didn’t feel like she had gotten a good answer as to why she wasn’t having regular periods and why she wasn’t ovulating. She reached out to me and she’s like, Hey, I have taken the root cause quiz. It says I have the insulin effect root cause type, and my doctor says that all of that’s normal, and I don’t have a problem with any of that. What’s really going on? What’s going on with my body? Through several conversations, we started talking, and Basically, she did have elevated testosterone and LH, but her glucose and her hemoglobin A1c and her insulin all looked normal. She was having a lot of specific symptoms and cravings and energy crashes and things like that would indicate that she was having some degree of insulin concern in her PCOS root cause. As we started working together, we really visited what was going on with her lifestyle that was increasing her insulin component as well as her diet and so forth. Then as we began to address those and look at her symptoms, we began to see that, yes, indeed, she had a very, very, very strong insulin effect root cause. I want to pause there in her story for a second and just explain what’s going on here metabolically.

In a 28-year-old, your body is going to compensate for everything that you’re doing, whether or not your body is hypersensitive to blood sugar. Basically, in PCOS, we can have a hypersensitivity to things, where if we eat something, our blood sugar may spike stronger and harder, or our insulin response to a fairly normal blood sugar spike with a certain meal is going to be bigger. That isn’t going to show up in a fasting insulin. It’s not going to show up even in a glucose tolerance test exactly, because really what we’re getting is we’re getting a little bit too much insulin sometimes when we’re eating something, or perhaps we’re just more prone to certain cravings. Throughout the day, in order to manage our energy, and because that insulin comes in so strong and hard, what happens is we eat something that is going to raise our sugar nice and high, and we get that nice energy boost and so it feels good but that Insulin overreacts and comes in so strong that it makes us crash really hard.

Then we do it again, and we do it again, and we don’t even realize how many times we’re doing that throughout the day. Well, nothing in that is going to indicate poor labs. Your hemoglobin A1c is going to be fine because you never really had high blood sugar. It spiked for a second, but that insulin came crashing in and took care of it. In fact, you may have even dropped very low a lot of times and so your blood sugar may, on average, actually be quite low, but you had several spikes throughout, and that insulin came into the rescue in large amounts, in high frequency, and that’s what I’m telling your ovaries to produce more androgens. If you want to hear more about that, you can go back to some of the previous episodes. We did a mini-series a couple of weeks ago on the root causes and how excess androgens are developed from those root causes. I will link to those in the show notes on the web page for this episode. If you want to go back and learn more about that but back to Ava’s story. Those excess androgens that were being elevated through her insulin because that’s what she was doing.

She was basically following her energy, and her energy was better after certain food. She ate to boost her energy, and then she would have these crashes, and then she would eat again, and then she’d have these crashes. She had grown up thinking that small, frequent meals were actually a healthy way to eat. She was eating fairly healthy foods during those small, frequent meals. What she essentially was doing was spiking her insulin and crashing, spiking her insulin and crashing through these blood sugar spikes. Throughout the day, she was basically telling her ovaries to release excess androgens. Those excess androgens were raising her testosterone and her LH levels and had essentially wiped out her periods. She would have a period every 60 to 90 days, and it would vary between being almost just a little bit of spotting to being just this intense, bleeding through everything period but even those were fairly short-lived. She’s like, Maybe three days of really a period, and then maybe a fourth day where I would just have to wear a panty liner or something to make sure that she didn’t have any staining on anything. But ultimately, she felt pretty healthy, her weight was fine, and so she had no idea why she wasn’t having regular periods. Her doctor had told her that losing 15 pounds would be really helpful because while she was a healthy weight, she wasn’t underweight. Her doctor had told her that a lot of who are struggling with ovulation, having regular ovulation, they find that if they just drop 5 to 15 pounds, that ovulation will spontaneously restart. She had been constantly trying to lose that weight and so partially where she was trying to eat these small little meals throughout the day and trying to just keep her energy up while she was trying to overall restrict calories, she did seem to lose three or four pounds, and then she would gain three or four, maybe a little bit more back and she felt like she was getting stuck in this back and forth.

So when we started working together, we talked about it, we looked at her body composition, and it wouldn’t hurt. She was not underweight, so she did have room to maybe lose somewhere between 5 and 7 pounds of body fat, but definitely not more than that. That would start putting her in the extreme or approaching the extreme because when we’re dealing with fertility, we really don’t want to approach the extreme.

She was just frustrated because she felt like really nothing had been working. Even when we talked about, Well, yeah, you could lose a little bit of weight. It wouldn’t be harmful to you but she felt really frustrated because she’s like, Well, I’ve lost three or four pounds, but it always comes right back. The problem was, is that underlying insulin effect. Really what we needed to do, and we ultimately helped Ava, was exactly this conversation we’re having right now, is taking that moment to re-verify what is going on in your body. While laboratory values can be really, really, really, really, really helpful, we should not let them overshadow what our body is telling us through symptoms. The symptoms are so, so, so, so, so much more relevant, but the labs can help us determine where the symptoms are maybe standing from, what I mean by that is that hormones, the slightest little adjustments, can make a huge effect in our symptoms. You could have a normal value in your labs and actually have quite a strong symptom to it. We see this a lot in testosterone levels where it’ll be just a little elevated, but having a catastrophic downstream effect of high LH levels that’s then messing with ovulation, which then creates this domino effect of just chaos in your natural hormones of your cycle and similar in our metabolic health, just a little bit of extra insulin spikes coming off of trying to dampen, let your body absorb the glucose spikes that you’re having can really affect and have a down-line effect of androgens and hormone imbalances and so forth, and can lead to those energy crashes. So when your body has a little bit of a blood sugar spike, which is normal, should happen when you eat something, right? Your blood sugar goes up. Insulin comes in to help your body use that blood sugar. It’s all a good thing but when your insulin comes in a little too heavy or a little too hard, then what happens is we actually bottom out lower. What we want to see happen is that going along, you realize that you’re getting a little low energy or it’s time to eat and you’re hungry. Then you eat a little food and your blood sugar comes up nicely, and your insulin gently comes in and helps your body absorb that glucose. Then you’re allowed to use that energy. Your brain feels that energy comes in, your muscles feel that energy, your body feels perked up, your tummy feels full, everything’s good, and you’re ready to wait until your next meal because now you got the energy to continue about your day until then.

After that insulin has done its job, your blood sugar goes slowly back to where it was prior to eating, and it hangs out there at a nice where you don’t feel too low, but you don’t feel hungry yet until your next time that you start to get hungry and feel low again. The problem is if your insulin comes in too strong, what happens is that it comes in and it takes all that blood sugar plus some because it came in so strong. You start crashing down. It’s like you rounded a peak and then you just dropped off a cliff. You’re climbing up, blood sugar is climbing up, climbing up, and then here comes the insulin. A lot of it lets it all go into the cells, and all of a sudden, your blood sugar just plummets. You felt really good while your blood sugar was climbing, and then all of a sudden, it’s all gone. There’s nothing to use slowly over the next couple of hours, and so you felt extremely low. We tend to then repeat, eat another small meal, eat a snack, feel like we need something to get us through, or take a nap because we’re just exhausted.

In doing that, it’s those crashes, actually, that are getting us almost more than anything else. Nothing on labs is really going to show us that unless we are measuring it very closely to see those crashes in our glucose. We may not see it extremely. It still may be within normal levels and so your labs aren’t going to turn red and be like, warning, warning, something’s not quite right here because you may have been hanging out somewhere. It’s not a fasting level, right?  So you’re hanging out somewhere in the 100 to 110 in your glucose, and then you’d go nicely up to 120, 130, and then you’re coming back down but instead of slowing down around 110 again, you’re dropping all the way down to 90, or you’re dropping down to 100, or just below 100. Just that little extra dip makes you feel sluggish, brain foggy. That’s where I see that those symptoms are telling us so much more than our labs are. Now, so helpful to have the labs. We don’t discount the lab but when we have a normal lab value, we can look a little deeper into what are our symptoms still telling us.

By doing this, Ava was able to finally understand why everything she had been trying so hard and why she kept not maybe making a couple of steps forward in progress and then just sliding back. When she finally was able to understand how her insulin effect was affecting her PCOS and her ability to lose weight and her cycles and her ovulation, she was able to, just with that confidence of understanding what’s going on in her body, stay the course long enough to start to see some progress, as well as adjusting the right things in her lifestyle to help her see that progress that she wanted.

So this is just a short recap and then her success, because that’s really an important thing to share here. I’m going to skip right over that. So ultimately, she only had to lose, I think, she had gone back and forth between losing that 3-4 pounds and so ultimately, she found her sweet spot right at about to seven pounds was her sweet spot and you’ll find that when you get down to your sweet spot with your weight, you’ll find a spot where everything just falls into place a lot easier.

Your maintenance becomes easier, your hunger and your hormones and your symptoms, all those symptoms that were fighting you before, start to just become less problematic. She found that sweet spot. Her periods became regular. She still wasn’t ovulating for a few months, but as her periods became more and more regular and her LH continued to lower each month so that she could have a more substantial raise, that’s when she started to see her ovulation return and ultimately was so much happier and felt so much better in her body. Her goal was not pregnancy, that was not her goal. Her goal was that she really wanted to regain her cycle. It was really bothering her that her period has become really haphazard. She was 28, looking to maybe in a couple of years start a family. She wanted her fertility to be optimized in that sense, but wasn’t trying to get pregnant at this time and ultimately, she remembers that just having gone from feeling like everything she was trying was just not quite adding up to working and not understanding what was going on in her body to finally understanding the pathophysiology of what her body was doing and able to confidently address that and move forward in a clear, this is the path forward way, then she was able to just put the time in, do the work, and ultimately see the results that she wanted.

I want your takeaway from this to be that, well, laboratory values are extremely important, and they give us a specific picture of what’s going on in our body or what’s not going on in our body. Listening to our symptoms is also highly important. The root causes in the PCOS Root Cause quiz is really about diving into understanding what your body is telling you through your symptoms to help you get a better picture of what is happening at a more metabolic and endocrine level that’s not as superficial and visible as things like weight gain, irregular periods, facial hair, acne, and things like that, or our energy or our mood. Those are things that we can see pretty easily but what’s going on in our metabolic health can be a little bit more masked, especially when we’re in our 20s and 30s and for the most part, our body is compensating for it. We’re young and we’re healthy, and our body is able to keep up with us. As we get older, our body starts to have a harder time keeping up with our lifestyle if it’s not working for our bodies and so we start to see more of a breakdown happen in our labs when we are over 40, over 50 and so important to remember that I’ve been getting so many questions about, Well, my labs all say these things are normal, but I’m still having these symptoms. What’s going on? What’s not showing up? Are the labs wrong? What’s happening? Hopefully, this helps us shed a little bit more light on, one, why that’s happening, and two, how as we get clear on what our body is telling us through our symptoms, we’re a lot more able to clearly and confidently address those things to finally get the results that we’re trying to get.

With that, if you have any specific questions or requests for episodes, you can find me over on Instagram @nourishedtohealthy. I look forward to hearing from you over, Until next time. Bye for now.