It's important to not ignore when you're 30, the things that could be an issue when you're 40 or 50. So having good blood sugar control in your 30s is critical, because when you hit perimenopause and you develop insulin resistance just because you're in menopause, you're going to like that. You already have the tools to know how to lower that insulin resistance to begin with, because you've had PCOS before, so you've been dealing with that.
So you know what? These are the tools that work for me in order to not let me become diabetic, PCOS or polycystic ovarian syndrome occurs in somewhere around 10% of women. And yet it's still really poorly understood, especially by patients. It can be really confusing. I have patients all the time who say, one doctor told me I did have PCOS, the next doctor told me I didn't have PCOS. And how do I figure out this answer?
Our guest today is Doctor Jen Rowlands. She's a board certified ob/gyn and integrative women's health specialist, and she treats women with PCOS every day. She herself struggled with PCOS and hypothyroidism and really shares that experience of what it's like going through that frustrating process of getting a diagnosis, but then jumping into what do I do about the diagnosis? She's going to share all of her tips and tricks on both sides of that question, including sharing with us one of her favorite treatments for polycystic ovarian syndrome, which is really underutilized and undervalued. The beauty of PCOS. We talk about kind of all the negatives, but man, PCOS women are warriors, right?
Thanks for coming, Doctor Roelands. Thank you for inviting me. I'm so excited to chat with you. I am too. This is an area that I think really resonates with a lot of people, and it can feel really confusing and like, what is the truth about this? I have a lot of patients who will say, well, one doctor told me I had PCOS, another doctor told me I didn't, so we're going to dive in. This is going to be very instructive. So I hope people will have a pen and paper if they're wondering about PCOS, so they can write down all the great tips you're going to share with us. Doctor Jen is a mom of four and has also struggled with PCOS and hypothyroidism herself, and now works as an integrative ObGyn, helping women to overcome these same issues.
So thank you for sharing what will be your own personal story, but also sharing your success of how you are helping these women really thrive with these diagnoses. Thank you. I'm excited to chat about it. PCOS is definitely a passion of mine personally and professionally. Yeah, well, I think we'll start with your own. I'd love to hear a little bit about your own story with PCOS.
And then why don't you incorporate into that or right after that. What is PCOS? Because I think that's a big question. I think that'll flow really nicely. Yeah. So I think like a lot of us who do functional and integrative medicine, we often have our own personal experience with the deficit in medicine about really understanding some conditions.
So when I was I was easily able to get pregnant with my first child, and then I was trying to get pregnant for my second, and nothing was happening like, no, it was not working. And I was starting to develop very irregular cycles, terrible acne, very fatigued. And I kind of suspected I had PCOS. And so I saw my own OB, Joanne, who said, no, there's no way you have PCOS because you are thin, like you're skinny.
We don't, we don't. You don't have it. There's no way. So I was sent to a fertility doctor and an area doctor who also said, I don't think so. I don't think that's the case. You should just keep trying and it'll eventually happen because you're only 29 years old. And so for me, I was kind of frustrated, just like most patients are, where they kind of get dismissed about what they know internally is really the right answer.
And so I ran my labs. The beauty of being a doctor is you run your laps, too. And at the time, my testosterone was actually 60. And, my free testosterone was like six. And the upper limit of normal there is 40 to 50. And the free testosterone is, I think, at five for. Yeah, yeah. So, it was high.
And then ironically, my thyroid antibodies came back as a thousand on each of those, and but my TSH was completely normal TSH, normal T4, normal T3 normal like. And so I kind of suggesting some autoimmunity against the thyroid, but the thyroid itself was still functioning just fine. Yes, yes. But clearly I met the diagnosis for PCOS and I had the this I mean, I didn't have hair growth, but I certainly had very horrible acne, very irregular, like every three month cycles.
Like I had kind of made that definition as well. And so at the time I, you know, went back to the fertility doctor and said, here's my issues, right. I don't have now this body Hashimoto's going on here. And then also have PCOS and by definition, PCOS. You know, there's a lot of different argument about, which criteria to use for diagnosis.
But the Rotterdam criteria, which is sort of the older the old school version is, you got to make two out of the three for diagnoses. So irregular cycles, evidence of high androgens either by blood work or facial hair or, cystic deep acne or on ultrasound. You see these cystic appearing ovaries. And then, you know, over the years they've sort of added some criteria for, for using as well.
You can do an image level, you can do some other factors. And it depends on some of like the androgen. The society has different criteria, but a lot of doctors go from the old school Rotterdam criteria for diagnosing PCOS. So by definition I had made that I had had a regular cycles, I had signs of it and I also had a high testosterone.
And so for me, I ended up having to use medication to try to how to use ovulation medication was very common that we use with women trying to get pregnant, called Clomid, to, be able to get pregnant for my second kiddo. And then ultimately, after I delivered that baby, I, you know, I did what every other PCOS patient does.
I was put on birth control, and put on synthroid, and I was noticing, like I was getting terrible anxiety from the birth control. So then I was given Zoloft, but then I couldn't sleep without a laugh, despite working 30 hours or 80 hours or, you know, all the crazy hours, which is so midway. And so then I was told to take Ambien.
So it kind of led to this constant. And overall, even with all those medications, I still was exhausted and still was feeling my cycles. Never really got regular. It just like things were never really working very nicely. And so for me, I was then going, well, there has to be more that we know that medicine is not told us.
I can't be the only person with our problems that feels like I need four cups of coffee. I was drinking 4 to 6 cups of coffee a day and just struggling with trying to still have acne and all the things that were not working, really with the pill. And so ultimately, I dove into nutrition and took an Institute of Integrative Nutrition course and was like, whoa, who told me that food is medicine?
Like, remember that tiny, tiny little course in medical school called nutrition? And then there was like for like for afternoons or something, and that was it. I just was shocked. Like, no one said anything about antibodies could be affected by your gut. No one said anything about Hashimoto's. Patients sometimes have gluten intolerance or dairy because of the location of those absorption in the in the intestine.
So none of this stuff was ever said in medical school. So for me, it kind of blew open a door to whoa. And I started thinking about patients. I had kind of said the same thing that other doc that the my doctor had said to me, like nothing else we can do, here's a pill, nothing else we could do, here's synthroid.
And so I was now seeing patients very differently in my mind. Like, maybe I should actually be telling them that these things are important to use, just along with synthroid and along with birth control pills. So it led me down that path of thinking about food as medicine, and ultimately ended up doing the Andrew Wilde program, which is a two year fellowship and also functional medicine courses, and then kind of essentially seen medicine, very different medicine.
3.0 yeah. Yeah. Well, thank you for sharing that personal journey with you, because I think it is really helpful to hear first hand how frustrating this journey can be. I've had so many patients that come and say, as I mentioned earlier, you know, my doctor told me that I didn't have PCOS, but I don't have periods and I have this hair growth in this acne.
So according to my Google research, it seems like I do have PCOS. It can be really frustrating for patients. Why do you think that still is happening? I mean, the diagnosis of PCOS is not that complex. There are much more complex things and functional medicine that we see that the diagnosis is so much more difficult. But PCOS is not one of those things.
So why is it that we still have so many women who are like, do I have PCOS? My doctors don't seem to agree. So I think there's actually two things that happened in medicine that I think are unfair to PCOS women. One is they're not getting the diagnosis, and two, when they are, they're being having it treated as a giant only problem, which is an issue.
So not getting the diagnosis, the word syndrome basically is it's not a disease, it's a syndrome. So it says you have to exclude everything else. And then the constellation of these symptoms mean that you're in this syndrome. And, you know, you and I have both see patients where they had the symptoms. They saw, you know, they had the hair growth and they had the irregular periods.
And then their testosterone comes back normal. And other doctors have said, oh, no, it's not PCOS. So it is a little confusing when you give them both choices to make a decision. And I've even had patients who've worked so incredibly hard on fixing their PCOS and and reversing them. And then their testosterone is normal. And then they go to their doctor and their doctor says, well, you don't have PCOS anymore.
It's like, yeah, no, it's called controlled PCOS, okay? It's actually under control. Like just as if you had thyroid antibodies. And then now you've cleaned everything up and they're negative. So I think people get dismissed from both ends, the initial diagnosis. And then once they have it in, they actually reverse their symptoms and feel great on it. They're like, oh no, no, you don't have it anymore.
It's like, wait, she's actually feels great because she's now eating for insulin resistance and she's lowering her inflammation. She's doing all the things she's supposed to do. And so therefore it seems as though she doesn't have it anymore, which isn't true. Yeah. Yeah. So I think that's part of the issue. And I do think we don't recognize the metabolic aspect of it, do you?
It's not just that you and province ultimately a metabolic problem. So someone will come in and say they have prediabetes. So we're focused so much on sending them to endocrine about prediabetes. We miss the bigger picture that it's actually part of PCOS. So it's a bigger scheme of what's going on with that patient as opposed to just oh, she has prediabetes.
It's like, yeah. But does she also have irregular cycles? Does she also have acne? Does she also have anxiety? Does she also have you know what I mean? The bigger of the whole body approach will. So let's I want to recap that. So so the diagnosis for PCOS, as much as I don't encourage patients to self-diagnose this one, I actually think you should know.
So you mentioned before the idea of having a certain look on ultrasound. I don't always do a pelvic ultrasound on PCOS patients because oftentimes it's so obvious that it just doesn't need the money. But you can have a particular look on ultrasound and that's Google able information. What is the criteria for a pelvic ultrasound. And then you also mentioned irregular cycles.
So that right there if a patient is having cycles more than every 35 days I think is the idea. But most PCOS patients it's like, well sometimes they're 35 and sometimes they're 60, or sometimes they're every 50 days. Or sometimes I have two a year. That's irregular cycles. That's an observation. And then the third criteria then is signs of elevated androgens.
Or are the male like hormones testosterone. And it's the main one that we usually measure. And that can be physical symptoms like hair growth on your lip or chin, hair growth on your breasts or abdomen, and then also, deep cystic acne along the jawline or sort of the classic things. You can have a positive blood test.
As you mentioned, yours was, is your testosterone was actually elevated in your blood, but it doesn't have to be in blood if you have the symptoms, on your face, that's enough. So that's kind of the general criteria. And two out of three are generally accepted. You mentioned also the anti-malarial hormone or the AMA. We think of that more fertility.
But in, in PCOS it can be quite elevated like in the teens or 20s. And that can be consistent with PCOS as well. Will you share with us what are some of the other classic things that go along with it of of that aren't necessarily part of the diagnostic criteria, but things that, that it's very common to struggle with, with PCOS.
You mentioned insulin resistance. Will you mention any other things that come along with PCOS? Yeah. So if you Google symptoms of PCOS or signs of PCOS, you're going to see at least 60 in there. Yeah, yeah. And that's because if you look at it from a metabolic standpoint, the the triad of insulin resistance, inflammation, gut health issues you can have throughout your lifetime.
You have PCOS, different of those that drive whatever symptoms you're having. So if you have insulin resistance so your fasting insulin is elevated or your hemoglobin even C dictates that you're actually pre-diabetic, then you may have weight gain. You may have the dark patches. You might actually have cycle changes because that blood sugar actually interferes with ovulation. Or you may have higher androgens because it also causes elevation in androgens when you have high insulin.
So you can have sort of all the symptoms that are related to that particular driver. And then so if it's inflammation you could have bad anxiety, you could have bloating, abdominal pain, GI like people get diagnosed with IBS all the time with PCOS you can have vitamin D deficiencies, vitamin B deficiencies. Because of the inflammation in your gut, you can certainly have food allergies that can develop.
And then here, you know, hair growth can be affected by insulin. It can be affected by androgens. It can be affected by inflammation, like all of those things can give you this sort of male pattern baldness or even just hair falling out in general. And an inflammation pathway to there are more comorbidities like Hashimoto's is much more common in women who have PCOS.
So you tend to sort of see those things in the inflammatory pathway. And then the gut pathway again, we there's so a lot of good research now on microbiomes that are different with PCOS, which is which I love. There's actually an older study that looks at the gut and the different changes in bacteria associated with PCOS women. And so you would imagine since estrogen is metabolized in the gut, you're going to have some gut health problems.
And that can sometimes feel like someone says, you know, I get bloating all the time. I have IBS symptoms where I have diarrhea, constipation problems. You may break out more because your gut is is inflamed. So there's there's a lot of symptoms depending on what the drivers are. And even when you get into, say, the perimenopause PCOS patient whose ovaries are not only kind of making the wrong distribution of the hormones, but now they're like on their way out, we're making a lot less, you see, sometimes these exaggerations of things that come in the rest of their metabolic, parameters like elevation and height, you know, getting high blood pressure, getting high cholesterol,
develops and kind of these metabolic syndromes that happen because of the dysfunction of the sex hormones. So there's a lot of different signs and symptoms because not everybody is the same. And you and I kind of talked a little bit about that before. In Western medicine we do kind of put everybody in a everybody's PCOS category. But in alternative medicine and even like naturopaths, they often describe it as, type a PCOS type depending on where, what's the driver of their symptoms.
So an adrenal type or a, insulin resistance type or a thin person, you know, like those are all different drivers. And so they've typed and we don't really type them in Western medicine, it's more like everybody you have PCOS in the same bucket and it can be very different. I described to patients my PCOS is can be very different than yours.
I didn't have much of an insulin resistance problem most of my life. More inflammation. You can imagine with thyroid problems. And so yours may be mostly insulin resistance. That's a problem. And so that's how we have different symptoms. And it's helpful then to understand that because if you Google like how do I treat my PCOS. You'll find a lot of different approaches.
And I think the main one that comes up is dealing with blood sugar. But if you go to the lab and you don't have abnormal blood sugar, you're going to need another approach. And so it's helpful to understand kind of how this is showing up in your body. I also think that, you know, there's not a lot of reasons for periods to be spaced out like that.
It's more than just PCOS, but it's not a lot more than PCOS. You know, there's hypothalamic amenorrhea, which is where our brain is saying don't ovulate. But of that, there's not a lot of other causes we understand. And I think as an ob gyn trained conventionally, we were just told if if it didn't fit the PCOS criteria, then it's some we call it dysfunctional uterine bleeding.
Then it's just I don't know. That's what it's called I don't know. Yeah. But I think more and more as we learn more about PCOS, PCOS is sort of encompassing this and ovulatory cycling. So let's move on then to what causes PCOS and why does it seem to be increasing? So no one knows exactly what causes PCOS. There's a lot of theories.
Certainly there's the theory that genetically you're predisposed to PCOS and, and it's likely an ovarian, a gene that affects ovarian production, right, of, of estrogen. And so you essentially you're not able to make the appropriate estradiol that you need. But there's also other theories like sort of this is where that triad sort of becomes confusing. It's like does someone actually develop an insulin issue and therefore then derails the sex hormones, or is it a sex hormone issue that derails the inside and then causes inflammation and then messes your your sex hormones like this sort of little triad that happens.
And so there are a lot of theories as to, exactly why does someone develop it. And there's even some great evidence and theories about, you know, you were sort of like like maybe the generation above, you determined that you might have PCOS. So their lifestyle and their insulin resistance. And exactly, there's a lot of newer studies now that really looks at the fetus and like an eggs of the mother, like, like how much can we determine if someone's sort of predisposed and things set that gene in motion to say, okay, you know, she maybe was destined to have PCOS, and then she ate poorly as a kid and now she developed it kind
of thing, for example. So there's still no one really has an exact answer as to what it is. We do know that the ability to make estrogen and the ability to really convert testosterone, estrogen is clearly a problem, right, with women. Yes. But as far as like, could you say, here is the test and this is why you got it not really doing any.
Yeah. Yeah. But also autoimmune I think of it sometimes. And this is in not in any way saying that that's what medicine says. But I do somewhat think of it along the same lines as what we do. We think about with autoimmune issues, like people are sort of adults and then something triggers it to say, okay, here you go.
Like often pregnancy on women for like thyroid, right. They they're likely to get thyroid problem and then they get pregnant and then wham postpartum they develop Hashimoto's. So yeah you never know what the answer ends up being for that. But, we do know that there are things that affect your development. Certainly lifestyle is a big factor.
Certainly endocrine disruptors, toxins that we're exposed to all the time. It's not helping. So whether or not, you know, hopefully in our lifetimes we'll be able to find the exact cause of why someone gets PCOS. But it's not right now. It's not accepted theory for everyone. Yeah, and that's helpful to understand why. It's kind of annoying because it's not it's not a black and white diagnosis.
There are some of those out there, but this is not one of them. It's it's like I said, it's kind of simple to diagnose, like it's not a major puzzle to figure out if someone has PCOS, but the why and the root causes and what's going onto it is a little bit more of a smattering of different factors that play into that, that make it difficult.
So help us to understand then what is your approach when someone comes to you and says, you know, I think I might have PCOS or my my other doctor said, I have PCOS. How how can you help me? Do you have an order of operations or what is your general approach when dealing with a patient with PCOS? Yeah, so I first ask him those questions like do you have irregular cycles?
Yes. Okay. Women often have these symptoms and signs. Do you have those. Do you have really deep cystic acne. It's not the kind of has little pimples that you can pop at the deep stuff. That's painful. Do you have a jawline you're pointing to? Yeah. Jawline. And do you have hair growth in what we would usually consider like male areas right along like a your jaw, your mustache, along your belly, like a line going up and down or, you know, along the breast.
Do you have those symptoms, yes or no? Have you ever had blood tests to see what your hormones look like? And I do strongly recommend people when you get blood tests, you need to make sure you know what day of the cycle it is, because. Q I mean, can we just say that again for the people in the back?
I can't tell you how many times patients come to me with lab work. And I say, what day of your cycle was this on? And they say, I don't know. They didn't tell me to go on a cycle. I know my hormone tests don't mean anything unless you know where you're at in your cycle. Now, if you have crazy cycles, then we just interpret it based on that.
But so yes, thank you for saying that. Yes, that's a big pet peeve of mine as well. It drives me crazy when, yeah, they're like the doctor said it was normal. I'm like, well, the range of hill is ginormous. So like, I mean, yeah, I mean if you had no progesterone, were you day 21. That's a problem. Were you day three okay.
Not a problem. Yeah, yeah. So we need to know where it is. And, and that's kind of, you know, that feeds into that whole other conversation about perimenopause too. Like, is it wrong to test them or not? But I think, you know, they need to. Did you have bloodwork? Did you have appropriately timed? I also you mentioned testosterone, but I also look at the adrenal contribution of androgen.
So when I do blood work I don't I do total testosterone free testosterone, DHEA, DHT, S and DHT. So I look at the steroid pathway that everybody loves and try to figure out, because some people have super crazy high DHEA DHT and they don't have they have somewhat decent testosterone. So you kind of want to know where is the androgens that are coming from which which direction, like coming from the adrenal is sure that coming from the ovary issue.
And then I also when I do bloodwork for patients, once I make a diagnosis, I always include vitamin D because there's a up to 80% chance that vitamin D deficient. I always clear thyroid panel full thyroid testing. I always include CRP for inflammation. I always include B12, so I do include more of the bigger whole body approach. Iron I often do iron panels too, just to kind of you mentioned earlier the blood sugar markers too.
Yeah. So fasting insulin. So the standard in Western medicine is usually hemoglobin A1, C, which is a measure of the last three months of your blood sugars. But that doesn't the cut off is like are you diabetic or are you not. So fasting insulin. And even if you were lucky enough to get a fasting glucose and do the ratio is a much better test in my mind to say, okay, you have prediabetes or you have, insulin resistance to know, then is this part of your PCOS or just maybe you have a metabolic syndrome.
Do I mean. Yeah. So I approach it that way. And then once I get bloodwork in an analysis then we can talk about what feels good from a treatment plan to you. Because when you do a functional and integrative medicine, they're patients who are like I would like to be on a birth control pill, I would like to be active and I would like to be on metformin, the traditional options.
Great. I have other patients. You don't, you know.
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And then also some of the supplements that you use and then also some of the lifestyle things that you use. Let's start with the prescription options. Yeah. So I describe to patients, you know have you multiple had to meet. You have multiple buckets. And you can choose from each bucket what you think makes sense for you. Yeah. So here's a lifestyle nutrition only here's an herb supplement and and lifestyle nutrition or here's herb supplement lifestyle nutrition and medicine.
Like we can pick all of these. So from a traditional medicine standpoint we usually put women on birth control pills because we're trying to keep their cycles regular. And we're also lowering androgens. And we're kind of like giving them the perfect conditions. From a Gyn perspective, if it doesn't do anything for fixing insulin resistance, if you have it, it doesn't do anything for fixing inflammation if you have it.
So if you're looking to do that, you have to look at the other Western medicine medications. So things like metformin help with lowering insulin resistance. And then Sparano lactose is a lower androgen medication that helps for people have really bad acne. So you use those. You kind of in my mind you're you're using a medication per symptom, right?
A medication per thing in the Western medicine category. And the alternative being in mind that that none of those are actually fixing anything now. They're really good symptom control sometimes. And they're they're pretty good band aids. Yes. So there's still good reason to use them. But it's important to understand that it's not a cure. It's not healing anything.
It's not even rebalancing anything. It's just forcing the body to do what you want it to do. Which has benefits. It has has good sites, but it's a little bit it's it's just important to understand that at the end of that, when people go off of that, sometimes they're surprised when it's like, oh, my periods went away. Well, of course they went away because we never fixed anything.
We just were mechanically forcing a period once a month, and then we stopped doing that. And now you're just back where you started. Exactly. Yeah, exactly. It's it's it's definitely a treat a symptom problem. Yeah. Yeah yeah. And it and doesn't help you where I don't like that approach in some ways is it doesn't help you in the future if you're 25 years old, guess what?
You're set up for a heart attack. Guess what? You're a set up for diabetes. Guess what? You're set up for high cholesterol and hypertension and all these things that you haven't done anything. You know, as we know so much more about longevity medicine, we know the health of what you wear earlier affects the health later. So if you're not doing anything for that preventative medicine strategy, you're going to hit 40 and it's going to be a whole nother ball game.
Yep. So in the sort of alternative medicine or integrative medicine, we look at those root causes. We look at does someone have insulin resistance. Great. Now you have insulin resistance. Would you like to use herbs to lower it in conjunction with nutrition like so. You need to eat for your for you eat for you and lifestyle factors to help you.
Do you know if it's inflammation? What are you being exposed to? What are you putting on your body? What are you putting in your body? Do you have other comorbidities that might be making your inflammation go up? So you have to sort of, use supplements, herbs, lifestyle based upon those particular drivers specifically. And certainly if it's gut health issues, you definitely have to look into, maybe you have a food.
I mean, it is fairly common for women who have multiple things like Hashimoto's and PCOS to not tolerate gluten, to not tolerate dairy, to not tolerate certain foods because of the inflammation, a leaky gut they've developed. So therefore they have to change those things. And I'm a very big fan of personal nutrition. I drives me crazy on Instagram.
When you see these people who are like, everybody should be dairy free and gluten free and you know who I'm referring to? I just it's like, how do you make a personal statement when there's so many different types of women with PCOS and say, everybody should do that? I think that's unfair because not everybody has that problem.
It needs to be personal. And and along with nutrition, it needs to be personal. For how many kids are you feeding? What are the food you can afford? Do you do do you have to do drive through because you're taking kids to soccer five days a week? Do you you know, you have to kind of put some of that into someone's nutrition plan to make it a lifestyle.
I'm so glad you say that, because I think even as functional medicine doctors, it's really easy for us to sometimes just get in our mindset about the steps and without actually seeing the person in front of us and saying, you know, it's not easy for people to put these steps in place, especially depending on various circumstances in life.
And so that's one of the things that you and I like to do, is to help them figure out what is the lowest hanging fruit that we can do easily. And honestly, that's when I think that medications can have a place is sometimes people aren't at a place where they can make giant lifestyle changes, but they can start.
And in the meantime, we can help their blood sugar with metformin or inositol or berberine. You know, like there are things we can do to kind of help jumpstart them while they're working on walking after a meal or decreasing processed carbohydrates and focusing on fiber rich carbohydrates. Right. There's this is what you're talking about is that we get to combine things based on the person sitting in front of us.
But I'm so glad you you bring that up about being a soccer mom or doing other things, because it's really overwhelming to women to just hear the advice and be like, how on earth am I supposed to do that? That means that I'm stuck. Like, I guess I can't get better because I can't do those three things that they told me I had to do.
Well, thank you for closing it that way. I mean, even GLP is I use compounded GP's with PCOS patients all the time. You know, it's not a thing where I feel like sometimes when you start breaking that inflammation insulin resistance cascade, it's motivating, right? If you're someone who struggled with weight and struggled with acne and struggle with anxiety, and someone gives you a little small microdosing GLP and you now are, what you're doing from an exercise and lifestyle is resulting in success.
It's motivating, you know? And so I think I'm not against medications at all. I think there are a lot of times they're great bridges to a long term solution, and a lot of times because once again, I'm here. It's motivating when things actually start working well for you. And I do think that some people need to be on them because they just don't are not able to have the time to be able to figure out what's going on with their life, and can't use something like a CGM to figure out what foods work for them.
They just don't have the time. So I think medications. That's why integrative medicine is so great as traditional and evidence based, alternative and put together. So you can kind of make a mix for that patient, you know. Yeah. So let me interpret there. So the GLP one agonists you're talking about are like the turs at the time the Banjara, the Ozempic, the semaglutide.
Those are medications that can help with that insulin resistance component of the PCOS and also that weight loss resistance component. I think that's one of the frustrating things about PCOS is there's that there feedback loop for weight gain and insulin resistance. So the more insulin resistant you are, the more you gain weight. The more you gain weight, the more insulin resistant you are.
Then you gain more weight than your morning. And it's this really frustrating cycle where people are told like, you just need to diet and exercise. And that's really not the case with PCOS because if you diet and exercise, unless you're dieting and exercising in a way that's addressing insulin resistance. Yeah. And then also dealing with gut health like you mentioned, and also dealing with, inflammation.
It's not going to work the same for you as it does to someone without PCOS. And I just want to shout that from the rooftops so that people can hear that is it's not the same now. Whatever got you there, whatever, it doesn't matter. But your body's not responding the same way, which means we have to treat it differently.
We have to address what those issues are. And the Magaro or TRS appetite or semaglutide are can be very effective. I call it a step stool. It can be really effective at saying, can I get you out of this? The slump. Yeah. Can I give you that stool to get out? Yeah. Where it's like now the inflammation is going down with the the GPU and agonist.
Now the insulin resistance is going down with the GOP one agonist. The food cravings and the food noise is getting better. And then patients come back to me and say, I'm starting to lose weight. My water retention is coming off. My periods are back. Now tell me what to eat and do to exercise so that I can not go back.
That's a wonderful process. I don't find that, you know, people say quote unquote cheating. I don't think that's cheating at all. That's a really great stepwise approach. So, anyway, so you mentioned the GLP one agonist, and then you mentioned CGM or continuous glucose monitor. Tell us any thoughts you have about that, but also then what you how you use the continuous glucose monitor.
Yeah. No, I do exactly what you said with this GLP. I think they're great drugs for lowering inflammation and insulin resistance both. Yeah and fantastic for PCOS and perimenopause because that's like even more of an issue. So I do think that there and I and I'm a big fan of using the microdosing the smaller doses as opposed to just hammering on up like the FDA sort of has written these axes.
So I do like them in that way. And, and they can be a great way to break that vicious cycle. And then once you break it, you have so much more ability to control those other parameters, too. So ktms continuous glucose monitors there. You know, there's such a great value because they tell you your chemistry, how you respond to food.
So I wear them all the time. You can see me doing picture like videos on Instagram. I'm wearing them and actually have one sitting right here I think 400. They basically it's a continuous glucose monitor. So you find out what your glucose is all the time, all day long, 24 hours a day for two weeks at a time.
And where the value comes in is there are foods that don't work with your chemistry. Like for me, as I love sweet potatoes, they're I love them and I used to eat them with butter and salt and pepper. Well, that makes my blood glucose go crazy high. Even higher than Oreos. Not that I'm complaining, because who doesn't want to be able to see the data that the science says you should not?
Sweet potatoes got to do what the science. That's. Yeah exactly. So the sweet potatoes. But what I've learned is I'm not going to give up sweet potatoes. So if I put olive oil on top of them and I put any sort of greens, it doesn't matter spinach or microgreens or whatever, I don't have that problem. And it makes nutritional sense because that oil is the healthy.
Oils are slowing the metabolism of those carbohydrates. The greens are also slowing the metabolism of those carbohydrates. So for me, I am very carb sensitive kind of PCOS person. I can't eat peanut butter and jelly sandwich and chips and ice cream. I'll just yeah, I'll gain 10 pounds thinking about it. So I that works really well for me to understand what are the foods that work for me?
What are the foods that help me, you know, love the foods that love you back, right? Yeah. And so I can then know, well, you know, if I'm going to have, something that I know is going to cause me a little bit of blood sugar issue, then I probably need to have a walk afterwards, or I probably need to coordinate it before I go to the gym, or I need to do something so I know I'm going to get rid of that excess glucose, because for me, it doesn't really work.
You can also do it from a, exercise standpoint. Obviously glucose goes up a little bit when you exercise because you're mobilizing glucose in your body to use for your muscles. But you can find out maybe some exercises that don't work so great for you and therefore know what to eat afterwards, or, you know, know how to eat that day.
If you want to do something that does tend to spike your blood sugar. Okay. So using we've talked about prescription medications metformin spironolactone birth control pills sometimes progesterone to cycle just to see how things are going and make sure the lining doesn't get too thickened. You also mentioned GLP one agonists. And then you talked about alternative therapies.
Looking at I don't think you mentioned a ton of them. Did you? I think, inositol, you said berberine and any others that. Yeah. Do you have any others that are your go tos? Yeah, I sort of have my little PCOS cocktail. Yeah. So I am obviously vitamin D. You need to put vitamin D back if you're deficient.
Omega threes love them. Having at least 2000mg, in your either diet or supplement fiber. If you're not getting 25 to 35g of fiber, inositol, great option 2 to 4g of of mayo and alcohol. Usually if you're trying to get pregnant or the D chiro mayo combo, if you're somebody like me who's in their 40s and not trying to get pregnant, I use berberine for blood sugar balance.
I sometimes use like bergamot for blood sugar. Cinnamon is actually a wonderful thing for blood sugar, for gut health. Ginger, licorice, tumeric for joint pain. Love that. And NAC is one of those ones that's kind of undervalued for PCOS women. We know we have some mitochondrial dysfunction issues, hence why we have this difficulty getting to sleep. Insomnia.
You know, the master clock is sort of getting messed up by this estrogen problem. And so I do think the NAC has some value and I don't necessarily put everybody on NAC, but it is definitely one that I kind of bring out a lot. And then, you know, you know, it depends again on if are someone who is, say, 20 trying to have a baby or 47 like me, who's on the other end of the spectrum that needs some more support from, you know, aging perspective.
Right. If you're adding some of the other, more sophisticated options. So let's cover just a couple of those bases that you just reminded me of. One is if someone's not trying to get pregnant, do they need to worry about having a period or not? Like if you have PCOS and you're not trying to get pregnant, who cares? Like just live with it.
So I do. You know, we know medically that you can't just go forever without a period, right? You can be three years into it. You should you should be having a period. Now, there is a I think there is a little bit of a controversial like how often is how often, right? I mean, some of the literature says you should have period every six months, to prevent tissue buildup in the uterus.
And ultimately that tissue stay there and transforming to hyperplasia, a pre-cancer or eventually uterine cancer. Yeah. Some people say a year. So there's kind of a little bit of a, you know, depends on whose book you use on the guidelines. So I tell patients that they're like, you know, I don't really want a period. And I go, well, you know, every six months you should probably take progesterone Provera to get a period.
While you're working on ultimately getting more spontaneous type cycles on your own from a healthy perspective. But if you don't, you should definitely get the tissue out of the uterus by having a period every six months or so. And then tell us about aging with PCOS as we get past our childbearing years and into our 40s and 50s and beyond, what are the risks we need to know about with PCOS and any other things that come up for you, as you mentioned, kind of moving towards that Perimenopausal transition, what are the big things that we don't talk enough about with PCOS?
Yeah, well, I'm smack in the middle of that one. With the perimenopause. There's no transition. I'm there. Yeah. I mean, you are it set by because it is a metabolic problem. You are at higher risk for man. Every chronic disease, right. High blood pressure, high cholesterol, obesity, diabetes, heart disease. Yeah. I mean it's all, you know, you run the gamut.
And some would even argue cancer's right if we we didn't have periods. And then you worry about hyperplasia like there's, there's some nothing that I'm aware of associate with breast cancer specifically. But there are some other in the cancer category that could be potentially linked. So, you know, that's why it's important to not ignore when you're 30, the things that could be an issue when you're 40 or 50.
So having good blood sugar control in your 30s is critical because when you hit perimenopause and you develop insulin resistance just because you're in during menopause, you're going to like that. You already have the tools to know how to lower that insulin resistance to begin with, because you've had PCOS before. So you I mean, if you've been dealing with that.
So you know what, these are the tools that work for me in order to not let me become diabetic. And then the perimenopause, you know, I really do strive for prevention. I get women Dexa scans early for their bones. I look at their brain health, I look at their muscle. I talk about the beauty of PCOS. We talk about kind of all the negatives.
But man, PCOS women are warriors, right? You look at the Olympics and a lot of those, what do they say? 40% of those women had PCOS like their it makes sense. We build muscle like we're kind of built to be the warriors, right? So that should be a great thing when you hit perimenopause because you could build muscle.
You got that testosterone. You know how to build muscle. You're sort of genetically built to do that. So I think that is kind of a bonus when you, when you start aging is the ability to be able to do that. So I think you really have to look at more of a prevention and trying to stay on top of all those things, getting that blood work every single year to make sure nothing is popping up, that you need to start addressing earlier rather than age 50, which is what Western medicine says.
Now get your cholesterol at 50. It's like, nope, I have people start doing that much earlier than that. Well, thank you for that. We kind of talked about prescriptions and we talked about supplements. We kind of skipped over lifestyle a little bit. You've mentioned it a couple times. Is there anything you want to remind people of specifically for PCOS?
That lifestyle is particularly important. Yeah. So movement in whatever form that you find makes you happy is important. I think there are online there's a lot of misinformation like don't do anything too vigorous, don't, you know, work out during your period. Like there's a lot of information about almost like we're a little bit like gentle PCOS women. And I think that that's unfair.
I think, you know, if you love hiking and it's your jam and it makes you happy, then hike. If you love dancing than dance. If you love hot yoga like me, then do our yoga. You know, like you have to have a love for movement and do it. And movement. I mean, muscle is a fantastic metabolic organ, like it burns glucose at rest and in motion.
So moving your body is key. However it means to you. We can certainly get into the nitty gritty about, yes, you should do resistance training and yes, you should do cardio for heart health. And yes, you should have hit, you know, we can get into these like minor details, but I think most women have to move more. I mean, just need to put movement into your butt, into your lifestyle.
However that that is there. I also think from a nutritionist standpoint, I try to make things not too complicated for patients. And I'm literally go, okay, look at your plate. Half of it should be the vegetables. You really don't want to eat the you know, the stuff, the non-starchy one, a quarter of it could be the good stuff that you want, like the potatoes and the rice and the starchy veggies.
A quarter should be protein. And then the fat is to make it all taste good on top of it. So a lot of times I don't get into these like, you know, measurements or macros or all these things. I'm like, just look at your plate, sit down. Like today I had spaghetti for lunch and I had put spinach on the bottom.
Otherwise I would fill the whole bowl full of spaghetti. Right. So spinach on the bottom. I put spaghetti and I put walnuts and pesto on the top. So I got fat, I got protein, I got fiber, I got veggies. So I didn't not beat carbs or spaghetti. I just made it make more sense for what I have to do for me.
So I think sometimes it doesn't have to be complicated. It can be more just think about how it makes sense for you. I was sitting in my refrigerator before I went to work. I was like, get some spinach, guys. Get me got some pasta, throw it in a bowl, get a fork. Let's go. Like, it was not complicated in any way.
So try to do things like you mentioned the low hanging fruit that are just something that you can do. Going to sleep. Sleep is very undervalued. And we have already a circadian clock problem with PCOS. So getting to bed at the same time, going to bed at the same time and waking up at the same time. Hugely important for your anxiety, for your stress or overall your hormones to begin with.
So those are really important parts. And then you kind of get more advanced and things like intermittent fasting, which can be great tools, even doing things that are like more, you know, resistance training. Like there's a lot more things that can be built onto a basic foundation, but you really want to kind of get the basics down.
And then I think the most important part, I think from this podcast, I would say, is find the people who make you feel good about it and yourself, because don't go to a provider that says, nope, you don't have PCOS and ignores you. Don't be around family members who are telling you that your anxiety is not related to PCOS.
Like find your people, find the people. There are a lot of great, and I'm not. I don't get paid by them anyway. But PCOS Association is a great, organization. You just need to find the people who get you so that you can then have this community. Because there's so much to be, so much value in having a community.
Thank you for sharing all of that. I want to recap a little bit, so tell me how. Tell me how I do. So when a woman comes in with PCOS, we're going to do some lab work and really focus in on the insulin resistance component so that we can really tackle that if it's significant. And then also looking at other components of nutrient deficiencies, any inflammatory markers, gut health from whatever labs or symptoms we're going by, and then tackling the PCOS from a lifestyle medication supplement perspective to really address those things that came up, specifically looking at movement and Whole Foods.
You also mentioned some supplements. We talked about the medications, finding that metabolic health rhythm that works for you, knowing that unfortunately it is a little bit more of an uphill battle sometimes, but not losing hope because we know that we can get the body in the right state. But I say that it's an uphill battle, so people hopefully feel validated that it's not just that they're not trying hard enough.
Yes, it is harder, but we have lots of tools that we can use to help get the blood sugars down, help improve the metabolic health, help decrease inflammation, make sure you're getting all the nutrients you need that are signaling the right way, getting the sleep and the circadian rhythm and the stress down so that you're signaling, you know, you're getting those nice cyclic hormone, signals, so that you can get everything in order.
Is there anything I've missed or anything that you want to point out about the treatment of PCOS? That, is just something that someone should have on their radar? Oh, we talked about a lot. I would say. Yeah. You know, I think some people do sometimes struggle with also explaining it to like, maybe their partner or their family or their, you know, or people around them.
And I think there are a lot of great resources for sort of having people be able to explain, like kind of what they're going through. Right? I mean, I've had patients who were like, my husband thinks that I'm gaining weight and it's my fault. And I don't, you know, I don't try hard enough. And so I think where we get lost in translation, there is it's like, well, this isn't a willpower problem.
This is like exactly an issue with your it's like perimenopause too, right? You start yelling at people and get upset. It's like, dude, this is happening to me. And so I think that sometimes can be harder for women to know what to say to their partner or say to their husband or whoever. And I think there are a lot of good resources in those associations and communities that can help you to to help other people like, explain and understand that you're not alone.
1 in 8, right? 1 in 10 depends on who statistics you use, the CDC or PCOS association kind of statistics, but it's very common and you're not alone. And there are people who see you and understand you. You just have to find those people. So don't feel like you're the only one in your by yourself. There are plenty of people who can come and uplift you.
Get. Right. So we're going to throw that in. Yeah, they're already there. Who can help uplift you and really just kind of, be your people, be your wingman, right. Are we women? Yeah. Yeah. Thank you so much. That's so positive. I mean, I think too many women with PCOS just feel so kind of devastated and so frustrated and so hopeless.
And there really is so much hope to feel better and to help your body function and to maintain its natural function. There's so many things that we can do to help. So thanks for teaching us. Yeah, and I do I do have a do you have PCOS quiz on my, website too. So people can do that if they are not totally sure and want to be asked the questions that should be asked by your provider, I can give you the link to that too.
Wonderful. And that's actually my next question is how can people find you and work with you so you can find me on Instagram? I'm Doctor Jenny, MD, but I have a YouTube channel now where I do a ton of education, so it's under my name, Doctor Jennifer Rollins. And then my practice is called Precision Health MD c.com or Precision Health MD and I'm licensed in ten states.
So awesome. Awesome. So wonderful. And that's telehealth only. No, no in-person and telehealth. But I mean, obviously we're in a different state. I'm in California. So if you're in Texas, then it's to be telehealth. Wonderful. Well, I'm excited to give people the opportunity to work with you. And thank you so much for coming on. Thank you very much.
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