Episode # 132: The Inflammation Factor: A Closer Look at PCOS

Welcome back to the PCOS Repair Podcast, where I’m excited to share an interesting research article I found a few weeks ago. It ties right into some of the more recent episodes about how the root causes all stack on top of each other, where we have the stress responses from cortisol. We have, of course, the hormone insulin playing a huge part in our root causes. Then, of course, there’s inflammation and a lot of times the word inflammation gets thrown around as something that is this catch-all like, Oh, that food must be causing inflammation, or you need to heal your gut because of inflammation, or you have aches and pains because of chronic inflammation, or your hormones are out of balance because you’re not eating a hormone anti-inflammatory diet, or you’re getting inflammatory particles from plastics and environmental concerns. We throw this idea around of inflammation. I’ve talked here on the podcast about how inflammation creates a lot of PCOS concerns and overall increases our excess androgen production and leads to increased symptoms. This research paper really breaks down the different ways that our body develops excess chronic inflammation and so that we can begin to address those in the ones that pertain mostly to us.

Each individual is going to have different ones that are more prominent in their life because we are all unique and we all have to look at a very unique approach to how we go about healing and repairing our PCOS root cause. I also want to point out, and there’s going to be an episode about this coming up, but we all have all of these root causes. We have the most prominent at any given time is the one that we tend to focus on. When you take the PCOS root cause quiz, it’s really doing its best to point out which one you’re showing the most signs of. This isn’t something that means you do not have the other ones. If you’ve taken the root cause quiz and you did not have inflammation as one of your key players in your PCOS root cause health, then I still encourage you to listen because you’re going to learn a lot of insights into how, whether or not you have an insulin root cause or a stress response root cause or a hormone disruption root cause, how those still play into actually contributing to increased inflammation. You’ll still learn a great deal about how your root causes are impacting your PCOS symptoms and overall health that you’re trying to improve. With that, the research article that we’re going to be reviewing today will be in the show notes. It is titled Inflammation in Polycystic Ovarian Syndrome, underpinning insulin resistance and ovarian dysfunction. I’ll put the link to the entire article so you go back and read it yourself if you want to but we’re going to pretty much just go through and cover some of the highlights here in today’s episode.

Okay, so I wanted to read a couple of parts from the abstract because they were just so well-worded. I can’t even paraphrase them better. Here it goes. Chronic low-grade inflammation has emerged as a key contributor to the pathogenesis of polycystic ovarian syndrome, PCOS. A dietary trigger such as glucose is capable of inciting oxidative stress and an inflammatory response from the mononuclear cells of women with PCOS. This phenomenon is independent of obesity. To recap, what that’s trying to point out is that each of these layers of our PCOS root causes are adding to our inflammation. When you think about having all of these root causes, we may have an external cause of, not external, but we may have a unPCOS-related root cause of inflammation but if we don’t have that, so that would look asthma or maybe some gut inflammation. That could be due to constantly needing to be on antibiotics or certain dietary things that have led to a very inflamed and unhealthy gut. Maybe we have autoimmune disorders or other inflammatory disorders such as psoriasis or gluten intolerance that we haven’t uncovered. These can all lead to inflammation in a very, very a large way in our body, and that inflammation can trigger and exacerbate our PCOS. However, inside of when we think about the root causes of PCOS, we can also be creating an inflammatory response. When we eat something and it creates an insulin over simulation, so we eat something and we’re constantly having insulin in our system, that can create inflammation. That can happen whether or not we are insulin resistant, that can happen whether or not we are diabetic, or whether all of our labs are completely normal. It can also happen independent of being overweight. As a side note, one of the things that this research article mentions is that just having excess weight increases our inflammation. Basically, when we have excess fat tissue on us. Now, we all need some fat.

This is not about getting rid of all fat. It’s not even about being at a certain body weight. This is where we’ll have an episode about this coming up, too, because this has come up in some conversations with individuals but when we start to think about what our ideal healthy weight is, it really has a lot less to do with what pants size we wear, how we look. It does matter how we feel but it really comes down to what is the body weight that your body is happy at? Not where is it happy, it’s not hard to lose weight or maintain, but where is it happy at because it’s not creating inflammation. When we lower our body fat percentage to a place where our bodies no longer are pumping out these cytokines, which is basically a pro-inflammatory response to extra fat tissue. When our body is pumping out these cytokines, our body is just becoming an inflammation factory. When we get our weight to a healthy place where it’s a healthy amount so that our body is happy. It doesn’t feel like it’s starving. It’s not so low that it feels like it’s starving, and so it’s working on a stress end of the cycle but at the same time, it is low enough that our body is not creating more inflammation than it can handle.

This is going to be different. Again, there’ll be an entire episode about finding your sweet spot when it comes to your body composition but essentially, there is a set point for everyone where our bodies become comfortable.  It’s like all of a sudden you got the mechanics working and everything is running smoothly. That is when, one, you’ve gotten your mindset and your habits in place, but two, your body is in a place where it is happy. It feels nourished. It feels like it’s not working too hard to keep up with what is being asked of it. It’s getting adequate rest but it’s also your own body composition. It is in line with what’s working for you. Now, I have seen this body fat composition or body fat percentage vary quite a bit. Some women actually can have a relatively high BMI, and their body works great at that set point. Mine is frustratingly quite low. That was something that was surprising to me when I started to work with women with PCOS, what is it? Like 9, 10 years ago now, when I first really started to understand how PCOS worked.

In my body, it was quite a low set point. If I start to get above a certain body fat percentage, I start noticing everything getting harder. My symptoms don’t necessarily come crashing back. My period doesn’t become irregular right away and so forth but what does happen is I feel like I am swimming against the current, that someone just put the incline up on the treadmill. It just starts feeling harder. The things that I’m doing are not working well. Whereas when I’m in that sweet spot of where my body is working well for itself, I can eat a lot more leniently. I don’t have to be quite so strict with no excess sugar, and I don’t have to be quite so rigid on 10K steps minimum today. I can be a little bit more fluid with life. I can have really great days. I can have, Okay, this day was a busy day, we did our best and then also some indulgences along the way. I can just be a lot more in flow with what’s going on with my life. Now, of course, I’m still paying attention to health is a priority for me, but I’m not having to live just so tight and so strictly.

I don’t have to feel deprived of being able to participate and do the things that I want to do or eat the things that I want to eat. That is something that I’m really happy this research article brings to our attention because I think it’s something that isn’t talked about very broadly in the realm of PCOS. I think women are told to lose weight. They are told to don’t eat sugar but there’s this nebulous reality where, well, what’s the right amount? This is that piece between the insulin effect and the inflammatory effect and whether or not you are a thin type or have a struggle with your weight when it comes to PCOS, is that these all play a factor, but they’re also independent of each other. You can have an inflammatory problem and you can have an insulin problem and you cannot be overweight or you can actually be doing relatively well with your insulin, meaning if you put a CGM on, you’re not living in a constantly spiked blood sugar, elevated blood sugar. That’s why your labs are normal. You are a little overweight, maybe perhaps, but not extensively. You feel like you eat pretty well, and your blood sugar would mimic to us that you’re eating pretty well, and yet you’re still feeling like you’re swimming upstream.

You feel like nothing is really working for you. Chances are you’ve got some inflammation working against you and you haven’t found that good set point in your body fat percentage. Now, of course, that begs the question of, Okay, what’s a catch-22? Because if I feel like I’m swimming upstream and I can’t make progress, well, how do I adjust my body composition so that I can start to improve my ability to manage my symptoms and stop feeling like I’m swimming upstream. Those are some things that really I get into more in the PCOS Root Cause Boot camp, but I think that answers a question that a lot of people have. It’s like, Wait, my labs are normal. I feel like my symptoms are worse, my weight hasn’t changed a whole lot. Various things where it’s like, I’m being told not to eat sugar. I’ve cut back on my sugar. It’s still not working. We start to wonder what else can be going on. I think this research article does a very good job at starting to introduce the nuances of how these root causes interact, as well as how these root causes can affect us without having the stereotypical cookie cutter approaches and causes that get talked about elsewhere on the internet. That’s why I think that these research reviews are so important here on this podcast.

The next thing that the research article goes through is what about the just chronic low-grade inflammation that we find in PCOS? One question that comes up frequently is, how do we test for inflammation? This is where it becomes a little bit dicey. The best tests or the most commonly used, and probably it’s not the best test, but the most commonly used test because it’s available and it’s accessible to most people is CRP, C-reactive protein. The problem with this is that, yes, it has been found in their research articles. Previously, they have talked about this genetic tendency in women PCOS to have a higher C-reactive protein. Some practitioners have started to test for C-reactive protein. I usually actually don’t test for it. I tend to look more towards monitoring and looking at the symptomatic changes when it comes to considering inflammation as a factor with PCOS management. The reason is because C-reactive protein, and the article has a section where it talks about I’ve noticed that although it’s elevated in women with PCOS, it is more significantly elevated and more routinely elevated in women with or without PCOS who are considered overweight.

It is sometimes elevated in thinner, less overweight women who have PCOS. I would consider that to be a really big indicator that inflammation is definitely a big contributor to the PCOS symptoms and so forth. However, for anyone who is even moderately on the overweight side of things, probably a BMI of 22 or above. I hate to give BMI numbers because BMI is so subjective. BMI is a funny one, and I’ve gotten into that in other episodes but if you feel like you could go down two or three pant sizes and still be not underweight. Chances are your C-reactive protein, if you have PCOS and you’re having symptoms of PCOS, is going to be slightly elevated. The caveat that I would throw in there is that that does not mean that inflammation is your top priority. It doesn’t mean it’s not, but it doesn’t mean that it is. It becomes one of those confusing labs. Sometimes confusing labs can be like a squirrel where all of a sudden we’re chasing something and losing attention of what we trying to focus on or would have benefited from focusing on more. I think that when it comes to C-reactive protein, someone who’s a really good, healthy to even probably maybe a little underweight and their C-reactive protein is high, I would take that one more seriously but again, this is one of those, take it with a grain of salt, make sure your practitioner who’s ordering your labs is looking at all of those factors that are going to contribute to your inflammation labs, Because as soon as we hear something like, Oh, inflammation may be making my PCOS worse, we run out and try to figure out, Well, is inflammation my problem? I would love to tell you that we had these amazing lab profiles that could tell us exactly what was causing our inflammation. If inflammation was the problem, we don’t. We oftentimes have to focus back on our symptoms. Then if we’re doing the things that should be helping and we’re not seeing the degree of help that the efforts we’re putting in should create, then we start to look at, Okay, what symptoms are still around? Are we being signaled that inflammation may be a problem here? That’s more how I would address looking at finding, do you personally struggle with inflammation? Then we’ve talked about how to test for it. We’ve talked about the causes of it being either more of a chronic non-PCOS-related situation, or maybe it is an excess body fat situation, but it’s also important to note that just the foods that we eat can create a constant inflammatory state for us.

Now, this is what’s really important is there are no good foods or bad foods, but what we eat on a regular basis does impact this microenvironment that’s going on inside of our bodies. If we have cake or cookies or donuts on occasion, ice cream, whatever your favorite highly sugary, usually slightly larger healthy ideal treat that you like to have, having that on a special occasion is not going to create a environment that you live in that is going to increase inflammation or the insulin effect or anything like that. These one-off things are not what I’m talking about, or even a weekly indulgence is not what I’m talking about. There are no good or bad foods. It’s not that these foods, if you eat them on occasion, are going to derail all other healthy foods that you’re eating. We all have to find our own rhythm of how often and how much we can incorporate them into our lifestyle. There are times during our healing journey that we can have more, and there are times when we would significantly benefit from having less if we want to see progress. That’s very individual and unique to each person but it is important to note that not only do certain foods spike our insulin and lead to excess but certain foods also increase our inflammation. They also can create an oxidative stress reaction, and they can also create inflammatory gut issues. All of those things can create inflammatory patterns inside of our body from slightly different angles and ultimately can escalate to creating quite a large inflammatory response in the body that will worsen your PCOS symptoms as well as make all of your other health endeavors harder. If you’re overall trying to eat low glycemic and get your workouts in, but you’re consuming foods that are strongly raising that inflammatory response, you are trying to hit the gas while also pumping the brakes. That’s where we start to look at, Okay, but are we seeing improvements with the effort that you’re putting in? Is the effort that you’re putting in addressing some of the problems that we’re seeing, but maybe something else is happening in addition that’s keeping the progress from occurring. This is where some people who have done keto or some people who have followed macros for their PCOS health have still struggled to see weight loss results, or they have still struggled to see their symptoms improve or their periods return.

That’s because we can follow keto and we can follow macros without being at all aware or concerned about the inflammatory aspects of the foods that we’re eating. I want to strongly emphasize, though, that I’m not saying there are good foods or bad foods, but we need a better understanding of nutrition for ourselves. There’s research out there. It’s not a secret what foods are good and what foods we should be eating primarily but for ourselves, there isn’t really a good hack. All these diets and things that people are pointing out that maybe if you do this, then you can still eat all your favorite foods and lose weight. The truth is we have to find that balance for ourselves. There’s not a way to eat processed stuff and live on processed foods and reduce that inflammatory aspect of our diet but that doesn’t mean we have to always avoid some of our favorite foods. Then this other section that I absolutely found fascinating for this example of what’s going on when we’re like, Why is it such a big deal when we elevate our glucose or our blood sugar when we have PCOS?

In PCOS, our mononuclear cells are preactivated. What happens is basically they are hypersensitive to glucose. This accounts for when we eat something and our glucose goes up, especially things that are really simple sugars or simple carbohydrates. Just because everything gets broken down into glucose, that’s not really so much the problem. It’s when we have these really heavy, fast loads of glucose entering our system. Basically, what happens is that we react to it but what’s interesting is that in contrast, we see these mononucleosis cells in normal weight ovulatory women that are not sensitive to hyperglycemia. When their blood sugar goes up, it doesn’t create… When they have this high blood sugar spike, they don’t have an inflammatory response to it in their mononuclear cells. This shows some of that just genetic predisposition that women with PCOS have. The ideal situation with this is just to, I mean, unfortunately, but at the same time, at least we have the knowledge to know, is to limit the amount of times that we create those glucose spikes. At least this shows us that there’s a reason, because I used to feel like when I was in my 20s, that why am I so sensitive to sugar?

Why can’t I have a cookie and just have it be random, every once in a while had a cookie. Whereas it’s like, if I have a cookie, I’ll have days of this domino effect of my health circling the toilet, where I’m like, I just had a cookie. I’ve been eating my vegetables, I’ve been exercising, all the things. Then all of a sudden, just this one little thing, and my health just goes into this downward spiral. This is where, side note from the research article, this is where what I have found with women that I’ve worked with, and myself personally, so many times, so I found this with myself personally, is that when we are in that ideal body composition for ourselves, and we have our metabolism humming along, and we’re drinking our water, and we’re doing all the lifestyle things, but we also have our body composition in our ideal range, which is, again, unique to every individual. When we are in our ideal range, and there’s usually about an average of 5 pound range plus Plus or minus, probably plus or minus three pounds. It’s the range that if we go below three pounds of our range, our symptoms don’t come back, but it becomes very difficult to maintain that weight.

If I go to the high-end pound range, then I’m going to start to feel like I’m swimming upstream. Those PCOS symptoms are going to start creeping back in, but it’s also just everything is going to feel harder again. This is where understanding that the sensitivities are there, what I’m talking about in this section of the article is that when we’re in that ideal zone of body composition, our sensitivity to glucose seems to diminish. Now, I don’t have research articles to prove that, but I have seen it time and time and time again. When we start to repair our PCOS root cause and we’re able to get our bodies into that ideal body composition range, all of a sudden, these sensitivities that are rooted in our genetics can start to lessen and start to work against us. Now, the hard part, of course, is getting it to that point but a lot of the things that we can do, and by being a little stricter in that healing phase, we are able to start to see the progress, the results, and when we get it to that set point, we’re able to start to see that we can actually live life in a more balanced lifestyle approach.

In conclusion from this episode, inflammation directly stimulates our ovaries to produce excess androgens. Those excess androgens are what lead to our PCOS symptoms, whether it’s not having regular cycles, whether it’s not ovulating, whether it’s hair loss, whether it’s facial hair, whether it’s excess weight gain, whether it’s mood disturbances, whether it’s acne. These excess androgens are what lead to those problems. As we’ve seen here, we have the stress response, we have the insulin effect, but a lot of it is all tied together with inflammation. All of these things, as well as some of the actual symptoms of PCOS, like excess weight, can increase our inflammatory levels and really work against us and make it feel like nothing is working for us. As we start to address those, it becomes so much more easy, in a sense. Things start to work, even though if the effort itself is still an effort. It’s not. It doesn’t just happen to eat healthy. We don’t just all of a sudden get our exercise without trying but the efforts that we put in start to pay off tenfold when we start to address the inflammatory parts of our PCOS, which is why I loved this article when I found it, and I was so excited to share it with you all here on the podcast.

This was actually a relatively, fairly easy and straightforward to read article. If you do find a scientific journal articles interesting at all, I I encourage you to go and read it for yourself, at least the sections that interest you. I will link it to the show notes below. If you have any questions about inflammation and PCOS, the best place to reach me is over on Instagram. When I get questions, especially when I get several of a similar question, I do try to create a post so that everyone can get the information that’s being asked about over there on my Instagram page, you can find me @nourishedtohealthy. And until next time, bye for now.