If you’re eating healthy, doing everything right, don’t resonate with insulin resistance… but are still experiencing PCOS symptoms, you may be experiencing Inflammatory-Type PCOS. The key with this type of PCOS is that there are other symptoms besides the PCOS symptoms going on. These symptoms are often rooted in the gut and liver, and may show up as pain, headaches, or on the skin. Over time, chronic inflammation can be a factor in the development of many types of dysfunction and disease in the body. Fortunately, with some relatively simple dietary and lifestyle interventions, inflammation can be kept in check. 

What is Inflammation?

Inflammation is a natural immune process that occurs in the body in response to a trigger. Common triggers are infection, injury or anything that the body identifies as a foreign invader. The body activates an immune response by increasing blood flow to the affected area so that white blood cells can attack foreign invaders in an attempt to protect the body. This type of acute inflammation is a normal and desirable process that’s essential to your health. However, inflammation can be problematic when it’s low grade and long-term (“chronic inflammation”). 

With chronic inflammation, your body is constantly on alert for foreign invaders. Chronic inflammation is linked to nearly all types of disease and dysfunction, including PCOS. If you suffer from inflammatory-type PCOS, it’s vital that you address the causes of inflammation. This isn’t just for inflammatory-type PCOS though. By addressing the root causes of inflammation, you’ll reduce all types of PCOS symptoms and you’ll improve your long-term health overall.  

Root Causes of Inflammation:

Toxic Load

Everyday we’re exposed to hundreds of chemicals in our food, water, air, clothing, textiles, technological devices, medication, industrial emissions, and so much more. A significant number of these chemicals have a harmful impact on our health — in particular our hormonal health. We can’t avoid these toxins 100% but we can try our best to reduce our exposure as much as possible.

The cumulative effect of these chemicals on our bodies is known as our toxic load. Your body’s ability to handle your toxic load depends on the type and frequency of toxins you’re exposed to, plus your body’s additional stressors, your resilience to those stressors and your genetic blueprint. In other words, some people are more susceptible than others to the harmful effects of their toxic load. Fortunately, everyone can take simple steps to reduce their toxic load and manage their stress. 

When trying to reduce your toxic load, it’s important to consider the toxins in your immediate daily environment. There are many chemicals used in food and  household and personal care products that wreak havoc on the endocrine system by mimicking or disrupting natural hormones, including estrogen and androgens — both of which play a role in PCOS. Endocrine mimicking and disrupting toxins compete with receptors for natural hormones, which can lead to altered hormone signals. They can also affect how the liver metabolizes and excretes hormones from the body. This can lead to a build-up of hormones, which can result in various hormonal symptoms.  

Here are some of the best ways to reduce your toxic load through common daily exposures: 

• Try to eat organic as much as possible, especially animal products. You would also do well to reduce or avoid dairy, as it contains not only toxins such as pesticides and antibiotics, but it also contains some of the animal’s own hormones, which further contributes to hormone imbalances in your body. If going 100% organic isn’t feasible, consider prioritizing the “Clean 15” and avoiding the “Dirty Dozen”.

• You can further reduce your exposure to food-related toxins by avoiding certain types of food packing, storage and cookware made from plastics and other known toxins. While many foods — even natural whole foods — are sold in plastic, try to store cooked and prepared foods in safer materials such as glass or stainless steel. Never heat food in plastic containers and don’t put hot food in plastic containers, as heat promotes the leaching of toxins into food. When it comes to cookware, avoid non-stick coatings and opt instead for glass, stainless steel and cast iron. 

• Drink filtered water and avoid water from plastic bottles. Although municipally treated tap water filters out certain pathogens that are harmful to our health, a number of other harmful chemicals are added in, including chlorine, chloramine and fluoride. These can cause adverse health effects. You can filter these chemicals using a water filtration system. There are a range of systems available at different price points. You might want to also consider filtering your shower or bath water, as this is a double whammy of toxic exposure. Your entire body is exposed to the toxins upon physical contact with the water and you also inhale chlorine and chloramine in vapour form, which is increased when the water is hot.  

• Just as you should be mindful of what you put in your body, what you put on it matters too. The skin is highly absorbent and it’s also the body’s largest organ of detoxification and elimination. The toxins found in conventional personal care and beauty products include phthalates, petroleum-based oils, synthetic fragrances, sulphates, and more all add to your toxic load and increase inflammation. Many of these toxins are specifically implicated in hormone dysregulation too. The great news is there’s never been more options on the market for clean beauty and personal care products. Have fun exploring the many new brands that are clean and non-toxic so that you and your home can still look great without the unnecessary toxins. As you know, my personal favourite is Beautycounter.

It might seem like a daunting task to avoid all of the many sources of environmental toxins, but don’t worry! You have to be realistic and accept that total avoidance is impossible. Just do your best and know that every little bit helps. The more you can educate yourself about environmental toxins and clean alternatives, the better position you’ll be in to make informed choices to support your health. An excellent resource for learning more is the Environmental Working Group. 

Dietary Factors

Certain foods and supplements promote a healthy gut microbiome and reduce inflammation, while others have the opposite effect. While there is no ideal way to eat, the Mediterranean diet is well-regarded as health-promoting and anti-inflammatory. This diet includes: 

• Lots of fresh vegetables and fruit

• Moderate amounts of poultry and fish and small amounts of red meat

• Legumes, nuts and seeds

• Minimal amounts of dairy, mostly in the form of cultured and fermented products like yogurt and feta

• Olive oil as the primary source of added fat

What’s noticeably lacking in the Mediterranean diet — which is one reason why it’s a beneficial approach to eating — are certain foods that are high in omega-6 fatty acids, such as vegetable oils rich in polyunsaturated fatty acids (including corn, sunflower and soy), conventionally raised grain-fed beef (beef that is not grass-fed), and processed foods. The body needs some amount of omega-6 fatty acids, but the ratio of omega-6 relative to omega-3 fatty acids is important. The modern Western diet typically includes too much omega-6 and not enough omega-3. Increasing the omega-3 to omega-6 ratio will help reduce inflammation. You can do this by following a Mediterranean diet and adding a fish oil supplement.   

Another dietary factor to pay attention to is your iron intake. There is a correlation between PCOS and iron overload. Ferritin (the storage form of iron) is increased in PCOS, especially if you have abnormal glucose tolerance. You might also experience menstrual dysfunction with PCOS, which could contribute to increased iron absorption. Get a blood test of a full iron panel, which includes ferritin and other iron markers to understand your true iron status, and avoid taking iron in supplement form if your levels are high. In cases where iron is low but ferritin is high, consider other sources of inflammation.

Vitamin D Deficiency

Vitamin D levels are often lower in people with PCOS. Depending on where you are located, synthesizing vitamin D from the sun may be difficult year-round. While I recommend sunlight exposure in moderation for a variety of reasons, gaining enough sun exposure can be difficult for those of us in the northern hemisphere, and especially if you are protecting yourself with sunscreen. Ideally all of my clients will obtain bloodwork to test their vitamin D status. This way, we can recommend an appropriate dose to bring levels up to optimal levels. Supplementation often becomes necessary in order to avoid vitamin D deficiency which has been shown to contribute to insulin resistance, fertility issues, and autoimmune conditions.

Gut Inflammation

If you’ve been following me for a while, you may know my story about how my gut issues really triggered my PCOS symptoms and hormonal imbalance. You can read more about it here. Your gastrointestinal (GI) system is the hub for nutrient absorption and assimilation, meaning that without good gut function, nutrients cannot get properly absorbed. There are a variety of GI issues that may implicate PCOS. In fact, this study found that those with PCOS had higher incidences of a bacteria known as H. pylori—a bacteria that disrupts stomach acid pH and impacts nutrient absorption as a result. That being said, working with a skilled practitioner who can understand what is causing your root cause PCOS symptoms, whether that is inflammation or other PCOS subtypes, is so critical to your hormonal healing.

One of the best ways we can reduce inflammation in the gut is through the “4R approach” to gut healing. The 4Rs are: reduce, replace, remove, and repair. Here are the steps:

Step 1) Remove

The first step is to remove exposure to whatever is causing your inflammatory symptoms. This includes:

• Known allergens, such as soy, corn or dairy. These can cause gut distress that manifest as gas, bloating, abdominal discomfort and even skin rashes. The best way to know if you have food allergies or pathogens that may be contributing to your gut symptoms is to get a proper workup by a holistic health professional. When in doubt, testing is the only way to accurately assess your situation. 

• Inflammatory foods such as refined sugar, gluten, processed vegetable oils with high levels of polyunsaturated fatty acids (e.g., vegetable, canola and soybean just to name a few), coffee, alcohol, food additives (e.g., caragenan). These can irritate the gut lining. 

• Pathogens such as harmful bacteria, yeast (e.g., candida overgrowth), parasites and fungi. These can disrupt a healthy gut microbiome and cause systemic inflammation and infection. A holistic practitioner can help determine if you are affected by pathogens by running appropriate tests and ruling out other causes. They can also advise you on the best healing protocol, if needed. 

• Environmental toxins. As discussed above, many of the chemicals you’re exposed to through common household and personal care products can wreak havoc on the endocrine system by mimicking or disrupting natural hormones, which can result in various hormonal symptoms. Try to incorporate the tips above for reducing your exposure to these chemicals.  

• Stress. This is a common culprit in poor digestion and overall poor health. See above for some super simple tips to manage your stress. Try these whenever you start to feel overwhelmed in the moment.

Step 2) Replace

The next step is to replace nutrients as well as stomach acid and digestive enzymes to help promote the breakdown and absorption of nutrients. Try to include a wide variety of whole foods, especially those with anti-inflammatory properties, such as: turmeric, garlic, mushrooms, omega-3s from fatty fish.

You can also add in gut-supportive supplements including: digestive enzymes, HCl and bile acids, or bitters.

Step 3) Reinoculate

The third step is to reinocolute the gut with “friendly” bacteria to ensure that you have a diverse and healthy gut microbiome. Having a diverse and healthy microbiome is important because we need different types of bacteria to perform many functions in the body, such as breaking down food, assimilating nutrients, making nutrients, and sending signals to communicate with other parts of the body, particularly the brain. 

Studies also show that women with PCOS have less diverse gut microbiomes than women without PCOS. This may be related to an excess of testosterone, a key factor in PCOS that happens to be correlated with reduced diversity in the gut microbiome. It may also be related to obesity, which is a common symptom in PCOS that happens to be correlated with reduced diversity in the gut microbiome. Probiotic supplements, especially the bacterial strains Bifidobacterium and Lactobacillus, are very helpful to cultivating a diverse and healthy gut microbiome. That being said, a diet rich in diverse plant matter is perhaps the most important component to a diverse microbiome. You can also add fermented foods to your diet. Sauerkraut, kimchi, tempeh and miso are a natural source of probiotics that can help diversify your gut microbiome. 

Lastly, Step 4) Repair

⁠The last step is to repair the gut. This can be done by adding in nutrients through food, supplements and herbs, and by engaging in practices that help the gut heal. In addition to healing foods, supplements and herbs, there are self-care practices that will further promote gut healing. One example is allowing the gut to take a break from the demands of digestion and detoxification. Ideally the digestive tract should get a 12 hour break each night so that it can start fresh again the next day. When you eat all day long and into the evening, you’re never allowing your body to slow down and repair itself. This puts stress on the body. 

When the digestive system is forced to work overnight, it disrupts your circadian rhythm, which plays a central role in regulating hormones and the immune system. When hormones and the immune system are dysregulated, it can lead to systemic inflammation and an exacerbation of PCOS symptoms. 

You can give your digestive system the regular rest and repair it needs by eating your last meal at approximately 7:00 pm or at least 3 hours before bedtime. This will also help you get a good night’s sleep so that you feel rejuvenated in the morning.  

Conclusion 

There is overlap between inflammatory-type PCOS and other types, and it's possible that you may have elements of more than one PCOS type, which is why a comprehensive look at your diet, lifestyle, symptom picture and lab work is integral to developing a holistic approach to healing, and targeting a root cause approach that is right for you. ⁠⠀