Thanks for joining us for episode 127 of The Ancestral RDs podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show.

Today we are thrilled to be interviewing Dr. Brooke Kalanick!

A Licensed Naturopathic Doctor (ND), Dr. Brooke attended Seattle, Washington’s Bastyr University where she earned a Doctorate in Naturopathic Medicine and a Master’s in Acupuncture and Chinese Herbal Medicine.

She’s a published author, co-host of the popular podcast Better Everyday With Sarah and Dr. Brooke, and a sought after hormone expert having been featured in Women’s Health Magazine, Fitness Magazine, Oxygen, Allure, and Health Magazine.

Dr. Brooke practices functional medicine primarily with women who have PCOS, Hashimoto’s Hypothyroidism, various autoimmune conditions or any other female hormone imbalance. Most importantly she teaches women how to actually listen to their bodies, how to tune into hormonal cues so they know exactly how to eat and exercise for their unique metabolism and imbalances. With these women she works to reset their hormones, their heads, and their habits so they can finally feel at home in their bodies.

You can learn more about Dr. Brooke on her website BetterByDrBrooke.com and connect with her on Facebook, Instagram, and Twitter.

Among prescriptions for the birth control pill and recommendations of a low carb diet with restricted exercise, trying to heal from PCOS can be just as difficult as getting a diagnosis.

Luckily, Dr. Brooke Kalanick is with us today to clear the confusion and guide us on a path to understanding our body’s hormonal cues to determine diet and exercise strategies for dealing with PCOS.

Today Dr. Brooke furthers our understanding of PCOS by explaining the types of PCOS and contributors to its development. She also opens our eyes to problematic dietary and exercise recommendations for PCOS.

You won’t want to miss the key issues to consider with fat and carbohydrate intake or Dr. Brooke’s guidance through the hierarchy to follow when beginning to address contributing causes.

You’ll even come away with Dr. Brooke’s exercise template for women with PCOS so you’ll know much and what types of exercise to focus on and adjust for your individual needs.

Here is some of what we discussed with Dr. Brooke:

• [00:05:06] Dr. Brooke’s Empowered PCOS program
• [00:06:54] How Dr. Brooke became a women’s health Naturopathic Doctor
• [00:10:39] The difficulty of getting diagnosed with PCOS
• [00:16:14] The major role inflammation plays in the development of PCOS
• [00:18:36] Triggers for inflammation in young girls and the importance of teaching them about diet and lifestyle
• [00:22:20] Clinical presentations of the two different types of PCOS
• [00:27:15] Three problematic dietary recommendation for PCOS in the conventional and Paleo/ancestral health model
• [00:32:34] The importance of figuring out your unique carb tolerance
• [00:33:40] Key issues to consider with carbohydrate and fat intake when you have hormonal imbalance
• [00:43:06] Where to start to heal from PCOS and the hierarchy to follow
• [00:51:16] Dr. Brooke’s exercise template for women with PCOS

Download

Links Discussed:

• DrCowansGarden.com – Use the code “ancestralrds” for 20% off your order!
• BetterByDrBrooke.com
• Follow Dr. Brooke on Facebook and Instagram
• Guide To Exercising For Your Hormones
• 5 quizzes to assess your hormones
• Dr. Brooke’s Hormone Hierarchy
• Better In 5  template
• Dr. Brooke’s Empowered PCOS program

TRANSCRIPT:

Kelsey: Hi everyone! Welcome to episode 127 of The Ancestral RDs podcast. I’m Kelsey Kinney and with me as always is my cohost Laura Schoenfeld.

Laura: Hi everybody!

Kelsey: We are Registered Dietitians with a passion for ancestral health, real food nutrition, and sharing evidence-based guidance that combines science with common sense. You can find me at KelseyKinney.com, and Laura at LauraSchoenfeldRD.com.

Laura: If you are enjoying the show, subscribe on iTunes so that way you never miss an episode. And while you’re in iTunes, leave us a positive review so that others can discover the show as well. And remember we want to answer your question, so head over to TheAncestralRDs.com to submit a health related question that we can answer on an upcoming show.

Kelsey: We have a great guest on our show today who’s going to share her insight into PCOS and what women can do to begin to heal from this condition. We’re so glad Dr. Brooke is joining us and we think you’ll really enjoy this episode. But before we get into the interview for today, here’s a quick word from our sponsor:

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Kelsey: Welcome back, everyone! We’re so excited to have Dr. Brooke Kalanick with us today. A Licensed Naturopathic Doctor (ND), Dr. Brooke attended Seattle, Washington’s Bastyr University where she earned a Doctorate in Naturopathic Medicine and a Master’s in Acupuncture and Chinese Herbal Medicine.

She’s a published author, co-host of the popular podcast Better Everyday With Sarah and Dr. Brooke, and a sought after hormone expert having been featured in Women’s Health Magazine, Fitness Magazine, Oxygen, Allure, and Health Magazine.

Dr. Brooke practices functional medicine primarily with women who have PCOS, Hashimoto’s Hypothyroidism, various autoimmune conditions or any other female hormone imbalance. Most importantly she teaches women how to actually listen to their bodies, how to tune into hormonal cues so they know exactly how to eat and exercise for their unique metabolism and imbalances. With these women she works to reset their hormones, their heads, and their habits so they can finally feel at home in their bodies.

You can learn more about Dr. Brooke on her website BetterByDrBrooke.com and connect with her on Facebook, Instagram, and Twitter.

Welcome, Dr. Brooke!

Dr. Brooke: Thank you! And I should warn you guys, I’m not very good at Twitter, so connect with me on Facebook or Instagram. I’m terrible at Twitter.

Kelsey: I’m not good at Twitter either.

Laura: Does anyone use Twitter anymore? I feel like I auto tweet things.

Dr. Brooke: I will sometimes send my Instagram posts to Twitter and that’s about it.

Laura: Yeah, that’s about what I do. I used to have an auto tweet set up and it would go out and tweet blog posts, but I don’t even know if I have that anymore.

Kelsey: Does Twitter even exist anymore?

Laura: Apparently our president still uses it.

Kelsey: That’s true.

Laura: So it’s good company over there on Twitter, but that’s alright. I feel like Facebook, Instagram, and then like you said, you have a website, and a podcast. So there’s lots of different places that people can meet you.

We have a lot of awesome things to talk about today. We actually just did a podcast a couple of weeks ago on amenorrhea, hypothalamic amenorrhea, a little bit of PCOS there as well. We talked about birth control and all that. So I think this is a nice follow up conversation for that because Dr. Brooke is an expert in PCOS.

Dr. Brooke, did you say you have a program? I don’t know if it’s coming out now or if it’s out already. I believe I’ve seen some, I don’t know if it’s ads or things just come up in my newsfeed talking about Empowered PCOS. Is that a program that’s already available, or is that something that’s on the horizon?

Dr. Brooke: Actually I’m running it live right now. This was my first foray into doing a program like that. This one, we’re in the middle of running it now. We’ve got two weeks left. This time I ran it live with me as part of a Facebook group to kind of help the women through it. I don’t know if I will do it that way again or if it’ll just be a do it yourself program in the future. But it will still be available on my website and I do have a waitlist going for that on the website. Anyone can email me about that if they’d like to get the lowdown of how that’s going to run the next time.

We’re in the middle of it right now, but it will continue to live on in some form.

Laura: Nice. Well congrats on creating your first online program!

Dr. Brooke: Thanks! That was technologically and emotionally very challenging for me.

Kelsey: We totally get that.

Laura: Yeah. I’m in the middle of a launch for my…it’s called Get Your Period Back. It’s kind of like a hypothalamic amenorrhea/kind of PCOS program. And this is the first one I’m doing on my own because Kelsey and I have done several launches of our Paleo Rehab: Adrenal Fatigue program. It’s nice to have someone to work with, so doing it on your own can be kind of a beast. But it is nice to have because I’m sure you’ve had the experience where you can’t work with as many people as you would like because you run out of time. So being able to offer that program will be awesome.

Dr. Brooke: Yeah, exactly. A lot of people for many reasons are aren’t able to work with me one on one. So this was a much more affordable option to at least get women kind of off the ground and cover most of the basics on their own.

Laura: Well let’s actually get into the PCOS topic a little bit. First because I’m sure some of our listeners aren’t familiar with you, can you give us like a nutshell version of your back story, how you got into just women’s health, and how you became a Naturopathic Doctor?

Dr. Brooke: Yes. My story is sort of funny. I kind of always knew that I would do something in medicine and was very much more leaning towards conventional medicine and I wasn’t entirely sure if I wanted to be a doctor.

What ended up happening was I sort of got accepted into pharmacy school probably earlier than I should have. I sort of applied and didn’t think I would get in that first round, and I did. I sort of jumped at it still thinking maybe I would go on to medical school or some other type of training after the fact.

But as I got sort of into that model and starting to work completing my internships for pharmacy, I was just really finding in my own personal life I was super stressed out as a grad student, and in a very demanding program, and not doing well.

For me, I had PCOS in my teens, but it was never really talked about. I mean I don’t even know if they really diagnosed me properly. I just got the pill because I was having all this stuff go on, which I took until my early 20s when I was in college and very stressed out. All these hormone issues sort of came to the front. I was not finding good help in my pharmacy model and was turning to actually my mom’s Naturopathic Doctor who was really helpful to me. I was like well, this is interesting. Maybe I will sort of combine this with being a pharmacist someday.

And then as my health sort of continued to be met with poor options in the conventional model, they were like you’re probably going to end up with diabetes, you’re not going to be able have a baby. I just was not feeling well, I was super tired, I had terrible headaches, my period was crazy. As soon as I would come off the pill, my skin would just go bonkers.

So as I was working with her, my Naturopathic Doctor, I was just getting so much better and learning that I had so much more control over this. I wasn’t necessarily destined to only have medications be my only option. What happened was I just decided that was probably a better fit for me. When I was done with my pharmacy training, I went to Bastyr and was studying to be a Naturopathic Doctor.

And as far as like how exercise and all of that kind of came in, I mean I obviously had my own hormone issues, which sort of I think made me want to help other women who had felt in my situation where we just didn’t have really great options. I also really didn’t like how I just didn’t understand what was going on. I feel like so many women feel that way. They have these symptoms and they have terrible periods, and they’re just sort of told well this is what it’s like to be a woman, or this is what it’s like to be a new mom, or this is what happens when you get older. I really didn’t love that I didn’t have really any understanding of what was going on in my own body.

So that was part of it. And then exercise sort of came in because I was really interested in exercise for myself. I’d always really loved being at the gym. I was not one of those people who hated going to the gym. It just sort of evolved into another tool that I could use in my in my practice.

Laura: Awesome! It’s kind of interesting how some women get into functional medicine because of the health issues that they’re dealing with. And then others, they just notice that there was a lot of women dealing with those issues. It sounds like you got passionate about it because you weren’t getting the help that you needed and you wanted to be able to share what you learned with the women that you were working with.

As far as PCOS goes, something that came up, I just did a webinar two days ago about the pill and how that’s not going to help people get their period back. I did get a couple questions about PCOS that I’d love to forward on to you since you have expertise there.

I think one thing that can be really confusing for a lot of women is getting a diagnosis and what it even means to be diagnosed with PCOS, or how they can actually identify whether or not they have it if they don’t have some of the typical symptoms of PCOS. Can you share a little bit about how to get diagnosed PCOS or what kind of things women should be looking for to figure out if they are dealing with a PCOS type of syndrome?

Dr. Brooke: Yes. First of all, it’s just kind of a bad name because it’s called polycystic ovarian syndrome and not every woman on the spectrum with some of these issues has polycystic ovaries.

One of the ways you can get diagnosed is we can do an ultrasound and we can see this sort of classic look of the ovary where we have these smaller underdeveloped sort of faulty follicles. That has sort of this classic look on an ultrasound, but not every woman will have that. I, for example, never had that. My ovaries always looked pretty normal.

Other ways you can look at it, we’ve got the ultrasound, we’ve got elevated androgens on a blood test. That can be testosterone, or DHEA, or some of those variants. We can have insulin resistance showing up on blood work. We can have other hormones out of balance such as high prolactin. Thyroid gets in the mix there, but it’s not typically part of this particular diagnosis. But there’s essentially a set of criteria that you can have and you need to have three of those to meet the diagnosis.

But part of the problem is women come in…I think two things happen. One is they’re having a lot of the manifestations of PCOS, like maybe they’re breaking out, and maybe they’re dealing with some low progesterone symptoms, and their ovaries don’t look quite right, but they’re getting a period. So they’re told this can’t be PCOS.

Or it’s a woman who doesn’t “look the part”. She might be what’s now being talked about as lean type PCOS. Before we sort of didn’t even have that categorization. It was just thought if you don’t have this classic look where you’re struggling with fat loss, you are breaking out, you have a lot of hair growth, then it can’t be that.

I hear this a lot from a lot of trainers where there’s a woman with PCOS and she’s saying I really can’t eat as many carbohydrates as you’re recommending. They make me really sleepy and they make me crazy. They’re like well you can’t have insulin resistance because you just don’t look like it.

So part of the problem is the name. Women think, well if I don’t have that on an ultrasound, then this is not what’s going on with me. I think a lot of women fall through the cracks. Another problem is that not every woman with this has every single symptom on the list. Not every woman has a particular body type or those sorts of issues.

Me, for example, I struggle with fat loss, I struggle with energy. But as long as I keep myself in check, I have a pretty regular period and I was able to get pregnant really easy.

It does look different for women. And so sometimes there are just the androgen issues, and sometimes there’s more of this bigger picture of PCOS. I hope in time we continue to kind of elaborate on this kind of constellation of symptoms and have there be better categorization. That way women can get more help when they sort of fall on like one end of the spectrum, but don’t necessarily meet all the criteria to get that formal diagnosis.

You guys know how it works. In our conventional model, it’s like you have to have the diagnosis to get the treatment. And in the functional model, we’re more looking at how’s your optimal health? How are you functioning? I care less if we call it PCOS than can we get your blood sugar and your testosterone under control so you have better hormones, better balance with that, better energy, better results.

Kelsey: Can a woman be diagnosed with PCOS if she only has you polycystic ovaries and none of the hormonal or insulin resistance type symptoms. Can that come later down the road with PCOS and the polycystic ovaries might be the first symptom that is found?

Dr. Brooke: Possibly. We don’t always do an ultrasound for a woman when she comes in. That’s usually done because a lab test is out of range or they’re not having a period. It’s called the Rotterdam criteria. There needs to be some sort of ovulation not happening, something’s not going quite right in your period for it to be called PCOS, you’re not ovulating.

Kelsey: Got it.

Dr. Brooke: Again, some women with PCOS do, but maybe that’s because their diet and lifestyle is such that they’re kind of getting that piece in line.

Kelsey: Right.

Dr. Brooke: It can get a little bit tricky for this. I think that many women are like I feel like I have this, but my doctor tells me that I don’t. There’s a lot of women that are just dealing with hormone manifestations in this realm and maybe don’t actually qualify for the diagnosis of PCOS.

But many women don’t know because this shows up at least initially, it starts to show up in puberty where we’ve got maybe heavy bleeding, or painful periods, or not getting a cycle. The coordination of the pituitary hormones in the ovaries don’t quite sync up and so we get this kind of long periods of time between your cycle.

Women so quickly are given the pill because it kind of “manages” that, at least normalizes it. It doesn’t of course fix anything underlying the cause, but it will sort of set the stage. It’s not until they want to have a baby, or like me, they go through a really stressful time that these hormone issues come up again.

Many women don’t discover that they have this until they’re trying to get pregnant or they try coming off the pill at some point. They just are like I just never knew because I was handed the pill so quickly in their teen years.

Laura: Obviously a lot of these symptoms show up when women are very young. I’m sure there’s women out there that have PCOS that might have been seeing these symptoms when they started menstruating, which could be as young as like 12 or 13 years old. What leads to the development of PCOS? Is it primarily genetic? Or are there things that happen when a woman is in her first 15 years of life that can actually drive the development of PCOS?

Dr. Brooke: There is a genetic component for sure and we don’t totally know what causes this. Many women are like, well my mom had this, or my mom had these issues, or my aunt, or my grandmother. So there is a genetic component and we don’t totally know exactly what that is. But one of the things that we’re starting to learn about PCOS…and I maybe didn’t answer your first question definitively, but I’ll go back to that.

The two things to get the diagnosis of PCOS is you have to have two of three things. You either have to have the high testosterone or high androgens, you have to have some sort of ovulation dysfunction, or you’ve excluded other reasons why you might not be getting your period or have high androgens. There’s other things like hyperthyroidism can look like PCOS, it’s technically not. So those you have to have two of those three. Hopefully that if someone’s looking for like a definitive test they can go back and look at that.

But as far as the causes, we don’t really understand the genetic component, but there does seem to be one and we’re studying that. But the kind of smoking gun that I think really gets missed with women with PCOS is inflammation.

We’re starting to learn in the last 10 years or so that that actually seems to be more of a core issue that’s probably actually causing the insulin resistance. Typically we thought of it more as the insulin resistance and this person also has inflammation probably resulting from that. But the research is starting to point to the inflammation might actually be the kind of underlying cause, which makes sense.

All of us talk about hormones all day. We talk about cortisol, and insulin, and thyroid. And the truth is, all of that is controlled by the immune system. All of that goes back to what I call the hormones of the immune system, which are the cytokines. Those really dictate what kind of flows from our end glands; the adrenals, and the ovaries, and the thyroid.

I think we’ll start to look at hormones sort of differently in the coming years and we’ll talk a little bit more hopefully about inflammation and the immune imbalances because that is really what appears to be driving a lot of our kind of what we think of as “hormone imbalances”.

Laura: I’m assuming you don’t work with 12 year olds with PCOS necessarily. But knowing that it can develop that early, what do you feel like are the big triggers for that inflammation at that age?

Dr. Brooke: Part of it with PCOS is we’re just hardwired for inflammation, so we genetically do things a little bit differently. We have a low grade inflammation even at best. When you think about all the things that we do in our lifestyle; the food we eat, the stress we have, all of the endocrine disruptors, all the inflammation we create, women of PCOS are just really, really sensitive to that and inflammation just goes on to create a whole host of hormonal imbalances. We can talk about how that works if you want.

Young girls are starting to see this start to pop up. Unfortunately, like I said, we kind of get handed the pill. The pill sort of levels your hormones. It’s a very artificial cycle, but you get a bleed and you get a little bit more predictability. Most moms aren’t necessarily looking at what is going on under the surface. I think that’s changing because I think more parents are trying to pay a lot more attention to our own health in this kind of toxic world. We have a lot of information at our fingertips these days.

I do think it’s really important for our young girls to start talking with them about these hormone changes are going to be profoundly affected by your diet and lifestyle. The classic teenage diet is pretty sugar and carb heavy. They’re not getting enough sleep. They have a lot of emotional stress.

We really need to be teaching our kids, you’ve got to pay attention to how you feel when you eat and eating certain foods are going to drive your blood sugar problems, are going to drive your breakouts, and your PMS, and your emotions are going to be less stable. And all of that just makes being a teen harder to deal with.

It’s kind of a subject of a different podcast maybe, but I think we really over-schedule our kids and put a lot of demands on them. I think we have to really work with teens in that age group. Maybe before we just hand them the pill, start teaching them about food, how they can better care for themselves, understanding their body.

You guys remember what it was like to be a teenage girl. It was sort of you were just scared of your cycle. They were like don’t wear white pants, don’t get pregnant, and this is really rough, but this is how it is to be a girl. You weren’t really taught like this is what it means if you’re bleeding really heavy, and this is what it means if you’ve got terrible cramps, and these are some things that you can do to fix that. We just we don’t teach girls that.

So that’s probably where we need start so that then women don’t need me as much in their 30s trying to undo this mess and relearn how to eat, and understand they have to meditate, and watch their stress.

Laura: I feel like you don’t normally think of teenagers as being super stressed, but obviously there’s a lot of things going on at that age that can be really stressful.

And then probably another factor that sounds like you are touching on a little bit is most of the teenage schedules, like high school starting at crack of dawn, that kind of thing, it’s not really well lined up with the typical teenager circadian rhythm.

I know that there’s been a lot of research showing that teenagers really need to be waking up later and not getting up for school at 5 o’clock in the morning or something like that. I’m sure that plays a big role in it. Even if they’re not over-scheduled after school, it may just be the fact that the high school timing isn’t really set up for the way teenagers should be structuring their day.

Like you said, there’s a lot of different things that maybe aren’t under their control, but there certainly are things that things like diet, and exercise, that kind of stuff that is more under their control. It’s just that they don’t get taught, or their parents don’t know, and it’s just they get set up for kind of bad hormone function. By the time they’re in their 20s and 30s, it’s like you said, undoing damage.

Another question that I feel like comes up a lot when it comes to PCOS that we had touched on a little bit a few minutes ago is the different types of PCOS. You had mentioned there’s the pretty typical insulin resistant, generally more weight loss resistant type of PCOS. And then there is the lean PCOS, which some of those women will have some level of insulin resistance or blood sugar dysregulation, but not all of them do and they tend to be either normal or underweight.

Do you find that those two different types of PCOS…would you classify them as different conditions. Or do you think that they’re the same condition, they just need to be treated differently? What’s your feeling about those two distinctions?

Dr. Brooke: It sort of depends. Like we’re looking at a woman who has that lean type that’s actually been diagnosed with PCOS, whether they’re not having a cycle, they’ve got some high androgens or the insulin resistance on blood work. I do find if we’ve got PCOS, we know we have inflammation, we know we have some level of insulin resistance.

The difference in the body types, I feel like lean and heavy types are just kind of bad names. Most women associate the heavy type with that’s something bad we don’t want to think of ourselves that way. I hate those names so I try to get kind back to always going back to the chemistry because that’s not of course our fault. This is our hormones and unfortunately I feel like PCOS kind of gets written off sometimes as a lifestyle condition. I hate that because again we’ve got this huge genetic component that makes lifestyle harder for these women. When it gets called that, it sort of makes me maddening.

With the lean and heavy types as they’re called, I tend to think of what we have to kind of remember with insulin resistance is we think of it as like you have it or you don’t. You’re insulin resistant or you’re not. And it’s more of a grayscale. It’s more of kind of a spectrum. Some women are more insulin resistant than another woman. Maybe they both have some degree of it and both have PCOS. So it can vary from woman.

It also various tissue to tissue. We’ve got women that are more insulin sensitive or resistant in let’s say their muscle tissue, or their fat tissue, or their liver. The ovaries tend to stay pretty insulin sensitive, which is part of why they’re so affected in this condition. We think about PCOS as this ovarian syndrome, but we talk about it of course in the sense that there’s inflammation, and insulin, and blood sugar problems. But the ovaries sort of take the hit because they remain sensitive to the insulin. So when there’s all that insulin around in a woman that’s insulin resistant, the ovaries really get hit with that.

When we release insulin because we’ve eaten something, that hormone is meant to take the fuel out of our bloodstream and stick it somewhere, so stick that into our muscle, stick it into our liver, stick it into our body fat. Women that struggle more with the being heavier type or having more of the fat loss resistance, they do a really good job of scooting that stuff into their fat cells whereas they don’t do as good of a job putting it into their muscles.

I tend to look at it that way. Like where are you more sensitive and where are you more resistant? I think it’s important for women to know it’s not black and white. You have sort of varying insulin and hormone responses in different tissues in your body and it makes this condition look very different for different women.

With the leaner type, so the ones that don’t struggle as much with losing weight, what they tend to have is even they will find like maybe they only want to lose five pounds, but that’s also still really difficult for them when they have some degree of insulin resistance. They also deal more with what we think of as the inappropriately termed adrenal fatigue. They deal more with like low cortisol or erratic cortisol issues as well.

While PCOS is thought of, of course, as a blood sugar problem in relation to insulin, cortisol is a big piece of this because that’s the other side of all of our blood sugar control. So whether we eat something or we stress about something, our blood fuel is going to rise and insulin is going to need to come in and help with us. When you’ve got that insulin resistant picture or that hyper insulin and over-exaggerated, response we’re still going to see that in both types of women, but it may not be driven as much from what they eat as it is from their stress response. So with the leaner type, we definitely really need to make sure we’re looking really closely at the other side of that, looking at their stress response.

But we do find in both when we look at the research for women, both the lean type and the heavy type do have this low grade inflammation. In fact, sometimes the lean types have shown it even more. Going back to that and making sure we have managed all sources of inflammation for both types of women, looking at what are they eating, is anything there causing inflammation, stress chronic infections, over-exercising, under-exercising, not getting enough recovery, making sure we’ve really looked at all the different sources of stress for them.

Laura: Definitely. Now I would love to talk a little bit about the dietary recommendations for PCOS. This is mainly because I feel like for most women who are just doing a Google search, the same kind of recommendations come up for PCOS no matter what the reason is behind their PCOS.

Can you talk a little bit about how you approach nutrition with these patients and if there’s differences between the types of PCOS or the reasons that a woman is experiencing PCOS, and how they should be eating?

Dr. Brooke: Yes. I think you probably get a couple of things when you Google search this. One is the blanket recommendation to just don’t eat carbs, just go low carb. That does a couple of things wrong. The women with more adrenal problems, whether they’re considered lean type PCOS or they…I wouldn’t have considered myself lean type PCOS historically, but since having kids, and my business, and not getting enough sleep, I definitely have more low blood sugar problems now. So I have to manage my PCOS in a whole new way. I used to be able to just be…I pretty much just avoid carbs and I was fine. That really, really helped me. But now I have to think of things a little bit differently and honor all of the hormones involved.

The first thing for when we think of just having insulin resistance and just going low carb, that doesn’t acknowledge that this woman might also have, like I said, struggling to keep their blood sugar up between meals, which is a cortisol problem, or hyperthyroidism which might be dysregulation their metabolism such that they need to think about their carbohydrates differently. I’ll talk about how to do that in a second.

But that’s the first thing. It’s just the blanket recommendation to go low carb is not going to work for all women. It’s going to work for the really insulin resistant ones that other hormones are pretty much a little bit more in balance and they’re not really struggling with any other side of the blood sugar equation.

The other thing women will see as well, as long as you just eat “good carbs”, like if you just eat whole grain bread versus white bread, you should be fine. And that of course doesn’t acknowledge inflammation because a lot of those wholegrain foods are going to be potentially problematic for a lot of women. It also doesn’t really acknowledge the fact that taking in…like I said, the difference between Ezekiel bread for a woman and white bread is different, but it may not be nearly enough to move the needle on their actual blood sugar response.

Those two things I see in the kind of conventional model. And then in the more Paleo or ancestral health model where I see women with PCOS kind of getting it wrong is sometimes doing the “good carbs” or the Paleo based more whole foods carbs with too much animal fat.

That combination can be really tricky for women with insulin resistance because there’s other hormones that get involved particularly when we do fat and carbohydrate together. We’ve got ASP, GIP, and these other hormones that actually kind of round about signal insulin when we eat fat. We get this really is exaggerated response in these women. So they have to kind of watch that combination, too, and that just doesn’t really get talked about at all.

And then also when we’re dealing with fat content, women with PCOS, and estrogen dominance, and this more sensitive female hormones system, we’re going to be the ones that don’t do as well with any of the stuff that can come along with excessive amounts of animal fats.

If we’re eating tons of bacon, tons of really fatty animal protein, we’ve got those persistent organic pollutants and just endocrine disruptors that build up in our own body fat and of course the animals that we eat. Even a well-raised animal is going to have some of that. They still live in our same toxic world. So there’s some of that that goes on.

And of course, that animals are going to have its own metabolism. Even if it wasn’t given hormones for growth, they still have estrogen in their body fat. That’s sort of where they put it, just like where we put it.

Those are kind of three things that I see go wrong. We get the blanket recommendation of low carb, we tell them just to focus on good carbs. Or in our world, which I think is better, we don’t always pay attention to their fat and carb combo.

What I tell women with all these hormone issues, when you’ve got multiple things going on, we have to honor our more delicate hormones first. We have to deal with excessive inflammation, low cortisol problems, low thyroid problems first. And then I usually say deal with high cortisol next, then insulin resistance, and then estrogen and progesterone.

The reason I’ve had to kind of break that down over time, because we don’t have just one thing wrong. Most of us don’t just have PCOS, or don’t just have insulin resistance, or don’t just have low cortisol. We’re probably also dealing with at least a borderline low thyroid. We probably have low progesterone. There’s multiple things going on. When they take to the Internet and they look at these different things, like how do they figure out what thing do I deal with first? Because oftentimes the recommendations for one are really counter to another.

So making sure you kind of have a bigger sense of what all your hormone issues are…and I do have a quiz on my website so you can take that and see if you’re kind of struggling. Obviously you can do testing, too, which is ideal. But for any woman and a really inexpensive way is to start to look at your symptoms and see how everything kind of shakes out, and see where you’re struggling, and then follow that hierarchy. Within that is also where I think the fat and carb combo comes into play a little bit. I have a couple articles on my site about that if someone wants to kind of get into the nitty gritty science of that.

But the most important thing for all of us I think is finding what I call your unique carb tolerance.  My low carb diet might be very different from Laura’s low carb diet. Your amount of carbohydrate, depending on your goals, your genetics, that hormone hierarchy, we really have to figure out which carbohydrate sources work best for us, what amounts, and what time of day.

There’s definitely different variables and that’s just such a bigger conversation. You can do that relatively easily either by watching your symptoms or by using glucometer and kind of figure out what works best for you for different sources, different times a day.

It takes a little experimenting and people don’t always like that. It’s I think human nature to just kind of want the plan, someone just tell me what to do. But doing it this way, it allows you to really dial it in for where you’re at right now. And then remembering women’s hormones; they’re a moving target. They’re going to change.

Again, like me, I used to just be low carb and now I have to do things differently with smaller amounts of carbohydrates a couple times a day, especially on the days when I don’t get enough sleep or I’m training hard.

Laura: I actually want to dig in a little bit into the what you’re talking about with combining carbs and fat because that’s something I feel like in the Paleo community especially doesn’t really get talked about. Because on one hand, a lot of the Paleo guidelines go pretty low carb and that might not work for a lot of women. I know personally, I don’t feel well if I’m not eating a pretty significant carb content in my diet, and like you said, especially on days where there is some higher intensity training.

But on the flip side, there’s also this concept that fat is perfectly fine, and you should eat as much as you want, and animal fat is awesome. I feel like that belief could potentially be causing a lot of problems for a lot of women that are following the Paleo approach.

When you talk about combining fat and carbs, does it have anything to do with going overboard in calorie content? Or is it completely unrelated to calorie intake and just has to do with the actual hormone response to those combinations?

Dr. Brooke: I actually think there’s probably three things that go on. I am so glad we came away from like the fat’s scary, from where were because that was a problem too. I think we’re in a better place. We’re not as scared of eating a steak. We’re not scared of eating something like bacon.

This is true for any women dealing with any estrogen and progesterone imbalance, when you’re having a lot of PMS, painful periods, any issues with your cycles getting more erratic, closer together, further apart, having PCOS, or endometriosis, or going through menopause. All of those female hormone imbalances, we do really need to take a look at insulin for sure.

Are we over-carbing? Are we under-carbing? Because remember if we under-carb, that’s a problem, too. Like you were saying you don’t feel as good, but that’s a stress for our body. We really have to find what works for us in, again, that unique carb tolerance. Like what do you need right now given your goals, and your lifestyle, and your current hormone imbalances?

But when it comes to fat, I think it’s all three things. I think because we’ve taken so many other things out of our diet, it’s really easy to overdo it on like the salami, and the bacon, and some of that stuff, and the avocados because it tastes really good.

Many women feel on a more Paleo diet, they feel better for many reasons. But I think sometimes that restriction comes up so we sometimes overdo it or we get this mentality that’s like well because it’s natural or because it’s on my Paleo plan, it’s a free for all. I see a lot of women sort of overdoing it in fat, just on calories just because it sort of naturally is the thing that we get to still eat, which when we are missing some of those other foods, and again we have that mentality that well it’s Paleo, so it’s okay, or it’s part of this whole foods plan, so it’s okay.

I do think calories come in. I find I don’t really address calories until a little bit later. But if you’re somebody who’s not new to this lifestyle and you’re wondering about your hormones or your progress, it is something to take a quick look at because a lot of times many of us are overdoing it. So there is that.

And then again, with particularly animal fat, we do bring in those POPS, those persistent organic pollutants that build up in our own fat, in an animal that lives in the same world. Are healthier raised animals, grass fed, hormone free certainly better? Of course, that’s a huge step above conventionally raised animals.

Even if we’re doing that though, we’d still have to acknowledge the animal has its own metabolism, it still probably gets contaminated water which has a lot of this stuff in it, and it’s just in our environment. It’s ubiquitous. We cannot get away from plastic and that’s really profoundly affecting all of us. So it is still in their environment.

If you’ve got a female hormone imbalance, if you’re eating more endocrine disruptors whether that’s from your spinach in a plastic container, or eating animal fat, or water out of a bottle, we just have to look at kind of the net results of the accumulation of all of those things. It is something to look at in that regard.

I do find a lot of women, if we just make the switch without thinking like I can never have bacon again, or I can never have a grass fed steak, just moving towards making sure you’re eating those proteins a few times a week and leaning towards getting more of your fat from plant based sources and doing more lean protein, more chicken, fish, turkey things like that, lean pork chops, that can be just an easy switch that doesn’t really make you feel like you made a huge difference in your diet. But it can make a big effect on your hormones.

When it comes to this particularly the combination with carbohydrates, it’s a big fat storing message when we eat…I like to think for the average woman, hormones are just sending a message. It’s like me sending Laura and Kelsey an e-mail. I just sent them some information about me. That’s just the way one part of your body talks to another one.

So the message is when you have fat and carbohydrates together we get an insulin response and we also get this acylation stimulating peptide, the ASP, and then another hormone called GIP. As a bit of a backdoor, we get an exaggerated insulin response from fat.

Fat is typically thought of as…we always thought about fat as not triggering insulin, it was insulin neutral. And we know now that these some of these other hormones in these molecules get in the mix, and that particular combination is a bit of a vicious circle. So insulin is going to, when the fat is around, going to trigger these ASP and GIP people, and they are going to in turn have you secrete a little bit more insulin.

Is this a big deal for every woman? I’m sure there’s a woman listening to this going, I’m eating like a ketogenic diet and I feel great and my hormones are awesome. So no, it’s not going to affect every single woman. But if you have insulin resistance, that particular combo is just harder for your metabolism.

Again, it’s not that we should never eat guacamole and plantain chips. That’s a good example. Or a burger with sweet potato fries. But if we’re doing that all the time, or like that classic Paleo hash where we got egg yolks, bacon, and sweet potatoes in the morning. It’s like that combination for some of us if we’re doing it too often, especially the more exaggerated your insulin resistance is, we can really struggle with that.

Laura: Yeah. It’s kind of funny, I feel like when people are on Paleo, they get ideas about what is right and wrong. And sometimes like you were saying with bacon for example, bacon is like, oh it’s an animal food, I can eat as much as I want. And then we’ll have clients where they’ll be afraid to eat more than half a banana because they think it’s too much sugar. I would imagine, and maybe I’m wrong, but I would imagine that eating a whole banana in the morning or at a meal or something is probably going to have less of a negative impact on hormones than eating six slices of bacon or something like that.

Dr. Brooke: Yeah, it’s going to really depend. I think we get so dogmatic about Paleo. I came to this diet when I was… Loren Cordain’s first book, well before any of our great gurus now. And it really saved me and this really was like a diet that for the first time I felt like on top of my hormones and my insulin resistance.

It’s such a great template, but we have to remember that it’s just kind of a jumping off point. It’s a really good template, but beyond that, everyone has individually, our own unique issues. Like for example, I can’t do bacon or bananas because they both are histamine intolerant foods. I am genetically hardwired to not do well with histamine. For the most part, neither of those foods work for me.

We have to first take the big picture hormones, like what this is doing to my master metabolic engines here? What’s this doing to my thyroid, my cortisol, my insulin? And that is my insulin, not necessarily what might work for you guys.

When we work with people, it’s hard because we have some biases about what’s worked for us or most of our clients. We have to always remember that’s just not going to work for every single person. So kind of honoring those master higher level hormones and then getting into like what are my preferences? What are my genetic issues?

Again, the histamine thing, we’re seeing more and more of that because more and more people have disrupted guts creating histamine intolerance, they’re having more chronic infections that are causing a low level histamine…or we can now get a hold of our genetic information.  I figured out that was the thing that was going on with me, which I knew that I didn’t do well with bananas. They made me itchy, but I didn’t understand fully why.

I do think we have to just take that good Paleo template, it’s certainly an upgrade from the standard American diet, and then we have to just work with what works with us and our own unique hormone issues. And it’s unfortunately why we can’t say here’s the PCOS diet, and here’s the thyroid diet, and here’s the CrossFit diet. We really have to take each woman as she comes.

Laura: It’s funny because like you said with the histamine piece, I mean obviously not all women with PCOS have histamine intolerance. But a food like bacon, or bananas, or even liver…I mean liver is something that we would consider a really healthy food for most women, but if you have a histamine intolerance issue, you might not be able to eat it and then you have to look for different ways you can get those nutrients in your diet.

I can imagine a lot of the women listening right now, you’re giving us all great information, but there may be some anxiety building about if there’s all this stuff going on, how do I figure out where to start? I mean obviously working with someone one on one would be awesome. But do you have any recommendations for where a woman can start if she knows she has PCOS and she wants to figure out where in her life she can really hammer into some changes first to get the best results?

Dr. Brooke: Yeah. Doing something like my quiz, again, you just go on and do it at home. You can get some information right now about these are the different hormones that are struggling. That’s been kind of my quest especially in the last few years is how do I take the overwhelm out of this? Because now women have so much information and most of time by the time someone gets to me, I’m kind of the end of the line. They’ve not only gone through their PCP and their gynecologist, they’ve probably worked with three other dietitians or functional medicine people and still struggling.

Sort of as time goes on, what happens is when we don’t rein one hormone in, then more and more dominoes fall. Most the time women are dealing with, again, multiple issues and the advice for one seems counter to the advice for another. Like the advice for insulin resistance is we need to exercise a lot and you need to not eat very much. And then the advice for low adrenal issues or dealing with HPA axis dysfunction, you’re supposed to rest a lot and eat more frequently. It’s counter, but how many women do we know have both of those things?

Looking through something like that quiz or getting testing with someone so you kind of know based on your blood work, your salivary panels, your DUTCH test, your symptoms, kind of getting a sense…and maybe you only have a couple of those pieces. Maybe there’s people listening that haven’t had any testing.

Look at the quiz and then start to see where things are going and then put it in that hierarchy. So again, address your big sources of inflammation first, honor your low cortisol. When you’re going to figure out like what do I do? How do I exercise? What do I eat? Honor the low cortisol, low thyroid stuff first. Heed that advice first. Get that healed up. Next you would heal high cortisol if you had any of that. Next you would address your insulin and then you kind of get to those more peripheral estrogen and progesterone problems.

How many women are dealing with let’s say PCOS and they’re given stuff to help their progesterone balance? They’re just given let’s say Vitex or natural progesterone cream and we’re missing all of those steps that had to happen. If we don’t address those first…first of all it takes out the overwhelm. But if you don’t address those kind of bigger picture ones, you’re never going to get anywhere with fussing with estrogen and progesterone. If you haven’t dealt with inflammation, your thyroid, making sure your adrenals are healthy, you’ve got the right amount of recovery, and then honoring your insulin resistance as far as the carb intake.

So I would say look at that hierarchy. You can see that on my Facebook page, on my Instagram page looking at that and kind of making sure you just kind of follow those steps. When your adrenals are better and you’re you’re not dealing with so much low blood sugar, can’t tolerate exercise, trouble with sleep, waking up super fatigued, when you’ve kind of dialed that stuff in, then you just kind of move on down the list.

I would say the next thing is find your unique carb tolerance. It doesn’t matter if you have PCOS or not. You really got to step away from all of that diet templates and find out again what works for you. I usually have women just address that first and know that it can change.

While insulin, and cortisol, and blood sugar, like they’re not sexy topics. Those are not new. The ASP and the GIP hormones, people are like that’s new, I didn’t really know that that happened with fat. Well we didn’t even know about those hormones 10 years ago. We’ve got cool new information. When I’m always harping on women about your blood sugar, and sleep, and insulin, cortisol, it’s so boring.

There’s a couple of reasons why I think those are so important. One is that those hormones, insulin and cortisol, they have such a profound effect on everything that flows out from that. They impact our thyroid. Thyroid is super important, too, but it’s not always something a woman can really handle on her own. We need testing and sometimes medications or higher level interventions.

But insulin and cortisol, they’re going to affect all those other hormones. They talk to us all day. We have my acronym of ACE’s: appetite, cravings, energy, sleep. When those things are off, that is mostly insulin and cortisol talking to you. We get this feedback after we eat, between our meals, when we try to go to sleep. We have this talk from our hormones all day and if we can listen to it, that’s like real time information. You don’t have to wait six weeks to get a blood test. You can intervene on that right now.

The other thing is when you start to listen to those symptoms, you can make changes in real time. Like if I’m over-eating past my carb tolerance or I’m feeling super sluggish after I have like a really heavy carb and fatty meal, I can make a different decision at lunch. So that’s just a few hours later that I can try something new and get a different result. You can start to really tune in. We’re always saying do what works for you. Well this is how you figure out what works for you.

And the last thing is we have a lot of control over those hormones. It doesn’t always feel like it. It doesn’t always feel like we can control what we eat or we can control how much stress is in our life. But when we stop and think about it, those are two hormones we have a ton of control over if we stop and kind of figure out how they’re working and really make those strides to do what works for us in terms of food, step away from our dogma, or even step away from the confusion and just start listening, and figuring it out, and then really paying attention to the many, many sources of stress in our life. When we do that, we really can have a really wide ripple effect on a lot of hormones.

Laura: And it’s funny because with food I feel like people will tend to be, they’ll get into the weeds so much with food where they’re like, I don’t know, is this too much sugar, or too much carbs?
They’re like, is it too many blueberries that is causing my blood sugar?

I’ll work with clients and I’ll see that they’re just not even eating protein at breakfast. I’m like alright, well let’s first just get some protein in that meal and maybe we’ll have better blood sugar control after that.

I think you can get a little bit caught up in all the minutia and miss the big picture. Like what you were saying about cortisol and insulin, that’s not just diet. That’s like you said, things like stress, things like sleep, things like exercise. It’s one of those things where if you get way too wrapped up in finding this perfect diet and you’re not paying attention to those other areas, you could be totally missing what’s going on in your root cause.

This is something that Kelsey and I see all the time where we have clients who are like super stressed out, or over-training, or not sleeping, or they have a job that they hate. And it’s like you can’t fix that kind of stuff with a perfect diet no matter how hard you try. I mean obviously it’s going to help if you’re eating well, but I find that a lot of women will just get like way too focused on the diet.

Dr. Brooke: Think about most of our clients. They’re willing to really micromanage their diet. They’re willing to take a ton of supplements, spend a lot of money. But they’re not willing to meditate, they’re not willing to go to bed earlier, or they’re not willing to take some stress off their plate. Maybe they make some changes in their finances that they think it would be less stressful if they do it, but it feels like oh I have to keep working towards that thing.

Those things are so much harder for people to change. We’ll get up at 5 to go to the gym when we need to be sleeping. It’s really funny and I think women are probably worse at this than men. I think we kind of suffer from this mentality of doing it all and look good doing it. There’s a lot of a lot of pressure. I’m the same way. Like I’m the last person to think going to bed early is the right choice. I should work more, I should do more things, I should get in another whatever.

And of course I’m having to change that. We were talking about teen girls and stuff, like we think kids can handle it because they’re young. And they can, until they can’t. Unlearning all that stuff now is really hard.

Laura: Definitely. Now I wanted to talk a little bit about your philosophy on exercise since that sounds like it’s a big part of the work that you do. Do you have any tips for women with PCOS in terms of exercise, either types of exercise they should be looking at, frequency, or anything like that?

Dr. Brooke: Yeah. With exercise, it’s just like the food. You have to still follow that template. You have to still exercise in a way that honors the low cortisol and the low thyroid first, the high cortisol next, the insulin resistance next, and then if there’s anything specific for estrogen and progesterone.

You start the same way. We don’t want to overdo it if your adrenals and thyroid are sad. We don’t want to overdo it if those hormones are struggling. We don’t want to do too much metabolic training if you’ve got crazy high cortisol. It’s just going to continue to drive that.

What we want to do, again, is try to make this simple. I’ve put kind of all of that information in my head and for the women I work with into a little…so there’s those five hormone imbalances and then there’s what I think is a pretty simple template for your week basically. And then you adjust these again as your hormones dictate.

You kind of always go back to this is just a template. Even my template is not perfect, but it does a pretty good job of honoring those most delicate hormones first. I have this little five, four, three, two, one. So five walks a week, four meals a day, three strength training sessions a week, two liters of water a day, and then one kind of prevailing positive thought about your body because I feel like women, of course we struggle with that, too, and I don’t want to ever forget that mindset piece of it.

The five walks, most women even like the most hormonally wiped out can tolerate walking. It’s also a pretty good hormone normalizer. It’s not going to be a type of cardio that is too much for most women. Now there are some women that it is and they can only walk a little way. So I usually try to encourage that.

And the four meals a day of course is variable. I find that four meals a day that are roughly the same size versus larger meals and smaller snacks works really well for women with PCOS and insulin resistance, trying not to overdo it at any one meal. Now if your adrenals, if you’re really struggling with the low cortisol or some of those issues, you might need to eat a little more frequently. If you’re super insulin resistant or have a really healthy metabolism, you might be able to have less meals. Maybe you’re doing intermittent fasting or maybe you do fine on just like three squares. So you adjust each piece of this template according to the hormone hierarchy.

And then the strength training is probably the place that I differ the most from other hormone experts when they’re dealing with people in the HPA axis dysfunction. I know adrenal fatigue is not a great term. We know that that’s not actually what that is, but it’s still pretty common for the average person. They know what that is.

When we’re dealing with those types of issues, the low thyroid, lots of inflammation, a lot of autoimmunity, or any of that HPA axis “adrenal fatigue” stuff, with the three strength training a week, a lot of people will say absolutely can’t do that. This person needs to walk and rest and they can’t do any strength training.

The type of strength training I find works the best…because we have really great anti-inflammatory, and hormone helping, and insulin sensitizing benefits from strength training. So I’m not just talking about weight loss, or physique, or even just the fact that strength training is so good for our bones and our longevity. We have anti-inflammatory, really good hormone effects from muscle mass and from strength training. So taking that away from someone who’s trying to lower their inflammation, and improve their health, and improve their hormones I think is sometimes a mistake.

Obviously we also can’t overdo it. The way that I recommend women start to again just honor those hormones is doing some heavier strength training, some more of like a 5X5, heavier lifts, not a lot of reps, plenty of rest. I find that most women can do that without feeling totally wiped out. Of course my sickest of my Hashimoto’s women can’t do that until we get all their inflammation dialed in and support their oxidative stress better. But for most women, this allows them to keep some muscle mass, work on some of the hormone benefits of exercise and muscle mass and not do nothing, but also allows them not to overdo it.

I have a guide on my website, The Guide To Exercising For Your Hormones, and it has that hierarchy in it so you can kind of go through that…and then a strength training template where you can also take it day by day. You take it hormone by hormone.

But let’s say you’re doing better. You can do a little bit more strength training on that day, you still honor that 5X5 and those heavier, lots of rest lifting up front. What I find that does is a woman can say okay, I feel good, I can do a little bit more today. Or I don’t feel that great, I’m only going to do this and that’s enough. You’re kind of getting the benefits without overtaxing your system.

Again, there’s going to be some variation in that. But I find that that template kind of keeps us from doing…I always want to gravitate towards lots of high intensity training. That’s what I like. I really like the adrenaline and dopamine rush. I always have. But that’s not something that really works very well for me anymore.

Many women find as their female hormones change, we don’t tolerate stress of any kind as well because we’re losing some progesterone and that sort of tempers the effect of cortisol. So many women find when they start going through menopause or they’re not ovulating right for whatever reason, we’re so sensitive to stress and some of the good exercise that we used to do for weight loss, lots of CrossFit, lots of spinning, lots of high intensity training can really kind of backfire for us.

Again, it’s a template, it’s a starting point for women. I feel like that hopefully gives them a place to start to think about it in kind of a framework, but then you just got to honor it for each individual hormone.

But that’s something that’s a little bit different with me. I know a lot of people when they’re dealing with those more delicate hormones that are low, they’ll just say you shouldn’t really do anything and I have found that that isn’t always the best.

Laura: Well and not to mention for a lot of women, not exercising at all is stressful on them because they really enjoy it. That’s something where in my hypothalamic amenorrhea program I’m going to be talking about because those recommendations happen with HLA lot where they’re like don’t exercise at all. And to be fair, I mean some women can benefit from a short break. But I find that most women don’t feel their best if they’re just not moving at all. I don’t think that’s normal or healthy. It can scare women a lot where they feel like they shouldn’t be doing anything.

Like you were saying, the kind of training you are talking about is not going to, or at least it shouldn’t overwhelm a woman’s adrenal system just on average. Obviously if someone’s got some severe cortisol dysregulation, you might have some trouble. But the average woman can do fine with three times a week.

The kind of training that you’re talking about, it’s not as sexy as like CrossFit, high intensity, that kind of thing. But honestly, it’s really effective and that’s the way that I train with my trainer. Kelsey, I feel like you kind of train that way, too, where it’s like you take a lot of rest breaks in between sets.

Kelsey: Yeah.

Laura: Like I said, it doesn’t feel like you’re killing yourself, which for some women they feel like I’m not getting a good workout because I don’t feel like I’m dying at the end. It’s like you have to retrain yourself to not only not expect that, but also like not continue if that’s how you’re starting to feel.

Dr. Brooke: If you want to add some of that, great. I always say don’t sacrifice that other training for that. So if you do that and then you want to do a metabolic circuit afterwards or some of that stuff, do it to your tolerance as long as you’re not ignoring those other hormone problems. And we’ve all done that, right? We’ve all over-exercised at one time or another, or done nothing. I think both are really not great for our hormones.

Laura: Right, especially because you were saying with the insulin resistance piece, building muscle is one of the best ways to improve insulin sensitivity. So definitely a good thing to be doing no matter which version or type of PCOS that you have.

I feel like we could keep talking about this for another hour. We’ll have to have you back on the show. But I think we got a lot of really good information today. A lot of myths were busted about whether you should be exercising, how to be exercising, how to eat, whether to eat carbs or fat, or what kind of fat. I’m really glad that we had you on the show today.

Can you just remind our audience where they can find you and learn more about the work that you do?

Dr. Brooke: Yes. My website is BetterByDrBrooke.com. It’s “Dr” for doctor and Brooke with an “e”. Everything that I talked about in terms of the templates and that hormone hierarchy, the hormone hierarchy is on my Facebook page, it’s on my Instagram.

I get such good feedback for the hierarchy and the little template; the five, four, three, two, one. Because again, we’re just all so overwhelmed, like how do I even begin to pull this off most of the time. And then in particular, women want more information about the template or using the strength training, there is that guide on my website. BetterByDrBrooke is pretty much my handle on most social media.

Laura: Perfect. We’ll link to those resources, so your website, and your Instagram, and all that on the page for this episode.

But we really appreciated having you on today, Dr. Brooke. It was really awesome to be able to talk to you about PCOS. Like I said, I’m sure there was probably about 30 more questions we could ask so we’ll have to have you on the future.

Dr. Brooke: Anytime.

Laura: But again, thank you so much for your time and we’ll look forward to talking to you again in the future! I hope everyone has a great week and we’ll see you again soon.

Dr. Brooke: Thank you.