PCOS Nutritionist in London

Polycystic Ovarian Syndrome (or PCOS) is a complex hormonal condition that causes the production of too many androgens.

Androgens are the name given to a group of hormones that include testosterone, androstenedione and DHEA-s. They’re made in the ovaries and, very importantly, in the adrenal glands (as well as some fat tissue). When they’re in balance, they help with focus, energy, a fired up sex drive and building muscle. As with anything in life, androgens become an issue when they’re in excess, which is what happens in PCOS. These higher levels of androgens are responsible for most of the PCOS symptoms, including negatively impacting ovulation.

Ovulation is the process where an egg is released each cycle. Every month, there will be 6 – 12 developing eggs, or follicles. The process of ovulation is when one of these follicles becomes dominant and is released. In the case of PCOS, there isn’t a dominant follicle to suppress the growth of the other follicles so we end up with many undeveloped follicles that are ‘stuck’ and that’s what is seen on ultrasound (often referred to as the PCOS ‘string of pearls’).

Here’s the thing though: ovulation is about SO MUCH MORE than just making a baby. Not only is it part of our Essence as women but it’s also considered the six ‘vital sign’ because it is that much of an important indicator for our health. We need regular ovulation for our skin health, our heart health, our bone health, our brain health, our metabolism. In other words, ovulation is a properly big deal!

And the great news? It is very possible to reduce androgens and start ovulating again.

There are other reasons beyond PCOS that can impair ovulation but in the case of PCOS, those high androgens are where our attention is at.

This is the question I’ll be asking myself with each and every client I see – because I take a functional medicine approach, I will push as far upstream as possible to piece together your unique story to understand why androgens are high in your individual case.

But before we get into that, there is something very important that needs to be understood.

Firstly, although research has shown that there very much so is a genetic component to PCOS and high androgens, something that has to be underscored with all the big, bright, flashing neon lights is that genes can be turned on and off by the environment they’re in.

This is called epigenetics.

Let’s use a simple analogy of two Marula trees. One Marula tree is in one field and produces the best Marula fruit you ever did come across while the second Marula tree is in another field, with zero sign of fruit and overall it’s not the biggest fan of life.

When the farmer comes along, she doesn’t look at the tree with no fruit and blame the tree itself, she’ll look at the environment that it’s in: the soil, the water, the sun, the wind. She asks whether there are pests present? A fungus maybe? Perhaps extra nutrients need to be added? So she looks at the environment that the tree is in and makes changes there.

And this is so true when it comes to PCOS: in a given environment, those of us with the PCOS are more susceptible *BUT* through tweaking that environment, PCOS symptoms can be reversed.

And we know that high androgens are a big part of the PCOS picture so what are the main drivers in the environment that are behind high androgens?

Inflammation and/or Insulin resistance.

There are other factors that can contribute to or exacerbate matters (such as the hormonal birth control) but inflammation and/or Insulin resistance are the two most common that I see.

We then zoom out even further to see what else within the environment is behind the inflammation and/or insulin resistance.

This is essentially where we get to finding the root causes (plural because it’s very unlikely that we’re going to discover one single ‘root cause’).

These can range from really simple, to more complex, things.

The root cause(s) allowing the inflammation and/or insulin resistance of PCOS to be present in the environment and therefore trigger high androgens can be anything from digestive issues, presence of parasites or pathogens, food sensitivities, when, what and how we’re eating, a tweaking out thyroid, lack of sleep, stress, strained relationships, a muddled mindset, exercise that’s not suited to your body, environmental toxins, unresolved traumas, mould exposure and more.

As you can see, there are many factors to consider that it often feels too overwhelming to know where to start – like we have to do a gabazillion things all 100% perfectly in order to see a shift in our PCOS symptoms.

But a core Marula Wellness philosophy is that we go deeper before we go wider.

Instead of scattering a whole bunch of seeds in the soil and simply hoping that something will grow, I help you implement foundation food & lifestyle factors that will make a difference to reversing your PCOS symptoms.

More about this approach

In the short term, we’re all about inflammation: it’s our body’s natural way of protecting herself through activating the immune system. You’ve experienced it as the redness, heat and tenderness after stubbing your toe or getting a paper cut.

But chronically, it’s not our favourite because it interferes with hormonal communication throughout the body. When it comes to PCOS, research suggests that it is an inflammatory condition.

Inflammation can cause the ovaries and the adrenal glands to make more androgens and that’s what we experience as hairy chins and chest and bellies, angry jawline acne, male patterned baldness and no ovulation. In addition to the above, other tell-tale signs of chronic inflammation in the body include painful joints, eczema, allergies and fatigue.

Inflammation can also cause insulin resistance. This is really important to understand because it highlights that adjusting carbohydrate intake might only get us so far if inflammation is what’s driving the insulin resistance in the first place.

Not everyone with PCOS has insulin resistance but studies show that approximately 70% do. (It’s also important to note that not everyone with insulin resistance develops PCOS.)

When we eat, there’s a rise in blood sugar (or glucose). Insulin is a storage hormone and its role is to get this glucose from the blood to the cells of the body for energy production and later use (in the liver & muscles).

This process of ensuring that the glucose doesn’t remain in the blood for longer than necessary, needs to happen because if it doesn’t then over time, these high levels of glucose can result in damage to certain organs and glands.

When it works well, it works really well. But when this process happens less efficiently we end up with insulin resistance and higher levels of insulin.

But more insulin is a problem when it comes to those androgens, and here’s why.

Firstly, high levels of insulin stimulate the ovaries to make testosterone.

Secondly, high levels of insulin also cause a drop in sex hormone binding globulin (SHBG) production. SHBG is like a little bus that transports the hormones around the body to where they need to be going, ensuring that they don’t run rampant. So, when SHBG is low (owing to the high insulin), it’s like your local bus service is on strike but there are the same number of people to transport about and we all know how chaotic that can get. The same is true when SHBG is low: low SHBG but the same number of hormones to transport around the body, means that there’s more free hormones (particularly testosterone) floating about the place. We then experience this as the typical PCOS symptoms.

Please also note that a fasting blood glucose test or HbA1c test aren’t sufficient to rule out insulin resistance.

For a very long time, it was thought that one had to be of a fuller weight in order to have PCOS. This however is not true for approximately 30% of women with PCOS; weight gain is just one symptom in PCOS and won’t express for everybody. It’s also important to note that insulin resistance can still play a role even when weight gain isn’t part of the picture (as was the case for me).

On this note, when you aren’t experiencing weight gain and high androgens aren’t seen in symptoms or blood tests but you’re struggling with lack of ovulation and/or menstruation? Together with your doctor, I would then suggest investigating other conditions such as Hypothalamic Amenorrhea or Congenital Adrenal Hyperplasia which can present similarly to PCOS.

I’m not a doctor and I cannot diagnose any condition.

My focus though is always to understand your individual body through a functional lens – one that keeps asking “What’s going on in there for you?”; one that views your body as a unique & beautiful tapestry of interconnected systems; one that knows that symptoms don’t just arise for no reason even if “test results are normal”.

But when it comes to PCOS, I want to make a couple of things really clear.

Firstly, you cannot be diagnosed with PCOS by ultrasound alone and neither can the absence of ‘cysts’ on the ovaries be used to rule out PCOS. Here’s why:

The Rotterdam Criteria is what it is traditionally used when diagnosing PCOS and it states only two of ANY of the following three criteria need to be met for diagnosis:

1. Infrequent or no ovulation
2. Raised androgens seen as either physical signs & symptoms (such as excess hair growth, acne & hair loss) and/or through blood tests
3. Polycystic ovaries as seen on ultrasound

So if we only need to meet two of any of the three criteria, then as you can see that means you can have infrequent or no ovulation with raised androgens and NO polycystic ovaries in order to meet diagnosis.

But the Androgen Excess Society took this a step further in 2009 by releasing a report that emphasises that PCOS does need to be defined by the presence of raised androgens.

Secondly, PCOS is one of the most ridiculous names in the whole world and it contributes hugely to the confusion.

This is because they are not cysts – they’re follicles that were never released when ovulation should’ve occurred; they’ve essentially become ‘stuck’. Every month, there will be 6 – 12 developing follicles. If ovulation occurs, one becomes dominant & is released. In the case of PCOS, there isn’t a dominant follicle to suppress the growth of the other follicles so we end up with many small undeveloped follicles growing just a little bit and that’s what might be seen on ultrasound. It’s also been shown that women without PCOS can have ‘cysts’ on their ovaries as seen on ultrasound.

To add to all of this, by taking the Androgen Excess Society’s stance on how androgens do need to form part of the PCOS picture, we know that androgens are made in the adrenal glands (plus some fat tissue), and not just the ovaries. So you might have PCOS but not have any involvement of your ovaries. But even then, because I appreciate that everything within your body is connected, I will always still take a full body approach and not just laser-focus on your ovaries or adrenal glands.

Finally we also need to bear in mind other conditions, such as Hypothalamic Amenorrhea or Congenital Adrenal Hyperplasia, can present similarly to PCOS. Because of this, PCOS is a diagnosis of exclusion so this means that other conditions need to be ruled out before reaching a PCOS diagnosis. But even in these instances, we’ll still keep coming back to you, your body, your story and how and why you’re experiencing the symptoms that you are.

Although clinical signs and symptoms can provide many clues in piecing together your individual story, certain tests can be extremely helpful too in guiding nutrition and lifestyle interventions.

Some of the standard blood tests that I will run with my one-to-one clients include: fasting insulin, fasting glucose, HbA1C, testosterone, DHEA-S, a free androgen index, sex hormone binding globulin, luteinizing hormone, follicular stimulating hormone, prolactin, a full thyroid panel (including antibodies), vitamin D levels, CRP. These are then interpreted together with your individual signs, symptoms and timeline.

If there are other signs and symptoms at play (such as digestive symptoms) that don’t shift through the implementation of certain foundational nutrition and lifestyle factors, then additional testing in these areas might be indicated. If this is the case, the need for additional testing will always be explained to you so that you feel confident in knowing what and why we’re testing.

Conventional approaches for PCOS tend to suppress symptoms without actually considering what might be contributing, causing or exacerbating them in the first place.

One of the main options given to women for PCOS is the birth control pill in order to ‘regulate’ cycles. One of the biggest concerns I have with the pill when it comes to PCOS is that it actually suppresses ovulation and ovulation is exactly what we’re trying to restore in PCOS so how is stopping it a solution? The pill has also been shown to worsen insulin resistance which, as we know, is one of the main drivers behind raised androgens and therefore impaired ovulation. The pill has also been shown to strip the body of beneficial nutrients (such as B vitamins and zinc) which are essential for ovulation. And while the pill does help to suppress androgen production, it only does so for the duration of taking it and then once it’s discontinued, we usually find a surge in androgens which can initially make matters a heck of a lot worse.

Metformin and Spironolactone are two other medications typically used for addressing insulin resistance and indirectly blocking the effects of raised androgens, respectively. In the instance of Metformin, a study indicated that lifestyle and nutrition modifications were in fact more beneficial in managing PCOS than Metformin and/or Clomid.

While I fully appreciate that there is a time and place for medications, and by no means am I ‘anti’ meds, at the end of the day, you know yourself and your needs best so you have to make the decision regarding the use of any of these for yourself – all I ask is that this decision comes from an informed place and one that sits best for you in whatever your life is right now.

Nope. But this doesn’t mean that there’s nothing that can be done to reverse your PCOS symptoms.

As I found out firsthand (and witness time & time again with my 1:1 clients), so much can be done!

After not having my period for more that a decade, daily dealings with very angry acne and endless excess hair? I got the support from a trusted functional practitioner, and through an incredibly non-linear healing journey, I was able to reverse my symptoms.

But this doesn’t mean that I can revert to my partying, drinking, disordered-eating, highly stressed way of living that all played a role in my PCOS symptoms in the first place. (To be honest, I can’t say that I’d want to either!)

Nor does it mean that I’ve never had a single flare up since.

You see, curing a condition (which is not what I claim to do) and reversing symptoms are two very different things.

We can reverse our symptoms but still be predisposed to PCOS. Because remember that if we have a genetic predisposition to PCOS, the necessary environmental factors need to be present for those genes to express. And that sometimes happens because, well, life happens!

This is one of the exact reasons why I place as much emphasis as I do on growing a trusting relationship with your body because flare ups are real! But if we can meet those flare ups with deep reverence for our body’s innate wisdom, we can respond to them from a place of care & kindness rather than fear & frustration. And that changes everything.

Firstly, HUGE credit to you for even considering this approach.

And secondly, we don’t do the forced formulas of diets here – the ones that overlook you as a human being, ignore your story, your desires, your preferences, your body’s preferences and send you sliding down a blame & shame spiral, even more convinced that “nothing’s working.”

I work with women who have literally tried every diet known to humankind to reverse their PCOS symptoms, but still don’t get anywhere until they come across Bloom, The Marula Wellness Signature Program.

That’s because here are a few of things that we do differently; we:

1. Honour your individual story & meet you where you’re truly at – instead of being prescriptive in our approach, we rather understand how & why we got to where you are today so that we’re better able to use food in an expansive, rather than a restrictive, way.
2. Understand you & your life – because we’ll be working so closely together, we can ensure that nutrition recommendations are realistic, sustainable and in true alignment with your desires for your body (not what society has deemed as acceptable!).
3. Appreciate that food isn’t limited to the physical alone – while I have huge respect for the impact that food has on how we feel & heal, I’m also well aware of the social and psychological roles of food too. In instances where further support is required in these areas, I have a great network of practitioners whom I work closely with.
4. Weave in growing a trusting relationship with your body (& food) – many of my 1:1 clients come to me resenting food & feeling as though their body has let them down big time. But because I’m aware of this, we take small but powerful steps in supporting you to grow a trusting relationship with both food & your body.
5. Go deeper before going wider – Have you ever felt that using food & lifestyle factors to reverse your PCOS symptoms feels like a full time job? There are SO many recommendations out there that many of my clients say that on their own, they simply don’t know where to start. A core Marula Wellness philosophy is to go deeper before going wider. In Bloom: The Marula Wellness Signature Program, I help cut through the noise of endless suggestions that leave you in a tailspin, and laser focus on the factors that are actually going to make a difference in reversing your PCOS symptoms.
6. Anchor into curiosity – we get curious about your story so far, how and why your body has responded in certain ways, your current relationship with food, what foods are most supportive for you (& which ones aren’t) and everything in between. This is my default starting point and in time, it becomes yours too. With curiosity on your side, it creates way more space to make changes with nutrition that are actually going to make a lasting difference to reversing your PCOS symptoms.
7. Tracking – we track both your intake & individualised symptoms but instead of having you sink in an ocean of overwhelm about what to do with that info? I’m here with my bucket loads of knowledge, holding space for it all so that we can make targeted changes with food that make sense for your situation and move you closer to making the desires for your body (and life!) your lived reality. And the best bit about it? It’s all done on a safe & secure app that allows for timely communication!
8. Untangle from blame & shame – diet culture leaves you feeling as though it’s your fault that the diet didn’t work. Instead of supporting you in taking meaningful steps to understand you & your individual situation, you’re sent to war with those really nasty voices in your head that are loaded with endless blaming & shaming, and ultimately keep you stuck. We are instead very intentional about using small but powerful ways to untangle from this untrue narrative so that your starting place can be one of care & deep self-compassion. That way, we’re able to move the needle closer to reversing your PCOS symptoms, growing a trusting relationship with your body and living your fullest & most satisfying life. (If further support is required on this front, referrals to highly respected practitioners are possible!).
9. We don’t focus only on the food – I have deep respect for the profound power of nutrition when it comes to PCOS. And, I also know that it’s not the only factor at play. Many diets will have you believe that what you eat will be the silver bullet answer to all your PCOS concerns, but there are some equally (if not more) important factors that have to be considered if what you eat has any chance of making a lasting difference to reversing your PCOS symptoms. In Bloom, The Marula Wellness Signature Program, the impact of these other factors is acknowledged.

This completely depends on what your favourite foods are, as well as the severity of your symptoms. For some, we might need to shake things up quite a bit, while for others, it’ll be a matter of tweaking a few things here or there. Either way, we show bland the backdoor – our aim is always to get you eating as great a variety of nourishing & delicious food as possible, and adapt your personalised meal plans accordingly. We also anchor into your desires for your body, appreciating the magnificent role that food plays in helping you make these a reality – and, in the very same breath, creating awareness that food is still only part of this picture. In summary: we’re not about hard rules, but rather expansive empowerment when it comes to food & your relationship with it.

Changing your nutrition is totally going to require that you show up for yourself but my aim is that we take as much of the overwhelm out of it as possible. I don’t want it to feel like hard work but rather an incredible opportunity to get curious about your body as you embark on this journey. We’re always coming back to the possibilities that feeling well would allow for you & your life, and we go as gradually as we need to whilst I gently challenge you in certain situations.

YES YES YES! Many of my 1:1 clients aren’t the biggest fans of cooking and I find that majority of the time, that’s because they’re so overwhelmed knowing what to cook to reverse their PCOS symptoms (or because they’re not the most trusting of food given all the diets they’d already tried). Once they know what works for them & their body though, there’s no stopping them. And remember, our aim isn’t for you to become a gourmet chef – we keep things simple, practical & tasty all while using food to support you in reversing your PCOS symptoms. We also look into ways of making the entire cooking experience fun & nourishing for you.

Firstly, we help you fully appreciate the priority of food on your journey (and we also factor in what’s behind having zero time to breathe & how this might be impacting all your previous efforts with ‘diets that didn’t work’). And then I help with all the practical stuff from shopping lists to deciding on what days will be best to do your cooking, and everything in between. Because we work so closely together, this is all highly personalised to you. I don’t love spending hours in the kitchen and I don’t expect you to either – we keep things simple.

This depends on the type of social life that you currently have. If (pre-Covid) you were used to spending Saturday nights dancing on bar tops and clubbing into the early hours of the morning, then changing your nutrition & lifestyle will probably have a pretty big impact on your social life. But if it’s a big impact that allows for big healing, and living more fully into yourself, then as clients who have made these changes have said, it’s totally worth it.

I’m also not here cracking some kind of whip – I’ve fully got your back and I’m here to help you figure out ways that we can support you through this. We find solutions to club scenarios that don’t reduce you to hiding in your cupboard for the next 6 months and we chat through what to do when you eat out, visit friends or travel. We always anchor back to what healing would mean to you, and we’re guided from there.

In summary, I’m here to help you with the practicalities of navigating social aspects while still honouring your desires for your body.

Yes, yes, yes and yes! I’ll often meet people whose jaws will drop when I explain how clients’ lives have transformed (their words, not mine) through changing their nutrition. To use the aaaage-old analogy of the car: if crap petrol goes into our car and if zero maintenance is done on our car, it’s a bit of a no-brainer when we find ourselves stranded on the roadside with said car smoking, spluttering and going no-where. And the same is MORE than true of us because we’re heaps more complex than a car! We have to factor in all kinds of beautiful physiology, not to mention emotions, memories, triggering events and all the factors that come into play when it comes to caring for our beautiful bodies, one of which is nutrition. Nutrition can influence everything from the health + diversity of our gut bugs, our skin health, our hormonal health and even our mental health so yes, it can make a massive difference to our wellbeing.

While nutrition is one of the main factors to consider, we’re going to take a multi-pronged approach that also considers stress, sleep, exercise, and even aspects such as purpose or loneliness that impact physiology.

Sometimes additional support is required in these other areas and I have a great network of incredible professionals whom I work closely together with. These include movement specialists, osteopaths, yoga instructors, hypnotherapists, life coaches, spiritual healers as well as mindfulness coaches.

You can book yourself in for a Complimentary Discovery Call!

Book a discovery call

When you click on the button above, you’ll be asked to complete a short questionnaire. From there, you’ll be able to book straight into my calendar at a time that suits you. We’ll meet on Zoom for 30 minutes at your chosen time – I hear more about where you’re at with PCOS and share how I can support you. There’s zero pressure & this isn’t a sales call – I only work with women who are a full-body yes to doing so. If that’s the case and we’re both keen as beans to work together, you’ll be set up with all your next steps to embark on one of the best journeys of your life: Bloom.