On this podcast episode we talked with Dr. Monique Brown. She is an OB-GYN practicing in Jamaica where she focuses on helping women with PCOS. In this episode we are specifically focusing on lean PCOS diet and nutrition. Whether you have PCOS or not, this episode is filled with lots of healthy tips for PCOS and overall health. 

What is lean PCOS?
PCOS is a hormone and endocrine problem which affects women in their childbearing years. Classic PCOS tells us the bearded woman type of story with excessive facial here, being overweight or obese, and maybe hormonal acne. Women with lean PCOS do not present in the traditional appearance. Lean PCOS is found in women who are of a normal BMI of 25 or less and are not overweight or obese. These women typically present as being normal or healthy because they don’t have the classic appearance. Women with lean PCOS might not have any of the physical symptoms we associate with PCOS, however, they still have the other symptoms.

When did we start recognizing this phenotype of PCOS?
PCOS had long been a condition only recognized in overweight and obese women. Women with lean PCOS were not recognized since they did not present with the typical physical appearance. Many women went undiagnosed and treated. In recent years more doctors began investigating because they were seeing women of normal BMI having high insulin levels and elevated testosterone levels.

How do you manage lean PCOS differently than the traditional PCOS?
When it comes to managing PCOS for all women it is important to look at them holistically. Each patient is different. It really depends on what they come in with, what problems or concerns they have, and what their symptoms are. It should always be a customized approach for anyone that comes into you whether it’s lean or the classic PCOS. In general 72% of persons with PCOS have insulin resistance as their main driver. That’s one of the main problems that’s going to be contributing to their symptoms. Studies have shown that it is the same for women with lean PCOS. So, it’s very important to find out what the main driver is for each person with PCOS. Additionally, someone with lean PCOS needs to be more aware of how often they’re spiking their blood sugar levels. Also, having good nutrition, diet, and lifestyle modifications would be instrumental in controlling PCOS.

Why does the Rotterdam criteria not include elevated insulin? How can we use that in diagnosing PCOS?
Remember, PCOS is a syndrome. And this is what they would have used to diagnose PCOS based on what they would have studied in the population all those years ago. Maybe they didn’t have enough research done to also check for insulin levels, and also the levels of the blood sugars versus just having testosterone and the appearance of hyperandrogenism. So it’s important that our patients and doctors do understand that insulin resistance is a big factor, whether it’s lean PCOS or classic PCOS. But I don’t think they will be modifying it a any point in time. So, take it with a grain of salt that yes, you need two out of three symptoms from the criteria to diagnose PCOS. But you should also be aware that insulin resistance tends to be one of the main factors, even though it’s not another term that is typically used among doctors since there’s not a prescription that we give for it. But it’s still something to be very much aware of, and patients need to be aware of so that they can get tested because in certain areas of the world, they can have their insulin levels checked. Versus in Jamaica here. We don’t have that luxury.

What are some ways to manage insulin levels?
When it comes to insulin resistance, or high insulin levels, nutrition tends to be the main factor, and a lot of the food we eat is slowly killing us. We need to be more mindful when it comes to what we’re consuming when it comes to insulin resistance, and the first factor is sugar. We have a problem with sugar addiction, so let’s start off with weaning off sugar. Sugar is quite inflammatory. Try a substitute like stevia or monk fruit, those are healthy substitutes that don’t spike your blood sugar levels, which is one of the main problems that causes the insulin resistance, continuing to spike your blood sugar levels, hence, you have continuously high insulin levels. The next thing is eating wholesome meals instead of snacks, fry bread, and all those other commodities that we tend to have, that would also reduce insulin levels. Next, eat 25 grams of fiber daily. Fiber is the buffer for blood sugar levels; it helps to control your blood sugar spikes. If you do something as simple as having more greens, more veggies and fruits with your meals, you will have better blood sugar control. I typically teach my clients to have half their dish being vegetables of some sort, a quarter as protein, and the other quarter a complex carbohydrate. So now we’re having more complex carbohydrates, which won’t spike your blood sugars. Simple carbs are going to be white rice, white bread, white pasta, donuts, iced tea, soda pop, things like that. Where complex carbs are brown rice, whole grains, oatmeal, sweet potatoes, quinoa, lentils, etc. Have some variety, so you are not eating the same thing every day but still managing blood sugar’s at the same time. Also, reduce your intake of processed foods because we do have a high consumption of processed foods.  I also recommend a short intermittent fast, anywhere from 12 to 14 hours. Of course, this is always something that’s best discussed with your doctor. And lastly, doing some type of resistance training. These are just some very simple easy steps that you could take right now to start controlling insulin resistance.

With something like a lifestyle change, is this short term or is this something that you really need to maintain for the rest of your lifetime, or at least through your reproductive years?
You really need to consider it a lifestyle change. We’re equipping them with the skill set and tools to make it adjustable so they can go out in the world, go to dinner, or a party, and they can make the best decision for their hormone and insulin levels. If you do it for six weeks or 3 months, and then everything goes back to “normal,” then you go back down the same downward spiral that you were trying to get out of and it becomes more unmotivating. And then you give up versus sticking to the structure. Awareness and mindful eating are very important.

Is PCOS something that can be cured; does it go away? Or is this something you have to manage for your lifetime?
There is no cure for PCOS. However, it is possible to control your symptoms to the point of having no symptoms. You would have regular periods, you’re ovulating, you’re getting pregnant, your hirsutism has minimized, your acne is controlled, your belly fat weight is down. All of those goals would have been met. You might see your blood results as normal. But once you have that diagnosis, you always have PCOS. If you stop controlling the symptoms, they will return.

Do you have any recommendations for treating some of the other symptoms, such as hyperandrogen and anovulation, other than diet and exercise?
Yes. Starting with hirsutism, excessive facial hair. There is laser therapy, electrolysis, and waxing. There have been studies to show that Spearmint tea has been quite effective in reducing parasitism and high androgen levels. So that’s something that you could take into consideration when it comes to the concept of not ovulating. It definitely does depend on what the driver is. If it’s insulin resistance, You need to treat that with lifestyle, nutrition and exercise. Those have the biggest impact. You also want to manage your stress levels because stress, anxiety and depression are extremely high in this population. Meditation can be very helpful. Having better sleep, from seven to nine hours per night, helps to reduce that groggy, fatigued, tired feeling that you get in the mornings. Improving sleep also helps with weight loss. For ovulation, inositol has been pretty well studied. There have been pharmaceuticals such as Metformin, which helps to sensitize your body to insulin. If you are trying to ovulate, speak to your doctor about starting inositol. It’s very safe and it’s one of the most studied supplements when it comes to PCOS, currently, and it’s known to improve fertility, improve the quality of your eggs, and also help with weight loss. Also, magnesium is a favorite when it comes to hormonal imbalance overall. Magnesium glycinate is one of the better options when it comes to being absorbed in the body. Magnesium helps you sleep, helps keep you calm, relaxes you, and that is an important factor. Also, research shows that people with PCOS typically have a vitamin D deficiency. You can get some vitamin D from being outside in the sun or by taking a supplement vitamin D3. As always, talk to your provider before taking supplements so you are taking the amount that is right for you.

How does stress, cortisol, impact PCOS?
Cortisol is literally called the stress hormone. And  you need a little cortisol in your life. However, chronically high levels of cortisol result in belly fat, a fatty hump between your shoulders, striations on your limbs, high blood pressure, and high cholesterol levels. Something as simple as when you wake up in the morning, after getting seven or nine hours of sleep and you’re still tired, you feel grumpy, you have a lot of belly fat, you find that you’re waking, maybe after two or three hours, you get up at two or three o’clock in the morning and can’t sleep, these are all signs that we aren’t managing our stress levels well, and we aren’t managing our stress hormone, cortisol. This can have long term effects. To help manage stress you can meditate, do deep breathing exercises, and go outside for a walk.

Final Thoughts
If you don’t think your doctor is guiding you on the path you desire, there are naturopathic doctors, depending on where you are, that you could always reach out to. Lastly, be more aware of what you consume on a day to day basis. 

You can find Dr. Monique on on Instagram @doctornique and TikTok @doctor.nique.