Amy Medling
Healing PCOS

Copyright

This book contains advice and information relating to health care. It should be used to supplement rather than replace the advice of your doctor or another trained health professional. If you know or suspect you have a health problem, it is recommended that you seek your doctor’s advice before embarking on any medical programme or treatment. All efforts have been made to assure the accuracy of the information contained in this book as of the date of publication. The publisher and the author disclaim liability for any medical outcomes that may occur as a result of applying the methods suggested in this book.

The names and identifying characteristics of certain individuals discussed in this book have been changed to protect their privacy.

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First published in the US by HarperOne, an imprint of HarperCollinsPublishers

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FIRST EDITION

Text © Amy Medling 2018

Cover design by Laura Beers Design

Cover photograph © Violet Gin/Shutterstock.com

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The Alan Cohen quotation in Chapter 7 is from A Deep Breath of Life © 1996 by Alan Cohen, used with permission from Hay House, Inc., Carlsbad, CA.

The Mark Nepo quotation in Chapter 7 is from The Book of Awakening © 2000 by Mark Nepo, used with permission from Red Wheel Weiser, LLC, Newburyport, MA, www.redwheelweiser.com.

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Foreword

I met health coach and PCOS Diva Amy Medling online when she invited me to speak on a PCOS Diva podcast. I had heard wonderful things about her from my patients with polycystic ovary syndrome (PCOS), who praised Amy’s inspiring website and coaching. I was delighted to finally meet Amy in person in Atlanta at the 2016 PCOS Challenge Conference. Amy is a serene and peaceful woman who radiates love and intelligence.

According to the Androgen Excess and PCOS Society, PCOS affects 5 to 15 percent of women worldwide. PCOS is associated with multiple symptoms ranging from irregularly spaced menstrual periods to hair loss, weight gain, and elevated blood pressure. In spite of the wide array of symptoms, PCOS is commonly regarded as a reproductive disorder, and most women with it are prescribed the birth control pill. However, no birth control pill can prevent metabolic problems or the development of type 2 diabetes. Furthermore, the role of a healthy lifestyle cannot be underestimated. American medicine is not equipped to provide the support for a healthy lifestyle in the broadest sense with regard to nutrition, movement, and spiritual health.

Derived from her own experience, Amy’s approach to PCOS stems from a health-based point of view rather than the disease-based paradigm of conventional medicine. Where conventional medical treatment is designed to pursue the enemy with a well-aimed bullet, Amy coaches about the fundamentals of self-care and the importance of eating well, moving regularly, and maintaining a positive mindset. This is not to say that medication can’t help PCOS, but without self-care the effect of medication is minimal.

Healing PCOS is an informative and inspiring step-by-step guide to learning to cherish yourself. Before you jump into changes in diet and exercise, Amy asks you to be mindful, create goals, and change the way you talk to yourself. With love and acceptance, she reminds readers that powerful women are not victims.

—Katherine D. Sherif, MD

Director, Jefferson Women’s Primary Care; Professor and Vice Chair, Department of Medicine, Thomas Jefferson University

Foreword

Amy Medling and I share the same mission: to help women with PCOS optimize their health and take control of their lives. If you are among them, we want you to feel strong, vibrant, joyful, and self-assured so that you can achieve your personal goals. I’m confident that reading Healing PCOS and following the plan Amy outlines in it will help set you on a path to health and healing.

Like Amy, I also have PCOS and had to travel my own path of self-discovery to find my way to health and joy. I experienced many of the same letdowns she did and had to self-diagnose, despite seeing “world-class” doctors at a major university medical school. Now we both take an integrative and holistic approach to the treatment of PCOS.

As a physician, board certified in both OB/GYN and Integrative Medicine, with a special expertise in PCOS, I order an array of tests to evaluate my patient’s inflammation, immune, and nutrient status; food allergies and sensitivities; gut microbiome; epigenetics; heavy metals and toxic load; and hormonal levels. But all the fancy tests in the world will have no real value for you if you do not address stress control, adequate and quality sleep, proper nutrition, and regular movement and fitness. In addition, embracing the concepts of living in the moment and having self-love is absolutely crucial for optimal health. The advice contained in Healing PCOS is the very foundation of care for women with PCOS, offering you the tools to take control of your health, your body, and your life.

I wish I could see you a month from now, after you have completed Amy’s program. I know you will feel better, with renewed joy and optimism. All best wishes on your journey!

—Felice L. Gersh, MD

Board Certified in OB/GYN and Integrative Medicine; Medical Director, Integrative Medical Group of Irvine

PART ONE
The PCOS Diva in You

1
Discover Your PCOS Diva

One evening about ten years ago, my husband and I were at a steak house for dinner. As I placed my order, I asked our server some questions about the loaded baked potato that came with my meal.

“Does it come with butter?” I inquired.

“No, it comes with margarine,” the waitress replied.

“I can’t have margarine,” I told her. She made a note to substitute butter for the margarine.

“Can I have a sweet potato instead of a white potato?” I continued.

She said that would be fine and asked if I wanted cinnamon sugar.

“No, thank you,” I said. “I’ll have straight cinnamon.”

“No, we only have cinnamon sugar,” she replied.

This back-and-forth went on for some time, as I tried to order an unadulterated sweet potato and broccoli with olive oil.

As the waitress made her way to the kitchen, my then clearly irritated husband, Cliff, posed the question that launched PCOS Diva: “When did you become such a diva?”

His question was certainly blunt, and it stung a little, but he was right: I was being a diva.

In that moment, a light went on. What I wish I’d known throughout my journey with polycystic ovary syndrome (PCOS) finally clicked—I deserve to be a PCOS Diva. I need to be a PCOS Diva.

What Is a PCOS Diva?

A PCOS Diva is a woman with hope. She has taken charge of her health and happiness and takes steps every day to enhance both. She chooses to thrive with PCOS and is empowered by the knowledge she gathers as she educates herself about PCOS. As a result of her regimen, she is able to give her best to herself and others and be an example of the power of self-care. She is capable of advocating for herself and surrounds herself with the supportive health-care team and community of friends and family she deserves. A PCOS Diva looks beyond the physical support required to manage symptoms and works to heal and enhance her whole person—mind, body, and spirit. A PCOS Diva is an inspiration.

Becoming a PCOS Diva doesn’t happen overnight. The journey of healing is lifelong. Every day, a PCOS Diva listens to her body’s signals and adjusts her diet and lifestyle, so that she can work in partnership with her body instead of fighting against it.

My path to becoming a PCOS Diva was long and winding. In high school and college, I struggled with hair loss, abnormal hair growth, stress, acne, insulin resistance, weight-loss resistance, and irregular menstrual cycles. I binge-ate and then punished myself with exercise. I could never get a straight answer from health-care professionals about the root cause of my symptoms or how to resolve them. I grew frustrated and hopeless.

It took me fifteen years to get a diagnosis of PCOS and years more to develop a holistic lifestyle plan that’s easy, effective, and enjoyable. Today, at age forty-six, I feel stronger, healthier, and more hopeful than ever before. What’s more, despite the common misconception that PCOS causes irreversible infertility, I have given birth to three beautiful children, the last conceived naturally after adopting the PCOS Diva lifestyle.

And I’m not alone. Thousands of other women who have followed my programs can attest to my approach’s effectiveness. By following an anti-inflammatory diet that’s rich in whole foods and mindful indulgences, prioritizing moderate exercise and self-care, and building a support system inside and outside the home, we’ve learned how to thrive, not just survive, with PCOS.

Congratulations! You have taken the first step toward becoming a PCOS Diva. Knowledge is power, and this book will help you develop a diet and lifestyle that work specifically for you. Soon you will be a PCOS Diva too.

The PCOS Diva Difference

The Healing PCOS 21-Day Plan is not a diet plan. If you have been diagnosed with PCOS, then your doctor has likely told you to exercise and lose weight. He or she may have prescribed a pharmaceutical or two as well and sent you on your way. For most women, this approach to treating PCOS doesn’t create true, sustainable healing, and there is a good reason for that. It isn’t that simple.

Sustainable healing with PCOS cannot be achieved by taking a pill, adopting a low-carb diet, and going to the gym. Healing takes so much more. We need to connect with our bodies and ourselves in a more loving way and learn to think like a PCOS Diva. Only then will we be able to willingly and joyfully make the small, day-to-day diet and lifestyle choices that heal our bodies and our minds and souls for a lifetime.

Healing from the inside out is the heart of the PCOS Diva difference. We thrive as a result of self-love and gratitude, not as a result of a trendy, temporary, and unsustainable diet.

Week One: Discover Your PCOS Diva

In Week One, you will discover your PCOS Diva by exploring the foundation of the 21-Day Plan—the way you think about your body, PCOS, and the way you eat. You will discover exactly what works for you. No two PCOS Divas are exactly alike, so you will learn to translate your body’s unique signals and work in partnership with it.

THINK LIKE A PCOS DIVA

We will begin by changing the way you think about PCOS and your body. Surprised? Many of my clients are shocked that the first thing we do isn’t talking about their diet. They expect lists of foods to eat and not to eat right out of the gate. Here’s the thing: until you think like a PCOS Diva, you cannot live like a PCOS Diva. You may make changes that last a few weeks. You may even start to feel a little better. But until you upgrade your thinking, nothing will stick.

In the long run, no drug, diet, or exercise will help you until you take this step. For many women, this is the biggest challenge. It may be easier to pass up a bagel than to look in the mirror and say something nice or prioritize your well-being over someone else’s wants.

So we begin by establishing your PCOS Diva mindset and practicing mindfulness. We will work together to develop a perspective that will drive every decision you make, from what to eat to how to deal with stress. Finally, you will learn how to use gratitude to fuel your journey. Over the next 21 days, we will cultivate these elements of your upgraded mindset:

Control: By the end of this transformative 21-day plan, you will have the tools you need to take control of your symptoms and environment instead of playing the role of helpless victim.

Partnering: Your body is not betraying you; it is calling for help. You will learn how to stop fighting your body and instead work in partnership with it to recognize its signals and respond in a loving and nurturing way.

“With PCOS Diva, I learned how important it is to care for me. I realized that if one of my children or my husband had PCOS, I would have been doing this program long ago. I would tirelessly research what was good for them, and I would do everything I could to help them live their best lives. Why wasn’t I willing to do that for me? I thought I was being selfish by taking care of myself. I now know the opposite is true. I was being selfish by not taking care of myself. My family needs me. Now they have a healthy mama, and wife who is energetic and engaged. They love the food I make from the meal plans and are moving with me.”

—EMMY DARDICK

Abundance: You will celebrate the abundance in your life. Instead of blaming situations on items you lack or imperfections in yourself and others, you will approach each day with gratitude. The positivity this brings will give you the strength to make the right choices for you.

Progress: You will work toward progress, not perfection. No one is perfect. You will set reasonable goals and celebrate the small wins.

Mindfulness: Truly savoring and being present in a moment will become a habit that will change your perspective on the world and how you move, eat, and love.

Nurturing: Caring for yourself is not selfish, and it is about to change your life. When you approach your body from a place of self-love and compassion, you are better able to hear the messages it is sending to you. You will respond to those messages in a kind and nurturing way, because you understand that you are worth the investment. You are a priority and deserve to feel good.

Please do not skip straight to the 21-Day Plan. There is important information in Part One! For example, you must read and internalize Chapter 3, “Think like a PCOS Diva.” It is the key to changing your life, controlling your PCOS, and thriving!

EAT LIKE A PCOS DIVA

During Week One, you’ll also think about what you use to fuel your body. I love the expression, “Nothing tastes as good as feeling good feels.” Although I believe that to be true, eating like a PCOS Diva is no sacrifice. We heal and nurture our bodies with nourishing foods without denying ourselves pleasure. You will discover that:

Food is medicine. Much of what you need to balance your hormones and soothe your PCOS symptoms can be found in the produce section of your grocery store or farmers’ market. You will learn which foods heal you and which foods exacerbate your symptoms.

Your body is sending you messages. Your body is telling you what it needs. Those cravings signal something. You will learn how to partner with your body to translate those signals and give it the nutrients it is asking for. There is no one-size-fits-all diet for PCOS. We will find yours.

Food intolerances, sensitivities, and allergies are at the center of many of your symptoms. You will learn how to detect what is inflaming your body and what is healing it. Do tomatoes give you canker sores? Does bread make you feel foggy? Does dairy cause mucus? Learning which foods to avoid will help you develop your individual protocol for eating like a PCOS Diva.

Preparation is essential. You will learn to set yourself up for success with a few minutes of planning and preparation each day. Preparation will save you from raiding the vending machine at work or skipping your daily walk when you get overwhelmed.

No diet is perfect. Day to day, week to week, an essential nutrient or vitamin may be missing from your diet. Which one is it? Which supplements are right for you? You will learn the supplements that commonly help women with PCOS and how to choose the ones that are right for you.

Indulgence is not an indulgence. Feeling deprived is no way to live, and it certainly is no way to live like a PCOS Diva. You will discover satisfying ways to indulge that will not make you feel lousy later.

Week Two: Live like a PCOS Diva

During Week Two, we add the next building block of the PCOS Diva lifestyle—movement. Truly living like a PCOS Diva is more than just how you think and what you eat. It requires regular, joyful movement. Your body is made to move, and once you are in the right mindset and your diet is helping to boost your energy, you will be inspired to move it!

MOVE LIKE A PCOS DIVA

No, this is not where you order a chaise longue to be carried about like Mariah Carey. We are not that kind of diva.

PCOS Divas know how to move joyfully. We understand that regular movement is an important part of the PCOS Diva lifestyle, but we do not punish ourselves with exercise. I cannot count the number of hours I spent on the treadmill, miserably trying to work off calories. Years later, I understand that by approaching exercise as an exhausting chore, I was hurting myself more than I was helping. Not only had overexercising exhausted my adrenal glands and made my symptoms worse; constantly punishing myself was emotionally taxing.

Most women I work with are in the same boat. Exercise is not joyful for them. Does this sound like you too? If it does, I’ll help you to find movement you enjoy and want to do regularly—and not because you are afraid of the consequences of skipping it. You deserve to feel great and take pleasure in your body and all it can do. You will discover:

The best movement for women with PCOS is . . . whatever you enjoy! Some of the best choices for our metabolism and hormones include high-intensity interval training (HIIT), yoga, and strength training, but the possibilities are endless.

Adrenal fatigue may be keeping you from reaching your goals. Women with PCOS are hormonally vulnerable. Overtaxing our adrenal glands, producers of hormones that control fertility and the stress response, with the wrong types of movement can throw everything out of balance.

The best way to overcome gym anxiety is to think like a PCOS Diva. There is no need to wait until you have a perfect body or lose 10 pounds to go to the gym. You will enjoy going to the gym because it is an act of self-love. Trust me.

Movement and exercise are not weapons to wield against your body. The gym is not a battleground. I know that finding movement you enjoy can be frustrating and even embarrassing. But you can do it, and before you know it, you will be moving like a PCOS Diva (and loving it)!

Week Three: Thrive like a PCOS Diva

During Weeks One and Two, we explore the basics of the PCOS Diva lifestyle and experiment with what works best for you. In Week Three, we add meditation to your daily regimen. At this point, you are ready to step out on your own and practice making your own schedules and menus. You will combine everything you’ve learned into a sustainable, mindful, and joyful lifestyle tailored just for you. You will discover that:

Meditation benefits the mind and body. Not only does meditation help to calm your mind and ease stress; it has physical benefits all over the body.

There are many ways to meditate. You don’t have to do tai chi or chant “Om.” You can meditate anytime, anywhere. There’s even an app for that.

There is a balance that is optimal for your life. Diet, career, movement, relationships—you juggle all of these things and more. The trick is to find a balance of all these elements. We will use the Thrive like a PCOS Diva Wheel to help find your balance.

Clutter creates chaos. Whether it is piles of stuff on your counters, thoughts racing through your mind, or relationships that don’t benefit you, clutter bogs you down. You will learn to clear this clutter and thrive.

This may seem overwhelming, but remember: “Small hinges swing big doors.” Becoming healthy isn’t going to happen overnight. However, by taking small steps, you can begin to heal your mind and body.

Your Transformation Begins Now

You are ready. The time to partner with your body and take control of your PCOS is now.

I can’t wait to start this journey with you. You will not believe the positive impact the changes you will be making over the next three weeks will have on you and even those around you. In fact, you will notice the benefits in as little as a week, but they can last a lifetime. Let’s get started!

2
Why You Feel Lousy

As early as age fourteen, I wrestled with many common PCOS symptoms such as acne, hypoglycemia, irregular periods, fatigue, scalp hair loss, and unwanted hair, especially on my face. I wasn’t alone. My mother and both grandmothers had similar struggles. It seemed to be the genetic fate of women in my family. Unfortunately, no one was diagnosed with PCOS, so we didn’t know there was a root cause for all of these symptoms.

My mother took me to a general practitioner, a dermatologist, a gynecologist, and even a psychologist, and I was subjected to countless tests including a scalp biopsy, yet I had no diagnosis. Not one doctor thought to check my androgens, insulin, or blood sugar. Still, I took the doctors’ advice, filled prescriptions, and followed orders. I felt like a victim of my genetics, destined to struggle to get pregnant and some days just to get off the couch. That is, until I chose to take control of my health.

Looking back, I am grateful for my journey. It has shaped the woman that I am and enabled me to help tens of thousands of other women to thrive with PCOS as well. But it was a long journey.

I remember clearly one day in college, when I found myself sitting in a cold medical exam room scared and confused, feeling lousy, not having had a period in months and months, and not understanding why. The doctor looked me in the eye and told me they would have to “jump through hoops” to get me pregnant one day. She renewed my prescription for the pill and sent me on my way. It was a dark moment. I felt helpless and hopeless. I still had no diagnosis. There was no end in sight for my out-of-control symptoms, and now I was facing infertility. Through my twenties, my symptoms worsened. I struck out on my own after college, and that meant eating a lot of inexpensive prepared foods like pasta and macaroni and cheese. I began to struggle with depression. I wondered what was wrong with me. I was a strong, successful, and intelligent woman. Why could I not stop myself from eating Tootsie Rolls? Why was my hair falling out? I was running every day without fail and still gaining weight. I visited an endocrinologist, who gave me spironolactone for my hirsutism (male-pattern hair growth), which did not help because it was only an attempt to treat a symptom. I still didn’t receive a diagnosis.

Eventually, I married the love of my life. We wanted to start a family, so I stopped taking the pill. My health struggles and symptoms continued, but four years later, with the help of clomiphene (Clomid), I became pregnant with my first son. He felt like a miracle. After his birth, we decided to try the Creighton Model for family planning, because I didn’t want to go back on the pill. I met monthly with a Creighton Model teacher who reviewed my charting, and she soon realized that I was not ovulating. She was the first to notice my patterns and mention PCOS. When we were ready to try for a second child, she referred me to a specialist who put me on Actos, guaifenesin, and Clomid. As with all prescriptions up to this point, I took them without question. No dice. I didn’t become pregnant, and I felt awful.

Then I searched out a reproductive endocrinologist. She knew the right labs to request and immediately ordered an ultrasound. Finally! At age thirty, I had my official diagnosis—PCOS. I was put on metformin (which made me horribly sick) and monitored cycles of Clomid. With this help, I conceived my second miracle.

After the birth of my second son, I felt worse than ever. I swore I would never go back on metformin or the pill because both made me feel so awful. I had two beautiful children and a wonderful husband, but I was exhausted all the time and could barely function. My fatigue, hirsutism, brain fog, and hypoglycemia were out of control. I certainly wasn’t the wife or mother I knew I could be. After years of following mainstream advice from countless doctors, I realized that nothing was helping. The drugs they offered made me sicker and more miserable. The drugs that helped get me pregnant couldn’t heal my PCOS. I was way too young to feel so old, and sick and tired of feeling sick and tired—I couldn’t go on living this way.

I knew that if I wanted to feel better, I had to adopt a different approach. I found a naturopath to help me get to the root of my symptoms instead of trying to put a Band-Aid on each one. At thirty-two years old, I found the right person. She guided me in selecting supplements that could naturally balance my hormones. Maybe most important, she taught me to how to use a glucometer. Thanks to this tool, I made the connection between what I was eating and how I was feeling. I had empirical evidence to help make sense of my symptoms. Glucometer in hand, I began to experiment with my diet. As I mastered this piece of my life, my energy returned, my hair slowly began to grow back, I lost weight, and my menstrual cycles began to regulate.

In working with my naturopath and doing my own research and experimentation, I realized that I had the power to take control of my health. No one else could do it for me. I couldn’t take advice at face value and continue to think and act like a victim.

I scoured the internet for information and read books about PCOS and holistic medicine by pioneers like Samuel Thatcher, Walter Futterweit, and Nancy Dunne. I went back to school to learn from experts about nutrition and healing. After hundreds of hours and tons of trial and error, I developed a protocol that allowed me to thrive. I changed my diet and lifestyle and, most important, my mindset. I started taking care of myself. My husband noticed the shift and declared me a “diva.” At first, I was offended, until I realized that in order to be my best and give my best to my family, I did have to be a PCOS Diva.

When my reproductive endocrinologist started seeing my success and sending women with PCOS who also couldn’t tolerate metformin or the pill to me for help, I knew I was onto something. I received my health-coaching certificate and began to formally coach women one-on-one with great success. Soon I realized that the small, manageable steps of what is now my Healing PCOS 21-Day Plan could help the millions of other women struggling to alleviate their symptoms with medicine and advice that didn’t help. Now sharing what I know about PCOS is my passion and career. And, despite what doctors warned all those years ago, I conceived my third child, an amazing girl, naturally. She’s the direct product of the PCOS Diva lifestyle I forged.

I want you to know that you are not a victim. Struggling with PCOS is not your fate. There is no magic pill, but you can thrive with PCOS when you embrace the power of knowledge, diet, and lifestyle.

What Is Polycystic Ovary Syndrome (PCOS)?

You are not alone. Polycystic ovary syndrome (PCOS) is one of the most common endocrine system disorders found in women and the most common cause of infertility in women. As calculated employing the widely used Rotterdam Criteria, PCOS affects approximately 15 to 20 percent of women worldwide, of whom less than 50 percent are diagnosed. It is present throughout a woman’s life from puberty through postmenopause and affects women of all races and ethnic groups.

As an endocrine disorder, PCOS disrupts hormone balance, negatively impacting many bodily functions including insulin levels, cell and tissue growth and development, metabolism, fertility, and cognition. A diagnosis is often difficult to obtain because PCOS is a syndrome, a collection of symptoms. It affects many different hormones, resulting in an array of symptoms that may seem unrelated and vary from woman to woman. Some symptoms include obesity, irregular menstrual cycles, insulin resistance, infertility, depression, male-pattern hair growth, acne, and hair loss.

In addition, women with PCOS have a four to seven times higher risk of heart attack, and 50 percent will develop prediabetes or diabetes before age forty. They are also more likely to develop endometrial cancer. The increased risk of these serious health issues makes managing symptoms even more imperative—and stressful.

What Are the Symptoms of PCOS?

You may have one or two of these symptoms or a dozen. Although some symptoms are more common than others, there is no single model for PCOS.

● Oligoovulation (irregular ovulation) or anovulation (absent ovulation)

● Polycystic ovaries (20–39 percent)

● High levels of insulin, insulin resistance (30–50 percent)

● Easy weight gain and/or obesity (55–80 percent)

● Fertility issues

● Acne (40–60 percent)

● Cardiovascular issues

● Type 2 diabetes

● Depression (28–64 percent)

● Anxiety (34–57 percent)

● Poor body image, eating disorders (21 percent)

● Sexual dysfunction

● Thyroid disorders

● High levels of androgens (60–80 percent)

● Irregular menstruation (75–80 percent)

● Male-pattern hair growth (70 percent)

● Skin tags

● Sleep apnea (8 percent)

● Gray-white breast discharge (8–10 percent)

● Scalp hair loss (40–70 percent)

● Darkening skin areas (acanthosis nigricans), particularly on the nape of the neck (10 percent)

● Pelvic pain

● Hidradenitis suppurativa (painful boil-like abscesses in the groin)

Some of the Most Common Symptoms

The most common symptoms of PCOS are insulin resistance and hyperinsulinemia, hormone imbalances, and chronic inflammation.

INSULIN RESISTANCE AND HYPERINSULINEMIA

Insulin resistance, when cells fail to respond normally to the hormone insulin, and hyperinsulinemia, chronically high levels of insulin in the blood, are both symptoms with which I struggled all my life. Unfortunately, as is probably the case with many of you, they went undiagnosed for many years.

I remember fainting multiple times in sixth grade. The nurse didn’t know what was wrong. My mom took me to doctors, who also found nothing and finally referred me for psychiatric evaluation. Imagine being twelve years old, feeling horrible, and being told it is all in your head. Many years later, still undiagnosed, I remember feeling baffled when every Sunday morning, after my fiancé and I had our traditional waffle breakfast complete with syrup and orange juice, I would get woozy in church. Little did I know, it was the waffle breakfast throwing my blood sugar out of whack and giving me hypoglycemia! Since then, I have learned to interpret my body’s signals. Now when I feel that way, I know exactly what to do.

Insulin resistance and hyperinsulinemia are conditions in which the body becomes less and less efficient at processing and managing levels of sugar (glucose) in the bloodstream. This has serious overall health consequences. In the short term, insulin resistance is at the heart of most PCOS symptoms, including infertility, obesity, hirsutism, hyperandrogenism (elevated androgen levels), chronic fatigue syndrome, immune system defects, eating disorders, hypoglycemia, gastrointestinal disorders, depression, and anxiety. In the long term, when insulin levels rise too high, type 2 diabetes may result. Hardening of the arteries (atherosclerosis) is a common result of insulin dysfunction and may lead to an increased risk of high blood pressure and stroke.

Symptoms of Insulin Resistance

● Weight gain

● Sugar cravings

● Skin tags

● Hypoglycemia

● Rough or red bumps on upper arms

● Dark skin patches on neck, knees, elbows, knuckles, chest, or groin

In a healthy system, insulin plays an important role in metabolism. This powerful hormone is produced by the pancreas and enters the bloodstream after a meal. Its main function is to transport glucose to cells throughout the body to be used for energy. When there is excess glucose, insulin delivers the glucose to muscles, fat, and the liver, which helps to lower the blood glucose levels by storing it and signaling the body to slow production of insulin. But in an unhealthy system, insulin resistance and hyperinsulinemia may result.

Between 50 and 70 percent of women with PCOS have some degree of insulin resistance. Insulin resistance may be caused by poor diet, ethnicity, certain diseases, hormones, steroid use, some medications, older age, sleep problems, and cigarette smoking. Although insulin resistance is often associated with obesity, research indicates that lean PCOS patients are also prone to insulin resistance. Research also indicates that the birth control pill may cause insulin resistance in all women, particularly those with PCOS.

Insulin resistance occurs when a person’s body does not react properly to the amount of insulin in the bloodstream. In a healthy system, after a meal, the pancreas creates insulin to balance the glucose in the blood. Ideally, the body detects if the level of glucose in the blood is still too high and signals the pancreas to create more insulin. The hope is that since there is more insulin, more glucose will be picked up.

Insulin in large quantities can be toxic to cells, so when there is too much insulin in the body over time, cells become insulin resistant in order to protect themselves. Alternatively, the hypothalamus may become insulin resistant and continue to send signals to the pancreas to create more insulin unnecessarily. When insulin resistance occurs, the insulin does not pick up or cannot deliver the glucose to the cells that need it. Glucose levels in the blood remain high, and diabetes and other serious health disorders may result.

Hyperinsulinemia results when more insulin is present in the bloodstream than is considered normal, usually as a result of insulin resistance. Although it is associated with diabetes, someone with hyperinsulinemia does not necessarily have diabetes.

Insulin resistance and hyperinsulinemia create a self-perpetuating and destructive cycle called the insulin resistance cycle. Insulin resistance creates chronically high levels of insulin, and those chronically high levels bombard cells, forcing them to protect themselves, thus perpetuating insulin resistance. Eventually, your pancreas can no longer keep up with the insulin demand. This means there is less insulin in the body to store and regulate glucose levels, and the result is diabetes.

In addition, high levels of insulin and insulin resistance sometimes pave the way for hyperandrogenism, excessive levels of male hormones. This may be the cause of missed periods and infertility in some women with PCOS. The relationship between hyperandrogenism and hyperinsulinemia in women with PCOS is unclear. Researchers disagree about whether hyperinsulinemia causes hyperandrogenism, hyperandrogenism causes hyperinsulinemia, or a third cause is responsible for both. One way or the other, we have a destructive cycle: insulin resistance leads to hyperandrogenism, which increases insulin levels.

A top priority of the Healing PCOS 21-Day Plan is to get your insulin under control.

HORMONE IMBALANCES

When my hair started falling out during high school, my mom took me to a dermatologist who did a scalp biopsy. When it came back negative, the hair loss as well as other symptoms such as fatigue, acne, and sporadic periods were written off as a result of stress. Things got worse as I grew older. I began gaining weight, growing facial hair, experiencing anxiety and depression, and still fighting the symptoms I had since puberty. The birth control pill that was supposed to be my “quick fix” manipulated my hormones, leaving me feeling moody and dull. I wish that I had had a better understanding then of how my hormones work and how hormone imbalances caused by diet and lifestyle choices could be the source of my symptoms.

Hormones are responsible for keeping your major bodily functions running smoothly, so when hormone levels become imbalanced, you’ll feel the effects in many ways. Hirsutism, acne, hair loss, higher stress levels, mood disorders, depression, anxiety, and infertility can all result.

The most common hormones that become imbalanced and the ones that you will learn to manage with the Healing PCOS 21-Day Plan are androgens, cortisol, progesterone, estrogen, and thyroid hormones.

Androgens: Androgens are male hormones, such as testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S). In males, these steroid hormones are responsible for sexual development and muscle mass. In women, they play a much subtler, though no less important role. Among other things, they help us maintain muscle mass, regulate our weight, and keep our libidos humming. They are produced in the ovaries, adrenal glands, and fat cells. The problem isn’t that women with PCOS have androgens; it is that we typically have an excess. This androgen excess, or hyperandrogenism, affects about 25 percent of women with PCOS and is often the root cause of common symptoms such as hirsutism, acne, hair loss, and infertility.

Androgen excess may be caused by:

● Ovarian dysfunction, which causes the ovaries to produce excess testosterone.

● Insulin resistance, which signals the ovaries to produce excess testosterone.

● Stress, which taxes the adrenal glands and stimulates the production of androgen hormones. For this reason, women with PCOS should practice stress relief from an early age.

● Early adrenal activation, which initiates early puberty and correlates with increased lifelong androgen formation. Girls who experience early puberty may have an increased risk of developing PCOS.

● Obesity.

● Genetics.

● Taking artificial hormones in birth control.

● Individual hypersensitivity to a normal amount of androgen.

● A defect in the hypothalamus, a part of the brain responsible for regulating the production of many hormones, including androgens.

Cortisol: Women with PCOS often make too much cortisol, the “stress hormone” produced in the adrenal glands. In fact, research indicates that many women with PCOS may naturally have higher cortisol levels. Being overweight also increases cortisol production.

Raised levels of cortisol change the way your body manages other critical hormones, putting you at risk for insulin resistance, anxiety, depression, and thyroid dysfunction. In addition, the overproduction of cortisol can overwork the adrenals to the point of adrenal fatigue. For this reason, stress—emotional or physical—takes more of a toll on women with PCOS than on those without it.

Progesterone: Progesterone is a hormone, produced mainly in the ovaries, that plays an important role in the menstrual cycle and maintaining and nourishing the body during pregnancy. After ovulation each month, progesterone helps thicken the uterine lining in preparation for a fertilized egg. This is called the luteal phase of the menstrual cycle. Women with PCOS almost always have low progesterone and thus a luteal-phase defect. This makes it nearly impossible to maintain a pregnancy even if ovulation and implantation do occur and is often the cause of miscarriage and unsuccessful assisted reproduction. Some doctors recommend supplemental progesterone for women with PCOS in order to support early pregnancy if they have suffered multiple miscarriages.

Signs of Low Progesterone

● Anxiety

● Waking at night

● Fibrocystic breasts

● PMS

● Bone loss

● Low libido

● Infertility or irregular periods

If you have a progesterone deficiency and your doctor suggests hormone replacement, you may be prescribed a bioidentical progesterone. Bioidentical, or natural, progesterone is a combination of elements derived from natural plant sources that identically matches the progesterone we naturally make in our bodies. Prometrium is a micronized (reduced to tiny particles and mixed with peanut oil) natural progesterone in the form of a pill. It is approved by the Food and Drug Administration (FDA) as a natural hormone-replacement therapy medication. Because natural progesterone is molecularly identical to the hormone produced by the body, it causes few side effects.

Alternatively, your doctor may suggest a synthetic progestin such as Provera, since it was the standard before good natural alternatives were developed. Provera is also a constructed compound, but its chemical structure is not identical to natural progesterone. As a result, it can cause changes in vaginal bleeding, blood sugar issues, blood clots, and depression. Unfortunately, many women are told that synthetic progestin is the same as natural progesterone. Be a PCOS Diva at the doctor’s office and discuss the differences between these two hormone-replacement options to find one that is best for you.

Estrogen: Estrogen, the primary female sex hormone, is produced in the ovaries, adrenal glands, and fat tissues. Many women with PCOS experience estrogen dominance, that is, too much estrogen and not enough progesterone to balance its effects. Symptoms such as heavy or painful periods, infertility/miscarriage, and hypothyroidism (an underactive thyroid gland) may result.

Signs of Estrogen Dominance

● PMS

● Headaches and/or migraines

● Fluid retention

● Heavy or painful periods

● Endometriosis

● Moodiness, anxiety, or depression

● Hypothyroidism

● Infertility or miscarriage

● Breast pain or tenderness

Thyroid hormones: Many women with PCOS have a dysfunctional thyroid. It may be overactive (hyperthyroidism) or, more commonly, underactive (hypothyroidism). Hashimoto’s disease, an autoimmune disease and the most common cause of hypothyroidism, is prevalent in women with PCOS.

If the thyroid is not functioning properly, the balance of thyroid hormones and every other hormone in the body will be disrupted, causing abnormal sexual development, menstrual irregularities, and possibly infertility. I encourage all women with PCOS symptoms to have a complete set of thyroid labs to rule out thyroid dysfunction.

“Think of PCOS as being in an extended state of puberty, where androgens, luteinizing hormone (LH), and insulin resistance dominate and follicle-stimulating hormone (FSH), estrogen, and progesterone haven’t established their rhythm.”

—DR. FIONA MCCULLOCH

Signs of Thyroid Dysfunction

Signs of Hypothyroidism (Underactive Thyroid)

● Unexplained weight gain or trouble losing weight

● Fatigue

● Depression

● Hair loss and dry hair

● Muscle cramps

● Dry skin

● Swelling of the thyroid gland

● Brittle nails

● Slow heart rate

● Irregular period

● Sensitivity to cold

● Constipation

Signs of Hyperthyroidism (Overactive Thyroid)

● Unexplained weight loss

● Palpitations

● Feeling wired or anxious

● Shakiness

● Sweating spells

● Feeling hot frequently

● Tremors

● Shortness of breath

● Itchy red skin

● More frequent bowel movements than usual

● Fine hair and hair loss

CHRONIC INFLAMMATION

I should be a dentist’s dream patient. My brushing and flossing habits are impeccable. I have my teeth cleaned every six months. I don’t poke around in my mouth with pointy objects. Then why did my gums bleed every time I went to the dentist? For years, no matter what I tried, from my dentist I would get that face and “the talk.” You know the one I mean, about brushing and flossing regularly? As it turns out, it wasn’t my oral hygiene that was the problem. It was my systemic inflammation.

Inflammation isn’t necessarily bad. Our bodies use inflammation to fight off microbial, autoimmune, metabolic, or physical attacks. For example, it’s what causes our knees to puff up and bleed when we fall and scrape them. It’s a sign the body is deploying white blood cells, which help heal injuries, fend off disease, and replace aging cells. The problem is chronic inflammation, inflammation lasting from a few months to several years. That type of inflammation takes a tremendous toll on every system of the body.

Symptoms of Inflammation

● Weight gain

● Allergies

● Brain fog

● Joint pain

● Irritable bowel syndrome

● GI issues (bloating, gas, diarrhea)

● Acne

● Asthma

● Gum disease

● Chronic sinusitis

● High blood sugar

● Depression

● Belly fat

● Fatigue

● Eczema

● Psoriasis

According to integrative physician Felice Gersh, chronic inflammation is the root cause of many of the conditions women with PCOS experience, such as obesity and weight-loss resistance, infertility, hirsutism, mood swings, and acne. And recent research suggests that women with PCOS have higher levels of circulating C-reactive protein (CRP), an indicator of general inflammation independent even of obesity.

Inflammation is widely recognized as the root of many of the major diseases that plague the Western world. Cardiovascular disease, metabolic syndrome, hypertension, some cancers, diabetes, and PCOS all share the common root of inflammation.

Chronic inflammation may be caused by obesity, food sensitivities and allergies, and stress. It may also result from environmental and lifestyle factors such as pollution, poor diet, smoking, lack of exercise, and poor dental health. Getting to the root of these problems through a proper inflammation-reducing diet and lifestyle is critical for women with PCOS.

Why Do I Have PCOS?

Although the exact cause of PCOS is unknown, it is generally agreed that genetics, hyperinsulinemia (high levels of insulin) and insulin resistance, and/or a defect in a hormone-producing organ play a role. I have already discussed the chicken-and-egg debate about insulin and PCOS, whether chronically high levels of insulin cause excess androgens or vice versa. With regard to genetics, studies show that a woman with PCOS has a 40 percent likelihood of having a sister with the syndrome and a 35 percent chance of having a mother with the disorder. It is possible that a mother’s obesity, insulin resistance, or exposure to food high in advanced glycation end products (AGEs) or industrial toxins such as bisphenol A (BPA) may be the root cause. If PCOS is genetic, the genes involved in its expression may be triggered by environmental stimuli such as poor diet or rapid weight gain.

Some women with PCOS first experience symptoms when they stop taking the birth control pill. Typically, there was a predisposition before taking the pill, but only when they stopped taking it did symptoms emerge as a result of the disruption in communication between the pituitary gland and ovaries. In this case, symptoms should clear as soon as communication is reestablished.

How Can I Get Diagnosed?

Getting a firm diagnosis can be a long journey. There are several things to remember when seeking a diagnosis:

Be honest with your doctors. Tell them all of your symptoms. Try not to be embarrassed, and don’t write symptoms off to genetics, saying something like, “My aunts all have thinning hair; it must be genetic.” Your aunts may all have PCOS!

PCOS has a name problem. Approximately 20 percent of women who do not have PCOS have cysts on their ovaries. Similarly, about 30 percent of women who do have PCOS have no cysts.

Doctors are not always well-educated about PCOS and may try to treat each symptom separately instead of looking for the root cause. Press to get to the heart of your symptoms.

Be assertive when asking for lab tests. The more information you and your doctor can collect, the quicker you will get to the root of your symptoms and develop an effective plan. For a complete list of suggested labs, visit PCOSDiva.com/labs.

There is no definitive test to determine whether you have PCOS, but the most widely accepted diagnostic criteria are the Rotterdam Criteria. These were developed by the European Society for Human Reproduction and the American Society for Reproductive Medicine and include the original National Institutes of Health and EAE-PCOS Society diagnostic criteria. To be diagnosed with PCOS, a woman must present two of these three criteria:

1. Oligoovulation (irregular ovulation) or anovulation (absent ovulation)

2. Hyperandrogenism (elevated levels of androgenic hormones such as testosterone, clinical and/or biochemical)

3. Polycystic ovaries (enlarged ovaries containing at least twelve follicles each, shown on an ultrasound)

Even with these criteria in place, diagnosis can be tricky. Medications like birth control pills alter androgen levels and make testing inaccurate. Keep in mind that women may have irregular or even regular cycles and not ovulate or only ovulate occasionally. Having a period does not mean that you are ovulating. In addition, the presentation of symptoms may vary. There is no one-size-fits-all characterization of PCOS. You may be overweight and have irregular periods and acne, and the next woman may be lean with polycystic ovaries, absent periods, and hirsutism.

It is possible that you do not meet the Rotterdam Criteria at all, but still suffer from the symptoms. PCOS is often used as an umbrella term to include women with similar symptoms stemming from hyperandrogenism. You may also have a thyroid condition, and, again, I encourage all women with PCOS symptoms to have a complete set of thyroid labs to rule out thyroid dysfunction. You may have post-pill PCOS, a temporary condition with many of the same symptoms as PCOS caused by coming off of the birth control pill. If this is the case, once you rebalance your hormones, your symptoms should clear up for good.

As you can see, no single treatment will work for all women. The Healing PCOS 21-Day Plan is designed so that you can examine your symptoms, find the root cause, and discover what works for you.

Why Medications May Not Help: The “Band-Aid Effect”

I hear from women every day whose PCOS journeys had a very similar beginning. In their teens, they had irregular periods, acne, and/or painful PMS. Their doctor “fixed” these symptoms by prescribing the pill. Now the journeys divide. Some women tolerated the pill, but when they got off it, their symptoms returned with a vengeance and they struggled to conceive. Others could not tolerate the pill (nausea, headaches, weight gain, loss of libido) and have struggled with their symptoms and a series of drugs meant to help ever since.

There is a reason that these drugs cannot provide real, sustainable healing. At best, they are nothing more than Band-Aids, covering symptoms but not treating the root cause. At worst, they complicate your health picture with destructive side effects.

The Birth Control Pill

The pill is hands-down the go-to prescription from doctors. It has been touted as a miracle drug for everything from regulating periods to clearing up acne. In many cases, it seems to work for a while, but eventually you stop taking it and your symptoms return. Unfortunately, the pill has some serious downsides that most women are never told about.

● Blood clots. Research indicates that women on the birth control pill increase their risk of blood clots by a factor of 1.6. For those taking pills with higher levels of estrogen, that risk is twice as high. This risk throws fuel on the fire for women with PCOS who are already at higher risk for heart attacks and stroke.

● Increased insulin resistance. Studies show that with certain types of birth control pills, women suffered “unfavorable changes of insulin sensitivity.” This was certainly my experience. Researchers believe that this may have to do with the ratio of estrogen and progestin used in the various pills. Due to this concern about estrogen and insulin resistance, many doctors do not prescribe the pill for women at risk for or who already have diabetes. Whatever the reason, women with PCOS should not be taking any medications that worsen insulin resistance.

● Lower libido. The pill, by definition, alters your hormones. Unfortunately, for some women, it dampens libido (you see the irony). This happens for a couple of reasons. First, the steady stream of synthetic hormones from the pill evens out the body’s natural cycle of high (around ovulation) and low libido. Second, it suppresses testosterone levels. That’s great for taking care of androgen-induced symptoms (acne, facial hair), but is lousy for your sex drive.

● Nutrient deficiency. The pill depletes levels of valuable nutrients such as B vitamins, folic acid, vitamins C and E, magnesium, and zinc. You need sufficient levels of zinc to maintain a healthy hormone balance. Weight gain, fluid retention, mood changes, depression, and even heart disease can all arise from nutrient imbalance.

● Candida. Estrogen promotes the growth of yeast in the gut, sometimes causing a condition called Candida overgrowth. Candida is a fungus (a form of yeast) that occurs naturally in small amounts and aids in digestion. If an overgrowth occurs, symptoms like brain fog, fatigue, digestive and skin issues, mood swings, and fungal infections occur. In addition, it breaks through the intestinal wall and allows byproducts into the surrounding area, triggering systemic inflammation. Since the major ingredient in the pill is estrogen, the risk of Candida overgrowth increases; it also causes sugar and carb cravings.

Metformin

After the birth control pill, metformin is the most commonly prescribed drug to “treat” PCOS. The purpose of metformin is to decrease the amount of glucose (sugar) and insulin produced by the liver and pancreas, and increase sensitivity to insulin in muscle cells. Getting insulin resistance under control is critical to thriving with PCOS, so it makes sense to take a pill and get quick results, right? Unfortunately, according to a National Institutes of Health

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