Introduction and Guest Background

Welcome to this episode of the PCOS SOS Summit. I'm your host, Dr. Felice Gersh. With me for this episode is a longtime friend of mine, Dr. Benjamin Brown.

He is a naturopathy physician, and he is in England. He specializes in nutrition and nutritional supplements, but he has a wide array of expertize. I can tell you that he has an incredible CV, which I'll let him touch on himself.

He is the host of the popular podcast, Positive Health Podcast. Welcome, Ben. Thank you so much for joining me for this episode. Please tell our audience a little bit about yourself and then we'll do a deep dove into nutritional supplements for PCOS.

Yeah, brilliant. And thanks firstly so much for having me. It's really is an honor to be talking about PCOS with Dr. Gersh. She really, you know, I feel humbled in her presence.

You're really the authority in integrative, you know, women's health. So, you know, I'm a real honor to be here. But just briefly, to give listeners a bit of background.

So as you mentioned, my background's in naturopathic medicine, but I've really gravitated towards nutrition as a as an area of focus. And here in the United Kingdom, I am engaged in lecturing and a few of the nutritional therapy colleges here.

And I also run an institute called the Nutritional Medicine Institute that holds seed PDP for health professionals as well as I'm editor of the Journal of the Nutritional Medicine Journal.

So that's sort of my background. And I'm also I've also been really involved in nutraceutical research and development for many years, having worked with some really big professional names like Metagenomics and Pure Encapsulation and others over time.

So hopefully what I can give listeners is, you know, a bit of depth around the site from practical and evidence based use of nutraceuticals with those, you know, I guess some education quasi academic and, and clinical as well as commercial background in that area.

Well, your depth of knowledge in this area is huge and so I'm really excited to learn from you so women with PCOS suffer from a wide array of medical issues and symptoms.

So I thought we could do like, you know, just sort of a great overview of a variety of different supplements, nutritional, herbal and how they can be applied to the various issues that women with PCOS face.

Myo-Inositol for Ovulation and Fertility

So what are some of your go tos to help women who don't ovulate regularly to improve their ovulatory cycles? Yeah, it's it's a great question. And also, I think a very important way to look at this as well as is much bigger than just a simple pill for a nail.

It really is a complicated condition with a lot going on and there's not like a magic bullet. And I think that's important context. So really happy to follow that that sort of theme and dove into different areas that are important for different people across the spectrum of PCOS and you know speaking to the and ovulation and you know when the hormonal cycle that goes along with that there's quite a few things that have been studied within that area that have been shown to influence hormone metabolism and start to normalize some of the key imbalances we see in PCOS. But and you know, there's many different things to choose from.

I could, you know, write a really long list like this inositol and vitamin D and probiotics seem to have some effect and acetyl cysteine and even things like fish oil and then some herbs like licorice, champagnie and spearmint and so on.

But I think if I could pick one or wanted to focus in a in a particular area that has more evidence, I think, than it has the more robust clinical data behind that.

That's Myo Inositol. So we can all dove into that and speak briefly to that. So why Inositol is a is actually a vitamin like substance. It was almost classified as a vitamin but didn't quite meet the the criteria or you know, but it works in a very similar way.

It's a nutrient that's widely present in natural Whole Foods, and it plays a really important role in human metabolism. And one of its functions. We're not sure exactly how it's working, but one of its functions has to do with hormone metabolism to a degree, but more so insulin resistance, which then can have knock on effects on hormone metabolism.

And it's been studied in the context of polycystic ovarian syndrome in a number of human clinical trials. And its effects are fairly clear. Is that really does help to normalize a lot of the metabolic picture we see in PCOS would be insulin resistance and some of the lipid ANA maladies that to your point, more importantly, it works on this hormonal sequel.

So it does seem to lower some of the or improve some of the abnormalities that we're seeing or or alterations that we're seeing and improve, importantly, ovulation fertility rates.

So there have been in these clinical trials that have been conducted, has been observed that it can really help improve ovulation and restore ovulation, improve regularity, but also importantly improve fertility as well and actually improve pregnancy rates and outcomes.

So I think that's a really important nutrient for listeners to be aware of. Oh, I 100% agree. I know there's been quite a bit involving the use within IVF and improving embryo quality implantation rates and so on.

So I agree everyone put a big circle around Myo Inositol and one of the things that you mentioned is how well a lot of the nutrients as supplements that you mentioned would have a wide array of benefits.

That's, I think, a very important takeaway. Wouldn't you agree that if you give something for one thing, it's side effects are probably benefits for something else that women with PCOS are dealing with.

And I think one that you mentioned, I just want to bring bring it up as a sort of almost a unique category in itself would be vitamin D. So maybe you could just mention like vitamin D, what does it do in the body?

And, you know, why should women with PCOS really want to be supplementing with it in most cases? Yeah. Yeah. And you're absolutely right as it is most cases.

So just to wind it back is what we know in women with PCOS is there's a much higher risk of vitamin D deficiency. And this in this group of women and and you know the answer to what does it do in the body is is more like what doesn't it do you know that would be easier to answer.

And and the answer is like probably there's nothing it doesn't do. And the reason its effects is so profound and work across so many different areas is that it's really fundamental to a lot of these very low sort of metabolic functions throughout the body.

Vitamin D and PCOS Support

And that sounds really complex, but the relevance of that to someone with PCOS is that it works across many different areas that are very important, like lipid metabolism, hormone metabolism, insulin sensitivity as well.

You know, and others. So what we do know about vitamin D is that you need to get your levels checked, like, you know, work with your doctor to define your levels and then to find a management regime with vitamin D and, you know, sensible sun exposure.

And what we see is that as you normalize and bring that vitamin D level back up to a healthier range, you will likely see subtle improvements across many different areas, including you know, blood glucose metabolism and hormone levels and even things like mood, you know, which might be a, you know, a problem for some people, you know, can start to improve with vitamin D.

So it's hugely important, very relevant to most people. And, you know, you need to get those levels checked out. Vitamin D is in the family of fat soluble vitamins.

So would it matter whether you took it with or without food or any particular type of food if you want to try to actually get it into you? Yeah, it's a good practical question and the answer is yeah, I think very good idea to take it with meals and generally speaking, people will eat a little bit of fat.

You don't need a lot to enhance fat soluble vitamin absorption. As little as a teaspoon will be enough so a generally any meal that has any sort of healthy fat in there will, you know, help optimize the absorption.

Not essential, but it will definitely help. Great. And one of the other supplements you mentioned, which is a favorite for many who deal with women with PCOS, is an AC or ANICETO system.

You mentioned that in the context of helping with ovulation, maybe you could share a little information about that particular supplement and what we know about it in terms of what it is doing in the female body.

Yeah, I mean, to be honest, you might have a better idea than me. I mean, I've spent quite a bit of time looking at the fine metabolism and then I say and probably some work in this area, but in terms of gynecology, you might be able to enlighten me.

What I can say is that from the human clinical work we know for sure there's this benefit. And you know, the I don't know if we want to go into the doses that are used specifically because it can be quite personal.

You need to check with your doctor that around 600 to 1200 milligrams a day in divided doses. And what these clinical trials are suggesting is that it does a lot.

So it's improving. You know, some of the key issues like hormone metabolism and insulin sensitivity and, you know, cardio metabolic health, that also has some interesting other effects, like addressing things like oxidative stress and inflammation.

And this has this really ubiquitous effect across metabolism. So I, I don't know if you can enlighten us on how it's working in the gynecological system specifically, but that's that's what I know clinically.

Well, I don't know exactly on the intracellular level either, but it does have a broad spectrum of benefits involving just what you said, oxidative stress and glucose metabolism and anything that improves it, like reduces an inflammatory state in the ovary and improves the ability of the ovary to utilize glucose for energy is going to help the ovary to work better.

NAC and Other Supplements for Insulin Resistance

So it's definitely considered one of the mainstays in a supplements are used in women with PCOS now women with PCOS as a group tend to towards insulin resistance.

What else can women use in addition to all the other lifestyle, nutrition? But in terms of supplements, what other supplements can be possibly beneficial for women who have PCOS and insulin resistance?

Yeah, this there's a long list but some of the the ones that I, I think again for me really stand out because the because of the quality of the evidence, you know that it's reliable.

We know they work and that they're safe and they can be quite useful. You know, simple things like I think, you know, I guess chromium, we haven't spoken to.

It's very simple trace mineral. And again, that's a little bit like some of the other nutrients we've spoken to is people are generally not getting enough in their diet and it helps improve insulin sensitivity, which as you've just spoken to, you know, helps improve the whole picture in terms of hormone metabolism and ovarian function and so forth.

And there's another mineral that falls into that camp that's probably even more important. We don't have the human clinical trials yet, but from observational studies we know for sure it's key and that's magnesium.

So so magnesium is, you know, it's a bit like the vitamin D no one's talking about because no one is getting enough in their diet. And when you don't get enough of this nutrient, your blood glucose metabolism really suffers.

And that's going to have huge implications for PCOS and cardio metabolic health and hormonal function. So I think, you know, just picking off a couple is those those nutrients or those minerals are really are really key.

And then I think something that might be worth speaking to is and this is a bit left of field almost is probiotics and and I say left the field because everyone's interested in the gut microbiome and fermented foods and probiotics like this buzz thing.

But yeah, we need to, you know, when something's a bit, you know, gets a lot of attention like that, we need to look at it cautiously. But what we are seeing is that there is something to this.

And probiotics, generally speaking, do seem to have some subtle benefit towards improving metabolic health in PCOS, but in general they may help support healthy blood glucose and lipid metabolism and so forth.

So there is something to it and it might be worth considering if you feel like, you know, if that fits the picture. Now, in terms of probiotics, are there any particular strains of probiotics that you recommend or how would somebody choose like if you going to a health food store?

I mean, there's a wide array of probiotics and they have 1 billion, 25 billion. So how would somebody know what to choose? And how about refrigerated versus not refrigerated live versus not live strains?

Maybe you could just tell us a little bit more because it is a lot confusing for most women when they try to go shopping. Yeah. Yeah, it is. And it it's probably the most confusing category of anything as well.

There's so much choice and I can give you a few tips that unfortunately it's not going to help massively. The best thing you could do is speak to someone who knows what they're talking about and ask for a good recommendation.

Because, you know, so someone like Dr. Gersh will will know, you know, which formulas work, what strains are effective and what dose works, that kind of thing.

So it really helps to go to an authoritative source, but very generally speaking, you know, you want a product that has clinical trials for what you want it, you want to use it for behind it.

So if you're generally speaking, if you're looking at something for PCOS, for example, it's really good to know if there's a clinical study in PCOS with that particular product and it won't always be the case and sometimes that generalizable.

But you know, beyond that, just a really good product with well studied strains at a dose that matches the clinical studies that you can see and not really helping you much.

But then in terms of potency, don't be tricked by more is better. It's not always the case. Sometimes probiotics work in a dose of millions, sometimes in trillions.

But it really depends on the product. So it's it's not necessarily more is better. But again, just looking for a dose that's been shown to work of that particular product and should it be in the fridge or out?

I think putting things to caution, especially if you live in a warm, you know, state or environment or whatever, is just storing them in the fridge is good practice if you can.

But generally speaking, a lot of products now are sort of shelf stable and they will have tests behind them to show that you can just leave them on the bench for the rest of your vitamins now.

So it makes it a bit more convenient if that if that's what works for you. So there's a few little insights that's great. And here in the United States, there's been this big explosion in the use of these drugs for weight loss and diabetes, insulin resistance, the GLP one agonist and some people are talking about Berberine as sort of like the natural version or that it can help.

So women are like here, you know, looking at, well, what is berberine? So maybe you could share a little bit about Berberine and is that something that you ever would recommend for women with PCOS who have insulin resistance?

Yeah, I think Berberine is really useful.

Probiotics and Berberine for Metabolic Health

It's a very interesting compound. So its origins actually come from herbal medicine primarily, and it's a chemical present in plants that have been traditionally used for things like, you know, blood glucose and weight loss and heart health and things like that and basically, it's, it's fascinating how it works is that actually it's probably mostly working on your gut bacteria.

Very little of it is actually absorbed. And through this interesting effect on your gut bacteria, it does seem to have quite potent effects on metabolic health, particularly blood lipids and cholesterol and blood glucose.

And there's so much research on berberine like people are surprised when they learn how much is there. But what we know from that work, which is primarily for blood glucose metabolism, is that it is comparable.

I don't know about the GOP one agonist, but it's comparable to things like metformin in terms of its effects on blood glucose. So you can really look at it as a safe blood glucose metabolism enhancing maybe to help balance your blood lipids as well, you know, nutraceutical and natural products.

Yeah. So yeah. Well, that's great. I know that Berberine is one of my, you know, go tos a lot for women with insulin resistance and you know, we talk around a bit, you know, the gut so you know probiotics a lot of people think of it for the gut.

But like you said, it actually can have a myriad of benefits, but a lot of women have Earbud Bell Syndrome or they have GERD acid reflux. Sometimes they have constipation, sometimes they have diarrhea.

It's a just a lot of bloating. So any things that you can just generally recommend for gut health other than probiotics? Yeah, it's a it's a good question.

I'm a big I mean, I've written a book on IBS if people want to look it up, not selling it here, but there's some recommendations. They it's called the Digestive Health Solution.

But two things that are not even products. They're foods that I think are really useful. One of them is linseed oil, flaxseed meal. So if you're you know, if you there's lots of different types of bowel problems, basically.

And and it's hard to know, you know, what any person is experiencing and what's best for them. But two foods that I think are really great is linseed oil, flaxseed meal, ground up about one or two tablespoons a day.

If you have more constipation, predominant symptoms and, you know, drink a glass or two of water when you take that and essentially that, it's a really easy natural source of fiber that doesn't it's very unlikely to cause more bloating, which is one of the real problems with a lot of fiber type supplements, is they can just aggravate things even more.

So that's a really simple food medicine kind of approach. And another one I really like is, is kiwifruit. You know, the little green fruits. So people again are surprised to learn this, but there's a huge amount of human clinical work on kiwifruit as a medicine for bowel disorders and they're really great for irregularity, particularly constipation, predominant symptoms, but also pain.

And, and that goes along with that. And the way they work is fascinating. They're really they're full of an enzyme. And that helps improve the breakdown of food, but also improves your gut function and improves the muscular contractions and movement.

And by eating two of them a day for about four weeks. So it doesn't work overnight, you need to stick with it for about four weeks. You can really see significant improvements in gut health function and regularity and and pain and so forth.

So, you know, not products but but foods. And those are two things that are worth knowing about. Well, that is great. And the the beauty with the flax seed, of course, is that it's also a phyto estrogen and has a lot of those additional like collateral benefits.

So that's really that's great. And I'm a big fan of Kiwi for gut health as well. And it doesn't get talked about anywhere near enough and in terms of emotions.

So women with PCOS tend to be more stressed, they have more anxiety, more depression, more trouble sleeping.

Gut Health Strategies for Bloating and Constipation

So any just general suggestions for women who like their brain is going a mile a minute, they can't fall asleep or they just feel wired all the time or just low and supplements that might be generalizable to the group of PCOS women who are having emotional issues.

Yeah, it's I mean there's so much that nutrition can do for that. And I mean, outside of food and diet and and integrative medicine like mindfulness and yoga and stuff like that, there are some really good things that come compliment, you know, and help regulate emotions and balance that instability.

And I guess there are different ways of looking at it and it depends a bit on your symptoms, but if there are more depressive type symptoms, I'm a huge fan of saffron.

So Saffron, you know, this beautiful spice, a huge amount of human clinical data on it for depression, but also helps with things like insomnia over time, you know, extract level at 30 milligrams a day and, you know, keep on it for a few months.

And one of the neat things about Saffron is if you are using medication, there's no known interactions with a you know, antidepressants, it seems seems to be quite safe.

But again, check with your doctor. So that's it. You know, if you've got more depressive type symptoms, that can be really useful. If you've got really anxious type symptoms, there are a few things that stand out.

One of them is I really like ashwagandha or what they use on the Farah old age Vedic herb, a dose of say 500 milligrams to 600 milligrams daily, you know, in a single or divided dose doesn't matter too much.

Really beautiful anxiolytic has some side effects like it improves your energy, it helps with thyroid function, it has all these other interesting benefits, as you point out and and, you know, and then a few nutrients like, again, magnesium and really important, even something as simple as a b-complex complex can be really valuable.

And so on this probably we could just go on all day about that. But there's a there's a few things to to think about. Absolutely. And you mentioned thyroid.

So Hashimoto's, thyroiditis or hypothyroidism is extremely common in women with PCOS beyond the the general population of women. So any nutraceuticals or, you know, nutrient that might help them to produce thyroid better or have the thyroid perform better.

Yeah, absolutely. This and I think this is really overlooked, sadly, is that, you know, people are often just put on thyroid hormone, but there are a whole load of nutrients that you need for your thyroid to function well that for some reason people have, you know, forget about in more conventional medicine.

But, you know, we should be starting there and things like iodine and selenium and zinc, vitamin D, you know, these things are really fundamental to thyroid function.

And often people starting on those simple things that are equal inverse and you know, not just the hormone levels but even the antibodies can go down.

You know, if they're elevated with something like selenium, then that and it's like, why is you know, why is this not more widely known? So, you know, some some great things that we can do nutritionally to help optimize thyroid function, which would be, you know, very relevant to PCOS and in some cases.

Well, that is great. I know most people don't even know what selenium is, right?

Mood, Sleep, and Stress Support

And so and how it is to having proper thyroid production. So that's great advice and zinc as well in mentioning zinc. So that brings in the skin. Unfortunately, women with PCOS will often have really stubborn and difficult to treat acne.

So is there a role for a zinc or any other nutraceuticals or herbals that can help women with acne? Yeah, absolutely. And you know, one of the great tragedies in medicine is that the relationship between nutrition and skin has been really ignored for a very long time.

And acne is a is a classic example. It responds can can respond very well to nutritional treatments and interventions. So zinc is a great example and you've raised it works as a to help improve insulin sensitivity which underlies acne.

Like people don't make this connection but bad food like junk food raises your insulin and a few other hormones that stimulates skin cells to like make more sebum get blocked up and cause acne.

And you know, in the case of PCOS, that's compounded by elevated androgens and you know, the whole line all changes. And you know, I wonder, we have a lot of acne, so some of these nutrients can really reverse that picture.

Zinc is one that helps improve the insulin sensitivity. It also helps normalize hormones that importantly, zinc in the skin is like a natural anti-inflammatory, antibiotic type substance as well.

So it really can make a big difference. And then, you know, there are other nutrients as well. I mean, anything that helps improve insulin sensitivity like Myo Inositol and chromium and magnesium we've all spoken to, you know, could benefit that picture and help improve skin condition.

Now, some women become desperate and they end up taking Accutane, which is like a very, very high potency synthetic form of vitamin A. So how about vitamin A or versus taking RETINOIDS or, you know, what's the role of vitamin A in the skin?

And and what should women with PCOS do who don't want to go on Accutane, but they want to have better skin? Is there a role for taking any vitamin A? Yeah, there is.

But the the trick with vitamin A is is you want to you want to make it you don't want to go like the drug approach. So the, you know, rocky chain is basically like a vitamin A type analog.

And it they're just using a really high dose to suppress the acne, basically. And then you don't want to mimic the with vitamin gods natural and just take loads of vitamin K you still want a little bit of vitamin E is going to be very important for skin health and function, but more like the level that's in a really good multivitamin and and healthy food and so forth.

And that will support the picture. But really what you want to get to is like what's causing the acne in the first place.

Thyroid, Acne, Androgens, and Closing Resources

And, you know, it's it's the insulin resistance and the hormonal abnormalities that go along with PCOS. So it's a you know, it's about understanding that the solution is not hitting it with a drug.

It's understanding the biology and the function and where it's coming from and and some of the nutrients that can help normalize that metabolic picture that we've already spoken to.

I definitely wanted people to know that they shouldn't go out there and megadoses themselves on, you know, pre-formed vitamin A because there are toxicities when you do that.

So don't go out there and try to mimic Accutane with vitamin A, right? That's dangerous. The don't do it. Yeah, right. And we can't finish without talking about testosterone or androgen excess.

You know, we talked about, of course, acne has some relationship to that. Is there anything out there while you're working on all of these other issues that are underlying a lot of the metabolic issues and gut issues and so on that women can do to just lower elevated androgens.

Naturally, anything that you can recommend? Yeah, it's a it's a great question. And actually a few of the things firstly we've spoken to will support that.

So my inositol and I see and so forth. So there's a really good list we've already covered, but I'm going to go left field and add something here in here because this story is is sort of fun.

Is this so what happened was a few several years ago in Turkey, a medical clinic was finding all these men coming in with really low testosterone and they tried to work out what's happening, like why is this bunch of men getting really low testosterone?

And they traced it back to the mint tea that they were drinking. So the men take it and then they tested that. And they showed in animal models that spearmint has this testosterone lowering type effect.

And then, you know, putting two and two together, some scientists said, well, that's really interesting. Let's test this in women with PCOS. So they tested and see in women with PCOS and it had a mild testosterone lowering effect.

And it also seemed to benefit some of the other problems like the positives and and so forth. So I think that's just the really interesting simple thing that people could look at doing.

If you like men to try and find a supplement if you can, and you know, two cups of that a day would be plenty. It's just a complement to your therapy and you know, will help support that improvement in metabolic some while you're working on other things.

I don't think you could have ended on a more positive suggestion than that because how women feel about themselves when they have hirsutism and androgenic alopecia and acne is is is just so demoralizing, right?

So just having the idea that you could relax or lower your stress, have two nice mugs of spearmint to a day and improve. All of that is like phenomenal.

So for those out there who say, I want to learn more, so how can they find out more of follow you and really get a deep dove? Well, you know, for self-help, obviously, like you said over and over, we definitely need everyone to find a really great practitioner to help guide them because everyone's an individual.

So these are broad general recommendations. But how about you? How can we find you and follow you? Absolutely. I'm I'm not so active on social media, but you can connect in by going to scientificwellness.com.

And then you'll find things like book and social media and links and stuff like that. So that's my own website, scientificwellness.com. And then if you're a, you know, if you're a health professional, which might be the case is you can go to the Nutritional Medicine Institute, which is nmi.health and, and see what we do there with the journal and conferences and so forth. So yeah, that's that's the short, the short answer to that.

And yeah. And maybe you could repeat the name of your book. Yeah, the book is The Digestive Health Solution, and it's in its second edition, so you can look for the second edition.

It's got a few nice updates in there and that is a consumer book. So, you know, anyone can pick that up and read it and, you know, focus on just improving gut health and function, particularly for people with IBS like symptoms.

That is great news for women with PCOS because the book, the vast majority of them will suffer from those types of symptoms. So thank you again, Ben, so much for sharing your wisdom and your wide array of knowledge on this topic of nutritional supplementation for women with PCOS.

Thanks again and I look forward to working with you. Maybe seeing you in England one of these days. You will and you know, again, a huge honor to be involved with this and, you know, a massive fan of the work that you're doing.

It's really important. So happy to support it in any way. Thanks for having me.

Benjamin Brown, ND

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