A Functional Medicine Approach to PCOS: How to assess and manage PCOS naturally

Polycystic Ovary Syndrome (PCOS) is a multifaceted condition that affects women across the globe, presenting a complex challenge to both patients and healthcare professionals alike. In the realm of functional medicine, a holistic and individualised approach to diagnosis and management is pivotal, offering a beacon of hope for those navigating this often misunderstood condition.

This article delves into the intricacies of PCOS, exploring its diagnosis, underlying causes, and the essential tests that illuminate the path to understanding this syndrome. Moreover, we review conventional treatments and natural remedies, providing a comprehensive overview that not only aids in managing PCOS but also aligns with the principles of functional medicine. Join us as we unravel the layers of PCOS, shedding light on how a functional medicine perspective can transform the journey towards wellness and balance.

 

Polycystic Ovarian Syndrome (PCOS) is a common hormonal condition affecting approximately 1 in every 5 – 10 women of reproductive age worldwide. The primary symptom of PCOS is irregular or long cycles; additional symptoms include excess hair growth on the chin, cheeks, upper lip, neck, nipples and belly (also known as hirsutism), hair loss, acne, difficulty losing weight, low sex drive and infertility. Long term associated risks of PCOS include heart disease and diabetes.

PCOS essentially comes down to an inability to ovulate which then has a knock-on effect of an overproduction of male hormones that are known as androgens. Given that ovulation is about so much more than just making babies (it’s our body’s way of producing hormones that are essential for bone health, heart health, skin health and mood, to name just a few) if we aren’t ovulating, it’s essential for us to figure out why.

But before we do that, let’s discuss:

 

How to diagnose PCOS

Firstly, it’s really important to note that an ultrasound alone is insufficient for diagnosing PCOS.

When it comes to actual cysts on the ovaries, the Androgen Excess Society state that “The finding of polycystic ovarian morphology in ovulatory women not showing clinical or biochemical androgen excess may be inconsequential.” It’s also important to note that the absence of cysts on the ovaries can’t be used to rule out PCOS either because you can have irregular periods and excess androgens and normal cysts on ultrasound but still have PCOS.

The Rotterdam Criteria is what it most typically used to diagnose PCOS. It states only two of the following three criteria need to be met for diagnosis:

1. Infrequent or no ovulation
2. Raised male hormones seen as either physical signs + symptoms (such as excess hair growth, acne + hair loss) OR on blood tests
3. Polycystic ovaries as seen on ultrasound

However, The Androgen Excess Society released a report in 2009 concluding that “Based on the available data, it is the view of the AE-PCOS Society Task Force that PCOS should be defined by:

1. The presence of hyperandrogenism (clinical and/or biochemical)
2. Ovarian dysfunction (oligo-anovulation and/or polycystic ovaries)
3. And the exclusion of related disorders.*”

* Related disorders include hypothyroidism, raised prolactin, side effects from certain psychiatric medications and rare pituitary or adrenal diseases.

The Androgen Excess Society emphasises that raised androgens (male hormones) need to be part of the PCOS picture – it essentially defines PCOS as a condition of lack of ovulation (with irregular or long cycles) together with raised male hormones.

Despite the above criteria, diagnosis can be tricky – that’s because no two women will present with the same symptoms: one woman might be slim, have acne, chin hair, irregular periods and cysts on her ovaries while another woman might be overweight, have thinning of her hair, have long cycles and no cysts on her ovaries. As a result, many women go undiagnosed for years or get misdiagnosed in the process – and that can be incredibly frustrating and disheartening.

What Causes PCOS?

There is no one cause of PCOS but certain situations increase the risk of developing PCOS.

Researchers have established that a genetic susceptibility (having a condition in families) puts one at risk of PCOS but it does not make it an inevitable fate. Genes express themselves based on their environment so even though someone may have the genes that make ovulating more difficult or increase the likelihood of overproducing male hormones, their current environment (nutrition, lifestyle and stress) will ultimately determine whether or not this actually happens.

It’s often said that that genes load the gun and the environmental factors pull the trigger.

Let’s look into these environmental factors further:

Insulin-Resistance and PCOS

One of the main players for the majority of women with PCOS is insulin-resistance. Insulin is a hormone and its role is to get glucose from the blood to the cells of the body for energy production – insulin is essentially “a key” that “opens” the cells. When we’re dealing with insulin resistance, the insulin receptors are no longer as sensitive to the “key” – this means that more insulin is made by the pancreas in attempt to get the message to the cells to open up.

The problem with this though is that high levels of insulin lead to inflammation and have a direct impact on ovulation in a number of ways. Firstly, high levels of insulin cause the ovaries to make testosterone instead of estradiol. Studies suggest that these high levels also stimulate the pituitary gland to produce excess luteinizing hormone which has the knock-on effect of the production of even more androgens (male hormones). Finally, high levels of insulin cause a drop in sex hormone binding globulin (SHBG) production – SHBG is a protein that binds sex hormones so that they can leave the body without causing any damage in the process; when levels of SHBG are low, there’s an increase of free testosterone.

Inflammation and PCOS

Research has found that PCOS is an inflammatory condition.

We’ve just seen above that high insulin can lead to chronic inflammation. Other factors that can create chronic inflammation include poor or inadequate sleep, stress, certain inflammatory foods, food sensitivities, lack of physical activity, imbalances within the gut bacteria, presence of parasites, exposure to toxins, excess alcohol consumption and smoking.

Inflammation in the short term is beneficial: it’s our body’s natural way of protecting itself through stimulating the immune system to produce chemicals called cytokines.

The problem with inflammation is when it becomes chronic. When this happens, the inflammatory cytokines (chemical messengers of the immune system) interfere with hormonal communication throughout the body by disrupting hormonal receptors. Chronic inflammation also causes the ovaries and adrenal glands to make more male hormones (or androgens) which simply exacerbates the PCOS cycle.

Beyond hormonal interference, physical signs + symptoms of chronic inflammation typically include joint pain, skin conditions such as dermatitis or acne, unexplained exhaustion as well as digestive symptoms. If you have any of these, together with irregular cycles and evidence of raised male hormones, then addressing the root cause of your individual chronic inflammation is where you’ll want to begin in addressing the environmental factors driving your PCOS.

How to test for PCOS

There is not one test for PCOS – and considering all of the above, about how differently different individuals can present with PCOS, we can hopefully understand that.

But let’s see what testing can be done to piece your individual puzzle together.

Insulin Resistance

Approximately 70% – 80% of women with PCOS will be insulin resistant. Severe insulin resistance can be detected on a fasting insulin blood test where levels should be below 10 mIU/L. Fasting glucose levels and HbA1C levels are also useful to assess the severity of insulin resistance as well as fasting triglycerides. Another way to test for insulin resistance is through the insulin glucose challenge test – this test is the same as a glucose challenge test with insulin levels measured in addition to glucose levels.

Androgens

Testosterone levels should be in the range of 0.5 – 3.5 nmol/L and are usually high with PCOS.

Free Androgen Index is another measure of male hormones and levels should be less than 5. Again, this will typically be raised with PCOS either caused by an excess of testosterone or a decrease of Sex Hormone Binding Globulin (SHBG).

It’s important to note here that testosterone is made in the ovaries, androstenedione (another ‘male hormone’) is made in both the ovaries and the adrenal glands and DHEA-S (dehydroepiandrosterone sulphate, another ‘male hormone’) is made only from the adrenal glands. The adrenal glands are where cortisol, the ‘stress’ hormone, is also made. If DHEA-S is raised, other reasons for it being raised need to be ruled out. Once this has happened, a high DHEA-S indicates that the triggering of PCOS likely started with stress.

LH + FSH

Luteinizing Hormone is the hormone that triggers ovulation. This should be between 2 – 10 iu/l and it is usually raised in women with PCOS. High levels of LH prevent ovarian follicles developing properly and cause the ovaries to make male hormones.

In addition to this, we typically find that follicle stimulating hormone (the hormone that stimulates the ovaries to mature an egg) is low in comparison to LH. A relatively broad normal range for FSH is 2 – 8 iu/l.

The timing of testing for LH + FSH is key. Even if you have an irregular period, you want to test these hormones on day 3 of your cycle so as to see what these levels are when they should be at their lowest.

Additional Tests

A thyroid panel including thyroid stimulating hormone (TSH), free T3, free T4 and thyroid antibodies should also be considered as hypothyroidism has been shown to worsen insulin resistance, other cardiovascular risk factors and interfere with ovulation.

Low Vitamin D levels exacerbate PCOS symptoms as Vitamin D plays a key role in optimal ovarian function as well as insulin sensitivity. Optimal levels should be between 75 – 125 nmol/L.

Prolactin is a hormone that is produced by the pituitary gland in the brain. Levels above 500 mU/l can cause an increase in the male hormone DHEA and therefore negatively impact ovulation. Levels are usually raised following a traumatic event but can also be impacted by chronic stress and poor blood glucose management, especially recurrent hypoglycaemia (low blood sugar).

SHBG – we’ve already come across sex hormone binding globulin (SHBG) which is a protein produced in the liver and is required in optimal levels so as to keep sex hormone levels in check. In people with PCOS, we typically find that levels are too low which results in high levels of unbound hormones, such as testosterone, floating around the body. In certain instances, these levels can be too high which means that there aren’t enough free hormones available – this is often seen after coming off the pill.

As you can likely tell, testing is not straightforward, and results need to be interpreted together with your clinical picture of not ovulating (with long or irregular cycles) and raised male hormones (as seen in the tests themselves or in physical signs and symptoms).

PCOS Treatment: Conventional approaches

Hormonal Birth Control

The pill is often seen as a ‘solution’ to ‘regulate ones cycle’. However the pill stops ovulation and when we’re dealing with PCOS, one of the primary issues that we want to address is the inability to ovulate so taking something to stop what we want to happen in the first place. This makes no sense, certainly in the long term.

Yes, the pill does suppress androgen production which is helpful but only beneficial for as long as you remain on the pill. Once it’s discontinued, we typically find that androgen production is even worse than what it was to begin with as a result of the androgen surge that can result when stopping the pill.

In addition to this, the pill has been shown to worsen insulin resistance – one of the main drivers of PCOS.

The pill also comes with additional side effects that include negatively impacting our beneficial gut bacteria (that can make it even more difficult lose weight) as well as depleting the body of B vitamins and zinc – nutrients that are essential for optimal overall and ovarian health.

The take home message with the pill is that when we’re wanting to address the root cause of PCOS concerns, it does little to support us with that aim.

Metformin

Metformin is a drug that is typically given to people with Type 2 Diabetes so as to re-sensitise the body to insulin and reduce the absorption of glucose. This at least attempts to target insulin resistance, which as we know well by now, is one of the main drivers of PCOS. Even though useful, studies show that improving diet and lifestyle are more beneficial than clomid and metformin for managing PCOS.

The side effects of Metformin include digestive issues, metallic taste in the mouth (for some) and depleting levels of vitamin B12. If you are on metformin, or choose to take it, please be sure to assess B12 regularly.

Spironolactone

This drug is a diuretic (rids the body of excess salt and water by increased urine formation) and actually intended for high blood pressure, liver cirrhosis and congestive heart failure. It’s used in the instance of PCOS to block the effects of androgens so as to lessen symptoms of acne and hair growth. It usually takes up to 6 months to notice the impact, is only effective when taking it and it can lead to irregular and abnormal periods – again, somewhat ironic when dealing with PCOS.

Natural Approaches for PCOS: Nutrition

When it comes to PCOS, ideally we’d want to get back to whole, unprocessed foods full of fibre, colours and anti-inflammatory properties. This would be a diet full of colourful vegetables, fruits, curcumin, cinnamon, olive oil, avocados and well sourced oily fish.

This is simply a good starting point. Below are a few factors and foods that we would then want to adjust intake of or avoid because of their impact on either worsening insulin resistance or inflammation.

Insulin resistance

A great starting point to address insulin resistance is to reduce the consumption of sugar and excessive levels of fructose. Fructose is a type sugar that can impair insulin sensitivity and enhance appetite but only at quite high quantities. And by avoiding fructose, I don’t mean avoiding fruit – yes, there is fructose in fruit but nowhere even close to the amount that’s needed to impact insulin sensitivity negatively. So please, even with PCOS, insulin resistance or weight struggles, 2 – 3 portions of fresh fruit/day can likely be included in your intake (not fruit juice which lacks the fibre or dried fruit which has a greater concentration of sugar). What we’re talking about here is added fructose in the form of chocolates, sweets, sauces, packaged + processed foods, sugary drinks, yogurts + breakfast cereals and the likes. A lot of these foods also contain high fructose corn syrup (which is not the same as fructose) but which has been linked to increased inflammation, insulin resistance and non-alcoholic fatty liver disease. Other foods to watch out for on the fructose front include dates (especially in the form of energy balls), honey and fruit juices – even though they’re “natural”, they still contain high quantities of fructose.

In order to improve insulin sensitivity, you may need to be strict with avoiding the high fructose and sugary foods listed above until things start to shift. Please understand from the beginning that this can be an extremely challenging (but not impossible) thing to do. To ease matters, try to do this when you aren’t dealing with numerous other external stressors and ensure that you’re getting sufficient sleep. Also know that your tastes will change and your cravings will dampen once you start to eat more healthily.

Reducing carbohydrate intake is the next step to address insulin resistance. This isn’t because carbs are bad at all – this is simply because carbs do cause more of a spike in blood sugar and therefore insulin so reducing them until you become more insulin sensitive can be beneficial.

Excessive intake of fats, especially saturated fats from the likes of high fat animal products like dairy and meats as well as plant based foods like palm and coconut oil should be well managed. Saturated fats in excess have been shown to create more insulin resistance.

So that brings us onto the Keto Diet for PCOS. Achieving a state of ketosis requires a reduction in carbohydrate intake to less than 30g/day. Once in this state, the body then uses ketones as its primary source of fuel. The Keto diet may help to address insulin resistance, achieve weight loss and reduce chronic inflammation in some people depending on how well it has been structured.

However, the downside to keto is that because it’s low in resistant starch, in the long term it can starve our gut bacteria which are dependent on resistant starch as their primary source of fuel. This could potentially lead to imbalances within gut bacteria that can then lead to inflammation and insulin resistance which is obviously not helpful for PCOS. In addition to this, a long-term low carb diet may actually result in losing your period.

A certain amount of carbohydrate is often supportive of ovulation, and that amount is different for everybody. It’s also important to remember that there are other ways to address insulin resistance without having to go into ketosis.

For the 30% of women with PCOS where stress is the main driver, going on a low carbohydrate diet will likely exacerbate matters by putting more strain on the adrenal glands.

Hopefully you’ll see by now that there’s not one diet for PCOS because it’s a syndrome with different drivers as the root cause – so when it comes to carbohydrates, although reducing them can be useful for the 70% of women with insulin resistant PCOS, it’s most definitely not the answer for everybody.

Inflammation

As we’ve established, PCOS is an inflammatory condition. The types of food we eat can therefore either help to quench inflammation or add fuel to the inflammatory fire. If they’re the latter, it’s not to say we should demonise these foods but rather to be aware that they could be contributing to chronic inflammation for certain people.

Gluten

Ah the controversy surrounding this protein found in certain grains! Some people won’t go near it with a barge pole and others would give up their right arm to show their allegiance to gluten. What’s going on?

As with everything, certain factors come into play when it comes to gluten such as our digestive health and of course, our genetic susceptibility. Severe reactions to gluten will typically show up as positive for coeliac disease on a blood test – it’s important to note though that gluten consumption has to be somewhat high a few weeks prior to testing otherwise you could get a false negative result. In addition to this, you might test negative for coeliac disease but actually still have an issue with gluten. This is known as non-celiac gluten sensitivity (NCGS) – research is beginning to acknowledge NCGS: where gluten causes an inflammatory response within the body (experienced as everything from acne, joint pain, brain fog, eczema, autoimmune disease, headaches, depression, inability to lose or gain weight) but might not have any digestive symptoms.

What does this mean for PCOS? If you have PCOS and have an issue with gluten, it could be causing an inflammatory response and as we’ve already established, because inflammation is one of the main drivers of PCOS, it could therefore be worsening your symptoms.

The best way to establish whether gluten is an issue for you is by taking a step back from it completely for 4 weeks (this is approximately how long it takes for any immune reactions you might be having to gluten to dampen) and see how you feel – it is recommended to get guidance on how to go about doing this. If you don’t feel any better after this time then it is likely that you need to dig a bit deeper than your gluten intake. If you do feel better, then you should then also challenge test yourself with gluten exposure to then see if you feel worse again as a bit of a double confirmation.

Dairy

Again, dairy is something that won’t be a problem for everyone but may be pro-inflammatory and contribute to insulin resistance for some. Dairy products can stimulate levels of insulin-like growth factor (IGF-1) – this has a similar structure to insulin and it may cause the storage of glucose in fat cells as well as triggering the production of testosterone. Studies have shown that not only do women with PCOS have twice as much IGF-1 as other women without PCOS, but they are also more sensitive to the effects of it.

The other issue with dairy is linked to a protein called A1 casein. Most dairy products in the west contain A1 casein and this protein can cause the immune system to react with those pro-inflammatory cytokines through an enzyme reaction. Unfortunately testing for A1 casein sensitivity isn’t widely available but signs and symptoms include eczema, asthma, sinus issues, hay fever and the likes.

Again, one of the best ways to establish whether this is an issue for you is to take a step back from it completely for a period of time and see how you feel, similar to the guidance above for gluten.

Well sourced goat and sheep products are fine to include as they don’t contain A1 casein. These will also cover calcium requirements, together with green leafy veg, bony fish, sesame seeds and almonds.

Alcohol

One of the main reasons alcohol is a concern is because it’s metabolised by the liver. The liver is the largest organ in the body with heaps of functions including detoxifying hormones as well as helping to stabilise blood sugar levels (therefore linked to insulin). If liver health is compromised then these functions get compromised and when it comes to addressing PCOS. Alcohol is also considered an ”anti-nutrient” because it can block absorption of certain nutrients, such as zinc, and depletes the body of glutathione – an extremely potent anti-oxidant molecule needed by every cell in our bodies. Alcohol also negatively impacts gut health which as we know, can have an impact on insulin sensitivity, inflammation and weight loss.

Vegetable oils

Vegetables oils such as canola, soy and sunflower oil contain Omega 6 polyunsaturated fat; Omega 6 oils are necessary for health in small amounts (with the best sources being nuts and seeds) but in large amounts, these oils can contribute to the pro-inflammatory process and should therefore be avoided when attempting to address inflammation and insulin resistance. PCOS studies have also shown that higher levels of Omega 6 in blood correlates with higher levels of testosterone.

Trans fats

Trans fats, often listed as hydrogenated or partially hydrogenated fats on food labels, are found in all processed foods to help increase their shelf-life. They are so bad for overall health that even regulators of the food industry have begun to ban them. Just a small amount of trans fats (4g/day) has been linked to interference with ovulation. They have also been shown to block absorption of essential fatty acids which are particular vital when addressing insulin resistance.

Again, everyone is different – these are simply starting points to factor in when attempting to address the main drivers of PCOS from a food perspective.

Natural Approaches for PCOS: Lifestyle

When it comes to PCOS, it should be pretty clear by now that food forms only part of the picture – you can be eating the most suitable diet for you but if you’re dealing with stress (in its many forms) or are exposed to endocrine disrupters, chances are you’ll only get so far in addressing the root cause of your PCOS.

PCOS & Stress

We’ve already explored some of the physiological links between psychological stress and PCOS. If you’re living in the 21st century, it’s very likely that you’ll be dealing with some form of stress in your life – be it work, finances, relationships or health concerns. These are all completely understandable but when it comes to PCOS, it’s essential that we find a way of supporting ourselves through the stressors of everyday life. With many of my clients who are extremely busy city workers, we start simply with including some intentional breathing into their day – be it two to three minutes mid-morning and mid-afternoon. Doing this helps to support the “rest and digest” branch of the nervous system, otherwise know as the parasympathetic nervous system.

It’s also important to note, that stress comes in many shapes and forms with psychological stress just being one of them.

PCOS & Exercise

The next one might surprise you: too much exercise. Yes, exercise is extremely beneficial when addressing PCOS because it can help to reduce body fat, improve insulin sensitivity and level out certain hormones but like many confused and frustrated women I see who are working out hard everyday but end up GAINING weight, you might actually be doing too much. That’s because exercise is a temporary stressor to the body and in order to reap the benefits of all of the above (reducing body fat and improving insulin sensitivity), your body does need time to rest and recover. This always seems counter-intuitive if we’re going by the way too basic understanding of the calories in vs calories out equation: eat less and move more. But take that temporary stressor and turn it into overtraining and we could be dealing with chronically high levels of cortisol that negatively impacts sleep, gut health, mood, weight (particularly around the abdomen) and you guessed it, period health.

So how much is too much? Again, because everyone is different, the answer to that will be too and it will also relate to how well you are eating in relation to the exercise you are doing.

If you’re dealing with chronic muscle and joint pain, ongoing struggles with your period, exhaustion regardless of length of sleep, getting sick regularly, difficulty focusing and/or “plateauing” with weight, it’s worthwhile taking a step back from the duration, frequency or type of workout. Consider strength a few times per week which is especially helpful for insulin sensitivity as is some level of higher intensity interval training. Move everyday, never underestimate the beneficial impact of general daily movement. This is becoming more of an issue as we adopt more sedentary jobs and often working from home. It is not unusual for people to be regularly doing under 5000 steps per day. This is simply not enough and strongly linked with weight gain and insulin resistance.

PCOS & Sleep

Not getting enough sleep is a biggie when it comes to PCOS. Again – you could be eating the most suitable diet for your body, exercising not too much and not too little but be sleep deprived? And Houston, we’ve got a problem! That’s because lack of sleep has been linked to insulin resistance (as well as impaired glucose tolerance) and chronic inflammation, our two main drivers of PCOS!

So, if you have PCOS, aim to be in bed at roughly the same time each day and get yourself a solid 8 hours of sleep. A couple of great ways to get good sleep include ditching any screens for at least an hour before bedtime, dimming the lights in the evening, creating an evening ritual suited to you, saving your bed for sleep and certainly not work, investing in some blackout curtains and putting your phone as far away from your bedside as possible, or even in another room.

PCOS & Endocrine disrupters

Endocrine disrupters are what we know as BPA, pesticides and certain toxins. They’re called ‘endocrine disrupters’ because they’ve been shown to do exactly that: disrupt the endocrine (or hormone) system by altering the way in which hormones are used or metabolised within the body. Research indicates a link between BPA exposure and PCOS so much so that exposure is thought to be a possible cause of increasing the risk of developing PCOS.

Where possible choose clean cleaning products, body lotions and cosmetics, organic food where possible and minimise warm food or drinks being directly exposed to plastics.

Nutritional Supplements to Support PCOS

When it comes to supplementation, there are a few points to make before diving into the details of what nutrients we’re after when it comes to PCOS and why.

Firstly, always, always, always get the foundational factors in place from the get go. While supplements can be very beneficial, if we’re not doing the basics (like chewing our food, eating to regulate blood glucose through appropriate foods and meal timing, avoiding pro-inflammatory foods, addressing stress, getting in enough sleep), then more often than not, supplements will only get us so far.

Secondly, it can be very tempting to knock back every supplement on the shelves simply because you read on some forum that “X” is great for you, or your neighbour’s niece twice removed used “Y” and she now feels great or this guru said take this or that and before you know it, you’re popping or kinds of pills and powders but aren’t so sure what’s what or exactly why you’re taking it in the first place. The point here, is that when it comes to PCOS, we want the nutrients included in supplement form to address the underlying cause, which as we know from above, is usually insulin resistance or inflammation, or a combination of both.

Finally, when you make nutrition and lifestyle changes and start supplements, give everything time. It takes approximately 70 – 100 days for follicles to become mature eggs so I typically say that we need at least 3 months to gauge the impact that everything is having. Be consistent, and patient.

Now that we’ve got that out the way, let’s look at the supplements we would want to consider for the different root causes.

PCOS Supplements for Insulin Resistance

Magnesium is a truly magnificent mineral and a go-to for PCOS. Not only does it improve insulin sensitivity (because a magnesium deficiency interferes with the tyrosine-kinase activity of the insulin receptor) but it is also anti-inflammatory, is involved in the making of steroid hormones and plays a key role in over 300 enzymatic reactions. Be aware of the form of magnesium as some types (such as magnesium citrate, hydroxide and chloride) can have a laxative effect and cause loose stools.

Inositol is a component of the cell membrane. Studies show that it improves insulin sensitivity (by acting as a messenger for insulin inside the cell) and it also helps to induce ovulation.

Vitamin D is gold in helping to improve insulin sensitivity. It’s made through skin exposure to sunlight so depending on where we’re living in the world and your own skin complexion, winter months can often lead to deficiency because even when there is sunshine, the sun is too low for effective synthesis. Other factors that can hamper synthesis include chronic inflammation and a magnesium deficiency. We’re aiming for levels around 75 – 125 nmol/L. Vitamin D testing is relatively inexpensive so assessing for deficiency and also assessing to ensure you are taking appropriate levels is relatively easy and inexpensive.

PCOS Supplements for Inflammation

N-acetyl-cysteine (NAC) is a derivative of the amino acid (protein building block), cysteine. It’s wonderful for inflammation because it is a precursor to glutathione, the body’s chief anti-oxidant. In PCOS, a systematic review indicated that NAC helped to promote regular ovulation.

Zinc not only helps in addressing inflammation but is also a key nutrient for ovulation and helps to address high androgen levels too. One of the best food sources of zinc is red meat so vegan and vegetarian diets do often require supplementation. The pill has also been shown to strip the body of zinc so supplementation is often required post-pill use.

Omega 3 fatty acids are powerful anti-oxidants. A 2015 double-blind clinical trial also demonstrated the benefits of omega 3s in PCOS with improvements in lipid profiles, waist circumference and insulin sensitivity.

Addressing Stress: we know that stress can trigger an inflammatory response so alongside meditation and breathing techniques, adaptogenic herbs, such as Rhodiola and Ashwagandha, can be considered to support stress (and therefore inflammation).

Compromised digestive health can also lead to inflammation so if you have digestive issues, a tailored protocol for your specific concerns is highly recommended.

There is a lot of information in this entire article. In summary, when it comes to PCOS, you should aim to:

• Understand the role of insulin resistance and inflammation.
• Make dietary changes, implement lifestyle changes and consider nutritional supplements based on the above.