Recap: Understanding endometriosis and PCOS | Dr Jen Ashton

0:00Zoe Williams:Hello, and welcome to Zoe Recap, where each week we find the best bits from one of our podcast episodes to help you improve your health. Today we're talking about gynecological health. Conditions like endometriosis and polycystic ovarian syndrome are more common than you might think, yet they're often misunderstood, frequently undiagnosed, and are all too easily dismissed. That's why it's essential for us to build a clear understanding of these conditions, how lifestyle factors can influence them, and when it's time to seek expert care. America's gynecologist, Dr. Jen Ashton, joins me to break down these complex conditions, helping you to feel more informed and empowered in your own body.

0:46PCOS, polycystic ovarian syndrome, it's called the most common but least well understood hormonal condition affecting women. And in the medical literature, it is quoted as affecting 10%, sometimes 15 % of women. I believe it could be even higher than that. So it's incredibly common. Hallmark features are signs of hyperandrogenism. Signs are increased testosterone levels producing acne, excessive body hair, male pattern baldness, difficulty losing weight or gaining weight, menstrual irregularities, so irregular periods. Those are a lot of the common signs or symptoms, but just to keep it fun and interesting, women can have PCOS and not have any of those signs or symptoms at all.

1:39Zoe Williams:As a woman listening to this, I think a lot of women will think, well, hold on, I might have one of those symptoms, which doesn't necessarily mean they've got PCOS. Unless you have one of those kind of symptoms and it's bothering you or impacting your life, is it something that if you didn't get it investigated, there would be no long-term harm? Well, the thing that's interesting about PCOS is that women and girls with known PCOS have a higher risk of going on to develop type 2 diabetes in their lifetime. So it's certainly not a scenario where we recommend screening every woman or every girl for this.

2:24But because of the constellation of symptoms and signs that we talked about, if they're persistent, if they're new, if they're bothersome, absolutely a workup, you know, an investigation should be done to see if that person has it. And I'll give you a couple of examples. Acne on the back or chest of a woman or an older adolescent or teenager is not common. And if it's persistent, it is generally a sign of PCOS. All of us can get a pimple on our face every once in a while. But extreme or even moderate to extreme acne on the back or chest of a woman is generally a sign of an androgen imbalance, so a higher level of testosterone.

3:13And the clue, both for a dermatologist as well as a gynecologist, will be when a dermatologist can't really have an impact on acne, I usually say, and most of them would agree, that that's because it's not a skin problem, it's a hormonal problem. And so all dermatologists are very accustomed to hormonal basis for acne. They see it all the time. And so their radar, their index of suspicion is generally up already. Maybe this isn't a skin problem. Maybe this is PCOS.

3:48Zoe Williams:I'd love to know about the relationship between diet and PCOS. There's been actually a decent amount of this reported in the peer-reviewed medical literature. Not enough, in my opinion, never enough. But there's been a decent amount of, you know, well-constructed studies that even though many of them are observational, it's still some valuable information that suggests that women with PCOS who lose 5 % of their starting body weight, and so most of that is going to be fat tissue, fat mass, can have a significant impact on their ovarian function, their ability to resume regular ovulation if that's a problem for them, and improve their insulin resistance.

4:38That's good because it's very, I think, empowering from a behavioral and nutritional standpoint. What's not so good is that it's easier said than done. If you talk about a woman who weighs 200 pounds or what is that, about 90 kilos, 85 kilos, You know, 5 % is 10 pounds of weight or 5 kilos. That's hard. And given how hard it is, is there any dietary changes independent to weight loss or in addition to when women are trying to lose weight? It's a great question. And I think the general approach has been a diet that is certainly lower in added sugar. and I really go by the max added sugar of no more than 25 grams a day, which is the World Health Organization recommendation for women.

5:35You'll hear people say for PCOS, low carb, but remember our bodies run on carbohydrates. That's what every cell needs to function is glucose. So not all carbs are created equally, right? So eating an apple is very different than eating a cookie when you're talking about metabolically and hormonally and PCOS for everyone. By the way, I would say that for men as well, okay? So for people with PCOS who are incredibly sensitive to how their body metabolizes carbohydrates, a diet that's higher in lean protein, even plant-based protein, higher in the healthy fats, like the olive oil, the avocado, the nuts, is going to be helpful.

6:19It's not gonna be a magic bullet, but it should be the mainstay of how someone with PCOS eats.

6:26Zoe Williams:There's another gynecological condition that I hear about a lot that I know affects about 10 % of women, and this is endometriosis. And it's something certainly I don't understand. I know lots of my friends talk about it, that they might have it. It's incredibly underdiagnosed as well. Could you just walk us through that quite briefly and how diet might be able to help? Let's talk about, first of all, what endometriosis is. It comes from the term endometrium, which is the inner lining, the type of cells that are inside the uterus. And in endometriosis, there are a lot of different theories as to why this happens, but in endometriosis, those endometrial cells are dispersed outside the uterine cavity, basically anywhere else.

7:12So they can implant on the sidewalls of your body. They can implant on the bladder, the bowel, the undersurface of the diaphragm. There have been women with endometriotic implants in their lungs. So it can be an incredibly painful and debilitating condition that is chronic. As you mentioned, Sarah, it is underdiagnosed because typically it's a diagnosis that has to be made surgically most of the time, not all of the time. There's some very exciting research, by the way, about ways to test for endometriosis using menstrual blood, which I think is maybe interesting down the road. Some other ways to test for it, but we're not there yet in terms of gold standard of testing or screening.

8:03Zoe Williams:So how could someone listen to this at home who has some concerns around this, how would they be able to identify it? Pain is the hallmark symptom of endometriosis. It's the most common and it's the most severe. Low pelvic pain that is generally, but not always, cyclic. So again, remember these endometrial glands, they're hormonally responsive. So just as the uterus lining sheds with a woman's menstrual cycle and change in her hormone levels, you can imagine that contraction of the uterus causing menstrual cramps occurring in microscopic areas all over the internal cavity where those endometrial glands are kind of splayed out.

8:46So it's very painful. Refractory pain or severe pain is a hallmark feature of endometriosis. There's a saying in gynecology that is still, I believe, valid, but it's not 100%, that a teenager, so an adolescent who has been put on non-steroidal anti-inflammatory medication, so that's something like ibuprofen available all over the world, and low-dose birth control pills, those two treatments together, who still has severe pain with her periods, have a 50 % chance of having endometriosis. So that could be a clue. And I believe for a woman of any age, so even an older woman, 20s, 30s, 40s, if you're on birth control pills for whatever reason, and you're taking a drug like ibuprofen for pain and you still have pain, that's a red flag.

9:48Zoe Williams:And there's things that you can do about it if you make it to a gynecologist? Yes, there are ways to manage it. There's not a cure for it. And it can be very difficult. The treatment should be individualized. And it really, really is important, ideally, if possible, for a woman who thinks she has endometriosis or knows she has endometriosis to go to a gynecologist who really has a tremendous amount of experience in managing it because it's not a one-size-fits-all treatment. Hosting this podcast means I get to quiz world-leading scientists every week about how to improve my health. But I'll be honest with you, for a long time, my snacking habit was completely out of sync with the science.

10:30Zoe Williams:I'd hit an energy slump, grab a snack bar, and usually inhale it in two bites while looking at my phone. I knew that the ingredients were a bunch of artificial additives and emulsifiers, but honestly, I was hungry and usually there was nothing else healthy to eat. It wasn't until our chief scientist, Sarah Berry, explained the physics of snack foods on this show that it finally clicked. Highly processed bars are engineered to be eaten fast and release their sugar immediately, which in my case caused a sharp spike and then crash in my blood sugar, leading a few minutes later to a collapse in my energy and a spike in my hunger.

11:07Zoe Williams:In my opinion, this is a cynical move by big food companies to make us eat more. I was furious, but Sarah said she thought we could solve this. She came back a year later with the Zoe Gut Health Bar and had done something completely radical. She'd left the natural cell structures of the plants intact. The first time I tried a sample, I realized you physically cannot rush it. It tastes great, but because the bar preserves that natural food matrix, it's also wonderfully dense and chewy. so it forces me to slow down and savor it. It delivers a huge diversity of over 12 plants and because it breaks down slowly in your body, you avoid that sudden sugar spike and crash.

11:52Zoe Williams:Plus, both flavors are just delicious. My favorite is, of course, the 70 % dark chocolate one. I've got to admit, as a chocoholic, I did ask our gut health scientists to make sure we had that option. If you're ready to swap your additive-laden snack bar for something that's designed to be good for your gut health, head over to zoe.com slash snackbar. That's zoe.com slash snackbar. Your gut will thank you.