PCOS Answers

PCOS brings up so many questions. The PCOS Answers Podcast will take complicated topics and bring it to you in easy to understand language with real life solutions. Episodes will be in snack size segments with practical information you can apply every time you listen.

Ep 27: Client Appt- PCOS Meal Modifications and Sperm Health for Fertility 10/04/2025

Ep 26: When the Plan Changes: Ana’s Story of Fertility, PCOS, and Finding Answers 09/27/2025

Ep 25: Why am I so Tired All the Time? 05/06/2025

Ep 25: Why am I so Tired All the Time? The episode explores chronic fatigue in individuals with Polycystic Ovary Syndrome (PCOS)—emphasizing that fatigue is not laziness, but a symptom tied to several physiological and hormonal imbalances common in PCOS. 🔍 Key Points Covered: 1. Fatigue Is Common with PCOS Many people with PCOS feel perpetually exhausted—low energy in the morning, need for naps, and “second wind” late at night. This isn’t a personal flaw, but a biologically-rooted issue often tied to PCOS-related conditions. 2. Insulin Resistance: The Energy Blocker Insulin resistance prevents glucose (energy) from entering cells effectively, leading to: Brain fog Energy crashes Cravings "Energy rollercoasters" ✅ Fixes: Balanced meals with protein, fiber, and healthy fats Supplements like berberine and inositol 3. Adrenal Dysfunction & Cortisol Imbalance Chronic stress leads to abnormal cortisol patterns, often causing: Feeling wired at night but tired during the day Trouble falling asleep Poor recovery from stress ✅ Fixes: Morning sunlight exposure Evening dim lighting and screen reduction Gentle morning/evening routines (tea, walks, breathing exercises) 4. Sleep Quality and Sleep Apnea Poor sleep architecture and possible undiagnosed sleep apnea worsen fatigue. High insulin or sugary nighttime snacks disturb melatonin and rest cycles. ✅ Fixes: Avoid heavy meals or sugar before bedtime Get a sleep study if sleep feels non-restorative Prioritize circadian-friendly habits 5. Nutrient Deficiencies Linked to common PCOS meds (like birth control or metformin): Magnesium – aids relaxation and sleep Vitamin B12 – important for energy (especially if on metformin) Iron – low levels can occur with heavy bleeding Vitamin D – supports energy and quality sleep ✅ Fixes: Supplement wisely (especially with bioavailable forms) Consider testing levels and optimizing through food and sun exposure 6. Mindset and Self-Compassion Fatigue often leads to internalized guilt or frustration. The speaker emphasizes compassion over self-criticism—recognizing that this is harder for PCOS bodies, not a personal failure. ✅ Tips: Journal about how to be more supportive toward yourself Train loved ones or co-workers to help encourage healthier habits (e.g., walking instead of coffee in the afternoon) 💬 Memorable Story: She shared a personal moment where she was exhausted but her husband encouraged her to go for a walk instead of napping—and she felt significantly better afterward. It was a powerful example of how support systems can play a role in breaking fatigue cycles. 📌 Takeaways: Fatigue with PCOS is multi-faceted: biological, hormonal, lifestyle-related. Small changes—like sunlight, balanced meals, supplements, gentle activity, and better sleep hygiene—can add up. Be gentle with yourself and ask for help. You're not alone in this. /episode/index/show/a78406e1-e87e-4cc9-99d0-483ae84f9aeb/id/36458700

Ep 24: Common Myths and Misconceptions in PCOS 04/25/2025

Ep 23: Fertility Medications Prescribed to Women with PCOS 04/08/2025

Ep 22: Androgen-Lowering Medications for PCOS: What You Need to Know 03/18/2025

Ep 21: Common Medications to Treat PCOS: Metabolic Medications 02/21/2025

Ep 20: 3 Hard Truths About PCOS and What to do About it... 10/03/2024

Ep 20: 3 Hard Truths About PCOS and What to do About it... With Caitlin Johnson, your functional medicine dietitian, this podcast is a private podcast. In every episode, I will leave you with something you can do today to help your PCOS. I'm so glad you're here. When you get a PCOS diagnosis, you have likely heard things like: "This may make it harder to get pregnant." "In order to improve your symptoms, you need to lose weight." "Here is a prescription for metformin and birth control." For some, there may also be medication for mental health, such as anxiety or depression. And you're likely going home thinking, When will my hair stop falling out? When will my chin hair stop growing so coarsely? What am I actually going to do to manage this condition I was just diagnosed with? I know when I was diagnosed, I asked the doctor what PCOS was. His response was that it was the number one leading cause of infertility for women in America. He left me with very little information about what was going on metabolically within my body and what I could do about it. He basically sent me off on a mission to lose weight—the weight that I had just gained. That was a hard pill to swallow because I had gained the weight while training for a half marathon. I was really at a loss for how I could manage my PCOS. Does any of this sound familiar to you? Do you feel like, Yeah, I was offered the same solutions, or I have the same questions and feelings? Well, here are some hard truths I’m about to deliver to you. Hard Truth #1: PCOS Is a Metabolic Health Issue PCOS is as much a gynecologic issue as it is a metabolic health issue. In order to treat the hormone imbalances driving your hair loss and coarse hair growth on your face, chest, or groin, we need to focus on metabolic health. Metabolic health impacts hormone health, and vice versa—your hormone health can make your metabolic health worse. Today, we’re going to talk about how we can improve those things so that we’re not just left with hard truths, but also with ways to manage them. Quick Break: Check out PCOS Formulas, specifically the Metabolic Berberine Formula. This combines alpha-lipoic acid and berberine to support insulin resistance, improve blood sugar regulation, and help shift your body into fat-burning mode. It’s designed to help you use fat for fuel, especially during fasting periods like overnight or between meals. For more information, head over to pcosformulas.com and check out the weight loss bundle today! Truth #2: Weight and Hormonal Health Your metabolic health impacts your weight, and your weight impacts your metabolic health. As we gain excess fat tissue around our midsection, we start creating hormone disruptions. These disruptions affect how full we feel, cause energy dips, influence testosterone and estrogen levels, and impact cortisol (the stress hormone). When your doctor says losing weight will help with ovulation, they’re not wrong. Losing weight can improve all symptoms related to high androgen levels (like testosterone, DHT, and DHEA). However, losing 5-10% of your body weight can feel overwhelming, especially if you’re already 250 pounds. A 5% loss would be 12.5 pounds, and a 10% loss would be 25 pounds, which is no small amount. I understand the frustration when losing weight feels nearly impossible. But doing something to improve how your body processes insulin can help. Here’s a tip: stop what you’re doing 10 times a day and do 10 squats. Wherever you are—unless you’re driving—stand up and do 10 squats. The next day, switch to push-ups. This helps your muscles use the insulin available in your blood more efficiently. You can also start your day with 30 grams of protein at breakfast or try using supplements like those in our metabolic bundle to support your metabolic health and help you lose weight. Truth #3: Hair Loss Takes Time to Improve Losing hair from the top of your head while growing coarse hair on your chin, chest, or belly button is driven by DHT, a potent form of testosterone. PCOS makes it way too easy for the body to convert testosterone into DHT, which affects hair follicles and causes male-patterned hair growth or hair loss. This process takes time to reverse, but it’s possible. I’ve seen clients improve these symptoms, but it requires patience. Dietary changes, supplements like spearmint or green tea, and products like Androgen Assist can help. Androgen Assist contains licorice and peony, which are known to lower testosterone levels. These changes take time, but they can reduce hair loss and slow down coarse hair growth. Temporary Solutions: Medications Temporary solutions like birth control, spironolactone, and metformin can help reduce symptoms but won’t reverse PCOS. When you stop these medications, if you haven’t worked on the underlying causes, symptoms may come back and be even worse than before. I’m not saying don’t use these medications—they can be helpful, and sometimes even life-saving. But they have risks, side effects, and downsides. When you talk to your doctor, make sure you understand those risks and ask about an exit plan. For example, “Let’s try this for a year while I work on my metabolic health.” Wrapping Up There is hope and light at the end of the tunnel. You can do things to improve your PCOS, like drinking spearmint tea, switching to green tea, eating more protein at breakfast, and engaging your big muscle groups throughout the day. Pick one small step to start today, and stay tuned for our next episode, where I’ll discuss medications for PCOS and how to advocate for using them well. That wraps up this episode! Thanks for joining me, and don’t forget to take action on one thing we talked about today. /episode/index/show/a78406e1-e87e-4cc9-99d0-483ae84f9aeb/id/33316077

Ep 19: Doing Everything, but Still Not Ovulating? 09/14/2024

Ep 18: Are low progesterone levels common in PCOS?? 08/27/2024

Ep 17: Protein to Net Carb Ratio 05/11/2024

Ep 16: Post Partum or PCOS: Why am I not Ovulating? 05/04/2024

Ep 15: My Weight Loss Update 04/11/2024

Ep 14: Thyroid Health in Preconception, Pregnancy, Postpartum and Perimenopause 02/09/2024

Ep: 13 PCOS and Thyroid Health 02/02/2024

Ep 12: Why Weight Loss is Recommended to Women with PCOS to Improve Fertility 01/19/2023

Ep 12: Why Weight Loss is Recommended to Women with PCOS to Improve Fertility If you have Polycystic Ovary Syndrome (PCOS), you have likely been told to lose weight. If you are trying to get pregnant with PCOS, I have no doubt you’ve been told to lose weight. The typical recommendation from doctors is to lose 5-10% of your total body weight. The truth is, it’s not all about losing weight. I’d argue that it’s the behavior changes that help weight loss happen that actually drive most of the benefits for fertility. [00:00:00.730] - Caitlin Johnson, RD Welcome to the PCOS Answers Podcast with Caitlin Johnson, your functional medicine dietician. This podcast is a private podcast only available through the PCOS Dot. It will provide practical sciencebased answers to all of your PCOS questions and every episode will leave you with something you can do today to help your PCOS. I'm so glad you're here. [00:00:27.610] - Caitlin Johnson, RD We are off to another episode about weight loss, but we are going to consider it within a different context tonight. So instead of talking about necessarily how to lose weight with PCOS, I want to talk about why this weight loss recommendation is so often provided to those of us with PCOS, from our physician or from our other medical provider. On the blog, we just published a really thorough article that talks about why weight loss is recommended to women with PCOS, specifically those that are trying to get pregnant. But I would like to pose to you the question of is weight the problem? If you've been following me for any amount of time, you know that I like to talk about weight or weight gain or weight loss resistance as a symptom of PCOS. [00:01:20.730] - Caitlin Johnson, RD If you have PCOS, you've been told to lose weight before. I know you have. If you're trying to get pregnant with PCOS, I absolutely know you've been told to lose weight. Most doctors will actually recommend a specific percentage of weight loss, typically between five and 10% of your body weight. So let's give a few examples of what that figure could look like. [00:01:43.090] - Caitlin Johnson, RD If you weigh 250#, 5% of your body weight is #12..50 and a half pounds before being exact. 10% is #25. Well, asking somebody to lose #25 is a lot of weight to be asking them to lose. If you're #200, you're being told to lose between ten and #20. If you're #175, you're being told to lose between nine and #18. [00:02:12.170] - Caitlin Johnson, RD Some of these numbers may feel more attainable. Of course, if you have more weight to lose, losing a bigger number is something that may actually even seem appealing to you. However, those of us that have weight to lose, including myself at this very moment, know that we have weight to lose. We don't need one more doctor to tell us, hey, you'd be healthier and probably ovulate if you lost weight. And especially when we're talking about a subject as sensitive as trying to get pregnant when you might already be struggling to get pregnant. [00:02:44.450] - Caitlin Johnson, RD It is kind of a hard thing to hear, especially with all the things that go in trying to conceive and all the insecurities and anxieties that go along with it, in my opinion. And take that for what it is. It's an opinion, but it is an educated, informed opinion. And I have treated many hundreds of women with PCOS at this point, one on one, many more hundreds in my course, and thousands of people that I affect with my online education. I do not believe it's all about weight. [00:03:19.970] - Caitlin Johnson, RD I'd argue that behavior changes that improve insulin resistance, improve overall health, and that may yield weight loss are actually what is providing benefit and ovulation when doctors are telling women to go lose weight. Because when you go lose weight, typically you're moving your body more. You may focus a little bit more about what you're eating, whether it's a portion size or changing what you're actually eating or going on a full blown diet, there is oftentimes more attention given to your behavior choices, to your daily activities, to what groceries come into your home, or what you choose to order when you're out. I don't think it's just weight loss. I honestly don't think it's just improvements in insulin resistance. [00:04:09.880] - Caitlin Johnson, RD And I don't think it's just behavior change. I think it's the synergy of all those. I think you could have two of the three of those and still see benefits in your fertility. When somebody with PCOS gets pregnant, if we've already addressed excess weight, that would be benefited if you lost them or we've already addressed insulin resistance. It's not just getting pregnant that we are impacting. [00:04:39.010] - Caitlin Johnson, RD We're also impacting the health of your pregnancy and even the health of your baby. And as we all know, you've heard me say this before, for sure. It's not about getting pregnant. It's about having a baby and being a mother and living this long healthy life with your family. So if you've been to a doctor trying to conceive or you've been to the doctor with PCOS or even to get your PCOS diagnosis, the story may have gone something like this you go to the doctor struggling to lose weight, my hair is falling out. [00:05:10.850] - Caitlin Johnson, RD I have hair growing on my nipples. I have really bad acne. I haven't had a period in a year. Whatever your symptoms or health concerns, typically with enough digging, they will come to the conclusion that you have PCOS and then they will offer you a prescription for metformin or birth control. And if you sought medical intervention or help or this diagnosis in the context of trying to get pregnant, they may move on to talk about what you can do right then to get pregnant. [00:05:40.050] - Caitlin Johnson, RD But for a lot of people, they don't get the diagnosis while they're trying to conceive. They get it younger in life or for many of us, at points of higher stress in our early 20s or so. And the doctor tells us, well, when you're ready to get pregnant, you just come back. I have a different medication for that. So you go about your life, you don't get any help with diet or exercise or any of the metabolic factors that go along with PCOS. [00:06:04.860] - Caitlin Johnson, RD And when you're ready to get pregnant, you show back up to the doctor, you go off birth control and maybe you don't get a period. And you go back to the doctor and the doctor says, well, you need to lose 5% to 10% of your body weight, and then you're likely to ovulate on your own. So you need to go do that and at least spend a year trying to conceive and then come back to me. Well, you can't conceive if you're not ovulating. So if you're listening to this and this is the first time you've ever thought about it, if you are not having a period and you're not on an oral or some type of hormonal contraceptive, you are not ovulating. [00:06:44.490] - Caitlin Johnson, RD And so there's no chance of you getting pregnant. Many women go off the oral contraceptive pills that they've been on since their mid teens and expect to get pregnant right away and their period doesn't show, and then they think they're pregnant and a lot of heartbreak ensues, and then they finally realize that they have a PCOS diagnosis or that they're not ovulating at all. So there are opportunities within this story for things to go better. First of all, the doctor could not have just handed the person a prescription. They could have said, hey, did you know that insulin resistance is a big piece of PCOS? [00:07:19.990] - Caitlin Johnson, RD And I'd like to offer you a referral to a dietitian or somebody that can help you learn about this and how you can manage your health to impact this. Most of us don't get that benefit, and so we go years just thinking the birth control is fixing this for us. And you know what the birth control also does? It makes insulin resistance worse. And so it's even harder for you to manage your weight with PCOS on the birth control pill. [00:07:44.680] - Caitlin Johnson, RD I'm not anti birth control pill. This is just the story that I hear over and over and over again. And we lose years of our life not managing other areas of our health so that when we're ready to try to conceive, we have kind of an uphill climb instead of flat road in front of us where it's just a matter of time. So oftentimes I get the question, why is it 5% to 10% of our body weight? Well, there are a number of reasons for this. [00:08:15.260] - Caitlin Johnson, RD First of all, it's really hard to measure eat a big breakfast, eat more protein. But your doctor can measure what you weighed this time at your visit and what you weighed next time at your visit. So it's just something that they can measure. That's one of the reasons. Okay. [00:08:33.750] - Caitlin Johnson, RD The other thing is that as weight loss occurs, insulin resistance improves. Now, this is one of those kind of chicken and egg situations. Sometimes weight loss happens because insulin resistance has improved because of nutrition and lifestyle changes. Sometimes insulin resistance improves because you've lost weight. And maybe it had everything to do with just eating less calories and had nothing to do with blood sugar regulation, or maybe you just started moving more. [00:09:02.190] - Caitlin Johnson, RD So this is kind of one of those chicken and egg situations. But we do see, as insulin resistance improves, as weight loss happens, the other one happens. Does that make sense? So when we get to this 5% body weight, especially in the research of those that are overweight or obese with PCOS, we start seeing significant improvements in insulin resistance and free testosterone levels. Free testosterone, again, is that hormone that floats around and does the testosterone dirty work. [00:09:37.670] - Caitlin Johnson, RD It's the one that's touching the ovary and saying, hey, don't let that follicle get to the point of being able to ovulate. It floats around and touches your chin and makes pimples happen and hair fall out off the top of your head. It's that free testosterone that's not bound, that's different than total testosterone. We want both those numbers to come down typically. But as weight loss occurs, we typically see free testosterone go down. [00:10:01.540] - Caitlin Johnson, RD We also see a protein that the liver makes sex hormone binding globulin go up, which is partly why free testosterone is going down. Weight loss improves those things. So weight loss alone can help improve hormonal abnormalities that are present in a PCOS woman's body that help improve ovulation. So one of the recommendations is there to just say, hey, weight loss that occurs at least at this percentage of your body weight, gives you a chance to ovulate at all or more frequently. Because if you're somebody that only gets a period bleed maybe three or four times a year, maybe every three months, if you're ovulating in those cycles, there's an asterisk on that if you're only ovulating three or four times a year. [00:10:46.510] - Caitlin Johnson, RD So when they send you off to go try for a year and then come back if you're not pregnant, you had three, maybe four chances to ovulate, whereas, like, the girl next door had twelve. Okay, so this is partly why we see it takes longer for women with PC us to get pregnant. Not that there are low chances of pregnancy, but it just takes longer for many of us because we have less frequent ovulation. Well, weight loss improves that. So does insulin sensitivity. [00:11:13.580] - Caitlin Johnson, RD So if we can get your body more sensitive to insulin, less resistant to it, we can help improve ovulation rates. So I dug into all the research to find, where did these numbers come from? What are these numbers? And I actually found some older research that showed weight loss less than 5 kg. So that's about £11 did not significantly improve ovulation rates. [00:11:43.790] - Caitlin Johnson, RD So there tends to be this amount of, like, okay, we need greater than #10 of weight loss to at least start to see these benefits. If you're somebody listening to this and you weigh #130 and you're like five foot four, you probably don't have #10 to lose. Okay? So we're not just talking weight loss at all costs. We're talking about weight loss that's indicated there is evidence that getting to this 5% to 10% weight loss does help improve pregnancy outcomes, not just ovulation pregnancy pregnancy outcomes and live birth rates. [00:12:28.510] - Caitlin Johnson, RD Because so many of us with PCOS struggle with weight, it can be really hard to hear one more person on top of our own internal dialogue all the time, telling us weight is something that's standing between you and what you want. Let me just say that again. It's really hard to hear a message that weight is the thing that's standing in between you right now and the you that you want. Motherhood, you holding that baby. So sometimes when we hear this, we shut down. [00:13:06.410] - Caitlin Johnson, RD Understandably so. And if you go into a doctor's appointment and all the doctor offers you is advice to lose weight and sends you out the door without a solid plan or help or a compassionate conversation about why this is probably more hard and difficult as somebody with PCOS, then I'm sorry, and you do need a new doctor. Don't settle for medical care like that. But just because I myself have been that patient, being told to lose weight and know how painful that is and know how painful it is to want to have a baby and see an uphill battle in front of me, I cannot disregard the literature and the evidence that weight loss helps improve these things. Now, listen to me clearly. [00:13:58.970] - Caitlin Johnson, RD I do not believe weight loss alone is the reason why it's easier to get pregnant. I think it's the improvements that happen with insulin and the hormones that trickle down from there and the behavior changes that also affect things like your circadian rhythm and stress levels. All of that. The whole package is improving. Ovulation, pregnancy, live birth rates. [00:14:25.360] - Caitlin Johnson, RD Okay, why does insulin matter in this equation? Well, insulin levels impact sex hormones. Insulin, high levels of it turn your ovary from an estrogen producing thing to a testosterone producing thing. Your actual follicles that become the eggs that get ovulated are the ones that make most of the estrogen and most of the testosterone. In an environment where your ovary is bombarded by insulin, you make a lot of testosterone. [00:15:02.360] - Caitlin Johnson, RD And when you make a lot of testosterone, it impacts your ability to ovulate. It basically stops the follicles from developing to be the egg that gets ovulated and leaves them in this immature form, and they're held in something called a cyst, and that is the polycystic ovary. It's a little baby immature follicle sitting in a little encasement of fluid that is normal. It's not bad. And they're stuck there. [00:15:32.220] - Caitlin Johnson, RD They're not maturing because they have way too much testosterone. If that isn't like, it just makes me laugh. Just makes me think of so many teenage hormone boys. That's basically what's going on in your ovary. And we need to switch those little teenage boys over into estrogen producing follicles for you to help you ovulate. [00:15:54.520] - Caitlin Johnson, RD One of the ways we do that is to lower your insulin levels. So when we talk about weight loss for ovulation, I'm going to step away from talking about the insulin and the testosterone. Right now I want to talk about one study. It was actually two different randomized clinical trials. And then in 2016, somebody went in and did a secondary analysis. [00:16:19.210] - Caitlin Johnson, RD They considered people who are trying to conceive with PCOS overweight or obese, and they give them an ovulation inducing medication called clomafine citrate for short. We call this chlomid. Group A gets chlomid. Group B gets a period of time with helpful lifestyle, education, intervention counseling, nutrition, education, and there's a period of time that allows for weight loss. And then they're given chlorine. [00:16:57.080] - Caitlin Johnson, RD And then a third arm of this study was where they provided birth control. Okay, so this period of preconception, they got birth control, oral contraceptive pill, plus education and nutrition, cognitive behavioral therapy. All the things that group two got, they got. And then at the same time that group two got told, okay, go try to get pregnant, group three also got Chlomid. So each group one, two, and three got Chlomid. [00:17:28.520] - Caitlin Johnson, RD Groups two and three had time before they got Chlomid to lose weight. Group three also had birth control during that time. Group one just got given Chlomid. Both groups two and three had more pregnancy rates, more ovulation, more live birth rates compared to just the Klomid group. It was significant that the hormone, the oral contraceptive piece of this study, it was kind of ruled out, statistically insignificant, that that helped improve outcomes, but that it was in fact, the weight loss that happened in groups two and three that impacted these ovulation rates, pregnancy rates, and live birth rates. [00:18:20.190] - Caitlin Johnson, RD When you consider a study like this, it's interesting to look at those outcomes because nobody just says, like, what? I can't wait to just be pregnant. I want to be pregnant for the rest of my life. No, the goal of pregnancy is a baby. The goal of ovulation is typically pregnancy. [00:18:36.410] - Caitlin Johnson, RD I have a very strong argument that you should be ovulating, whether you're trying to conceive or not. That is for a different day. But so when we look at a study, we want to look at the findings of not just did they ovulate, not just did they get pregnant, but did they get a baby out of that pregnancy? There's a poignant quote from the study that I want to read to you. It says, one of the striking findings of the study is the marked improvement in live birth rates out of proportion to the more modest but still significant improvement in ovulation rates, suggesting yet again that improving the quality of ovulation is as important as improving the frequency of ovulation. [00:19:16.130] - Caitlin Johnson, RD So weight loss helped us see those higher live birth rates. So we're not just trying to lose weight to lose weight. We're not just trying to lose weight to get access to Chlomon. The whole synergistic approach helps improve this end goal of a healthy mom, healthy baby at the end of this. So again, I pose the question, is it weight or is it something else? [00:19:44.810] - Caitlin Johnson, RD I believe that it is a synergistic effect of behavior change, weight loss, insulin improvements, and how insulin improvements help trickle down to other hormones. Let me talk to you a little bit about that. We talked about weight loss and insulin improvements, how that trickles down and affects testosterone levels and how those testosterone levels can trickle down and impact ovulation and even egg quality. While there are a number of other hormones that insulin high levels of insulin impact, one of those is called luteinizing hormone. Your pituitary gland sends out follicle stimulating hormone, the one that gets the eggs ready to be ovulated. [00:20:28.950] - Caitlin Johnson, RD And then luteinizing hormone, and you get a big surge of luteinizing hormone to signal the ovary to ovulate. Okay? When this big surge happens, the brain tells the ovary, it's time you've got a follicle... /episode/index/show/a78406e1-e87e-4cc9-99d0-483ae84f9aeb/id/25654260

Ep 11: Metabolism, BMR and Weight Loss for PCOS 01/12/2023

Ep 11: Metabolism, BMR and Weight Loss for PCOS Losing weight with PCOS is hard to do, yet it's one of the first things that a doctor will recommend to help improve symptoms and fertility. Understanding metabolism, BMR and unique advantages related to PCOS can help set a course of losing weight successfully and increasing your metabolism for the long term. [00:00:00.650] - Caitlin Johnson, RD Welcome to the PCOS Answers Podcast with Caitlin Johnson, your functional medicine dietitian. This podcast is a private podcast only available through the PCOS app. It will provide practical science-based answers to all of your PCOS questions, and every episode will leave you with something you can do today to help your PCOS. I'm so glad you're here right now, in real-time, as I'm recording and releasing this episode. It's just fresh into the new year. [00:00:30.410] - Caitlin Johnson, RD It's early January, and if you're anything like most of the world, you may have set some health goals for this upcoming year. And usually, that revolves around or has some sort of goal related to weight loss. This is also something that's particularly relevant in the PCOS crowd because it's usually a main method of treatment that is prescribed to us. Your doctor tells you that you have PCOS, he offers you a prescription for metformin, potentially birth control, and then he tells you if you lose weight, your cycle will improve, your symptoms will improve. And while he's not wrong, if you lose weight, your cycle and symptoms can improve and even your fertility can improve. [00:01:15.250] - Caitlin Johnson, RD Weight loss is actually something typically pretty hard to come by for somebody with PCOS, and it's usually not any type of news flash that we need to lose weight. And we've typically tried all the things to lose weight. So I want to start into a multiple-episode series on weight loss with PCOS, and I want to start with talking about metabolism. I recently published a new blog article, a health article within the PCOS app called Increasing BMR. It's one of the best ways to lose weight with PCOS, and this is really true. [00:01:50.610] - Caitlin Johnson, RD But let's go over just some of the basics. If you're somebody with PCOS, you've probably thought sometime in your life, why is it just so hard for me to lose weight? I really feel like I have a much slower metabolism than other people. For me, when I was diagnosed with PCOS, I should have been losing weight. But instead, in about a three month period, while training for a half marathon and running 25 plus miles a week, I had gained £60. [00:02:20.080] - Caitlin Johnson, RD And it just did not make sense. If a metabolism was going to work and calories in and calories out mattered, then I should have actually lost weight in that period of time, not gained it. So in medical terms, the metabolism is basically the process that your body uses to change food or drinks into energy. Calories and metabolism are often kind of talked about an interrelated. I don't want to say interchangeable, but in kind of like a codependent way. [00:02:52.950] - Caitlin Johnson, RD So I want to define calorie too. Calorie is just a unit of measurement. We could honestly call it anything. We could call it I'm looking out my window right now. I could call it a tree, I could call it a box. [00:03:05.340] - Caitlin Johnson, RD I could make up a word. [00:03:09.290] - Caitlin Johnson, RD What is that? Well, it's a calorie. It's a unit of measurement. It's a way for us to say this food has this much energy in it, or you require this much energy to just continue surviving. If you don't eat for a great period of time, your body will no longer work. [00:03:26.920] - Caitlin Johnson, RD It will use all of its resources up, and then it will die. So we need to eat energy, and the energy that we measure is calories. So when we talk about metabolisms, we're usually talking about how much calories does our body burn in a day? We often talk about eating to either meet our calorie requirements or to offer something called a calorie deficit, where we eat underneath the energy that our body needs to survive and do the activities that it does. This is literally how people prescribe weight loss. [00:04:01.860] - Caitlin Johnson, RD They say, move more so you increase your metabolic needs, how many calories you should be eating, or eat less. So your body activity should remain stable, but you're eating less, so you're having less calories to perform the same amount of work for your body. Now, the problem with eating less and moving more is that your body knows how to adapt. It's very good at that. Its primary goal is to keep you alive, keep you living. [00:04:32.120] - Caitlin Johnson, RD Its primary goal isn't to add muscle. Its primary goal isn't to reproduce first. You have to stay alive to do any of those other things. Okay? So it will adapt to a decrease in how many calories you're eating. [00:04:47.940] - Caitlin Johnson, RD It will adapt to an increase in the amount of fiber that you're eating. Which fiber has calories in it? We just can't really break those apart and use them ourselves. It will adapt to increases in energy, and so it will try to become more efficient in any body process that it can to use less calories to do that same body process if you're moving more and not eating more. So I want to talk a little bit about this term BMR. [00:05:17.890] - Caitlin Johnson, RD BMR is really just an expression of how much energy it takes for you to do all the body processes you have to do while you're at a full rest. Okay? So you're still breathing, your heart is still beating. You have to maintain a certain body temperature. Your fingernails will grow while you're at rest. [00:05:38.480] - Caitlin Johnson, RD Your hair will grow while you're at rest. Okay? It takes about 60% to 70% of our total calorie intake just to maintain our basal body needs. Okay? But your BMR is not how many calories you're burning in a day. [00:05:56.150] - Caitlin Johnson, RD There are three things that contribute to how many calories you burn in a day. And your BMR is just one of those three. The other two are your physical activity and something we call the thermic effect of food. It sounds super sciencey, but it's actually a pretty simple thing to understand. I'm going to start with the thermic effect of food. [00:06:17.290] - Caitlin Johnson, RD This accounts for about five to 10% of the calories that you actually burn in a day. Calories are just a measurement. We just call them calories, okay? Your body needs to work to get that energy, though. Your body has to break apart the food, grab the nutrient, send them around your body. [00:06:38.350] - Caitlin Johnson, RD It has to get the food into your mouth, and you have to chew. You have to then swallow. Your stomach has to kind of squish the contents around and mix it with gastric juices and then send it into your small intestine, where it gets broken apart and then passed over into the cells of your small intestine and then into your circulation. That takes a lot of work. It takes energy to do all of that. [00:07:01.660] - Caitlin Johnson, RD Even though you're getting energy from your food, it takes energy to break that apart. Have you ever heard the term that celeries have negative calories? They aren't negative calories. They actually have calories in them. It just takes your body more calories to break them apart than it does like what you're actually going to gain from the celery itself. [00:07:23.870] - Caitlin Johnson, RD Now, this is not me advocating that you should just eat only Celery because it'll take your body a lot of work to eat it and get the nutrients from it. And that, in and of itself, will put you into calorie deficit. Celery is great. Super great. Super tasty. [00:07:39.210] - Caitlin Johnson, RD I love it with peanut butter on it. It's no longer a negative-calorie snack. However, it just goes to show you this idea of the thermic effect of food. It costs money to do work. It costs calories to get the calories and the energy from your food and distribute it around your body. [00:07:59.530] - Caitlin Johnson, RD Now, physical activity, makes up 15% to 30% of your total energy expenditure in a day and your total energy needs in the day. So you walk to your car, you carry groceries in, you pick up a small child, you go for a run, you do some weightlifting. Physical activity doesn't just mean exercise, okay? This is the area that most people tend to focus on when they're trying to lose weight. It's either eat less or move more. [00:08:30.530] - Caitlin Johnson, RD I want to pose to you that we should actually also be focusing on your basal metabolic rate. So this is the third piece of the pie, and it takes up 60% to 70%, sometimes 75% of your total energy needs for survival. So since this is the biggest portion, one very smart question would be, how can I increase this? How can I make this spend cost more so that the calories that I'm eating, takes up a bigger portion of them? How can we increase your BMR? [00:09:05.210] - Caitlin Johnson, RD Now, one of these ways you'll have probably heard before, and one of these ways you actually may not have, one of the most efficient ways to increase your BMR is to increase how much muscle you have. Muscle requires a lot of energy okay? It takes in more calories than fat tissue does. So if we can increase your lean body mass, your muscle tissue, we can make your body require more calories to just maintain its own body composition and its own needs. Now, you actually have a really great advantage for improving or increasing your lean body mass. [00:09:45.480] - Caitlin Johnson, RD And that advantage is testosterone. Testosterone helps signal that you can create more body mass. It's partly why men have more muscles and gain more muscle more quickly and more easily than women do. They tend to have more androgens, well, this thing that becomes a major hurdle and symptom driver and frustration in PCOS, we can actually use it to our advantage in this one particular way and help signal that it's okay and safe too. While we're strength training and doing weight resistance type activity, we can increase our lean muscle mass and increase our BMR, increasing our total metabolism. [00:10:27.370] - Caitlin Johnson, RD The other great thing about strength training is that we're using that testosterone. And so that testosterone kind of gets flushed through our system more easily. So the more strength training exercise that we do, the lower antigens we actually have. And there's another mechanic to that in that as we increase our lean muscle tissue, we actually can become more insulin sensitive. And as that happens, our liver makes more of a protein called sex hormone-binding globulin, which can grab hold of androgens and kind of turn them off. [00:10:59.400] - Caitlin Johnson, RD So strength training and increasing lead muscle mass can actually improve androgen levels in multiple ways. The other way that we can increase your BMR is to eat more. Now, that's a shocker to you, I bet, because as you decrease your caloric intake, your body tries to become more efficient at doing its job. If you eat less, your metabolism slows down. Period, end of story. [00:11:27.210] - Caitlin Johnson, RD If you eat slightly more. Now, I'm not saying like, go eat an extra hamburger and milkshake at the drive-through, but if you eat 150 calories more every single day, not adding 100 to 150 calories more every single day. So today's 150. Tomorrow is 300. Now, if you just increase by 150 calories for the next month or so, you actually may not gain any weight, especially if you're doing some sort of regular physical activity. [00:11:57.180] - Caitlin Johnson, RD Your body will say, hey, there's more energy available. Let's just be a little bit more efficient with it. Now, there are people on Instagram that are, I see it every day, eating less. And a calorie deficit can't not work here. That double negative. [00:12:13.440] - Caitlin Johnson, RD It can't not work. It will always work. Calorie deficits will work until your metabolism meets your input. Okay? So you could cut 500 calories from your intake today. [00:12:25.790] - Caitlin Johnson, RD You could eat less, and that would work for weight loss for a period of time. But eventually, your body will adapt and become more efficient at the processes that it's trying to do. Because there's less energy available, it doesn't feel safe. So it's going to kind of down-regulate everything. One of the ways that it does this is through thyroid hormones and once this happens, it's really difficult to reverse. [00:12:51.180] - Caitlin Johnson, RD So dieting can actually have a really negative impact on your metabolism overall. So if we can instead focus on strength training and body composition changes in increasing your BMR without a major decrease in calorie intake, we can have long-term sustained weight loss or weight stability at a healthy weight for PCOS. One concern that I hear from women with PCOS is that strength training is going to make them really bulky. And this is a huge misconception in kind of the fitness and health industry at large. It takes a massive level of strength training exercise, very small amounts of carbohydrates, and just a lot of toning and zeroing in on physique training to obtain kind of that muscle mass like a woman bodybuilder. [00:13:51.530] - Caitlin Johnson, RD It takes so much protein intake as well. And I am a huge advocate of increasing your protein. I'm talking about hundreds and hundreds of grams more protein than I would ever recommend to someone with PCOS to build that type of muscle tissue regularly two to three times a week. Strength training with moderate amounts of weight that are still difficult for you are not going to turn you into this huge hulk type body physique. In fact, as your body uses the testosterone in the system and hormone levels change and improve, you will have over time lower levels of androgens and it's less likely for you to continue building that high level of muscle tissue. [00:14:37.010] - Caitlin Johnson, RD Many women bodybuilders with that kind of look that so many people are concerned about having, are actually doing things for their hormones to increase androgens to be able to obtain that type of physique. But I will say, I think in general, we should be really excited about adding strength as women mental strength, emotional strength, mental emotional flexibility, but particularly physical strength and metabolic strength. And that is really improved by increasing BMR and increasing your lean muscle tissue. So let's look at that as an advantage and something that's working in our favor rather than being something that we're really trying to avoid or are kind of staying away from strength training because we want to avoid that specific look. One of the most efficient ways for you to increase your BMR is to strength train and focus on large muscle groups. [00:15:40.580] - Caitlin Johnson, RD So think of the muscles from your shoulders to your knees, both on your front and backside. These are the largest muscle groups that you have and they require the most amount of energy or calories. That doesn't mean that you shouldn't do things like a bicep curl or focus on functional strength and movement, but lifting weights and using the big muscle systems that you have. So do squats with a little bit of weight resistance or just start even with your own body weight. This is a great way to increase muscle tissue in those larger muscle groups and become more metabolically strong, having a higher metabolism. [00:16:25.690] - Caitlin Johnson, RD I really believe that working with experts in the realm of physical fitness and strength training is not just imperative, it's essential, especially if you want to avoid injury. So if you can, and if your budget will allow, or you have a friend that might be an expert in one of these areas, having somebody help you with your form, spotting you in exercises, can be really helpful. So that you can have a length of journey and not jump straight into weightlifting and then really hurt your knee or your hip or your shoulder or something. So I spoke briefly about increasing your BMR. Also has something to do with something outside of exercise that food matters too, and over-restricting calories can have a negative effect on this. [00:17:18.220] - Caitlin Johnson, RD But I want to focus a little bit on protein. You cannot build tissue out of nothing and you cannot turn fat into muscle. That doesn't work. You lose fat, you gain muscle. They don't come from one to another. [00:17:31.010] - Caitlin Johnson, RD You can pull blood sugar from fat tissue. It's an incredibly inefficient process. And your body will try to improve your blood sugar levels using other things first, if it can. But your body, to create lean muscle tissue, needs to be eating adequate protein. And when I say adequate protein, if you're doing strength training, it's probably more than just like a palm size of protein three times a day. [00:17:55.450] - Caitlin Johnson, RD You're going to need to really be focusing on protein at snack times, maybe even including something like collagen or a protein shake into your day. And this can help with blood sugar balance too. But if you are doing a lot of strength training and undereating and under-eating protein specifically, you're not going to build muscle tissue. Your body is going to be incredibly stressed and it's going to start pulling from stores and nutrients that you don't want to mobilize. So increasing your protein intake, if you're starting to increase strength training, is incredibly important. [00:18:27.810] - Caitlin Johnson, RD And you will see as these things shift and your body composition changes, this will impact insulin resistance and it can lower androgen levels can also help you feel more satisfied after eating because adipose tissue, as you decrease it, your body is more receptive to leptin. And leptin is that hormone that tells you, I'm full, I'm satisfied, they don't need to eat anymore. And so many of us struggle with cravings that are related to high levels of insulin, blood sugar, irregularity and leptin levels, and a level of leptin resistance. And if we can improve our BMR, we actually see this kind of metabolic abnormalities that are not so great with PCOS improve. Now, there are lots of factors that affect your BMR that you can't change. [00:19:16.530] - Caitlin Johnson, RD You are female, you are the age that you are. We can't go back in time. We can't control your genetics. We can't even control whether you have PCOS, but we can use that to our advantage when we're talking about our BMR. So as people age, our androgen and our specifically our testosterone levels decline. [00:19:37.030] - Caitlin Johnson, RD Whether you're male or female, this happens. And as those levels decline, so does our lean muscle mass, which is our most metabolically active tissue. As people age, they also tend to become less active, and that also impacts our total metabolic burn. But when we're talking about our BMR, it's this lowering of androgens lowering of lean muscle mass that impacts our BMR. So if we want to go into our later years in our aging process, the most metabolically active, we'll be able to maintain a metabolism for a much longer period of time. [00:20:13.350] - Caitlin Johnson, RD Having a higher metabolism going through perimenopause into your menopause and postmenopausal years into aging can be incredibly helpful. Like, you want to start high if we're going to... /episode/index/show/a78406e1-e87e-4cc9-99d0-483ae84f9aeb/id/25587459

Ep 10: Keto, IF, Breakfast and Ovulation - Part 2 01/04/2023

Ep 10: Keto, IF, Breakfast and Ovulation - Part 2 Diving into two studies that discuss time of day and meal size and it's affect on metabolic outcomes and ovulation. We also discuss the take aways from intermittent fasting and keto style eating patterns. Caitlin Johnson () Welcome to the PCOS Answers Podcast with Caitlin Johnson, your functional medicine dietitian. This podcast is a private podcast only available through the PCOS app. It will provide practical sciencscience-basedebased answers to all of your PCOS questions, and every episode will leave you with something you can do today to help your PCOS. I'm so glad you're here. Welcome to another episode. Caitlin Johnson () We are here today to do part two of considering Keto, intermittent fasting, and breakfast and how that might affect ovulation. So in the last episode, in episode nine, we talked a little bit about why Keto and intermittent fasting are proposed in this PCOS population, their impact on insulin resistance, and a few things from each of those methods that are worth extracting and applying in our PCOS lives. But if you can remember one of the take home points. While keto and intermittent fasting have benefits in lowering insulin resistance, so increasing insulin sensitivity, lowering the amount of insulin that you make, which can then lower the amount of testosterone that you make, which can then improve your overall PCOS symptoms, potentially improving ovulation, potentially improving egg quality in all these different areas. Caitlin Johnson () Even though these diets can do this, one of the most compelling reasons to not jump into one of these diets is that you don't have to be that strict or extreme to enjoy the benefits of improving insulin resistance. So that's the take home message from the last episode that I want to jump start this episode with. So this question is kind of the next logical question to me. Does the time that you eat your meals affect ovulation? Does the time that you eat your meals affect insulin resistance? Caitlin Johnson () It's such a great question. So I'm glad you asked, or maybe I proposed it, but we're going to dig into it. Breakfast definitely impacts ovulation. So when you eat a good portion of your calories at the beginning of your day, it can actually help you ovulate. So when you eat a large portion of food towards the beginning of your day, even in the middle of your day, you still have many active hours where you're doing things. Caitlin Johnson () You're changing laundry, you're walking to your car from work, you're going into the grocery store, maybe you're hitting the gym where your body is active and moving and can utilize the energy that you're taking in. When we bulk a lot of our intake towards the end of the day, we don't have that same kind of metabolic activity that metabolic output for our body to soak in the sugar and use it. So if you eat a larger portion of your calories towards the front end of your day, it can actually help with insulin resistance. And we've seen in multiple studies that it can actually impact ovulation. So let's look at a couple specific studies and see how this eating structure in the day can impact insulin and ovulation. Caitlin Johnson () So in the first study that we're going to look at. It was a study done for twelve weeks with participants put into a breakfast group and participants put into a dinner group. The breakfast group ate their biggest meal at breakfast. Why? We called it the breakfast group. Caitlin Johnson () And that meal was almost 1000 calories, which I'm sure you're hearing this and you're going like, that's what somebody told me to eat in my entire day. Okay? They're eating a very large breakfast. Lunch was about 650 calories and dinner was about 200 calories. I'm rounding. Caitlin Johnson () It was 980 at breakfast, about 640 at lunch, and about 190 at dinner time. So a big breakfast, a moderate size lunch, a small dinner. Now the dinner group had exactly the opposite. They started their day with a small breakfast, about 190 calories. The same size lunch, about 640 calories. Caitlin Johnson () And then their largest meal of the day was dinner. 980 calories. So here's the interesting part, guys. The meal size matters. The breakfast group saw improvements in insulin resistance and they also saw improvements in testosterone levels, meaning testosterone levels went down. Caitlin Johnson () They also saw more improvement in ovulation. The breakfast had a decrease that was significant under the total area of a glucose curve. So when you think about that, we're just looking at kind of like a bell curve, that curve went down by about 7%. Not huge, but the total area under the insulin curve decreased by 54%. So 54% less insulin in a 24 hours period. Caitlin Johnson () Floating around your body, you can see how that would then trickle down to lower testosterone levels and improving ovulation. That's huge. It means that the insulin levels were really impacted by eating the largest meal of the day at breakfast. Caitlin Johnson () The breakfast group also saw lower levels of free testosterone. Now pay attention to this. This is really important. Free testosterone went down by 50%. Free testosterone is something that we want lower. Caitlin Johnson () This is the testosterone that isn't bound to another protein so it can bounce off cells and do its dirty work. Can go to your ovary, install ovulation. It can go to your chin and make your hair more coarse and beard like. It can go to the hair on the top of your head and tell it, hey, fall out. This is the testosterone we really want to decrease. Caitlin Johnson () The breakfast group. The people that just ate a bigger breakfast saw a decrease in free testosterone by 50%. That's a huge deal. The sex hormone binding globulin. This is the thing that goes around and grabs onto the free testosterone and other male hormones androgens, and turns it off. Caitlin Johnson () This increased by 105%. So if the number at the beginning of the study was in like the 30s, it went up above 61. That's huge. This is kind of like the helper, the Mrs. Pacman that floats around and starts eating up all the free testosterone. Caitlin Johnson () So meal timing and size of meal actually matters. Both groups saw ovulation rates increase in the second month of the trial. But the third month of the trial, the breakfast group had about 50% of their participants ovulating. That is crazy. The other thing that's interesting about this study, if you read it, is it wasn't like these meals were incredibly balanced. Caitlin Johnson () So if you were to just extract some helpful keys from this, if you're not used to eating a larger breakfast, starting to implement eating breakfast at all, or starting to increase your breakfast even just a little bit, and what if that breakfast was pretty well balanced? Imagine what we could see with your free testosterone, your ovulation. Now why does eating a larger breakfast and a smaller dinner impact insulin and ovulation? Again, I'm very glad that you asked this question. When you eat the largest meal of the day in the morning, you have that bodily activity to manage the increases in blood sugar. Caitlin Johnson () It's also something that has to do with our circadian rhythm and how our body kind of rests and recuperates overnight. Having more kind of empty your stomach during that time allows your body to do that work better. Your normal activity during the day is higher than the overnight period. So eating a bigger breakfast, a moderate sized lunch, and getting most of your fuel from those meals has an impact on your overall insulin output. Ending the day with a really large meal sends large pulses of insulin into your body right before you're about to lay down and snooze an insulin. Caitlin Johnson () Second job is to tell cells if there's extra energy stores fat. So not only are we impacting symptoms free testosterone, ovulation, having your largest meal of the day be dinner is something that can actually impact weight and hormone signaling. What can we glean from this? We don't need to eat 1000 calorie breakfast and only 200 calories at the end of the day. But could you eat your largest meal of the day at breakfast or lunch and make dinner the smallest meal of your day? Caitlin Johnson () This really flies at modern culture, at least in the United States, where the biggest meal of the day is typically at the end of the day. And a lot of us find ourselves starving ourselves either at breakfast or at lunchtime because we're too busy and we can't really stop to eat or we haven't planned and prepped or brought along what we really need. And then dinner is kind of normal and then we binge in the evening time and edd. So adjusting and shifting and creating safety in your day and allowing your body to have more fuel in the morning and early afternoon will allow your body to use that energy and be able to improve insulin and allow your body a better rest period overnight and likely improved sleep quality. Now that study that I told you about was done in a PCOS group of women that were of normal BMI. Caitlin Johnson () This is typically what people call lean PCOS. Personally, I hate this term, so we will describe it as those that had a normal BMI. What happens if we look at a group that has an overweight or obese level BMI, but still we're looking at a PCOS population? A very similar group of scientists took a very similar study design and said, okay, we want to be able to tell if eating a bigger breakfast and smaller dinner produces the same metabolic benefits in overweight or obese women with PCOS. Can it lower insulin? Caitlin Johnson () Can it lower fasting glucose? Can it lower Homa IR scores? Now, the one major difference in this study design is that they put obese and overweight women into a calorie deficit. So this was a calorie intake that should have yielded weight loss, but the groups essentially ate the same amount of calories. Okay, so both groups ate a total of 1400 calories daily. Caitlin Johnson () In the breakfast group, again, this is the group that eats the bigger breakfast. Breakfast was about 700 calories, lunch was about 500 and dinner was about 200. Then the dinner group that switched breakfast was the smallest meal of the day at 200 calories. Lunch was 500 calories and dinner 700 calories. In both groups, we saw weight loss. Caitlin Johnson () Okay, we restricted calories. That makes sense. We expect to see some level of weight loss. Although the fasting glucose, the insulin and a hunger hormone called grelin were also reduced in both fasting glucose insulin and Homa IR reduced, they went down to a greater degree in the breakfast group. So we saw metabolic improvement in fasting glucose insulin and taking those numbers and calculating the Homa IR index, we saw that the breakfast group saw more improvement. Caitlin Johnson () Improvement was seen with calorie restriction and weight loss. But there were other differences in the groups. The breakfast group's triglycerides went down by 33.6%, so the triglycerides went down by a third. In the dinner group, the triglycerides went up by 14.6%. So again, we see that timing of meals when you have your largest meal of the day impacts metabolic outcomes that you wouldn't necessarily expect to see. Caitlin Johnson () Why would eating just a little bit of a bigger dinner have higher levels of triglycerides? So their triglycerides actually went up, and having a larger breakfast and a smaller dinner, we saw triglycerides go down by almost 34%. So both groups completed an oral glucose tolerance test to test the insulin levels. After this twelve week study was over. And the group that ate the bigger breakfast had a greater decrease in glucose and insulin. Caitlin Johnson () The group also lowered the hunger hormone ghrelin and their hunger scores. They were more satisfied after their meals. So when we talk about improving insulin resistance and we're talking about trying to improve some of the behaviors that help us succeed at either weight loss or balancing our plate or not feeling really victim to our hunger cues, lowering grelin the hunger hormone, improving Satav and improving food cravings is actually really important. And we saw that to a much greater degree in the group that ate the larger breakfast. So eating a larger breakfast, whether you're in a calorie deficit or not, whether you need to lose weight or not, and decreasing your evening amount of calories, can improve insulin resistance. Caitlin Johnson () We also see in other studies, independent of calorie restriction, that breakfast eaters are more likely to ovulate. So when I think about these kind of fad diets, and I think particularly about intermittent fasting, most people that intermittent fast skip breakfast. Sometimes they kind of, quote unquote, break the rules. They have coffee, but they put MCT oil in it. There's no carbohydrate or really any protein. Caitlin Johnson () And so we're not necessarily spiking your blood sugar and creating an insulin response there. But having that much caffeine on an empty stomach can spike cortisol. So there are other hormones that are involved here. Cortisol is that stress, chronic stress hormone that your adrenals also make. As your adrenals make more cortisol, your body makes more of an androgen a hormone from your adrenals as well called Dhgas. Caitlin Johnson () And its entire job is to protect your brain from cortisol. So when you start your day without eating and then you add onto that burden of expecting a lot out of your body without a lot of fuel using caffeine, and we speed up your heart rate, we are not surprised to see higher levels of cortisol. I would expect that I am then not surprised when I see higher levels of DHEA-S, which also impact hair loss, acne, hearsitism anovulation egg quality, the list goes on. So the idea of completely skipping breakfast does not equate to quality health with PCOS. Do I think having a sufficient overnight fast can be incredibly helpful for your PCOS? Caitlin Johnson () Yes, absolutely. Do I also think you should eat breakfast? Yes, absolutely. Now, if you're not somebody that's used to eating breakfast right now, you're going to say to me I don't wake up hungry, then I'm going to say to you, then let's not start at breakfast tonight. I want your dinner to be half the portion that's normal and go to bed quickly. Caitlin Johnson () Tomorrow morning you'll wake up hungry, I promise. And if you do wake up and you still feel like I just can't think about eating, grab a handful of nuts, have a hard boiled egg and a piece of fruit, you can start small. You don't have to go from eating no breakfast to eating 1000 calorie breakfast tomorrow. That's not what I'm saying. I'm saying let's create a sufficient overnight fast, gain the benefits of an overnight fast and what that can do for our insulin resistance. Caitlin Johnson () See if over time we can stretch to a full twelve hour, maybe even 13 or 14 hours overnight fast, but still have a quality breakfast, and then have a quality sized lunch. And then dinner can be something a little bit smaller, a vegetable with some really nice lean protein next to it. A small portion of carbs would be very sufficient dinner. And if you train your body that it's used to eating more amounts in the morning, then it won't be shocked or surprised when dinner rolls around and you don't need as much to eat. So we can take and pull from different fad diets eating patterns, see what the science actually says and take the best of those things and leave the rest. Caitlin Johnson () Okay? We don't need to be strict. We don't need to be restrictive. We don't need to cut out entire, not even food groups. But macronutrients, you don't need to go completely carb free to manage your PCOS. Caitlin Johnson () Now the other kind of side effect to eating more earlier in the day is you're less likely to be grabbing for those snacky foods that just are I don't even want to say the bad word in my head that I'm thinking about. They're just a void of nutrients. Okay, I'm going to say it. They're kind of crap food. They're not really food. Caitlin Johnson () Do they give you calories? Yes. Do they give you nutrients? No. And I see this huge fear of people. Caitlin Johnson () I'm afraid to eat an orange because the carbs, we deprive ourselves of the way nature package carbohydrates with fiber and vitamins and all these other wonderful things that we need. And after that we get hungry for carbs. At the end of the day, we're stressed we didn't eat enough and then we dive headfirst into chips and salsa or spicy Doritos or cheetos or popcorn or whatever it is for you. So stop being afraid of carbs. Eat enough protein at meals. Caitlin Johnson () Extend your overnight fast. If you can eat a bigger breakfast and eat real food as much as you can, lots of different colors of fruits and vegetables, and I promise you, I promise you, you will see more balanced energy levels. You will feel more satisfied. It won't happen overnight, but it will happen as you start employing these different principles. So I hope this helps you, especially in this early season of 2023. Caitlin Johnson () And we're thinking about different decisions or resolutions or ways that we're going to impact our health in this new year. We have such a quote unquote, clean slate. Let's not go extreme. Let's pick one thing to implement this week. Is that going to bed 30 minutes earlier and not having a snack right before bed and waking up and eating a little bit bigger of a breakfast. Caitlin Johnson () What if you eat right now, two eggs, a piece of toast and some avocado on that toast? Well, maybe tomorrow you could eat two eggs and two egg whites with that same piece of toast and avocado. What if you're used to having a smoothie as you run out the door and tomorrow you make a smoothie and have two hard boiled eggs on the side? How can we slowly increase your breakfast so that you're not as hungry at the end of the day and you can extend your overnight fast and what will that do for you? So my ask of you today is to hop in the community section of this PCOS app and ask a question. Caitlin Johnson () What did this spark in your head? What questions do you have? What are you thinking about committing to in this next year? Let's discuss these things together and create discourse and support one another as we transition into a wonderful, wonderful new year together, where we're going to have so much support, so much education, so much joy, so much hope, and we're going to do it together. /episode/index/show/a78406e1-e87e-4cc9-99d0-483ae84f9aeb/id/25504023

Ep 9: Keto, Intermittent Fasting, Breakfast and Ovulation 01/02/2023

Ep 9: Keto, Intermittent Fasting, Breakfast and Ovulation Improving insulin resistance is a cornerstone of all effective treatments of PCOS, however, is it necessary to go extreme and restrictive to obtain these results? Let's see in this episode of PCOS Answers Podcast. Caitlin Johnson, RD () Welcome to the PCOS Answers Podcast with Caitlin Johnson, your functional medicine dietitian. This podcast is a private podcast only available through the PCOS app. It will provide practical science-based answers to all of your PCOS questions and every episode will leave you with something you can do today to help your PCOS. I'm so glad you're here. Welcome to another episode of the PCOS Answers Podcast. Caitlin Johnson, RD () Now, if you've been diagnosed with PCOS for any length of time, you've likely had a doctor tell you that you need to lose weight. And that suggestion usually comes with no helpful advice at all on how to do that or with incredibly unhelpful information that isn't evidence based or sustainable. I can't tell you how many different things I've heard women tell me that their doctor told them to do in order to lose weight with PCOS. Now, there's a good reason why this is something that doctors typically recommend both for helping with symptoms, helping with overall health, your longevity, and also with ovulation and fertility. It is true that evidence shows 5% to 10% body weight reduction. Caitlin Johnson, RD () So weight loss of 5% to 10% of your body weight can help you ovulate and it can actually help you conceive. Now, a lot of women with PCOS either ovulate, really infrequently or don't ovulate at all. So this is a really great goal just to get yourself ovulating naturally. Now, other doctors may kind of dangle something out in front of you like, hey, we can try IUI or IVF, but not until you obtain a certain amount of weight loss. So while this recommendation comes with some good science behind it, it doesn't typically come with really helpful advice. Caitlin Johnson, RD () And we are just left out in the wind, right, for the picking for any diet, culture or fitness expert to come in and say this is the only way that's ever going to be effective for you to lose weight and keep it off. So I am here to tell you, even though there's a lot of debate these days over the most effective way to treat PCOS with diet and lifestyle, that there are some things to consider with popular diets and there are some things to consider in terms of pulling the best from different ways of eating and making a sustainable plan for you. Truly, a simple search on the internet will give you as many ways to try and lose weight as the number of pounds we need to actually lose. Probably more, okay, probably more different diets and fads and exercise routines than the pounds we have to lose. But diet, culture and the landscape of fitness, we literally have too many options and we're making it too difficult on ourselves. Caitlin Johnson, RD () So while 5% to 10% weight loss is actually a great thing to pursue, it can be a really frustrating recommendation. I want to talk a little bit about is weight loss important for those of us that don't need to lose weight and does weight loss help with every different kind of key measure for hormone change? There was a study that was done in Saudi Arabia, this was published in August of 2020 and they basically looked at the ratios of LH to FSH. LH is luteinizing hormone. FSH is follicle stimulating hormone. Caitlin Johnson, RD () It's really normal for women with PCOS to have too high of LH numbers. This is the thing that pulses from your brain and basically tells your ovary, hey, it's time to Ovulate. Now, they were looking in obese versus nonobased women. Were there changes in this LH to FSH ratio? And what they saw was that weight was not something that impacted this high LH to FSH ratio. Caitlin Johnson, RD () It didn't matter if you were overweight or whether you were a normal weight. Weights didn't impact LH and FSH ratios. Since there are people that are abnormal weight and people who are overweight with PCOS, we can't see that weight loss is going to be a great solution for everyone because it won't impact this LH to FSH ratio. This particular hormonal abnormality is one of the reasons why it's more difficult for women with PCOS to Ovulate. Weight loss doesn't help every hormonal abnormality. Caitlin Johnson, RD () Now, weight loss does impact insulin resistance and improving insulin resistance can impact weight loss. So maybe this is a little bit of a better area to start looking at. One of insulin's main jobs is to shuttle blood sugar from the blood into the cell. So blood sugar becomes cell sugar or essentially energy for the cell to do its jobs. The problem with PCOS is we get so much of this message that there is energy available, take it in that we stop listening to that message, we stop recognizing that message and doing that job really efficiently. Caitlin Johnson, RD () So our body becomes insulin resistant, yet most of your tissues in your body will become insulin resistant. Your ovaries will not, okay? So they get more and more and more of this message. The energy is available. And part of what that does is it shifts what your ovary does with that blood sugar. Caitlin Johnson, RD () It changes the output from being estrogen, a hormone that actually helps with follicle development, to test testosterone, a hormone that basically stops follicle development. So chronically high levels of insulin can cause chronically high levels of testosterone instead of the estrogen that we need. So our follicles don't develop, and one doesn't get kind of tapped on the shoulder and thrown into the game as the egg for the cycle that's going to get ovulated. So there are some really popular strategies right now to impact insulin levels, and these are dietary strategies. Two of the most popular are the Ketogenic diet and intermittent fasting. Caitlin Johnson, RD () And I want to talk about both of these and consider, could these be effective ways to help ovulation? I always get asked about the ketogenic diet and intermittent fasting for PCOS, and for good reason. There is evidence that both of these dietary patterns can lower insulin resistance. Okay. They increase insulin sensitivity, meaning you don't make as much insulin less insulin, less testosterone, better ovulation. Caitlin Johnson, RD () Makes sense, right? So let's start with a ketogenic diet. Basically, this diet was created because we realized that blood circulation of ketones and using that instead of blood sugar could lower the incidence of seizures in children that had many, many epileptic seizures. Now it's becoming much more popular in adults that just want to lose weight to hop on the Ketogenic diet, it was not designed for adults that just want to lose weight, but there's nothing new under the sun. This diet has been reimagined a number of times. Caitlin Johnson, RD () I remember it most popularly in the 90s called the Atkins Diet, but now it's popular just under the name keto. It essentially promotes low carbohydrate consumption. And when I say low, I mean less than 30 grams per day. That's like less than one piece of fruit. In order to get enough energy, though, when you're eating that low carbohydrates, you have to increase your amount of fat and protein. Caitlin Johnson, RD () So this eating pattern essentially shifts your body into a metabolic burning state called ketosis. You're no longer using blood sugar as your main source of energy. You're using ketones. Ketosis is not an efficient way to get calories from your food. So this inefficiency is actually helpful for weight loss. Caitlin Johnson, RD () It takes more energy to get the energy from the food, and so you actually burn calories trying to get the energy from your food. That may sound a little funky, but it's actually really efficient. It means that you lose weight with this pattern of eating without really having to try too hard. But even in a state of ketosis, you have to eat less calories than you're burning, even with that metabolic inefficiency on your side for weight loss, you still have to eat in a calorie deficit. That's something hard to obtain when most people eat high amounts of things like bacon, and cream cheese on this diet. Caitlin Johnson, RD () So even though eating in a keto kind of style with lower carbohydrates and higher fat and protein can be really helpful for weight loss and for insulin reduction, it doesn't really pass the test, in my opinion, of being something that's sustainable. Okay? As soon as you eat a bagel or a cookie or a handful of chips, your body gets pulled out of ketosis. And that metabolic state takes days to enter, so it will take you days to get back into. All the while, you'll be eating tons of fat and high amounts of calories. Caitlin Johnson, RD () There's, like, no wiggle room in this diet, which is really frustrating. The other thing that is hard for me in terms of giving this diet a pass for women of reproductive age that are trying to ovulate and potentially because they're trying to ovulate, I'm assuming they may want to get pregnant. This diet is devoid of many, many nutrients that we really need for proper development, for antioxidant status, for lots of things for you and future baby. So with the lack of sustainability, the fact that most people that eat this diet tend to overeat calories, even though they're in a state of ketosis and don't really obtain that long term weight loss that they're trying to obtain and the fact that it's devoid of a lot of nutrients. It really is a hard sell, even though it does improve insulin resistance. Caitlin Johnson, RD () The other thing. Caitlin Johnson, RD () Thing is that most studies on this Keto Diet are either done in small children for epilepsy or are done in adult males. They're not done in women with PCOS women of reproductive age, and they aren't done typically looking at long-term intake of this diet. And news flash, if you can't be on a diet for the rest of your life, whatever benefits you're going to obtain from that diet, you're not going to have forever. The benefits are going to go away as soon as you stop eating that way. So let's talk a little bit about intermittent fasting. Caitlin Johnson, RD () If you've been alive in the past five years, which if you're listening to this, I know you have been, you've heard of intermittent fasting. It's just a fancy way of saying time-restricted eating. This is not new. And frankly, if you are live and listening to this, you've done it before. Do you stop eating between dinner and breakfast? Caitlin Johnson, RD () Most nights. Yeah, me too. That's an overnight fast. That's a time restricted eating. Intermittent fasting crowd takes us to an entirely new level with way more restriction over those eating hours and increasing those fasting hours. Caitlin Johnson, RD () But essentially that's intermittent fasting. Most people that intermittent fast do one of two things. They do something called a 16 eight, where they only eat in an eight hour window of the day and fast for 16 hours, or they choose to fast for a full 24 hours period, usually one to two days per week. Now, among those two different categories I just gave you, there's wiggle room. Maybe that eight hour fasting window is from noon to 08:00 p.m.. Caitlin Johnson, RD () Maybe it's from 10:00 A.m. To 06:00 p.m.. Maybe you are more extreme and you only for like 6 hours, and you fast for more like 18 hours. So there's variations. However, the point of intermittent fasting like the Ketogenic Diet is really to lower insulin levels. Caitlin Johnson, RD () And for most people, for weight loss. When you eat in less hours of the day, or you eat for less hours of a total week, your body has less time that it's making insulin. You don't make as much insulin when you're not eating insulin's. Job is to shuttle that food from your blood into your cell. If you're not eating, there's not as much blood energy, blood sugar available to get into the cell. Caitlin Johnson, RD () It can be efficient at insulin sensitivity, like increasing the amount of insulin sensitivity, lowering insulin resistance. But it isn't sustainable for most people that live real lives, that have jobs or families or somebody trying to conceive. Okay? Because we're trying to create safety for your body, a routine for your body. Your body having a way to say what happened yesterday is likely to happen tomorrow, and so it's safe for me to ovulate. Caitlin Johnson, RD () Eating in an intermittent fasting way may not create that safety that you're looking for with your body. I guess this is a double edged sword. I love and hate about this diet is that intermittent fasting doesn't limit food choices. As long as you eat within this eating window, any food is really fair game. Well, when you're trying to ovulate and have quality eggs and grow a baby, what you eat matters. Caitlin Johnson, RD () It really, really matters. So intermittent fasting doesn't get a pass in my mind. For somebody that's trying to ovulate and get pregnant and stay pregnant. Now, there is evidence in the literature that intermittent fasting can improve insulin sensitivity. This makes sense. Caitlin Johnson, RD () If you eat in a smaller window of time, your body makes less insulin over time, and over that large amount of time, less insulin means less testosterone, which means you might ovulate. The theory is there, and the science is kind of there. However, once again, we don't have studies in women with PCOS or even a lot of studies in women at all, and less of women in reproductive age. And you guessed it, not a single study on women with PCOS trying to get pregnant. So I want to tell you a little bit about things that I've seen from clients who have tried to intermittent fast or have done keto in the past. Caitlin Johnson, RD () Most of those women come to me in a very stressed out state in their body. Their levels of androgens that come from their adrenal glands, which is kind of your stress organ, are off the charts. It also is something that has really triggered past eating disorders, both in ways of restriction and binging. Even though you eat less carbs or you eat less total amount of time, or you burn fuel in a less efficient manner and potentially maybe lose weight. The other most compelling argument against doing a full on intermittent fast or going keto is that they really aren't necessary to improve insulin resistance. Caitlin Johnson, RD () You can do it so many other ways and they really aren't necessary to restore ovulation. I've seen in hundreds, thousands of women that just implement, really obtainable sustainable, delicious eating patterns and windows of time of eating that are really natural, be able to sustain and obtain ovulation without going so extreme, increasing quality fats and oils. I am here for that. Okay? There is some merit to not eating your last bites of food right before you lay down for insulin resistance improvement and really good digestion and rest for your gut overnight. Caitlin Johnson, RD () If you're somebody that stays up late and has a snack at 930 or 10:00 P.m. And eats breakfast at seven or 08:00 A.m., you're not even getting like a normal twelve-hour fast overnight. So something that you can do over the next month or so is giving yourself an extra hour every week. So let's go with a real-life example. Let's say you have your last snack right now at 09:30 P.m. Caitlin Johnson, RD () And you eat breakfast at 730. What if over the next week, we moved your last snack to 09:00 P.m. And breakfast to 08:00 A.m.? We just gained an extra hour of overnight fast without moving things really drastically. And then the next week, your last bite comes in by 830 and breakfast is at 08:30 a.m. Caitlin Johnson, RD () Hey. Now we have a twelve hour fast overnight and you can move that anywhere between a twelve-hour and a 14 hours fast overnight and enjoy some of the benefits of intermittent fasting without super strict hour requirements. Now, what if you have a night that you're up super late for whatever reason? Can you get hungry before bed? No big deal. Caitlin Johnson, RD () Eat when you're hungry. Okay, I'm not trying to advocate that you skip hunger signals. I'm just trying to say, hey mama, we can over time over the next three to four weeks, extend your fast overnight without being super restrictive and give your body some of the benefits of increased insulin sensitivity. Now that being said, this is not something to go crazy over. The other great thing about that is we're not even really changing what you're eating. Caitlin Johnson, RD () We're just saying, hey, extend your overnight fast. Now that's going to be really hard to do if staying up super late and you eat dinner early. So let's say you go to bed right now at midnight, but dinner is at seven. It's going to be hard to last those 5 hours without eating again. This is your full suggestion and begging from your functionally trained dietitian that we need to work on your circadian rhythm too, for you to be able to have an overnight fast that's long enough because you can't stay up super late and just expect yourself not to want to snack before bed. Caitlin Johnson, RD () Other added benefit of extending your overnight eating window is that if you're not eating between the hours of like eight and midnight, you're less likely to grab spicy Doritos, cheetos cereal, ice cream, whatever. That late night snack. I'm super hungry. I just want to munch on something. Craving thing is for you. Caitlin Johnson, RD () You're likely to eat less of it. So okay, I want to tell you a little bit more about this and I want to dive into two studies about breakfast in its effect on ovulation meal timing. Its effect on ovulation. But you're going to get that in part two of this podcast. So stay tuned for episode ten where we dig into breakfast innovation. /episode/index/show/a78406e1-e87e-4cc9-99d0-483ae84f9aeb/id/25482480

Ep 8: 5 Why's in Starting the New Year 12/30/2022

Ep 7: PCOS and Inflammation 12/21/2022

Ep 7: PCOS and Inflammation PCOS Overview PCOS is a hormonal and metabolic syndrome causing symptoms like fertility problems, insulin resistance, fatigue and so much more. There is research showing that women with PCOS have higher levels of inflammation than those without PCOS. Inflammation and PCOS: Inflammation is your body’s natural response to fighting off pathogens or foreign substances in the body, and is helpful when dealing with illness. It’s also normal - we need inflammatory processes to work to protect our health. However, a chronic state of inflammation has been shown to , such as a decreased immune response, cardiovascular disease, and even decreased fertility1. How Would I Know If I Have Inflammation: HS-CRP Homocysteine IL-6 Symptoms of inflammation can be very prominent. When you get a cut, your body sends extra white blood cells to the area, so you may see something like puss. It’s also common to see redness, heat, and swelling. When we are talking about chronic low grade inflammation it can sometimes be harder to know which symptoms correlate with this type of inflammation because they can cross over with many other conditions. You may experience: Headaches Joint pain Joint stiffness Sore muscles Weakened immune system (catching every illness) Swelling Gastrointestinal problems Fatigue Resistant weight loss It wouldn’t be hard for most of us to check off a few of those items with PCOS and hormone issues. So How Can We Decrease Inflammation?: Like many other areas of PCOS hormones and symptoms, inflammation is something that is impacted by every meal we make and other environmental factors. This can feel overwhelming, but I’d recommend you look at it as an opportunity to make huge strides towards health at every meal. Blood sugar management Increase anti-inflammatory foods in your diet to help manage your PCOS. Avoid foods that promote inflammation: Inflammatory oils (canola and other industrial seed oils) Harsh chemicals (pesticides and other food production chemicals) Artificial food dyes Highly processed foods Foods that you may have a specific reaction to like: food allergies or sensitivities Spices that fight inflammation Spices are a great affordable and accessible way to boost the anti-inflammatory benefits of food. That’s not the only benefit, they also taste great too! Smelling these spices while cooking helps your body create digestive enzymes allowing you to better digest your food! Some of the most potent and healing spices are: Ginger Cinnamon Turmeric (combined with black pepper for full benefits) Garlic Other Ways to Fight Inflammation: Increasing antioxidants in supplement form Address auto-immune triggers (for example foods like gluten if diagnosed with celiac or hashimoto’s disease) Work with a doctor if you are struggling and consider steroids. Your doctor can suggest the best and most personalized option for you. In Summary Women with PCOS struggle with inflammation more often than those without PCOS. Inflammation can sneak into our lives in the food we eat, the products we use, or the stressors we deal with. There are options for decreasing inflammation that can greatly decrease negative symptoms that often trouble women with PCOS. Perhaps one of the most important foundations is blood sugar balance, something we see repeatedly as a benefit for those of us with PCOS. You can also increase your fruit and vegetable intake, and incorporate some anti-inflammatory spices. You can also request the blood markers of inflammation at your annual visits to monitor inflammation levels. Take away: eat a meal with two different colors fruit/veggies and a size of protein at least as big as your fist. Source: . . /episode/index/show/a78406e1-e87e-4cc9-99d0-483ae84f9aeb/id/25392036

Ep 6: Hey, I'm Caitlin and I have PCOS 12/07/2022

Ep 5: Celebrations and Holidays While Still Managing PCOS 11/18/2022

Ep 4: Blood Sugar Friendly PCOS Recipes 11/15/2022

Ep 3: How PCOS is Diagnosed? 11/14/2022

Ep 2: What is PCOS? 11/12/2022

Ep: 1 The PCOS App and PCOS Answers Podcast 11/09/2022

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