[SPEAKER_00]: Hello and welcome to the Aquaman podcast.
[SPEAKER_00]: This is an exploration of woman kind.
[SPEAKER_00]: Here we discuss what it is to be a woman in the modern world while utilizing ancient and modern modalities in tandem to create a bounty of health for the body, mind and spirit.
[SPEAKER_00]: Good day ladies and welcome back to the part.
[SPEAKER_00]: Today we're talking all things PCOS.
[SPEAKER_00]: I did have a podcast episode all about PCOS, but that was published around one maybe two years ago.
[SPEAKER_00]: And a lot has happened in the research and a lot has happened for me as well.
[SPEAKER_00]: I've done a lot more research personally on PCOS.
[SPEAKER_00]: And I would like to do a little bit of a refresher.
[SPEAKER_00]: So welcome to this podcast all about PCOS.
[SPEAKER_00]: This is a nice foundational episode because I'm going to be interviewing a really interesting,
[SPEAKER_00]: researcher who is based her career around PCOS research, she's from Monash University, I just thought, you know what, it would be really good to have a good foundation here that you can listen to and then you can go and listen to that podcast so you can have a really amazing well-rounded information on PCOS.
[SPEAKER_00]: Before we get into the nitty-gritty of this amazing episode, let's power respects to the elders past, present, and future residing on the lands of literature,
[SPEAKER_00]: OS has always will be baby.
[SPEAKER_00]: If you've ever sat in a GP's office and been told that your symptoms quote aren't that bad or your ultrasound quote looks normal or quote you just need to lose some weight or interestingly also you're not fat enough to have PCOS.
[SPEAKER_00]: This episode is for you.
[SPEAKER_00]: PCOS affects 8 to 13% of reproductive age women globally making it the most common
[SPEAKER_00]: in indigenous Australian women prevalence is around 21%.
[SPEAKER_00]: Under the Rotterdam Criteria applied prospectively, community prevalence may be as high as 17.8%, that is 1 in 6 women and despite this huge prevalence, there's a lot of women who have PCOS.
[SPEAKER_00]: approximately half of women who meet the criteria remain undiagnosed by age 35.
[SPEAKER_00]: In one of the largest international studies of PCOS diagnosis experiences, 185 women across 32 countries.
[SPEAKER_00]: More than one third, they waited two years and saw three or more health professionals before being diagnosed.
[SPEAKER_00]: And that is absolutely unficable.
[SPEAKER_00]: PCOS, if left untreated, can be really dangerous from a cardio metabolic perspective, like it is not just a benign endocrine disorder, with superficial symptomology.
[SPEAKER_00]: No, it's it's symptomology and pathophysiology.
[SPEAKER_00]: They really run deep, so it's important to treat this sooner rather than later.
[SPEAKER_00]: It's quite concerning that these women are going undiagnosed.
[SPEAKER_00]: So why is PCOS so misunderstood?
[SPEAKER_00]: So it sits in the gap between gynecology, endocrinology and metabolic medicine.
[SPEAKER_00]: It is everyone's and no one's specialty.
[SPEAKER_00]: And it's been historically framed as a fertility or cosmetic issue, not the lifelong cardio metabolic condition that it truly truly is.
[SPEAKER_00]: Research funding lags significantly behind comparable prevalence conditions.
[SPEAKER_00]: And the other thing that I need to say is the name is a part of the problem, so the name really fixates on a single ultrasound finding that isn't really required for the diagnosis and international survey of 7,708 participants found that 86% of women with PCOS.
[SPEAKER_00]: and 76% of health professionals supported renaming their condition.
[SPEAKER_00]: We will talk about this more in a few sections.
[SPEAKER_00]: But first, I just wanted to talk to you about the episode arc.
[SPEAKER_00]: First, we're going to be talking about the Rotterdam Diagnostic Criteria and why and where they fall short.
[SPEAKER_00]: Secondly, we're going to be talking about the two rename PCOS, which is something that I am super bloody excited about.
[SPEAKER_00]: Thirdly, we're going to be covering the four types of PCOS and the biology and pathophysiology behind each of them.
[SPEAKER_00]: We're going to be talking about lean PCOS and why thin women keep getting missed.
[SPEAKER_00]: Why generic, calorie deficit advice can really backfire.
[SPEAKER_00]: We're also going to be covering the gut-overy access.
[SPEAKER_00]: While building muscle is one of the most powerful interventions that you can use, we're also going to be covering lifestyle interventions that are really
[SPEAKER_00]: quite powerful.
[SPEAKER_00]: Do not underestimate diet, sleep, exercise, and we're also going to be covering the basic supplementation with the strongest evidence base.
[SPEAKER_00]: So before you skip ahead to learning about the supplements, because that's what everyone does, I know what you're doing.
[SPEAKER_00]: I know what you're listening to on this podcast guys.
[SPEAKER_00]: There's a there's a great few of you that are listening to the whole thing through and through, but there are a few of you that just see the subheading supplement and you press on it.
[SPEAKER_00]: I can see that data.
[SPEAKER_00]: don't do that.
[SPEAKER_00]: Don't go anywhere near the what do I do about it before we have a talk about how it actually gets diagnosed because half of you listening probably weren't diagnosed correctly the first time around.
[SPEAKER_00]: So let's talk about the Rotterdam criteria.
[SPEAKER_00]: So what is the Rotterdam criteria when were they established?
[SPEAKER_00]: So the Rotterdam criteria were established by the International Panel convened in Rotterdam in 2003.
[SPEAKER_00]: If you didn't know Rotterdam is a really cool city in the Netherlands and it was published in human reproduction and fertility and stability in 2004.
[SPEAKER_00]: The Rotterdam Criteria replaced the narrower 1990 Nihage Criteria, which required both hyper-androgenism and ovulatory dysfunction, meaning that many women with PCOS were being missed entirely.
[SPEAKER_00]: So the foundation of the Rotterdam Criteria is the three criteria.
[SPEAKER_00]: You need to have two out of three.
[SPEAKER_00]: so you need to have oligo or an ovulation.
[SPEAKER_00]: So this can appear in your cycle as a regular cycles or absent ovulation.
[SPEAKER_00]: And you can pick this up if you're tracking your BBT, a lot of women with PCOS, we'll just say I don't have an obvious change in temperature.
[SPEAKER_00]: So if you don't know what I'm talking about,
[SPEAKER_00]: Your temperature is low in follicular and ovulatory, your estrogen dominant phases of the cycle, and then it jumps up up to you ovulated, and that's because progesterone likes to build babies, progesterone pro pregnancy, and it's going to make you hotter, so you turn into some what of a human incubator, if you know what I mean.
[SPEAKER_00]: And so we can basically tell when a woman has ovulated based on her temperature changes.
[SPEAKER_00]: It's not a perfect metric, but it is really, really great if you're doing it at home.
[SPEAKER_00]: So a lot of women with PCOS will say, I don't have a temperature change.
[SPEAKER_00]: So that's a regular cycles.
[SPEAKER_00]: And that's also absent ovulation.
[SPEAKER_00]: A regular cycle is sometimes my full cycle is 23 days.
[SPEAKER_00]: Sometimes it's 47.
[SPEAKER_00]: Sometimes I go three months without any type of ovulation or any type of period.
[SPEAKER_00]: That is one of the criteria of the Rotterdam criteria.
[SPEAKER_00]: Secondly, is clinical or biochemical hyper-androgenism, so that is high-androgens, though testosterone being one of them.
[SPEAKER_00]: And that can cause acne, or endrogenic alopecia on a clinical exam, or you can have elevated androgens on blood test results.
[SPEAKER_00]: The third criteria is polycystic ovarian morphology on an ultrasound.
[SPEAKER_00]: So this is where you can have a trans vaginal or you can have a stomach ultrasound.
[SPEAKER_00]: And it was originally if you had 12 follicles that were 2 to 9 millimeters per ovary.
[SPEAKER_00]: And now it's updated to 19 to 25 follicles.
[SPEAKER_00]: using high-resolution probes and very likely that's going to be a trans vaginal ultrasound.
[SPEAKER_00]: So what is that?
[SPEAKER_00]: That is follicles.
[SPEAKER_00]: Those are follicles that failed to launch.
[SPEAKER_00]: They failed to ovulate.
[SPEAKER_00]: Policistic ovarian syndrome in this case is we can see all the cysts that did not pop basically.
[SPEAKER_00]: They did not go on to form a corpus loodium and produce lots of progesterone, we're seeing them benign in the ovary.
[SPEAKER_00]: So you only need two out of these three.
[SPEAKER_00]: You don't need cis, you don't need to have a blood test out of range necessarily, right?
[SPEAKER_00]: So you can have someone come, they're very, very fit, but they have really irregular cycles, and they have bad acne when we do a trans vaginal ultrasound, it doesn't come up on their ultrasound.
[SPEAKER_00]: That person has PCOS, and so does the person who has 30 follicles inside of their ovaries.
[SPEAKER_00]: So you can understand that the name is a little bit misguided.
[SPEAKER_00]: The other thing I need to say is that the Rotterdam Criteria is the gold standard for diagnosing PCOS, but it is very controversial.
[SPEAKER_00]: So Rotterdam Criteria creates four distinct phenotypes, A, B, C, and D. Scientists are so creative.
[SPEAKER_00]: They have very different metabolic risks, meaning a single label hides a lot of biological diversity.
[SPEAKER_00]: So, phenotypes A and B carry the highest cardio metabolic risk, while phenotype D is the most metabolically benign.
[SPEAKER_00]: Ultrasan criteria should not be applied in adolescents within eight years of menach.
[SPEAKER_00]: So, say you got your period at 14 years old.
[SPEAKER_00]: You actually can't diagnose within eight years of your first period.
[SPEAKER_00]: And the 2023 International Guideline that was updating the
[SPEAKER_00]: If you go to a good doctor and you say I think I have PCOS these incentives that are showing up, they might run you through a quick survey of the Rotterdam criteria and then they go, okay, yeah, let's run some tests.
[SPEAKER_00]: What are the tests they run?
[SPEAKER_00]: So we'll be going through a few here, and this is also a nice guide.
[SPEAKER_00]: If you do think you have PCOS, if you wanted to order these yourself, or if you wanted to go to your doctor's super pet, get a pen and paper.
[SPEAKER_00]: First up, we have L-H and F-S-H and we also have the L-H to F-S-H ratio.
[SPEAKER_00]: If you don't know what any of these hormones are, please go and listen to my other podcast across course in your hormonal cycle.
[SPEAKER_00]: Go and listen to that and come back because then you'll understand everything we're talking about here.
[SPEAKER_00]: In classic PCOS, OH is often two to three times higher than FSH, due to the increased G&RH pulse frequency.
[SPEAKER_00]: The brain is shouting, please make eggs, please release eggs in the wrong rhythm.
[SPEAKER_00]: So the ratio does not rule out PCOS.
[SPEAKER_00]: So what we're basically saying here is L-Hage is the hormone that's released from your brain to cause ovulation.
[SPEAKER_00]: So we have all of the follicles there, they're ready to ovulate, they're ready to go.
[SPEAKER_00]: But L-Hage cannot do its job.
[SPEAKER_00]: It cannot break down that barrier between the follicle and the ovary and that means that ovum cannot pop.
[SPEAKER_00]: It can't ovulate and go on its journey.
[SPEAKER_00]: That means we don't make any progesterone.
[SPEAKER_00]: So your body keeps trying to make LH over and over and over again and that makes the follicle thicker and makes it harder and harder and harder for it to ovulate.
[SPEAKER_00]: So that's why we generally see high LH and we can see normal episodes in this case as well.
[SPEAKER_00]: The second lab you'll want to look out for or ask for is total and free testosterone.
[SPEAKER_00]: total testosterone can be really normal while free testosterone is elevated and that's because something called sex hormone binding globulin is low.
[SPEAKER_00]: So sex hormone binding globulin basically whenever you hear globulin in endocrinology so that that's your hormone system in your body.
[SPEAKER_00]: I want you to hear jail.
[SPEAKER_00]: Sex hormone binding globulin is the sponge that mobs up free.
[SPEAKER_00]: androgens.
[SPEAKER_00]: It also mobs up any free hormone traveling in the body.
[SPEAKER_00]: It's a secondary way that your body manages the amount of testosterone, estrogen, progesterone, yadayada, yada, yada, in your blood system.
[SPEAKER_00]: Interestingly, insulin, so too much insulin, directly suppresses the production and release of SHBG.
[SPEAKER_00]: Production in the liver.
[SPEAKER_00]: So low SHBG, in of itself, can be a bit of a sign, a bit of a fingerprint of hyper-insulinemia, which is
[SPEAKER_00]: Following from total and free testosterone SHBG, we have DHES.
[SPEAKER_00]: This is adrenal androgen, so this is the androgen that is made from your adrenal glands.
[SPEAKER_00]: Approximately 20% to 30% of women with PCOS have isolated DHES elevation with normal ovarian androgen.
[SPEAKER_00]: So we have normal testosterone, but DHES, which is that androgen coming from your
[SPEAKER_00]: adrenal glands is really, really, really high.
[SPEAKER_00]: So that's in 20 to 30% of women with PCOS.
[SPEAKER_00]: Next, we have anti-muleurion hormone, also known as AMH.
[SPEAKER_00]: This is made from small atrial follicles.
[SPEAKER_00]: In PCOS, it's often quite high, 2 to 3 times higher, usually.
[SPEAKER_00]: than controls.
[SPEAKER_00]: When I'm saying controls, I'm saying women who don't have PCOS.
[SPEAKER_00]: The 2023 International Guideline accepts that AMH is a valid alternative to an ultrasound in adults, but it is not a standalone diagnostic.
[SPEAKER_00]: So this can be a really good way to get yourself onto a diagnosis of PCOS.
[SPEAKER_00]: if you don't have access to a transvaginal or stomach ultrasound to look at your ovaries.
[SPEAKER_00]: Next, we have fasting insulin, Homer AR, HP A1C, and 2-hour OGTT.
[SPEAKER_00]: Using the Golden Standard Clamp method, insulin resistance was found in 75% of lean and 95% of overweight women with PCOS.
[SPEAKER_00]: So almost all women with PCOS readless of weight, had
[SPEAKER_00]: high insulin, which means insulin resistance, which we're talking about at later point in this podcast.
[SPEAKER_00]: And this was independent of BMI.
[SPEAKER_00]: So screening for fast and glucose alone, massively underestimates the problem.
[SPEAKER_00]: And that's something that I see a lot of doctors still doing is that they like, no, you're fast and glucose is fine.
[SPEAKER_00]: No, no, no, no, no.
[SPEAKER_00]: We need to look at fasting insulin.
[SPEAKER_00]: We need to look at HB1AC.
[SPEAKER_00]: We need to look at fasting insulin.
[SPEAKER_00]: We need to look at home AR.
[SPEAKER_00]: We need to look at HBA1C and 2-hour OGGT.
[SPEAKER_00]: Okay, those are the things that you absolutely need to have checked.
[SPEAKER_00]: Following from that is pro-lactin and TSH, and this is to rule out hypo-prolactinemia and thyroid disease, which both mimic PCOS.
[SPEAKER_00]: So that's really important.
[SPEAKER_00]: You might go down the realm of going, I am going to assume I have PCOS, but you might not have PCOS and you might actually make something else worse.
[SPEAKER_00]: So that's why we always say, if you're not testing, you're guessing.
[SPEAKER_00]: And finally, for your labs is your lipid panel, so we're going to be looking at your lipids because PCR wears is a metabolic condition, right?
[SPEAKER_00]: It's a part of the metabolic phenotype.
[SPEAKER_00]: So usually we see low HDL and high triglycerides.
[SPEAKER_00]: So you might go and get all of these tests and still be dismissed.
[SPEAKER_00]: So let's just talk about three elements of this.
[SPEAKER_00]: So number one is your ultrasound looks normal.
[SPEAKER_00]: This is something a lot of women with PCRs have been told.
[SPEAKER_00]: But ultrasound isn't a requirement in the two out of three rule for the Rotterdam Crateria.
[SPEAKER_00]: So you might have PCOS, but you might not have lots of follicles in your ovaries.
[SPEAKER_00]: So don't fall for that trap.
[SPEAKER_00]: That is not supported by the literature that is not supported by the Rotterdam Crateria.
[SPEAKER_00]: Secondly, is your testosterone is in range, so total can be normal, so total testosterone can be normal while free is really elevated.
[SPEAKER_00]: So if any doctor, any health practitioner is looking at your labs and they're saying you don't have PCOS because your testosterone is in range, the questions to ask is did you test for SHBG?
[SPEAKER_00]: Did you test for free testosterone?
[SPEAKER_00]: Did you test for bound testosterone?
[SPEAKER_00]: What is the actual ratio here, right?
[SPEAKER_00]: You need to be looking
[SPEAKER_00]: of testosterone, not just one marker of testosterone, and the other one that I think is really tricky is your cycles are 35 days.
[SPEAKER_00]: That's fine.
[SPEAKER_00]: I would say anything that's regularly outside of, I would say, 24 to 35 days.
[SPEAKER_00]: that qualifies as oligo ovulation, and that has been backed up in 2023, underneath them you guidelines as well.
[SPEAKER_00]: And those are the three biggest reasons I think of why women with PCOS get dismissed.
[SPEAKER_00]: So rounding up this section, we have a 22 year old name, we have a syndrome that has at least for very different biological flavors and diagnostic processes that misses about half of women, and so this is why researchers want to name it, and I really support the name
[SPEAKER_00]: The name PCOS describes one ultrasound finding that isn't necessary, isn't sufficient and isn't even cis.
[SPEAKER_00]: The 2012 U.S. National Institutes of Health, Evidence-Based Mythology, Workshop, that was a mouthful.
[SPEAKER_00]: Formerly concluded the name PCOS is a distraction and an impediment to progress, and that was in 2012 of so long.
[SPEAKER_00]: go.
[SPEAKER_00]: And they also said it focused on ovulation morphology that is neither necessary nor sufficient for diagnosis and approximately 85% of women with PCOS have insulin resistance and yet the name suggests that it is primarily an ovarian condition which which it does not I say this again and again.
[SPEAKER_00]: PCOS is a cardio metabolic disease that impacts your ovaries.
[SPEAKER_00]: It is not an ovarian disease
[SPEAKER_00]: PCOS is associated with type 2 diabetes, non alcoholic fatty liver disease, sleep apnea, depression, anxiety, cardiovascular disease across the lifespan.
[SPEAKER_00]: It is a systematic metabolic condition, not a structural ovarian one, right?
[SPEAKER_00]: I always say this, and I'm going to say it again, PCOS is not an ovarian disease that happens to impact the metabolic system.
[SPEAKER_00]: PCOS is a cardio metabolic disease that affects your ovaries, okay?
[SPEAKER_00]: It is a metabolic event.
[SPEAKER_00]: It is a metabolic disease.
[SPEAKER_00]: So throughout 2023 and 2025 we've felt this huge international push for a change.
[SPEAKER_00]: So an international workshop found that 81% of 94 voting delegates supported and name change.
[SPEAKER_00]: Along with your survey of 7,708 participants,
[SPEAKER_00]: published in clinical medicine of 2025 they found that 86% of PCOS patients and 76% of clinicians support renaming with endocrine, metabolic, earning the strongest support so it has to include endocrine and has to include metabolic that's kind of where we're going with the renaming.
[SPEAKER_00]: So there are four proposed names.
[SPEAKER_00]: And I don't know which one I like the most.
[SPEAKER_00]: So there's metabolic reproductive syndrome proposed at the 2012 N.I.
[SPEAKER_00]: workshop.
[SPEAKER_00]: The second one is Andrew and XS and all Vulatory dysfunction.
[SPEAKER_00]: I don't like this one.
[SPEAKER_00]: I do not like this one.
[SPEAKER_00]: This was proposed by the Andrew and XS and PCOS Society.
[SPEAKER_00]: Hmm, I'm going to vote no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no,
[SPEAKER_00]: Look, it's a Thai metabolic reproductive syndrome.
[SPEAKER_00]: I feel like there's a little bit of an overt oversimplification, an ovarian disc metabolic syndrome.
[SPEAKER_00]: I think puts too much of an emphasis on it being an ovarian condition.
[SPEAKER_00]: Wouldn't it be great if there was like a short concise name that we could come up with that really describe that it is a cardio metabolic disease that affects the ovaries, not the other way around?
[SPEAKER_00]: But I'm not going to put my hand up for that.
[SPEAKER_00]: I'm really, really not.
[SPEAKER_00]: There are already experts working on this.
[SPEAKER_00]: But those are my thoughts on those four proposed names.
[SPEAKER_00]: I've already spoken about the harm that PCOS as a name can cause, but I think let's just break it down a little bit more.
[SPEAKER_00]: So number one, cystic.
[SPEAKER_00]: What an ultrasound shows are arrested, atrial follicle.
[SPEAKER_00]: So as I described before, they are follicles that haven't burst within over and inside of them.
[SPEAKER_00]: They're generally two to nine millimeters in diameter.
[SPEAKER_00]: They're not pathological cysts.
[SPEAKER_00]: and the name triggers unwarranted anxiety about ovarian removal.
[SPEAKER_00]: Secondly, ovary places are a lot of focus on one organ in a systematic whole body metabolic condition, again.
[SPEAKER_00]: So it's not just the ovary, it's the entire body that's impacted by the pathophysiology of PCOS.
[SPEAKER_00]: When a clinician sees the name PCOS, they might not see that it's within the domain if they're outside of gynecology.
[SPEAKER_00]: So a gynecologist will go, okay, PCOS, I feel very comfortable treating this, but they don't have any specialty in cardiovascular metabolic disease, but a someone who has studied cardiovascular metabolic diseases does and they actually would be a little bit more helpful.
[SPEAKER_00]: So that means that because of this name, we're movement
[SPEAKER_00]: This also has a huge negative impact on funding.
[SPEAKER_00]: So research dollars don't follow when the condition sounds like a gynecology niece.
[SPEAKER_00]: What are we?
[SPEAKER_00]: 20 something minutes in and misogyny is here.
[SPEAKER_00]: So there is a huge impact on funding.
[SPEAKER_00]: So when people who fund studies here, PCOS, they think gynecology and gynecology is underfunded, generally.
[SPEAKER_00]: For something that is from the literature, we've proven that PCOS is a cardiometabolic event, a cardiometabolic disease, but because it has ovary and cyst in the name, it is categorized as a gynecological issue and therefore doesn't get funding because we live in a misogynistic patriarchal hellhole, basically.
[SPEAKER_00]: We will find out on what the new name is later this year.
[SPEAKER_00]: I'm very excited about it when that happens.
[SPEAKER_00]: I'm going to be renaming all of my resources to accurately back what that change of name is.
[SPEAKER_00]: I'm really excited to find out what it is.
[SPEAKER_00]: So let's move on to the next section.
[SPEAKER_00]: Let's talk about what the research already shows about the for very different variations of this condition.
[SPEAKER_00]: I really want to spend a lot of time in this section because a lot of women just assume that PCOS is all the same, but that is complete misinformation.
[SPEAKER_00]: They are very, very distinct types.
[SPEAKER_00]: I want to say a note here before we get into the four types of PCOS, that the four types framework groups women by predominant biological drivers, it overlaps with the Rotterdam criteria.
[SPEAKER_00]: So those four phenotypes, A, B, C, and D, but they are not exactly the same.
[SPEAKER_00]: So in here, we're going to be talking about type 1, type 2, et cetera.
[SPEAKER_00]: So the first type, type 1 is insulin resistant to PCOS, and this is in 70% of the cases.
[SPEAKER_00]: So the predominant symptoms that women will see here is central and abdominal weight gain.
[SPEAKER_00]: So lots of weight gain on your stomach, acne especially on your jawline and around your mouth,
[SPEAKER_00]: postmeal sleepiness and sugar cravings.
[SPEAKER_00]: Also weirdly, skin tags and also velvety dark patches at the neck and underarms and in your groin.
[SPEAKER_00]: So this is an increased malination and darkening of skin in these areas.
[SPEAKER_00]: Commonly seen labs for type 1 PCOS is elevated or fasting insulin, is elevated fasting insulin and Homer AR.
[SPEAKER_00]: We often see normal fasting glucose, which is the body kind of compensating.
[SPEAKER_00]: We also see elevated total and or free testosterone.
[SPEAKER_00]: We also see low SHBG, elevated LH to FSH ratio, which basically means
[SPEAKER_00]: more ill-hage than FSH, we also see elevated AMH here, pathophysiology.
[SPEAKER_00]: So insulin resistance is in 75% to 95% of women with this type independent of body weight, so you can be very lean, and you can still have type 1 PCOS.
[SPEAKER_00]: insulin here is the main driver, right?
[SPEAKER_00]: So insulin acts directly on the thicker cells, thicker cells are these amazing cells that are around your ovum and they make up the barrier.
[SPEAKER_00]: And basically, insulin can act on these cells via IGF1 and insulin receptors to upregulate something called CYP17.
[SPEAKER_00]: And so this is a rate limiting enzyme of hydrogen synthesis.
[SPEAKER_00]: What that means, basically, in layman's terms, too much insulin is essentially ordering
[SPEAKER_00]: lots and lots and lots of engines from these thicker cells.
[SPEAKER_00]: High in sealant also amplifies LH signaling at the pituitary and that increases LH pulse amplitude and that further drives thicker cell androgen production as well.
[SPEAKER_00]: We also see SHBG suppression, so low SHBG.
[SPEAKER_00]: And that's because I said said previously at the start of the podcast.
[SPEAKER_00]: In sealant directly suppresses hepatic SHBG synthesis.
[SPEAKER_00]: less sponge in the bloodstream means more free testosterone causing symptoms.
[SPEAKER_00]: Visceral fat expresses high levels of aromatase and aromatase is an enzyme that takes androgens and turns them into estrogen.
[SPEAKER_00]: And so this then can suppress FSH and this then can contribute to follicular arrest.
[SPEAKER_00]: And so that is those quote-unquote, not really cis but we have everyone calls them cis to form.
[SPEAKER_00]: So basically that
[SPEAKER_00]: PCOS types, also tend to have impaired glut for Translocation.
[SPEAKER_00]: So in PCOS skeletal muscle, there is a post receptor defect in insulin signaling.
[SPEAKER_00]: The doors that let sugar into the muscle get stuck, and so this can cause problems in skeletal muscle for women with PCOS.
[SPEAKER_00]: We also see excess engines directly in pairs, skeletal muscle, insulin signaling via the hydrogen receptor.
[SPEAKER_00]: And so basically these two last points, this creates a vicious cycle.
[SPEAKER_00]: Incylinder drives, engines, and engines drive more insulin resistance, and that can impact your skeletal muscle.
[SPEAKER_00]: Type 2 is post-pill slash inflammatory PCOS.
[SPEAKER_00]: I'm just going to say the outset here.
[SPEAKER_00]: The pill does not cause PCOS.
[SPEAKER_00]: It does not.
[SPEAKER_00]: Anyone online saying that it absolutely does and there's lots of literature to back it up, doesn't know right from wrong.
[SPEAKER_00]: Doesn't know up from down, basically.
[SPEAKER_00]: There's no literature to suggest this.
[SPEAKER_00]: What the literature does suggest is that after you go off the pill, if you went on the pill at like 14, because you had acne and you had a regular cycles, well, you probably had PCOS before and going off the pill, if you were just uncovering something that was already there.
[SPEAKER_00]: If you're like no, I had completely normal cycles.
[SPEAKER_00]: I had no symptoms of PCOS before I went on the pill and now I've come off of it and I have acne on my jaw and losing hair.
[SPEAKER_00]: I'm not sleeping.
[SPEAKER_00]: I'm always bloated.
[SPEAKER_00]: I can't lose weight.
[SPEAKER_00]: I have all of these symptoms of PCOS.
[SPEAKER_00]: What that is is basically when you go off the pill.
[SPEAKER_00]: You have an hydrogen rebound and you can also have your insulin can be a little bit mismanaged after you go off the pill.
[SPEAKER_00]: because surprise surprise, normal circulating hormones do impact more systems in the body than we usually take note of.
[SPEAKER_00]: So what this can be is post-pil PCOS.
[SPEAKER_00]: Did the pill cause your PCOS?
[SPEAKER_00]: No, very often this is a temporary period of time where women develop PCOS and then eventually with lifestyle interventions, it can go away.
[SPEAKER_00]: So basically, I really want to reiterate it here.
[SPEAKER_00]: No, hormonal birth control can cause PCOS.
[SPEAKER_00]: Okay, back to Type 2 postpills slash inflammatory PCOS.
[SPEAKER_00]: So the predominant symptoms here are acne flare-ups that usually occur three to six months after stopping the pill.
[SPEAKER_00]: Sudden cycle irregularity postpill, hair shedding, and often no significant weight changes here.
[SPEAKER_00]: Commonly seen labs, so androgens are really elevated, transiently.
[SPEAKER_00]: So a few months after you go off the pill, your androgens will be sky high and then they'll come back down to normal and baseline.
[SPEAKER_00]: Insulin and glucose are typically normal and LH rebounds might be high as well.
[SPEAKER_00]: So what's the pathophysiology, what's the explanation of this?
[SPEAKER_00]: So your HPO access, your hyperthalamus, pituitary ovarian access, right?
[SPEAKER_00]: This communication between your brain and your ovaries throughout a cycle.
[SPEAKER_00]: That is suppressed with oral contraceptive or any type of contraceptive use.
[SPEAKER_00]: and it can take 69 months for your LH and your FH pulses to come back online and become really generated and be really reestablished after you discontinued the pill.
[SPEAKER_00]: This is very well-known.
[SPEAKER_00]: We've known this since 2002.
[SPEAKER_00]: As I
[SPEAKER_00]: I said previously, there is post-pill androgenary balance here as well, so transient rise in adrenal and ovarian adrogens as the HPO axis reboots, and this appears like PCOS but often resolves within 6 to 12 months.
[SPEAKER_00]: So there's a difference between post-pill PCOS and actual PCOS here.
[SPEAKER_00]: Also, we need to talk about, as well, if you are taking oral contraceptives specifically, I mean, we do definitely see this with the marina and other types of hormonal birth control,
[SPEAKER_00]: oral contraceptive use, long-term use of these to pleats B9, B6, B12, B2, vitamin C, vitamin E, magnesium, selenium, zinc, so this can give you a milieu of different symptoms.
[SPEAKER_00]: So B6 is a co-factor for progesterine supporting serenogenesis, fololate and B12, a required for methalization or ovulation, and u-site quality, synchronous required for insulin synthesis, and hydrogen receptor function.
[SPEAKER_00]: possibly 900 enzymatic reactions, including insulin signaling, which I spoke about, a lot in the magnesium podcast episode if you want to go and listen to that.
[SPEAKER_00]: Also alongside this, there are inflammatory drivers.
[SPEAKER_00]: So elevated HSCRP into Luchun's six.
[SPEAKER_00]: TNF alpha, these are all seen in this type, specifically also NFKB pathway activation in response to glucose has been demonstrated even at normal weights as well.
[SPEAKER_00]: So for this, so talking about the layman's terms in flammatory drivers, when we talk about inflammation, we're talking about the action of white blood cells.
[SPEAKER_00]: which are part of your immune cells, right?
[SPEAKER_00]: Your immune cells are really, really reactive.
[SPEAKER_00]: After going off the pill and also if you have this inflammatory type of PCOS, so even if glucose hits a normal level, or even if it's
[SPEAKER_00]: slightly high, this triggers an inflammatory response in the body, so your body is very very very sensitive to little tiny changes.
[SPEAKER_00]: The third type of PCOS is a adrenal PCOS, so the predominant symptoms are stress, triggered cycle destruction, anxiety, sleep disturbances, fatigue, hair thinning, specifically at the temple, so we don't usually see in adrenal PCOS that hair loss in the middle of the head on the top of your skull, we see it at your temples instead,
[SPEAKER_00]: and so that's something that is supported as well in lots of different old medicine understandings like TCM I think as well adrenal PCOS types are also interestingly often slim or normal weight.
[SPEAKER_00]: Commonly seen labs in this criteria are elevated DHES, so it's often the only elevated antigen
[SPEAKER_00]: We usually see low or normal LH, normal fasting insulin.
[SPEAKER_00]: And we often also see normal ovarian morphology on an ultrasound.
[SPEAKER_00]: 20 to 30% and a women with PCOS have isolated DHES elevation, meaning the adrenal gland, not your ovaries, is the hydrogen source.
[SPEAKER_00]: And that is making up this group.
[SPEAKER_00]: of type 3 adrenal PCOS women.
[SPEAKER_00]: So this is where your HPA access, so your hypotherlamic pituitary and your adrenal access is really hyperactive.
[SPEAKER_00]: So we have an exaggerated cortisol and ACT H response to stress that have been demonstrated in this substrate.
[SPEAKER_00]: If you can imagine zero to 100, 100 being the most stressful event known to men.
[SPEAKER_00]: When you experience a stress level that usually you would experience as it as a 10, it is now your body is viewing that level 10 stressor as a level 70 stressor.
[SPEAKER_00]: Your body is viewing the same stimuli that previously wasn't really stressful as really, really, really, really scary.
[SPEAKER_00]: And so that's talking to that HVA axis, hyperreactivity.
[SPEAKER_00]: In this group, as well, we see cortisol, C-R-H, and G-N-R-H disruption.
[SPEAKER_00]: What this basically is saying is that, whenever we see a group of women with PCOS who have chronically high stress and chronically high cortisol, we also see a suppression in G-N-R-H. And G-N-R-H is the precursor to L-H-N-F-S-H, which is the precursor to your cycle, basically.
[SPEAKER_00]: so that contributes to ovulatory dysfunction.
[SPEAKER_00]: Because of the adrenal glands being in this constant state of stress and putting out a lot of stress hormones, they're putting out a lot of DHES and your peripheral tissues, so your tissues away from the center of your body, they convert that DHES into testosterone.
[SPEAKER_00]: So in layman's terms, stress hormones are essentially being shunted into hydrogen production.
[SPEAKER_00]: So in this group of women as well, we generally see that they have experienced adverse childhood experiences and they're linked to lifelong HBA access hyperactivity.
[SPEAKER_00]: So, stored trauma in the body basically.
[SPEAKER_00]: If you've ever heard of the ACE test, ACE test, maybe look it up with a friend or a close family member or someone you really trust and have a look.
[SPEAKER_00]: If you're listening to this and you have PCOS, we know that this subset of women are highly likely to have experienced traumatic events and we're seeing that reflected in the pathophysiology of their stress system.
[SPEAKER_00]: So, who gets this type of PCOS, high stress women,
[SPEAKER_00]: people pleases in Durin's athletes, this overlaps with relative energy deficiencies, and, as I said previously, women who have experienced traumatic life events, usually younger in life.
[SPEAKER_00]: Type 4 is thyroid inflammatory PCOS.
[SPEAKER_00]: This is often called lean PCOS.
[SPEAKER_00]: The predominant symptoms in this group, so lean or normal weight, system fatigue, like fatigue that does not give up.
[SPEAKER_00]: You cannot focus on anything.
[SPEAKER_00]: That symptoms, like blotting and irregular stalls, out acne or diffuse hair thinning, and cycles are irregular, but often less dramatically so.
[SPEAKER_00]: So you might have a 28-day cycle and then you'll have a 32 and then you'll have a 35 and then you'll have a 26.
[SPEAKER_00]: Right, so you go to a doctor with that and they say it's kind of regular, you know, it's not that bad, but, you know, generally a healthy body is like clockwork.
[SPEAKER_00]: Every single time, you know, if you're 28, you're 28, if you're 32, you're 32, that's kind of how your body should be working.
[SPEAKER_00]: commonly seen labs, so often normal, or mildly elevated endrogens, and they often we often see elevated prolactin in approximately 10 to 25% of women with TCLS, which makes up this entire group.
[SPEAKER_00]: There's also a really big Hashimoto's overlap here as well with positive thyroid antibodies, so that's present in 22 to 27% of women with TCLS.
[SPEAKER_00]: which is roughly three times the general female rate, so we're seeing a lot of representation of positive thyroid antibodies here in this group, but also seeing elevated HSCRP, so that's inflammatory marker, alongside another inflammatory marker, IELS.
[SPEAKER_00]: If you're interested in learning more about your thyroid, have an amazing podcast with Tire Nelson, who's a naturopath specializing in the thyroid.
[SPEAKER_00]: There is a really new degree podcast episode.
[SPEAKER_00]: You'll need to slow it down, write things down, but we do talk about a lot of the pathophysiology.
[SPEAKER_00]: of Hashimoto's in that podcast.
[SPEAKER_00]: So if you're listening to this and you're thinking, oh my gosh, that's me, or you know what's you?
[SPEAKER_00]: That's a really great one to follow up with.
[SPEAKER_00]: So what's the pathophysiology of Type 4 in Flametry thyroid PCOS?
[SPEAKER_00]: AKA lean PCOS.
[SPEAKER_00]: Number one is TSH receptors and thyroid hormone receptors are expressed on
[SPEAKER_00]: on your follicles.
[SPEAKER_00]: We have receptors for TSH and thyroid hormone, so T3 and T4.
[SPEAKER_00]: Thyroid hormone directly modulates follicular maturation.
[SPEAKER_00]: So your ovary has thyroid hormone antennae, and your thyroid problem becomes an ovary problem in a way.
[SPEAKER_00]: So it starts with the thyroid and it impacts your ovaries.
[SPEAKER_00]: So elevated T-R-H, so that's when your thyroid hormone is low, that's when this is released, a lot.
[SPEAKER_00]: It stimulates prolactin secretion.
[SPEAKER_00]: Prolactin then suppresses G&I-H and L-H contributing to ovulatory dysfunction, so irregular cycles.
[SPEAKER_00]: So inflammatory markers, we generally see in
[SPEAKER_00]: TNF alpha and NFKB activation and glucose ingestion alone can trigger an inflammatory cytokine release in their immune cells.
[SPEAKER_00]: So a lot of these women will say, I cannot eat a doughnut.
[SPEAKER_00]: I'm going to get a flare up the next day.
[SPEAKER_00]: I feel so tired.
[SPEAKER_00]: I think a lot of women listening to this like, oh my god, that's me.
[SPEAKER_00]: I can't eat a bowl of pasta and feel okay the next day.
[SPEAKER_00]: This might be what's going on.
[SPEAKER_00]: There's also a connection between your gut microbiome, LPS, inflammation and then HPO disruption.
[SPEAKER_00]: So gut dyspiosis, which basically means your gut is out of whack, leads to LPS translocation.
[SPEAKER_00]: and that drives systemic inflammation and that then disrupts your HVO access function.
[SPEAKER_00]: So basically, what I'm explaining here is that you don't actually have anything wrong with your metabolic system.
[SPEAKER_00]: It is your thyroid, it is stress, it is your gut being in a dysphiotic state, and your white blood cells and your body reacting to these things that then impact your cycles that then can impact
[SPEAKER_00]: Lean PCOS accounts for approximately 20 to 30% of all PCOS diagnosis and this obese hairy infertile understanding and stereotype dating back to 1935 still really shapes clinician pattern recognition and women who don't fit into that stereotype report greater diagnostic delay and that is also dangerous because we're talking about your thyroid here, your thyroid runs everything in the body.
[SPEAKER_00]: And it's really sad because lean women are dismissed and misdiagnosed.
[SPEAKER_00]: They're told you kind of PCOS because you're too thin by clinicians who haven't seen any updated literature.
[SPEAKER_00]: And I'm talking literature that came out in 2018, okay?
[SPEAKER_00]: You know, that women in this subtype, they are denied scans, blood work, and referrals.
[SPEAKER_00]: and the grief of years of unexplained symptoms starts to impact them into health.
[SPEAKER_00]: So the rates of moderate to severe depression and anxiety are three times higher in PCOS than controls and that's independent of BMI.
[SPEAKER_00]: So it didn't matter whether these women with PCOS,
[SPEAKER_00]: were thin, were overweight, had a good amount of muscle mass, or didn't, didn't really matter.
[SPEAKER_00]: They were still dismissed, they were still misdiagnosed.
[SPEAKER_00]: There's also another misconception that I'm seeing online a lot at the moment, which is a huge red flag to me.
[SPEAKER_00]: And it's people saying that lean PCOS types can't have insulin resistance.
[SPEAKER_00]: T-O-F-I, thin outside fat inside, right?
[SPEAKER_00]: So normal BMI with high visceral and atopic fat in the liver and pancreas.
[SPEAKER_00]: So this was discovered by Thomas Bell and colleagues in Imperial College in London of 2020-12.
[SPEAKER_00]: And so this basically describes that 75% of lean women with PCOS.
[SPEAKER_00]: have insulin resistance and even when we're using the gold standard clamp method, right?
[SPEAKER_00]: So we're finding it when we're using the gold standard method for finding insulin resistance and that's comparable to the magnitude seen in non-obes non-PCOS controls.
[SPEAKER_00]: Lean PCOS types can have insulin resistance.
[SPEAKER_00]: Insulin resistance leads to negative cardio metabolic events.
[SPEAKER_00]: Therefore, it is dangerous to misdiagnose.
[SPEAKER_00]: And you might be thinking, hey, how can this happen?
[SPEAKER_00]: I described it before.
[SPEAKER_00]: The mechanism is that post receptor deficit in muscle insulin signaling.
[SPEAKER_00]: It exists independent of body fat percentage.
[SPEAKER_00]: And inflammation is also a primary driver when insulin is normal as well.
[SPEAKER_00]: So lean women with PCOS have hydrogen sensitized immune cells that mount an exaggerated inflammatory response to glucose and that places inflammation upstream of insulin resistance in some cases.
[SPEAKER_00]: And we've known that from 2012, we've known all of this information for a really long time.
[SPEAKER_00]: So
[SPEAKER_00]: This information, you know, is old.
[SPEAKER_00]: We should not be touting these misunderstandings and this misinformation anymore.
[SPEAKER_00]: I'm going to follow up again with why BMI is a poor diagnostic tool.
[SPEAKER_00]: It's a really poor tool overall.
[SPEAKER_00]: So BMI misclassifies up to half of women with elevated body fat as normal weight.
[SPEAKER_00]: All right, so waste hip ratio and waste circumference are way better and more clinically useful than BMI.
[SPEAKER_00]: And going on from that, I would even say a dexter scan is probably more effective.
[SPEAKER_00]: So DEXA, you can go and get a dexter scan as well.
[SPEAKER_00]: And so that shows you your body fat percentages.
[SPEAKER_00]: And so usually you should have a lot more muscle tissue than you have that tissue.
[SPEAKER_00]: Next, let's talk about why calorie deficits don't work for all PCOS types.
[SPEAKER_00]: And who keeps saying the reason why you can't lose weight is because every time you bend your elbow, your mouth opens and that's why you can't lose weight.
[SPEAKER_00]: It's just so insensitive and it's really, really, uh, fucking frustrating because we're more with PCOS are more likely to develop eating disorders and just sort of eating in comparison with women who don't have PCOS.
[SPEAKER_00]: And that's because they've been told this rhetoric of just eat less and exercise more and they do it and they get down to eating 800 calories a day and they can't lose anyway.
[SPEAKER_00]: So let's talk about why calorie deficits might not work for all PCOS types.
[SPEAKER_00]: Number one, why it might not work for insulin resistant PCOS.
[SPEAKER_00]: When we have a severe caloric restriction, when you go to eating 1,200 calories a day, that really acutely raises cortisol.
[SPEAKER_00]: Calorie tracking and chronic restriction rays perceived stress and saliva rate cortisol regardless of the weight outcomes.
[SPEAKER_00]: Then going on from now, elevated cortisol drives hepatic gluconeogenesis, which raises blood glucose and it drives compensatory insulin secretion and that worsens high insulin.
[SPEAKER_00]: And then cortisol also feeds into the same precursor tool as DHA.
[SPEAKER_00]: which pushes more antigen production, right?
[SPEAKER_00]: So that makes the situation worse for that woman and makes it harder for her to lose weight.
[SPEAKER_00]: Speaking to all types here for the HPO Access, energy availability below 30 kcal per kilogram of fat-free mass a day just drops the ability of your body to pulse with L-h.
[SPEAKER_00]: within just five days.
[SPEAKER_00]: So if you're going through a really restrictive diet in five days, we've already seen lower LH.
[SPEAKER_00]: So aggressive restriction can push the body towards high-perthelamic ameneria territory and that happens faster than most people realize.
[SPEAKER_00]: So really restricting your calories can make your cycles more irregular and it can stop your cycles all together.
[SPEAKER_00]: for adrenal PCOS specifically, calorie deficits act as a physiological stressor.
[SPEAKER_00]: So that will surge DHAS, and that will work in adrenal patent symptoms again, and for these women restriction often makes acne, hair loss, and cycle restriction worse.
[SPEAKER_00]: not better.
[SPEAKER_00]: So you might lose a kilo, but your acne might get worse.
[SPEAKER_00]: You might lose more hair and your cycles become more irregular.
[SPEAKER_00]: For lean and flammatory PCR S types, restriction drives nutrient depletion and worsens gut barrier integrity.
[SPEAKER_00]: So in this group of women we already have dysbiotic guts and that makes it worse.
[SPEAKER_00]: So dietary restriction can shift your microbiome towards a less diverse, more pro and flammatory composition, which can make symptoms for this PCR
[SPEAKER_00]: Okay, so for most PCOS types, we are understanding from the literature, both proven literature and also mechanistic literature, that the calorie deficit might not be the most amazing thing.
[SPEAKER_00]: So what does the evidence actually support instead?
[SPEAKER_00]: Number one, macro nutrient composition, so your composition of protein, fat, and carbohydrate.
[SPEAKER_00]: matters far more than total calorie reduction for hormonal outcomes in PCOS.
[SPEAKER_00]: That was from the University of Adelaide in 2013.
[SPEAKER_00]: Low glycemic load diets are also really great.
[SPEAKER_00]: So, when we ingest carbohydrates, there's different glycemic loads.
[SPEAKER_00]: And so, higher glycemic loads is a table sugar, for example.
[SPEAKER_00]: That boosts up your glycemic response really significantly.
[SPEAKER_00]: But if you eat, say, broccoli, that has a pretty low glycemic response.
[SPEAKER_00]: So if we eat a low glycemic diet, menstrual regularly improves in 95 versus 63% of standard healthy controls.
[SPEAKER_00]: So in this study in 2010, this was released in Journal of Clinical Health.
[SPEAKER_00]: This was burnt down by the University of Sydney.
[SPEAKER_00]: they placed two groups on diets.
[SPEAKER_00]: So one, they gave a low glycemic low diet and that improved menstrual irregularity by 95%.
[SPEAKER_00]: So 95% of them saw an improvement in menstrual regularity compared to the other group that had a standard diet that was not low glycemic.
[SPEAKER_00]: So both of the calories were the same.
[SPEAKER_00]: So we're seeing a better improvement if we focus on glycemic load instead of calorie restriction.
[SPEAKER_00]: Following on from that is the type of foods we're eating.
[SPEAKER_00]: So the Mediterranean diet, higher adherence inversely associated with insulin resistance and higher for hydrogen inia.
[SPEAKER_00]: Basically that means people who ate a Mediterranean diet had normal insulin, so they had less incidence of insulin resistance and they had normal androgen levels.
[SPEAKER_00]: following on from this again, anti-inflammatory dietary patterns.
[SPEAKER_00]: So, higher inflammatory diet scores, correlated with significantly higher PCOS prevalence and symptoms severity.
[SPEAKER_00]: So, overarchingly, what the evidence actually supports is removing ultra-processed foods, removing refined carbohydrates.
[SPEAKER_00]: And this produces metabolic improvement before any deficit is created.
[SPEAKER_00]: So deficit might not be the most important thing for women with PCOS to focus on.
[SPEAKER_00]: There are a lot more applications of understanding a diet and what is actually effective.
[SPEAKER_00]: And this is actually far more fulfilling, literally.
[SPEAKER_00]: Like you can eat more food and you'll have better outcome on your PCOS pathophysiology.
[SPEAKER_00]: Let's talk about the gut microbiome in PCOS.
[SPEAKER_00]: I'm going to be doing a podcast next month with a doctor all about the gut microbiome and very excited about that.
[SPEAKER_00]: So let's look forward to that.
[SPEAKER_00]: I can't go a deep dive into the gut right now, but I'm just going to assume that you haven't been living under a rot and you know about the gut microbiome.
[SPEAKER_00]: Women with PCORS show a lot of gut symptoms, so significantly higher rates of IVS type symptoms and small intestinal bacterial overgrowth, also known as Cibo in PCORS compared to controls.
[SPEAKER_00]: Bloading and constipation are also super common, and this is because Androgen's slow gut transit by reducing intestinal smooth muscle of motility.
[SPEAKER_00]: There's also a connection between your gut and your ovaries.
[SPEAKER_00]: This is called the dogma hypothesis, D-O-G-M-A hypothesis, yes, and being 100% for real, that is what it's called.
[SPEAKER_00]: And it is as follows.
[SPEAKER_00]: Dispyosis of gut microbiota, which means we have an imbalance in good versus pathogenic bacteria in your gut.
[SPEAKER_00]: That means LPAs, that means that LPS starts to translate hate.
[SPEAKER_00]: that creates systemic inflammation and it really disrupts that HPO access and it can lead to insulin resistance.
[SPEAKER_00]: So multiple independent studies have since confirmed reduced microbial diversity in women with PCOS versus matched BMI controls.
[SPEAKER_00]: So they had women with PCOS, say they were a certain BMI and they found women who didn't have PCOS who had the same BMI as them,
[SPEAKER_00]: and the women with PCOS had far more likelihood of having reduced microbial diversity.
[SPEAKER_00]: So we want lots of diversity in the gut, we want as many different microbes as possible, and women with PCOS tend to have lower diversity.
[SPEAKER_00]: There's also just an overall change in the microbiome in women with PCOS.
[SPEAKER_00]: So we see lower lactobacillus, Bifidobacterium,
[SPEAKER_00]: Accomansia, fake hally bacterium, rosbria, and pran's nitsisi.
[SPEAKER_00]: These are all associated with lower gut barrier integrity and inflammatory functions.
[SPEAKER_00]: On the inverse side of this, we see an increase in pro-inflammatory bacteria, including bacteria roads, and esturia, and shegula.
[SPEAKER_00]: Loki, I know I said all of those wrong, and that's because I learned from reading, so I'm really sorry if I mispronounced a few of those gimmibrik.
[SPEAKER_00]: In your gut, so basically what happens is you have gut microbes that are really helpful.
[SPEAKER_00]: Lactobacillus, for instance, they eat fiber that we don't digest.
[SPEAKER_00]: You know how we eat fiber because it's good for us?
[SPEAKER_00]: Well, the reason it's good for us is because lactobacillus and all of these other amazing different microbes in our gut,
[SPEAKER_00]: they eat that fiber and then they fart out short chain fatty acids like buterate, acetate, these are associated with so many great things in the body.
[SPEAKER_00]: Short chain fatty acids are used for so many different processes in the body.
[SPEAKER_00]: They're amazing, they're associated with longevity, love short chain fatty acids.
[SPEAKER_00]: But short chain fatty acids were reduced in 30 to 66% of women with PCOS in comparison to women who don't have PCOS.
[SPEAKER_00]: Number one, buterate is the primary fuel for colonocytes, and that supports tight junction proteins that keep the gut wall sealed.
[SPEAKER_00]: If you've ever heard of leaky gut, we want tight junctions that keep everything in place and keep the gut in its integrity, so nothing can get in or out without permission.
[SPEAKER_00]: And so if we don't have buterate, we can't have that, and we have leaky gut.
[SPEAKER_00]: Next, we have propryinate, so this is a short-chain fatty acid.
[SPEAKER_00]: This improves insulin sensitivity and satiety by receptors in the gut lining.
[SPEAKER_00]: In layman's terms, if we have less short-chain fatty acids, we have a leaky gut, and we have less insulin sensitivity in the body.
[SPEAKER_00]: Both of these things are highly associated with PCOS.
[SPEAKER_00]: Next, let's talk about LPS.
[SPEAKER_00]: So when the gut wall is compromised, LPS
[SPEAKER_00]: That is a huge no brainer, because that creates a lot of inflammation.
[SPEAKER_00]: LPS is not supposed to be anywhere else, but in the gut, okay?
[SPEAKER_00]: It's supposed to be in the gut.
[SPEAKER_00]: If it goes into bloodstream, your white blood cells basically go ballistic and create all of these inflammatory
[SPEAKER_00]: molecules, they push it out and it creates an inflammatory environment in the body.
[SPEAKER_00]: There's also a connection between the gut microbiome and hydrogen metabolism.
[SPEAKER_00]: So there is something called beta-glucer on a day, and that's produced by a certain gut bacteria.
[SPEAKER_00]: This tends to turn already digested.
[SPEAKER_00]: So say, your body has released estrogen and antigens into the gut because they need to go into waste because they're old and they're janky and they're not really working properly.
[SPEAKER_00]: Baita Claranojace is really naughty.
[SPEAKER_00]: She likes to turn these previously digested hormones back on and puts it back into circulation, right?
[SPEAKER_00]: And so this ties in with something called the astrobeleum.
[SPEAKER_00]: This is the bacterial genes capable of metabolizing estrogens in the gut, and they directly influence how much estrogen and androgen re-circulate systematically.
[SPEAKER_00]: And as you can imagine, in women with PCOS,
[SPEAKER_00]: This system is janky and out of balance.
[SPEAKER_00]: And if you thought the gut was one of the great untreated levers of PCOS, the second one I'm going to be talking about is one that almost no one talks about for where move PCOS.
[SPEAKER_00]: It's skeletal muscle.
[SPEAKER_00]: When I say skeletal muscle, it is the muscle around your skeleton.
[SPEAKER_00]: Skeletal muscle accounts for approximately 80% of post-prainial glucose disposal.
[SPEAKER_00]: It is the largest site of blood sugar clearance.
[SPEAKER_00]: In layman's term, what does that mean?
[SPEAKER_00]: It is the biggest mop for glucose and insulin in the body.
[SPEAKER_00]: It balances your hormones, skeletal muscle, balances your hormones.
[SPEAKER_00]: In PCOS, the glut4 transporters that move glucose into muscle cells don't respond normally to insulin, so those doors are stuck, so glucose stays in the blood system.
[SPEAKER_00]: but do know what actually does work in this essence, muscle contraction.
[SPEAKER_00]: So muscle contraction, translocates, glut-4 via AMPK dependent pathways that completely bypass this broken insulin signaler, which means that you, my lovely PCOS sister listening to this.
[SPEAKER_00]: going out and lifting some weights, contracting your muscles.
[SPEAKER_00]: We'll get all of the glucose into your muscles.
[SPEAKER_00]: A lot of women say to me, I can't be bothered going to the GMO PCOS I'm so fatigued.
[SPEAKER_00]: That's because glucose can't, glucose can't actually get into your cells.
[SPEAKER_00]: How you fix that problem is moving.
[SPEAKER_00]: Muscle contraction, translocates, glut4 via AMPK dependent pathways,
[SPEAKER_00]: that bypasses this broken insulin signaler.
[SPEAKER_00]: Please go workout.
[SPEAKER_00]: You will feel better afterwards.
[SPEAKER_00]: You will feel better.
[SPEAKER_00]: When you contract your muscle, glucose goes in, even when insulin isn't being heard.
[SPEAKER_00]: Exercise is a back door into insulin resistance.
[SPEAKER_00]: Okay, and alongside this, the more you work out, the more you do resistant training, the more it builds these doors.
[SPEAKER_00]: Progressive resistant training increases muscle protein, and therefore it increases glut4 protein content, and therefore it improves insulin signaling.
[SPEAKER_00]: So, more muscle equals more glut4, equals lower circulating glucose, equals lower insulin.
[SPEAKER_00]: Amazing, right?
[SPEAKER_00]: Alongside this as well, there is a connection between muscles and Androgens.
[SPEAKER_00]: So, improved insulin sensitivity raises hepatic SHBG and that directly reduces free testosterone, which means when you work out, you produce more SHBG, which is that jail for Androgens.
[SPEAKER_00]: and that puts the Androgens in jail so they can't attach to receptor sites, which means your acne gets better, you have less hair on your face, on your chest, on your hands, et cetera.
[SPEAKER_00]: And this has been proven in São Paulo, in medicine and science and sports exercise of 2016.
[SPEAKER_00]: They proved that progressive resistance training produced significant
[SPEAKER_00]: with a capital T, reductions in free androgen index and improvements in lean mass in women with PCOS.
[SPEAKER_00]: Go to the gym, go to the gym, following on from that.
[SPEAKER_00]: Let's talk about myocans.
[SPEAKER_00]: This is the muscle as an endocrine organ.
[SPEAKER_00]: When we contract our muscles, it releases something called a myocone.
[SPEAKER_00]: These are signaling proteins, and they include muscle-derived interlution six, which is very different from chronic inflammatory aisle six, and irescent.
[SPEAKER_00]: So basically what this means.
[SPEAKER_00]: These have anti-inflammatory and metabolic effects, and every contraction is a hormonal signal.
[SPEAKER_00]: I think people just forget that your skeletal muscle is an endocrine organ.
[SPEAKER_00]: it is a secondary balancer to our endocrine system, our sexual endocrine system.
[SPEAKER_00]: Let's talk about resistance versus cardio in PCOS, a huge bone of contention for no good reason, because there's a lot of literature behind both of them.
[SPEAKER_00]: There's a lot of talk online, is resistance training that is cardio, that is yoga, okay, is doing this, is doing that, and what I will say
[SPEAKER_00]: I was speaking to someone in the corner about this last night, he's amazing, he's really, really great, he's studying sports physiology, he's a personal trainer, he was just like just depends on what you want out of the exercise, all exercises is good for different reasons, and I'm going to back that up here.
[SPEAKER_00]: So both resistance training and hit workouts improve metabolic and hormonal outcomes, strength training particularly improved free Android index in head to head comparisons.
[SPEAKER_00]: So if you want to lower your
[SPEAKER_00]: work out.
[SPEAKER_00]: If you want improved metabolic and hormonal outcomes, both resistance training and hit were both great.
[SPEAKER_00]: At 2025, network metronolysis, where they looked at 19 randomized control trials.
[SPEAKER_00]: So the number of people in that study was 888 women with PCOS.
[SPEAKER_00]: They found that hit and yoga were most effective for lowering home at AR.
[SPEAKER_00]: While resistance training showed the strongest effects
[SPEAKER_00]: do an array of different exercises and make sure you're focusing on resistance training.
[SPEAKER_00]: So that should be the baseline of your workout is trying to go to the gym, trying to go to the gym two to three times a week and then go for a run, go for a walk, go for a hike, go for a swim, go for a dive, go climb up a wall of that's what you're really into.
[SPEAKER_00]: You can also put stretching and yoga in there as well.
[SPEAKER_00]: Basically, every killer of muscle you build is another sponge for glucose.
[SPEAKER_00]: It's another factory for SHBG, and it's another source of anti-inflammatory mitochondria.
[SPEAKER_00]: Muscle is not an aesthetic thing.
[SPEAKER_00]: It is an endocrine tissue.
[SPEAKER_00]: So now we know what's happening.
[SPEAKER_00]: Let's talk about what actually works.
[SPEAKER_00]: Let's talk diet.
[SPEAKER_00]: Let's talk sleep.
[SPEAKER_00]: Let's talk exercise.
[SPEAKER_00]: Let's talk supplements in that order.
[SPEAKER_00]: Let's talk about diet.
[SPEAKER_00]: This is basically everything you need to know.
[SPEAKER_00]: So low glycemic load, a 12-month randomized control trial compared low GI versus high standard versus standard healthy diets in PCOS, and they found that menstrual regularly improved in 95% of those the low GI group.
[SPEAKER_00]: So low GI is kind of what you want to be going for because that lowers your insulin and therefore that can control your insulin sensitivity.
[SPEAKER_00]: Secondly, Mediterranean diet.
[SPEAKER_00]: So higher adherence inversely associated with high androgens and high insulin.
[SPEAKER_00]: Okay, and this has been confirmed with multiple RCTs.
[SPEAKER_00]: There was a 2022 trial that compared Mediterranean low carb versus low fat hypocloric diets and Mediterranean low carb was superior for weight hormones and metabolic outcomes.
[SPEAKER_00]: Number three, anti-inflammatory foods.
[SPEAKER_00]: One of the mainstays of a Mediterranean diet is that it's anti-inflammatory and it's anti-inflammatory because of the amount of a omega-3 fatty acids, polyphenols and dietary fiber.
[SPEAKER_00]: So these are the three things you really need to be
[SPEAKER_00]: focusing on it.
[SPEAKER_00]: It's not so much how little calories am I eating.
[SPEAKER_00]: It's how much omega 3 is today today.
[SPEAKER_00]: How many polyphenols were as I exposed to?
[SPEAKER_00]: What was my dietary fiber?
[SPEAKER_00]: Was I getting 35 grams of dietary fiber today?
[SPEAKER_00]: These are the core of your diet because they lower inflammation in the body and that consisting
[SPEAKER_00]: and that consistently correlates with PCOS severity.
[SPEAKER_00]: Protein is important.
[SPEAKER_00]: So higher protein intake, so 30% of energy, improved fat loss.
[SPEAKER_00]: It also retained lean mass retention and also improved antigen profile in over six months in women with PCOS.
[SPEAKER_00]: And so that's the study from 2012.
[SPEAKER_00]: Protein is really important.
[SPEAKER_00]: If you have PCOS, you have high endrogens and that grows your muscle tissue.
[SPEAKER_00]: So you want to be supporting muscle tissue growth with protein.
[SPEAKER_00]: as I said before, avoid ultra-processed foods and refined carbohydrates.
[SPEAKER_00]: This is supported across literally every single dietary intervention.
[SPEAKER_00]: This was a mainstay in every single one of them.
[SPEAKER_00]: Okay, let's move on to sleep.
[SPEAKER_00]: A single night of partial sleep deprivation, so four hours,
[SPEAKER_00]: reduces insulin sensitivity by approximately 25% the following day.
[SPEAKER_00]: Sleep restriction for one week in Pes glucose tolerance to a pre-diabetic level, basically in layman's terms, un-bad night of sleep, or a week of bat sleep, has comparable metabolic effects,
[SPEAKER_00]: to a sustained dietary indiscretion, which basically means you're eating a lot of junk food.
[SPEAKER_00]: This is not a metaphor.
[SPEAKER_00]: So this is a measurable biochemical event.
[SPEAKER_00]: Sleep is also so important.
[SPEAKER_00]: And the reason why is because circadian rhythm disruption is associated.
[SPEAKER_00]: With menstrual irregularity, remember the start of your menstrual cycle doesn't occur in your ovaries, it occurs in your brain with FSH and L-hate, right?
[SPEAKER_00]: So L-hate surges and ovulation are circadian gated.
[SPEAKER_00]: You need to have a healthy circadian rhythm to have a healthy infradion rhythm.
[SPEAKER_00]: Women with PCOS have approximately 30 fold increase odds of developing obstructive sleep apnea, which is basically you can't breathe properly in your sleep, and that was proved in a 2001 study where we found BMI match controls for women with PCOS.
[SPEAKER_00]: The pooled prevalence of obstructive sleep apnea in PCOS is 32 to 37% in comparison
[SPEAKER_00]: to 6% of women who do not have PCOS.
[SPEAKER_00]: So if you've never done a sleep apnea test at home and you have PCOS, please consider it.
[SPEAKER_00]: Please please please consider it.
[SPEAKER_00]: Sleep apnea needs to be taken very, very seriously.
[SPEAKER_00]: So what's the mechanism behind this?
[SPEAKER_00]: So, androgen excess and visceral atoposity together, they promote upper airway collapse.
[SPEAKER_00]: And so that creates in a minute herpoxia that then worsens insulin resistance.
[SPEAKER_00]: So this really vicious cycle that makes it worse and worse and worse.
[SPEAKER_00]: You can't speak to any type of obstructive sleep at near advice.
[SPEAKER_00]: I've not trained in that.
[SPEAKER_00]: Please go and talk to your physician and doctor about the treatment and diagnosis for that and move forward on that mission with them.
[SPEAKER_00]: Okay, let's get into supplements.
[SPEAKER_00]: You better not have skipped forward.
[SPEAKER_00]: You better not have skipped forward, right?
[SPEAKER_00]: Really important for you to listen to everything else.
[SPEAKER_00]: Let's start with a Nossatole, specifically Maya and Nossatole in Dicarro and Nossatole in a 40-1 ratio.
[SPEAKER_00]: Don't just take one.
[SPEAKER_00]: I've heard a lot of women with PCOS car.
[SPEAKER_00]: I was taking a Nossatole for late 12 months and I did nothing.
[SPEAKER_00]: and they were only taking D-Hyrit.
[SPEAKER_00]: All of the evidence highly suggests that we need to take it in a 40-to-1 ratio.
[SPEAKER_00]: So how it works?
[SPEAKER_00]: It is a secondary messenger of insulin signaling.
[SPEAKER_00]: So my inocitor also restores FSH signaling in the follicle, which is why it's really effective at helping you to start cycling again.
[SPEAKER_00]: So the dose we usually want two to four grams of maoenocetol, so ideally, in my perfect world.
[SPEAKER_00]: In my perfect matriarchal world, it's 2,000 milligrams of maoenocetol and about 40 to 50 milligrams of dichiro, okay?
[SPEAKER_00]: So most good ratios of enocetol marketed to PCOS will have this.
[SPEAKER_00]: This is really good for insulin resistant PCOS.
[SPEAKER_00]: and it's also shown to improve ooze site quality in normal weight women with PCOS.
[SPEAKER_00]: Generally, if you're PCOS enough still should be at the top of your list.
[SPEAKER_00]: Secondly, Nazium, you knew it was coming, you know I love magnesium, so it's a co-factor for over a possibly 900 enzymatic reactions ring.
[SPEAKER_00]: Insulin signaling and it supports HPA access regulation.
[SPEAKER_00]: Okay, hey, keeps you chill.
[SPEAKER_00]: So you want to be going for 200 to 400 milligrams a day.
[SPEAKER_00]: Please go for Glacinate.
[SPEAKER_00]: Okay.
[SPEAKER_00]: 3N8 can be good if you have fatigue in the day.
[SPEAKER_00]: I have that podcast on magnesium.
[SPEAKER_00]: Please go on listen to that if you want to learn more about that.
[SPEAKER_00]: Magnesium deficiency is really, really, really common in women with PCOS.
[SPEAKER_00]: So co-supplementation improves metabolic and inflammatory markers in all RCT data found.
[SPEAKER_00]: It's really great for all types.
[SPEAKER_00]: particularly post-pill.
[SPEAKER_00]: So if you're coming off the pill and you're a little bit worried, magnesium is really, really great.
[SPEAKER_00]: Also, another note on magnesium is that you can only absorb so much, right?
[SPEAKER_00]: So if you're going, I got I'm so good at taking 800 milligrams of magnesium every morning, dull, you're only really absorbing 200 milligrams of that.
[SPEAKER_00]: So to say, you're peeing at the rest.
[SPEAKER_00]: It's really, if you want to take higher doses of magnesium, of course, under the guidance of a health care provider, it's really great to do a dose in the morning, dose at night, and if you really wanted to have a horrible low, you can dose it three times in the day, but who has time for that low key?
[SPEAKER_00]: Good on you if you do, okay, doll, I couldn't be you.
[SPEAKER_00]: Next up we have Burberine, so the mechanism is it's an AMPK activator.
[SPEAKER_00]: Remember, that thing that bypasses insulin and gets glucose into the cell, Burberine helps with that.
[SPEAKER_00]: It also regulates GLUTE, Glut4 expression, so that hormone that gets insulin and glucose into the muscle cells, so it does both.
[SPEAKER_00]: So it's really, really great for that, and it's also really amazing for modulating
[SPEAKER_00]: So, dosing.
[SPEAKER_00]: You can take 500 milligrams to three times a day.
[SPEAKER_00]: Please keep in mind that a lot of people can have negative health outcomes with their GI tract.
[SPEAKER_00]: If you're having, like, diarrhea, or constipation, or bloating, or you're just feeling a not so nice feeling in your stomach, but very might not be for you.
[SPEAKER_00]: And you might be dosing it too much.
[SPEAKER_00]: Like,
[SPEAKER_00]: Just take here once a day with breakfast is okay.
[SPEAKER_00]: It's most effective when you take it 15 minutes before you eat.
[SPEAKER_00]: So start with breakfast, do that for a week.
[SPEAKER_00]: Then move on to lunch, do that for a week.
[SPEAKER_00]: And if you feel up to it, you can bring on dinner as well.
[SPEAKER_00]: But it does decrease your weight.
[SPEAKER_00]: So if you're a lean PCOS type, berbering might not be for you.
[SPEAKER_00]: Berbering is best for insulin resistant PCOS types.
[SPEAKER_00]: Next, let's move on to NAAC.
[SPEAKER_00]: I love NAAC.
[SPEAKER_00]: I don't have BCOS and I take her every single day.
[SPEAKER_00]: She is a glutathione precursor, which is an antioxidant in the body, which improves insulin receptor activity.
[SPEAKER_00]: You want to be taking 600 to 1,800 milligrams a day, but commonly in trials, it's 1.2 grams, which is 1,200 milligrams.
[SPEAKER_00]: So it improves ovulation and pregnancy rates, and it's also really, really great for improving progesterone and endometrial thickness.
[SPEAKER_00]: It's really great for insulin resistant, post-pill, and also women with hissios who are trying to conceive because it improves consumption rates.
[SPEAKER_00]: Next, we have zinc, so mechanism.
[SPEAKER_00]: It's required for insulin synthesis.
[SPEAKER_00]: It's required for antigen receptor function, and it's required to regulate sleep and regulation.
[SPEAKER_00]: And it's also really great for decreasing cystic acne.
[SPEAKER_00]: Anything more than 40 milligrams, I think, is a little bit of a waste, but some evidence does suggest that it can be helpful at 50 milligrams, but I personally speaking, yeah, I'm not sure about that.
[SPEAKER_00]: it improves insulin and lipid markers in RCT data and it reduces alopecia and hereticism as well.
[SPEAKER_00]: So who is it best for?
[SPEAKER_00]: So post-file PCOS specifically because zinc is depleted by any type of contraception, inflammatory PCOS and skin symptom predominant type.
[SPEAKER_00]: So if you have acne, zinc has got to be at the top of your list.
[SPEAKER_00]: Next let's move on to vitamin D. So vitamin D and he's still a whole podcast on vitamin D because they love her.
[SPEAKER_00]: She's so interesting.
[SPEAKER_00]: So vitamin D receptors are expressed in the ovary, adipose tissue, immune cells, it modulates AMH, aromatase, insulin sensitivity, and inflammation and fun fact.
[SPEAKER_00]: You've probably heard this on social media.
[SPEAKER_00]: It's a vitamin, we produce it, we can eat it, and it's also a hormone in the body.
[SPEAKER_00]: So you can be aiming for 1,000 to 4,000 items a day.
[SPEAKER_00]: Yes, that's higher than your government's RDI.
[SPEAKER_00]: There's a lot of evidence to say that having that much is very, very safe.
[SPEAKER_00]: But of course, talk to your physician, the evidence behind this supplementation reduces home IR and fasting insulin, particularly in deficient women, and it also improves ovulation and pregnancy rates, so it's best for insulin resistant and inflammatory types, but everyone is deficient in vitamin D. Pretty much everyone.
[SPEAKER_00]: and I've never seen a woman with types that are not insulin resistant or inflammatory types with PCR as benefit from any type of vitamin D supplementation or dietary intervention, so vitamin D really great.
[SPEAKER_00]: And meager three fish oil, so it's so hard as it work.
[SPEAKER_00]: Mainly, it's anti-inflammatory and it also stops androgen production in the body in a certain way.
[SPEAKER_00]: So it can stop and pause and stop the overproduction of D-D-H-H-E-A-S.
[SPEAKER_00]: So the dose is 1-3 grams of combined EPA and DHA per day.
[SPEAKER_00]: The evidence is a significantly reduced CRP, total testosterone and L-hage, and increase SHBG and total antioxidant capacity in all metronoluses.
[SPEAKER_00]: So this is from a 2021 metronoluses by 1 at L. It also improved menstrual regularity at 2 grams a day over 6 months.
[SPEAKER_00]: So pretty much good for everyone with PCOS, but specifically inflammatory, lean, and anything to type that's associated with HSCRP.
[SPEAKER_00]: If you see high HSCRP, going get yourself in a mega three-fisher oil.
[SPEAKER_00]: Let's talk about spearmint.
[SPEAKER_00]: New York's coming, I love spearmint tea.
[SPEAKER_00]: It's anti-antrogenic.
[SPEAKER_00]: It also reduces five alpha reductase activity.
[SPEAKER_00]: So that is an antigen activity.
[SPEAKER_00]: So it can reduce all of those nasty, high-antigen symptoms like hertocism and acne.
[SPEAKER_00]: So two cups of swim and herbal tea per day.
[SPEAKER_00]: If you don't want to load your body full of microplastics, just get the loose leaf tea and invest in a little stainless steel tea thinking about what I'm talking about.
[SPEAKER_00]: The evidence is approximately 30% reduction in free testosterone.
[SPEAKER_00]: In a 30-day study, it showed significant reduction in free testosterone and self-reportive herticism versus placebo.
[SPEAKER_00]: This is best for hyper-androgenic phenotypes with herticism and acne.
[SPEAKER_00]: Next, we have the vitamins, specifically B6, folate B12.
[SPEAKER_00]: If you can just get a methylated B complex, you're going to be doing a lot of good for your body.
[SPEAKER_00]: So it's a co-factor for methylation in the body.
[SPEAKER_00]: Neurotransmitters synthesis, it's used in home assisting clearance.
[SPEAKER_00]: Home assisting is commonly elevated in PCOS.
[SPEAKER_00]: Didn't have time to talk about that today, but just a little fun fact.
[SPEAKER_00]: So, be complex.
[SPEAKER_00]: You want to be aiming for 5 to 10 milligrams of B6, 40800 MCG of methyl folate of 1,000 MCG of methylated B12.
[SPEAKER_00]: And the evidence behind this is really great.
[SPEAKER_00]: If you have post-pil PCOS,
[SPEAKER_00]: it's going to improve all of those depletions that took place over the period of time that you were taking contraceptive or you had a contraceptive in your body.
[SPEAKER_00]: Next we have Ashburg Ganda.
[SPEAKER_00]: So it's an adaptogen in modulates HPA access and also helps to attenuate cortisol responses as well.
[SPEAKER_00]: So it keeps you cool, calm and collected.
[SPEAKER_00]: So the recommended dose is 300 to 600 milligrams a day of standardized root extract, the evidence behind it.
[SPEAKER_00]: So we see a 27.9% reduction in serum cortisol versus placebo in 60 days.
[SPEAKER_00]: What I will say though about Ashwaganda is all of the studies I've read have really highly suggested that you take it for 12 weeks and you take 12 weeks off.
[SPEAKER_00]: So what you can swap it with is Rudiola.
[SPEAKER_00]: but you can take rodeola in the morning, because rodeola will help you with your fatigue.
[SPEAKER_00]: So you can take rodeola in the morning and then for 12 weeks, and then you can do actual gander for 12 weeks.
[SPEAKER_00]: So you don't wanna go over that because it can upregulate your immune cells.
[SPEAKER_00]: And what I will also say about actual gander as well is if you get your labs back and you have a really highly inflammatory body, actual gander might not be the most amazing thing for you, right?
[SPEAKER_00]: So you really need to address your labs with your practitioner and make sure you're using the right herbs.
[SPEAKER_00]: Yes, herbs in natural, but it does not mean they are benign and they can't actually harm you.
[SPEAKER_00]: Because they can.
[SPEAKER_00]: If any part of this episode made you feel seen, I'm so happy it did.
[SPEAKER_00]: The next step is not to overhaul your life.
[SPEAKER_00]: It's to find a clinician, a dietitian, and dog.
[SPEAKER_00]: and nutritionist who's willing to help you on this mission.
[SPEAKER_00]: First, you need to investigate which of the types of PCRS you have and run the right labs just to reiterate.
[SPEAKER_00]: L-H-H-F-S-H-Total and FreeTestosterone, SHB-G-D-H-E-A-S-A-M-H, Fasting Insulin, 2-H-O-G-T-T.
[SPEAKER_00]: HP A1C, ProLactin, TSH, CRP, Vitamin D, and Alipad panel, and while you're there, why not get an intracellular magnesium test as well and build from there?
[SPEAKER_00]: Thank you so much for taking the time out of your busy day to listen to this episode.
[SPEAKER_00]: If you loved it, please remember to like, subscribe, and send to a loved one.
[SPEAKER_00]: If you want to learn more from our quaman, please check out the website at arquaman.com.au where you can find a pothora of offerings like charts, masterclasses, courses, and organic clothing.
[SPEAKER_00]: You can also head over to patreon.com slash arquaman.
[SPEAKER_00]: or sub-stack.com slash our comment to join the community.
[SPEAKER_00]: I hope you have a really beautiful morning, afternoon or evening wherever you are in the world, and I will see you on the next episode.