Dr. Samantha Van De Wal, ND
Episode Summary
What is PCOS, how is it diagnosed, and what can you actually do to manage its symptoms?
In this episode of Girls Gone Wellness, naturopathic doctor Dr. Samantha Van De Wal joins hosts Victoria and Jeanette for an in-depth conversation about polycystic ovary syndrome (PCOS), including PCOS symptoms, diagnosis, insulin resistance, nutrition, supplements, exercise and fertility.
Dr. Van De Wal explains that PCOS can look very different from person to person. Common signs and symptoms discussed in the episode include irregular or absent periods, difficulty ovulating, acne, coarse facial or body hair, hair loss, weight changes and weight-loss resistance. She also breaks down the Rotterdam criteria used to diagnose PCOS and explains why having ovarian cysts is not required for a PCOS diagnosis.
A major focus of the conversation is the relationship between PCOS and insulin resistance. Dr. Van De Wal discusses fasting glucose, fasting insulin and HOMA-IR, why standard blood sugar testing may not always provide the full picture, and how metabolic health can influence PCOS symptoms. The episode also explores how nutrition, stress, under-fuelling, gut health and lifestyle factors may interact with insulin sensitivity.
The conversation then turns to diet for PCOS. Do you need to follow a low-carbohydrate diet? Are carbohydrates bad for PCOS? Should everyone with PCOS avoid gluten or dairy? Dr. Van De Wal explains why nutrition needs to be individualized and why highly restrictive diets are not automatically necessary for everyone with PCOS. She discusses protein intake, balanced meals, carbohydrates, healthy fats, non-starchy vegetables and how dietary strategies may differ depending on a person's degree of insulin resistance.
Dr. Van De Wal also reviews commonly discussed PCOS supplements, including inositol, berberine, vitamin D, magnesium, omega-3 fatty acids, chromium, alpha-lipoic acid and cinnamon, and explains the reasons these may be considered in an individualized treatment plan.
Finally, the episode tackles several common PCOS myths, including whether women with PCOS need to eliminate gluten and dairy, whether high-intensity exercise should be avoided, whether diet causes PCOS, and whether a PCOS diagnosis means you will struggle with infertility.
For anyone newly diagnosed with PCOS, experiencing possible PCOS symptoms, concerned about insulin resistance, or wondering how PCOS may affect fertility, this episode offers a detailed discussion of the condition and the many factors that can influence its presentation and management.
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What is PCOS?
PCOS stands for polycystic ovary syndrome. It is a syndrome that can affect menstrual cycles, ovulation, androgen levels, metabolic health and fertility. As Dr. Samantha Van De Wal explains in this episode, PCOS can present very differently between individuals, which means there is no single appearance or symptom pattern that defines everyone with PCOS.
What are common symptoms of PCOS?
Symptoms discussed in the episode include irregular or absent periods, lack of ovulation, acne, coarse facial or body hair, hair loss around the scalp, weight changes and difficulty losing weight. Some people may have several of these symptoms, while others may have only a few.
How is PCOS diagnosed?
The episode discusses the Rotterdam criteria, which use three main features when evaluating PCOS: signs of androgen excess, irregular or absent ovulation, and polycystic-appearing ovaries on ultrasound. A person generally needs to meet two of the three criteria, meaning that ovarian cysts are not required for every PCOS diagnosis.
Can you have PCOS without ovarian cysts?
Yes. As discussed in the episode, polycystic ovaries are only one component of the Rotterdam diagnostic criteria. Someone may meet the other criteria for PCOS without having polycystic-appearing ovaries on an ultrasound.
Can you have regular periods and still have PCOS?
Potentially. Dr. Van De Wal explains that having a regular menstrual cycle does not necessarily confirm that ovulation is occurring. The episode discusses tools that may be used to assess ovulation, including basal body temperature, cervical mucus patterns and appropriately timed progesterone testing.
What is the connection between PCOS and insulin resistance?
Insulin resistance is an important topic in PCOS and is a major focus of this episode. Dr. Van De Wal discusses how elevated insulin may interact with androgen production and PCOS symptoms and why evaluating metabolic health can be useful when developing an individualized treatment approach.
What is HOMA-IR, and why is it discussed in PCOS?
HOMA-IR, or Homeostatic Model Assessment of Insulin Resistance, is a calculation that uses fasting glucose and fasting insulin to estimate insulin resistance. In the episode, Dr. Van De Wal discusses using these markers together when assessing metabolic health in some patients with PCOS.
Does everyone with PCOS need to follow a low-carb diet?
No. One of the major themes of the episode is that PCOS nutrition should be individualized. Dr. Van De Wal discusses situations in which carbohydrate modification may be considered, particularly when significant insulin resistance is present, while emphasizing that a restrictive low-carbohydrate diet is not automatically appropriate for everyone with PCOS.
Are carbohydrates bad for PCOS?
Not necessarily. The episode discusses looking at the overall diet, the amount and type of carbohydrates being eaten, whether carbohydrates are paired with protein and fats, and the individual's metabolic health rather than automatically eliminating carbohydrates.
Do you need to avoid gluten and dairy if you have PCOS?
Not necessarily. During the episode's myth-busting section, Dr. Van De Wal identifies the idea that everyone with PCOS must be gluten- and dairy-free as a myth. Dietary changes should instead be based on the individual's symptoms, health history and needs.
Can you do high-intensity exercise if you have PCOS?
Yes, depending on the individual. Dr. Van De Wal explains that high-intensity interval training may be useful in some circumstances, while factors such as stress, recovery, nutrition and how someone feels after exercise should also be considered.
What supplements are commonly discussed for PCOS and insulin resistance?
Supplements discussed in this episode include inositol, berberine, magnesium, vitamin D, omega-3 fatty acids, chromium, alpha-lipoic acid and cinnamon. Dr. Van De Wal explains how these may be considered depending on an individual's symptoms, nutritional status, metabolic health and overall treatment plan.
What is inositol, and why is it used for PCOS?
Inositol is one of the most commonly discussed supplements for PCOS. In this episode, Dr. Van De Wal discusses myo-inositol and D-chiro-inositol, including the commonly used 40:1 ratio, in relation to insulin sensitivity, menstrual cycles, androgen-related symptoms and reproductive health.
Is berberine used for PCOS?
Berberine is discussed in the episode as one potential option for supporting insulin sensitivity. Dr. Van De Wal also explains why its effects on the gut microbiome and the individual patient's health need to be considered rather than treating it as a supplement everyone with PCOS should automatically take.
Does PCOS cause infertility?
A PCOS diagnosis does not automatically mean infertility. Dr. Van De Wal describes this as one of the biggest myths she wants to challenge. PCOS can affect ovulation and fertility for some people, but the episode emphasizes that many women with PCOS are able to conceive and that addressing ovulation and reproductive health can be an important part of PCOS care.
Can lifestyle changes improve PCOS symptoms?
Lifestyle strategies are a major part of the discussion in this episode. Nutrition, adequate protein and overall food intake, movement, stress, sleep, metabolic health and other individual factors may all be considered when developing a PCOS management plan.
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Girls Gone Wellness & Dr. Samantha Van De Wal, ND
This transcript has been edited for clarity and readability while preserving the substance of the conversation.
Jeanette Titus
Hi everyone welcome to another episode of Girls Gone Wellness Today we have a very special guest Dr Samantha Van deal Dr. samantha van dervahl is a naturopathic doctor with a special interest in PCOS fertility aND preconception prior to becoming a naturopathic doctor. Dr. Van de wah worked as a secoNDary school teacher during her professional career as a teacher. She became introduced to naturopathic medicine falling in love with this model of care. She decided to complete her holistic nutrition Diploma. The Institute of Holistic Nutrition while simultaneously continuing to work as a teacher aND completing her master's degree too. She then decided to pursue naturopathic medical school while completing her training. She worked closely with women with pcos ultimately creating the PCOS Repair Plan. A twelve week program that digs deep into women's unique root causes of their pcos with practical evidence-informed approaches to help them reverse their symptoms with accountability community aND support in May Twenty Twenty Two Dr Van de wa graduated with her doctor of natutropathy degree from the Canadian College of Naturopathic Medicine. AND now works with patients one on 1 in her virtual clinic. In addition to her program. She is also the creator of the PCOS kickstar blueprint ebook the 4 pillar success system to manage PCOS symptoms for good which will be released in spring twenty twenty four. Dr. Van Deh is an active aND good staNDing member of the college of natropas of Ontario Ontario Association Of Naturopathic Doctors aND canadian association of natutropathic doctors aND of this past October she is a new mom to a baby girl. Thank you so much for being here with us today.
Dr. Samantha Van De Wal
Oh thank you both so much for having me. It's such an honor I'm so excited to chat today.
Victoria Gasparini
I was personally Sam so excited to have you on the podcast a lot of people don't know this but you were my intern when I started my very first year at CCNM aND which is like full circle moment because Jeanette aND I start our internship this coming week. which is just insane but you I don't know if I ever really got the chance to tell you how much you changed my life in first year of this program. just even dealing with stress aND then how that was impacting aND making my own PCOS so much worse. you weren't even a licensed doctor at the time aND yet you had the biggest impact on my health out of everybody that I saw so when we started this podcast I said to Jeanette like Dr Van de wall is the first person I want to message to have on the podcast.
Dr. Samantha Van De Wal
AND. My gosh.
Victoria Gasparini
Because I think so many people need to hear this conversation.
Dr. Samantha Van De Wal
Oh my gosh. Well you're gonna make me cry. Thank you so much Victoria it honestly. Yeah it is a full circle moment I'm so proud of you for reaching internship. It's a huge milestone moment for for. Naturopathic students for those who don't know so it's gonna be incredible. The lives that you will now touch aND help I know you will you have a incredible Instagram aND you are always such an amazing source of knowledge. So yeah, it's gonna be amazing to see the things that you do, but thank you so much aND I'm so glad that I made.
Victoria Gasparini
Thank you.
Dr. Samantha Van De Wal
Such a positive impact it really really warms my heart.
Jeanette Titus
That's awesome. Okay, so we're gonna get right into it. Dr Van deal tell us about how you got into naturopathic medicine aND your focus on pq specifically.
Dr. Samantha Van De Wal
Awesome! Yeah, so as we talked about in the bio. I was formerly a secoNDary school teacher aND while I was completing my training as a teacher I did teach abroad in South America Molly was there I got really sick I Didn't know it then but that would be my sort of gateway into naturopathic medicine essentially I got diagnosed with ibs following that trip shortly after but you know still kiND of went on with my merry way. I have always had an interest in health aND wellness aND so despite seeing like gastroenterologists aND other doctors I decided to so pursue a naturopath appointment aND there they really introduced me to this concept of like okay we can work on your gut using. Diet aND supplements which I fouND really intriguing so that's when I began transitioning out of teaching aND into holistic nutrition aND now naturopathic medicine I decided. Okay I'm going to you know, still teach a little bit I was getting my master's at the time. So I said I'm going to complete that part time. But I'm gonna enroll in holistic nutrition diploma at the same time aND so I was doing a lot of things I you know was new to Toronto I'll never forget like I was driving to York Region to teach driving to school I was working at Lululemon aND then doing my masters so it was. Very full days aND you know ironically I was you know, probably uNDer fueling. Well definitely uNDer fueling surviving off of a lot of caffeine to you know, complete those papers aND study for nutrition. AND by the time my nutrition Diploma was done aND my master's was done I was starting to get irregular cycles acne on my jawline hair loss which was so new to me so I just remember always inputting my menstrual cycle like I didn't track it to the degree that i. Was tracking it prior to having a baby. but I always knew my cycle was regular I never dealt with hair loss aND I was you know fortunate to not have to deal with acne at any point in my life. So this was all very new aND keep in miND I was like in my mid 20 s so to have acne arouND that time you're like okay well what's. Going on aND I also you know thought I was eating okay, right? like I remember I probably didn't have breakfast which I'm sure we'll talk about in the in the podcast today but you know I thought I was doing good I had like a chickpea salad for lunch aND I'd probably have you know something sort of similar for dinner. But those symptoms really came with a vengeance aND of course I was like okay well let's explore it aND I'd heard about PCOS but what I had known about PCOS was that you had to be overweight aND you had to eat excess carbohydrates aND I was like okay well that's not me. So I don't have pcos let's go chat with the doctor to see what's going on aND so he ran some blood work. they did an ultrasouND called me back aND I'll never forget the day you know he says to me. Okay, you know, based on your ultrasouND you have a string of pearls ah of Cis on your ovaries. aND you have a regular cycle. So based on that you have PCOS but all your hormones look normal. He said to me aND I was like okay so because my hormones were normal. My blood sugar was normal. He just set me on my merry way I actually was never prescribed birth control I was never prescribed metformin I was prescribed nothing so I don't know. You know in hiNDsight looking back like what's worse to be prescribed nothing or to you know, be given some sort of tool. but I'll never forget. You know I left that appointment I called my boyfrieND my now husbaND aND I was like I don't know what to do like you know PCOS number one cause of infertility. That's what I knew about it aND I just thought to myself you know. You so want to be with me like what does this mean for the future of our family like what does this mean in terms of my life right now like how can I do things differently to reverse this aND so that's when I really you know I sulked for a little bit aND then I was like no like I have the tools I'm in nutrition I'm a nutritionist like how would i. Approach this if this were something somebody coming to see me aND but I needed to learn more so you know I atteNDed tons of webinars I looked at the research I went to conferences aND I you know I said to myself I want more tools to be able to help other women who will have pcos. So after working with a few people on their PCOS working on myself eventually you know reversing the diagnosis to the point where I didn't meet the Criteria I decided. Okay I'm going to go become an atropathic doctor so I can run labs aND really support people in the way that I want to support them the way that they deserve. So that they can leave with more hope coming out of these appointments because I think that is the biggest thing that people leave the conventional doctor's office with when they're diagnosed with it is this feeling of okay well what does this mean now for my health my fertility aND so on aND so forth.
Jeanette Titus
Yeah I think that's well first of all, that's an amazing story aND it it really came full full circle for you. So that's amazing aND I think that's also like a problem because. Someone goes into their doctor's office aND they come up with this diagnosis aND then someone will go on the internet or they'll go on social media aND they'll see all of this stuff aND then they'll go into a downward spiral so they don't really have anyone to turn to so I think seeing a naturopathic doctor nutritionist or something like that can be really? Amazing to have like that other aspect of like lifestyle aND stuff that you can focus on for sure.
Dr. Samantha Van De Wal
Yeah, absolutely aND I think you know, looking back something that I didn't touch upon that is not quite as obvious aND aND we can talk more about it later perhaps but the fact that you know I did go teacher abroad I had an ibs diagnosis aND my gut health was was impacting my hormones. In addition to my lifestyle so that you know is something that was never addressed by my medical doctor. In fact, he like I said he just sent me on my mirror away. Oh he did say do HIIT training I forgot he did say do HIIT training. which when you think about the state that I was in I'm not sure that that would have done. You know I was already working out a little bit so I'm not sure that that would have made the big impact but as an ND we see things holistically so we know that we need to talk about aND ask about you know gut health in terms of what that means to somebody's hormonal picture too. So. Yeah, these were all things that were sort of working against me that I think now we can shed light on or I can shed light on so that other patients in the future will have an uNDerstaNDing that all of these things are impacting their PCOS diagnosis.
Victoria Gasparini
I Think you made a really interesting point too When you said that you didn't look like what you thought PCOS looked like right aND it's so easy to have hopefully I don't get in trouble for saying this but there I just won't mention the name. But there is a doctor who all 3 of us are aware of that made a comment about PCOS being like bearded lady syNDrome aND it just goes to show like we all have this image in our head of what PCOS looks like but because it's a syNDrome it presents so differently across the board.
Dr. Samantha Van De Wal
Who here? yeah.
Victoria Gasparini
AND you know I have PCOS you have PCOS but our issues were completely different right? aND it's just there's no textbook image of what PCOS looks like aND I think that that makes it harder on people who have these set of symptoms to know. First of all what to bring up at the doctor. What to.
Dr. Samantha Van De Wal
HuNDred percent
Victoria Gasparini
Ask for aND to be able to advocate for themselves right? Yeah yeah.
Dr. Samantha Van De Wal
100% aND I know there's a lot that we're going to touch on today. So'll let us kiND of get to those questions but it definitely makes me think about all of the patients aND the clients in the past that I have seen sitting in front of me that don't present like your tuck. Book PCOS picture.
Jeanette Titus
if.
Victoria Gasparini
Definitely I Think that's my biggest worry with going to clinic. It's like all we've learned is textbook aND now I'm like oh this is real life. You know? Yeah, totally So why don't we.
Dr. Samantha Van De Wal
Yeah, yeah, but you'll be okay because you know now right? like you have that experience. So.
Victoria Gasparini
Start with you telling our listeners. First of all, what is PCOS in case somebody who's listening doesn't know. how do we get diagnosed. Maybe like what are some things that we should be looking for symptom wise that might alarm us to get to get checked or to look into it.
Dr. Samantha Van De Wal
Yeah, okay, so let's start with some of the symptoms that somebody might be experiencing. So you know I mentioned a few of my own so the irregular or absent cycles aND irregular irregular cycles would mean you know greater than thirty five days in length aND there is always. Going to be some variability to a cycle if somebody's experiencing stress for example, so if somebody's on like a twenty eight day cycle but they are really stressed for a week that could postpone ovulation for one month aND you know would be that thirty five days that we're talking about you know, consecutive cycles where there is irregularity. Or absence cycles altogether coarse hair. So this could be on the jawline or in the neck we see this on the breast as well as below the belly button. AND you know something to keep in miND is that there are cultural differences with this so that in in of itself is maybe not necessarily diagnostic. We need to inquire further about that. But if it's something new to an iNDividual that should definitely spark some curiosity hair loss particularly arouND sort of the crown of the head. That's ah. Big one? aND you know I I am hesitant to say weight gain but sometimes there are some weight issues for people aND sometimes there isn't it's so nuanced. but even weight loss resistance could sort of be a symptom of it as well when we are talking about how to actually go on to diagnose it. It's based on what's called the Rotterdam criteria aND you need to have 2 of the 3 criteria so pcos staNDing staNDing for. polycyststic ovarian syNDrome. It's a misnomer aND of it in aND of itself because one of the criteria is cystst on the ovaries. So that means if you have the other 2 criteria. You don't actually need to have cyststs on your ovaries in order to be diagnosed aND an important distinction here too is that the. cyststs on the ovaries should resemble a string of pearls or there should be multiple cyststs on the ovaries aND this is different than an ovarian cysts there's sort of 2 different patho physiiologies at play with ovarian cystst to the polycyststic ovaries the next criteria is. you know signs so visible signs of high testosterone. So the things that we talked about like the acne the coarse hairs aND hair loss the hair loss resembling you know male pattern hair loss aND or high testosterone on blood work. So this could also mean that your patient is presenting with you. You know, no clinical observable signs. But then we have the lab work to prove that there is elevated testosterone or DHT which is really what's going to implicate the hair loss aND DHEA. Yeah, they don't have to have all 3 they could just have one of them. aND there's sort of different reasons why each of those would be elevated but that could be presenting aND then the third one is the an ovulatory cycle so cycles they could be cycling but they might not be ovulating which is a huge important distinction. or not having cycles at all. So you know when I see patients who have a history of pcos aND let's say they are wanting to start to conceive but they have regular cycles this is where I say like okay we need to ensure that you actually are ovulating. Because there are females that will have a regular cycle but won't be ovulating so just to recap it's 2 of the 3 of those that we want to eventually make that diagnosis of PCOS for.
Victoria Gasparini
Ok questions couple questions. so if somebody is cycling consistently. they have let's say signs clinical signs of high aNDrogens. They pretty much have to get.
Dr. Samantha Van De Wal
Yeah, yeah.
Victoria Gasparini
Ah, transvaginal ultrasouND then to have that confirmation of a diagnosis right? even because how do we know if they're ovulating.
Dr. Samantha Van De Wal
Yeah, yeah, that's a good question. So I mean yes I would say get the transvaginal ultrasouND but then you could also inquire about ovulation by doing a couple things so you could run a progesterone. Ah, serum progesterone get them to go to the lab seven days after suspected ovulation now if they have signs of ovulation like that egg white quality cervical fluid I would say okay go to the lab seven days after you see that or what I think is sort of the gold staNDard of. Ovulation detection is basal body temperature So seeing that stark rise in temperature would iNDicate that ovulation has taken place aND then if we want to be really serious aND determine. You know how strong.
Victoria Gasparini
Remember.
Dr. Samantha Van De Wal
That lh surge was how strong is your progesterone now is to run progesterone seven days after they see that spike.
Victoria Gasparini
Okay, okay, good to know, in terms of a transvaginal ultrasouND I mean from personal experience when I was told Okay, you have to do this because you don't meet the other criteria I was like ah I'm good. Maybe I don't need a diagnosis. So.
Dr. Samantha Van De Wal
Yeah, fair, yeah fair.
Victoria Gasparini
Even though we know PCOS is so common I think it's probably more common than we even think because there's so many of us that are like yeah no I'll pass I don't really need to get to get this checked? but I actually do woNDer how accurate they are because I know sometimes with a transvaginal ultrasouND you have to do it a couple of times.
Dr. Samantha Van De Wal
Yeah. Yeah.
Victoria Gasparini
To see what we're looking for is that right? or am I am I off with that I.
Dr. Samantha Van De Wal
to be honest with you I don't know the answer to that question I could you know imagine that it is cycle depeNDent as well right? because we could see some of those cyststs disappear at the next cycle. so if that's what you're referring to yeah I think there's accuracy.
Victoria Gasparini
Right.
Dr. Samantha Van De Wal
In what you're saying there I haven't heard in terms of like statistics or research. I just know that that's sort of the gold staNDard aND I will say I mean to your point how many more PCOS cases would there be if we routinely ran this as part of maybe like a physical exam.
Victoria Gasparini
Right. Yeah.
Dr. Samantha Van De Wal
But you know one of the benefits of doing a transvaginal ultrasouND is that they would be able to detect other types of reproductive concerns so things like fibroids or you know t true ovarianance cyststs which could be you know they often sort of come up haND in haND like a fibroid PCOS situation is.
Victoria Gasparini
right.
Dr. Samantha Van De Wal
Quite common. so that can certainly guide the treatment moving forward if they if there are other things that come up on the ultrasouND.
Victoria Gasparini
Okay, good to know I need to clarify that for myself. Yeah.
Dr. Samantha Van De Wal
Yeah, yeah I mean I can look into that too aND because yeah, that's a good That's a good point in terms of the accuracy because things will be changing but I think there is there is benefit if if there are other symptoms presenting.
Victoria Gasparini
Okay, good to know.
Dr. Samantha Van De Wal
Especially sorry you just on that point too like especially painful periods in your case, you're saying well if I am having a regular cycle like why do I need to do this but in cases where iNDividuals maybe aren't having a regular cycle. This is even more important because of that risk for the eNDometrial hyperplasia.
Victoria Gasparini
right.
Dr. Samantha Van De Wal
Which puts you at risk for eNDometrial cancer so you want to make sure that you know the eNDometrial layer hasn't gotten too thick because with menstruation. Of course we're shedding that layer if somebody's not menstruating then that could continue to grow aND puts you at risk like I said for the eNDometrial cancer so that would be picked up on on that.
Victoria Gasparini
Right. Okay, that's good to know good to clarify because for me personally I mean I was working with you while I was going through all this aND so from my perspective it was like well we're going to treat this kiND of regardless because it was sort of clear what I was dealing with aND obviously I mean it really helped to do all the treatments we did.
Dr. Samantha Van De Wal
Yeah, yeah. Yeah.
Victoria Gasparini
Also knew I wasn't going to use the conventional options like metformin or birth control. Not that there's anything wrong with those options. It just wasn't what I needed at the time but I think for the average patient getting a diagnosis could be empowering aND it could also be a way for them to advocate for the right treatments with whatever Physician they're seeing So it's good to know that.
Dr. Samantha Van De Wal
yeah, yes.
Victoria Gasparini
You know these are these are the aspects of getting that diagnosis.
Dr. Samantha Van De Wal
Yeah, 100% aND you know I think what you're saying that that is an important lesson for patients too is that you know your doctor should not necessarily be doing anything that's going to like Not change the course of treatment so you know unless we're talking about things that you know are could involve higher risk. But if they're making you uNDergo multiple tests. But at the eND of the day you know they're going to treat in a certain Way. We have to beg the question you know is this test necessary right.
Victoria Gasparini
Totally yeah aND I mean transvaginal ultrasouND is not exactly a test. We all want to be doing right? So only doing it if it's necessary.
Dr. Samantha Van De Wal
Yeah, yeah, absolutely exactly.
Jeanette Titus
So my question is you mentioned high testosterone on lab work. do you seND all your patients for lab work aND do all PCOS patients have high serum testosterone because I know sometimes we hear either or. Things So I just would like to clarify that here.
Dr. Samantha Van De Wal
Yeah that's such a good question. so do I seND all of my patients for lab work pretty much yes aND sometimes they'll you know we're located in Ontario so their medical doctor will often cover a lot of lab. Labs that you know their MD wants them to run which we can use which is great because it's covered by the Ontario Health Insurance Plan aND what I'll usually do is I'll like fill in the gaps for the things that they don't run aND this is ah as a cybar conversation right? like naturopaths are going to treat differently than conventional doctors aND so everybody who is like they come into my office aND they're like. Well, you know my my doctor won't run this lab aND I said well this's because they're they're they're not going to know like what to do with that information. They're running the stuff that they then can treat right? hemoglobin A1c if it's high. They'll do metformin right? whereas if we're looking at. Markers so that some of the things that I'll run for example is fasting glucose fasting insulin. that can tell us way more information than hemoglobin A1c hemoglobin A1c is like what's going to happen in three months from Now versus what can we do now to prevent what could happen in three months from now or beyoND. So we're looking at it from more of a preventative perspective aND also from a root cause perspective versus wanting just primarily to treat disease. So that's the distinction there aND it's no fault if their own is just the differences in how we're practicing. so some of the tests that I will run Yes, so fasting Insulin is usually not one that medical doctors will run. we might be able to get the fasting glucose from them. So just something that's important to do is to get those markers done on the same day for most accuracy. AND then together we bring them into the office aND the virtual office aND I'll calculate their degree of Homo or their degree of insulin resistance. It's called the HOMA-IR aND aND we can talk a little bit more about that later but that is something that I'll definitely run. from the perspective of testosterone oftentimes their doctors will run testosterone which is great. we n DHEA aND DHT doesn't often get looked at with respect to DHT. That's usually the one that's like causing. Not usually but often the one that's causing like a lot of the hair loss a lot of the acne. So This test is a little bit more on the price of your side aND this is a perfect example of like well if we're going to treat assuming that this is high anyways like we might not necessarily have to run this lab so it's more about like you know. Informed consent discussing cost aND discussing. You know if you're okay to move on with treatment without seeing these results per se but yeah I don't know if that did that answer part 2 of your question in terms of the high testosterone piece.
Jeanette Titus
Yeah, yeah, definitely I Just yeah I hear like different things Sometimes some people will say like oh you'll go off with the clinical signs aND then you'll kiND of like you mentioned you'll assume that it's you know testosterone playing a role or some doctors will like to run testosterone so I was just curious about that.
Dr. Samantha Van De Wal
I see. Yeah, so just to kiND of explore this further or talk about it. Further Yeah, so there are times where I'll say Okay, well yeah, we we could assume testosterone is high aND if you want to do sort of the basic blood work that would be like fasting Insulin fasting Glucose. some of those metabolic markers because that's ultimately what is the driving force of those markers Anyways, right? So They're nice to get a benchmark because at the eND of the day objectivity is is nice to follow so that we can see like things are Changing. But so are symptoms Sometimes the blood markers will change faster than the symptoms you know, hair loss aND the coarse hair growth. The hirsutism is very stubborn. So You know it takes a long time to see those things change aND patients might get frustrated which I can totally appreciate having experienced those things with how slow it takes to move the needle on the symptoms. So Sometimes that's where the blood work is nice to see that progress is actually being made So Let's stick to the plan versus shifting it.
Jeanette Titus
Right? that that makes complete sense for sure.
Victoria Gasparini
Yeah, I'm so you said insulin resistance is the driving force for a lot of these PCOS related symptoms right? So I'm woNDering this is more of an opinion based question. But I'm woNDering if you think that.
Dr. Samantha Van De Wal
Yes, okay.
Victoria Gasparini
Insulin resistance. So I guess testing that HOMA-IR aND I'm going to ask you how that works too How we can calculate that but do you think that should be part of a diagnostic criteria like I'm just woNDering this Rotterdam Criteria does it need to be updated.
Dr. Samantha Van De Wal
You aND. Yeah,, that's a really good question. in terms of it being a part of the didostic Criteria I mean the stat is arouND 80% of iNDividuals with PCOS have some degree of Insulin resistance. So That's pretty significant. aND Then. We also have to get curious about like what about the other twenty it begs the question of like the different types of different Phenotypes I don't know if it should be a part of the diagnostic Criteria Probably to be honest with you because hemoglobin A1c doesn't always tell us enough. You know they could be in a normal range but then still have. Insulin resistance aND again if the insulin resistance is present if untreated you know how long until that HOMA-IR is elevated or sorry the hemoglobin A1c is elevated I mean there. There's really no blood marker. Other than the high testosterone piece that is part of the diagnostic workup. I Guess if we added that in it would expaND the the diagnosis aND are we including. Too many non PCOS iNDividuals by doing that I don't know it's nuanced. so I don't I don't really know the answer to that one quite yet.
Victoria Gasparini
Right.
Jeanette Titus
living.
Victoria Gasparini
Okay, good to know because you know you hear people say that PCOS is more of like a metabolic coNDition than a reproductive one aND I is that true like I woNDer does that apply to everyone.
Dr. Samantha Van De Wal
Yes, I would absolutely say that. Yeah, because really, you know when we think of like elevated testosterone elevated DHT These are really just the messengers. It's not the actual message itself. So when we look at the root cause of all of these issues oftentimes it is.
Victoria Gasparini
Okay.
Dr. Samantha Van De Wal
Insulin aND there's root causes to insulin too right? Like why is insulin resistance present. There's the dietary piece absolutely but 1 piece that often gets missed is the stress piece aND you can fiND different root causes for the stress piece if you dig deeper into the stress piece is it external stressor so in in the example of. Ah, myself using me as an example, if you looked at my my lifestyle just like kiND of burning the caNDles at both eND aND I think this is true for a lot of ah lot of females who are ambitious aND you know want to excel in different areas of their life. They you know they're kiND of running on empty. Oftentimes aND that's what I see a lot of in my practice too. So there's that external stress. But then there's the internal stress too again using me as an example I had ibs. But when I uncovered that it was ah you know a variety of bacteria that I needed to treat. AND all of these things are going to contribute to insulin resistance. Not just a diet that is rich in Carbohydrates. So I Think that's why that insulin resistance piece is it's nuanced when it comes to the diagnosis of PCOS. really when we come when it comes to the Diagnosis. We're looking at like the presentation of it aND yeah, the the root causes is just so robust.
Victoria Gasparini
Definitely okay I want to get into treatment because I know that's why people are listening Jeanette aND I sometimes we forget we forget that because we're in like the clinical piece. We want to know like how am I diagnosing my patients but like the people who are listening want to know what to do like right now. So.
Dr. Samantha Van De Wal
Yes, yes.
Victoria Gasparini
I'm going to just quickly have you tell us how to that HOMA-IR situation just so people know that this is how we can calculate that aND then we'll move into what we can do to treat patients aND also some myth busting.
Dr. Samantha Van De Wal
Yes, Okay, so the HOMA-IR if you go online. There is a calculator aND I don't even know exactly like what it's multiplying aND dividing. There's conversions that have to go in so I don't have that memorized off the top of my head but I use the online calculators. You plug in your fasting glucose you plug in your fasting insulin aND it gives you a number aND basically you're looking at degrees of severity when it comes to homa I r so usually when it's over. Like uNDer 1 you're good like there's something else that play roughly arouND 1.9 is sort of the cutoff for early insulin resistance I would say for myself anywhere from like 1 to 1.9 I'm getting curious. I'm really curious about like okay like is there something that we could modify to get this one like more towards 1 over 2 is when insulin resistance is definitely playing a role aND we can talk about you know should somebody go low carb or not this is when I would say. We need to start talking about carbohydrates in terms of how many carbohydrates to somebody consuming. Are you consuming naked carbohydrates. How often are you eating things like that. aND then over. I would say we're looking into more severe insulin resistance where we do want to definitely modify the carbohydrates to a low- or no-carbohydrate intervention for you know, something like six weeks as long as that person is you know. Capable aND able aND really educated on the topic as well because you are moving into restriction aND that is you know? ah a conversation piece that needs to be had with with the patient in front of you.
Victoria Gasparini
Totally that makes sense.
Jeanette Titus
So so we know that treating PCOS is highly iNDividualistic as you mentioned before aND diet is highly iNDividualistic as well. But say you have a patient that comes to you. They've just been diagnosed with PCOS. They have that high insulin resistance piece. What would you say would be your number 1 step with them to first start off with.
Dr. Samantha Van De Wal
So high insulin resistance like in terms of high HOMA-IR yeah sorry I also just looked at the cutoff. The cutoff is two point nine sorry I think I said for 2.9 for significant insulin resistance. So it is a little bit lower than than what I mentioned.
Jeanette Titus
Yes, yes, sorry, that's what I meant. Yeah. The.
Victoria Gasparini
Okay.
Dr. Samantha Van De Wal
So In the case of Significant Insulin resistance. So a HOMA-IR of Greater than 2.9. yes, this is where we do want to look at modifying Carbohydrates. So First of all looking at the person holistically right? Like. What are some of the other causes of Insulin resistance for this person if they have severe gut issues. We do want to treat the gut something that's great that we can talk about later because I know we'll get into supplements is berberine that has an effect on the gut but it also have an effect on Insulin too. So looking at that looking at lifestyle factors that are contributing to stress aND like this could be significant fasting like unintentionally for example. Because at the eND of the day. This is a slight stressor that's going to elicit the formation of new glucose molecules which can contribute to insulin resistance. but then the flip side of it is there is some therapy that intermittent fasting can provide for significant insulin resistance to. But then looking at carbohydrate too so this would be like a 30% or below carbohydrate makeup in terms of the entire macronutrient profile that they're having that day. again depeNDing on their severity aND. When we approach this It's really like education first because you know we could have a patient come into our office aND like say that they have tried low- or no-carbohydrate but then you know they've done a really sort of poor ketogenic diet type of situation. or really like poor Atkins diet situation. where they're replacing all sugary things with like sugar alcohols. We know this you know contributes to some poor gut ah health outcomes or you know, bacon aND eggs. Routinely which is going to increase the cardiovascular disease risk so it involves a huge conversation piece arouND diet. but yeah, replacing some of those more saturated fats with things like nuts aND seeds. ah. Really good quality oils like avocado oil a little bit of coconut oil because at the eND of the day that is a saturated fat all of oil olives. those things are going to be really tremeNDously beneficial at lowering the total insulin load for the day pairing it with protein rich foods as well. So. this could be like a vegan sort of plant-based protein powder which I typically will recommeND some type of protein powder for most if not all of my PCOS patients just because we really are severely protein deficient I think like as a society lean. Ah. Poultry So like Turkey Chicken fish fishes aND poultry but fish in terms of like ah a lean protein option. eggs are great as a healthy fat. So really leaning into those aND then the non-starchy vegetables as Well. You know those are going to be very filling. Yes. Because they're volume but also they're full of micronutrients that are really important for creating a healthy Microbiome creating a healthy diet aND insulin sensitization in this system because we know that things like dark leafy greens for example are rich in magnesium. Are going to play a huge role in the Glucose Tolerance factor in sensitizing Insulin So All of these things are going to have a profouND impact on the diet in terms of you know what carbohydrates you know are sort of best in this instance, you know any type of like root vegetable will be. But be fantastic as an additional fiber source aND mineral source. I Love whole grains like Quinoa Buckwheat is fantastic aND even whole grain breads as well. So You know it's not necessarily about Restriction I think something too that we should mention is that somebody could have a high degree of insulin resistance aND not necessarily be needing to lose weight aND so there's a difference between lowering the sort of calories that they need to consume versus modifying that macronutrient profile. aND you know I say this with caveats because again like everybody is going to have a different journey. when it comes to diet aND nutrition aND so a lot of people will have come to me aND they've already tried like all of these different things. Ah, different types of very restrictive diets aND so the goal is to really introduce these foods in a way that is sustainable aND enjoyable for these iNDividuals I think I mentioned that I just think is really important to emphasize is Having a like a lower carb intervention should really be. You know it should be a therapeutic intervention. This is not you know a solution for life. We want to do this for six weeks we want to reevaluate insulin at that time aND ideally you're doing this alongside. The insulin sensitizers you know I mentioned berberine that would be 1 of them aND we'll talk about a few later on just to really help move the needle aND so that we can sort of reset the system to become more sensitive to insulin so that they can include. Carbohydrates in a healthy balanced manner in the future.
Jeanette Titus
I Think you made such a good point at the eND there that was actually my next question was is this something that someone with PCOS has to do for life because I think someone would get a little worried like oh do I have to cut out. You know all bread all carbohydrates for life now that I have you know this diagnosis. So I think that's. a hot like a very big misconception I think in that area.
Dr. Samantha Van De Wal
Yeah I agree like people you know patients. Really believe that this especially patients who are new to naturopathic medicine or new to PCOS They like fear that this will be something that they have to incorporate for life or the people who haven't worked with somebody that has expertise. in this area because I've seen you know like I've mentioned there's a history of sort of yo-yo dieting. where this worked aND then they couldn't sustain it aND so then their you know the weight comes back. So yes, it has to be you know.
Victoria Gasparini
here.
Dr. Samantha Van De Wal
It's an intervention. It has to be you know, professionally Led. We want to be looking at outcomes we want to be looking at the the blood markers the Insulin resistance via Blood. There's ways that we can measure it using ah like measurements in terms of. specific areas of the body that can dictate a little bit more of that insulin resistance piece. just to make sure that it it is working so that we can get them off of it I Think that's always sort of the eND goal but also recognizing that for. So.
Jeanette Titus
yeah.
Dr. Samantha Van De Wal
Some iNDividuals there are certain things that certain sort of diet aND lifestyle habits that we do want to replace for sort of the you know the long haul. you know uNDerfueling would be 1 of them right? Protein insufficiency would be 1 of them lack of hydration is another one lack of movement if these are things that have been a part of their life. Historically again, it's our job to help incorporate help that person incorporate them more routinely more regularly so that it can become. Ah, lifestyle change long term for them.
Victoria Gasparini
I Think when patients start to see results. It's easier to to keep those changes right? AND that's where when we do restrictive diets. It's impossible to keep those changes you you can't you physically can't your body won't allow you to but when you.
Dr. Samantha Van De Wal
Yes, yeah. Yeah.
Victoria Gasparini
AND I think you did a great job emphasizing this when you work with a naturopathic doctor versus just getting your information on the internet instead of you know, asking the Starbucks burista to add a scoop of butter to your coffee because you read somewhere that you shouldn't be having any carbohydrates aND that you know bananas are bad for you.
Dr. Samantha Van De Wal
yes, yes, yes.
Victoria Gasparini
You're talking to a professional who's making it so much easier on you to have this sustainable long-term plan aND like you said there might be aspects of it that are shorter term but just to even sit down with a patient hear them out validate their concerns aND then give them a step by step approach I think is. The beauty of our career really.
Dr. Samantha Van De Wal
100% Yeah, we have so much more time with patients to be able to educate them aND I think that is the most important thing that an iNDividual with PCOS will really need. AND we're talking about Significant Insulin resistance in the case of this you know, therapeutic low-carb intervention. But in cases where there's mild to moderate Insulin resistance aND perhaps you know, no need for weight Loss. You know we we can certainly allow for more carbohydrates. It's more of a discussion about like like I I keep saying like.
Victoria Gasparini
Okay.
Dr. Samantha Van De Wal
Properly fueling like I think back to myself aND I've seen so many patients like myself aND clients in the past that were that were like myself where they were skipping breakfast aND they were uNDernourishing entirely aND because of this significant stress load that was implicating their insulin resistance so in that case. Yeah, you know we can talk more about like a balance plate method. You know, choosing to eat carbohydrates with protein aND fats for a better balanced blood sugar. but it's not necessarily you know required for them to limit carbohydrates to let like uNDer 30 or less macronutrient.
Victoria Gasparini
Right.
Dr. Samantha Van De Wal
makeup right? So it is very iNDividualized aND this is really why I want to stress addressing the root cause for each iNDividual who presents with PCOS.
Jeanette Titus
Okay.
Victoria Gasparini
Definitely that makes so much sense. Okay, so it's obvious how effective diet is is there evidence based aND supplements. There is of course you've mentioned berberine by give us a little bit of a backgrouND of berberine aND then any other supplements that you might consider using.
Dr. Samantha Van De Wal
Yeah, yes.
Victoria Gasparini
Ah, for your PUS patients with insulin resistance.
Dr. Samantha Van De Wal
Yeah, so. Berberine is great. Berberine has been studied against Metformin which is that sort of like gold staNDard insulin sensitizeer drug that's used for iNDividuals prediabetes aND diabetes. so it's similar dosing strategy. You're taking about five huNDred Milligrams typically like 2 to 3 times a day with meals aND like I said performs as effectively as metformin in lowering hemoglobin A1c aND insulin resistance the sort of catch with berberine is that you know similar to like a low carb diet this is. Something that you want to use short-term something like six weeks aND then reevaluate because of its effect on the gut. Microbiome I was mentioning how it is beneficial for iNDividuals with perhaps a bacterial overgrowth. Or in cases where we want to modify the gut microbiome because it is antimicrobial in cases where we don't want to modify it or in long-term use then you know berberine might not be the number 1 choice. You really have to again look at the iNDividual. because it's kiND of similar to taking an antibiotic. Right? So it's going to wipe out some of those good guys aND we don't always want that we want a healthy balance of beneficial bacteria in the gut to some of those you know quote unquote less beneficial bacteria. So that's sort of the catch with berberine but you know, really great research in terms of its effectiveness at.
Victoria Gasparini
yeah.
Dr. Samantha Van De Wal
Lowering hemoglobin a OneC aND insulin resistance the one that sort of you know when you google PCOS aND supplements that will always come up is inositol I fiND you know. Many naturopaths are different in in this realm but based on the research that I've looked at aND the anecdotal research in my practice. The best form of inositol is that 40 to 1 ratio of myo-inositol to the D-chiro-inositol.
Victoria Gasparini
Interesting.
Dr. Samantha Van De Wal
I personally have fouND this work better than just mayo aND osottol on its own aND the research will say that too. The research will also say that myo-inositol is also effective. So I don't think 1 is necessarily more right I have just seen it perform better in practice aND when you look at. The demaNDs of an oscitol in PCOS. It's usually the ratio that is you know what? the body is craving more in in terms of the dehyro we need. We need a little bit of that to help support the insulin sensitization. So. Inositol is it's like a b vitamin aND it has you know like I'm saying that insulin sensitizing effect usually comes in the form of a powder but you can get it in capsule form 2 it's very easy to to take aND works really great at helping with if there is some weight loss to. Some weight to lose works great for that works great for lowering testosterone aND for regulating the cycles aND one of the benefits that inositol has actually there's 2 in addition to you know all the things that we're talking about the first one is that it works on ovarian quality. So egg quality. So for iNDividuals especially who are hoping to conceive in the future this is going to help to improve the quality of the eggs. aND also when we do this, we improve the quality of progesterone too. So great for hormone balance aND then the other. Thing is with PCOS we haven't talked about some of the comorbidities but oftentimes anxiety will go haND in haND with PCOS so aND inositol has a nice calming anxiolytic effect as well. So that's really great. some of the other ones that I love to use in practice from a fouNDational perspective are vitamin d aND you guys will see when you run vitamin d 9 times of the 10 people are severely deficient aND that's just based on the range right? I think the range is like 75 to 300 so it's. Huge range we want to see people in like the 21 s one forty s so vitamin d deficiency can certainly worsen insulin resistance aND this is a contributing factor to insulin resistance aND this is why not everybody needs a low carb diet with PCOS right? Sometimes we just need to look at. People's vitamins aND mineral status. really important for the activation of Vitamin D is Magnesium aND Magnesium is also important I talked about this when it comes to like dark leafy greens aND nuts aND seeds in which Magnesium is fouND in but it's important for. The glucose Tolerance factor so regulating glucose aND helping with insulin sensitivity aND similarly too like helps with the anxiety profile of iNDividuals with with PCOS if they are experiencing that too. So I Love those 2 from a more fouNDational perspective.
Victoria Gasparini
here.
Dr. Samantha Van De Wal
Usually people are very deficient in both of them. You can test vitamin d aND you can test magnesium to see where people are at for both of those to help guide you with your dosing strategy for those aND then other mineral minerals that have benefits for glucose metabolism chromium is really good. aND then other. Things that have a have some research for insulin sensitization that I might use depeNDing on the iNDividual are things like omega, 3 fatty acids especially if there's an inflammation type picture then that's really helpful. alpha-lipoic acid is really great aND cinnamon cinnamon is great because you can incorporate that I think the dose is arouND 1 to 6 so it's quite a range of dosing so depeNDing on where they're at in terms of their insulin sensitivity one to six grams per day but you you know it's a culinary herbs. So it's really. Easy to incorporate into like a smoothie or an oatmeal which I love instead of giving somebody. You know another pill to swallow or another supplement to have to pay for aND take so it adds some flavour aND helps with helps with the metabolic profile too.
Victoria Gasparini
definitely I like that most of these supplements are fairly affordable. I know aND inositol can get pricey but it lasts quite a while. So I think for me.
Dr. Samantha Van De Wal
Yeah, yeah, yeah, yeah.
Victoria Gasparini
Jeanette aND I are like the biggest advocates for inositol. We always talk about it. aND it lasts right? So I think that that's a great option aND what I love about most of the supplements you mentioned they cover a lot of the comorbid stuff that comes with PCOS so that depression piece. or that anxiety piece with the anaa. All the vitamin D you know also thyroid right? The vitamin D aND E inositol are also amazing for your thyroid health aND there's a connection between thyroid coNDitions aND PCOS. So you you're kiND of covering a large territory with these supplements too. It's not just that insulin resistance piece which is nice right.
Dr. Samantha Van De Wal
Yes, a huNDred percent yeah aND that's that's one of the reasons why I love the 3 that you've mentioned in particular aND then especially the vitamin d aND magnesium aND even the omegas. in the pos repair plan program that I created I do suggest a fouNDational sort of supplement routine aND you know some of the ones that we've listed today are in there just to cover the basis make sure that they're really set up for. Success in terms of hormonal regulation aND mood aND cycle regularity too. So yeah, they're like you said affordable they cover a lot of grouNDs Very you know uNDervalued I think in terms of their use.
Victoria Gasparini
Yeah.
Dr. Samantha Van De Wal
an important distinction too with magnesiums. You guys know there's a different. There's a lot of different varieties on the market. So for those listening you know the one that I typically will recommeND for iNDividuals with PCOS alone is the magnesium glycinate. It's great for anxiety. It's great for stress. It's great for insulin sensitization. But. Magnesium citrate is another good one aND there's a few other really good ones I would say those are sort of the 2 that are the best in terms of affordability aND absorbability for the symptoms that we're talking about today. Yeah.
Victoria Gasparini
okay, good to know.
Jeanette Titus
Okay, amazing. so next we're going to do a little bit of a rapid fire So we have some myths here that kiND of surrouND the realm of PCOS So we're just going to get into them aND then we can do a quick rapid fire here. So the first one I have.
Dr. Samantha Van De Wal
Perfect.
Jeanette Titus
The first one I have here is you have to go gluten aND dairy free with PCOS ah.
Dr. Samantha Van De Wal
Meth.
Victoria Gasparini
Tell us why just quickly aND.
Dr. Samantha Van De Wal
Ah, okay I actually had this conversation with the patient last week because she she had seen it a naturopath prior to me. Ah, couple years. This is not going to be quick. It's going to be longer than we expected but she had seen an naturopath before me like a year or 2 prior aND we were talking about diet aND we were actually talking about like protein sufficiency aND she said okay well what about gluten free like I was gluten aND dairy free in the past aND it worked really well aND I said well do you think it was.
Victoria Gasparini
That's okay.
Dr. Samantha Van De Wal
Because you took out the gluten or because you took out a lot of gluten-containing foods that are also highly refined carbohydrates aND you replaced them with probably fruits aND vegetables aND nuts aND seeds aND she really thought about it aND she was like I think it was the latter. AND so this is why that education piece is so so important there are instances where a Gluten-free Diet. You know can be aND should be implemented. Ah again like either therapeutic trial. or you know depeNDing on the iNDividual right. AND what's coming up for them. But as a gold staNDard of care that is a myth.
Victoria Gasparini
Okay I think patients will be happy to hear that. okay, the next one so this is specific to patients who they like to run they like to do higher intensity exercise the myth or the truth you got to tell us you cannot do any high intensity. Exercise with PCOS.
Dr. Samantha Van De Wal
Okay, this is a myth with like a caveat. so in instances where there is severe Insulin resistance high intensity Interval training can be effective at modifying it. I would say the caveat is when you know a patient presents with extreme levels of stress. They're uNDernourished they you know are very anxious, irritable. then I would say we need to work on putting that person into a better. Place in terms of like the HPA axis aND helping them to just really calm their nervous system a little bit before incorporating something like that. So you know I've talked about HIIT training on my social media before aND that's sort of the caveat like the literature supports it. For modifying weight for modifying insulin resistance. But it's a stressor. So I you know this is where I think the term evidence informed I I Really love it because I want to look at the data I Want to look at the evidence but I want to look at the person in front of me. So if somebody's severely stressed aND you know what the the way that I.
Victoria Gasparini
Right.
Dr. Samantha Van De Wal
Ah, determine this is I ask them? How do you feel after you do a HIIT workout. How do you feel the next day or right after aND that will tell you exactly what needs to be done if they feel really good like immediately after aND the day after then you're probably okay with it aND there's also ways that we can assess for cortisol too. Like serum testing urine testing which is sort of another conversation. But that's why there's a little bit of a nuanced there.
Jeanette Titus
Such an important point because I feel like everything gets so blown up in social media. So I was I'm happy that you were able to debunk that here the next one here. we could do a whole episode on this. But.
Dr. Samantha Van De Wal
Yeah, yeah.
Jeanette Titus
Someone's quote Unquote Unhealthy diet caused their PCOS.
Dr. Samantha Van De Wal
Oh yeah, myth but I would say like a caveat to right because first of all like what is unhealthy like we need to define that that's a sort of interesting nomenclature in aND of itself. That being said, you know a staNDard american diet if. That's what an iNDividual has consumed their entire life then I would say they're probably at a higher risk for turning that PCOS switch on but then so like you know, similarly modifying the diet to incorporate you know more of an anti-inflammatory. Whole foods based diet most of the time will probably likely you know switch the flip off or did I say that right flip the switch off. so you know the thing is is we've talked about that in today's podcast that there's so many things that that can also contribute to the diagnosis. You know. Internal Stressors external stressors but diet it. It does play a big role in the sense that you know it's going to also contribute to that internal stressor right? So with a staNDard American Diet. It's going to modify that gut. Microbiome. To a degree where that could contribute to some of that PCOS diagnosis that we're seeing so hope that helps.
Victoria Gasparini
Ok, so basically we sock at Rapid fire aND it depeNDs it just depeNDs on the person. Yeah.
Dr. Samantha Van De Wal
Oh these things are so nuanced right? like there's yeah it it really depeNDs aND it's it just I don't want anybody to think like oh my gosh like I caused my PCOS That's not that's the takeaway that I think I'm trying to articulate.
Victoria Gasparini
right? who.
Jeanette Titus
Yeah.
Dr. Samantha Van De Wal
But we know that you know there are going to be foods when consumed more regularly that could contribute to some of this metabolic dysfunction that's contributing to the symptoms.
Victoria Gasparini
Right? AND aND you know what I think at the eND of the day. It's empowering to know that because then you know that you can make changes aND you can see you know the outcomes Change. So I think that that's a good thing actually on what is. Ah, one myth so we eND every episode with this question. What is one myth that you want to bust in the PCOS Wellness space once aND for all.
Dr. Samantha Van De Wal
Okay, many but I would say the one is that PCOS is an infertility diagnosis. That's the biggest one aND if anybody is listening aND they have been diagnosed with PCOS aND they thought to themselves like oh my gosh like I'm never going to be able to have children you know, please leave this episode with hope.
Victoria Gasparini
Yeah,
Dr. Samantha Van De Wal
That you will because when we start regulating the cycle aND when we start working on Ovarian function improving egg quality really like magic happens aND so a lot of the things that we talked about like I'll say like you know there's Nuance. There's nuance aND aND that's. It's because it's really an iNDividualized approach aND once we figure out how to work with you work with your body work with the needs that you require then like I said magic happens so leave with that leave with hope aND yeah, the uNDerstaNDing that it is not an infertility. Sentence.
Victoria Gasparini
yeah, aND you are like actual living proof of that right with your new little one. Yeah.
Dr. Samantha Van De Wal
It's It's been Yeah, it's been beautiful. Yes, absolutely I'm I'm truly blessed aND I hope you know I look at her aND I'm like you know you are my you're in my purpose now right? like because of you I'm able to to talk about this aND show that. You know it's possible.
Jeanette Titus
That's so amazing. That's so awesome to hear. Well we we want to thank you. So so much for being on the podcast with us today. We're so grateful to have you on aND all of your expertise.
Dr. Samantha Van De Wal
Oh thanks ladies.
Jeanette Titus
where can our listeners fiND you aND how can they book with you All of that.
Dr. Samantha Van De Wal
Thank you so much for having me ladies. they can fiND me at Instagram I'm at Dr Samantha Van de wall or you could fiND me at my website Samantha Van Dewal Dot Com those are the 2 best places. to fiND me aND from there. There's ways that you can email me personally or just always seND me a dm there's also a booking button on my website page aND a link to book on my Instagram too.
Victoria Gasparini
Amazing aND you do have a new plan ebook coming out right? This spring. Okay.
Dr. Samantha Van De Wal
Yes, yes, so I had an ebook a long time ago aND I've sort of like built from that now based on you know all the clients aND patients that I've seen it is sort of like ah a little mini. PCOS repair plan but in ebook form so it'll highlight a lot of the things that we talk about in my twelve week program but obviously it's just an ebook so it's not going to be guided or anything. But if you want some of the more detailed. You know responses to a lot of the things that we talked about today too. It'll include that which is really exciting I'm excited for that to be launched I've been working away at it my when my daughter is napping which she's not always good at doing so.
Jeanette Titus
Yeah, okay, great aND we'll put all of this in the show notes too. So people can fiND that very easily thank you.
Victoria Gasparini
AND aND.
Dr. Samantha Van De Wal
That's great. Thank you so much to both of you.
Victoria Gasparini
Thank you.
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Dr. Samantha Van De Wal is a naturopathic doctor with a special interest in PCOS fertility aND preconception prior to becoming a naturopathic doctor. Dr. Van de was worked as a secondary school teacher during her professional career as a teacher. She became introduced to naturopathic medicine falling in love with this model of care. She decided to complete her holistic nutrition Diploma at The Institute of Holistic Nutrition while simultaneously continuing to work as a teacher and completing her master's degree too. She then decided to pursue naturopathic medical school while completing her training. She worked closely with women with PCOS ultimately creating the PCOS Repair Plan- A twelve week program that digs deep into women's unique root causes of their PCOS with practical evidence-informed approaches to help them reverse their symptoms with accountability and community. In May 2022, Dr. Van de was graduated with her doctor of natutropathy degree from the Canadian College of Naturopathic Medicine, and now works with patients one on 1 in her virtual clinic. In addition to her program. She is also the creator of the PCOS kickstar blueprint ebook the 4 pillar success system to manage PCOS symptoms for good. Dr. Van De Wal is an active ND in good standing member of the college of natropaths of Ontario, Ontario Association Of Naturopathic Doctors, and canadian association of natutropathic doctors.