Preparing for Pregnancy with PCOS [Podcast] - PCOS Diva

Preparing for Pregnancy with PCOS [Podcast]

PCOS Podcast No. 54 - Preparing for Pregnancy“If you’re listening and you think that the only way to regulate your cycle and induce ovulation is with Clomid or you’ve been told Metformin’s going to do it, I can assure you that for ninety-five percent of you listening, you can do it in a different way that’s more natural.” – Dr. Marc Sklar

What can you do to prepare for a healthy pregnancy? One of my favorite fertility experts, Dr. Marc Sklar, is here to share his philosophy, protocols and wisdom. Every woman with PCOS needs to hear what he has to say about finding “your secret recipe,” of your personal combination of diet, exercise, stress reduction and supplementation needs in order to ovulate and maintain a healthy pregnancy. Listen as we discuss:

  • How does your PCOS phenotype impact your treatment plan?
  • Diet & lifestyle protocols for PCOS, especially to avoid gestational diabetes during pregnancy
  • Suggested tests (including for thyroid and the Dutch test) and how to advocate for the right testing
  • Why women who are under stress during their fertile window, have a forty percent less chance of conception
  • Changes to make to avoid pharmaceuticals (Metformin)

A full transcript follows.Ovusense Fertility Monitor review

sklarFor more than 15 years, The Fertility Expert, Dr. Marc Sklar, has been helping couples struggling to conceive and have healthy babies.

In addition to his Doctor of Acupuncture and Oriental Medicine, Dr. Sklar trained at the Harvard Medical School, Mind/Body Medical Institute. He is the creator of and, the co-author of Secret to Conception and a Fellow of the American Board of Oriental Reproductive Medicine and Medical Advisor for Natural Health International.

Dr. Sklar lives in San Diego, with his wife and two sons. If you’re ready to start a family, The Fertility Expert can help!PCOS prenatal supplement

Full transcript (with links):

Amy: Hello and welcome to another addition of the PCOS Diva podcast. This is your host, Amy Medling. I’m a certified health coach, and I’m the founder of and today we’re going to be answering many of the questions that I receive from PCOS Divas and so many of you, I know, are trying to conceive. You are wanting to know what can you do to prepare for a healthy pregnancy, and what kind of testing you need, and what do you eat before and during pregnancy? I know a lot of women with PCOS are dealing with gestational diabetes, and we want to kind of stave that off. In today’s podcast, we’re going to give you some information for you to do that. I brought in one of my favorite fertility experts, and that’s Dr. Marc Sklar, so welcome to the PCOS Diva podcast, Dr. Sklar.


Marc: Thanks so much for having me, Amy. I’m super excited to be here.


Amy: Let me give our listeners a little bit of your background. For more than fifteen years, Dr. Marc Sklar has been helping couples struggling to conceive and have healthy babies. In addition to his doctorate of acupuncture and oriental medicine, you trained at Harvard Medical School, Mind Body Medical Institute, you’re the creator of and, the co-author of Secret To Conception, and a fellow of the American Board of Oriental Reproductive Medicine, and a medical advisor for Natural Health International. You are the fertility expert. You’re … Just to let folks know that you are in San Diego, so if anybody is local in that area, they can find you. I know you’re online, too.


Why don’t we start with preparing for conception with PCOS? For the women that are trying to conceive, what should they be thinking about?


Marc: Yeah, you know, I think this is a really, really important topic, and certainly the place to start when I start working, coaching, or treating patients. Either patients already know that they have PCOS or have been told, or they have maybe some inclination that they might have it, but they haven’t done any initial investigation to figure that out. My first step is really all about, in terms of preparing for conception, is really about gathering information, and gathering more information about the type of PCOS that someone might have. I know you’ve covered the variations and types of PCOS in other podcasts, so the listeners can kind of reference that, but most women that I find that I work with and that I see who have PCOS, it’s very uncommon to find someone … Two patients who are very similar in their presentation.


We’re all very unique and very different in need. A little bit of a focus in our plan when we’re trying to get pregnant, or even just trying to regulate PCOS and our hormones, and so I think it’s really important to start with that gathering more information phase. A lot of that, really for me, comes back to the investigation part, the testing phase and lab work part of it, as well as trying to figure out how to make the changes that need to be made your own and work for you. That preparing phase for conception, I find to be very individualized for patients, or at least I find that when it’s the most effective, it should be individualized for patients. Those are kind of the initial framework of how I start to look at it.


Amy: You know what? Would you mind for those women who haven’t really heard the podcast or read the articles about the different phenotypes of PCOS, could you give us just a quick overview?


Marc: Sure, yeah, absolutely. There are … Depending on what you read and reference, there could be upwards of ten different types of PCOS, some even as simple as just having poly-cystic ovaries, but all your other lab work being normal. Then there’s going to be four specific variations that I find that come up, that we see, and it’s been somewhat documented in the past, in some research. You have the first type, who would be someone who has poly-cystic ovaries, but also is not having a regular menstrual cycle or no cycle at all, and also has increased androgens or testosterone, to keep it simple. Then the second type would be a woman who just has the increased androgens and testosterone, and also doesn’t have a regular cycle or has no cycle at all. The third type is a woman who has a regular cycle, which is great, but her androgens are still elevated, and her ovaries are still poly-cystic. Then the third one is that the androgens are normal, but the cycle is still irregular and the ovaries are poly-cystic.


Then it really can start to really get much more complex, that’s why there’s the four basic types and then we go on from there. I think the overarching theme with all patients is this blood sugar, glucose, insulin factor that definitely needs to be looked at across the board.


Amy: Okay, so when a woman is ready to begin this process of her fertility journey, what … How can she advocate for the right testing with her doctor? Think that’s something that’s really important. She needs to sort of understand the baseline tests that she should be receiving.


Marc: Yeah, I couldn’t agree more. It’s hard. The advocating piece, I find, is really difficult for patients. I think there’s a fine line, and a lot of it really depends on the gynecologist that you’re working with, and their reasonability, and if they don’t allow their egos to get in the way, to work with patients, really is I find to be key. Also, going in with … Loaded with information of what you should be having tested, often times women have been diagnosed when they were young in their teens, or they’re just purely diagnosed based off of the visual of the poly-cystic ovaries and because of that, they say, “Well, we don’t need to look at anything else.” I do agree with you, you need to be your own advocate, and you need to really go in with information.


In many ways, I think it’s important that they start off asking nicely, but at some point, I think you have to demand it, and if you’re not getting what you want, I think the two ways to then get what you want is to either switch gynecologists, or to order the tests on your own. There’s a lot of ways that you can get blood work on your own, as a consumer, and actually for a much lower and reduced, and somewhat reasonable out of pocket expense as well, and then you can always try to submit it to insurance afterwards.


In terms of testing, let’s review some of the basics that I like to recommend. I do like to have blood work done, and having … The first place to start would be having your blood sugars checked, so fasting glucose, fasting insulin, and then the diabetes marker, which is hemoglobin A1C. Then also having your androgens tested, so testosterone, both free and total testosterone, and then DHEA as well. Those are some of the key markers for overarching, looking at your … To see where you fall. It helps dictate which one of those four phenotypes you’re going to fall into. Then if you haven’t had any of the initial blood work done at all, then I do think having your FSH, your follicle stimulating hormone, your luteinizing hormone LH and then estradiol, as well as anti-mullerian hormone checked, I think is essential, as well.


Those are some of the basics. I always, if I’m doing that, will also throw in progesterone as well, to have that looked at and taken into account with the whole picture. Ideally, in a perfect scenario, and I know that’s hard with PCOS women because if you’re not having a regular cycle or no cycle at all, this could be difficult, but ideally, those last set of hormones, the LH, FSH and estradiol are done on day two, three, or four of your cycle.


Amy: Okay, and then what about thyroid? As you know, so many women with PCOS are hypo-thyroid or even have Hashimoto’s which is the auto-immune thyroid condition, and are often … Don’t even know they have it. I know that that can really come into play when it comes to trying to conceive, to sort of know where you are with your thyroid.


Marc: Yeah, I think it’s an excellent point. Fifty percent of my PCOS patients have some aspect of a thyroid disorder. Absolutely, I do test all my PCOS patients for … With a complete thyroid panel, including the antibodies, like you mentioned, to test for the Hashimoto’s disease. That’s going to be a much harder process, I believe, to get ordered through your gynecologist. One, because most gynecologists, I think, do a poor job of managing thyroid in general, and they’re not the most comfortable with it, so they tend to refer out to the endocrinologist.


Additionally, in the western world, the treatment for thyroid disease, and the most common thyroid issue, hypothyroidism, is Synthroid or some variation of that, and so they only tend …Because Synthroid works on regulation TSH, thyroid stimulating hormone, they only tend to test that. Maybe you’d get, if you’re lucky, get another one of the hormones tested, but there’s upwards of nine or ten different thyroid hormones that can and should be tested, and most physicians are not going to want to order that. They’re somewhat binded by insurance companies and being scrutinized on their own, and so I find it’s very hard to have patients get those tested through their gynecologist, and quite frankly even through their endocrinologist as well, because it wouldn’t really dramatically change their treatment at all. I find that I’m usually the one ordering those more often than not for my patients, when it comes to thyroid. I do think it’s an essential piece to figuring it out.


For me, that goes a little bit beyond the basics of finding out about PCOS, your hormones for PCOS, but I do think that in the long run, that that absolutely has to be tested. I should expand a little bit on the blood work side of things. I even go a step further when I’m testing hormones for patients. I do the blood work that I mentioned earlier, and I do the thyroid blood labs as well that we just discussed, but I go a step above that and I do a dried urine hormone panel, also known as a Dutch test.


I do that for a couple of reasons, because one, it gives me a lot more information on a woman’s hormones, and it tells me what their metabolism … How they’re metabolizing and using their hormones. I don’t just see, let’s just say the … That testosterone is elevated, I’m going to see the by-products of the testosterone, the androgens, and see where a woman is more prone to in their androgen side. Are they more prone to develop more androgenic … More potent androgenic type of symptomatology like the classic PCOS symptoms, or are they not prone to that and are they going to be the atypical PCOS patient? That gives me a lot of useful information in the treatment side of things, more so.


Then additionally, because I do find that stress is such a big part of managing PCOS that the Dutch test also gives me an adrenal profile, which gives useful information in terms of managing the stress side of things.


Amy: I’m so glad that you mentioned the stress. It really is so toxic, and wreaks havoc on women with PCOS. I can’t tell you how many times I’ve worked with a client on lifestyle who’s really actively trying to conceive, and I just ask them to consider taking, while they’re in my program, taking six months off and just focus on their health. Once you sort of let that pressure off, and that stress of trying to conceive, in addition to making these diet, lifestyle, mindset shifts, what can happen for women’s fertility. I’m sure you’ve seen that in your work, as well.


Marc: Oh, absolutely. I’ve seen it in both ways, the way you just described it, and I have a specific patient that comes to mind, who I’ve been working with her for quite some time, for initially getting her to have a cycle and maintain the regularity of it. Now she’s on maintenance until she’s getting ready to start trying, because when she came she wasn’t married yet and she wasn’t trying. The only time that her cycles become irregular now, is when her stress levels increase. Invariably, every time I ask her what’s changed for you, she says, “Well, my diet’s the same, my exercise,” everything else is the same but her stress levels increase. I see it in both sides, that if they relax and forget about it for a little bit, and kind of just enjoy life, like you mentioned, that the likelihood of them getting pregnant increases, and then on the flip-side, also that it does show that their cycles go away if their stress increases.


I’m not sure if you’ve seen a recent study that came out. I think now it’s probably been, I saw it maybe two or three months ago, that showed that women who are under more stress during their fertile window, have a forty percent less chance of conception that cycle.


Amy: Wow, that is really significant.


Marc: It’s significant, yeah.


Amy: For those of you who really want to learn how to reduce your stress, we have two great podcasts, one with I know … Dr. Sklar, one of your colleagues, Amy Raupp, and we talked about learning mindset shifts and managing stress when you’re trying to conceive, and also we have Dr. Victoria Mazes, so check out those podcasts. Dr. Sklar, so, that Dutch test sounds really amazing. What can you do for women when you have all of that extra information about their hormone profile?


Marc: I think once you have this information, that really sets the stage for how you move forward. I get questions often on my Facebook page or emails, “I’ve got PCOS, can you tell me what I can do?” It’s just not how I work. I work on more customizing plans for patients, and so this really allows me to do that for you. This also helps set the stage for developing the lifestyle and the plan for what you’re going to do pre-conception, which will lead into the pregnancy itself and maintaining that progress that allowed you to get pregnant, into sustaining a healthy pregnancy. A lot of that will not only influence the supplementation that I give, but that by far is something that it does influence quite a bit, is how I supplement a patient, but it will also influence what I do with diet, especially what I do with exercise and stress. It really has … Those labs have such a far reaching effect in how I approach a patient, and how a patient should approach themselves and their health overall.


We always hear these blanket statements with almost any health condition, right? If they know a little bit more about their individualized issues, then they can focus more so in one area, where maybe they’ve been focusing on a different area in the past. I think this really helps to get them started on their plan to developing not only a healthy lifestyle before pregnancy, but into the pregnancy itself.


Amy: What do you like to do for patients that are not ovulating? I know that’s, for a lot of women with PCOS, that’s one of the main issues. I know the mainstream approach is using Clomid or now Letrozole. Do you have other ways that you work with women to help them ovulate, or is it kind of combination of those pharmaceuticals and acupuncture or maybe give us some insight?


Marc: Yeah, so I try as much as possible not to use pharmaceuticals, when we can, and if the patient is up for it and lets me. I find that that one, it’s a little bit easier for me to get results. The only time that I do think someone needs the pharmaceuticals is if they’ve got a really extreme case of PCOS and it just makes sense to try to get that under control as quickly as possible. Sometimes, that’s when I’ll start to blend those things. It’s typically not just pharmaceuticals that I’m recommending. It would be that in conjunction with all the other changes that we’ll discuss.


You mentioned, so I’ll start there. I love acupuncture for PCOS. There’s tons of amazing research studies on the use of acupuncture to facilitate ovulation, allow patients to get a regular menstrual cycle, and support conception. That is a big part of my patient population locally here in San Diego, and for my patients who I work with remotely, then I do typically recommend that they’re doing acupuncture in some way. I think that’s a wonderful way to get their cycles in order, and then it’s really about that secret recipe, how much of exercise do we put in, how much of stress reduction, how much of the supplementation, and I do think that when they’re anovulatory completely, that supplementation’s going to be essential.


The lifestyle and the diet can’t be ignored, because ideally, I don’t think any patient wants to stay on either medication or supplements forever, and so that’s where I find the lifestyle, the stress management, and the diet come into play, because once we’ve gotten them to have a regular cycle, we can start to pull back on some of those other things and watch their body maintain the progress that they’ve achieved thus far, which is awesome to see. Acupuncture’s great, I do like, depending on what we’re seeing in their blood work, certainly regulating their blood sugar and reducing the androgens. I find that if we can reduce the androgen load and allow them to maintain their blood sugars appropriately … I do think that the androgens is a bigger key to it, if that’s playing a piece of the puzzle. Then I do think doing that is huge, and so that could be done through some dietary modifications.


Green tea’s a wonderful thing that helps reduce testosterone levels, and then there’s other … Depending on the severity of it, there’s other things that I like to use as well. Myo-inositol is a key one that I like with D-chiro. That’s a nice…


Amy: Yeah, I’m just going to interrupt. For those of you that have seen Ovasitol, that’s one of the popular combo.


Marc: Exactly.


Amy: Yeah, D-chiro products that people might be familiar with.


Marc: Yeah, exactly. There was a wonderful new study that came out, on the small patient population load that did show the benefits of resveratrol on PCOS and regulating levels which is awesome. I love to see new research like that, and so that’s also another one that can be used.


Amy: Yeah, and I have to clarify because I can’t tell you how many articles I’m seeing online saying, “Drink red wine if you have PCOS.” Maybe you could just clarify that, for us.


Marc: Resveratrol is the anti-oxidant that’s extracted from the grapes themselves or from the wine in the making of it. It’s not the wine, although the wine does have resveratrol, but you’d have to drink so much red wine to get that, which defeats the purpose, because now you’ll be an alcoholic. The benefit is not from drinking the red wine itself. You really want the extract, which can be found typically in some sort of supplement form, either in liquid or pill. It does not have any alcohol in it, and it does show some promising results, which is nice to see, and I think something that’s safe to take as well, as long as it’s not in the alcohol form.


Amy: Right, right. What about peony and licorice? I know that’s something that possibly could be an ovulation inducer for women with PCOS.


Marc: Yeah, I don’t isolate, just because of the way my Chinese medicine mind works and my training, I don’t tend to isolate individual Chinese herbs, because that’s just not how they tended to work. I do use them in formulation and in a more robust formula for patients, and I do think that they work wonderfully, but those are specifically … I don’t recommend anyone just try and go find those two, I think that … I use anywhere between three and five different herbal formulas on patients more commonly with PCOS, and it all depends on how they’re diagnosed from a Chinese medicine perspective. Their underlying diagnosis is what’s going to dictate which herbs or which formula we use, but peony and licorice are ones that can be found very often in those formulas, as well.


Amy: Yeah, I guess I just wanted to highlight that there are alternatives to these pharmaceuticals if that is something that you’re not really interested in. Chinese medicine isn’t something that I think our regular allopath doctors really recognize, but there’s just a tremendous amount of value, and I just kind of wanted to bring that to listeners’ attention, too.


Marc: I think it’s an excellent point. If you’re listening and you think that the only way to regulate your cycle and induce ovulation is with Clomid or you’ve been told Metformin’s going to do it, I can assure you that for ninety-five percent of you listening, you can do it in a different way that’s more natural, and that’s one of the things I try to instill in my patients. I will say, though, on that note, if you’re looking for the easy fix and the pill that’s going to do that for you, that’s just not how natural medicine works. It usually takes a little bit longer, although often times we get results fairly quickly, but it usually takes a little bit longer than, “I’m going to give you Clomid for five days and you’re going to ovulate ten days from now.” It doesn’t work in that fashion, that quickly, and if that’s what you’re looking for, you might need to look elsewhere, but I do think that the natural approach is extremely powerful and very, very effective, if you give it just a little bit of time.


Amy: Yeah, and the great benefit is you’re getting your body healthy to support a healthy pregnancy.


Marc: Yeah.


Amy: Why don’t we dive into that topic? Kind of preparing yourself for a healthy pregnancy.


Marc: Sorry, what was that?


Amy: What can we do to prepare ourselves for a healthy pregnancy?


Marc: Yeah, absolutely. It kind of goes along with the points that we’ve just been saying, that if you stick with some of the pharmaceutical things, they’re not fixing anything, they’re trying to circumvent it, and trying to force the issue, whereas, if you’re really focusing more so on the natural perspective, the real goal with natural medicine is that we’re trying to correct things at its core, so that way the issue gets handled more effectively. That’s where focusing on all those core areas in advance is going to not only benefit you to start a regular cycle and induce ovulation more regularly and consistently and hopefully get you pregnant, but it’s also going to allow you to maintain a much healthier pregnancy moving forward.


This is not just for your benefit, as the intended mom, so that you have a healthier pregnancy, but it’s also for the benefit of the baby as well, because there is … Plenty of research shows that your genetic makeup during conception and during the gestational process of pregnancy absolutely affects the genetic makeup and health of the baby that you’re carrying.


Making sure that you’re focusing on your right, moderate exercise regiment, not too much, not too little, which is key. Focusing on your nutrition. Once you know where you need to be at with what you’re trying to affect in your blood work, then really creating the plan there. I find that that’s, by far, the hardest for patients. Eating right is not made so easy for us, at least not in the U.S., and so it’s also not as convenient, and so a lot of that really comes into a lot of the preparatory work. I find that the patients who are most successful with the dietary changes and the lifestyle changes have planned things out, have gone shopping, have scheduled it, have made time to cook and prepare their food, they have the right ingredients at home so that they’re not scrounging when they’re hungry. They have the right foods.


It takes a lot of effort up front until you kind of make it your own and it becomes routine. I find that that’s really, really key to success, is having the plan for the week, and knowing what you want to have, and having those ingredients at home, or having that buddy that’s going to go with you and go walking or exercising, three, four, five times a week that you can count on and is going to be there for you.


Really, as you mentioned, Amy, working on your stress. You can either do that through stress management techniques … It’s one of the things that I find myself working more and more with patients on is helping them with their stress and how to manage it, and giving them tools for that. Acupuncture is also a wonderful thing for stress management. It helps you relax, it resets the nervous system, and gives you time for yourself and the space for that, which is excellent. Those are some keys that I think is really important to preparing for pregnancy, which would really lead into how you develop a healthy, and maintain a healthy pregnancy as well.


Amy: Yeah. I’m so glad that you mentioned planning and food shopping. I call that sizzling in the kitchen, and that’s a big part of my Jumpstart program, is to help women learn how to meal plan, and to get in the kitchen and cook real whole food from scratch. You’re right, it’s not easy to get that all set up, but boy you really reap the benefits, and it’s so worthwhile, because I think that’s the number one thing we can do to help our PCOS. I’m just so glad that you mentioned that.


The other point that I was going to make about the stress, is I just discovered this great little device. It’s called the Spire, S-P-I-R-E, and you just … It’s like a little soft river rock on a clip. You clip it on your bra, and it measures your breathing, and it’s attached to your app, like an iPhone app. It will tell you if you’ve been breathing shallow. It sort of senses based on your breathing whether your stressed. It will remind you to breath and take some deep breaths. That has done wonders for me, so I just thought I’d share that little tip.


Marc: I love it. That’s great, because one of the things I really talk to patients about is just … It doesn’t have to be for a long period of time, and it doesn’t have to be super complicated. It can just be about breathing, like you mentioned. I always used, when the phone rings or your cell phone vibrates, before you answer it, use that as the meditation bell, that as soon as that happens, you take a moment, you stop, you pause, you take a deep breath in and out before you answer, just as a little tool mechanism. We’re always … We’re like Pavlov’s dog, right? The phone rings and we jump to it. Just kind of taking that stress away from the phone ringing is also another simple tool. I’m going to check out the Spire. That sounds great.


Amy: Yeah, it really is. I think it’s about a ninety-nine dollar, so it’s a little bit of investment, but it’s really well worth it. It’s made a big difference in my life.


Finally, let’s just talk a little bit about your diet protocols for women, especially to avoid gestational diabetes during pregnancy.


Marc: Yeah, and I’m glad you mentioned that because I wanted to come back to that point anyway, is that if you set yourself up right before you get pregnant, and you’ve made all the … As you mentioned, you do the sizzle work beforehand, and you do all the preparatory work, and you make it part of your lifestyle so it’s easy and commonplace for you, then you’re really setting yourself up to maintain and prevent gestational diabetes once you’re pregnant. I find that patients who are able to do that in advance are the ones who are the most successful once they are pregnant in preventing it and keeping it at bay.


That’s really where it comes back to; I think that the key here is managing the sugars and carbs, which essentially are the same thing, but those are going to be some of the key factors and key components to managing our diet, which are not the easiest, because those fill us up and they make it easy, but we have to find the right carbs for ourselves, the right grains. I like a little bit of quinoa, I like the sweet potatoes and yams, but with everything, as my mom always whispered in my ear, and now I hear her talking in my head almost constantly, “everything in moderation.”


It’s also okay if we slip up a little bit, or we consciously know that we’re going to not eat appropriately for our diet, as long as we don’t allow that to be a stressful moment for us. If you give yourself a little bit of flexibility once you’ve got things managed, that okay, ten percent of the time or twenty percent of the time, I can give myself a little room to wiggle, and that doesn’t increase your stress and you don’t beat yourself up for it, then I think that’s okay. In general, really managing your carb load, really focusing on your vegetable intake, your protein and your fat, I think are the key components for me. I think if you can really focus on a healthy balance of protein fat and veggies being your main component of carbs, and then if you have a little bit of what some of you might think of as carbs in terms of a sweet potato or some quinoa or something like that, then I think that starts to even things out quite a bit.


That takes some persistence initially, but that will pretty much become your own in a short period of time as well. I think if you’re able to do that, then you’re really able to maintain and prevent gestational diabetes. One of my favorite books that I try to have patients reference, who have PCOS, once I find out that they are pregnant, is a book by Lily Nichols on … I think it’s called, “Preventing Gestational Diabetes.” It’s all diet-based. Completely diet-based. Her specialty for most of her professional career has been in the gestational diabetes spectrum, but working for the state, and now she’s basically written a book on how you can do it on your own, which is excellent as well.


Amy: Oh, I haven’t heard of that book, so I’m definitely going to have to check that out. It sounds like a great resource.


Marc: Yeah it is. It’s excellent.


Amy: Yeah, I think for women listening, we’re definitely getting away from the misnomer that you’re eating for two, or that you can kind of let it all go once you finally do get pregnant, because we just can’t really let that happen.


Marc: Yeah, I tell patients, “Just because you’re pregnant doesn’t give you the right to eat like crap, now.” It’s actually even more important of a time for you to eat well, and it’s more difficult, especially in the first trimester, to do that as well. I recognize that. It’s not as easy, but if you set yourself up right in advance, it should be easier to maintain.


Amy: Yeah, that’s a good point. Before we wrap up, I do want to ask, because I know I was one of those women with horrible morning sickness for all three pregnancies, and I found that I had to force myself to have some protein. That was what usually made me feel a little bit better. Do you have any tips for women … It seems like women with PCOS, from my experience working and even hearing from women, do have quite a bit of morning sickness that first trimester.


Marc: Yeah, they do, they do. I think my key … Actually, before I forget, because I pulled it up, Lily’s book is called, “Real Food For Gestational Diabetes.” The key there, with the nausea and morning sickness is really one, not to overeat, not to under eat, and not to over drink, and not to under drink. It’s about having some food always in your stomach, even though you don’t necessarily want to eat. If you can get ahead of it, you’re going to feel much better in the long run, so like every two to three hours pushing it, you need to be eating something even if it’s just something small. Then I do find that the more protein you can get in, the better you’re going to feel, even though you might not be attracted to it.


It’s okay. I also want patients to recognize, it’s okay to have carbs in the first trimester. That’s what you’re craving, and the baby actually needs that in the developmental process, but we just can’t overdo it, so we do need to be mindful of what that means, and how much carbs are okay, and then what forms. Try to stick with the sweet potatoes and vegetables as carbs. Lily gives some wonderful recommendations in the book of how to set yourself up with meal planning, as well.


Those are some of the keys. If you need something more hardy, if you will, you can find some simple crackers, although I would urge you to make them gluten-free versus not, but you can find a little bit of that, but then mix that with some fat and or some protein, so it sustains for longer periods of time in the body, and it doesn’t set off your blood sugar, it helps to regulate it. That’s where the fat in that protein combination really come in to manage blood sugar.


Amy: Well, you’ve given us so much really great information in our short amount of time together. Now for those women that would be interested in that Dutch test and maybe having you go over their labs with recommendations, how can women listening find out more about your work and working with you?


Marc: Yeah, so you can find me … For those in San Diego, you can find me locally in San Diego, but for those abroad and outside the city, then I work virtually, and my website is and Amy will have a link, but it’s M-A-R-C-S-K-L-A-R, and you can work with me either one on one privately, or through one of my programs, and I do have a specific or special online e-course for PCOS that allows … Gives you the basics from beginning to end on how to figure out where you fall into your phenotype, or what type of PCOS you have, and how to move forward and address that through diet and supplementation and lifestyle, and gives you all the resources and tools for that as well.


Amy: Great, well, we’ll have all that information at the bottom of the podcast, and thank you so much for your time Dr. Sklar, it was a pleasure.


Marc: Thanks so much, Amy, for having me. I loved being here.


Amy: Well, thank you everyone for listening, and I look forward to being with you again soon. Bye-bye.



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