nutrition coaching pcos

Stress & PCOS

What are adrenal glands?

Adrenals are the little organs above your kidneys that effect hormonal imbalance. The adrenal glands are controlled by the hypothalamus, which also controls the ovaries and thyroid.

How does stress effect PCOS?

High levels of stress over a long period of time makes our adrenal glands send signals to the hypothalamus, telling it to turn off ovulation. Extreme stress will translate in our bodies as "not a good time to bring a baby into the world."

Part of the adrenal gland produces DHEA-S, which is similar to testosterone. It causes facial hair and acne as well. DHEA-S is the best measure of adrenal stimulation.

What are possible stressors?

1. overexercising- you may be hanging on to high intensity exercise because you feel like your weight is spiraling out of control, however you need to let go of that to heal adrenal fatigue.

2. gut infection- even if you're totally calm laying on the beach, you may have dysfunction in your gut microbiome

3. not enough play- do something for enjoyment like going out for a walk or a hike for the pleasure of meeting new people

4. lack of social support- this could be living away from family or not having a good friend group

5. too little sleep

6. psychological stress (work/money/family)

7. disrupted wake and sleep cycle- the blue light in our devices can cause this when we use them late at night. our body mistakes it as sunlight and pushes back our circadian rhythm


The most comprehensive way to test adrenal hormones is by taking a DUTCH Comprehensive test. Speak with a Registered Dietitian, who can provide this test for you and interpret your results.


For more information on understanding how adrenal fatigue triggers symptoms, take a look here:


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PCOS Biomarkers


When managing PCOS, there are multiple symptoms that may occur, because there are multiple causes for having PCOS. Some symptoms include facial hair, hair loss, acne, mood swings, or weight gain. It is important to take an individual approach. There is no one cause or cure.

You may need a completely different treatment plan than another woman. Consider speaking with a registered dietitian for direction on how to treat your symptoms.

The following chart includes biomarkers for the different types of PCOS along with their functional ranges. These ranges are different than the reference ranges you may find when you get your blood drawn. PCOS can often go misdiagnosed due to the misinterpretation of references ranges. Take a look at the following golden rules for PCOS lab work:

Types of PCOS

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3 Day PCOS Meal Plan (gluten-free, dairy-free)

Trader Joe's is here to make eating gluten-free and dairy-free as simple and easy as possible.

We don't always have time for meal prepping, but that is never an excuse to not put your health first, especially if you have PCOS. With their wide selection of frozen foods and pre-packaged salads, you can grab your lunch and a couple of snacks to take with you on-the-go. 

To make your life a bit easier, here is a 3 day gluten-free and dairy-free meal plan for the girls out there who want to eat right for PCOS!

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Is the Ketogenic Diet right for your PCOS?

First, it is important for me to explain as a Registered Dietitian, that there is not one PCOS, therefore there is not one best diet to treat it.

Since PCOS is a syndrome, we may have several side effects such as high androgens, missing periods, cysts on our ovaries, which all have different underlying root causes. One of the main causes, though, can be insulin resistance...but it can also be stress, so it is important to figure out what is impacting you the most before considering the Ketogenic diet.

50% of women with PCOS have high stress hormones, DHEA-S levels. For these women, a low carb diet would put more stress on their adrenal glands and potentially result in worsening symptoms. But for some women with PCOS – especially those with insulin resistance and obesity – a ketogenic diet can work really well.

A few weeks ago, I saw a patient who booked a consultation to discuss her struggle with weight and fatigue due to PCOS. She explained that she cut back on calories and started Metformin, but still is unable to lose the weight.

“But I’m following all the low GI recommended for PCOS, so how can it not work?”

As we reviewed her blood test results, I showed her the tests that were indicating that she had severe insulin resistance.  I explained that this meant that her hormone insulin, like a key, could not fit into the lock on our cells to open it up and let the glucose in, so her body was effectively not able to use any of the carbohydrates she was eating (even if they were ‘slow release’ low GI carbs). 

So if a low glycemic index diet doesn’t work for someone who’s severely insulin resistant, what does?

A Ketogenic diet.

A keto diet is a very low carbohydrate diet.  The keto diet changes the “fuel” that our body uses for energy. Severely restricting sugars (carbohydrates) from our diet forces your body to run off the fuel provided by our stored body fat. 

My client's body wasn’t able to use the carbohydrates she was eating as her insulin ‘key’ couldn’t open up the ‘lock’ on the cell, so instead she was storing those carbs as fat and getting more tired in the process!

So by turning her body into fat burning mode means that she could now use some of her own fat for energy and as she was eating very little carbohydrate, she wasn’t storing any more fat. 

But this doesn’t mean that a keto diet is right for all women with PCOS, or even all women with PCOS insulin resistance. And I also didn’t recommend that my client should do this long term- only until  she’d reversed her insulin resistance.

If you do try the keto diet then I recommend cycling in and out of it. This might mean that you stay on a keto diet for 3-6 months, then add some starchy carbs back in for 1 month to feed your gut bacteria.

What to do after Being Diagnosed with PCOS

Polycystic Ovarian Syndrome is a common hormonal imbalance that affects 1 in 10 women in the United States. Although the syndrome is widespread, women’s symptoms seem to vary. Side effects can be expressed as anything from mood swings to hair loss, cystic acne, weight gain, irregular periods, and facial hair.

One of the most common triggers of PCOS is insulin resistance, which has detrimental inflammatory effects on the body if it is not addressed early on.

Insulin resistance is when your cells are not able to take up insulin-bound glucose. As a result, the body struggles to burn off glucose, ultimately leading to weight gain and, potentially, type 2 diabetes. When insulin and glucose are left floating around in the bloodstream, they can wreak havoc and cause inflammation. The ovaries become stimulated to produce more of the androgen hormone (sex hormone), leading to adrenal dysfunction. This cascade effect that insulin triggers on your hormones can lead to facial hair and cystic acne. Once adrenal dysfunction is triggered, cortisol levels become too high and end up overriding your body’s sex hormones. This contributes to mood swings, irregular periods and infertility.

After being diagnosed with PCOS, don’t delay on getting started with a treatment plan. The longer you allow symptoms to continue, the longer it may take to reverse and the more new symptoms will appear. Consider speaking with a Registered Dietitian who specializes in Women’s Health to guide you on your journey toward reversing PCOS.

The following are a list of steps you can take to regain control over your body and eventually get your symptoms to become dormant.

1. Intermittent Fasting

When cells have been continually exposed to high levels of glucose, they become insulin resistant. The insulin is left floating around the bloodstream, contributing to low-grade chronic inflammation.

Consider intermittent fasting to reboot your cells and improve their glucose uptake.

Intermittent fasting can be done many different ways, but it is best to start with eating every couple hours, within a 9 hour period of time. This means you are having breakfast at 9:00am and eating your last meal at 6:00pm, being sure to fit in all your calories within that window at a pace that keeps your blood sugar balanced. In order to improve glucose uptake, studies suggest allowing your cells to take a break, or “fast,” from constantly being exposed to glucose.


2. Don’t Go Hungry

It is not unusual for women who have PCOS to feel as though it is impossible to lose weight. Cutting back on calories and going on extreme appetite suppressants are an easy go-to for quick results, however this can exacerbate your symptoms of PCOS and lead to gaining even more weight. Eating for PCOS requires nourishing your cells with highly anti-inflammatory foods every couple hours to regain hormonal balance and heal the chronic inflammation. Consider keeping a food journal and documenting your level of hunger and fullness, before and after

eating meals and snacks. You want to find yourself in the middle of the range, feeling satisfied and not restricted. That way, you can be sure to eat enough and ultimately keep your blood sugar balanced throughout the day. Consider speaking with a Registered Dietitian who specializes in women’s health and can provide personalized meal plans as well as step-by-step instruction on how to incorporate a PCOS friendly diet into your life.


3. Choose Anti-Inflammatory Foods

PCOS is an autoimmune disease, which means that your body is in a chronic state of inflammation and “attacking” itself. Studies suggest that “leaky gut syndrome” is directly correlated to autoimmune diseases and your body’s inflammatory response to food. In short, this means that the tight junctions in the lining of your stomach become weak from constantly being exposed to inflammatory foods, allowing the food to be released into your bloodstream through the semipermeable gut wall. Many studies suggest that glucose and dairy sensitivities contribute to leaky gut syndrome and cause chronic inflammation, disrupting the endocrine system and ultimately leading to hormonal imbalance. Consider taking a Food Sensitivity Test to uncover which grains, fruits, vegetables, chemicals and dyes are disrupting your body’s balance and leading to leaky gut syndrome.


4. Set Up a Self Care Routine

With all of the change you may be experience after becoming diagnosed with PCOS, it can get a little overwhelming. Anxiety and stress are not uncommon components of hormonal imbalance. Unfortunately, they can contribute to insulin sensitivity as well. Stress causes your body to release cortisol, which raises your blood sugar and secretes more insulin. This constantly bombards your cells and leads to insulin resistance, yet again. Consider setting up a self-care routine for yourself and incorporate relaxing activities throughout the day. This can be going on a morning walk, sitting fireside with some tea, going out in the sun for 30 minutes, cooking healthy meals, having dinner with the family, meditation and practicing gratitude.

5. Light Exercise

The best type of exercise for PCOS is something that does not cause stress to your body and increase your cortisol levels. This can be jogging, yoga, pilates, and moderate weight training. These exercises will increase your body’s sensitivity to insulin, which will have a positive cascade effect on inflammation and hormonal balance. Moving for 30 minutes or more a day can also help with weight management, mood swings and improving your menstrual cycle.

6. Eat More Fat

Studies suggest that a high-fat, low-carb diet may be beneficial in reducing insulin sensitivity in women with PCOS. Eating more healthy fats, such as avocado, coconut oil, salmon, chia seeds,

and walnuts will help you stay satisfied and maintain a balanced blood sugar throughout the day. If you choose to cut out carbs, be sure to transition slowly and stay in tune with your body to prevent a sudden drop in blood sugar. If you are considering a ketogenic diet, speak with a Registered Dietitian who can guide you in choosing ingredients that will enhance the quality of your diet and lead you to healthy, long-lasting results with reversing PCOS.

The 5 Types of PCOS

PCOS, it’s not easy... especially in the beginning when you don’t know what is causing it and you’re bombarded by terrifying information on google. Trust me, I’ve been there!

I had appointments with every doctor’s office, from the gynecologist who just prescribe birth control and told me I was infertile to the holistic doctor who overloaded me with expensive supplements. Neither doctor had any idea what the root of the cause was and whenever I begged for answers, they would say that research is inconclusive, there is no cure, it’s either birth control or testing a bunch of expensive supplements out until you hopefully figure out the solution.

It took a lot of trial and error to find the right doctor, and to think I was studying nutrition, telling everyone I wanted to be a dietitian at the same time as struggling with weight, mood swings and acne!

Luckily, I didn’t give up and one day in grad school, while I gave a presentation on PCOS, someone came out and said that she was insulin resistant and an acupuncturist was able to bring her period back. Thanks to somehow fearless standing in front of the class telling everyone I have PCOS... I found my solution. I took control of my insulin resistance and my inflammation through acupuncture and a gluten free diet and have been having regular periods ever since! I recently got an ultrasound just to be sure I don’t have an ovarian cyst that I’m unaware of, and they told me my ovaries look MUCH improved.

PCOS can be caused by many factors and to make it become dormant, you will need to treat the root of the cause. Remember, you can have several causes at once since they are all correlated. For example, insulin resistance can be exacerbated by stress hormones which can be triggered by chronic inflammation. Here are the most common causes that can be tested and addressed with a Registered Dietitian, acupuncturist or endocrinologist.

1. Insulin Resistance

This is the most common cause of PCOS. If you are one of the 70% of women with insulin resistance-related PCOS, your doctor may have prescribed you metformin. My route to healing insulin resistance was acupuncture by Erica Docimo as well as significantly reducing carbohydrates from my diet.

Insulin helps our cells store glucose. When glucose is left in the bloodstream, it causes damage to the cells in our brain, liver, pancreas, eyes etc and leaves us susceptible to type 2 diabetes. In order to prevent that, insulin tries to store glucose in our cells if they are not insulin resistant. When cells have been bombarded by glucose too much, low grade inflammation occurs and the cells start to get resistant. High insulin ends up stimulating the ovaries to produce more androgens, resulting in two contributing causes of PCOS: insulin resistance and adrenal dysfunction.

When our bodies have too much glucose in the blood, it can be toxic and the glucose will store as fat. This is why it is so easy to put on weight with insulin resistance and very hard to lost it. Everything you eat, whether it is a healthy balanced diet or junk food, can stick to your body.

The best test is the oral glucose tolerance test, which is when glucose is given and blood samples are taken to measure how quickly the glucose was cleared out of the blood. If this is not possible at your healthcare facility, your doctor will likely ask for a fasting blood glucose test and HbA1c, which are not as accurate. It is important to know that test results that are still in the “normal” range may be deceiving. Medical normal range does not signify optimal blood glucose range, which is what I refer to when looking at my patient’s lab results.

2. Post Birth Control

For some women, it is easy to get regulated after getting off the pill, but for others it is difficult. The pill disrupts the communication between your brain and ovaries and sometimes it’s difficult for our bodies to bounce back after getting off the pill. You want to get two hormones to function properly and those are Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). If the ratio of LH to FSH becomes greater than 3:1, ovulation will not be able to occur. Unfortunately, your body’s ability to bounce back could take some time and patience as well as the help of an endocrinologist.

3. Adrenal Dysfunction and Stress

When taking a blood test, DHEA-S, cortisol or cortisone will be especially good indicators. If they are high, then stressors affecting adrenal dysfunction is likely the cause of PCOS. Adrenal dysfunction can be triggered by many factors, some of them being controllable. I see patients who work long hours, with stressful deadlines on top of over-exercising daily to try to keep their weight off. These patients are only to see discouraging results because it’s causing adrenal fatigue and exacerbating the PCOS. As mentioned previously in number 1, adrenal dysfunction stems from having too much insulin left in the blood stream, so it is important to address insulin resistance at the same time.

I could definitely fit myself into the “exacerbated” category while I was in college and you may be able to too. I realized I had to make a change. That was when I started to practice mindful meditation, yoga and read The Power of Now by Eckhart Tolle every night.

4. Chronic Inflammation

Inflammation starts with the gut and can be triggered by the mediator response to certain foods. One possible test for inflammation in the body is C-reactive protein (CRP). Inflammation has shown to increase androgens and prevent you from ovulating. If you find yourself getting sick all the time or having sore joints, IBS and skin problems, these could be indicators. One way to reduce diet induced inflammation is to take a food sensitivity test and change your diet with the help of a Registered Dietitian.

Even if you have a genetic predisposition to PCOS, the right environmental conditions must be present for those genes to show. The good news is that we can do our best to figure out what those triggers are and once we remove those triggers, PCOS can be reversed. Don’t waste another minute jumping between diets, supplements and medications. Try to find your causes and treat those specifically.