While the etiology of HA and PCOS are very different, the two conditions can present very similarly in the clinical setting. In this episode, Sam and I unpack the similarities and differences between HA and PCOS and share some foundational nutrition and lifestyle habits that are beneficial for healthy hormones and fertility if you’re unsure which condition you have. 

Sam Abbott, MSEd, RD, LDN, is a registered dietitian nutritionist who helps those with PCOS ditch diets and balance hormones without feeling guilty or stressed about food. She is the owner of PCOS Nutrition Company, where she helps clients  improve hormone regulation without a side of diet culture or weight stigma. In her Nourished with PCOS Program Collective, her non-diet nutrition membership, she empowers people with PCOS to find peace and balance with nutrition, hormones, body and life. You can find Sam on Instagram at @pcos.nutritionist or on her podcast, the Nourished with PCOS Podcast, where she gives free tips and support around managing PCOS without dieting.

In this episode:

• Why weight shouldn’t be the focus when it comes to balancing your hormones
• Looking holistically at each individual to accurately diagnose PCOS
• Why nutrition recommendations for PCOS and HA don’t have to conflict 
• Understanding the different “types” of PCOS
• Is adrenal PCOS just HA? What does the research say
• Why comparison is the worst metric for whether or not you’re eating enough 

Transcript:

Sam Abbott  00:00

Healthcare as a whole is very weight centric. I’m sure you receive the same type of training, weight centric training, where it’s kind of like the outcome that we’re looking for is for somebody to lose weight as a means to improve their health. Weight is an outcome. It’s not a behavior. Weight is also something that can be largely outside of our control. People with PCOS are told to restrict carbohydrates because of insulin resistance. They were told to lose weight because PCOS is a metabolic condition. 

Sam Abbott  00:32

But I think as nutrition practitioners, we should really be focusing on what do we see as being effective and what’s really helping our clients. Let’s look at behaviors and what we know can help PCOS, hormone dysregulations. And I think something really important for people to know is PCOS symptoms as a whole. So many things can be improved independent of weight. 

Lindsey Lusson  00:57

Welcome to the Period Recovery and Fertility Podcast. Here, we discuss the challenging, rewarding and life changing process of recovering your period and finding freedom with food and exercise. Whether you’re hoping to regain your cycle to get your health back on track or you’re ready to become a mama, this podcast is for you. While the recovery process isn’t always rainbows and butterflies, it’s my hope to bring you both information and inspiration during your own recovery journey. I’m your host, registered dietitian and fellow HA woman, Lindsey Lusson. 

Lindsey Lusson  01:28

Sam Abbott, MSEd, RD, LDN, is a registered dietitian nutritionist who helps those with PCOS ditch diets and balance hormones without feeling guilty or stressed about food. She is the owner of PCOS Nutrition Company. Where she helps clients  improve hormone regulation without a side of diet culture or weight stigma. In her Nourished with PCOS Program Collective, her non-diet nutrition membership, she empowers people with PCOS to find peace and balance with nutrition, hormones, body and life. You can find Sam on Instagram at @pcos.nutritionist or on her podcast, the Nourished with PCOS Podcast, where she gives free tips and support around managing PCOS without dieting.

Lindsey Lusson  02:03

Welcome back to another episode of the Period Recovery and Fertility Podcast. I have a colleague on today to talk to us about all things hormone, all of these confusing things between HA and PCOS. So today we have a PCOS expert. Welcome Sam. 

Sam Abbott  02:17

Thank you for having me. I’m excited to be here. 

Lindsey Lusson  02:20

I’m excited to chat with you. I feel like you have a unique perspective on PCOS and managing PCOS. And I think we’re very aligned in our nutrition philosophy. So I think that this is going to be a little treat for listeners. 

Sam Abbott  02:31

Awesome. Well, I can’t wait to dive in. 

Sam Abbott  02:33

Well, tell us a little bit more about you. I think that when we talk about being  a PCOS dietitian, or a fertility dietitian or an HA dietitian, right? So many times people are like, Oh, that’s so cool. That’s what you went to school for. And I know for me, personally, I had very little training in women’s health and hormones and fertility. I’m curious if you feel like your undergrad and graduate work led you to what you’re doing today. Or if there was other things. How did we kind of stumble into this niche? 

Sam Abbott  03:01

That’s a great question. Because I feel like a lot of people don’t know the background of becoming a dietitian. But we don’t receive any sort of… I don’t want to say any sort of disease specific or condition specific education in our internship. But our internship is pretty broad in terms of our rotation. So I definitely don’t even think I had heard of PCOS when I was in school. I worked in school nutrition, and then I went back to school and did my dietetic internship. Then I worked in clinical for five or six years before I started my private practice. 

Sam Abbott  03:35

But yeah, I stumbled into PCOS because when I had a brick and mortar private practice in Charlotte, North Carolina. This was before the pandemic. I really wasn’t specializing in anything, I just saw a broad type of client base. I accepted insurance. So really, whoever came in through physician referral or insurance, it’s who I would see. And I just kept seeing client after client after client who had PCOS. I wasn’t very familiar with the specifics of PCOS. I knew in general that it had to do with insulin resistance and obviously the nutrition recommendations for that. But when I started seeing clients that in this specific population, I was like, Okay, I need to know everything that I can about PCOS. 

Sam Abbott  04:29

And ironically, PCOS runs in my family, and so I had heard of it. But even I feel like that goes to show how little information there is about it. Because even with family members having PCOS and me being a dietitian, I still wasn’t very familiar with it. So, yeah, I did not get any sort of reproductive health/PCOS/anything really related to women’s health type education in my internship at all. It’s everything that I learned after I realized this was an area that really interests me.

Lindsey Lusson  05:03

This is also funny to me, because I’ve only known you in private practice. And I’ve only known you or in virtual private practice, rather, and as a PCOS expert. So it’s funny to just hear a little bit of the behind the scenes, and you used to see all the things. You kind of had to do probably a lot of additional training, education, reading, client experience. I mean, that’s definitely kind of how I got where I am today.

Sam Abbott  05:28

Yeah, yeah. When I were I worked in the hospital as an inpatient clinical dietitian, and I really enjoyed things like tube feeding and IV nutrition and things like that. But a lot of what we did was education consults. And I loved the education side of things. But when somebody was in patient in the hospital, it’s not, I feel like even really an appropriate time to be providing nutrition education. And so I think that’s what really drew me to working in an outpatient setting where I could really sit with a client for an hour and get to know them. And really understand their obstacles. 

Sam Abbott  06:09

Initially, when I was trying to learn more about PCOS, I was reading all the books I could find. A nd I was taking smaller trainings. But when I realized how passionate I was about PCOS, I got more involved with PCOS advocacy. I joined several organizations that really focus on PCOS and androgen excess. So I was able to hear kind of what’s the newer research that’s coming out that hasn’t really been published yet. Or, the PCOS guidelines were updated last year, I was able to sit on a panel that reviewed them and gave feedback. So I feel like it’s a whole new side of education and learning for me, and I really love it.

Lindsey Lusson  06:55

That’s so cool. I wish that there were more HA is, I guess, just a little bit more niche, and the research is a little bit more newer. But if I can be a little optimistic here we were both kind of commiserating over, well, we didn’t really hear much about PCOS when we were in college. And I’m pretty sure I’m older than you. But maybe that’s also because I was in college 2005 through 2009.I finished my master’s in 2012. I feel like people were just now discovering what PCOS was, and how common it actually is.

Sam Abbott  07:30

I think a lot of that has to do with the rise of social media, to be completely honest. Because I feel like, of course, there’s the not so great side of social media with the misinformation. But there’s also a lot of opportunity for people to connect with each other and connect with healthcare professionals. And to receive education that they might not be receiving from their doctor. Or that they might not have access to just because of lack of resources. So I definitely attribute social media to be part of that.

Lindsey Lusson  08:04

Yeah, I’d say the exact same thing about HA. So speaking of social media, and nformation on the internet, I think, on the one hand, it’s 2024 we have more access to health related information than we ever have in the history of anything so cool, right? At the same time, there’s a lot of information, and not all of it is the most accurate. And not all of it is the most practical or effective, when you’re actually talking about you do more boots on the ground. Like actually working with people on their PCOS, versus being like, Oh, this is what you should do. And so you write a really good, unique perspective. 

Lindsey Lusson  08:39

In fact, I think it’s a little bit different than if I were to get on Google right now and say, How do I manage my PCOS? I think kind of top three things that would come up would be to exercise, to limit refined carbohydrates, not eat carbohydrates, and to manage your weight to lose weight. That isn’t exactly the take that you have towards managing PCOS. So tell us a little bit more about why that is. Why you think that those recommendations may not be the best for everyone? And what you kind of learned in your practice and working with women with PCOS?

Sam Abbott  09:10

Well, I think healthcare as a whole is very weight centric. And a lot of healthcare professionals. I’m sure you receive the same type of training, weight centric training, where it’s  the outcome that we’re looking for is for somebody to lose weight as a means to improve their health. So I am a weight neutral or weight inclusive dietitian. Meaning that I don’t focus on weight or weight loss with my clients. And that has really been a progression. But it it started when I had my brick and mortar practice, and I just kind of realized how ineffective it was to really focus on weight and weight loss. 

Sam Abbott  09:50

I mean, weight is an outcome. It’s not a behavior. And weight is also something that can be largely outside of our control. I mean when we look at the research we have around dieting. Almost everyone who diets will probably regain all of the weight that they lose when they’re dieting. 1/3 to 2/3of dieters will regain even more weight. And people with PCOS are told to restrict carbohydrates because of insulin resistance, and then they were told to lose weight. Because PCOS is a metabolic condition. So there’s kind of this thought process that if you’re losing weight, then you’re having less inflammation, less insulin resistance, and theoretically your symptoms should be getting better. 

Sam Abbott  10:37

But I think as nutrition practitioners, we should really be focusing on what do we see as being effective, and what’s really helping our clients? And what I was seeing in practice is that people were just going through these cycles of trying to lose weight and then regaining weight. And then their loss are getting worse, where they want to get pregnant and they’re not getting a period, and the thing that they’re focusing on is weight loss. It’s not really helping them. And so I help my clients take a step back and say, Okay, let’s look at behaviors and what we know can help PCOS, hormone dysregulation. 

Sam Abbott  11:16

So from a behavior standpoint what can we do to help insulin resistance. What can we do to decrease inflammation? What can we do to identify and treat any nutrient deficiencies that could be leading to symptoms like fatigue? And I think something really important for people to know is that with PCOS symptoms as a whole, so many things can be improved independent of weight. I have clients all the time who see a decrease in their blood sugar. And they may not necessarily see any weight loss. Or they’re having sleep issues or extreme fatigue or irregular periods. And these things can be improved independent of weight. 

Sam Abbott  11:57

So when I’m working with my clients, I’m really helping them identify what health means to them. What’s a holistic overview of health? What are your specific PCOS symptoms? And can we just track those, or follow those? And see if we can connect the dots with some nutrition changes or body movement changes?

Lindsey Lusson  12:21

I love that. It’s funny whenever we talk about using evidence based practices in healthcare. I mean, if you look at the statistics on diets or intentional weight loss program, I feel like diet has almost become a bad word now. And people are like, Oh, it’s not a diet. It’s like, okay… You’re restricting calories and telling people they can’t eat certain types of foods at certain times of day, that’s a diet. 

Lindsey Lusson  12:44

But it doesn’t work. And to your point weight is a symptom, potentially of a problem or maybe weight isn’t really… This is kind of where I go with a lot of my clients from an HA perspective, is like, I don’t really think your weights the problem, right? Like, with HA a lot of times the recommendation from doctors is, so we’ll just gain weight. Women are getting and they’re not actually seeing their symptoms improve, they’re not teaching any of their unhealthy behaviors with food and exercise. And they’re not getting their periods back, and they’re not getting pregnant. So kind of same, but different. Like, weight isn’t actually the problem in either of these scenarios.

Sam Abbott  13:21

Yeah, I really encourage clients to take a step back from viewing weight as part of the overall big picture. And definitely not in a way that we’re dismissing any experiences somebody has had in life because of their weight. Because I do work with a lot of clients in larger bodies who’ve experienced weights. So I definitely want to validate that we’re not dismissing that. But taking a step back, bodies come in all shapes and sizes. They always have and they always will. So I don’t think it’s a very helpful approach to focus on PCOS, as you know, a quote, unquote weight condition. Which a lot of do. And you could be really managing your PCOS very well and feeling great, and not really see weight loss.

Lindsey Lusson  14:14

Well. And I think that one of the places that I see a lot of my clients get stuck when they’re trying to decide, do I have ha or PCOS,  Is they almost feel like, I don’t want to work on HA recovery. Because I don’t want to make my PCOS work.Almost like they’re like these polar opposite. And here we want to say they’re not the same thing. But people almost think about them as polar opposite conditions and having to do polar opposite things to manage and improve those two conditions. 

Lindsey Lusson  14:42

So maybe we just start with what are the major differences between the two? Or leaning more on PCOS, how does someone know they have PCOS? What is the diagnostic criteria? What do you notice as obvious PCOS, signs and symptoms and the clients that you’ve worked with? Let’s start there. 

Sam Abbott  14:59

Well, the diagnostic criteria for PCOS, you have to meet one of these three. The first is having a regular or missing periods. Second is having polycystic ovaries that could be either on an ultrasound or… we were chatting before we were recording. They recently updated the guidelines to include elevated AMH levels. Either the ultrasound or the elevated AMH levels. And then the third piece would be elevated androgens. 

Sam Abbott  15:29

So an elevated androgens, like testosterone, that can be diagnosed either with labs or just by symptoms. Sometimes androgens are difficult to test. So a lot of times physicians will just go by physical symptoms, like hirsutism, is the biggest one. Having facial hair here on your chest or your stomach. Cystic acne along the jaw line is another symptom. Or cystic acne in general, is the symptom. A lot of times it’s seen along the jaw line. Androgenic alopecia, or that hair thinning and balding, especially along the front of your hairline. 

Sam Abbott  16:07

So those are the three pieces of criteria you only need to meet two. And PCOS is a diagnosis of exclusion. So other causes of missing periods, and other conditions that could be causing these symptoms, like Cushing’s disease, can cause a lot of overlapping symptoms related to elevated androgens. So those are supposed to be ruled out first. That’s kind of how PCOS is diagnosed. And then I think with looking at, does somebody have HA or PCOS and they have the missing period piece of things. I would want to look at couple of different things. I would want to see do they have the elevated androgen piece of things? Hirsutism is one of the big symptoms that we look at with elevated androgens. So that would be one thing. 

Sam Abbott  17:03

And then also the metabolic piece of things. Because when we talk about metabolic health, we see an increase in insulin resistance, which can lead to pre diabetes or type two diabetes. It’s common to see elevated triglycerides or blood pressure, or labs related to liver health. Fatty Liver is more common with PCOS. Sleep apnea is more common with PCOS. Elevated cholesterol levels. So I’m looking for the androgen piece and the metabolic piece. And sometimes, honestly, Lindsey, there might not be, like a physical or lab marker. It might just be, based on our clinical evaluation or based on some trial and error. 

Sam Abbott  17:53

I totally agree with you. I understand where this thought process is coming from, of like, oh, well, I do one thing to treat HA and I do the polar opposite to treat PCOS. But we actually have research that shows that people with PCOS are not eating more than people without PCOS. So I never recommend restriction for my PCOS clients. Even when they do have elevated blood sugar or cholesterol or fatty liver or anything like that. We want to make sure still that like you’re eating enough and you’re eating regularly and you’re you’re taking care of yourself. And you’re not putting too much stress on your body. And those are all overlapping.

Lindsey Lusson  18:42

You’re the first person I’ve talked to that’s ever brought up bringing in the metabolic labs for supportive… I don’t want to say diagnostic, right, because it is out of our scope of practices dietitians to actually diagnose somebody. But kind of giving clues on what’s going on with this individual, and how can I help them? I’ve never heard anybody bring those in, and that makes a lot of sense. There’s a couple that I think would be great distinguishments between the two different conditions. With HA, I never see elevated triglycerides. I rarely see insulin resistance, I do sometimes see elevated cholesterol. 

Lindsey Lusson  19:16

Somebody’s hormone levels are so tanked out that there’s just extra cholesterol in the bloodstream. Because it’s not being utilized for hormone formation. But that’s an easy distinguishment. If somebody’s estrogen is like five and their cholesterol is like 220, we could put it together. But  I kind of just love what you just said in that helping somebody. We really have to look at things a little bit more holistically than what’s your AMH, what are your physical symptoms. When was your last period? Like, we kind of have to look at a to look at a lot of different things.

Sam Abbott  19:44

Yeah, definitely. And even with the insulin resistance piece of things, a lot of times with PCOS, somebody starts out with more mild insulin resistance. So their blood sugar and their a 1c is normal. They just updated the PCOS guidelines to recommend an oral glucose tolerance test in place of an A1C or fasting glucose, If those are normal. But even still, somebody could have insulin resistance, but if they are in a place of always under eating or just always avoiding carbohydrates. Their labs may still seem low or normal. So I do think it is getting a big bird’s eye view of everything that’s going on and how that person is feeling. And what are they eating, what are their lifestyle habits like? 

Lindsey Lusson  20:41

Yeah and I know we brought up insulin resistance and blood sugar balance. I think we have a similar approach. I know people are like, well, I don’t want to eat more carbs because I don’t want to make my insulin resistance worse. And a lot of times, whenever we’re helping somebody recover their period with HA, like, blood sugar balance is actually a really important part of it. It’s making sure that enough and making sure that you’re not just eating carbohydrates. But that we’ve got that good, proper pairing with protein and fat. And really just balancing things out. 

Lindsey Lusson  21:06

So I think sometimes, whenever people think, I think this is really common to it’s easier to think of black and white than to think about the grain, to think about things objectively. But also, too, like, in my clients in particular, they’re kind of in this hyper, stressed, out, chronically undernourished state. And so everything is black and white. There is no gray. It’s either I’m exercising for 20 hours a week or I’m not exercising at all. It’s I’m eating bare minimum calories, or I’m binging, right? Like, there isn’t a whole lot of middle in between. So it makes sense that people tend to go there when they think like, oh, well, I can’t do this if I have this. And then they kind of get paralyzed and just keep doing what they’re doing and don’t really take action on on any of it.

Sam Abbott  21:48

Yeah, that black and white thinking can definitely be really paralyzing. And the way I like to explain to my clients is, yes, of completely avoiding carbohydrates may decrease your blood sugar in that moment. But what we’re after is something that’s realistic and sustainable and that’s going to help you feel your best, physically, mentally and emotionally long term. And so instead of being scared to eat carbohydrates, how can we help your body use those carbohydrates in the most efficient way possible? And like you said adding in protein and fat and fiber. That is actually really important for PCOS. And that is important for nutrient absorption, and omega three fatty acids are beneficial for some of the hormone dysregulations we see with PCOS. So having that balance is important.

Lindsey Lusson  22:48

Yeah, talk to us if you can about how under eating and under nourishing might make somebody’s PCOS worse, or would it make someone’s PCOS better?

Sam Abbott  22:57

Yeah, I think it’s really individualized. First of all, we see an increased risk of disordered eating with PCOS, especially binge eating. So anytime somebody is under eating, that’s a very big concern for me. Because with binge eating a lot of people think it’s like a lack of discipline or a lack of willpower. But it’s really your body’s not getting what it needs, and it’s trying to meet that unmet need.

Under eating also and putting stress on your body can be inflammatory, and so that’s another thing that we’re concerned about. And I do see clients and I know we’re probably going to talk about this, but they do just start eating more, and they get their period back. And they do also have PCOS. But then there’s a question of like, okay, well, did you lose your period because of your PCOS and elevated androgens? Or did you lose your period more because you just weren’t right?

Lindsey Lusson  24:01

Yeah, and that’s a really good question. I know sometimes I have clients that have this kind of mixed picture of HA and PCOS. And I always tell people, well at the end of the day you do have to be nourishing, and you can’t be over stressing your body with too much exercise. It’s a kind of a fine line. So at the end of the day, there are some non negotiables of just ways that you should be treating your body for hormonehealth and fertility. 

Lindsey Lusson  24:23

Do you see people with PCOS? Because I feel like it’s common in the non… I’m not in the major PCOS circles, but I feel like, from an outsider’s perspective, a lot of times people are like, Oh, you just don’t get your period with PCOS. Do you feel like amenorrhea, like not having a period for, like, years and years and years is pretty common with PCOS. Could that be a clinical manifestation of just uncontrolled insulin resistance or some of the other things that go along with it?

Sam Abbott  24:50

Oh, 100%. Yeah, that can be a major piece of PCOS. I would say, if somebody is getting regular medical care, and their physician is asking them about their cycles a lot of times. That’s where birth control is prescribed. So people may not realize like that that could be a piece of it. But yeah, I’ve definitely had clients in that situation and we have to provide.

I know it’s a little different with HA, but with PCOS, if you are not getting a regular cycle and you’re not on birth control or anything, that’s kind of taking over your reproductive system. That can lead to endometrial hyperplasia and an increase of endometrial cancer, and there’s a little bit of an increased risk of breast cancer with PCOS. So that’s actually, I know people are very frustrated by the advice of, like, we’ll just take birth control. But like, that’s one of the main reasons that birth control is prescribed for PCOS.  

Lindsey Lusson  25:59

Yeah. And what’s interesting with HA is that that’s really not the bigger concern that we have. Like, we don’t have as big of a concern for endometrial hyperplasia, increased risk of endometrial cancer. Because women with HA are not building up a uterine lining. So our bigger…

Sam Abbott  26:20

It’s like the opposite. 

Lindsey Lusson  26:22

So our bigger cause for concern when somebody comes in, and this is why getting the right diagnosis is important. The bigger cause for concern is your bones. So we see a lot of osteopenia, a lot of osteoporosis in women who have missing periods with HA. Because there’s just no estrogen. And so old school thinking was, well, let’s put everyone on the pill. This is fine and dandy. Well, now we have several… I’m talking, dozens of research studies that show that birth control actually doesn’t help prevent osteopenia and osteoporosis in women that aren’t cycling with HA.  I personally think that there’s a nutritional component going on too. Because we know that vitamins and minerals and adequate nutrients are also literally the building blocks for bone. 

Lindsey Lusson  27:04

But now the push is to put everybody on hormone replacement therapy. And I think that hormone replacement therapy can have a time and a place. But again, it can definitely turn into kind of like that band aid solution. But that’s so interesting that the advice that people are given from their doctor, if they’ve got the wrong diagnosis, to go on the pill, or to take Provera or progesterone, we need to show that lining. We need to show that lining. And then you’ve got women with HA that aren’t even responding because they don’t have a lining. 

Sam Abbott  27:30

When we were talking about differentiating between the two, this could be another thing to bring up with your doctor, especially if you’re getting an ultrasound already. Or just bringing that up in conversation of I understand what PCOS. Sometimes, if I haven’t been getting my period, I can havea thickened endometrial lining. But I know with HA it might be thin, what do you think? Or what does mine look like? That could be a point of conversation.

Lindsey Lusson  28:01

And I don’t know if you look at labs with your clients often or not. Like cycle day three labs. But usually too, when I look at labs with my clients who aren’t cycling, or even people who are more, like a mild case of HA, they’re kind of stuck in that like your labs are normal. But you’re not actually ovulating. We’re still usually seeing pretty low estrogen. I usually see estrogen below 50 in, I’d say 90% of the clients that I work with HA.

Sam Abbott  28:25

I think it’s really important to look at lab ranges. rather than just whether or not they’re normal. Because that can give you a barometer for things too, 

Lindsey Lusson  28:35

Yeah, for sure. Because technically, if somebody had an estrogen of 49. I’ve even had labs time years ago when I wasn’t cycling and my estrogen was like five and it would still be in the green range. But then if you looked like on the sidebar, it would be like for postmenopausal women. So won’t always be flagged necessarily correctly.

Sam Abbott  28:58

What happens a lot with PCOS when you’re not having a regular cycle, it’s like your body is kind of in a place where it’s trying to ovulate and it can’t. Because of the elevated androgen piece of things. So if anything, estrogen may not necessarily be elevated, but it’s kind of acting like it’s elevated because there’s an imbalance of estrogen to progesterone.

Lindsey Lusson  29:27

Yeah, so is somebody with PCOS, Do they always have is like the for the most part, is the driver of it androgen excess? Or are there other types of PCOS, or other things that might be applied?

Sam Abbott  29:42

Androgen excess is kind of seen to be the core of PCOS. But when we look at the diagnostic criteria, elevated androgens is just one piece of it. So technically, there is a phenotype of PCOS where you don’t show or have symptoms or show any androgen excess. I think that’s a really interesting area to be studied. I know that’s like a big topic of conversation in the PCOS space, and there’s a question of, like, is that truly PCOS? As of right now, it is. But yeah.

Lindsey Lusson  30:20

Yeah, because I feel like on social media, there’s a lot of buzz around what type of PCOS you have. And I’ve seen up to four different types. I was just curious if there’s any clinical validity to that, or where you see any of this going in the next five to 10 years. 

Sam Abbott  30:37

Yeah. So there are four different phenotypes of PCOS based off of which diagnostic criteria you meet. Those aren’t really used in practice much when we’re looking at treatment from a nutrition standpoint. Or when your doctor is looking at treatment from a medical standpoint. They’re just looking at what symptoms do you have that need to be managed to help you feel better. I believe what you’re referring to is the inflammatory type, the adrenal type, the insulin resistant type. That’s not something that’s kind of medically recognized. 

Sam Abbott  31:15

Is actually kind of funny, because not too long ago, it was either a PCOS symposium or an NIH meeting about PCOS. But there was an endocrinologist who was presenting on some updated PCOS research and she did a Q and A. That was one of the questions we asked her was, what do you think about these types? She had never even heard of it. She was like, that’s not even a thing. I think where this comes from, and this is where I think I understand why people look for information online. But I am trying to figure out the best way to wear this, because this is something that’s recognized. And like all naturopathic space.

Lindsey Lusson  31:57

That’s where I come across it where it seems to carry the most clout. 

Sam Abbott  32:02

So just to explain it a little bit more, most people with PCOS have higher levels of inflammation. It’s not like a specific subset. And then most people with PCOS have insulin resistance, and we see in research that people who don’t are at an increased risk of developing it throughout life. The concept of adrenal PCOS, which I think that when we’re talking about the confusion of Ha versus PCOS, a lot of times we’re talking about what people think of as that adrenal PCOS. There’s a thought that so much stress on your adrenals causes PCOS, and that there’s really not research to support that theory. 

Lindsey Lusson  32:49

For sure. And I guess that’s kind of where I where I was going with it was this idea between a stress induced or a adrenal subtype of PCOS. So typically, the way that I see it presented is okay, so you don’t have signs of insulin resistance. You’re probably not having those clinical signs of elevated androgens, but your DHEAS is off the charts. And your cycles are really irregular. You’re not ovulating regularly. But in my experience this is biased experience, because really, they’re coming to me because they probably know that they actually do have issues with food and exercise and stress might also be a layer there too. 

Sam Abbott  32:49

And actually androgens, there’s some newer research that androgens can be produced in other parts of the body too. Like it doesn’t always have to start with your adrenal glands. People with PCOS, they need to be supporting their adrenals anyway. And thinking about decreasing stress and what types of things put stress on the body. So, again, I don’t think of it as a separate subset. Now I also said that overlap of PCOS versus ha with this subset of people I think that’s something interesting to be studied. But yeah, those different types, that’s not something that’s clinically recognized. And I think it adds to the confusion, because people see this online. Then they want to go ask their doctor about it, and their doctor’s, this isn’t a thing. And then people feel dismissed by their doctors. 

Lindsey Lusson  34:20

But yeah, I also find that a lot of times these are people who are exercising accessibly. These are people who are in high performing jobs, sleeping five to six hours. You know, there’s just a lot to address there, whether or not it’s a true PCOS or not, I think that that’s something that we can really only know long term, once somebody’s  actually addressing those lifestyle factors. Let’s see if that gets the body to cycle regularly. And then if there’s other symptoms that are popping up in the future. Maybe we, in retrospect, could say that that was going on too.

Sam Abbott  34:49

Definitely, no matter if you are debating or trying to figure out whether you have HA or PCOS. I mean eating enough and not over exercising. These are foundational things that you probably need to establish first before you can start exploring other things.

Lindsey Lusson  35:06

Do you feel like we’re at a place where PCOS is being correctly diagnosed? Or you mentioned you got to sit on an advisory board. Are there other things that you feel like should be included in diagnosing PCOS? Or other types of resources that could help women really better understand the condition, what’s going on with their body, and how to approach it?

Sam Abbott  35:27

That’s a really interesting… That’s a loaded question. I feel like that there’s a long way to go with PCOS care. And I think the biggest obstacle that I’m seeing right now is that the updated information is not really trickling down to healthcare providers.  I feel like a lot of people with PCOS are still dismissed. They still have to go to several doctors even with the current diagnostic criteria. And to be completely honest, I feel like our healthcare system is set up in a way where, when we talk about, like a diagnosis of exclusion. Sometimes I feel like my clients are the people that I work with. They don’t even have enough of an opportunity to sit with their healthcare provider to really give like a big picture of what’s going on. 

Sam Abbott  36:22

I mean, I’ve had clients before that ended up having Cushing’s disease, or they ended up having a thyroid problem or things like that. I could see that a little more clearly because I have the chance to sit with them for an hour every week, for multiple weeks. And unfortunately, I know a lot of physicians would love that opportunity, and they they don’t have that because of limitations with our healthcare system. So yeah, I think we still have a long way to go with diagnosing.But I don’t know for sure if it’s because of the diagnostic criteria versus just provider education. There’s also still a lot of misinformation about  oh, your diet caused PCOS, your lack of exercise caused PCOS, your weight caused PCOS. Like, these are all things that people are commonly told that have very have been disproven.

Lindsey Lusson  37:16

And I think also, too, there’s this, yeah, with like that, almost patient blame first of all, that’s not empowering or really helping anybody. But also, too, I think there’s this belief too, that people can fix or reverse their PCOS through diet. I’ve even seen that as quick bait headlines on social media, reverse your PCOS. And can we clear that up for a second? Is PCOS something… Because HA actually is something that through proper lifestyle changes… I have never experienced HA after recovering my period seven years ago. It is no longer would not be relevant in my current health conditions. But PCOS, correct me, if I’m wrong, is not the same way. Like that is more of a chronic condition?

Sam Abbott  37:59

Yeah, PCOS is a lifelong condition. Unfortunately, it’s not something that will go away. It’s not something that will go away with a hysterectomy. And it’s a metabolic condition too. So when we talk about things like diabetes risk or cardiovascular disease risk, that’s something that we want to monitorall throughout life. So unfortunately, it’s not something that you can reverse or fix. And something I really like to encourage is, instead of thinking of your symptoms or your PCOS as a whole, is something to fix, instead ask yourself, how you can support yourself with PCOS. I mean, symptoms can be managed, labs can be managed. But at the end of the day we’re concerned about your overall well being. 

Lindsey Lusson  38:07

I think that’s super powerful. Do you know if there’s also… because it seems like a lot of times you’re talking about like, we don’t necessarily know how PCOS pops up, but it’s safe to say there is probably some sort of genetic component?

Sam Abbott  39:06

We are fairly confident that there is a genetic component. Something else that’s being explored as an environmental component too. Like, if you’re exposed to BPA in utero, or elevated androgens in utero. Is this something that can cause PCOS? And when we’re talking about environmental factors, like, that’s what we’re talking about, is, are these environmental endocrine disruptors? I saw a physician explain this online the other day. Of like, exercise was when you hear environmental factors. She was saying, lack of exercise causes PCOS, and that’s your environment. I was like, No, that’s not really what we’re talking about. But yeah, there is an interesting area of research about these endocrine disruptors and things and plastics and things around us. And is that a contributing factor too. 

Sam Abbott  40:02

That is so interesting. I mean, that actually makes a lot of sense. All the more reason just for more like education around that and policy change. But, yeah, that’s incredibly interesting. I know, with Ha, there’s also a pretty strong genetic component. There’s a pretty good research study that talks about how women who experience ha share genes with women who experience primary amenorrhea. Women who are born with common syndrome or early onset of puberty. So it’s kind of like they have the similar genes. They’re just not as strong. So it just makes them more susceptible to kind of their endocrine system. Shutting down or being dormant for a finite amount of time when exposed to kind of chronic stress and chronic undernutrition. 

Sam Abbott  40:40

Oh, that’s really interesting, yeah. Because everybody’s body is so different in terms ofwhat they can tolerate in terms of lack of nutrients.

Lindsey Lusson  40:50

And how their bodies are going to respond, right? Because to maybe even tie this back together, somebody with ha and or PCOS might have kind of some of the same triggers. But their body reacts in different ways. Some people could totally lose their period. And some people might start to experience excess androgens or estrogen and progesterone imbalance, things like that. So maybe to bring it all home, Sam, what would you say to somebody who’s listening and  they’re not really sure if they have ha or PCOS. Or after listening to this, they’re like, I’m pretty confident I have both. Where would you tell somebody to kind of start with approaching lifestyle changes to best support their hormones with PCOS?

Sam Abbott  41:32

Well, if there’s a question of PCOS and HA, I would bring things back to the basics and say are you eating regularly meals and then snacks? If you’re going a long period of time in between meals. What does body movement look like? Do we need to back off of the more intense or extensive time periods of exercise and maybe move to something that’s a little more restorative for your body. What does sleep look like? What does stress management look like? Those are all things that I would visit first. 

Sam Abbott  42:08

I would also recommend making sure that you’re including carbohydrates in all of your meals and snacks as well. And then, depending on kind of where you are and your healing journey, if you want to look into bringing in protein and fat. I feel like that’s a little if you’re in a space where you’re really concerned, you have ha and you’re trying to bring that back. Depending on where your mindset is, sometimes bringing in a lot of nutrition principles can be counterproductive. I would focus on the HA, piece of things first.

Lindsey Lusson  42:42

yeah, 100%. I mean, I think bottom line is eating regularly, trying to get a good, mix of things throughout your day.  I think the hardest part for people just listening without getting a higher level of support, is, this is all very subjective, right? Like, yeah, don’t over exercise if most people probably won’t be watching video of this. But I’m using air quotes here. I mean, what is enough food for your individual body? I think that that could be really hard to understand, especially if you might have 10 plus years of restriction, disordered eating, chronic dieting.

Sam Abbott  43:18

Yeah, it’s interesting to think about. Because when I used to work one on one with clients, now I have a membership. But when I used to work one on one with clients, one of the first things we would do is go over a food diary. And yeah, a lot of times, though, when I would ask my client like I would look at it on paper and feel like it wasn’t enough.But I would Say, do you feel like you’re eating enough? 

Sam Abbott  43:43

And so often, somebody could sit back and say now that I’m thinking about it and I’m looking at it on paper, I don’t think I am. It is subjective. But part of the reason why it might be hard to tell is because we’re paying attention to all these outside influences and what we think we should be doing and food rules. Bu you know your body like better than anybody else. So a lot of times, I feel like when we are given the space to really reflect on our own, on our own diet, we can make some determinations that are individualized to us.

Sam Abbott  44:25

Yeah. And like, how are you feeling, and what are your thoughts? If you have low energy, or you’re always craving food, or you’re always thinking about food, or you’re very regimented, and it’s stressful when you’re not regimented. Or you know your food behaviors are impacting your social life and things like that. Those are all red flags where you could take a step back and be like, okay. There might be some restriction going on here.

Lindsey Lusson  44:25

I agree with that. I think that having somebody else look at it can be really powerful. But also to a lot of our listeners arein healthcare or know a lot about nutrition. So really think about it. When I had HA I was like, Okay, I know the amount of exercise and roughly the amount of calories that could and should burn. And I know how much I am consuming, and there is this very, very, very clear gap. I don’t think you necessarily have to count calories to know that. Maybe maybe it kind of starts with having an honest conversation and maybe even turning off the noise of what.is the influencer on Tiktok eating? Or who does so and so eat, right? Because I think sometimes we, like, compare ourselves to what other people are eating. And it’s no, but like, Is that enough for you? Right?

Lindsey Lusson  45:38

 Yeah, 100%.  Well, Sam, if somebody wants to know more about what you do or get in touch with you, what is the best way for them to connect with you?

Sam Abbott  45:45

Well, you can find me on Instagram. My handles @PCOS.nutrition.

Sam Abbott  45:58

I have a membership called Nourished with PCOS, for anybody who knows they have PCOS and they want to learn how to manage it without restriction. I have a podcast called nourished with PCOS. took a little break over the summer, but there’s some really good episodes still there. Lindsey is in one of the episodes. Yeah, that’s how you can find me. And yeah, feel free to send me a dm. I’d love to chat.

Lindsey Lusson  46:27

Okay, amazing. And if anybody does have PCOS, and they are looking for a way to manage their PCOS, even alongside their HA 10 out of 10 recommend Sam and her approach for very long nutrition philosophy. So thanks for coming on today.

Lindsey Lusson  46:39

Thanks for having me.

Connect with Lindsey Lusson: 

Instagram: @‌food.freedom.fertility
Website: www.foodfreedomandfertility.com/
Twitter: @LindseyLusson
Tiktok: @food.freedom.fertility