Functional Medicine and Women’s Health: Interview with Joel Evans, MD
Part 2: PCOS & Preconception Care/Fertility
In this series, we sat down with Joel Evans, MD to talk about Functional Medicine options for common women’s health issues.
Q: What is polycystic ovarian syndrome (PCOS), and what causes it?
A: In order to understand polycystic ovarian syndrome, it’s important to understand that it is a syndrome. When we use the word “syndrome” in medicine, it usually means there are many different symptoms and many different causes. PCOS has hyperandrogenism, or elevated androgens, irregular ovulation, elevated insulin and irregular menses.
The cause is totally unknown. What we do know is that there are different underlying metabolic abnormalities to PCOS, and those metabolic abnormalities that cause PCOS also can cause problems later in life. When we look at underlying causes, what we see are usually elevated insulin, or insulin resistance, as the common cause. What we then see as the common metabolic downstream consequences are increased lifetime risks of type 2 diabetes, fatty liver, metabolic syndrome, high blood pressure, and obesity.
Q: What are the symptoms of PCOS?
A: Irregular ovulations, which means irregular or absent period, and unwanted hair on the body. In addition, some women experience heavier bleeding and infertility.
Q: How is PCOS treated in a traditional medicine environment?
The first question we ask is, does the woman want to get pregnant now? If the answer is yes, she gets medications to make her produce an egg, to make her ovulate. If she doesn’t want to get pregnant now, it’s usually treated with birth control pills and/or metformin, which is something to normalize insulin levels.
Q: How does Functional Medicine treat PCOS?
A: In Functional Medicine, there are many different ways to address PCOS. We have all of these protocols to normalize insulin levels because elevated insulin is usually the underlying imbalance. The ways we know to normalize insulin levels include: eating a low-glycemic, Mediterranean style diet or a ketogenic diet, depending on patient and practitioner preference, achieving the ideal body weight, and supporting healthy glucose and insulin levels using supplements like cinnamon, chromium, vanadium, alpha-lipoic acid, fiber, and rho-iso acids. Then there’s a natural compound called inositol. There are two types of inositol supplements. One is called myoinositol; the other is called chiroinositol. Both seem to be equally effective.
Women with PCOS are also helped by reducing oxidative stress, so antioxidants in the form of a phytonutrient-rich diet as well as phytonutrient supplementation is part of the Functional Medicine approach. Additionally products like fish oil, rho-iso acids, and herbs and spices like curcumin, quercetin, bromelain, and the resolvins.
In summary, the Functional approach to PCOS is to achieve ideal body weight, treat metabolic syndrome and dysglycemia, and reduce oxidative stress,
Q: What are typical physiological and lifestyle factors that prevent women from conceiving?
A: The biggest factors that prevent conception are gynecologic issues like failing to produce an egg every month or having endometriosis. There are also non-gynecologic issues like inflammation, oxidative stress, dysglycemia, and other functional imbalances: inflammation in the gut, SIBO; all of those things cause problems with conception.
Q: What diet and lifestyle recommendations do you make to women who are trying to conceive to aid in success and to help give a healthy start to a pregnancy?
A: The best diet is a low-glycemic-index Mediterranean diet. The key is, people must avoid foods to which they’re sensitive. Food-sensitivity testing has an important role here, so if people are sensitive to gluten, dairy, and eggs, when they eat those foods, they will increase the inflammation in their body, and that’s not good.
The best way to eat is a phytonutrient-rich diet, which means fruits and vegetables from all colors of the rainbow. This means a whole-foods diet, not one that has a lot of processed foods, with as much organic as possible.
Reducing stress is a huge issue. That’s pretty intuitive, but it’s not easy to do. I think reducing stress is key. A lot of people don’t realize they need to avoid foods to which they are sensitive, and they often don’t know what those foods are.
Joel Evans, MD
Joel Evans is the Director of The Center for Functional Medicine in Stamford, CT, a member of the core faculty of both The Center for Mind/Body Medicine and The Institute for Functional Medicine, and formerly an assistant clinical professor of Obstetrics, Gynecology, and Women’s Health at the Albert Einstein College of Medicine. He is a nationally recognized wellness expert, educator, author, and physician specializing in nutrition, functional medicine, mind/body medicine, and spirituality. Having pursued studies in spirituality, metaphysics, and personal transformation for many years, Dr. Evans has recently created a core curriculum designed to share ancient spiritual wisdom with others in order to help bring health and happiness into their lives.