Dr. Fiona McCullouch is one of my go-to naturopathic doctors when it comes to PCOS. Not only is her fantastic book, 8 Steps to Reverse Your PCOS, a “mini-encyclopedia” of PCOS, she is up-to-date on PCOS-related research. In this podcast episode, we discuss the latest PCOS news and topics including:
- The anti-müllerian hormone study- is there a PCOS cure?
- New research on the connections between mood, depression, and inflammation
- Hyperthermia and the science behind why exercise improves our mood
- Why women with insulin resistance need more selenium
- Pros and cons of bariatric surgery and hysterectomy for PCOS
Also From Dr. Fiona:
Amy: I often talk about the blessings of PCOS and one of the blessings that I’ve experienced is that I’ve been able to meet some amazing women on my journey with PCOS and my podcast guest today is one them. I’m just so happy to have Dr. Fiona McCulloch back on the podcast, and she is a board-certified naturopathic doctor. She is the founder and owner of White Lotus Integrative Medicine. She’s worked with thousands of people seeking better health over the past 18 years of her practice.
She’s the author of one of my favorite books on PCOS, the 8 Steps to Reverse Your PCOS and she’s been a very popular contributor to PCOS Diva with guest posts and podcast over the years. In fact, when I was preparing for this podcast, I realized that she was just the second interview that I did when I launched my interview series back in 2013. I’m just so thrilled to have her back on and to be chatting with her this morning. Welcome.
Dr. Fiona McCulloch: Thank you, Amy. I have really enjoyed interacting with you just over so many years and even before that podcast, I had no idea that was one of your first ones because I had been following you for long and I just love your book, and it’s just been cool to just go through this journey together and really see so many things change for women out there.
Amy: And what’s neat too is getting to know you and your family, and seeing your three boys grow up, and seeing them blossom and flourish. That’s really a cool part of this too.
Dr. Fiona McCulloch: Oh, I know. And same for yours. I just saw all the amazing footage of your son graduating. It’s just amazing to see how quickly they grow up and how well he’s doing. It’s phenomenal.
Amy: We’re both women with PCOS and we’re really here to tell you that you can thrive and you can have children. If doctors have told you … I know they did in the past for me they’d have to jump through hoops one here my baby is going to be turning 18 and going off to college. So, there is so much hope.
Dr. Fiona McCulloch: There is, absolutely. I really feel like most women who have PCOS do have children. It’s really awful that they’re often told that, that’s not a possibility because we see it again and again, and it’s very possible.
Amy: So, you are … And I know because you’re one of my go-to experts when some new research comes out and I need to sort of make head or tails of it. I reach out to you because you really are an avid researcher and you’ve published articles and major naturopathic journals and your book is so research driven. So, I thought it’d just be a great opportunity today to kind of catch up on some of the latest research and you can kind of give us your assessment, and I’d like to ask you some questions too. But I thought I would just sort of hand the mic over to you and you can get us up to date with some of the latest PCOS research out there.
Dr. Fiona McCulloch: Sure. And you know I’m such a nerd. I love reading research. It’s one of the things I do every day is go through my feeds of all the new studies that have come out. So, there’s so many new things to share and there is always new things every week actually. So, it’s very, very interesting.
I think one of the big ones that’s the big one that a lot of people have been asking about is the study on Anti-Müllerian hormone in pregnancy. There was this study that came out, which basically found that … They looked at rats actually and they gave the rats a hormone called Anti-Müllerian hormone, which we know is often quite high in women with PCOS. What they found was that the offspring rats actually developed PCOS because of the effects of this hormone on the brain.
They also found out that women who have PCOS have higher than average level of Anti-Müllerian hormone in pregnancy. So this is something that makes a lot of sense. But then they went on to conclude that this is the single cause of PCOS, which cause the very big kind of uproar in our community. And the suggestion as at the end of study at end of the study was that, giving a medication like [inaudible 00:04:59], which is basically a fertility drug would reverse PCOS entirely, which obviously sounds very exciting but also there were quite a few concerns with this being a little bit over-simplifying of this complicated condition.
Amy: Yeah. I know a lot of the headlines were saying that a cure has been founded for PCOS and really celebrating that. And it really does women a disservice because now they’re ready for that magic pill. So, “Give me the pill that’s going to make my PCOS go away.”
Dr. Fiona McCulloch: Exactly. And then the other thing that was found in the study was that this correlation only held true for the lean women and also that the AMH didn’t induce any of the insulin resistance that we see in PCOS. This is part of … It’s showing us, basically, the ovulatory problem but not the rest of the condition. So, it’s oversimplifying PCOS as a fertility condition, again, which I’m always so against because it’s really so much than that. And we know that once women go through menopause when ovulation is not an issue, they still have issues.
We know there’s the cardiovascular risk, the diabetes, the inflammation. So this didn’t answer any of those elements of the condition. If a cure for PCOS was defined as just regular ovulation, that really does not cure this condition. We know that there’s lots and lots of women who have so much difficulty with weight loss. They end up getting diabetes. They have inflammation and cardiovascular disease, that is so important. I mean, ovulation is one part of it, we can induce ovulation very easily with medication or with other natural methods as well but still, that other element is very, very important for our health. In fact, I would say much more important.
Amy: I know one of my other podcast guests from way back was Dr. Andrea Dunaif and she has sort of led an effort to change the name of PCOS to one of the suggested names, and I think it’s a good name, Metabolic Reproductive Disorder because it does have that metabolic piece to PCOS. I don’t know if we necessarily need to change the name of PCOS but I do think what you’re saying is to emphasize that there is a metabolic component of PCOS.
Dr. Fiona McCulloch: Absolutely, yeah. We even see that in children who go on to develop PCOS late. They have lower levels of hormones like adiponectin, which are really associated just with the metabolic elements. So, it’s really not just as simple as an ovulation condition. There is a very interesting study in that. It shows that the prenatal environment does really influence our outcomes. And we know that if you give animals our testosterone, for example, the offspring will develop PCOS, or if you expose them to endocrine disruptors of various types like bisphenol A, that’s in plastic bottles, for example, or other types of plastics, that can also induce PCOS in the offspring.
So, it’s really like endocrine disruption in general, prenatal state disrupts the development of the ovary and its connection to the brain, but it suddenly doesn’t tell us that there’s one specific endocrine disruptor that does that. It’s quite a variety of different endocrine disruptors that can induce this effect.
Amy: Right. And not every woman with PCOS is going to produce an offspring with PCOS either.
Dr. Fiona McCulloch: Yeah, absolutely not. There is some families where some children end up having PCOS and then others don’t. So there is definitely complex genetics involved there where are certain genes that might be passed and certain ones that are not, and there is the environmental turning on and off of the genes, which we call epigenetics. So there’s just so many … It’s a really complicated condition and I think the more that we learn about it and discover, the more we realize it’s very multifactorial. So, there is no one cause or one cure. I think that we’re actually seeing that’s actually not the case.
Amy: Right. That’s a huge take a way that it is such a complex condition. I’ve got to give a shout out to advocates for PCOS that are really raising awareness to gain more research dollars to put behind PCOS because I was … I shared that I was in Washington DC for PCOS Advocacy Day and that was really a main thrust of why we were there to try to get more funding for PCOS research dollars because right now, the National Institutes of Health, their research budget, there’s only point 0.01% advocated towards PCOS research.
And that’s a problem when now the statistics are as high as one in five women have PCOS. It’s really important if you’re listening and you want to make a difference, and to get more research done so that we can kind of figure out what’s going on with PCOS and this complex disorder. Join organizations like PCOS Challenge and contact your representatives, and Congress, and the Senate, and ask them to allocate more funding for PCOS research. That was just my little plug.
Dr. Fiona McCulloch: It’s amazing. I didn’t know that that little … I knew was it was a very small amount but I didn’t know it was quite that small. So it’s fantastic that this advocacy it’s very needed. It’s a huge problem. I mean, we think about cardiovascular disease as the number one cause of death in women and a lot of us, we feel like, “Oh, we’re too young for that,” but the cardiovascular disease, all of these problems accumulate over time. So it’s happening in our bodies now. So, the more that we can learn about how to reverse and prevent these problems from happening, it’s going to be beneficial for us but also for our children. So, it’s so, so important. So many women are affected by this and from what I can see, it seems like it’s on the rise.
Amy: Yeah. I think so too and speaking of the cardiovascular risks, when I’m doing kind of like just little updates, looking on PubMed or Google Scholar about PCOS research, it seems like a lot of research is directed at the cardiovascular risks. And I know that there was a new study that just came out a little while ago saying how … And we already kind of know this but it’s just reaffirming that women with PCOS are at risk for cardiovascular events.
Dr. Fiona McCulloch: Yeah. Absolutely. And we see all of their risk markers are elevated ahead of time. So HSCR is a blood test that … It’s an inflammation marker but lots of women have high levels of this and that chronic inflammation really does increase that risk. So, it’s great that there is research being directed at that now so I’m really hopeful for the future and that we’re going to be able to figure out a lot more about what’s been going on with this condition.
Amy: Inflammation does play such a significant role. There are more studies that you’ve seen that sort of ties inflammation to risk factors of PCOS.
Dr. Fiona McCulloch: Yeah. Absolutely. So one of the things that I’ve been finding really interesting, just that I’ve been researching lately is about mood and inflammation. And we know that women with PCOS, it’s very consistent that we see in all the studies that were at higher risks for depression, and anxiety, and other mood disorders of various types, and this actually seems to hold true outside of some of the stressful kinds of elements of PCOS.
So, there’s obviously like if you have infertility that’s very stressful, if you have hirsutism like hair growth where you don’t want it, that’s stressful. Hair loss is stressful, acne is stressful, but even outside of those, we see an increase in depression and anxiety. And so, what’s causing that? Is it the hormone imbalances or what? So, a study actually came out just today that I was reading about insulin resistance and the risk of depression, and it’s basically showing that the more insulin resistant women are, the more the depression seems to go up. And it seems to go up by 2.3-fold, which is a huge increase. And we know that insulin resistance is related very much with chronic low-grade inflammation.
Some of the interesting research I’ve been reading, there’s a researcher’s name is Dr. Charles Raison and he’s done a lot of research on depression, and the immune system, and the brain and how that works. So what he’s found is that there’s a reason that we have depression in the face of inflammation. So if you think about how most of the risks for survival in our past, before we had our Western society as it is here, would be dying either from an infection or from an injury.
And so, say for example you had a really bad viral infection, that’s a pretty serious risk for life before we had hospitals and medicine to help us survive these things. So the body’s mechanism for protecting yourself during those really inflammatory conditions, because those are inflammatory is basically to go into your cave or your house and stay there until you get better rather than going at … You don’t want to be going out finding food, or mating, or anything else because you’ll probably be eaten because you’re weakened.
So, basically, the body’s mechanism for self-protection is to go inside, and heal, and get better. So that’s inflammation. It does cause that in our brain which looks a lot like depression. So, if you’re sick with the flu, you’re going to be lying in bed all day. You’re not going to be going out. That’s normal. We don’t call that depression. But if you acted like that every day, that would be then considered depression.
So, what they find as well as when they inject animals with inflammatory cytokines, which are the same kind that we have with PCOS, the chronic low-grade inflammation, the rats actually start to become depressed and they’ll go into their little burrow, and they’ll just sit there, and they’ll be very quiet. And when they take away those inflammatory cytokines, the rats actually stop being depressed again. So it’s quite interesting and that this chronic low-grade inflammation is really related to our mood and that trickles down into so many things. So outside of even cardiovascular risk, depression, anxiety, this is all really associated to the inflammation that we all have.
Amy: Yeah. Well, I know from a personal perspective when I’m fall back on sort of the SAD diet, that Standard American Diet. I find-
Dr. Fiona McCulloch: I love that acronym.
Amy: Yeah. I know because it really does make me sad and I find myself just wanting to curl up on the sofa with the shades clothes and watch, I don’t know, the period films that I like.
Dr. Fiona McCulloch: Right?
Amy: I don’t know, just to escape from it all and not engage. And it’s funny because now, my husband and I have been married now for … We’re going on 22 years. So, he knows me, and he’ll usually say … Like kind of force me to get to the gym to kind of get those endorphins going or say, “What did you eat today or what have you been eating?” Because I, honestly, can track it back to foods that are inflammatory to me like gluten and sugar, and it really affects my mood. I think it’s so satisfying to hear this research to realize that … I kind of figured out what was going on in myself just by listening to my body. I didn’t need the research, but it’s great to hear it to kind of back it up.
Dr. Fiona McCulloch: Yeah. Absolutely. And it makes a lot of sense given that our bodies are made to really survive and this is the only time that we even had these kinds of threats against our life in society, pretty much ever. And it’s so true like I know if I tend to eat outside of what I know I should be eating, I also tend to feel more down and maybe like watching too many episodes of … I don’t know if you’ve watched The Crown.
Amy: Of course.
Dr. Fiona McCulloch: I’ve watched those over and over but it’s sounds so true. It’s like you want to just kind of curl up be away from everything. And the other interesting thing that this researcher was looking at, he was actually looking at something called hyperthermia which I just thought I’d bring out because it’s something that’s so easy to do and it kind of answers some of these questions about why exercise really improves our mood so much.
So, what he found was that, when you raise the body temperature, it almost induces like … Your brain thinks it’s like a fever and that you fought whatever this inflammatory infection is and it induces anti-inflammatory responses in the body. And so this is actually part of the biggest reason they feel that exercise seems to be an antidepressant because you’re raising your core body temperature for a certain period of time.
Amy: Oh my gosh, that’s fascinating.
Dr. Fiona McCulloch: Yeah.
Amy: I would not have thought of that. That’s so interesting.
Dr. Fiona McCulloch: And they were able to induce the same exact benefit by putting, for example, what they would call a hot box like a sauna, but raising the core body temperature but also induce these same anti-inflammatory mechanisms in the body and people would feel … They do feel significant relief from depression as a result of that.
Amy: Have you ever done Bikram yoga.
Dr. Fiona McCulloch: I have.
Amy: And you really do feel fabulous when you get out of there, don’t you? I mean, it’s a big commitment. I was talking to my girlfriend about it because it’s a 90-minute class, and it’s downtown. So it takes me about 15, 20 minutes to get there and get home, and then you definitely need a shower after. It’s big commitment to go but you really feel wonderful.
Dr. Fiona McCulloch: Yeah. For anyone with mood disorders, I would highly recommend it because it really … More than even any other kind of exercise, it’s the heat I think that has … Especially after reading this research or even as sauna can be really helpful for the same reason, and I think there’s a lot of history of using saunas in Europe for so many disorders but now we’re kind of finding out why. It’s has a lot of anti-inflammatory effects on our body and probably coming from that, when our body temperature is raised, that’s what we do to fight an infection but we’re not getting out of that state. We’re just inflamed all the time. So it kind of turns that on in our body.
Amy: There was a study that came out about a month or so ago because I posted it on Facebook and it was about how hot tubs were … Like soaking in a hot tub was really beneficial for women with PCOS. Do you remember seeing that?
Dr. Fiona McCulloch: I did and I was so interested in that because I have a hot tub, and I got that mostly because I liked it, but at the same time, I’m like, “Great. It’s got actual benefits,” but I really think it’s the same mechanism. I don’t think it matters in a way how you raise that temperature. Just that it happened somehow and all of these methods are really beneficial.
Amy: Yeah. So, I was wondering if you could give listeners some tips like if they feel like they may be in this inflammatory state of depressed moods, and sometimes you can just feel the inflammation, you’re puffy, bloated, achy joints. What would you recommend to help kind of things that we can do to quell the inflammation?
Dr. Fiona McCulloch: Yeah. Absolutely. I think the first thing is diet, really, getting rid of some of the anti-inflammatory food. So, sugar, and we were talking about the sugar dairy and you don’t have to be perfect but at least try to cut it back to some degree, gluten, and also anything that makes you feel not great. So if you eat something and you kind of feel like, “Oh, I ate that and I feel really bummed out for three to four hours,” there’s probably something in there that’s inflammatory, that you’re not responding well to because everyone is a bit different.
There are foods that other people are fine with but they react to. So, listen to your body, and just take note when you eat, what is it that you ate today if you’re really feeling down or inflamed. So working on those types of things. Keeping your blood sugar really stable is really important to you. So, making sure you have enough healthy fats, proteins, lots of fiber with every meal, and enough carbs that you’re not going into a more stressful type of situation. That really depends on each person and how much they need.
There are anti-inflammatory supplements that are really kind of cornerstone. Just to take that down some notches and we know that things like fish oil, omega-3 fatty acids are pretty. We have really good evidence that they’re anti-inflammatory. We see benefits for mood for cardiovascular disease. So those are all really through that same pathway of those being anti-inflammatory. N-acetyl cysteine is a really good antioxidant that is anti-inflammatory.
Dr. Fiona McCulloch: A recent study came out that showed us, even I think a couple weeks ago, that people who have abdominal fat, so basically insulin resistant people. For example, most women with PCOS, myself included, have lower levels of selenium and that actually is because it’s being used up more by you know the inflammatory process because selenium is used to quench oxidative stress, which is what makes inflammation what it is. Those supplements can really help. And then, of course, all those, looking at things like exercise and just knowing the mechanism by how that works. It’s actually a very physical mechanism or trying some things like a sauna or hot yoga. If you do all of those things together, most people would really be able to reduce their inflammation quite a bit.
Amy: Yeah, and you can feel better fairly quickly.
Dr. Fiona McCulloch: Absolutely, yeah.
Amy: So, I do want to ask you a question that I get a lot and I know that there’s been some research out there recently about bariatric surgery and PCOS. Women want to know, “Is that going to help my PCOS? Is it worthwhile to look into out?” I’d love to get your thoughts and how you might counsel a patient that comes to you asking about bariatric surgery.
Dr. Fiona McCulloch: I do have quite a few patients who’ve had this done, and I think my views on it are kind of that it does have significant side effects and risks. And so it will change life your forever in ways that are both possibly beneficial and also not. And so I always recommend to try everything else first because of those long-term effects because of the surgery, you can’t undo that. So, if there is some way that you can manage your symptoms without having a surgery like this, it’s always better to do that.
However, there are some women for whom they have tried absolutely everything and it’s not working, and the benefit of it might be better than the risk. In which case, I would say, find a very good surgeon and get everything and just make sure you really understand the whole process. It can really change what you’re able to eat, not only the amount but what you can eat, how much you can eat at a time, and it might change a lot of your bowel movements might be different actually for the rest of your life.
So, I’ve seen people have had this and they do have to do a lot of management of it ongoing but I think it’s a very individual type of decision and definitely not something that’s going to work for the vast majority because it is such an intense intervention.
Amy: Yeah. And there’s other ways to reduce your antigens and regain menstrual cycles, and improve your metabolic outcomes.
Dr. Fiona McCulloch: Yes. There are many, many options these days. It’s just there’s so much you can do. There’s so much that we’ve learned, and the vast majority of women do very, very well with the lifestyle interventions once they know exactly what to do for PCOS specifically because there’s just so many diets out there that don’t necessarily work well for PCOS there. It might work for other people but you’ll see a lot of women saying, “Well, I tried all these things that other people are trying and they’re not working for me.” It’s really because the program’s themselves are not really designed for the severe insulin resistance that we see in PCOS.
Amy: Right. I want to just ask you where women can find out more information because we’re kind of running out of time and I also just want to give another shout out to your book, the 8 Steps to Reverse Your PCOS. And what I love about your book … I think we have a whole podcast where we talk about it, but I love how you’ve broken down PCOS into different phenotypes. I just thought, somebody’s not familiar with your book, maybe you could just give a quick overview about what that’s all about.
Dr. Fiona McCulloch: Yeah, sure. So my book is basically a mini-encyclopedia on PCOS. So, it goes through all the different elements of PCOS that are involved and these elements can actually change throughout a woman’s life span. So at certain points in time, she might be dealing with way more androgens, especially when she’s younger and at other points of time, maybe not so much. So, it goes through all of the different key elements so that women really understand what are the factors that make up PCOS and then how to expect those to change at different times as well as different things you can do at the different times of your life are impacted by the condition because it’s something that really evolves from childhood all the way through past menopause.
Amy: Yeah, and a hysterectomy isn’t going to cure you.
Dr. Fiona McCulloch: No, absolutely. It will not. We know that, that’s the case. I actually have a lot of postmenopausal women as patients who have PCOS and they still have the same problems. They don’t have periods anymore, so you can’t see that, but the insulin resistance is all still there, the inflammation. So, yeah, it’s absolutely not going to be cured by hysterectomy.
Amy: I love the work that you’ve done and the contribution that you’ve made to the PCOS community. As I said in the opening, you’ve really been a blessing to me, just personally and professionally, and I just want to thank you for that.
Dr. Fiona McCulloch: Thank you so much, Amy. I just want to say the same to you. You’re such a tireless advocate and helper and you always have so much wisdom to share and I just feel so lucky to have met you and to be able to work with you.
Amy: And I’m looking forward to seeing you this summer, hopefully, at the conference we go to every year.
Dr. Fiona McCulloch: Absolutely. I’ll be there.
Amy: Yay! So, how can people learn more about your work?
Dr. Fiona McCulloch: You can just check out my website it’s at drfionand.com. And if anyone’s in Toronto, I have a clinic at whitelotusclinic.ca that you can check out. We treat lots and lots of women with PCOS there.
Amy: Do you Skype consults?
Dr. Fiona McCulloch: Right now, we don’t. We used to do that, but now our regulations have made it such that we don’t do that anymore. However, if people are interested, they can give our clinical call because sometimes that might change or there might new ways that we can accommodate distance patients if they’re to fly up. So just let us know or reach out to us. My clinic’s email is firstname.lastname@example.org.
Amy: Excellent. Well, thanks for taking time to come onto the podcasting and share some of the recent research. Maybe we can make this a regular appearance. Every six months or so, you can share the latest with us.
Dr. Fiona McCulloch: Sure, I would love to. I just love geeking out on research. So I’m happy to do that any time.
Amy: Okay. In the show notes, I’m going to point your article about AMH that you wrote and that recent study that you mentioned. And also link to our previous podcasts so people can listen in.
Dr. Fiona McCulloch: Thank you so much, Amy.
Amy: Thank you, everyone, for listening. I look forward to being with you again soon.