Vitamin D Improves the Metabolic Health of Women with PCOS
Polycystic ovary syndrome (PCOS) heightens your risk of metabolic disorders, but recent research shows that vitamin D supplementation counteracts this and enhances your metabolic parameters.
STORY AT-A-GLANCE
Vitamin D deficiency and insufficiency are prevalent among PCOS patients, especially those with insulin resistance and obesity, as highlighted by numerous epidemiological studies
A July 2024 study published in the Journal of Ovarian Research found that vitamin D supplementation in PCOS patients with deficiency improves metabolic parameters, including body mass index (BMI), insulin sensitivity and lipid profiles
PCOS is associated with an increased risk of eating disorders, particularly bulimia nervosa and binge eating disorder, as well as an elevated risk of Hashimoto's disease
By addressing gut microbiome imbalances and optimizing your vitamin D levels, you’ll be able to manage PCOS more effectively, as it positively influences your gut-brain axis
Additional strategies for managing PCOS are included below, such as reducing your PFAS exposure, lowering your stress levels, addressing excessive estrogen load and helpful supplements
Polycystic ovary syndrome (PCOS) is a common endocrine disorder that affects 6% to 10% of women of childbearing age worldwide.1 Characterized by irregular menstrual cycles, elevated androgen levels and ovarian cysts, PCOS impacts not only fertility but also overall metabolic health. It has been associated with numerous metabolic disorders, including Type 2 diabetes, cardiovascular disease and nonalcoholic fatty liver disease (NAFLD).2
While there's no cure for PCOS, effective strategies exist to manage its symptoms and the related metabolic disorders. One such approach is vitamin D supplementation, as numerous epidemiological studies have highlighted the prevalence of vitamin D deficiency and insufficiency among PCOS patients, especially those with insulin resistance and obesity.
To investigate the role of vitamin D status on PCOS, researchers from Xi'an Jiaotong University in Shaanxi, China, conducted a randomized controlled trial3 on vitamin D-deficient PCOS patients and found that supplementation led to beneficial effects on the women's metabolic parameters.
The Link Between Vitamin D and PCOS
The featured study, published in July 2024 in the Journal of Ovarian Research,4 involved 60 PCOS women with vitamin D deficiency or insufficiency. They were randomly divided into the vitamin D group and the control group, with each group consisting of 30 participants.
The vitamin D group received a daily supplement of 2,000 IU of vitamin D for 12 weeks, in addition to basic treatment that included dietary advice and recommendations for outdoor aerobic exercise. The control group only received the basic treatment without vitamin D supplementation.
Throughout the study, researchers measured several key parameters, including serum 25-hydroxyvitamin D (25(OH)D) concentrations, insulin levels, lipid profiles, body mass index (BMI), waist-to-hip ratio (WHR) and lipid metabolism parameters.
The results revealed significant improvements in the vitamin D group compared to the control group. PCOS women who received vitamin D supplements experienced increased serum 25(OH)D concentrations, reduced BMI and WHR, lower insulin levels and improved insulin sensitivity. They also showed decreased triglycerides and LDL-cholesterol levels. These improvements were more pronounced in obese participants and those with insulin resistance. The authors concluded:
"This study provides evidence that vitamin D supplementation significantly increased serum vitamin D concentration in PCOS women with vitamin D deficiency and insufficiency.
Furthermore, this RCT (randomized controlled trial) study supports beneficial effects of vitamin D supplementation on metabolic parameters in PCOS women, including significant improvements in BMI, WHR, serum insulin concentrations and HOMA-IR [a measure of insulin resistance], lipid metabolism parameters, especially in women with obesity or IR (insulin resistance)."5
Recent Study Shows PCOS Increases the Risk of Eating Disorders
In addition to metabolic disorders, PCOS has also been associated with an increased risk of developing eating disorders, as evidenced in a systematic review and meta-analysis published in August 2024 in The Journal of Clinical Endocrinology and Metabolism.6
The researchers analyzed data from nearly 29,000 women with PCOS across nine countries, comparing their outcomes to those of over 258,000 women without the condition. Their findings showed increased odds for specific types of eating disorders in women with PCOS, particularly bulimia nervosa and binge eating disorder.
In a press release from the Endocrine Society,7 the study's lead author, Dr. Laura Cooney from the University of Wisconsin, stated:
"This analysis is the first time we've been able to confirm an increased risk of specific eating disorders, including bulimia nervosa, commonly called bulimia, and binge eating disorder. Many women with PCOS experience weight stigma, and that can be detrimental to mental health generally and contribute to disordered eating."
They also found that women with PCOS had higher mean disordered eating scores, regardless of their BMI. This suggests that the link between PCOS and eating disorders is not solely dependent on weight but also influenced by other factors associated with the condition.
While no link was found between PCOS and anorexia, the researchers emphasized the importance of remaining vigilant for any disordered eating patterns in individuals being evaluated for PCOS.
"Our findings emphasize the importance of screening women with PCOS for eating disorders before clinicians share any lifestyle advice," Cooney noted.
"The lifestyle modifications we often recommend for women with PCOS — including physical activity, healthy diet and behavior modifications — could hinder the recovery process for eating disorders. Health care providers need to be vigilant about screening for eating disorders in this population."
PCOS Is Also Linked to Elevated Risk of Hashimoto's Disease
Another condition commonly seen in women with PCOS is Hashimoto's disease, also called autoimmune thyroiditis. This autoimmune disorder targets the thyroid gland, leading to insufficient production of thyroid hormones (hypothyroidism).8 A meta-analysis published in Frontiers in Endocrinology9 delved into the association between these two conditions.
"This meta-analysis showed that patients with PCOS were more likely to develop HT (Hashimoto's thyroiditis) than those without PCOS," the authors wrote.
"At the same time, the study demonstrated that the risk of PCOS in HT patients is higher than that of non-HT patients. These findings suggest a significant association between PCOS and HT."
The researchers highlighted several factors contributing to this connection, including genetic, metabolic, hormonal and immune factors. Specifically, genes like fibrillin 3 (FBN3), which affects transforming growth factor beta (TGFβ) levels, could be involved in the pathogenesis of both PCOS and Hashimoto's disease.
TGFβ plays a role in immune regulation, and lower levels in patients with both conditions reflect disrupted immune processes. Additionally, chronic low-grade inflammation and metabolic abnormalities associated with PCOS further contribute to its link with Hashimoto's disease.
The Role of Your Gut Health in These Interlinked Conditions
Emerging research10 11 suggests that gut health plays a role in the relationship between PCOS, thyroid disease and eating disorders. Imbalances in the gut microbiome influence the gut-brain axis, which in turn affects immune system function and inflammation.12
For instance, a compromised gut barrier, or "leaky gut," exacerbates autoimmune responses and chronic inflammation. This dysbiosis not only contributes to the symptoms of PCOS13 and Hashimoto's disease14 but also impacts the development and progression of eating disorders.15
Addressing your gut health, therefore, offers benefits for managing PCOS, Hashimoto's disease and associated eating disorders by reducing inflammation and improving overall immune function. I recommend you start by lowering your linoleic acid (LA) intake, which is found in seed oils used in most ultraprocessed foods. Other LA-rich foods you need to avoid include seeds and nuts, as well as chicken and pork fed a diet high in PUFA (polyunsaturated fats).
It's also ideal to avoid using antibiotics unless absolutely necessary, and eliminate conventionally raised meats from your diet, as animals raised in concentrated animal feeding operations (CAFOs) are routinely injected with antibiotics.
If you do take an antibiotic, make sure to reseed your gut with fermented foods and/or a high-quality probiotic supplement. Regular consumption of fermented foods will also help maintain a healthy gut microbiome.
Learn more tips to optimize your gut microbiome in my article, "Why You're Bloated and How to Address It." Interestingly, bloating is also a common symptom of PCOS, often associated with imbalances in the microbiome and hormones.16
Considerations for Optimizing Your Vitamin D Levels
Going back to vitamin D, research indicates that optimizing your levels not only alleviates PCOS symptoms but also enhances the outlook for eating disorders17 18 and thyroid conditions.19
While the Journal of Ovarian Research study focused on supplementation to optimize vitamin D levels, I recommend getting this nutrient from proper sun exposure, if possible, as it provides benefits beyond vitamin D optimization, such as a reduced risk of cancer,20 enhanced melatonin production21 and increased longevity.22
However, while sun exposure is important for overall health, keep in mind that it can also be harmful if you're not careful. Your diet is one of the most important factors you need to address before spending time in the sun. If your diet is high in seed oils (rich in LA), you need to approach sun exposure with caution, as these oils migrate to your skin and oxidize in when exposed to sunlight, causing inflammation and DNA damage.
As a result, you're more prone to sunburn when you're on a high-LA diet. I recommend avoiding high-intensity sun exposure until you've been off seed oils for four to six months. At that point, you can gradually increase your sun exposure. Eventually, you will be able to enjoy an hour or more of peak sunlight hours without the risk of sunburn.
If you're unable to get adequate sun exposure, vitamin D supplementation is a wise choice. For health and disease prevention, aim for a level between 60 ng/mL and 80 ng/mL. In Europe, the measurements you're looking for are 150 to 200 nmol/L, respectively.
To determine how much vitamin D3 you need to take, measure your vitamin D level, ideally twice a year. Your ideal dose is whatever it takes to keep you within that 60 ng/mL to 80 ng/mL range. It's also important to remember that calcium, vitamin D3, magnesium and vitamin K2 must be properly balanced, as these four nutrients work together.
More Strategies to Improve PCOS Symptoms
Other lifestyle strategies for reducing PCOS symptoms and enhancing reproductive health include:
Consider using natural remedies for support — Incorporating these natural supplements into your health regimen provides additional support in managing PCOS symptoms:
CoQ10 — A study in Reproductive Sciences23 found that CoQ10 is a safe and effective treatment for PCOS as it enhances insulin sensitivity, increases sex hormone levels and improves blood lipids.
Ashwagandha — An adaptogenic herb with multiple purposes, ashwagandha has been shown to improve PCOS by rebalancing hormone levels, including thyroid hormone, estrogen and progesterone.24
Licorice — Research25 shows licorice provides adrenal gland support, reduces androgen levels, exerts anti-inflammatory effects and improves the symptoms of PCOS, including weight loss.
L-Carnitine — A systematic review and meta-analysis26 involving women with PCOS revealed that carnitine supplementation ranging from 250 to 3,000 milligrams daily for 84 to 90 days significantly improved ovulation and pregnancy rates, while reducing BMI and insulin resistance.
Inositol — According to a study in Reproductive Biology and Endocrinology,27 inositol is a safe and effective treatment for PCOS as it improves menstrual regularity, glucose levels and other metabolic markers.
Lower your stress levels — Chronic stress exacerbates PCOS symptoms by increasing your cortisol levels,28 which in turn leads to insulin resistance and hormonal imbalances. Incorporating stress-reducing strategies, such as mindfulness meditation, regular exercise and breathing techniques, is beneficial for managing your symptoms and improving your overall well-being.
Learn more ways to address stress in my article, "‘Stressed' — An Eye-Opening Perspective on the Effects of Stress." Progesterone can also lower cortisol levels (I'll discuss how to use it below). I recommend reading "What You Need to Know About Estrogen and Serotonin" to learn more.
Reduce your PFAS exposure — Per- and polyfluoroalkyl substances (PFAS), aka "forever chemicals," are endocrine-disrupting chemicals (EDCs) that have been linked to hormonal disruptions, reduced fertility and an increased risk of PCOS.29 Some of the household items you need to avoid to reduce your exposure to these chemicals include:
Items pretreated with stain repellents, such as new furniture and carpets
Water- and/or stain-repellent clothing
Items treated with flame-retardant chemicals, such as furniture, mattresses and pillows
Fast food and carry-out foods
Microwave popcorn
Nonstick cookware and other treated kitchen utensils
Oral-B Glide floss and any other personal care products containing polytetrafluoroethylene or "fluoro/perfluoro" ingredients
Address excessive estrogen load — Women with PCOS typically produce excessive amounts of estrogen, a condition known as estrogen dominance, which further exacerbates symptoms such as irregular periods, unwanted hair growth, weight gain and acne. Unfortunately, estrogenic substances are ubiquitous in the environment.
To reduce your estrogen load, choose products that are Earth- and animal-friendly, sustainable, certified organic and GMO-free. This goes for everything from food and personal care items to building materials, carpeting, paint, baby products, furniture, mattresses and more.
It's also ideal to replace plastic containers with glass or stainless steel alternatives to minimize your exposure to estrogen-mimicking chemicals like bisphenol-A (BPA) and its substitutes. Additionally, switch to natural cleaning products to reduce your overall exposure to xenoestrogens in your environment.
EDCs like xenoestrogen activate the estrogen receptors. To counteract this effect, you can also use transmucosal progesterone, mixed with vitamin E, as described below.
How to Use Progesterone
Before you consider using progesterone, it is important to understand that it is not a magic bullet, and that you get the most benefit by implementing a Bioenergetic diet approach that allows you to effectively burn glucose as your primary fuel without backing up electrons in your mitochondria that reduces your energy production. My new book, “Your Guide to Cellular Health: Unlocking the Science of Longevity and Joy” comes out very soon and covers this process in great detail.
Once you have dialed in your diet, an effective strategy that can help counteract estrogen excess is to take transmucosal progesterone (i.e., applied to your gums, not oral or transdermal), which is a natural estrogen antagonist. Progesterone is one of only four hormones I believe many adults can benefit from. (The other three are thyroid hormone T3, DHEA and pregnenolone.)
I do not recommend transdermal progesterone, as your skin expresses high levels of 5-alpha reductase enzyme, which causes a significant portion of the progesterone you're taking to be irreversibly converted primarily into allopregnanolone and cannot be converted back into progesterone.
Ideal Way to Administer Progesterone
Please note that when progesterone is used transmucosally on your gums as I advise, the FDA believes that somehow converts it into a drug and prohibits any company from advising that on its label. This is why companies like Health Natura promotes their progesterone products as "topical."
However, please understand that it is perfectly legal for any physician to recommend an off-label indication for a drug to their patient. In this case, progesterone is a natural hormone and not a drug and is very safe even in high doses. This is unlike synthetic progesterone called progestins that are used by drug companies, but frequently, and incorrectly, referred.
Dr. Ray Peat has done the seminal work in progesterone and probably was the world's greatest expert on progesterone. He wrote his Ph.D. on estrogen in 1982 and spent most of his professional career documenting the need to counteract the dangers of excess estrogen with low LA diets and transmucosal progesterone supplementation.
He determined that most solvents do not dissolve progesterone well and discovered that vitamin E is the best solvent to optimally provide progesterone in your tissue. Vitamin E also protects you against damage from LA. You just need to be very careful about which vitamin E you use as most supplemental vitamin E on the market is worse than worthless and will cause you harm not benefit.
It is imperative to avoid using any synthetic vitamin E (alpha tocopherol acetate — the acetate indicates that it's synthetic). Natural vitamin E will be labeled "d alpha tocopherol." This is the pure D isomer, which is what your body can use.
There are also other vitamin E isomers, and you want the complete spectrum of tocopherols and tocotrienols, specifically the beta, gamma, and delta types, in the effective D isomer. As an example of an ideal vitamin E, you can look at the label on our vitamin E in our store. You can use any brand that has a similar label.
You can purchase pharmaceutical grade bioidentical progesterone as Progesterone Powder, Bioidentical Micronized Powder, 10 grams for about $40 on many online stores like Amazon. That is nearly a year's supply, depending on the dose you choose.
However, you will need to purchase some small stainless steel measuring spoons as you will need a 1/64 tsp, which is 25 mg and a 1/32 tsp, which is 50 mg. A normal dose is typically 25-50 mg and is taken 30 minutes before bed, as it has an anti-cortisol function and will increase GABA levels for a good night's sleep.
Unfortunately, this vendor frequently runs out of product, and if that’s the case, then you can use Simply Progesterone by Health Natura. It’s premixed with vitamin E and MCT oil. Again, while Health Natura states that its product is for “topical use only,” I recommend applying it transmucosally, by rubbing it on your gums.
If you are a menstruating woman, you should take the progesterone during the luteal phase or the last half of your cycle, which can be determined by starting 10 days after the first day of your period and stopping the progesterone when your period starts.
If you are a male or non-menstruating woman, you can take the progesterone every day for four to six months and then cycle off for one week. The best time of day to take progesterone is 30 minutes before bed as it has an anti-cortisol function and will increase GABA levels for a good night's sleep.
This is what I have been personally doing for over a year with very good results. I am a physician so do not have any problems doing this. If you aren't a physician, you should consult one before using this therapy, as transmucosal progesterone therapy requires a doctor's prescription.
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