What do we do once we’ve identified the root cause of your PCOS?
Okay so in previous blogs we’ve learned about PCOS myths, facts and symptoms. We’ve discussed androgens in-depth. We’ve even talked about the role insulin resistance plays in our acne and why balanced testosterone is important. But what about treatment plans?
First, let’s talk symptoms
Before we get to treating you we have to diagnose you. We ensure all our clients have thorough investigations through blood pathology, functional pathology (including the DUTCH method if required).
But sometimes testosterone levels can be within the normal range but patients still present with androgen-related acne. This can be due to the increased local production of androgens within the skin. In these cases we can also potentially identify androgen excess through symptoms like irregular menstrual cycles, short fuse, excessive hair growth on belly, nipples and face, hair loss and weight gain.
If your acne cleared up whilst you were on the pill or an androgen blocker that’s also a sign that your acne is hormonally driven, and this will guide our treatment plan. Just FYI, we can also help you come off the pill and prevent post-pill acne.
Okay get but get to the treatments already!
There are two main ways to tackle androgen excess – dietary intervention and lifestyle intervention. When it comes to diet, we’ve found many women with PCOS to be deficient in certain nutrients and that directly affects insulin function, testosterone production and ovulation. These are also nutrients which are depleted by the pill!
#1 Increase zinc
Zinc is required for more than 300 different bodily pathways and its primary role in supporting skin health is in its regulation of testosterone metabolism. Our body doesn’t have a storage back up for zinc, so we need to make sure we are maintaining healthy levels through diet and supplementation.
Women over 19 need approximately 14mg of zinc per day to meet our RDI (recommended daily intake, though this doesn’t take into account individualised requirements). However in clinic we’re often prescribing anywhere between 25mg – 50mg per day to ensure we’re optimising your zinc levels.
Typically we can identify zinc deficiency through signs and symptoms though we often also do blood tests. Acne is a potential sign of zinc deficiency as well as anxiety, depression, poor wound healing, gastrointestinal inflammation, white spots on nails, scarring, dry and dull skin, poor appetite, poor sense of taste and smell, elevated testosterone and irregular menstrual cycles.
Dietary sources of zinc can be quite difficult in a vegan or vegetarian diet and this is something we screen for in our clients.
Some good food sources include; oysters (6 oysters is 76mg zinc), beef (85g cooked is 8.9mg), crab (85g cooked is 6.5mg), pumpkin seeds (30g is 2.25mg), sunflower seeds (30g is 1.75mg).
#2 Increase magnesium
Magnesium deficiency has been shown to worsen insulin resistance in PCOS due to its role in supporting glucose metabolism. Magnesium supports blood sugar regulation by improving sensitivity of the insulin receptor. It’s also been shown to directly reduce inflammation, which may be caused by insulin sensitivity in the first place!
Just like zinc, magnesium is required for hundreds of different pathways in the body. Magnesium deficiency can present as: painful periods, headaches, muscle pain and twitches, insomnia, anxiety, depression, poor energy, insulin resistance, irregular periods.
Basically, magnesium is an essential mineral for everything! Deficiency can arise from a combination of inadequate dietary intake, poor absorption in the small intestine, increased excretion due to elevated cortisol and high protein intake.
On average, women over 19 need approximately 400mg per day, whilst the therapeutic dosage range when we are prescribing in a supplement can vary from 300-1200mg. There are so many different forms of magnesium but that’s where we can decide what is right for you and your condition!
You can find magnesium in your green leafy vegetables and foods including almonds (30g = 80mg of Mg), Spinach (1/2 cup = 78mg of Mg), cashews (30g=75mg of Mg) and brown rice (1/2 cup = 42mg).
#3 Increase dietary fibre
When addressing androgens we need to reduce the trigger of elevated testosterone but we also need to help support its excretion out of the body. By increasing dietary fibre (such as flaxseeds) in the diet, we can work towards increasing SHBG. This will help with binding to all the free testosterone circulating around and reduce its ability to act on cells!
#4 Reduce inflammatory load
We’re always talking about inflammation, but that’s because it’s so important. By avoiding some of the key modulators inflammation, ie: dairy, gluten, sugar, caffeine and alcohol for 12 weeks this allows us to really focus on as many underlying drivers of inflammation as we can.
We also have access to some really great tests that can further assist us with identifying dietary triggers that may be causing you inflammation and flare-ups of your acne. We also ensure our clients are optimising their omega 3:omega 6 status to reduce the production of pro-inflammatory mediators that could be aggravating your condition whilst optimising the production of anti-inflammatory mediators.
Some ways we reduce inflammatory load include:
- Reducing (or eliminating depending on the source) omega 6 in the diet: high intake of almonds and other nuts, canola oil, soybeans, corn, sunflower oil, meat, dairy and eggs. Too much Omega 6 in the diet can directly affect the quality of our cellular membranes and negatively affect hydration of the cells and inflammation/redness associated with acne.
- Increasing omega 3 in the diet. Ie: get as much oily fish as you can! Sardines, herring, mackerel and salmon are our favourites. Omega 3 is essential in high concentrations within every cell and will govern our nutrient absorption, inflammatory reactions and quality of our skin integrity. Omega 3 actually helps with producing short chain fatty acids within the gut that help with strengthening the gut lining that acts as a gatekeeper for pathogens. If that gut lining is weak, we can have more bacteria and toxins pass through the gut and end up on our skin! We tend to have too much omega 6 in the diet and not enough omega 3 – setting us up for an inflammatory storm!
#5 Regulate blood sugar
Our Clear Skin Experts diet teaches you all the tips and tricks on balancing your carbohydrates, fats and protein within each meal to help stabilise your blood sugar and avoid those highs and lows throughout the day.
When we are consuming high sugar foods (chocolates, lollies, sweets, refined sugars etc.), this will drastically increase the amount of glucose in the blood and what comes up must come down so you get this dip in your blood sugar. We work with you to try and stabilise this through the below methods so you can have an even balance of glucose in your blood without the highs and the lows!
- Ensuring that you are having a complex carbohydrate with every meal allows for a slower release of glucose within the blood and avoids having any drastic highs or lows that could mess with your hormonal signalling. Complex carbohydrates include brown rice, oats, fruits, vegetables, legumes and other whole grains.
- Avoiding prolonged periods of fasting – much to medias disbelief, we aren’t always pro fasting for our clients! This can work for some but not for all, a prolonged period of fasting may cause dips in your blood glucose (especially if you already eat low carbohydrate) as you haven’t eaten for a little while. Testing through the GP can assist us with identifying if this may be an issue for you.
- Prescribing Inositol – Inositol is a B vitamin (B8) which we have in our toolbox to support blood sugar regulation that may be impairing ovulation. When the cell needs to allow glucose to enter, insulin will act as the key for the gates but inositol is actually what allows the gates to open. Women with PCOS have found to have a deficiency in Inositol within ovarian cells which can actually happen as a result of having elevated blood sugar. Through changing the diet and through supplementation we can work on correcting this blood sugar imbalance, improving the ovarian cells receptivity to insulin, decrease testosterone production and improve ovulation!
Exercise is such an important part of treatment when managing PCOS – it is essential for reducing inflammation, improving insulin response and supporting detoxification pathways as well. Your exercise prescription will vary depending on the type of PCOS and we would recommend you speak to an exercise professional about what may be most suitable for you.
In terms of insulin resistant PCOS, studies show that exercise may assist with improving menstrual cycle regularity and improve body composition. Weight loss may then improve insulin receptor sensitivity, signalling of testosterone production and ultimately reduce sebum production! In adrenal PCOS, it can often be the opposite and we need to make sure you are doing a lot of restorative practices to allow your adrenal glands time to find it’s balance and reduce this over stimulation.
#7 Restoration and relaxation
Incorporating rest and relaxation is the primary part of many of our scripts! When there are elevations in our external or internal sources of stress, we have an increase in the concentration of a specific hormone within the skin called corticotropin releasing hormone (CRH) to help our bodies adapt to that level of stress.
CRH regulates the function of the sebaceous gland which controls sebum production, therefore more stress = more CRH = more sebum production within the skin as well as impairments with proper cell division and inflammation! This constant elevation in stress requires high amounts of vitamin C and B5 to keep up with the amount of stress hormones being produced and both are so important for skin repair, controlling lipid metabolism within the skin, collagen production and reducing inflammation.