S1 E12: PCOS Part 2


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Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it. 

Emily: Okay, we are back with Part Two of our PCOS series, and we’re gonna get into a lot of things this episode, so get ready. But if you haven’t listened to our previous episode, that’s Episode 11, make sure that you do, because in that one we break down exactly what PCOS is and how it’s diagnosed as well as the different root causes. So that’s a very important precursor to this episode. And in this episode, we’re going to be talking about a lot of the different mistakes that we see women make with PCOS that is not really their fault. It’s more so the general modern Western medicine advice that is kind of given to them about what they should do when they have PCOS that we’re going to kind of go through and break down the issues with this. And we’re also going to give you our recommendations for how to heal yourself and what to do instead. So we really hope you enjoy this episode—it’s going to be packed with good information.

Amanda: Yeah, we’re basically just taking all the terrible advice that you get from your doctor, or that most of us have gotten from our doctors, when given that PCOS diagnosis and breaking down why maybe that’s not the best option. And I think we’re gonna start with the, what I think is probably one of the most important ones and the ones that you typically hear first. And that’s when women are, have that PCOS diagnosis and they’re recommended to lose weight and exercise more, right? That’s typically one of the first things that they’re told is, well, if you lose weight your PCOS symptoms will go away. But the issue with that is that your weight doesn’t really tell us anything about your health, especially when it comes to your hormones. And in my opinion, I think focusing solely on losing weight is actually going to drive yourself way further into the ground, increase your stress, and exacerbate your PCOS symptoms. Because truly weight loss is stressful on the body even when we do it in a healthy way. And eventually we will have podcast episodes on fat loss, not specifically weight loss but fat loss, and we’ll kind of dig into how to break that down.

But it’s just so important to lay the foundation first, right? When you’re a woman with PCOS and you’re already dealing with metabolic issues, weight loss can feel impossible. And then this puts you on a hamster wheel where you’re going with extreme dieting, usually with advice from your doctor to try to lose weight. This exacerbates your PCOS symptoms and leaves you right back where you started. So when it comes to healing PCOS symptoms we have to look deeper than weight. And we need to focus on supporting the metabolism replenishing nutrient deficiencies and imbalances in the body so that you can have a healthy insulin and stress response. That’s what truly helps to reduce PCOS symptoms long term. 

Emily: Yeah, I just think it’s so interesting, the whole advice or tip to lose weight from medical professionals when someone has PCOS. And the reason I think it’s interesting is because speaking as someone who was told she had “lean PCOS” if the weight was the whole issue, if that was going to, you know, solve all your problems, why would lean PCOS even be a thing, right? So you cannot just look at someone and make an assumption based on how much they weigh, how healthy they are, and what’s going on in their body. So it’s interesting, because we often demonize in our, in our society, we demonize things like body fat, when in reality someone who’s holding on to a lot of body fat…that’s how their body might be protecting themselves, right? 

Because we often gain weight when there’s something going on and the body is trying to just make them feel safe. It’s kind of like going back and forth between if you’re undereating or if you’re not nourishing your body in the way that you should be. Sometimes you’ll gain weight because the cortisol is up and your body’s like, oh gosh, no, I need this extra weight, these extra pounds to stay safe. So you cannot just look at someone and assume where their health is that, and that is why I hate that prescription of like, okay, well just exercise harder and reduce your calories because you just need to lose weight and then your PCOS will just disappear. No, that’s not how it works, and there’s so many things that impact body

Amanda: And I think one quick thing I just want to mention is you can’t tell if someone exercises. You can’t just assume they don’t exercise, right? If you feel like they have weight to lose, like, I have so many clients that you may assume that they don’t exercise. If you are thinking of like your typical, like, fitness type of influencer and stuff online…just because someone doesn’t look like that doesn’t mean they don’t workout. So it’s like, that’s kind of the other thing of a doctor giving someone that advice is like, what if they are exercising and already doing all the things that you’re saying, You’re just assuming that they’re not, because their weight hasn’t changed.

Emily: For sure. And even on the opposite side of the spectrum, you know, I’ve known women who exercise so much that they are constantly in the gym or constantly doing physical things and they’re gaining weight as they’re doing this. And that could also be a sign from their body, hey, you know, you need to slow down because this is just way too much for a healthy body. So again, you never know. And it’s not about what someone weighs. It’s not about how much body fat they have. It’s not about how much muscle they have. Like there’s so many different things at play here.

And just a few of them to list off are things like your energy intake. So yeah, like how much calories you’re eating. Your gut bacteria is a huge one. What’s going on with your microbiome. Your sex hormones, your stress hormones, your insulin, and blood sugar, obviously weighs into that as well. And then genetics, of course. We were just actually talking about before we started recording about how mothers and daughters…their bloodwork and their hair tests and all of that often look identical, because your mom just kind of passes down what was going on with her at the time that she had you on to you. And so all of these factors play in when we’re talking about something like a condition like PCOS. And it really, really boils down to supporting your metabolism and eating enough so that your body does feel safe and improving how your body uses energy before you can even attempt weight loss, okay? So like Amanda said, weight loss is going to be what comes pretty much last when it when it comes to kind of healing your body and making sure that it feels good, it feels like it’s in a proper and safe place in order to kind of shed that excess weight. And the longer you’ve been yo-yo dieting or undereating, the more your body needs to feel safe and needs to support the metabolism first.

Amanda: And I think that’s the big takeaway from this first, like, losing the first tip for your doctor saying lose weight and then that will heal your PCOS symptoms. It’s not about your weight. And if you are consistently gaining weight, make note of it, pay attention, but that’s a piece of information. Like Emily said, like your, all those different factors are going to affect how much body fat that your body either continues to store or add on. It’s not like we want to just ignore your weight completely, but it’s not what’s going to dictate whether or not you’re improving your PCOS, and I think that’s the biggest takeaway. And it’s just a piece of information, like, your weight is one measurement that doesn’t really tell us a ton.

And I was on a client call yesterday with a really sweet woman. And she has seen a lot of success, but she hasn’t lost any weight. But her cycles went from 120 days to 50 days, which I’m like, this is huge. First of all, we need to, like, celebrate. And then she goes, like, I haven’t lost any weight, but my clothes fit a lot looser, and my face…like she could definitely see it in her face. And even I noticed when we were on our call. So she’s obviously lost body fat, which is like this is a great thing. This is telling us that your body feels a lot safer, because she’s been working on eating more. And this is a woman that’s been chronically undereating for basically her entire life. So of course her body is going to store that fat even if she’s not taking in a lot of energy. It’s like this weird assumption that you have to be overeating to gain weight—that’s not actually true. It all kind of depends on how stressed out is your body and what does it feel like it needs. So it’s, it’s one of those things where it’s just one piece of the puzzle. You can see zero weight changes, but you could see body fat and muscle changes. 

And then of course, hopefully with that will come improvement in whatever your specific symptoms are. If that’s like not ovulating, have really long cycles, maybe it’s acne, maybe it’s hair growth, all different types of things, whatever kind of your specific main issue is. But we can’t, can’t forget that and there’s so many other things you can monitor. We talked about in the last episode basal body temperature and pulse. That’s kind of like the big takeaway from the weight piece. Weight is not everything and exercising more is also not everything. 

I think, you know, we assume that if we eat less and exercise more, we’re going to lose weight. For women with PCOS it usually makes them gain weight. And when it comes to, we get this question a lot, of like, what’s the best type of exercise for women with PCOS and specifically like, or if you just have hormone imbalances, fatigue, thyroid issues. Across the board, we love strength training, and that’s because, especially for PCOS, because that’s going to help improve your cells’ ability to use insulin. And anyone with PCOS, most women have, they’re on some spectrum of insulin resistance, even if it’s not necessarily their main issue, especially if even the adrenal type PCOS or lean PCOS…those women are still usually dealing with insulin and blood sugar problems because of the amount of excess cortisol.

So no matter where you fall, we do think strength training is a great fit for those. And this could be a strength training with your bodyweight, especially if you’re new to strength training—you don’t have to immediately jump into lifting weights. And eventually, you know, ideally, you use some weights. And a mix of both, honestly, I think is the best because there are certain bodyweight movements that are really challenging. And I find like for myself when I do a mix of both, it’s, it’s a lot easier not to over-train and completely burn myself out. So strength training is great. Walking is huge. Another really good one for if you have high cortisol, high DHEA, because walking can help reduce that cortisol. If you’re someone, really no matter where you kind of fall in that PCOS spectrum you can definitely benefit. And especially in the beginning, like, if you are in a place where your body is very stressed out, you’re just getting into supporting your metabolism and nourishing your body. Start with walking. We don’t need to go crazy and jumping everything right away.

Emily: Yeah, and I just like to add to this. So the whole strength training idea was completely new to me a couple years ago, when I was dealing with my worst PCOS symptoms like acne and major fatigue and the hirsutism like all that stuff. I was doing probably an hour of cardio a day. Again, my doctor had told me, hey, you really need to try to do as much cardio, like, try to do it at least three times a week, maybe do the elliptical run if you’d like to run or jog. I didn’t do any strength training at all. I probably had zero muscle mass, because I was just wanting to burn excess fat, I was wanting to burn calories, I was wanting to get my heart rate really high. And again, just to kind of prove our point, my symptoms only got worse from that. So it wasn’t until I started incorporating more walking, as you mentioned can lower the cortisol, that I started noticing my cortisol symptoms, like my high cortisol symptoms go down. And the strength training helped as well. And now all I do is just strength training and then I walk and then some yoga just to help with like the cortisol. So I’ve noticed a huge difference. And I don’t want to like call anyone out, but I might. Because have you heard of Kayla Itsines sweat program, Amanda?

Amanda: Yeah, I can like think of her handle.

Emily: Okay, so she, I mean, she’s great. She is, has helped tons of women. So I’m not trying to like throw shade. But I did her program for a while, probably a couple years ago, just to try it out. And after eight weeks of doing it three times a week, and I will just preface this by saying I felt like I was gonna die after each workout. Like I was putting, you know, pat on the back, because I was like, oh my gosh, I am killing it with these workouts. I will tell you at the end of the eight weeks, I was so drained, I was puffier than I’ve probably ever been, I got sick after the end of the eight weeks so I had to stop because I, my body just caught an infection, probably from my you know, immune system being so low from the stress hormones. So that was when I was like, okay, I’m done with HIIT forever. Like this is not for someone who already has that high cortisol, that high DHEA, and so it was when I was just like, I’m gonna prioritize yoga, walking and maybe a little bit of lifting weights and see how that works. And I promise you guys, the harder is not always better. So I noticed a complete reversal in so many of my symptoms. So yeah, that was a really long tangent, just to go off what you were saying. But…

Amanda: I mean, I think it’s good for people to hear and I, I mean, a lot of people probably know I come from that competitive CrossFit background. I was on the rowing team in college. I mean, I was overtraining. I think that’s why I got that PCOS diagnosis when I came off the pill. I don’t think I got ovulation back because my body was just way too stressed out. So it’s just finding a balance. I do think it’s really important to enjoy the type of exercise you do. I would, like, really recommend, like, try different programs. I feel like I still do that. I still like hop around and try something else and see if I like it.

Some of the people that I really, really trust and love their work. One of them is Adina Rubin, it’s @adinarubin_ on Instagram, but if you type in Adina Rubin, it’ll come up. I also follow her so you could definitely find her under the people I follow. And then Libby Westcombe, which I hope I said that right, she’s in Australia, I believe, but she is like, it’s not specifically focused for PCOS, but it’s, like, it’s strength training. Adina is very hormone-minded so if you’re a beginner do Adina’s. She has a whole program you can do at home, she teaches you how to use stuff around your house as weights. If that’s kind of your pace, I would start with her. And then @megsquats is another great follow on Instagram. And I actually did her program for like six months, she, it’s called Strong Strong Friends, we’ll link it in the show notes. But it’s only like $8 a month. And it’s four days a week of strength training. So it’s like two lower body two upper body days. Adina’s is all like full body three days a week. But those are two programs that are very accessible. Adina does coaching if you want to do that.

And then if you’re someone that maybe you’re not totally ready and you want to learn more the basics, Steph Gaudreau has a great book that I can’t think of the name of, but we’ll put it we’ll put it in the show notes, and she has like kind of visuals. I will say for @megsquats program, the Strong Strong Friends, she has gifs of each movement. So you can, if you don’t know what it is or how to do it, you click on it. And instead of watching a whole video, you just watch the short gifs. So she’s great. And it’s true strength training, okay, it’s like you gotta be careful because some people say it’s, it’s strength training, it’s weightlifting. And then it’s like cardio, you know. So I would say experiment with those, start with your bodyweight. I know that it’s not always fun to be a beginner at something. And I think that’s why a lot of women don’t strength train is because they don’t know how to do it. And it is a learning curve. And obviously, you don’t want to get hurt. But if you listen to your body, go slow, learn with your bodyweight first you’ll pick it up. And most women really start to enjoy it because they’re like, I feel strong, and I, when I ended my workout I feel better than when I started. And that’s the goal, right? If this is, how you know if something is too much for you is if you leave the gym and you feel worse, or you’re later in the day and you’re exhausted…it, that’s not, it’s too much, right? It’s not appropriate for this time.

Emily: Yeah, I love that advice, Amanda, because I think that is really…that hits the nail on the head. If you feel better after your workout before, than before you start working out, you are on the right track, because that means you’re getting stronger, you’re giving your body what it wants. And you really can’t go wrong with that. So good rule of thumb.

Mid-Episode Ad 17:35 
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Amanda: And Adina has a podcast episode that I will share in the show notes as well that she has a podcast with this woman, Diane. So we will share that in the show notes. And they talk about PCOS and exercise. And they focus a lot on strength training, obviously, because that’s what they, their main thing is. So we’ll share that as well. And then the last thing I’ll say about exercise is you want to have fun with it. If you don’t love strength training, do it like two days a week and then do something else the other days. Like it doesn’t have to be this, like, prescriptive thing. I think if you struggle with insulin resistance and carbohydrates, then try to prioritize it, because it’ll make it so that you can like tolerate a lot more carbs and improve that insulin signaling. Typically, you feel better. I get a lot of people that are like I love running, or I love biking, it’s like that’s…so you have to enjoy what you’re doing. But again, like when you start tuning into your body, you’ll know when it’s too much. And I would say like intervals right? If you can work some rest into the cardio that you enjoy and let your heart rate come back down. It’s not going to have the same crazy intense type of impact on your body. But you know make changes slowly. You don’t have to immediately be like oh, I’m, if you’re doing like HIIT, CrossFit, or some sort of workout class five days a week. You don’t have to immediately stop, like your body’s probably not going to feel amazing. I would just start looking at how can I start switching this up? 

Emily: For sure. And every body is different, right? So HIIT may not work for me, it may work for some other people. But I think the key is balance, just finding what works for you and making sure you’re not overdoing it, because that will hurt you in the long run.

Okay, so we’re gonna move on from exercise. We’re going to talk about my favorite topic, and this is why low carb is not the answer for PCOS. And if you are an avid listener to this podcast, we’ve talked about this before, or we’ve talked about why low carb isn’t necessarily the way to go. But especially for people with PCOS, who tend to have more of that sluggish thyroid, or those thyroid symptoms, the higher cortisol, the higher androgens—low carb is going to do a lot more harm than good. And I love talking about this, because if you know my story, you know that I tried to go low carb for a number of years. I was terrified of juice, I was terrified of so many whole food carbs because of how they would impact my blood sugar. And a lot of us with PCOS are going to be dealing with things like insulin resistance. So I completely understand if you are someone who is dealing with PCOS, has gotten their blood work back and has been told they’re insulin resistant, or that they have pre-diabetes…whatever it may be, I understand the fear that surrounds many types of foods, because you don’t want to exacerbate that right. 

And I get that, and I think it is, it is a shame because we do put a lot of pressure on women with PCOS to go low carb and to try that, to try the keto, to try the intermittent fasting, to see how it affects your blood sugars. And for awhile it might actually, you know, look like it’s working. Your blood sugars might come down, you might be feeling really good, lighter, like, you’re not in that fatigue wired blood sugar spiral. And that’s great. But here’s, here’s the thing, when we do that for a long amount of time, our problems start cropping up with our thyroid, with our sex hormones, and our cortisol, our DHEA…that can all get worse as we continue this type of eating. And so what we like to tell people is, okay, if you are insulin resistant, why is it that you’re insulin resistant? What is at the root of that insulin resistance? Why can’t we focus on that rather than taking away—I’m doing air quotes right now—the thing that you think is behind that insulin resistance, which in this case would be carbs. Why don’t we focus on giving your body what it needs to become metabolically flexible, right? So being able to eat a good balanced ratio of protein, carbs, and fats with each meal in order to keep our blood sugar stable and to give our bodies the nutrients they need in order to combat that insulin resistance.

And that’s what it comes down to is we want metabolic flexibility. We don’t want to be the people that, you know, we go low carb forever and then the second we eat a cookie we are spiking high and we’re freaking out because oh, this is why I don’t eat carbs. Well, what if you could actually eat carbs and your body knew how to deal with those carbs? That is the goal. And so we don’t want to remove those carbs because the body can’t currently tolerate them. We want to reduce the insulin resistance to improve how our body uses that energy.

Amanda: And this kind of goes back to when we first started the episode and we were talking about doctors tell women with PCOS to lose weight. Even though the whole body fat thing is so much more complex. It is the same thing with carbohydrates. If your body is in a very stressed out state, and you are making a lot more cortisol, maybe you’re not eating enough food…that is going to increase insulin resistance and your, it means your body’s not going to use that energy well. So the first step that we have for women that are struggling with this is to eat enough food. And I know we talked about this in our Nourishing Nutrition Foundation episode, I think it’s Episode Two, but we can’t stress it enough. Because people often want to skip this step. They’re like, should I do this herb? Should I take the supplement? I’m like, it literally doesn’t matter if you’re not eating enough, especially with PCOS.

So I would say one of the best things you can do after tracking your body temps and pulse is getting a gauge on am I eating enough? Or how much am I currently eating? I think a lot of us don’t have a ton of awareness around this. You might if you’ve tracked your food in the past, you might have like a general idea. But if you don’t, it can be really helpful to track your food for a few days and see. Maybe you’re only eating 1600 calories and you’re like oh my gosh, I thought I was eating way more than that. Or maybe you’re eating a lot more than you thought—either way you need that information. So that’s really step one. And then it’s looking at how are my meals balanced with macronutrients, because macronutrients are also very important with women with PCOS and any sort of insulin resistance—they’re going to change over time. Like, for example, when you’re first starting and you’re eating, you’re trying to eat a balance of protein, fat, and carbs. You, if you’re coming from a low carb background, you won’t be able to just immediately jump to eating like a whole potato at a meal. You might not feel great, right? You might not tolerate those carbohydrates. So we always say, like, try to increase the carbs slowly to build on that carb tolerance. And we’re going to talk more about, like, micronutrients that you want to focus on as well, but eating enough food, balancing your meals or protein, fat, and carb. 

And then the third big part of this kind of like energy and take on macros is being mindful of your fat intake. And this is a sneaky one, because when you start eating whole foods and your, you know, you want to get the healthy saturated fats in, you’re eating animal proteins, so many things already contain fat. And then you’re cooking with fat, and then you know, who doesn’t love cheese, you know, then all of a sudden, you’re getting all this fat in your diet…and that, having a lot of fat and a decent amount of carbs, that can actually make it very difficult for your body to process those carbs when insulin resistance is present. This is another reason why we like strength training, because the more muscle mass you have, the more your muscles are going to be sensitive to the fat, like, the fatty acids in the body and then the glucose can be taken up by your other cells. So you add carbs in, say, you start to immediately gain weight, you don’t feel as good…look at your fat intake. You really want to make sure it’s moderate compared to the carbs. And it does take time. Women get very, very focused on like, I’ve been doing this for a month, and I’m not seeing any changes. I’m like, fantastic. How long have you been eating low carb or undereating or dieting, right? Like, you have to look at the big picture. So it takes time for your body to adjust. You’re changing fuels, you know, if you’re undereating, whether you’re low carb or not, you’re using that alternative fuel source, making more cortisol. So your body has to now feel safe and adjust to using this other fuel source. So we would just say, you know, pay attention. If you feel like you’re struggling with the carbs, look at your fat intake, you… A really easy way to reduce it is to do lower fat dairy products. Maybe like, not like cheese, because that wouldn’t taste good, but like lower fat milk, lower fat yogurt, if you’re eating those kinds of foods. And then being mindful, you know. If you’re having eggs, I wouldn’t add a bunch of avocado, you know, because eggs are already high in fat. Getting some leaner protein sources in that can really help. And then that way, you don’t necessarily have to track your food, if you don’t love doing that or if it’s not realistic. And then you’re still making that adjustment with fat and carbs. And that will help make your body a lot more tolerant of those carbohydrates.

Emily: And we totally understand that this is probably, it goes against everything you’ve probably heard. You know, we are such a fat-focused society now, which is honestly a good thing because I was not all about the low-fat stuff either. But again, there is a specific ratio that works for your body and you just kind of have to play with it. And you know, just see what, see what makes you feel the best.

And when we talk about carbs, too, I want to just make sure this is mentioned. We’re not talking about maybe what in your mind, you’re thinking of carbs. So we’re talking about whole food-based carbs. So what does that look like? Things like potatoes, sweet potatoes, parsnips, carrots, these, like, carbs that are rich in micronutrients. Like potassium, for example, is a big one. We have a whole blog post on how certain micronutrients play into blood sugar balance, so go check that out if you haven’t—we’ll link it in the show notes. But potassium is really important for how the body utilizes sugar. So it helps get those, shuttle those glucose in the cells. So it kind of has like an insulin-like effect. And potassium is found in carbs. So things like potatoes, fruit, lots of good fruit, and then coconut water is another good one that we love, obviously for adrenal elixirs.

But another one too is, don’t be afraid of sodium. So sodium also works with potassium and iodine to get thyroid hormone and nutrients into the cell. So as someone with PCOS, we want to be careful about our thyroid, and not only will eating whole food carbs help our thyroid, eating things like sodium, sea salt, with these potassium-rich carb sources…that’s all going to help with both thyroid and glucose. And then we’ve talked about adrenal cocktails. So that’s a great way to get your potassium and your sodium in at a really good ratio because you want to keep those balanced. 

And lastly, we like magnesium, because magnesium is really important for insulin and blood sugar. And it’s important for ATP production. So without enough magnesium, we can’t make enough energy. I mean, we say this all the time. But just prioritizing those four micronutrients is going to be really, really good for things like blood sugar and thyroid health.

Amanda: And a couple of carbs I want to add are plantains, yuca, and I do think that rice and beans work for a lot of people, especially if that is something that you have grown up eating…then don’t fear those foods, you just might need to change the amounts in comparison to the protein at first. But I

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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