PCOS Awareness Expert Interview with Dr. Fiona McCulloch

Understanding the complexities of PCOS and how to manage it properly is the key to success.

PCOS can be complicated to treat because it doesn't display as one-size fits all. Every woman's symptoms and presentation is unique and requires different interventions. PCOS is a complex hormonal and metabolic disorder. With that said, you need to have a clear understanding of how your hormones work. So I went to one of the best who specializes in women's health and fertility. Today, I am honored to introduce you to Dr. Fiona McCullough. Dr. McCullough is the founder and owner of White Lotus Integrative Medicine based in Toronto, Canada. She is a Naturopathic Medical Doctor who specializes in helping and advocating for women with PCOS and serves on the medical advisory committee for the PCOS Awareness Association. When I want to know about PCOS, or the latest research, I look to Dr. McCullough. She is intelligent, caring, compassionate, and she really wants to help women with PCOS get the best care possible. I have followed her for some time and am always amazed by her wealth of knowledge and how she can relay difficult medical concepts in a clear and concise manner. If I lived in Canada, Dr. McCullough would definitely be my doctor!!  

Below you will see the Q&A that I had with Dr. McCullough. 

1.      What hormones tests should every woman with PCOS have done and how frequently should they be tested?

With PCOS, a variety of different tests are helpful to run. When it comes to hormones, FSH, LH, Estradiol, Testosterone, DHEA-S, and DHT are important to screen. These can change from cycle to cycle or with age. A full thyroid panel including antibodies, TSH free T3 and free T4 is important as thyroid impacts the metabolic health. The frequency of these would depend on the patient, but often during treatment, every few months levels can be reviewed.

For insulin resistance I often order fasting insulin, fasting glucose, triglycerides, hs-CRP and if possible an insulin-glucose challenge - also known as a glucose tolerance test with insulin assay. In this test, both glucose and insulin are measured at intervals after consuming 75 grams of glucose. Please review my article here for more information on this test - I think that this possibly the most misunderstood section of lab testing in PCOS. I typically will test metabolic hormones monthly during treatment.

2.     Many women are confused as to who should be managing their PCOS care, who is best suited to be their primary doctor when it comes to PCOS?

I believe that any skilled doctor including an Ob/Gyn, naturopathic doctor, reproductive endocrinologist, endocrinologist or family physician can successfully manage PCOS if they have a special interest in the condition. I always suggest looking for a doctor who has a specific focus on and sees many patients with PCOS in their clinical practice because it is a fairly complex disorder.

3.      Can you still be insulin resistant if your A1C is normal? What other tests determine insulin resistance?

Yes, you can. A1C measures the average of blood sugar over the past few months. However, many women have excessively high levels of insulin, yet completely normal blood sugar and A1C levels. Some of the tests that can pick up insulin resistance include fasting insulin, fasting glucose, c-peptide, triglycerides, and the glucose tolerance test with insulin assay. 

RELATED: 5 Signs You Are Insulin Resistant

4.     There are supplements (inositol, NAC, cinnamon, berberine) to help lower blood sugar, how do you determine which one would be the best to use? Can you pair any together like inositol and cinnamon or inositol and NAC? Are these supplements that should be taken for the rest of your life to keep insulin resistance in control?

I work in a certain order when treating PCOS, which effectively determines what supplements I will recommend at which time.  Supplements for insulin resistance tend to improve blood sugar regulation which actually tends to reduce the risk of hypoglycemia and in many cases they can be combined. That being said, before combining any supplements or medications, it is always important to check with your doctor as each person is different!

RELATED: 4 Natural Alternatives to Metformin

5.   What are your top 5 supplements for women with PCOS?

Since PCOS is so unique and changes through the lifespan, I adjust supplements based on unique needs at the time.

Some of the key nutrients I prescribe often are inositol, n-acetylcysteine, omega 3 fatty acids, magnesium, zinc, and selenium.

6.     How can women with PCOS and hypothyroidism increase their energy levels?

Keeping blood sugar regulated is one of the most important factors for energy levels in PCOS. If blood sugar is following a rollercoaster pathway as is common in PCOS, this causes the release of the stress hormone, cortisol. The body is less able to produce T3, the active thyroid hormone when cortisol levels are high, and this causes fatigue. 

Also, many women with hypothyroidism feel better on a natural desiccated thyroid hormone product, as it contains both T4 and T3. 

7.   Are there any healthy foods (for example legumes and beans) that women should stay away from that will spike their blood sugars?

It is all about balance. A food like legumes may spike blood sugar if eaten on their own, without enough fiber, fat, protein to balance out the meal. My approach involves teaching women to structure meals so that their blood sugar is stable for hours, and within that context, legumes, beans, and other starches can be included with some meals. 

Interestingly, dairy protein is one of the strongest triggers of insulin release - yet it is low on the glycemic index! 

8.     Can you explain the Food Insulin Demand and how that differs from the glycemic index?  Which one is more important for women with PCOS?

The glycemic index is a measure of how much a food we eat raises blood sugar levels. The insulin index does more – it tells us about how much a consumed food raises insulin levels. 

Foods that are high on the glycemic index are also high on the insulin index – which comes as no surprise since insulin is released in response to increases in blood sugar.

The opposite isn’t true – in fact, some of the highest foods on the insulin index are in fact very low on the glycemic index and don’t raise blood sugar levels much at all.

Dairy foods contain protein building blocks called branched-chain amino acids which enter the bloodstream rapidly and cause a surge of insulin release.

Most people are shocked to learn that low-fat yogurt provokes more insulin release than two slices of white bread. Some other foods may surprise you as well – beef spikes insulin levels more than chicken, and whey protein powder is one of the highest foods on the insulin index.

The insulin index tells us how much insulin will be released for 240 calories of a food. The food insulin demand (FID), a related index, gives us the amount of insulin that we release after eating a certain quantity of a given food – an exceptionally useful tool we can use to plan meals.

9.   How can women with PCOS reduce inflammation?

Inflammation in PCOS is often the result of “leaky fat” cells - meaning that inflammatory fatty acids leak out of the adipose tissue and cause inflammation. Insulin resistance is the biggest contributor to this, so nutrition has a major impact. Avoiding sugar, dairy,  processed foods, and deep-fried foods will make a major difference. 

Also, gut health is foundational in an anti-inflammatory protocol. Correcting any issues like bloating, dysbiosis, food sensitivities or motility issues can help to calm inflammation.

10.    How do you know if the natural remedies are working for you? How long before you should try something else?

With insulin resistance, I typically like to see improvement in a month. When it comes to regulating menstrual cycles, it takes quite a bit longer - around 3 months. If something isn’t working by this time, it is often helpful to reassess. 
 

11.    What’s one secret tip you use to manage your PCOS successfully?

Self-acceptance. At a certain point, I finally integrated the knowledge that my body naturally fluctuates. Most times I’m amazing with my diet, with my exercise and yet I still have those “off days” -- and that’s OK. This the natural ebb and flow of the female hormonal system, we can feel different at different times - it really is a gift to have these fluctuations. I focus on one day at a time when it comes to nutrition and health, and look back at how far I have come on my journey! 

I'd like to thank Dr. McCullough for providing her expertise and knowledge. I encourage you to follow her for more information and tips. She is one of the best in the PCOS community! 


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Dr. Fiona McCulloch, the founder and owner of White Lotus Integrative Medicine has worked with thousands of people seeking better health over the past 16 years of her practice. She is committed to health education, sharing the most current information on health topics, nutrition and natural medicine.

Fiona has published many articles and is a regular contributor to NDNR, one of the leading journals for naturopathic doctors as well as other publications for health professionals. Her popular research-based blog has 30,000 readers per month and her book “8 Steps To Reverse Your PCOS” is a women’s health best seller.

As a woman with PCOS herself, who struggled for many years with its symptoms, she’s passionate about health education and advocacy for women with PCOS, and serves on the medical advisory committee of the PCOS Awareness Association and as an expert on IVF.ca. She is also a medical advisor to Open Source Health – a women’s health technology platform. The Open Source Health Precision Medicine PCOS Project was started in December 2015 and may be the largest ever project to use state of the art genetic and molecular research, science, evidence-based integrative medicine and technology to help the growing under-served community of women with PCOS.

Fiona also frequently lectures to professionals including naturopathic doctors and integrative medicine clinicians and also to students at the Canadian College of Naturopathic Medicine.

Fiona is a proponent of evidence-based natural medicine and peer-reviews for Natural Standard, an database on evidence-based natural medicine.

Fiona is a graduate of the Canadian College of Naturopathic Medicine (2001) and the University of Guelph (Biological Science/Molecular Biology and Genetics).

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