The Inflammation-PCOS Connection: How Diet and Exercise Can Both Fight and Fuel Inflammation in PCOS 

Inflammation and PCOS are intricately connected. In this blog, we’ll unpack how inflammation is a common missing piece of PCOS onset and management.

PCOS, or polycystic ovary syndrome, is both a metabolic and hormone-related condition. Common symptoms associated with PCOS include irregular periods, lack of ovulation, fertility challenges, acne, unwanted facial hair growth, hair loss, as well as insulin resistance and difficulty losing weight.

Within functional medicine, we classify PCOS into 4 different types – insulin-resistant, inflammatory, post-birth control, and adrenal PCOS. While inflammation very clearly is at play in inflammatory PCOS, it serves as a driving factor for all types of PCOS.

 

Understanding Chronic Inflammation and Its Role in PCOS

Inflammation is a natural immune system response that our body initiates to protect us and initiate the healing process. Inflammation can be described as acute or chronic. 

Acute inflammation usually lasts days to a few weeks, and is triggered by tissue damage, infection, and other injuries. We can think of acute inflammation as being especially protective, part of our body’s first line of defense.

Chronic inflammation, however, is more of a slow burn. It can last many months to years, and is much more detrimental to our health, contributing to the development of nearly all chronic diseases and health issues. Chronic inflammation is caused by a variety of factors, and often there are multiple factors at play.

Chronic inflammation can be fueled by low grade infections or microbial overgrowth, for example often seen in the case of an imbalanced gut microbiome. Autoimmune conditions are known to fuel chronic inflammation, given the body’s overactive immune response, and attack on its own cells and tissues.

Chronic inflammation can also be caused by the presence of environmental, chemical, or biological irritants that aren’t able to be fully cleared by the body. This can include short or long-term exposure to mycotoxins or mold, endocrine-disrupting chemicals, or even simple histamine responses that repeatedly activate the immune system. 

Chronic inflammation can also be driven by inflammatory situations that cause mitochondrial dysfunction and oxidative stress, which is the build up of harmful compounds called free radicals that cause damage to our cells. This can occur when the body does not have adequate antioxidant reserves from dietary intake to neutralize oxidative stressors. As you can see, inflammation affects our bodies on even smaller than a cellular level, by affecting the cell’s energy producing powerhouse, the mitochondria.

 

The Role of Inflammation in PCOS 

Chronic inflammation activates the sympathetic nervous system, also known as the “fight, flight, or freeze” response. Both the nervous system and immune system communicate with the rest of the body through hormones.

When inflammatory signals are chronically firing, over time this can lead to hormonal changes such as insulin resistance, low active thyroid hormone (free T3), high or low androgens (i.e. DHEA, DHEA-S, testosterone, androstenedione), low vitamin D, elevated cholesterol, nervous system dysregulation, and even autoimmunity. 

Blood sugar fluctuations, both instances of high and low blood sugar levels, can stimulate a stress response and lead to inflammation. When blood sugar increases, insulin is released to move glucose from the blood into the cells and tissues. When blood sugar levels are frequently elevated, and insulin remains high, our cells can become less sensitive to insulin, and thus insulin resistance develops. This is a main driver of PCOS and is implicated in about 70% of all PCOS cases.

Cortisol is the body’s main stress hormone, produced when the sympathetic nervous system is activated. Cortisol drives insulin resistance by preventing glucose being taken up by the tissues for storage. It does this protectively, to help fuel our immune system, which is helpful in an acute setting, but harmful when chronically activated.

High cortisol levels and the subsequent inflammation fueled by that can inhibit the restoration of the brain-to-ovary connection, which is a critical pathway involved in post-birth control PCOS. 

Inflammatory pathways also affect the thyroid gland and thyroid hormone levels. This has countless downstream effects hormonally, like on the adrenal glands, where cortisol and many sex hormones are produced. The adrenal glands alone are responsible for 20-30% of the elevated androgens seen in PCOS.

 

Alleviating Inflammatory Factors to Improve PCOS

Fighting Inflammation through Nutrition

It’s been discussed how blood sugar dysregulation can develop into insulin resistance. This can both be a cause and driving factor of PCOS. One critical way to fight inflammation through your diet is by ensuring your meals are well balanced to support optimal blood sugar levels. 

In addition to blood sugar dysregulation and excess carbohydrate intake, it’s also important to be aware of the types of fats you’re consuming, prioritizing healthy fat sources and anti-inflammatory omega-3 fats, such as those found in salmon, sardines, flax seeds, chia seeds, and walnuts.

Too many omega-6 fats in the diet, particularly in relation to omega-3s, can fuel inflammation. We find omega-6 fats primarily in hydrogenated vegetable oils, such as canola, safflower, corn, and soybean oils, which are commonly found in highly processed foods, even many that are touted as healthy. 

Other foods that can fuel inflammation include added sugars, gluten, dairy, corn, and soy. Many people may notice an improvement in symptoms by limiting or eliminating some of these foods, and increasing antioxidant-rich and anti-inflammatory foods. This includes dark leafy greens, dark berries, allium vegetables, high-quality extra virgin olive oil, green tea, ginger, and turmeric.

We can also eat to support optimal liver function and detoxification! This is a critical aspect of ensuring any toxins, waste products, and even excess hormones are effectively eliminated from the body, as opposed to recirculating and fueling inflammation. Cruciferous and allium vegetables, protein, and bitter foods such as arugula, citrus, and dandelion are all packed with liver-supporting compounds.

Of course, there is no shortage of supplementation that can be utilized to bolster anti-inflammatory processes in the body, for those who may need additional support. 

Omega-3 fish oil and curcumin, the active compound of turmeric, are both powerful anti-inflammatories that can be supplemented at therapeutic dosages that otherwise would be more difficult to get through diet alone. Myo-inositol, found in our own Functional Fueling Hormone Potion, has been shown to significantly benefit those with PCOS by improving insulin resistance and helping regulate hormones.

 

The Role of Exercise in Inflammation

Within the inflammation-PCOS conversation, it’s critical to understand how exercise can either help or hinder the inflammatory and hormonal environment. 

Exercise triggers a short-term inflammatory response and spike in cortisol. For those with PCOS, it’s important that physical activity is tailored to be truly hormone-friendly, from the types of workouts to the frequency and intensity. By doing so, we can leverage physical activity to actually help reduce inflammation.

What this looks like is alternating between a few days of Zone 2 aerobic exercise and a few days of full-body resistance training. By prioritizing full-body strength exercises, we are able to maximize our muscle activation, a key factor to improve insulin sensitivity. Progressive overload is also critical to ensure you are actually getting stronger and more fit, without creating more oxidative stress for the body. These are all pillars of our Strength in Hormones Workout Program.

Equally as important as type of exercise is ensuring we are properly fueling and recovering from workouts, in order to bring down that cortisol response. You can learn about all this and more on the Strength in Hormones Podcast, as well as in our Inflammation Hormony group program, where we walk you through our step-by-step framework to effectively lower inflammation and help restore vibrant health. Join us for our next live program in August 2024!

 

Written by Romana Brennan, MS, RD