PCOS and HA? Navigating nutrition when you have both

Dec 20, 2023 | Let's Hear From The Experts

Cory Ruth is a Registered Dietitian Nutritionist and women’s health expert. Cory is the founder and principal of The Women’s Dietitian and Instagram account @thewomensdietitian, a private practice and digital platform for women seeking nutrition support for hormone balance, PCOS, fertility, and weight management. She specializes in PCOS and nutrition therapy for infertility and assisted reproductive technology. Cory is also the creator of the successful online programs The PCOS Boss Academy and Get Pregnant with PCOS– It is through these programs that she is able to help countless women on their journeys to weight loss and fertility with PCOS. Cory has launched a PCOS supplement and protein powder line called Vita-PCOS to further support women with PCOS symptom management. She also has a new podcast, The Imperfect PCOS Podcast!

In this episode:

  • The blurred line between HA and PCOS when looking at labs 
  • Understanding a true PCOS diagnosis
  • Cory’s experience in developing HA while having PCOS
  • Tips for navigating HA recovery when dealing with a dual diagnosis
  • The importance of balance versus restriction 
  • Key supplements for managing PCOS

Transcript:

Lindsey Lusson  00:00

Hey guys, Lindsey here. So excited to dive into this week’s episode but before I do, I want to remind you that we will be answering a handful of listener questions. If you haven’t been able to submit listener questions be sure to subscribe to my email list linked in the show notes and that is the best place to submit your questions for me to answer whether it’s related to getting your period back fertility, disordered eating etc. I am happy to answer those questions for you. So stay tuned. Be sure to listen to the whole episode because those listener questions will come at the end. And with that, let’s get into this week’s episode. 

Lindsey Lusson  00:34

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 Lawson.

01:07

Cory Ruth is a Registered Dietitian Nutritionist and women’s health expert. Cory is the founder and principal of The Women’s Dietitian and Instagram account @thewomensdietitian, a private practice and digital platform for women seeking nutrition support for hormone balance, PCOS, fertility, and weight management. She specializes in PCOS and nutrition therapy for infertility and assisted reproductive technology. Cory is also the creator of the successful online programs The PCOS Boss Academy and Get Pregnant with PCOS- It is through these programs that she is able to help countless women on their journeys to weight loss and fertility with PCOS. Cory has launched a PCOS supplement and protein powder line called Vita-PCOS to further support women with PCOS symptom management. She also has a new podcast, The Imperfect PCOS Podcast! All right, and welcome, Cory. 

Cory Ruth  01:56

Hi. Thank you. Hi, Lindsay. 

Lindsey Lusson  01:58

Well, I have been wanting to have you on here for quite some time, because I think we have so much to talk about, as I’m sure like you run into too like the confusion between HA and PCOS. Like it just comes up so often. And then I know you have a really unique story and experiencing both at the same time. So can’t wait to just get into all the things. But why don’t you just kind of lead and tell us a little bit more about like, us dietitians, there are so many different routes that we can take with like our schooling and credentialing and education. Why women’s health? Like how did you get into this part of you know, health?

Cory Ruth  02:32

Yes, yeah, good question. And I love this question. Because I feel like anyone who, if anyone has PCOS, and is listening to this, they will 100% relate. And, there’s a touch of sadness with it, because of all of the, misinformation and misunderstanding that a lot of people have around PCOS. But I also love to put a positive spin on it, because this is really what I have dedicated my life and career too. So I always knew something was off with me, with my own body. I always knew something was different. I remember being in the locker room in high school, and you’d get ready every single day in high school, like, bless it, I never even do that right now at all. But, you know, we were in the locker room, and we were like, straightening our hair, you know, probably frying all the ends off and talking about our periods and stuff. And I remember some friends saying, “Oh, my periods coming on Saturday”, and then you know, the girl next or one of my other friends, “Oh, mine’s coming on Sunday”. And I was thinking to myself, “Oh, how do they know that?” “What, like you just know, when you’re getting a period that is mind blowing.” And I was hearing more and more, you know, girls my age talking about how regular they were, or at least that was the underlying summary of what they were saying. And I could not relate at all. My period would come in completely out of the blue after months of being missing, hang around for weeks, or just kind of spot randomly. There was never a schedule. Like I remember it being irregular in the beginning, which actually is normal, but it never regulated. So the touch of sadness was I felt like I was less of a woman because I wasn’t getting this normal period. And I felt like less feminine, you know, all of those those those silly things that make no sense. But when you’re young, you’re impressionable, you’re vulnerable. You’re self-conscious of everything. And you’re just trying to figure it all out. It can be this big, scary question mark. So I really wish that I could go back to that locker room and to my high school self and just give her a big hug and just let her know that there’s nothing wrong with you. You are perfect the way that you are and you’re perfectly normal. That’s just normal for your body. And there’s things you can do to turn the ship around, right. So as I got older, again, period stuff never regulated,

05:00

other symptoms popped up. And I finally got my diagnosis for PCOS, which is polycystic ovary syndrome, which is, by the way, the most common endocrine condition worldwide and the leading cause of infertility. I got that diagnosis in my early 20s. And I kind of knew was coming. I knew enough about the diagnosis. But at that time, I was already in route to becoming a dietician, and what little I knew about PCOS, it was just so complex, so complicated. And I thought, Okay, I’m going to open my own private practice. And the one thing that I don’t want to ever talk about is PCOS. Because it’s so complicated. It’s such a big topic, and it’s just so messy, and I don’t get it. And so as I went along, I learned more and more about it. And I learned the huge connection, just like HA, to what we’re eating and how our symptoms are showing up. So I thought, “Here I am. All right, a registered dietician, I have a Master of Science degree, and I have PCOS.” Okay, I’m kind of the perfect person. And I begrudgingly went into working in PCOS and I am so glad I did I have never looked back. It is my passion, my mission in life to help other women with this condition. So that’s how I landed where I am. 

Lindsey Lusson  06:17

Well, and you know, I want to touch upon something that in your story that I know so many listeners can relate to with HA, even, it’s just this idea of not having a period and feeling less like a woman. And this is not something anyone can empathize with, unless they’ve dealt with that. Because it sounds weird to say it out loud. But it’s like you feel like some of your femininity has been taken from you when you aren’t having a regular period. So gosh, you’re not alone in that. And I hear that so often. 

Cory Ruth  06:47

That’s so true. I also hear from HA women too and PCOS ladies who have missing periods. Like I never thought that I would want a period so bad. Through, you know, there’s so much rhetoric around and so much discourse around ” Oh, my periods here”. But for those of us who are just wishing that it comes, it’s that we feel like we’re on the outside knocking on the glass looking in

Lindsey Lusson  07:09

It does, or like there’s this exclusive club that you don’t get to [inaudible]. Yeah, I mean there are parts of having periods that like are not the best thing in the world. But I think whenever you kind of start to learn about why we have periods and why they’re important, and we’ll get into that, too, I think that it helps you to have just more of like an appreciation for the whole thing.

Cory Ruth  07:32

Totally. I know. Personally, I wish that she would show up for like a day and then be like, “[inaudible] later, and then you’re like, “cool”, you know.  But anyways, that’s another story. 

Lindsey Lusson  07:41

Or if like the hormone cycle was like every other month or something like a natural healthy cycle as frequent as it is. 

Lindsey Lusson  07:51

Well, tell us a little bit more about your story. So I know one of the things that I love about you and I think could be so helpful for listeners and just to kind of, you know, feeling connected and also like [inaudible], today is, even though you do have PCOS, and maybe also let’s just start there. PCOS. Like, okay, so HA like I always tell people like this is reversible like you have HA and we can fix this. And then you can potentially never have HA again. PCOS is not that [inaudible]. Let’s just start explaining the differences between the two. 

Cory Ruth  08:23

Totally. So yeah, PCOS, there is no cure, you can absolutely put your symptoms into remission, as I say. But the thing about that is, it’s not like we take a seven day course of antibiotics and the infection is gone, right? This is something that we have to continuously manage. This is something that we have to continuously put in the work when it comes to diet, nutrition, movement, stress reduction, and I’m sure it can be the same with HA too. But there really is no, you can’t just slack for years and expect everything to be hunky dory, you have to continuously manage and make sure that you’re on top of all of the lifestyle changes that are supportive for healthy hormones with PCOS. So yeah, PCOS is more of… we don’t exactly understand what causes it. There’s theories around a potential genetic link like daughters of mothers with PCOS are eight times likelier to have PCOS. So we have some studies demonstrating that genetic tie. But you know, there also could be argument there’s people who don’t have any PCOS on their family and then it pops up so we don’t exactly know. And HA, correct me if I’m wrong, but it’s something more, some women have more of a genetic predisposition to getting HA but it’s mostly lifestyle. Like some of the choices that we are making when it comes to food intake, energy expenditure are more related to HA than PCOS actually the root cause of it. So that’s a key difference there.

Cory Ruth  09:58

For women with PCOS, we often have elevated androgen levels, which are male sex hormones like testosterone, DHEA DHT. These drive a lot of our symptoms. There’s also a big blood sugar component. So if you hear a lot about insulin resistance, but it also expands into just blood sugar dysregulation, like if you’re somebody who tends to go hypoglycemic, which is low blood sugar, or you’re having like a high fasting insulin or fasting glucose, and we can talk about lab testing, but that plays a big role in PCOS versus HA. You might have something like reactive hypoglycemia or something like that. But insulin resistance typically is not part of the picture. 

Lindsey Lusson  10:41

Well, and this is already so helpful because when I’m looking at people’s labs, even when [inaudible] there is a lot of overlap, those are honestly the two things that I really look at because we don’t see elevated androgens with HA. So if you have that, you at the very least, have just PCOS [inaudible] or right so like that one is super important. And you’re right with HA. If we look at fasting glucose, if we look at fasting insulin, those are more than likely low. There’s gonna be some stress component where there’s, you know, those labs are mirroring more PCOS and that’s where it gets a little bit murky. But yeah, those are the two that I also look forward to, Cory, or like, if androgens are low, not high, probably not PCOS and then was blood sugar look like? I do find though, and I’m sure you can kind of empathize with this too, and working with so many women with PCOS, and maybe we can even talk about like, not everybody with PCOS is insulin resistant. But I do hear about a lot of people, they go to the doctor, they have a missing period. And they’ll do an ultrasound. They’re like, “Oh, they’re cysts on your ovaries. So here’s the Metformin”. And I’ll be like, “Well, did they test your blood sugar? Did they test your fasting insulin?” and like nine times out of 10, they’re like, “No”. I think that that’s kind of the first line of defense from doctors. 

Cory Ruth  12:00

Giving doctors grace, birth control, Metformin: Those are two pharmaceuticals that they are trained to prescribe, in any kind of event where there’s period irregularities that are not life threatening, but are bothersome, right. Because Metformin, and birth control both can potentially be helpful in what we say, for y’all just listening to the audio here, “regulating the period”, right, bringing us a predictable bleed, and basically replacing our natural sex hormones with synthetic versions. Metformin is actually a type two diabetes drug. But for some women with PCOS, it can help to restore ovulation, which means they’re getting a more regular period. And for those who have this insulin resistance, blood sugar issue, which not all women with PCOS have, but a lot of us do, Metformin can be helpful in regulating our blood sugar, which in then, in turn, helps a lot of our other symptoms. So you know, in terms of like cravings, weight gain, if that’s something that we’re struggling with, period irregularities, even things like testosterone related symptoms, we can see improvements sometimes from Metformin, and birth control. So you know, doctors aren’t trained to give nutrition and dietary advice, which is why they should be referring out to registered dietitians. We are the experts in our field in the healthcare realm but they’re not trained to give that advice. So that is the advice that they are trained to give is a pharmaceutical.

Cory Ruth  13:36

So that’s really why it’s not because doctors are evil, and I don’t care. It’s because that’s how they’re trained. And right you know, we always have to lean on the training that we receive. There are doctors who will look beyond that and really help toMget into the nitty gritty and dive in. But most, you have it the way that our insurance system is set up, we have a 15 minute maximum slot from documentation and hospitals are understaffed. I mean, we could go on and on. But that’s really the reason why it’s not the all doctors are horrible. That’s just what they’re trained to do.

Lindsey Lusson  14:12

Right. So it’s kind of like and what I’m hearing you say is like it can serve a purpose to in treating PCOS as kind of like the equivalent of someone going to their doctor or getting an HA diagnosis and saying, Here’s hormone replacement therapy. Let’s try Provera and see if you can bleed basically, right, you know, like, those those items can serve a point and I also love that you touched upon like, you know, I think sometimes we put too much burden and too much pressure on doctors Right? Like it is not necessarily their job to tell us how to fix our problems, and we expect them to but like really that’s not how they’re trained and that’s not how they’re going to approach issues like that right depending upon your goal you would get pregnant or you not here’s [inaudible] good on this treatment or you know, start this this will make things better. Always looking at things holistically, which isn’t necessarily [inaudible] It just may not be what best serve ideal. 

Cory Ruth  15:07

Exactly. Yeah. And that’s why people like us exist who have the time and the capacity to be able to dive in deeper and say, here’s actually what you need and here, you know, because diet is connected to every single health condition that we know of. So that’s where we’re able to really work as a team, taking into consideration what your doctor says. But then also saying, “hey, Metformin, and birth control are one choice, but they’re not your only choice. Here are 100 Other things that I recommend you do, they’re going to cost you less and have zero side effects”. So you know, it’s really up to us to give those alternatives. So it’s nice to know you have that if you want that, if you want that route, want to go that route, but then there are people you know, like registered dieticians, who worked from a whole different perspective, and it just depends on what route you want to go. 

Lindsey Lusson  15:57

Yeah. Well, let’s talk more about PCOS and how it presents. So what do listeners need to know about if they’re having labs done, what is looking more like PCOS? Like when should yours be perking up being like, “Oh, [inaudible] just going on also or in addition to? 

Cory Ruth  16:15

Yeah, so if your period is missing, and you are wondering, do I have HA do I have PCOS, you want to get your labs done. And most insurance companies cover at least annual bloodwork, like once a year, so you can usually fall back on that, at least here in the US, usually. And you could get a full hormone panel. That would include things like estrogen, progesterone, thyroid stimulating hormone, testosterone. Sometimes they’ll throw in like DHEA or prolactin. You want to look at FSH, LH, you want to try to get a pelvic ultrasound if you can to look at your ovaries. And then you can also get tested, I recommend looking at your vitamin D, because low vitamin D can cause period irregularities, like a missing period. And that’s super common with PCOS. You can look at your iron and your vitamin B12. And then I also always recommend getting that blood sugar checked. So that would look a one C and then also you could get either fasting insulin or fasting glucose, either one can be helpful. And that will help us take a look and see is blood sugar dysregulation part of the clinical picture which would really, you know, kind of point to more PCOS. If that testosterone or DHEA is high, that would also point to PCOS. If your LH to FSH ratio is off, like it should be relatively even. And if you’ve got is it doubled? I think it’s double the amount of LH versus FSH then it could be something like PCOS. And the other thing that you want to look at is called AMH,  and that is a you know being considered as another diagnostic criteria for PCOS. If AMH is elevated that points to PCOS. The last time I had mine checked, it was like off the charts. So I was like, “okay, great, like one more criteria I fit”. But that’s something to look at, especially if you’re looking into fertility. So those are the labs that I would really take a look at and see if your vitamin D is low, if your AMH is high, if your testosterone is high, or there’s any blood sugar issues, those can all point to PCOS versus something like hypothalamic amenorrhea.

Cory Ruth  18:23

So symptom-wise, irregular periods fall into both categories, right, you could have a scanty kind of missing or just kind of spotting, light bleed and you could have PCOS or HA, you could have a missing period and have PCOS or HA and I will also say sometimes just because of the inovulatory component of what an ovulatory bleed could look like, you might feel like you’re bleeding all the time or spotting all the time, it could potentially be either one because all three of those things point to either you’re not ovulating regularly, which means every cycle every you know roughly 25-35 days or you’re not ovulating at all. So that’s a big symptom. If you have symptoms like facial and body hair growth, really bad acne, you know, cystic severe acne, hair loss or hair thinning on the head, that could be PCOS. Those are androgen excess symptoms. If you have really intense cravings, like sugar and carb cravings, that’s a sign your blood sugar’s off. Now that could also play into an HA sign, right? Because if you’ve been restricting, then that’s kind of, you know, up for grabs in terms of where in the Venn diagram that lands, but that could be something that could potentially be PCOS. What’s the other one, I was gonna say? Oh, obviously, if you got the ultrasound done if you have polycystic ovaries, right so you’ve multiple, these aren’t really cysts, that’s the thing.

Lindsey Lusson  19:50

Yeah, maybe we keep out here for a second because I hear from so many people that they have cysts on their ovaries. What is there like, are we looking for a number, are we looking for size? What is hallmark PCOS?

Cory Ruth  20:04

I believe it’s over, I want to say six or maybe it’s 10. I have to go back and look but I forgetting at this [inaudible]. I believe it’s over six or 10, what we call little cysts on the ovaries. So I got like drug through the mud and on TikTok when I posted about this because everyone was like “you’re gaslighting me” because I posted that pain is not a symptom of PCOS. Because women are having these like big cysts like these, you know, you hear about women like “oh, I had a grapefruit-sized cyst and it burst and I went to the ER”. That, you can have that concurrently along with PCOS but that is not coming from your PCOS. Yeah, so if you’re having painful periods, really really painful that could either be unfortunately you’re normal, it could be inflammation, it couldn’t be endometriosis. [inaudible] doesn’t cause pain. So we call cysts and there are so many of us advocating for a name change because of all this.

Cory Ruth  21:07

These are not actually cysts on our ovaries. What they are are tiny, immature, underdeveloped follicles, what those are, each month, each cycle, your ovaries have these little sacks basically, and they’re all trying to grow an egg, right. And one, one of those eggs is going to get kicked out. That’s the winner. It’s going to ripe into maturity, it’s going to be kicked out. That’s the egg that you ovulate. So what happens in PCOS is we’re getting all these hormones misfiring to the point where none of those sacks of eggs are maturing correctly. And so what happens is they just basically build up and they’re tiny little egg sacks. That’s all they are. They’re not actually cysts, not the ones that can enlarge in and rupture. So that’s a huge, a huge missed misconception about PCOS. And so, if you have true ovarian cysts that’s not coming from your PCOS, You can have both but it’s not from your PCOS. 

Lindsey Lusson  22:07

Yeah, no. And I think that that just like education piece is so important too, because people will be like, “I have cysts on my ovaries.” And I’m like, “Well, if you have ovulatory cycle in months or years that, like of course you have stuff in your ovaries. And that doesn’t automatically mean PCOS.” Okay, so having that criteria is super helpful. When you talk about do you know, like off the top of your head, like, because people will be like, “oh, yeah, like my androgens are high.” Like, how high are we talking, If somebody gets their labs done, like what is you know, what is crossing the line into potentially PCOS territory?

Cory Ruth  22:44

You know, every lab varies. Not for every lab, right, like, thyroids, pretty standard, A1C standard, testosterone labs, I have seen every number you can imagine as far as a reference range. So unfortunately, I don’t have one number that would point to height. You have to look at whenever you get labs looked at or drawn, you get your results back, make sure that they include a reference range. Yeah. Because if you don’t have a reference range, if your testosterone is 47, you Google it and you say testosterone, 47, high, you know, or whatever your search query is, and it says testosterone should be, you know, five to 11. You’re like, “oh my god [inaudible], going on”. But if your labs reference range is normal testosterone is between 30 and 50. You’re like,” Okay, well, I’m within the realm of normal.” So you want to look at that reference range. 

Lindsey Lusson  23:39

Okay, that’s super helpful. And all of the things that you’ve said is so interesting, because like the LH to FSH ratio. So one thing that I just wanted to bring in here in case somebody is like feeling 90% they have Ha, but now they’re hearing this like, “Oh, my gosh”, one, and I can explain it, but one thing that I have noticed during the recovery process if somebody has HA, you know, let’s say,  and typically with HA just to draw some distinctions here for listeners, we’re typically seeing kind of low everything, low estrogen, low FSH, low LH, although during recovery, FSH and LH will be normalized into the normal range, the normal reference range a lot faster than estrogen does. And sometimes during recovery, we see LH sort of overshoot as the body is trying to ovulate because you know, like the way our hormones, you know LH isn’t remarkably high or low throughout the cycle, except for [inaudible]. So I have had a handful of clients catch their like, surge, basically. And then doctors be like, “Oh, my gosh, it’s PCOS”. And I’m like, “Whoa, let’s rewind.” So I think you know, also, maybe this is like a good place to pause and also say that, like, the more labs you have, the more information you’ll have and like understanding that labs are a snapshot of what’s going on in your body at one point in time.

Lindsey Lusson  25:02

Do you know, Cory? What percentage of people with PCOS don’t have insulin resistance? 

Cory Ruth  25:07

The latest stat that I have read is about 70% of us have some kind of insulin resistance, blood sugar issues. I think the trickiest patient, and I speak from experience the trickiest patient is somebody who has PCOS. Like they for sure have PCOS. They’ve got you know, all these symptoms flaring, who doesn’t have insulin resistance and doesn’t have high testosterone. So they’re PCOS, about 10 to 15% of us roughly have what is what we consider more adrenal based PCOS. This is so tricky when you’re trying to distinguish from HA, because we don’t have the blood sugar and testosterone piece. All we really have to go off of is like stress, which you can also make an argument for HA. But here we’ve got all these symptoms that are very clearly not HA, right. And even when we are getting ovulation back, it’s still happening kind of haphazardly. It never goes to like a normal schedule. So it’s like the trickiest one. And it can be so individual to get symptoms under control in that person. Because you can’t always just follow like, you know, take it testosterone lowering supplement and taken off at all, and you’re good to go kind of thing like, [inaaudible] if the person’s at a normal weight, weight loss isn’t going to restore ovulation for that. So that’s one of the trickiest patients that we can see with PCOS. Yeah. 

Lindsey Lusson  26:41

And is that kind of our “lean diagnosis”, or like, what some physicians are throwing that term out? Yeah, yeah. So that’s tricky. And then also, something else I wanted to cover is like, what if you have both, you know, and then you said that that’s part of your story. [inaudible] you share and walk us through a little bit about like that progression and how you even realize that that could be going on? 

Cory Ruth  27:06

Totally. So for me, my PCOS has always been with my irregular periods. I call my lovingly, I call some of my patients, my bleeders, because their anovulatory cycles are just kind of like they’re like bleeding all the time, like spotting, you know, here, bleeding here, irregular period here. Then I have my PCOS patients who go have their period periods go missing for years, right? So I am in the first camp, when my period gets off track, I like just spot all the time, or I have like bleeds that just hang around for weeks. And it’s super annoying. So for me, when I went through my first and second, I’ve been through kind of two bouts of HA, in my early 20s. My period was completely missing. And for me that was different. Because for me, my period either was, you know, on time, most of the time wasn’t, or just like would, you know, all the time bleeding you feel like. So that was that was kind of a tip off to me that something was going on. And I just got really into, what did I, watch a documentary, Forks Over Knives. And they basically preach a vegan fat free diet to reverse type two diabetes, essentially your pre diabetes. So I watched that documentary. I was very, you know, just kind of getting into nutrition and diet and my early 20s, dabbling in it. And I was like, “Oh, cool. Like, I want to try that.” And I lost a ton of weight. Of course, like eating a vegan fat free diet like “Duhh”. [inaudible] for almost a year. And I mean, everyone told me how good I looked right? Like, I’ve never been so thin. I was always overweight in college. And so I kept going with it. And then after about eight months, I was like, “Huh, you know what, like, it took me that long”, because my period was so all over the place. Like, you know, I haven’t really had like a bleeding episode or like period in a long time. You know, then of course, you freak out thinking you’re pregnant or something, right? That was not the case. So yeah, for me, that’s what it looked like. But again, like there are so many ways that an ovulation can manifest different from your, what’s already different. It could be a tip off that it could be you know, you’ve got something else going on. But I also kind of knew that my lifestyle choices, like I was, this was obviously pre kids and I had a ton more time, but I was exercising every day, you know, for doing a ton of cardio and really restricting my eating, keeping my calorie intake low, and just really pursuing that like staunch veganism fat free thing, and that was the perfect storm for me.

Lindsey Lusson  29:59

Right. Well, and I think it’s so important. And I feel like as women, we have that success that intuition. Like you knew, even though it wasn’t normal, normal cycle, you knew it was kind of normal for your body and then going through this, you’re like, “something is off”. And I hear that so often. And I’m sure [inaudible] whenever people’s lifestyle choices aren’t in alignment with what their body wants and needs, like something is off, even if you aren’t 100% ready to admit, right, that could be related to your diet and over exercise. I think that we all just kind of had that internal gut feeling about what might be off. So what did reversing HA look like for you? 

Cory Ruth  30:45

So welL Yeah, so I and also to I just, I think we’ve talked about this on my podcast when I had you as a guest. I just so wished that I had you and I had your page, and I had your podcast as a resource at that time. Because here I am, you know, in my early, early 20s, missing my period thinking it’ll never come back thinking “okay, I already like I already had a wacky period to begin with now it’s gone forever. Like, am I ever going to ever become a mom, because I want to do that one day, you know, I don’t know when but at some point,”. So anyway, um, it was just a scary time. And I so wish that I had access to, you know, people and practitioners like you, but we didn’t really have social media at that time. But um, yeah, so So for me, it was really accepting that fortunately, for me, my body likes to be at a higher body weight. Not not a huge amount. But I knew that going the other direction also was bad for my PCOS. I had to get clear and get honest with myself about where does my body like to live, right? I basically had to find my body’s most comfortable weight. And I do everything I can to stay within that, which means not restricting fully, because I could go there, but I don’t want to go there. Because my body doesn’t like it. And it’s not that fun anyway, right? Like, I want to enjoy things. I wanna enjoy life. But I can’t go crazy, because my PCOS doesn’t like that either. So I’m in between this too heavy PCOS mode to like piece HA mode. So I have to be where I’m at now to have a regular period, when I don’t even have a semi regular period and I’m happy with that. I’m very pleased with that progress, because it was better than it being missing for eight months, you know. So I had to I had to eat more, obviously, and I had to exercise less because I also with exercise, and I do not come from a family of athletes, y’all like, do not like my family, no. Like we’re just not we’re like creatives, we’re, you know, lots of physicians in my family. My mom’s an attorney, we’re just kind of more seekers. We’re not athletes. When I try to go be super athletic, every time my period is late, delayed, ovulation gets delayed. I have to be very careful with exercise. And I tell clients, you know, there are some women who are Olympic athletes, right? They get their period every month, no problem. Me, the way my body’s designed for whatever reason, it doesn’t love when I exercise a ton. So I have to be careful about how much I’m exercising, which really isn’t a problem as much now that I have two kids, right?

Lindsey Lusson  33:47

Right, like a total game-changer. Even if I wanted to train as well that I did when I wasn’t getting my period, life has made that physically impossible. 

Cory Ruth  33:58

Exactly. So it’s a blessing in disguise, right, I really cannot go attack that and pursue that even if I want to do but I don’t. Because I want my hormones to be happy with me. And I want my bones to be protected and all that good stuff that we think about, you know, as we get older. But yeah, exercise was really key for me. I would say as important for me as the calorie piece, the diet piece. 

Lindsey Lusson  34:23

Totally. And I think that, you know, it’s all about finding that balance for the individual, which is going to look different for different people. But like, yeah, that reckoning, that reconciling of “oh my gosh, like, even if my body size is bigger than someone else’s, right? Yeah, this isn’t where I’m happy”. And so figuring out the puzzle pieces about where my body is happy. And I know for a lot of like us HA ladies, the recovery process does, in some ways look and feel like you’re swinging in the other direction but what I always try to tell people is it’s like a pendulum right. Okay, so if you’re over here, and the only way to come back to the middle is to move it this way, and then you’re gonna kind of level off. So it sounds like that’s kind of that was kind of your experience as well. A little bit more with, obviously, with more complexities with the PCOS. And so,you know, with our people who potentially have dual diagnosis, and I want to also just pause here and say that, I do think it’s a little more rare than common because I hear from so many people. I feel like more people think that they have both and really do, I would say more often than not, whenever somebody’s like, “what if I have both?”, I’m like, “Okay, well, we have to heal HA first, because then if you if you never address this piece of it, you could be doing everything right for your PCOS, and never actually get your cycle back, right, because you’re still engaging in HA behaviors.” And so I say, like, let’s address the HA first. And then if we, you know, get our period back, and then we have some of the patterns that you talked about or labs or looking wonky, more like PCOS, then you know, then once you know address that then. But more often than not, like the HA resolves, And to your point, right, like, this is where it kind of gets into this 10 to 15%. of is it lean PCOS, Or is it HA? Well, if you do all the things to heal your HA, and your period comes back, and you’re ovulating and if you’re trying to get pregnant, you then get pregnant, I think it HA. 

Cory Ruth  36:15

Yes, yes. Totally. Yes. I know. Yeah. I can totally imagine it feels like so all consuming when you’re considering not only one, but two of these diagnoses that are, both of them are poorly misunderstood. 

Lindsey Lusson  36:31

Right. Right. And there is I think, you know, I tried to separate them and highlight the differences, but there really is like a decent amount of overlap. So let’s talk to that person, though. Let’s talk to Cory going through HA and healing her PCOS. How do we attack both without potentially making the PCOS worse? 

Cory Ruth  36:51

Yeah. So here’s what I always say, for someone. And I do have you know, I run these big PCOS groups, and I have thousands of members. And I do have women who are struggling with both or you know, purportedly. So I always say, regardless of HA, that diagnosis, if you have PCOS, even if you’re working on weight gain, right, or, you know what, let’s talk about the dietary piece, your blood sugar balance is so important. So I really try and it’s difficult, right, because you don’t want to put them back in restriction ville, but I really tried to help them understand the importance of macros, because there’s, you know, there’s gaining, if weight gain is something that you feel is necessary. And that would help, you know, to kind of get your period back on track. There’s weight gain, and there’s weight gain in a way that promotes more stable blood sugars. And that means really prioritizing that protein, fat and fiber component. Fats are probably the most important there because they’re so calorically dense, but they’re not going to throw off your blood sugar. So it’s really teaching them how to work on nutrient repletion without, you know, taking things. And that’s why I also like to work in the space that I do, like all foods can fit with PCOS. So it’s just showing them how to do that. And I think that’s where it works well with HA versus somebody who works in PCOS who’s like, “well, you just have to, you know, eliminate gluten, dairy, soy and sugar and you’re fine”, you know. Yeah, for someone who has HA, that’s not gonna work. So that also helps.

Lindsey Lusson  38:28

And I’m so glad that we’re having this conversation because like, and also like, I mean, I already knew this. But I honestly, feel like we’re actually a lot more in alignment with our nutrition philosophy [inaudible]. Because I so often, people like, “oh my gosh, more like, I don’t want to like focus on healing my HA, and then throw myself into PCOS.” and I’m like, “Right. Inside my program, we’ve been eating enough. And we, in macronutrient balance, right? We don’t want to carbs we want protein and fat with the carbs because A, you feel better and B, the blood sugar balance.” For HA, typically, we’re trying to bring it up, right? We try to bring it up and stabilize it. We don’t want the swings. But you know, there has to be enough of it. But what I what I’m hearing you saying is like you also focus on macronutrient balance. And so it doesn’t have to be this extremes that I think in their head like you’re talking about other people. So some other approaches to managing PCOS are a little bit more extreme, are a little bit more restrictive. 

Cory Ruth  39:25

Yeah, yeah. And they’re not going to work as well for someone with HA. 

Lindsey Lusson  39:28

I also think too like, philosophy on exercise is probably more in alignment than people might realize [inaudible]. Because like, I’m not telling people don’t exercise, but we do wanna make sure that you’re not running your body into the ground. You’re not super stressing your body, right? So it’s the movement that works with your body, not the movement that’s going to push you away from where you want to be. 

Cory Ruth  39:49

I know. Yeah, I think there’s a lot of and this is no shade to them this is just how they work, but a lot of them like food freedom, you know, accounts on social media that really, they don’t focus at all on macros, they don’t focus at all on blood sugar balance, and that’s totally fine. That’s their jam. But that’s something that I would find to be more helpful for someone who’s potentially looking at HA and PCOS, hormone balance does depend on blood sugar so much, right. And, you know, saying like, “Oh, like if you, you know, your cravings for vegetables will come once you start, you know, allowing yourself to eat all” and that might be true for some people, but for some of us, it doesn’t. So teaching people how to incorporate that in, in a way that is healthy and works for their bodies, and their blood sugar is so much more I think of a valuable teaching method than just like, eat whatever, you know. So I think that’s really important. Yeah, yeah.

Lindsey Lusson  40:50

It’s gonna come in stages, right? Step one might be eat enough food, even if that mean eating more air quotes, “junk food” and the beginning and then let’s figure out how to have a cup of milk with the brownie. Well, that’s getting more color onto your plate, right? So some people will come into stages, but for the vast majority, especially with my HA, woman, it’s like, “okay, you got the protein down, you’ve got [inaudible] down. Let’s get those carbs back in. Let’s do [inaudible] that, right. So it’s more about addition. And for most people with HA, the balance is going to come from more of the things and sometimes bad things. [inaudible] out all of the good that’s already there. 

Cory Ruth  41:28

So true. Yep. Yep. And I can see how it’s totally individual too. I love that. Love the focusing on the addition and that’s the same. Yeah, with PCOS, there’s so much about deletion and subtraction and restriction. Yeah, really is more about addition to [inaudible].

Lindsey Lusson  41:45

It’s more sustainable with that mindset. Right. Like, what can I add to versus what can I not have? 

Cory Ruth  41:51

Totally, absolutely agree with that. I think the second piece to this is talking about supplements. Yeah. So if you are working on, like we talked about like, if you need to be, if you have HA and PCOS and you are wanting to work on getting your period back and you think that you know, maybe gaining a little bit of weight or adding more calories and reducing movement can all be helpful for you that may not do enough to lower something like testosterone if you’ve got high testosterone. So you want to bring in some the right supplements to help kind of you know, with some of those levels of whatever hormone is off kilter. So supplements are, I always like to start out with my so my supplements spiel, they are supportive of your journey. They are not a substitute for a diet that lacks you know, everything under the sun. They are one piece of the puzzle. They’re not the whole puzzle. Yeah. So great. Yeah. Yeah. So it’s so funny. Every time I post something about, like, you know, say I put like, five tips to lower testosterone, and I’ve got like, four awesome lifestyle strategies. And then I have one supplement, I have like, 185 comments about the supply. Like I get it, like I get it. And that’s why I wanted to create a supplement line because there’s so much bad stuff out there. That isn’t third party tested, you know, there and it’s really just a blend of random and, you know, random dried leaves that I’m like, why is that even in there? You know, it’s a filler. So I wanted to create supplements that actually work, that women can rely on, you know, as a fellow woman with PCOS and, you know, a small business owner, I wanted to create something that women could actually depend on to help their PCOS symptoms. So that’s where either you could do something like if you have high testosterone or high DHEA you could do something like an androgen blocker or a cortisol calmer which really, the cortisol calmer is more and this is great for HA too like. Yeah, it’s got phosphor title sarine It’s got adaptogens in there. It is amazing for sleep and stress support, which I mean who couldn’t use that, but it’s really great for those adrenal you know, adrenal stress based PCOS patients as well as women who have HA. The androgen blocker is more for the woman with PCOS who has high androgens that can help to lower that and potentially relieve some of those symptoms like irregular periods, facial hair growth, acne, things like that. If you have PCOS, and you are looking to get pregnant, if you don’t have PCOS too, you should always be looking at a high quality prenatal. There’s so many prenatals out there that I looked at like,why did that why doesn’t that include that like that’s a major brand. 

Lindsey Lusson  44:51

They are so lacking across [inaudible]. There are so many that are marketed really well but marketing nearly missed the mark on really important nutrients. 

Cory Ruth  45:02

Yeah, exactly. Yeah. So, so I have a prenatal that’s specifically formulated for PCOS. But you know, really any woman could could benefit from it. Yeah. And then I have some collagen proteins that I love because this too, if you’re working on HA and you have PCOS, that protein, along with the fat is so key. And sometimes, you know, we find ourselves like how do we meet those protein goals. You see these big lofty protein goals and you’re like, “how do I get there”. Proteins and I love collagen because it’s such a clean pure form of protein. It’s not an isolate, it’s literally just collagen, pure collagen. And I make two flavors, and they’re sugar free and they are delicious. And those are great, you can mix them with milk, you can do like a hot chocolate. I’ve been doing that a lot in the winter, you can add it to a smoothie, you can just mix it with water and that is almost 10 grams of protein in each scoop. And you can just add those in a couple of times in the day and you are boosting your protein goals intake significantly.

Lindsey Lusson  46:05

Well and to get back to blood sugar, I’m on a huge collegen kick right now. So I’m definitely I’m definitely going to have to order your because that sounds [inaudible] flavors. But you know even like so many women with HA are just skipping breakfast or they’re like scraping by, but they love their coffee. So like let’s make [inaudible] milk. Let’s put some collagen. We have protein, fat, boom, like it just reporting blood sugar balance, getting your body some nutrients in the morning. So it’s such an easy one. And yes, I am obsessed with collagen. 

Cory Ruth  46:33

So I know I agree. It’s so easy. And honestly, I’ve since I’ve been on a collegen kick too for a while. And I have noticed such a big difference in my skin. It’s really been a huge difference, I’ve noticed. 

Lindsey Lusson  46:46

Well, I’ll just totally like age myself here. But like I started, so I was taking it when I was pregnant and I started talking again postpartum when I started working out again, because I was like, I’m so achy, like my joints. I wonder I wonder what this collagen will do. And like, I swear it really does make a difference for me. So I’m loving it. 

Cory Ruth  47:03

Yeah, that’s cool. Yes, yeah, I know. And as we get older, that becomes more an issue.

Lindsey Lusson  47:10

Right? Not to age ourselves too much more. Hey, Cory, where can everyone connect with you tell us a little bit more. What you have going? Obviously we have supplements. We’ll link those in the show notes. But what else is going on? Somebody has PCOS, potentially HA or maybe you know and listen to their podcasts, they realize that it probably is PCOS or they’re ready to explore that more. How can they get in touch with you, work with you or you know, just follow along and what you what you do and what you have to say?

Cory Ruth  47:34

Yeah, so I’m most active on Instagram on social media. I have TikTok, YouTube, Facebook as well but mostly active on Instagram, @thewomensdietitian. And my supplement line is Vita-PCOS and that is a separate website. It’s connected to my website that you can buy any of my supplements on, try them out. I have bundles you can save. And then I also have a book. I have a podcast too, The Imperfect PCOS Podcast. [inaudible] new, I started in August. So I still consider it new. And I had Lindsey on as a guest. So you can check.

Cory Ruth  48:13

So full of great, great, great knowledge. And then lastly, I have a book on PCOS coming out sometime next year. I’m on like chapter four, I think but it will be done. And I’m, you know, hopeful to get it published by you know, a well known publisher. So it’s out there. And people actually have, you know, evidence based nutrition out there. There’s a lot of PCOS books, and there are a lot of written by doctors and the diet sections are horrendous. So here is a book that has every bit of that great information in there. But it also has all of the nutrition, you know, science backed advice, that’s non restrictive. And I have recipes and meal plans that will all be in there too. So yeah, 

Lindsey Lusson  49:00

It’s amazing. Love. Well, thanks again for your time and sharing all of your wisdom, some of your personal journey, helping people to connect with everything. And we just appreciate you coming on. 

Cory Ruth  49:10

Absolutely. Thank you.

Lindsey Lusson  49:12

All right, let’s get into some listener questions this week, and help you guys have what you need to support you in next steps and getting your period back. So the first question that I’m going to answer is from Sandra, and she asked, “How do I deal with fullness and discomfort when I need to reach a 2500 Calorie minimum every day they get my period back?” 

Lindsey Lusson  49:34

I really appreciate this question because this is some of the hard work that we do inside the Food Freedom Fertility Society. There are a lot of reasons why you might be dealing with fullness and discomfort as you’re working on period recovery. One of the reasons is that digestion is slowed down when your body doesn’t have enough energy to support normal body processes. So a lot of times we think about period loss as this like isolated event I lose my period. And that’s the only thing that I need to fix, when in reality there are a lot of body systems that are suppressed when the body is operating in a low energy state. And one of those things that is so suppressed is proper digestion. So as you began to eat more, you will have an increase in metabolism, your body will begin to produce digestive enzymes in the proper amounts, and you’ll be able to digest food better and you won’t be dealing with as much bloat and discomfort and a variety of digestive issues that can come with under fueling. I see this all the time in my clients, nine times out of 10, those digestive issues resolved when the body is fed, and when cycles return and everything kind of starts to get back into balance. 

Lindsey Lusson  50:43

But how do you get here, there are a couple of tips that I give my clients and the first is to cut down on your fiber intake. This one is hard because a lot of women who experience period loss with HA are generally healthy eaters, they might be eating a lot of foods that are fruits and vegetables, whole grains, nuts and seeds, lots of high fiber foods, but fiber definitely overtax our digestive system, and you can definitely overdo it on fiber. So if you’re dealing with fullness while you’re trying to increase your food intake, that would be my first tip is to cut down on high fiber foods. And again, this one’s hard but kind of going against the grain like choosing like a white sourdough bread over a whole grain bread. Cutting down on the amount of vegetables that you include at meals, that doesn’t mean not eat vegetables, but it does mean probably don’t make your entire plate of vegetables at every single meal. The next one is to limit your intake of artificial sweeteners. The body can’t fully break these down. And a lot of people experience digestive issues when over consuming artificial sweeteners and even if you’re not putting artificial sweeteners in the foods that you’re eating a lot of high protein foods like protein bars, protein powders, those types of foods naturally contain a lot of sugar alcohols and artificial sweeteners. So anything that ends like sorbitol, xylitol, anything that ends in O L is a sugar alcohol, so cutting down on your sugar alcohol intake. And then the last one is to cut down on carbonated beverages that may not be one that everyone thinks about. But artificial sweeteners, carbonated beverages, those are going to be contributing to bloat. And then of course, those high fiber foods are slowing the passage of food and waste through the digestive tract. And so food can sit in your stomach longer. And it isn’t ideal for ha recovery. Also, too with vegetables, in particular, they’re high in fiber and also high on water. So they’re going to contribute to that extra full feeling without providing your body with enough nutrients to support period recovery. So Sandra, I hope that that helps. Of course, we individualize those recommendations a lot more to you and your specific situation inside Food Freedom Fertility Society. So if you’re applying these things, and still struggling, definitely reach out for more support. 

Lindsey Lusson  52:56

All right, next question is from Katie and Katie shares “I am short, 5’2 and I just feel like eating 2500 calories would be so much for me. Do I really need this much?” Katie, I get this question all the time. And I totally appreciate it especially being a registered dietician and learning so much about nutrient requirements and how height is a factor that is considered in assessing somebody’s need for calories. That being said, there are a lot of things that go into caloric needs. Taking it a step further, your needs during recovery aren’t just maintenance. So if we were to factor in the idea that someone who’s five too might need more calories compared to somebody who’s five nine. While that might truly be true from a maintenance perspective, when we’re talking about recovering from HA, the goal is not to hit maintenance, but to get your body in a surplus. And so while I know that focusing on calories, and this number can seem really high and really scary, I would really encourage you to remember that 2500 calories is a baseline, I don’t recommend calorie counting because a lot of times this can become very limiting for the individual. I have worked with clients that are close to five foot who have needed over 3000 calories to recover. 

Lindsey Lusson  54:14

Everyone’s bodies are different. And if you are trying to limit yourself based on your height, that’s something that can really hold you back from nourishing your body properly for period recovery. All right, let’s do one more and then wrap for the week. So this last question is from Gabriella and Gabriella asks, “Is it still possible to have ha after three periods?” She shares “I recover my period for three cycles but now it’s gone again. Could it be that I have this going on still or is it something else?” Well, it’s such a great question Gabriela and I think that it absolutely could be something else. However in my experience in working with over 250 Women on HA at various stages of recovery and HA meaning I work with clients who haven’t had a period for 10 or 15 years. I also work with women that have gotten their periods back but are still dealing with cycle irregularities after HA recovery. And I work with women who are having semi regular cycles, but they’re not ovulating or they have low progesterone in their luteal phase. So they’re struggling with infertility. As a result, what I can tell you is that if you have a history of HA, that will always be a consideration. If you’re having cycle irregularities after HA recovery, your body is just genetically more sensitive than somebody who’s never lost their period. And so if you’ve had a recovery period or three recovery periods in this case, Gabriella, I think that that’s amazing. Clearly, your body can do it. And you know, in some ways what to do to have a period. That’s awesome. 

Lindsey Lusson  55:46

Anytime someone is experiencing cycle irregularities after eight day recovery, it’s my recommendation to go back to the basics. What did you do to get your period back? Let’s do more of that. And also considering the variables that might have changed. Have you lost a little weight? have you incorporated exercise back in? Are you restricting food? Have you changed the way that you’re eating? Those things are all contributors to irregular cycles after HA recovery. So those are just some things to think through Gabriela, but to also know that while there could be something else going on, and that’s definitely something for you and a medical professional, like an OBGYN to explore, HA is definitely a likely cause, or what I like to refer to as hypothalamic dysfunction, meaning that you are getting a period but there’s something still off with the way that your body is perceiving stress or the energy availability. And that’s where I think I would go first, of course, with additional testing to give insights to make sure that it isn’t something else going on. 

Lindsey Lusson  56:42

So I hope that you guys find that these Q and A’s helpful. I’d love to do more of these in the new year in 2024. So be sure to check out the show notes of this episode to get on my email list and you’ll be able to ask your questions for the next podcast episode.

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MEET THE HOST
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I’m a fertility nutritionist and registered dietitian who specializes in hypothalamic amenorrhea. My passion is helping women trying to conceive find freedom with food and exercise, so they can recover their period, and get pregnant naturally.

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EPISODE 1: MY RECOVERY STORY

Jan 19, 2022

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