Hormones and mental health- a doctor's perspective..

Candid conversation- PCOS, Insulin resistance , infertility are they lifestyle driven?



Today, I had this opportunity to chat with a super cool and fabulously fit Dr Shashi Ajmani who is a physician in the OB/GYN group at Saint Alphonsus Regional Medical Centre in Boise, Idaho ( USA). I was really lucky to speak with her on topics very close to my own Nutrition practice. With her residency completed in 1998 from USCF - Fresno program in California she has over 2 decades of experience to share with us.



Here are some excerpts from our conversation..





Dr Shashi what is PCOS?


“ It is a complex disorder with a combination of Inheritance factors and external factors. Diagnosis of PCOS is based out of 2 out of three things. 1. Not ovulating 2. Hyper androgenic ( high testosterone, facial hair growth etc) 3. Polycystic ovary ( cysts) .

Diagnosis is when 2 of these 3 are present.”


So what contributes to what?


“it’s a complex interplay between insulin and testosterone”. It’s like a chicken and egg situation

“At the core – Hyper testosterone environment in the ovary which feeds on itself causes LH (Luteinizing Hormone) to surge . Hyper LH state causes more Testosterone and this eventually causes Insulin resistance”


Who are more susceptible to developing PCOS?


“ There are 2 types of PCOS , One a non ovulating woman ( even though she is lean )- Reproductive

Second is Metabolic PCOS patients who are obese”


So how do you manage such cases and what’s their treatment like?


“ Both these types are handled the same way. Behavioural modification / Lifestyle changes, watching refined sugar/ processed carbs intake and specially including some exercise regimen”.


Well we both agreed on how important strength training is as more Muscle mass uses more glucose. Strength training as a woman is important more so when PCOS or Insulin resistance is diagnosed.


Have you seen patients reverse PCOS with lifestyle changes, nutrition etc irrespective of genetic pre- disposition?


“ Absolutely , Yes! Even 5 to 10 % of reduction in weight can cause regularity in period and increases the chance of live birth rate by 25%”.

“Women who have trouble getting pregnant , there are medications to induce ovulation, however their chances of birth rate goes higher if they did pre – medication, pre- ovulation induction lifestyle modification. If they had lost some weight and made lifestyle changes , they responded much better to medications”.


She further adds when asked about 4 things that are important through lifestyle changes to reverse PCOS are –

1. Diet

2. Exercise

2. Sleep

3. Manage stress


“ Cortisol regulation, better sleep habits, exercise, meditation , eating good fats , some protein and fibre are essential”


Finally, What’s your take on Intermittent Fasting as a tool to incorporate in the lifestyle ?


“ There’s some great data on introducing some fasting , not only from the perspective of weight loss, more so for DNA repair. If your body is not always working hard at processing food, it will be given the time to rest and repair”


For anyone starting their fasting lifestyle , even a 12 hrs fast 7pm to 7 am have beneficial effects?