Adrenal PCOS or hypothalamic amenorrhea? DIY'ing PCOS + food recs and testing for PCOS with Jillian Greaves, MPH, RD
This week on The Less Stressed Life Podcast; I am joined by Functional Dietitian and Women’s Health Specialist Jillian Greaves MPH, RD. We discuss the different types of PCOS, food recommendations, and testing.
- PCOS Myths
- Types of PCOS
- Adrenal PCOS Symptoms
- The difference between hypothalamic amenorrhea & PCOS
- Eating to heal your PCOS
GUEST SHARED HELPFUL TIPS ON:
- Get diagnoses for PCOS & how to identify which type of PCOS you have
- Support foundations for PCOS
- The starting point for healing PCOS
LINKS TO PREVIOUS PCOS EPISODES:
#050 PCOS Nutrition with Angela Grassi, MS, RDN
#069 Painful periods, endometriosis, PCOS, fertility & inflammation with Melissa Groves, RDN
#120 PCOS and Estrogen the Superhero with Dr. Felice Gersh
#018 Food writer to Food Woes: How overcoming PCOS, Thyroid and Gut health issues changed Kate's Kordsmeier's young life
Jillian is a Functional Dietitian and Women’s Health Specialist. She provides comprehensive nutrition and lifestyle counseling to women, with a special emphasis on PCOS, hormone balance, and digestive health. Jillian helps clients identify and address the root causes of their hormone and digestive symptoms naturally using advanced lab testing, personalized nutrition, and supportive lifestyle therapies as the first line of intervention. Jillian runs a virtual private practice based in Boston, MA and is the creator of the Empowered PCOS Program. It's her mission to empower women to take back control of their health, reclaim their confidence, and experience life at its fullest potential.
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If you are putting a lot of stress on the body from undereating over exercising, you can experience, you know, abnormalities with androgen that are unrelated to what's going on with the ovaries. So you can also experience some of those kind of classic P C O S symptoms in terms of, you know, the cystic acne, the unwanted hair growth
Stress is the inflammation that robs us of life, energy and happiness. Our typical solutions for gut health and hormone balance have let a lot of us down we're overmedicated and underserved at the less stress life. We're a community of health savvy women exploring solutions outside of our traditional Western medicine, toolbox and training to raise the bar and change our stories each week. Our hope is that you leave our sessions inspired to learn, grow, and share these stories to raise the bar in your life and home
Access to functional or specialized medicine testing and standard blood work is a big piece of personalizing care plans to help our clients succeed, but getting accounts with multiple labs and ordering and tracking results from many different web portals slows efficiency by bogging us down and admin work. This is why I'm completely obsessed with our podcast sponsor at Rupa health. It's a single portal that allows you to order from over 20 specialty labs in one incredibly simple dashboard, I'm talking less than 30 seconds to set up your free account and about 30 seconds to order the labs you need, all the results are in one place, and I can securely send clients their results with the click of a button. A big advantage for our clients is that standard blood work can be ordered for almost two thirds, less than other direct to consumer lab sites.
Rupa is a lab concierge, so they send the lab invoices on your behalf of a client pays for their own labs. They help them get set up with a lab, draw, navigate testing questions, and they provide the requisition forms. It's literally a dream go sign up for free to help streamline your practice and simplify ordering labs for your [email protected], that's RPA health.com and let them know I sent you when you sign up, you can also check out the show notes for this episode for a short video walkthrough of how I use Rupa health in my own practice. All right, today on the less stress life I have Julian graves, Jillian is a functional dietician of women's health specialist. She provides comprehensive nutrition and lifestyle counseling to women with a special emphasis on P C O S or polycystic ovarian syndrome, hormone balance, and digestive health. She helps people identify and address the root causes of their hormone and digestive symptoms naturally using advanced lab testing, personalized nutrition and support of lifestyle therapies. As the first line of intervention, she runs a virtual private practice in Boston, Massachusetts, and is the creator of the empowered P C O S program. It's her mission to empower women to take that control of their health, reclaim their confidence and experience life at its fullest. Potential welcome Jillian.
Thank you. I'm excited to be here.
Thanks. So I got to spend some time with Jillian eating oysters and octopus a few weeks ago. It was lovely and I had to get after her because she had not booked an interview yet. And so here we finally are after, uh, a couple of months. So we'll get into, we have some past episodes on P C O S I'll link those in the show notes, but today Jill and I are gonna dive into some different types of P C O S I think often our past episodes talked about testing, how long it takes or actually more so diagnosis, how long it takes to get diagnosed. But we didn't really dive in so much to some of the lesser known one of my favorite types of P C OS now, but the lesser known, which is adrenal P C O S. So to set the stage, Jillian, a couple things, first of all, first of all, tell us a little bit of your own story, cuz that always helps us connect to you. And second of all, I wanna jump into why you ended up in the P C O S world more so like why this ended up being the emphasis and then we can get into types of P C O S.
Awesome. Yeah. So in terms of kind of how I got into all of this and just my own personal journey, there is kind of a personal angle, professional angle. And I think I'll address all of the questions by kind of walking you through that, but with my own personal health journey, I think for most of us, uh, you know, there's a variety of reasons we got into this space and kind of specialize in, in what we do, but I think many of us have had our own personal health struggles and challenges that have really kind of motivated us to look outside the box and led us to practice kind of how we do now. So for me, with my own personal kind of health and healing journey, it started almost a decade ago. I would say about a decade ago now, where, you know, at the time I was in just a really busy season of life, you know, I was working full time in a pretty, uh, demanding research setting and going to grad school at the same time.
And generally just had a lot of, lot of stressors in life. And on top of that, I was, you know, eating predominantly a plant based diet. I was doing lots of hit training, running half marathons, and I'd also been on hormonal birth control for 10 or 11 years. And I started to experience some really unpleasant symptoms, things like eczema, uh, hives, my hair was thinning. I was experiencing a lot of anxiety bloating. I was getting, you know, breakouts just in terms of acne, some of that cystic jawline acne and was, you know, really confused because in my mind I'm doing all the things, right. I'm eating healthy, I'm working out and you know, it just, it didn't make sense to me based off the training that I had. So I sought out care from my, you know, primary care physician express, my concerns and, you know, started to actually kind of investigate, you know, what this birth control pill was kind of, you know, doing to my body and kind of what role that might be playing given that I had been taking it for a decade and, you know, know hadn't really investigated that or considered, you know, the role that that was playing.
So I went to talk to my PCP about it, who basically laughed in my face, you know, sent me out of her office in tears and told me, you know, basically, you know, you're the picture of health. You're totally fine. Go see the dermatologist, you know, go, you know, if you're anxious, we can talk about anxiety meds. And I was just kind of being thrown around from, you know, one provider to the next and feeling really, really frustrated. And I also just felt like, you know, I was not going to settle for here, take this medication to kind of bandaid, you know, X symptom. So I really started to kind of dive deep into, you know, female physiology kind of questioning how my own diet and lifestyle, you know, and stressors were supporting or not supporting rather my body. And that really kind of brought me into the world of just kind of women's health functional medicine.
And, you know, it was really kind of the first time that I realized that there was a lot more to the story when it came to birth control and my health. So that's really, when I kick started my journey to changing the way I approached, you know, lifestyle changing the way I approached my diet and also took myself off the birth control, which was a whole, whole nother journey in itself. But I was really hacking things together for a long time and, you know, getting more advanced training in, in the functional medicine in women's health space. But I will be very honest that, you know, even at that time with graduate degree, undergraduate degree, becoming registered dietician, all these trainings that I'd had, it took a long time. It took a long time to feel like I was in a place where I wasn't experiencing the really outward, you know, unpleasant symptoms and that I had a really much better pulse on, you know, my body and kind of understanding how it was communicating with me.
And that was really, uh, motivating for me to just want to provide women with the support that I wished I had had when I was really, you know, kind of struggling way back. So that was kind of my long winded personal health journey in terms of why I became so passionate about women's health, you know, in this work. And then from a professional lens, my first job as a dietician was as an outpatient dietician in endocrinology at a big Boston hospital, which I was super jazzed about. Like, this is exactly what I wanted to do, you know, so I went into that setting and was gonna, you know, change the world for women and, you know, all these different hormone conditions. And actually, this was really my first big exposure to working with women with P C O S in this setting. I didn't really get a ton of exposure in my internship.
And, you know, I had all these young women, uh, diagnosed with P C O S being sent to my office for nutrition counseling that were, you know, physicians were telling them, you know, get educated on a 1200 calorie diet. Here's some appetite suppressants, the Metformin, this spiral lactone Nope, you have, you know, anxiety, here's the, you know, anxiety meds. And it was like, you know, all the medications, super restrictive approaches they were recommending, and these women weren't getting any better. If anything, you know, often they were getting worse or it was kind of this yo-yo situation, um, where they were dependent on medications. And once they suppressed that symptom, something else popped up and it didn't sit well with me. And, you know, I think to layer on even more there, I was just all attrition education at this big, you know, hospital was, it's like, you know, it was just so old school, right?
Everything was fixated on calories. And, you know, I felt like I was just, you know, fighting against all the things, trying to provide women with any type of good quality, like support and information. And I just became really frustrated and felt like, Hey, there's gotta be a better way here. And that's where I kind of dove specifically into the P C O S piece of things. And I started seeing clients privately just on the side. And, you know, in addition to working my outpatient job and was getting really incredible results and decided, you know, what, I wanna do my own thing, do it on my own time and support women in a way that, you know, I know is effective and really supportive. So I had not kind of, uh, dove into anything thinking I was gonna be specializing in P C O S but I found that there was just such a tremendous need for better support for these women.
Yeah. That was a real buzz kill to listen to, you know, you forget that that's like the common approach, but 1200 calorie diet Metformin, first line therapy for basically metabolic dysfunction, AKA diabetes, or that's usually the first line medication for blood sugar support under meds, and then sperm Lacone dumps testosterone, which is interesting. Cause I wanna get into the types of P C O S and this would be like totally worthless <laugh> for the type of P C O S that we're gonna maybe jump into. I mean, typically, so I almost feel like we can compile some P C O S myths, like a P C O S thing that I feel like is mainstream, that kind of irks me is that like, you can't have a baby, if you have P C O S I think that's like, so red, ridiculous, like who in the world is telling women this or that you have to eat less and exercise more like also a useless, and sometimes we'll get into this in like one second here. Why does this make it worse? So actually, can we just categorize the types of P C O S real quick?
Yeah. So kind of the predominant types of P C O S are gonna be insulin resistant, P C O S. So, you know, kind of blood sugar issues, adrenal factor P C O S so kind of cortisol issues, uh, stress response issues, post pill, P C O S, which is one that's also, I would say, not talked about not supported, you know, enough at all. And then inflammatory and gut driven P C OS. Those are kind of the four predominant types.
So usually, and I'm not sure how you feel. We can talk about stats for P C O S in general, but so we've got these subtypes, and I don't know if these subtypes driven, recognized conventionally. I don't know that they're, I'm not under the impression when I get people with adrenal style, P C O S in my office, they're usually getting the recommendation to eat less and exercise more, which is actually gonna drive them further into a deficit or a they're gonna be worse. They're gonna be much worse off. So what do you know about the stats of P C O S in general, and then you may or may not know, or, or whatnot, but on stats of like, how often do you see what's kind of the split in practice for you that you're seeing these, and I'm sure there's a little bit of overlap that can happen. Like insulin resistance can overlap with inflammatory P C O S right. And post pill, P C O S. That can be resolved. Right. Mm-hmm <affirmative> and maybe arguably adrenal, P C O S can be resolved, I would assume. Right. So what are you seeing for stats in the big picture, and then in your practice, how are you feeling about the prevalence of these different types or whatnot?
Yeah. And, you know, I will say, I agree with you that there's a lot of overlap often between these and people don't, you know, always fit into a perfect little box of having one type or two types. And sometimes, you know, it's a variety of these types. So I think it's important not to get too bent outta shape in terms of trying to classify, you know, your specific type of P C O S. But I do think it's helpful to be aware of these things, because these are the big drivers essentially, that are contributing to the progression of, you know, P C O S. So I think it's helpful to be aware of them and, you know, most women gravitate towards one or two more so than others in terms of what feels really relevant for them, but definitely, you know, to your point as well, these things aren't tested for specifically or classified in any type of a clear way in our conventional healthcare system, either.
And most what's being paid attention to is kind of the insulin resistant P C O S type since it is generally the most predominant. And I think the most recent statistic that I've read is that anywhere from 70, 75% of women with P C O S have some degree of insulin resistance and possibly more, I think insulin resistance is under kind of identified in P C O S because women with P C O S that are experiencing shifts with weight are often the only ones that are getting that investigative work in those full workups. But oftentimes, you know, providers are not testing, you know, fasting glucose, fasting, insulin A1C, like getting a good picture at what's happening with blood sugar. And if someone is, you know, not experiencing weight issues, they can still have some of those metabolic abnormalities, but they're often not being investigated at all.
So, yeah, so insulin resistant is kind of the most prevalent and most well recognized, definitely in our conventional system, but in practice, I see a lot of all of these things. And I would say because there is a, a big lack of support for some of the non, you know, insulin resistant types. I'm seeing a lot of more of those in my practice. So with the adrenal factor, P C O S the post pill, P C O S I think women are seeking out, you know, working with providers like myself more so, so because they're just fallen through the cracks in our conventional healthcare system.
Well, that brings up a couple other questions for me. So I looked this up, first of all, in 2020 center, physic disease control and prevention said, P CS prevalence is between six and 12%. So up to one and every 10 women, we could just estimate. But I think the stat is that it takes seven years to get diagnosed and what I'm wondering. And so there's probably just a lot of people walking around with lack of diagnosis, but I don't think what we're talking about here is very common knowledge with these different types. And so do you find that you get women that don't have a diagnosis as a P C O S but hear a podcast like this and then go in and self-diagnose because P C O S comes, usually you get a positive diagnosis, two outta three criteria, irregular cycle symptoms of high testosterone, usually hair down the center of the face of like mustache chin around nipples belly button.
So those are more elevated testosterone symptoms typically, and then undeveloped follicles on the ovaries, AKA sys, this always seem like a worse word than undeveloped follicles in my brain, uh, ultrasound. So some of the past conversation we've had in other episodes has been that you cannot just diagnose P C O S via ultrasound, only that you need have two of these three criteria, et cetera. However, you know, you could feel like just not awesome and it could fit under this umbrella piece. What you one would do functionally for P C O S would be useful for all women. I'm gonna make an argument. Most of it. I mean, cuz if you're supporting your adrenals, if you're supporting your blood sugar, if you're supporting your hormones in general, if you're supporting your gut health helpful for everyone. So what I wanna ask is do you get people that don't have a diagnosis at all and kind of self diagnosing themselves based on this criteria, cuz it's like mentioned these three criteria and it's like, well, I, I fit all three or, or two or the three. So do get that. And then I wanna know also conventionally what happens to women after a diagnosis? Now some of 'em are gonna get referred to endocrinology if they have more insulin type P C O S but if they don't then what happens to them?
Yeah. Great question. So to speak to your first question about, you know, people who don't have that formal diagnosis, I see that all the time. So women will often reach out, you know, to work together and they'll say, you know, I have all of these symptoms and sometimes they've even been told by their doctor that you probably have P C O S and it's kind of just like, you know, it's poo pooed in, in a sense, and maybe they can't achieve, you know, a, a diagnosis off of like the roam criteria that you just described because they are on hormonal birth control or they're on, you know, a medication that's impacting the ability to like, you know, assess a certain kind of factor that would lead to that diagnosis. But I do see that all the time in terms of women really present very classically in terms of like all the things they experienced, they've maybe tried to investigate further and haven't been super well, you know, supported in doing that.
And in those cases too, what I will always say is yes. I mean, it's always of course helpful to have a, a clear diagnosis if we're able to achieve that. If not, it doesn't mean we can't dive in and start working on all of those fundamental things that you mentioned are gonna be, you know, super, super supportive for women with P C O S but also just women in general, right? So the balancing blood sugar supporting gut health, the stress management and improving stress, resilience, lowering inflammation. So, you know, I think it's something that I do see very often in practice.
And as I interview colleagues and friends that have successful businesses, you know, we have a mutual friend Dion and she works in cancer. And what I keep finding is like, oh, we have the same pillars of what we do with clients. <laugh>, you know, there just might be a different lens on the top, which I think I hope is useful for people to hear because there's this expression, success leave clues or like my brain just searches out common denominator. So I might be kind of like a weirdo. I'm just always looking at like, what is the connection between all of these things? And so that, one's a real duh. So I wanna dive a little bit into adrenal P C O S, which is I think an underrated one. I feel like it was an area where I kind of got whiplash for about six months in my practice because people were being referred in as P C O S and then I'm like, oh, this is not insulin or blood sugar type P C O S I mean, yes, there are blood sugar issues, but not in the same capacity.
They're more like just unstable hangry, feeling shaky, all those things because with adrenal P C OS, you're gonna have that as well. Cuz the adrenal secrete DHA, which helps regulate blood sugar. And if your adrenals are in a toilet, you know, you're not gonna produce those hormones. So let's jump into adrenal P C O S and how that's characterized. And I believe so. I don't know. I think you mentioned this briefly, we didn't totally qualify it. I don't know if there is a, for sure people get a conventional diagnosis of adrenal style, P C O S or if that's only a functional area, you would probably know that better than I would, but how do we characterize adrenal P C O S versus others?
Yeah, so actually, I mean, what I found is that it's, it's recognized in research so you can read, you know, papers on it and it's very, you know, kind of clearly a P C O S type or, you know, kind of that driver. But I find there's something that gets lost in translation from research to practice, which, you know, we could say that about a lot of things, but you know, you can, can pull up plenty of papers that are kind of investigating that adrenal component with P C O S but it would be very, very rare for me to, you know, speak with a client that had a provider who's actually, you know, kind of diagnosed them with that adrenal factor, adrenal dominant PT, O S and you know, or very rare for me to talk to a conventional provider. You know, maybe if I'm, we're collaborating on a client for them to have that, even on their radar mm-hmm <affirmative>, which I find is very interesting. And I think a, a big piece of that is because, you know, the tools for supporting, you know, P C O S in a conventional toolbox are P C O S low-cal diet spiral, OME Metformin. So it's not really, I think, on people's radars because they don't have that medication in their toolbox to treat the thing. If that makes sense.
Yeah. It's very lifestyle. Yeah. I mean, they're, obviously, if you can get some high quality supplementation in tandem with lifestyle, you could heal faster for sure, right. With if you're adrenal storm re shape, but I have this conversation with people, a lot people will complain about conventional care and my thought is more, Hey, your doctor's just as burned out as you are. And we just don't recognize adrenal issues. The testing is like, well, you're basically dead before. It's a problem. <laugh> unfortunately, and even some of our functional testing is not, it has issues. And I, so I think that you can fall into some issues sometimes if you are just relying only on a test and you're like expecting that test to be perfect. I've had people who are like a hundred percent adrenal mess type things and they're urinary or salivary cortisol testing came back looking kind of funny because cute problem.
If you're looking at just cortisol testing your abdominal adiposity. So any like stomach fat can actually see pre cortisol and depending on the method of testing can make it look off. So this is, and my point is, is just that you must look at things from symptoms. And so adrenal symptoms, let's just like run through some of those that would say like, you can always, I always think like, what is a common denominator? You can always love on your adrenals, cuz that's loving on mitochondria. So symptoms of like your adrenals may not be in beautiful shape, might be just inability to wake up with energy being exhausted in the afternoon. I know those are big topics, but they are some more obvious ones be like from sitting to standing or lane to sitting up feeling lightheaded, always registering on the lower end of blood pressure.
For me, I used to have a little dull ache above my kidneys. Like, I'd be like, it would be like a lower back pain and you know, those symptoms that you've had Jillian, you know what? This is like, like I've had skin issues as well. Like it's a hallmark of my medical history. And so until you have that issue, it would be hard to describe like how it is for you. Right. Type thing. And so if I had not experienced this like ache in my lower back, I could not have told you and then supported my adrenals and had to go away immediately. Could not have told you that that was what that was. I always, I also have described it to people. Like it also feels like someone pressed all the air outta me at the end of the day. Like I'm just like bull, like dead. And my, I don't even know how low, I mean, I just knew my adrenals were in rough shape, but I'd have to look at my re most recent testing and then compare it to other people. But my point is, is like there's all kinds of symptoms. Would you add other several other things? Like what pops into your head when you think of like adrenals are in trouble, you better support them.
Yeah, definitely. I feel like some of everything that you kind of just described, I don't know. Did you mention insomnia or like disrupted sleep?
That's a big one where it's like, you know, there's that chronic fatigue, but then there's also often I will see just sleep disruption, neither difficulty falling asleep, staying asleep or both,
Um, like sleeper, especially I would say. Right?
Yep. Yeah. A hundred percent definitely that afternoon slump also that situation where no matter how much you sleep, it's just, you know, you feel like you're in a fog, really tired, low libido is a big one, which I think driven by a variety of things. But I think when stress is really persistent and there's that adrenal factor component, there's just no libido in my experience.
Well, and I think let's talk about that for a hot second just because this had come up. So I just wanna talk about this clinically for fun. You and I, I know we both use the Dutch test sometimes. It's not always like a, I don't start with the Dutch test personally, because I like to start with foundations that influence hormones, instead of like here, let's do the hormone test and then jump all over the place. That's just my preference. But sometimes people love that baseline. I know you use it in different instances more than one way to achieve an outcome. For sure. So use that test sometimes when the testosterone is really low, sometimes that's what we're thinking about with libido, right? It's a common thing possibly just when you're exhausted, how could you have libido? But anyway, like if your testosterone is low, we are usually gonna attribute that for sure as a libido factor.
And what I find is that if cortisol is also low, AKA, your adrenals cannot produce an essential hormone because of long term stress. That it's really hard to get that testosterone up. It's like broken because some of the ways that we produce testosterone would be, I talked about this a few minutes ago. If your blood sugar is really unstable and your hangry, your adrenals produce D HHA, right? That hormone that kind of helps buffer or helps with blood sugar regulation, so to speak. And that can be partially a source of how we create testosterone in the body. And so I hope this is making sense. Like if the first Tomino, if you're adrenals, don't have good mitochondrial function, how can you produce the DHA? And if you can't do that, how do you produce the testosterone very beautifully. So I've just been intrigued by this because I've done things to support testosterone and not gotten the type of results I wanted cuz the cortisol is flatlined.
And so I'm just trying to get like really obvious on like why this would happen to someone like, yes. So with adrenal P C O S I think we're talking about essentially the adrenals not working cortisol is usually gonna look low. And would you say another hallmark is that usually with P C O S testosterone is higher or that's like a hallmark of it, but with adrenal P C O S it's usually gonna look lower on this testing. Right. Done. Okay. Often, not always got it. Are there other factors, like if you have someone coming into your practice, how are you helping them identify what kind of P C O S they have, cuz that's gonna change the plan of action.
Yeah. So if I'm working with someone one-on-one really just kind of diving into a deep assessment and I think also really understanding their timeline and the progression of things, because I think, you know, depending out on how long, you know, certain dynamics have been happening, things can look different over time, right? Where, you know, at some point people might have, you know, the high cortisol, the high D H E a the high, you know, testosterone. And then if we're sort of in this kind of situation where everything is being stimulated chronically, then we end up in sort of this like real burnout situation where hormones are plummeting and there's more kind of damage dysfunction there, but really I'm kind of diving in and assessing a person's history. I'm getting really, uh, clear getting a really clear understanding of what their symptoms are. Um, and then also just what the heck is going on in their life, what's going on with their diet.
And that will typically be just a good starting point in terms of a, a thorough assessment. And then, you know, kind of bringing in lab work from there to tie all the pieces together a little bit more so, but it's pretty amazing what you can gather from a really comprehensive assessment. I also have people fill out some questionnaires that I've developed some kind of, you know, root cause questionnaires that help people to kind of tap into how their body's communicating with them. You know, what, uh, symptoms are really kind of glaring and standing out, and that will help to narrow the focus as well. So it's not, you know, definitely not kind of a, a perfect process, but I think, you know, a really thorough assessment kind of understanding symptoms, understanding the history timeline, and then bringing in lab data to sort of fill in the gaps or kind of confirm, you know what, we're probably already thinking.
Mm-hmm <affirmative> I know we wanna talk about different types of stressors, but I'm gonna bring that back for later because you just mentioned testing and I was just alluding to some testing stuff. So I know we wanna talk about a couple topics yet, which would be testing around PCs, cuz it's a question people have automatically like, well how do I test my hormones? I'm like, oh, it's big topic. So if you have someone that comes into your office and they have P C O S what are some testing that you may or may not opt for? Do you like, or is there any conventional blood markers that you might tell a listener that this could be a useful thing as part of your treatment pie or not really? So what kind of testing might you like look at for P C O S and specifically adrenal P C O S cuz we're kind of leaning toward that a little bit more. Yeah.
Yeah. So, you know, it definitely depends on the person in general. I would love if, you know, an individual came to work with me and they already, you know, had a workup done with some of the kind of more basic routine type things to get even a starting point. Sometimes they have that oftentimes they don't, which is okay, but definitely at least having, you know, a full thyroid panel, a good kind of complete assessment of, you know, blood sugar, and then ideally having, you know, just basic blood labs on androgen. So like your free testosterone, total testosterone, D a G a S your androstenone. So kind of a, a good picture of what's going on with androgens again, if someone's on hormonal birth control, which I find that, that sometimes women, you know, even without a P C O S diagnosis will be, you know, if they've been experiencing some of these symptoms or they had a regular cycle or they're dealing with, you know, cystic acne, sometimes they're put on, you know, the birth control without any of the investigative work, in which case we can't, you know, kind of assess what's going on hormonally the way that we would, if someone was off of birth control.
But yeah, so I would say full kind of, you know, complete look at blood sugar, definitely a full thyroid panel. And then, you know, having a good assessment of androgens, if we're able to look at those would be really helpful lipid panel, vitamin D I'd say those are the things I like to have for people right off the bat. And then, you know, if they haven't gotten those or they can't get those just kind of from their conventional provider, their PCP I'll, you know, often run those basics. But what I really like to do is be able to kind of bring in more of that advanced testing, like a Dutch test or a GI map or things like that that are gonna give us different information, a different look at things to kind of assess alongside the, uh, symptoms and, and kind of the clinical assessment.
Yeah. They help you fill in some of the root causes of why even those blood markers can look off. Right. So something I wanted to talk about is E C OS versus hypothalamic am. Amen. So hypothalamic am amen being the absence of a menstrual cycle. So true or false most adrenal P C O S includes hypothalamic am. Amen, but not all hypothalamic. I just made this up like a minute ago, but not allic is P C OS
Say that again,
Trying to get fun. I'm trying to get fun here, Jillian, most or a lot of adrenal, P C O S cases include hypothalamic am, but not all hypotheic Amoria is P C O S or adrenal P C O S.
<laugh> all right. All right. Well, let's just characterize the difference a little bit, and I think let's just pull that together. Cause sometimes it's like, we've talked about a lot of things and we did kind of touch on this already. How P C O S is one of three criteria. And by the way, if I say something wrong, cuz this is your, like, this is like your niche just correct me, cuz this is how I perceive it as someone who's worked with P C OS, but it's not like my only thing. Yeah. Feel free to correct me at any time. So I wanna just hear like, do we ever see hypothalamic am amen being the kind of misdiagnosed as adrenal P C O S or what do you thinking here?
Yes. So I definitely see fairly often hypotheic Menor that is misdiagnosed as P C O S. There can be a lot of similarities apps, absent or regular cycles being, you know, the, the biggest one, both with P C O S and with hypothetical amenorrhea, there, there can be those polycystic appearing ovaries or the large number of, you know, those immature follicles. So there are a lot of similarities that can make it a little bit confusing or kind of, you know, there's some overlap essentially. The other thing is that because, you know, so with this adrenal, what, what a lot of people don't realize, I think is when we think about P C O S and you know, androgens or this category of hormones that are elevated that drive, you know, the TISM the unwanted hair growth that you were describing, you know, cystic acne, things like that.
When we think of P C O S often, we just think about the ovaries, you know, overproducing androgens, but the adrenals, the adrenal glands produce a large proportion of, of androgens as well, or certain types of androgens. So you can have normal functioning ovaries and kind of nothing going on there, all the overproduction of androgens via the adrenals and those same symptoms, right? So if you are putting a lot of stress on the body from undereating over exercising, you can experience, you know, abnormalities with androgen that are unrelated to what's going on with the ovaries. So you can also experience some of those, you know, kind of classic P C O S symptoms in terms of, you know, the cystic acne, the unwanted hair growth. So things can look similar with certain labs. Things can look very similar with some of the outward symptoms that women deal with, but they are two very, you know, kind of very, very different things.
And it's, you know, something that I do see often, like I said, is just, okay, someone actually has hypoth EMIA, but they're presenting with a lot of P C O S like symptoms, which, you know, are being misdiagnosed as the hypothalamic EMIA essentially. And, um, there's no kind of one set thing that's gonna differentiate too, like, okay, I can do this one lab test and it's gonna tell me which it is, but there is. And that's where you get kind of deeper into like symptom assessment. And then also just looking at more complete labs to be able to kind of tease things apart, to be able to differentiate. And that is very, very important, you know, to be able to identify if it's a hypothalamic situation, you know, or if it's a P C O S situation. Because even though the foundations like we're talking about are all important and similar, we wanna make sure we're eating enough, balancing blood sugar, you know, interventions would be similar if it's a true hypothalamic situation. That definitely needs to be identified in my opinion.
Sure thing. You know, you mentioned the undeveloped follicles and we were, I was kind of like complaining, do we like this word, sys, this is like, another conversation has had over the years. It's, they've talked about how, yeah. It's really not the best, uh, name for this condition, but it's taken too long to get recognition the way it is. So we're not gonna change the name. How do you feel about the word SISs in this whole context? Like, for me, I'm like, I prefer undeveloped follicles personally, but I know SISs, isn't CYS just sounds terrible for some reason in my brain. Do you have any opinion here?
Oh my gosh. I feel the exact same way. And it just, it's not an accurate representation of what's going on. Right. So, you know, if you look at kind of polycystic appearing ovaries on an ultrasound, it will appear cyst, like in terms of that string, you know, string of pearls that it's described as, but they're not CTS at all. So it's very confusing. And I feel like I actually spend a lot of time trying to explain to,
Yeah, so it's annoying. It's actually,
Well, it's called this, but these actually aren't sys at all. So I have no idea why we still call it this. And I think a lot of practitioners feel the same way where it's like, all right, when are we gonna, you know, regroup and adjust the name here since it has nothing to do with actual
CYS, never it's never gonna happen. This took me back to, this is a super random question. You may not even wanna answer it, but this takes me back to, uh, I cannot remember this is like a few years ago when I used to, like, I was exploring the use of certain types of enzymes away from food, the heck that we call pretty lytic pretty or digest tissue. Do you ever use pretty lytic enzymes? Yeah. In regard to this me neither just wondering <laugh>
In regards to CYS. I do not,
Right? Yes, yes, yes. One
Thing I'll say the topic of, you know, P C OS to hypoth MEIA and that, okay. There's no perfect way to, you know, differentiate, but the things that I would make sure to push forward would be an assessment of LH to FSH ratio. And then also making sure that you're getting that complete blood sugar panel done in terms of assessing a fasting insulin, oftentimes in like a true hypothetical memory situation, a, a fasting insulin will be, you know, really low. And the LH to FSA ratio will be low as well in comparison to a P C O S situation where often the, you know, LH to FSH ratio is high or higher. Not always, but often that's what makes it confusing. There's no set rules. And then, you know, like we had mentioned, there can often be issues with, with insulin even just kind of low grade elevations.
Thanks for differentiating that. I think you should go ahead and explain what LH and FSH are, cuz it doesn't get talked about very often. So if you will just touch on or at least like elaborate just a little bit on that and talk about why the ratio is low. I think that would be helpful.
Yeah. So basically LH is stands for izing hormone. FSH stands for, uh, follicle stimulating hormone. And basically these are the pituitary hormones that are kind of orchestrating or kind of governing what's going on with the menstrual cycle. Like behind the scenes, I'll often refer to them as like backup dancers, you know, to clients where it's like, we have our backup dancers, we have our like stars of the show, which is gonna be our, you know, sex hormones, estrogen, progesterone, testosterone, but you know, LH and FSH are, are super important, you know, since they play a really big role. And like I said, kind of orchestrating or governing what's going on with the menstrual cycle. So when it comes to P C O S specifically, actually to take a step back in terms of what these guys are making sure in a normal situation that we have a follicles, multiple follicles, uh, developing throughout the menstrual cycle.
So follicles being like the little sacks on the ovaries that, you know, hold our eggs essentially. So basically we are making sure that these follicles are developing and eventually the kind of healthiest, biggest strongest, you know, follicle is going to release an egg that's ovulation in the menstrual cycle where we can get pregnant or not get pregnant. So, you know, that's kind of what LH and FSH are doing behind the scenes in terms of the background communication between the brain, the ovaries, to make sure that we're ovulating regularly. And what happens with P C O S is that there is some disruption in that communication essentially where we have lots of immature follicles on the ovaries and we don't get kind of that one follicle that hits a point where it's going to be fully mature and mature enough to release an egg or to ovulate. So that's kind of happening behind the scenes, if that makes sense.
No, it's great. Thank you for sharing that. So we talked about testing and then we went back and talked a little bit more about testing, which I think was useful. And we talked about some lesser known testing, LA gen F S H testing, and the ratio for that, you clarified, he sound like a manure and P C O S because I think that those can end up in the same basket and maybe we do some of the same interventions, but class clarifying those. There are some nuance to both, of course. So some other things I do wanna cover before we're done here would be in your program. I was looking at your program modules before we jumped on the call today, and I saw that you had down supportive food and supplements. So we don't have to get into supplementation. Cause I feel like can, can be kind of a topic on its own, but I do wanna talk about people always wanna ask about like, what can I eat for blah, blah, blah. And I'm sometimes like, when this question comes up, I'm like, it's not really like that. But with P C S there are some like blood sugar supportive stuff. So I'd love to hear like maybe three things, five things, two things, whatever you wanna share, just because I feel like it's a question people like to ask, so I wanted to ask it for them, for you.
So in terms of, you know, specific foods, what I always like to emphasize, which I think we're very, you know, similar in this approach is that the foundation's always come first. Right? So getting, you know, fixated on or too zoomed in on like specific food is gonna be a waste of energy. If we haven't, you know, developed that really kind of solid foundation.
And before, before we get into foods, I'm gonna ask for us to establish the foundation, blood sugar stress. What else do you wanna put under the foundation that must be looking good before it really matters about foods.
Yeah. Yeah. So I would say meal timing. So like meal frequency, meal composition, those are, you know, absolutely essential, you know, from a food perspective before diving into, you know, more zoomed in approaches with like singular foods mm-hmm <affirmative>, but I would even say too that before you're diving in and focusing on, you know, specific foods and kind of therapeutic supplements and things like that, you know, kind of optimizing the sleep schedule and, you know, um, supporting circadian rhythms and, you know, starting to think about, you know, stress and, you know, stress reduction or stress outlets recovery for the body. So I think all of those diet and lifestyle basics are important first and foremost. So balanced blood sugar, you know, start exploring. I, I always talk about stress in an interesting way. I don't know if you do this at all, but I think stress feels like just this.
I don't know. It's like so ambiguous. I feel like when people are thinking about it, talking about it, and sometimes I think it's just very awkward to say, you know, man, it's stress or reduce stress. And I think there's a lot of nuance there, but definitely getting, I think, real about stress starting to at least check in with their body, see if there's opportunities for outlets for recovery. I would say it's, those are some of the big ones. And then once we kind of lay the, the foundation with those pieces actually, and alongside that too, I would take a good hard look at how like the movement and exercise routine is supporting things. You know, I often work with women with P C O S that are, you know, doing all the things with exercise in, you know, kind of that are very well intended basically in terms of wanting to improve their P C O S but we end up in like this over exercising type situation.
So I think just making sure all of those things are well balanced and actually supporting the body, not creating more stress. And then you can kind of dive in and focus more so on specific foods and things that, you know, might be really supportive and, you know, examples of what that might look like would be, you know, I think will really, we have data that says from a kind of P C OS type perspective, most women with P C O S do experience chronic low grade inflammation to some degree, some more severe than others, but something I always like to do after we create that supportive foundation with food. So meal frequency meal composition is starting to think about things like anti-inflammatory foods specifically that could be things like, you know, broccoli sprouts and fermented foods and, you know, finding these foods that really sort of pack a punch with, you know, supporting the gut lowering inflammation is an example of, you know, something I might dive into.
So in interest of time in being considerate of that, um, let's kind of wrap up a little bit here. So, so far we've covered. And I think there could be a, we could do a part two on circadian stuff. And I know that was an, an area that you've really enjoyed. It'd be fun for us to compare notes on that because I was doing an adrenal program a couple of years ago and I just got so into circadian rhythm stuff. And I was like, man, this is old research and no one ever did anything with, from like the eighties. And so it'd be fun to chat through that a little bit. So we can reschedule a circadian rhythm episode, but we talked about P C O S this, we talked about the types that we lightly covered, the types of P C O S what you see most commonly in practice, what the issues are with what the most common type is and how that's not serving the type of P C OS.
We kind of dove into, which was adrenal P OS. We characterized, uh, Heon like ahea versus P C O S. We dove in just a touch where covered like different labs that may be useful, including thyroid blood sugar. And then you gave specifics around different other hormones that may be useful related to androgens and FSH, LH cetera. Uh, we talked about, we just touched a little bit on meal composition stress or ciran rhythm and stress being ambiguous, and then just mentioned food a little bit. So the question that people wanna know the most, or we wanna make sure we're always covering as we wrap these episodes up is okay. So I've either DIY or diagnosed self diagnose myself with P C O S based on the Rotterdam criteria that you mentioned earlier, two of three positive symptoms, which again, would've been signs of that elevated testosterone, like Herid male pattern, um, hair loss, irregular cycles, or lack of a cycle and undeveloped follicles. And we lamented about the CST word. So if someone is like listening to this and feeling like, Ooh, boom, boom, boom. This is why I listened to this. And I really am getting crappy advice, like eat less and exercise more from my provider. What do you wanna tell that person is the number one starting point for today or tomorrow for them,
If a person's thinks they have CS or they're diagnosed and they, that's the only advice they've received where to start.
Yeah. So I feel like food and nutrition is the best place to start, you know, and specifically I think with blood sugar balance. So making sure you're eating three well-rounded meals a day and kind of fill in, in any long gaps with, you know, well rounded snack and, you know, generally I think something, I just see which it, you know, isn't super sexy or exciting, but something I see often with women is just like, not even enough protein, you know, which can make a huge difference, uh, with something like blood sugar is gonna be foundational. So, you know, maybe just starting by doing a, an audit of protein intake and trying to get, you know, good high quality protein source at every single meal mm-hmm <affirmative>. Um, so I think, you know, something like that would be a, a starting point. Is that kind of what we were?
Yeah, no, it's great. And actually you're totally right. That's such a profound thing and such an easy thing to accidentally yeah. Not be doing. It's just really easy to not be doing a lot of it. It's like for so long, they talked about too much protein and now we're just kind of fighting with like, but really we do need protein. We need to digest. It will. So we could keep talking about this all day, but you have lots of resources online, like a lot. So where can people find you online? Jillian?
Yeah. So you can find me on my website, Jillian greeves.com. And I have more information there in terms of pre resources, tons of articles and different things that actually kind of dive into some of these P C O S topics in more depth. And then I also have a nutrition course specific to P C O S uh, called et or P C O S. And I also have a comprehensive group program called the empowered P C O S uh, group program for people that really kind of wanna do a deep dive, you know, in supporting their P C O S.
Awesome. Thank you so much for coming on today and for talking to me about P C O S and at all, all the other things related to it.
Thank you for having me. I know, I feel like we could do this for forever.
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