Type 1 : Insulin Resistant PCOS
Classic PCOS has the symptoms of weight gain, failure to ovulate, infrequent periods, infertility, facial hair, acne, hair loss and a predisposition to diabetes. They key feature is high testosterone on blood test.
The high testosterone is actually the side effect, rather than the cause. In type 1 PCOS, The real underlying issue is insulin resistance and leptin resistance.
What is Insulin Resistance: Under normal circumstances, insulin is tightly controlled by a natural homeostasis feedback mechanism. With every meal, insulin is released as carbohydrates enter the blood stream. In a healthy body, the insulin receptors in the cell membranes respond to the hormone, and take up carbohydrates and other nutrients. This, in turn, reduces the production of insulin.
The problem starts when the tissue fails to respond to insulin. When this happens, the sugar in the blood remains high despite the presence of insulin, and the body has no choice but to release more insulin. It becomes a vicious cycle because it is actually the presence of insulin that makes the tissue more and more resistant to it.
This is how insulin exposure determines the rate of ageing: with every insulin release, cell membranes become a little bit more insulin resistant. A gradual increase in insulin concentration over time is normal, but the current epidemic of severe insulin resistance is a modern phenomenon.
What is Leptin Resistance: Consumption of refined carbohydrates, especially sugar and fructose causes an excessive release of leptin. Over time, when the brain is exposed to this much leptin, it has to stop listening. It has to adjust, because from the brain's perspective:
"Surely that cannot be the correct information? We cannot have eaten that much sugar! There must be some mistake. I better change the way I do things."
The entire leptin signaling system is thrown off the rails. Leptin is no longer the helpful satiety message that it once was. It has a dark side.
When the brain brain becomes leptin resistant, it does not know that there is enough food and enough fat stores. It is under the false impression that food is scarce. It sends out powerful messages to eat, and it tells the body to store fat.
The leptin resistant person wants to eat all the time. Fat tissue accumulates, and secretes more and more leptin, but the brain still isn't listening. It still thinks the body needs more food! In the meantime, the excess leptin does damage. It signals the liver to secrete excess blood sugar, it increases inflammation in the body, and it interferes with normal ovulation and reproduction.
Improper signaling from these metabolic hormones inhibit ovulation and cause the ovaries to produce testosterone. It is a problem with the metabolic hormones that is the main cause of weight gain. The symptoms of excessive testosterone, such as acne and facial hair will improve when insulin and leptin sensitivity improve.
Causes of Insulin resistance and Type 1 PCOS:
- leptin resistance
- too much sugar
- smoking
- Hormone-disrupting toxins such as BPA
- birth control pill
An endocrinologist will prescribe weight loss with a low GI diet and exercise, as well as a blood sugar lowering drug such as Metformin. This is approximately the correct approach, but metformin does have side effects such as nausea, diarrhea and abdominal bloating. Fortunately, there are natural alternatives to metformin. In my experience, the natural supplements lower blood sugar as well, if not better, than Metformin.
Treatment Summary for Type 1 PCOS.
Diet - When the body is insulin resistant, it simply does not remember how to use carbohydrates for energy. It can only store them as fat. At the same time, an insulin resistant body does not have the ability to burn fat stores for energy. The solution is to restrict carbohydrates for six weeks to "remind" the body how to use them for energy. You may need to go down to 30 or 40 grams of carbohydrate per day, but you still must eat vegetables for their fibre and nutrition. Your best source of calories during this time is fat, not protein. Protein puts a stress on the kidneys, and is also converted easily into sugar, whereas fat is simply burned for energy.
- Eliminate refined sugar from the diet
- Supplement Magnesium and chromium - Minerals to improve sensitivity of the insulin receptor
- Supplement Resveratrol - improves sensitivity to insulin and leptin
- Peony & Licorice herbal formula to lower testosterone, which will alleviate acne and facial hair.
- Indole-3-carbinol to assist with estrogen metabolism and clearance
- Detoxify environmental toxins such as BPA that may be interfering with the insulin receptor
- The Pill is not an appropriate treatment (but sometimes is the only treatment till a better one comes along).
Type 2: Non-Insulin-resistant PCOS
What if you have confirmed PCOS, but your insulin and blood sugar are normal?
The ultrasound may show multiple, undeveloped follicles. LH may be elevated, and periods do not occur regularly. Testosterone may be high or normal. If testosterone is normal, the acne and facial hair exist because estrogen is too low (compared to testosterone). Body weight can be normal.
In insulin-resistant Type 1 PCOS, the ovaries were prevented from ovulating because of insulin. In type 2 PCOS, the ovaries are prevented from ovulating because of something else. But what?
Causes of Type 2 PCOS:
- Elevated LH from Post-pill syndrome (see above)
- Vitamin D deficiency
- Iodine deficiency
- Hormone-disruping toxins such as BPA
- Adrenal stress which disrupts ovulation (Stress , Low Blood Pressure, and Lack of Sleep)
- Thyroid disease
- Insufficient of dietary fat.
- Leptin deficiency. (Leptin is a hormone secreted by fat, and can be deficient, especially if there is a history of an eating disorder.)
- Metformin is not a treatment for Type 2 PCOS. Nor is the Pill. The Pill will induce a monthly bleed (which is a drug-withdrawal bleed - not a period). The Pill does nothing to restore normal ovulation.
Treatment Summary for Type 2 PCOS.
- Do not take the birth control pill
- Iodine and vitamin D to promote normal ovulation.
- Detoxify to remove hormone disrupting chemicals.
- Avoid cow's milk to reduce inflammation and clear acne
- Magnesium and zinc to block testosterone.
- Peony & Licorice herbal formula to lower testosterone, bring on the periods, and alleviate acne and facial hair.
- The herbal medine Vitex (Chaste tree) should NOT be used, especially if LH is elevated. It will worsen symptoms.
- Tribulus herbal medicine.
- Indole-3-carbinol to assist with oestrogen metabolism and clearance
- Natural Progesterone to suppress LH secretion (from the pituitary) and allow ovulation to occur.
Other Potential Combinations
While the two types of PCOS described above tend to be the most typical presentations, there are some who break the categories down to as many as five different types:
1. Type 1 PCOS:
The classic PCOS presentation described above, with ovulatory issues, increased testosterone, and insulin-resistance.
2. Type 2 PCOS:
The non-insulin-resistant PCOS we have already described, with ovulatory issues and increased testosterone levels.
3. Non-Traditional PCOS 1:
Presents with ovulatory issues, normal testosterone levels, serve inflammation, obesity and insulin-resistance.
4. Non-Traditional PCOS 2:
Presents with normal ovulatory patterns, increased testosterone levels and mild insulin-resistance.
5. Idiopathic Hirsutism:
Presents with normal ovulatory patterns, increased testosterone levels and no insulin-resistance.
As you can see, there are many variations when it comes to this condition, which can make finding the appropriate treatment for individual patients difficult. Understanding the factors behind your own case of PCOS, and finding a specialist you trust to help you seek the answers you need is the best way to combat this disease which affects so many others as well.
Type 3 : Non Traditional Inflammatory PCOS.
Along with the Non Traditional type PCOS in Type 2 above you would have intense Inflammation – or chronic immune activation - results from by stress, environmental toxins, intestinal permeability and inflammatory foods like gluten. Inflammation is a problem for PCOS because it impedes ovulation, disrupts hormone receptors, and stimulates adrenal androgens like DHEA and androstenedione.
You have other symptoms of immune-dysfunction such as recurring infections, headaches, joint pain or skin conditions. Your blood test shows inflammatory bio-markers such as vitamin D deficiency, abnormal blood count, elevated C-RP, thyroid antibodies or gluten antibodies. You may have elevated DHEA, and a positive urine test for intestinal permeability.
Treatment ideas. Reduce stress and exposure to environmental toxins like pesticides and plastics. Eliminate inflammatory foods like wheat, dairy and sugar. Treat intestinal permeability with zinc, berberine and probiotics. Supplement magnesium because it is anti-inflammatory and normalises adrenal hormones (HPA axis). Improvement is slow and gradual over 6-9 months.
Type 4 Non Traditional PCOS Mild Insulin Resistance
Non traditional PCOS 2 mean you can have regular ovulation month to month but you have increase testosterone levels. You will see excess hair and elevated levels in blood work. The symptoms of insulin resistance can be mild, so you may not know you have the condition until a doctor runs diagnostic tests on you.
Type 5 Hidden-cause PCOS
This is the ‘simpler-than-you-think’ type of PCOS. Fairly often- at least once every week – I encounter a PCOS patient who does not meet any of the criteria for the first 3 types of PCOS. These are my favourite cases, because -very often – there is one simple thing that is blocking ovulation. Once that single thing is addressed, this type of PCOS resolves very quickly, usually within 3-4 months. Common hidden-causes of PCOS include:
- Soy is an anti-estrogen and can block ovulation in some women
- Thyroid disease impairs ovulation because your ovaries need T3 thyroid hormone.
- Vegetarian diet because it causes zinc deficiency and your ovaries need zinc.
- Iodine deficiency because your ovaries needs iodine. Please be careful with iodine supplementation.
- Artificial sweeteners because they impair insulin and leptin signalling.
- Too little starch in the diet because your hormonal system needs Gentle Carbs.
Is this you? You do not exactly fit the criteria for the first 3 types of PCOS. You have tried a number of natural PCOS treatments and nothing seems to work. Look deeper.