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The PCOS Newsletter is a weekly publication answering one PCOS question at the time so we can be empowered by knowledge.

An issue will land in your inbox each Sunday

PCOS and Inflammation

Today we discuss a fascinating question and topic: inflammation 🥵.


The question question:

How do I know if I have Inflammatory PCOS?

I have recorded the answer to this question, so if your prefer video, head over to the link below. Otherwise, keep reading.




 

In this article, you will learn the following:

  • Is there such a thing as Inflammatory PCOS?

  • What is inflammation and chronic inflammation?

  • What leads to Chronic Inflammation?

  • Why do women with PCOS have higher levels of inflammation?

  • The test that can show you if you have chronic inflammation.

  • The principles to follow to lower inflammation.


 

I want to start by clarifying that no scientific research or medical body categorises PCOS in the categories we see on the internet: inflammatory, insulin-resistant or adrenal. I believe this categorisation tries to give PCOS a black-and-white definition when it’s more like shades of grey 🌚. As humans, we like clear definitions as we are very uncomfortable with not knowing. The answer is in trying to understand the complexity of it.


Of course, there is some truth to this, and it is indeed true that women with PCOS have been found to have higher inflammatory markers. I don’t want to dismiss the fact that those can be drivers of PCOS, but they are not as clear-cut as we hope they would be. Let’s get into it and understand the shades of grey.


What is inflammation?


As soon as something looks like a danger to our body, our immune system alarms all of the immune cells to come and take care of the threat to our body. This includes white blood cells, cytokines and all sorts of other soldiers. The fight between our immune system and the danger creates a temporary state of inflammation where the opponent can be defeated. As in any type of conflict, there are some casualties and damage. If this conflict is sustained for a long time, there will be a lot of damage. In the case of our bodies, prolonged inflammation states can damage our tissues, organs and interfere with hormone signalling.


We need inflammation, as it’s the primary mechanism by which our immune system works. Without it, we would be pretty much dead from bacterial infections and all of the stuff we encounter in our environment. The moment inflammation becomes problematic is when our immune system reacts to things that it shouldn’t (think hay fever), and when that inflammation is sustained for an extended period. This is called chronic inflammation.


What leads to Chronic Inflammation?


There are a few well-known things that lead to chronic inflammation:

  1. Persistent infections: Certain bacterial, viral, or fungal infections that have not been able to be eliminated entirely and stay present (e.g. H-pylori, Candida etc.)

  2. Autoimmune disorders: In autoimmune disorders, the immune system mistakenly attacks healthy tissues in the body, leading to chronic inflammation (e.g. Rheumatoid arthritis, Psoriasis etc.)

  3. Exposure to a particular irritant that our body doesn’t agree with (Eg. gluten sensitivity, dairy sensitivity, pollen, perfume ingredients etc.)

  4. Poor diet: A diet high in processed foods, sugar, and saturated fats can create reactive oxygen species (ROS), leading to oxidative stress, which triggers the inflammatory response (more detail on this in follow-on newsletters).

  5. Excess adipose tissue: Abdominal obesity or extra adipose tissue releases inflammatory markers raising the state of inflammation. This is one of the reasons why weight loss is recommended for PCOS.

  6. Genetics: Changes in the inflammatory pathways can be down to genetic modifications.

Ok, so why do women with PCOS have high inflammation?


A large meta-analysis looking at 85 studies showed that women with PCOS have higher levels of inflammation. This inflammation was measured by looking at C-reactive protein (CRP) and IL-6 (Interleukin 6), two key measurements of inflammation. The reason for this inflammation comes down to the complexity of the things PCOS creates in the body. Mainly, higher levels of androgens, insulin resistance, excess adipose tissue and a poor diet seem to be driving the higher inflammation state in women with PCOS.

This becomes a vicious cycle, where these unbalances create more inflammation, further increasing these unbalance. We basically don’t get a break 😮‍💨. I also want to let you know that all chronic conditions are underlined by inflammation. As described above, when the body is out of balance, the immune system reacts by trying to bring it back into balance.


The primary mechanism is that inflammation markers (IL-6, TNF-alpha, ROS) disrupt the ovulation process by increasing the rate at which follicles grow but stopping them before they can release an egg, stopping ovulation from happening. High androgens, insulin resistance and the imbalance we have between LH and FSH are all contributors to this mechanism. It is very unlikely that only one of these is the main culprit, hence my reservation with the black-and-white classification of PCOS.


How do I know if I have it?


Saying that chronic inflammation is present in women with PCOS is a blank general statement and can sound scary. The best way to know is to measure it. A very inexpensive blood test can help you determine if you have high levels of inflammation and the associated risk.


Inflammation levels can be tested very easily by measuring the blood's CRP (C-reactive protein) level. CRP is a liver-derived protein produced in response to interleukin-6 (IL-6). These are released from activated immune cells.

The thresholds are as follows:

  • < 1 mg/L - low risk and levels of inflammation

  • 1-3 mg/L - moderate risk and levels of inflammation

  • >3 mg/L - high risk and levels of inflammation.

In the meta-analysis I mentioned above, 35 of the studies reported moderate levels of inflammation. So whilst women with PCOS have higher levels of inflammation, it’s important to note it’s usually in the moderate risk bracket. My latest blood test results showed a CRP level of 1.68 mg/L. This shows that my inflammation levels are reasonably controlled, given the condition I have. I am not worried about it.


Symptoms that may indicate higher levels of inflammation are: chronic fatigue, body aches, recurrent infections, gastrointestinal issues and mood disorders.


What can I do about it?


Engaging in a healthy lifestyle overall will ensure that levels of inflammation stay healthy. These are some critical pillars that can help with this:

  1. Getting our androgen and insulin levels in balance. The truth is that managing our PCOS well will lead to a decrease in inflammation.

  2. If you believe that there is a particular irritant your body reacts to (such as gluten, dairy, pollen, or toxins from the environment), avoiding it could be a good idea. Please note, NOT EVERYONE should be avoiding things just because someone is sensitive. Getting to know your body well and listening to what it reacts to can be very powerful (easier said than done, I know).

  3. Lowering intake of foods which are known to contribute to inflammation: high in sugar and processed foods, and saturated fats.

  4. Ensuring adequate intake of Omega 3s: this micronutrient is critical in our ability to balance inflammation. If you don’t consume fish 2-3 times per week, I would strongly recommend considering a supplement (I will write a post on Omega 3s in the future).

  5. Ensuring adequate intake of antioxidants: these miracle micronutrients clean up the damage from inflammation and keep things in balance. The key to getting enough of them is to ensure that there is a variety of fruits and vegetables in the diet.

  6. Exercise: exercise creates temporary inflammation but helps release anti-inflammatory molecules in the long run. It also supports insulin sensitivity and reduces insulin resistance.

  7. Lowering our adipose tissue levels: I am very intentional in not saying losing weight (I will touch on this in the following weeks) because it mainly lowers fat levels, especially around our abdomen, making all the difference.

As you can see, there are no magic pills or bullets. There are no “anti-inflammatory” diet rules. The truth is that actively engaging in habits that keep us healthy is the key to unlocking our health. If I wanted to sell you on a specific diet type, I could, but the truth is that it doesn’t exist. There is clear guidance on how to keep yourself healthy, and it doesn’t involve a specific type of diet.


So, how do I know if I have Inflammatory PCOS?


You don’t. Inflammation is present in all of us. The most important thing to do is test CRP levels to understand where you stand and assess if your diet and lifestyle are actively contributing to inflammation. The things we experience in PCOS are a system of issues that go into a vicious cycle. Trying to minimise this cycle is what we are aiming for. It will be more complex for some of us, and I want to be clear that I am not trying to paint a “eat healthily, and everything will be fine” picture. I know how hard and how much work it takes to get this cycle under control. I want you to be patient with your body and yourself, learn how to listen to what bothers it and fully immerse yourself in knowing it.


Inflammation is a very complex topic. Immunology is probably one of the most complex branches of biomedical science. Please let me know if there are things in this newsletter that confused you or raised more questions. This is a topic we will undoubtedly come back to throughout our journey, as it’s a complex one that deserves more unpicking.


Sources

Aboeldalyl, S., James, C., Seyam, E., Ibrahim, E. M., Shawki, H. E.-D., & Amer, S. (2021). The role of chronic inflammation in polycystic ovarian syndrome-A systematic review and meta-analysis. International Journal of Molecular Sciences, 22(5), 2734. https://doi.org/10.3390/ijms22052734


González, F. (2012). Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids, 77(4), 300–305. https://doi.org/10.1016/j.steroids.2011.12.003


Pahwa, R., Goyal, A., & Jialal, I. (2022). Chronic Inflammation. StatPearls Publishing.


Rostamtabar, M., Esmaeilzadeh, S., Tourani, M., Rahmani, A., Baee, M., Shirafkan, F., Saleki, K., Mirzababayi, S. S., Ebrahimpour, S., & Nouri, H. R. (2021). Pathophysiological roles of chronic low-grade inflammation mediators in polycystic ovary syndrome. Journal of Cellular Physiology, 236(2), 824–838. https://doi.org/10.1002/jcp.29912



 

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