Nothing Seems To Work

The Pandemic Hiding in Plain Sight

Today, we’re talking PCOS. On 1 September, the world marks World PCOS Day, so it is fitting that we tackle this tough subject.

PCOS (Polycystic Ovarian Syndrome) was recently renamed to PMOS (Poly-endocrine Metabolic Ovarian Syndrome). The new name is still not widely recognised, but since it is a better description of the clinical condition, we will use PMOS instead of PCOS in this post.

At the latest estimate, PMOS affects 8–15% of women globally. Exact figures are difficult to come by due to varying definitions. PMOS is considered the leading cause of female infertility worldwide. The numbers are big, but media coverage is scanty. As a research topic, it is also under-represented in the literature. It is the invisible pandemic.

For all its prevalence, it remains one of the most misunderstood conditions in women’s health. The name PCOS itself is misleading: the ovarian cysts are a symptom, not the cause. Some women present with every classic symptom yet have no ovarian cysts at all. It took decades for medicine to acknowledge that the cysts are a side effect, not the root cause.

PMOS – A Deep Dive

Diagnosing PCOS was once a complex and conflicting affair, involving many tests, some of them invasive. The diagnostic criteria for PMOS, on the other hand, are simpler and less invasive. Below is what is known as the “Rotterdam criteria” for PMOS:

1. Ovulatory Dysfunction

• Chronic irregular cycles
• Infrequent ovulation (oligo-ovulation)
• Complete absence of periods (anovulation/amenorrhoea)

2. Hyperandrogenism

• Masculine traits, such as excess facial or body hair (hirsutism), severe acne, or male-pattern hair loss
• Biochemical elevations in blood androgen levels (e.g. testosterone)

3. Polycystic Ovarian Morphology (PCOM)

• Ultrasound evidence of more than 20 follicles or enlarged ovary/ovaries
• Elevated serum anti-Müllerian hormone (AMH) levels

Exclusion of Other Causes

PMOS is not diagnosed if one or more of the following are present:

• Thyroid disorders
• Hyperprolactinaemia
• Non-classical congenital adrenal hyperplasia
• Cushing’s syndrome

Women in their fertile years who meet at least two of these core criteria are diagnosed with PMOS.

Still, no mention is made of insulin or insulin resistance. Here’s the twist, though, and it changes how we should think about PMOS: chronically elevated insulin levels — a state known as hyperinsulinemia — are present in almost all cases of PMOS. After all, elevated insulin is why there is an “M” in “PMOS”. Simply put, in a woman’s body, insulin induces masculine changes (it does the opposite in men).

Let that sink in.

While doctors focus on the hormonal changes, they miss the main cause of PMOS. If you do not address the cause, you cannot offer a cure. Oh, sorry — “cure” does not appear in medical textbooks. Seriously, it doesn’t. Doctors are discouraged from ever using that four-letter word. “Remission” is the term they may use.

We will now leave the docs and their diagnostic criteria behind us and focus on insulin instead.

What About Genetics?

Yes, PMOS runs in families — but lifestyle and dietary choices also run in families. You are likely to eat what your parents ate and live as your parents did. What shows up consistently across the research is that women with PMOS are mostly highly insulin resistant, far more so than the general population.

Big Pharma desperately wants you to believe in the “Genetic Theory of Everything”. If people can be induced to believe that a condition is genetic, they will stop looking for answers and simply do everything their friendly doctor tells them to do. PMOS is no exception. We’re not saying that PMOS has no genetic components, but this simply means women with PMOS have to work harder at their lifestyle discipline than the general population. It does not mean they have no power in this situation.

The Insulin Theory of PMOS

It is worth noting that hyperinsulinemia (a high fasting insulin level) occurs in approximately 80% of classic PMOS patients. A fasting insulin level above 10.0 µIU/mL is strongly associated with a diagnosis of PMOS in women.

“How is insulin linked to PMOS?” you may well ask.

Insulin resistance refers to a hormonal imbalance where high insulin levels and high glucose levels coexist. Insulin is supposed to drive glucose levels down, but when there is insulin resistance, this feedback mechanism is broken. Insulin triggers fat gain and stops fat loss. Thus, in classic PMOS, women gain weight easily and find it genuinely hard to lose even small amounts of fat.

Over the long term, insulin resistance also carries a meaningfully higher risk of type 2 diabetes and cardiovascular disease.

At the cellular level, two bodily tissues do not develop insulin resistance the way that muscle and liver cells do: fat cells and the ovaries. As the rest of the body becomes desensitised (resistant) to insulin, fat cells continue absorbing excess glucose and storing it as fat — explaining the weight gain. Meanwhile, the ovaries also remain insulin sensitive and deposit fat (hence their increased size). Since both glucose and insulin are inflammatory in excess, the ovaries become inflamed as a result. The exact mechanism is still being mapped out, but the pattern is consistent.

Insulin also impacts the sex hormones at multiple levels, allowing testosterone levels to rise beyond their physiological range.

Thus, insulin excess can explain all the diagnostic criteria of PMOS. It is the key that unlocks all the doors.

The Heavy Burden of PMOS

The inability to lose weight carries a heavy psychological burden. Society tells PMOS sufferers to “eat less and move more”, but this well-meaning yet misplaced advice only serves to increase guilt and shame.

As a result, women with PMOS often report depression and a persistent sense of hopelessness, particularly around weight loss. Feelings of failure and inadequacy disempower these women from doing anything about their situation. Understanding that the system itself is dysregulated, rather than assuming a willpower deficit, is genuinely part of the solution.

Allopathic Solutions (That Don’t Work)

(In case you’re wondering, “allopathic” refers to standard Western medicine.)

Let’s say you’re diagnosed with PMOS. What is your GP or gynaecologist likely to prescribe?

• Weight loss. You will be told to lose 5–10% of your body mass but not given the right tools. The advice to eat more frequent, smaller meals to lose weight makes matters worse, not better. More guilt and shame when this approach fails.
• Exercise. You will be told to do resistance and aerobic exercise combined. Nobody considers how you’re going to manage this with your inflamed body. That’s your problem. More failure.
• Low-glycaemic-index or Mediterranean-style diet. On the surface, these approaches seem sensible, but they won’t help you lose weight.
• Regulating menstrual cycles. You will be prescribed various contraceptive solutions to help normalise your cycle and reduce male hormone excess. Downside: these tend to increase weight. They do not address the cause and only help a fraction of women improve health outcomes. They do not help women fall pregnant, obviously — which is often the chief reason a woman with PMOS seeks medical attention.
• Metformin. This old diabetes drug is sometimes prescribed off-label for PMOS. It increases insulin sensitivity and may help reduce androgen excess. It is moderately successful with relatively few side effects but does not form part of the standard protocol.
• Hirsutism and acne treatments. At this point, some seriously toxic drugs are often prescribed. Most of them suppress fertility or will harm an unborn child, so they’re not really useful if your goal was to have a baby.
• Fertility / ovulation induction. When it comes to helping you have a baby, the medical industrial complex swings into full action — as long as you have deep pockets, of course. Success rates are low, however, and don’t ask for a money-back guarantee.
• Metabolic and cardiovascular treatments. Cholesterol-lowering therapy is commonly prescribed. Oops — you can’t take these if you want to fall pregnant. They may actually reduce fertility, though the jury is still out. GLP-1 agonists are all the rage for metabolic health and weight loss. However, they have many downsides that the media glosses over. Beyond the exorbitant pricing, they have nasty, sometimes irreversible, side effects. They induce muscle loss and need to be taken long-term. Once discontinued, many patients report the weight coming right back — and then some.
• Mental health. Depressed? Big Pharma has a pill. Oops — they often cause weight gain. They’re not safe in pregnancy either, and many psychiatric drugs also worsen insulin resistance.

Summary: The allopathic approach to PMOS, based on treating symptoms instead of addressing the root cause, offers no hope — only lifelong bondage to multiple treatments that have little benefit and often produce side effects that worsen other distressing aspects of PMOS, like weight gain or infertility. Is there another way?

A Better Way?

If we accept the insulin theory of PMOS, then lowering insulin should reduce PMOS symptoms, possibly reversing the entire syndrome.

1. Diet

Diet is the most obvious and direct way to address high insulin levels. A growing body of clinical research points to low-carbohydrate-high-fat (LCHF) and ketogenic diets as among the most effective dietary interventions to lower insulin levels. Here are some of them.

A 2005 pilot trial — one of the earliest in this space — followed six obese women with PCOS on a very-low-carbohydrate diet of under 20 grams of carbs per day for 24 weeks. The results were striking. Weight dropped, testosterone fell, the LH-to-FSH ratio normalised, and fasting insulin decreased substantially. Two participants became pregnant during the study, despite prior fertility struggles.

A 2020 trial in significantly overweight women with PCOS found that 12 weeks of ketogenic eating reduced body weight, visceral fat, fasting glucose, fasting insulin, and triglycerides, and produced measurably better reproductive hormone balance across the board.

There are many more clinical trials, but you get the idea. The outcomes consistently reinforce the insulin theory of PMOS as a valid and effective clinical approach.

How do these diets work?

“Nutritional ketosis” is the state in which carbohydrate intake is low enough that the body is forced to burn fat for fuel. This reduces the need for insulin. As insulin levels drop, so does the hormonal and metabolic chaos. After 3–6 months, significant physical changes become apparent.

However, it’s not just about a low-carb diet. The quality of fats and oils also matters. Seed oils (sunflower, safflower, canola, and sesame) deserve particular attention. These industrially processed vegetable and seed-derived oils disrupt mitochondrial membranes — the energy generators inside our cells. Ovaries contain an unusually high concentration of mitochondria. High intake of seed oils may directly damage the ovarian environment. They should be removed from the diet. Use cold-pressed, virgin oils instead, such as olive oil, macadamia nut oil, and extra virgin coconut oil. Beware of adulteration and false labelling, both of which are common nowadays. Buy from a reputable source.

Animal fats — such as butter, lard, tallow, and schmaltz — were verboten for forty years because they ostensibly caused heart disease. Ironically, every large trial designed to prove this hypothesis found the opposite (and got buried as a result). The truth is coming out slowly now. Contrary to popular belief, fat does not make you fat. An over-simplified explanation of the role of dietary fats goes something like this: if there is enough animal (saturated) fat in the diet, the body does not have to provide its own fat stores. It can let go of stored fat, since the environment provides enough.

So, which type of diet is best?

Don’t get bogged down in details. The best diet is the one you can maintain for the rest of your life. A carnivore diet is the lowest-carbohydrate diet possible, but few manage to stick to it for longer than a few months. Still, a few months may be enough to make major advances before moving on to a more sustainable diet. In a carnivore diet, meat, fish, eggs, and dairy are allowed (full-cream milk only).

Note 1: The first month on a carnivore diet is difficult, due to excessive tiredness. Thereafter, carnivores report abundant energy, amazing sleep, and a clear brain.

Note 2: Contrary to popular misconception, a carnivore diet is not much more expensive than a standard Western diet, despite high meat prices. Animal products eaten in the absence of dietary fibre are much better absorbed. This means you get more nutrition out of each meal. After the initial adjustment period, total meat intake drops significantly. The final cost is only marginally higher than before.

Note 3: We apparently do not need to eat all that plant fibre. Use psyllium husks or chia seeds for regularity if needed.

Other than a carnivore approach, an LCHF or ketogenic diet is usually more sustainable, although the benefits accrue somewhat more slowly. However, ketogenic diets are generally easier to stick to over the long term.

2. Fluids

To keep it simple: you may only drink water, tea, or coffee. Many types of tea are adulterated with artificial fragrances, flavour additives, and colourants. Make sure your tea is pure. Most importantly, do not add sugar or sweeteners to your beverage of choice. A bit of full-cream milk or cream is allowed. Your tongue will get used to the unsweetened taste soon enough.

Your target is a fluid intake of 2–2.5 litres per day.

3. Fasting

Dietary benefits can be further accelerated by fasting routines.

If done correctly, there is nothing to dread about a fast.

The ideal fast has four elements:

• A predetermined limitation on food intake
• For a predetermined length of time
• For a predetermined number of times
• To achieve a predetermined goal

“Predetermined” is not optional. It is the core of fasting. Properly done, fasting increases your confidence, grit, and willpower. You don’t get there overnight, however. Having an overall goal is critical. An individual fast will not help you achieve any specific target on its own, but as part of a bigger fasting plan, it is easy to motivate yourself to stick to each one.

When it comes to PMOS, it is best to have longer fasting windows — typically 36–48 hours. These are the most effective at lowering insulin. Obviously, you cannot fit too many of these into a week, and obviously you’re not going to start with a 48-hour fast. Baby steps.

For most people, it is easy enough to skip either breakfast or supper. Let’s say you skip breakfast — then you only take your first bite of food after 12 noon. This already drops insulin. During this 16:8 fasting window (eat in an 8-hour window, fast for 16 hours), liquids must still be taken to keep the body hydrated.

Once you’re used to 16:8 fasting, you may try doing OMAD (One Meal A Day) on any three days of the week. Skip any two consecutive meals and don’t snack. Keep drinking fluids, though. It usually takes 2–4 weeks for the body to adjust to this type of fasting.

From there, you can progress to a 36-hour fast two or three times a week. Remember to drink enough. If repeated for three months and linked to the right diet, you should find most of your health outcomes achieved. If there are still some loose ends, just continue with this routine.

Won’t fasting slow down my metabolism?

Fasting up to 48 hours at a time will not slow down your metabolism. This is one reason why we do not advocate long-term fasting, which often stalls weight loss. This sounds counterintuitive, but take it from those who have tried — and won.

What is the difference between fasting and starving yourself?

There is a world of difference. When you fast, every aspect is predetermined. You plan for a fast, and you execute it exactly according to plan. During starvation, you have no choice; you are disempowered. You simply allow your appetites to drive you, knowing that, eventually, the appetites will win and you will hate yourself all over again.

Won’t I feel ravenous while fasting?

This is the surprising thing. Society has been telling us that we can’t be without food for even a few hours. Yet as soon as you begin lengthening the intervals between meals, you find your appetite gradually adjusting. The first time is always harder, but the second time is already easier. When you put your will in charge of the fasting process and both the plan and the goal are clear, the appetites become obedient to the will. This is the true power of fasting.

How much weight will I lose?

You should lose about half a kilogram per week. Initially, it may be faster; later, it may be slower. This does not sound exciting, but you’re not in it for a fad. This is the body you want to carry with you for the next couple of decades. Patience with the process will pay off later, when weight loss becomes harder.

Note: Do not simply decide to extend a fast, even if you’re feeling good. The duration you predetermined is the duration. You need to stick to it to achieve the mental benefits of a fast — namely, the knowledge that you are in control of your body. No need to make impulse decisions; you are working with a steady plan.

The key principle is gradual and gentle progression. Jumping to aggressive fasting windows too quickly is neither necessary nor wise. The physiology adjusts over time, and what feels difficult in week one tends to feel routine by week three or four.

4. Exercise

We previously said exercise is not helpful, so why is it mentioned here?

In the bigger scheme of life, quality of life is determined by quality of muscle. The purpose of exercise is to consolidate the gains already achieved and to prevent things from sliding downhill again.

Few people know that the body’s metabolic rate takes about five hours from waking to reach its daily operating level (and you thought your Windows PC took long to power up). By exercising early in the morning, the base metabolic rate climbs faster. In other words, you can burn calories simply by raising your base metabolic rate, and this can be done with a simple exercise routine when you wake up. You can burn as much as 200 kJ per day simply by exercising early in the morning in your PJs in the comfort of your bedroom.

Start with “placeholder exercise” — simply doing something light and easy for a few minutes in the morning. Do this six days a week. Make it part of your daily habits before expanding the exercises you do. If it’s a tough morning, fall back to your placeholder exercise. Don’t ever allow time constraints to completely crush the gap you created in your daily schedule. Even one minute of leg raises is better than nothing at all. If you ever allow time constraints to crowd out your exercise slot, it will be much harder to start again. Baby steps.

Over time, your body shape will change, your inflammation will reduce, and you will be able to do more resistance and aerobic training. Not to lose weight, mind you, but to build muscle.

5. The Mind Game

Finally — but also most importantly — the psychological dimensions of managing PMOS should not be neglected. With PMOS, progress is genuinely slower than it is for women without the condition. The metabolic deck is stacked against easy weight loss. Patience, realistic expectations, and self-compassion are not soft add-ons. They are practical components of sustained management. Depression is common in PMOS. Addressing it through CBT (Cognitive Behavioural Therapy) or pastoral counselling sidesteps the potential problems caused by prescription therapy. Also, having one or two people working through their PMOS with you is mutually motivating and can help lighten the psychological burden of loneliness and isolation.

Cortisol, the stress hormone, impacts PMOS significantly. The pattern looks like this:

Stress → Cortisol goes up → Glucose goes up → Insulin goes up → Fat gain

There are many strategies to manage stress, which we cannot cover in detail here. For now, suffice it to say that this area needs attention too.

6. Supplements

When it comes to lowering insulin levels, supplements do just that: they supplement a strategy. Supplements cannot replace steps 1–5 above. Use the below in conjunction with lifestyle changes, not instead of them.

Specific nutrients play targeted roles in supporting the hormonal and metabolic pathways disrupted by PMOS. Fortifying these pathways can accelerate health gains.

Several supplements have been evaluated in randomised controlled trials (RCTs) for managing PMOS, showing benefits for insulin resistance, hormonal balance, metabolic health, and even fertility rates. Follow these links for further reading: Link1, Link2, Link3

Insulin Sensitisers

• Inositol: Improves insulin sensitivity and lowers fasting insulin and testosterone levels. Supports ovulation and egg quality.
• N-Acetyl Cysteine (NAC): An antioxidant that improves insulin resistance. Also shown to enhance ovulation and pregnancy rates.
• Alpha-Lipoic Acid (ALA): A powerful antioxidant that lowers blood glucose and improves insulin sensitivity.
• Omega-3 Fatty Acids: Lower triglycerides, reduce fasting blood glucose, and help decrease testosterone and ovarian inflammation.
• Coenzyme Q10 (CoQ10): Improves lipid markers, insulin sensitivity, and pregnancy outcomes.

Vitamins

• Vitamin D: Powerful anti-inflammatory effects when used at the right dose (5,000–10,000 IU/day). Improves insulin sensitivity and reduces high androgen levels.
• B-Complex Vitamins (Folate, B6, B12): Lower homocysteine levels (a marker of inflammation) and support metabolic and reproductive health (especially when combined with inositol). Note that folate is the naturally occurring form of folic acid.
• Vitamin E: Acts as an antioxidant to help decrease oxidative stress. Improves lipid and hormonal parameters.

Minerals

• Magnesium: Improves energy production and insulin sensitivity.
• Zinc: Reduces oxidative stress in the ovaries, helps improve lipid profiles, and may reduce unwanted hair growth by reducing androgen activity.
• Chromium (as Picolinate): An antioxidant mineral that lowers blood glucose levels and may improve certain lipid markers.
• Selenium: A powerful antioxidant mineral that improves insulin sensitivity and lipid markers.
• Iodine: Studies are lacking, but in Japan (with high iodine intake), a diagnosis of PMOS is rarely accompanied by obesity or hirsutism. Iodine’s well-known metabolic support may play a role.

Herbal and Other Products

• Pre- and Probiotics: Gut microbes produce important anti-inflammatory substances. Boosting them reduces inflammation and improves hormonal and metabolic balance. Kefir has been shown to reduce fasting blood glucose and increase insulin sensitivity.
• Curcumin (Turmeric Extract): Lowers fasting blood glucose, insulin resistance, and inflammatory markers.
• Berberine: Improves insulin sensitivity, lowers fasting blood glucose, and reduces total cholesterol. Also helps with weight management.
• Sutherlandia (Cancer Bush): While there is no research on this remarkable plant in PMOS, anecdotal evidence points to its ability to lower fasting blood glucose and normalise hormonal balance.
• Cinnamon (Cinnamomum cassia): Improves insulin resistance and helps normalise the menstrual cycle.

What Does Integrow Health Offer?

We have many of the nutrients mentioned above in our line-up. If funds are limited, just get inositol powder. If you have money left over, consider FIRE Power as well.

• Alpha-Lipoic Acid — Take 2 capsules daily.
• Bravo! Vitamin B Complex — Take 1 capsule daily.
• Cancer Bush Plus — Take 1–2 capsules daily.
• FIRE Power Basic and FIRE Power Plus — Our easy-to-take combo of nutrients to increase insulin sensitivity. Save money and time by taking everything in one glass. Take 1 scoop once or twice daily, before meals.
• Gut IQ-1 Capsules — Our brand-new 15-strain probiotic in acid-protected capsules. Don’t tell anyone — we’re launching it next week. Take 1 capsule 3 times a week, with food.
• Iodine Spray 9 ml — Take 1 spray in the mouth daily.
• Liposomal Curcumin — Take 1–2 capsules daily, with food.
• Magnesium Capsules — Our MgO and Brain-Mag supply magnesium in a readily absorbed format. Take 1–2 capsules daily.
• Mega D3 (40,000 IU Vit D3 / capsule) — Take 1–2 capsules weekly until your Vit D blood levels are at or around 80 ng/mL.
• Omega-3 Fatty Acids — Our Fish Oil and Algae Oil softgels both supply omega-3 fatty acids. Take 1 softgel twice daily.
• Pure Powder Inositol 150g and 300g — Take 5g daily.
• Zinplex Triple — A combination of zinc and selenium. Take 1 tablet daily.

In Closing

We trust this in-depth overview puts the power back in your hands. There is a LOT you can do to address PMOS!