Transcript EP 284 – PCOS & Infertility: Debunking Myths & Managing Hormone Imbalance with Registered Dietitian Nutritionist Cory Ruth
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Dr. Taz: Welcome back everyone, and welcome back to another episode of Super Woman Wellness, where we’re determined to bring you back to your super powered self. And we’re about to break down a topic that you guys probably already know is near and dear to my heart. In fact, it’s the very reason that I veered off from emergency medicine and critical care medicine and peds into the world of integrative and holistic medicine.
Dr. Taz: So you probably guessed it, but I brought on an expert in PCOS, or polycystic ovarian syndrome. I want you guys to meet Cory Ruth. She’s a registered dietician and nutritionist, a women’s health and PCOS expert, and the CEO of The Women’s Dietician. She built her wildly successful brand through social media by supporting women who suffer from polycystic ovarian syndrome.
Dr. Taz: Cory started her journey after years of suffering from her own PCOS diagnosis without any relief, and she also, sick of the one size fits all recovery options, decided to flip the script and dedicated her career to this complex condition.
Dr. Taz: Now, she empowers women to take back control of their reproductive and hormonal health through science-backed research, individualized nutrition and lifestyle changes, and along with her online program and supplement brand, Vita-PCOS, that treats the root cause of this disease’s debilitating symptoms. Welcome to the show, Cory.
Cory Ruth: Thank you so much for having me. I’m excited to get started.
Dr. Taz: Yeah. So, what’s going on? All right. I got to tell you, in practice I diagnose more and more and more PCOS with every passing year. And I know I’m liberal with my diagnosis because I actually think it’s a metabolic and physiologic issue, not a hormone issue, but it continues to be swept under the rug.
Dr. Taz: And that’s my story. These guys have heard it. I spent a solid five years being a different version of who I am with this diagnosis and all the symptoms. But tell us what’s going on in the landscape of PCOS. What’s happening from your perspective and how did you even get into this whole journey?
Cory Ruth: Yeah. So well, I’ll start from where I decided to get into this field. First of all, when I started my private practice, I thought the only thing that I’m not going to touch with a 30 foot pole is PCOS because it’s way too complicated, there’s way too much going on, and here I am.
Cory Ruth: So I think just having PCOS myself and understanding what a lack of care there is out there available for us, was something that helped me identify that there’s a need, right? And being a dietician already and knowing the ins and outs of nutrition and the power of it when it comes to helping to support something like PCOS, and blood sugar regulation, insulin resistance, all of that swirling together I think allowed me to step into the space really easily. And so I’ve been doing it for several years. I opened my practice at the end of 2018.
Dr. Taz: Gotcha.
Cory Ruth: Yeah.
Dr. Taz: Well, in your perspective, what other story… I mean, I can share a couple of mine that I’m still hearing. Because, remember my journey started 20… How old am I? 50. But my journey started almost 23, 24 years ago, right?
Dr. Taz: So even though so much time has gone by, I don’t feel like the needle has shifted from what I’m hearing from patients. What are you hearing from your clients in terms of the time to diagnosis and the management of symptoms, the success in that scenario?
Cory Ruth: Yeah, it’s all over the board. A lot of complaints about needing to get multiple opinions on whether or not they have PCOS. There’s also this mild PCOS title floating around, when I guess maybe they’re not meeting all of the criteria and doctors aren’t really sure where to place that particular patient. But again, I think just overall, just a big sense of frustration with the time and the energy it takes just to get the diagnosis.
Dr. Taz: Yeah.
Cory Ruth: And then all that, and then we’re told, “Take birth control, or lose weight, or come back when you want to get pregnant.”
Dr. Taz: Yes.
Cory Ruth: So frustrating.
Dr. Taz: It’s really frustrating. And the biggest part of what you just said that I think is so wrong, and I hope everybody out there listening will spread this message, PCOS is not a disease of fertility. It’s not just about getting pregnant and how easily you can get pregnant. PCOS is actually an adolescent disease. It is a disease of your twenties. It’s a disease in your thirties.
Dr. Taz: It is a perimenopausal issue. It’s even a menopausal issue. And our family is testament to that with a 70 plus mom, all the way down to my youngest sister who… Actually, no, we should go further, all the way down. My youngest sister’s actually just turned 30. And then my daughter is 14. You see it run through each and every one of us with different presentations and different manifestations.
Dr. Taz: And so it really irks me when people refer to it as just something you have to worry about because you’re trying to get pregnant. So and then, one of the things that the American Society of Endocrinology impressively enough came out with, and I think the year was 2018 or 2019. I’m not 100% sure. But they talked about how this is actually a metabolic issue, and it’s just named wrong.
Dr. Taz: And so when we start thinking about it that way, a lot of the work you do becomes really relevant. So why do you think… What’s happening there? Why is nutrition, stress, lifestyle, genetics… What’s happening in that soup, so to speak, that triggers the expression of PCOS?
Cory Ruth: Yeah. Oh gosh, I wish I had a more clear answer. In my opinion it’s bodies are changing, and they’ve been changing for decades. And I think that can play a role, and there is a weight component. There can be. Not always, but there can be. So we see that coming into play sometimes. And then, I think there’s a big adrenal and stress component and sensitivities to different stressors.
Cory Ruth: Especially since I feel like things have also been exploding since the pandemic has happened and more people are stressed out and feeling the effects of that stress. And also diet, our diet has changed a lot over the last… It keeps changing. But the heavier reliance on convenience and that’s a huge part of our lives just because we’re all so busy.
Cory Ruth: And not getting the nutrients that we need and relying on… Just getting more carbohydrates overall and our blood sugar being impacted by that. So I think there’s a lot of different moving parts, but those are some things that I can see that are clear areas for me to target as far as someone who works in dietetics and nutrition.
Cory Ruth: So how can I help them change their diet to better optimize their blood sugar function or regulation. And we often see… We make really good strides just changing dietary patterns alone, adding in some exercise. We’re more sedentary than ever, so adding in some movements, some stress reduction techniques.
Cory Ruth: It’s not rocket science, but once you drill it down and help somebody understand and see where they need to go in terms of some of those changes, dietary lifestyle, we see really big improvements in PCOS and getting ovulation back on track.
Cory Ruth: That’s a huge one. That’s one that a lot of women with PCOS struggle with, right? Irregular periods. But also some of the other things that come along with elevated androgens. So facial and body hair growth, acne. Those types of things can all be helped from a dietary standpoint too.
Dr. Taz: So we both know that PCOS isn’t really a one size fits all type deal, right? But would you agree that the central tenant is really insulin regulation? Is that really the unifier with all the different patterns? At least that’s what my experience has been. Would you agree based on your experience?
Cory Ruth: Yeah. And I think someone doesn’t have to have the classic insulin resistance PCOS to still benefit. Blood sugar regulation from a dietary standpoint.
Dr. Taz: Yeah. And that’s such a great point because I’ll say the words, insulin resistance, but an A1C will look okay, or a fasting insulin level would look okay, but there’s still a blood sugar issue that you can sometimes pick up maybe on a glucometer, or you can even pick up on more detailed lab work like fructosamine and some of these other numbers that will reveal it. So if we think about it that way around blood sugar, what are the most impactful dietary changes? And I want to pick your brain about keto too, but what are the most impactful dietary changes you’ve seen successful for PCOS?
Cory Ruth: Yeah. So I’ll start here, there’s a lot of buzz about taking out gluten and dairy, and some people find that really helpful. But what I see is when people take gluten and dairy out, they eat a healthier diet overall. They’re eating less processed carbohydrates, they’re eating out less, which means lower caloric intake.
Cory Ruth: They’re eating less sweets, dairy, gluten in a lot of our pastries or ice creams, things like that. So we see improvements just from doing that in my opinion, not taking out the gluten and dairy alone, but the effects of what their diet looks like post taking out, post elimination. So you’ll hear a lot about that, but it’s not essential from what I found.
Cory Ruth: I’ve treated thousands of women with PCOS at this point, and they’re all still eating gluten and dairy in moderation. So in my practice, in my experience, that’s not essential. But what is essential, what I do find to be the most helpful is really focusing on protein and fiber and fats. And not to say we cannot eat carbohydrates, that’s not what that means.
Cory Ruth: But we’re just lowering the amount of carbs that we’re doing. If we think about it, if we go out to an Italian restaurant, we go get breadsticks served to us before we get our meal, we have a salad with croutons, we have pasta. So that’s carb, carb, carb. We have a drink, maybe that’s another carb. Then we have dessert, that’s a carb.
Cory Ruth: So we’re taking in a lot more carbohydrates than we might really realize. So focusing on paring those down and really making sure we’re upping our protein, our fat, our fiber. Fiber’s really important too. I find that to be incredibly effective when it comes to this blood sugar balance piece to PCOS.
Dr. Taz: So is there some structure and some rules we can give folks listening? Do you tell them to eat every three or four hours? Do you give them a serving size? Some people like macros and numbers, some people get really overwhelmed by that.
Cory Ruth: I know.
Dr. Taz: What is a little bit of the structure they could start to put in place if they’re listening today and they’re ready to make some changes?
Cory Ruth: Yeah. So it can vary per person, obviously, depending on what their needs are. But generally speaking, I like to recommend three meals per day, three smaller meals and two protein rich snacks. So if we’re looking down at our plate… We teach the plate method. So if we’re looking down at our plate, we want half the food on that plate to be low starch vegetables.
Cory Ruth: So when I say low starch, I’m not talking so much about potatoes, sweet potatoes, corn, winter squash, those starchier vegetables. I’m talking about things like, think about your greens, right? Your broccoli, your green beans, your Brussels sprouts. But also your peppers, mushrooms, carrots, eggplant.
Cory Ruth: So think beyond your greens. So those low starch vegetables are taking up about half the food on your plate. They’re high in fiber, they’re high in antioxidants, they’re high in anti-inflammatories, so they’re the star of the show. And I guarantee you, if you go out to a restaurant, it’s not going to be common that you’ll find plates put together like this.
Cory Ruth: So cooking the majority of your meals and snacks at home is something that I always teach in my practice. So we’ve got half that plate of low starch vegetables. Then we have about a quarter of that plate as a source of protein. And protein can kind of range, typically I’ll recommend about a four ounce protein size.
Cory Ruth: And you can do plant based. You can do tofu. You could do beans, lentils. You could do meat or fish or eggs, whatever sounds good to you. And then you want to have one serving of carb. So when I say one serving, it… The portion size can change. But I typically recommend something like a grain, it would be about a quarter cup cooked. And that’s a lot smaller than what we’re used to and a lot smaller than what we get served at a restaurant.
Cory Ruth: But remember, we’re really mindful of blood sugar right now. So we have that carb piece in. And the reason why I like to leave carbs on the plate, even if it’s a smaller amount, is because when we try to exclude carbs 100%, and we go really hardcore, it’s really hard to sustain that. And PCOS is something that we can’t just focus on and then back off. Our symptoms are going to come back with a vengeance.
Cory Ruth: So it’s something that we have to continuously work on. It’s a learning process. It’s a journey, I always say. So trying to get that carb in, in a way that is helpful when pairing it with a protein, pairing it with fiber, it’s all going to help to minimize the potential impact that it has on our blood sugar.
Cory Ruth: So when it comes to that carb, if you can make it complex, great. That’s not the reality all the time, every time, but that would be the difference between white rice and brown rice, right? We pick that more fiber full carbohydrate that’s better for blood sugar and insulin. And then we have our fat on our plate somewhere.
Cory Ruth: Typically, fats are easier to get than like a… We don’t have to try very hard to get our fat on our plate. A lot of times it’s cooked into our food, right? Like if we’re sauteing our food in olive oil, it’s there. So get that fat in there, but don’t feel like you have… Especially if you’re working on the weight management piece, don’t feel like you have to add a bunch of additional fats because a little goes a long way with those fats.
Dr. Taz: You mentioned non-starchy vegetables, what are some of the starchy vegetables that we could be getting fooled by thinking we’re doing vegetables, but they’re actually impacting our blood sugar?
Cory Ruth: Yeah. So potatoes, big one, sweet potatoes, peas and corn and winter squash is what I practice. So winter squash would be… I always say you can use the fingernail test. So if you could take your fingernail and scratch the skin off like a zucchini, it would not be starchy. It would be something like a low starch summer squash. But if you tried to do that to a butternut squash. Good luck. You’re not going to puncture it. So that’s what we consider to be starchier. That’s a good rule of thumb.
Dr. Taz: Awesome. And then what are your favorite… Well, two questions. What are your favorite complex carbohydrates? Because people hear that all the time and I think they get confused. So give us maybe a few examples of those. And then the follow-up question would be, all us are busy, this is Super Woman Wellness, we’re running around. What are your favorite protein snacks? People ask me that one all the time.
Cory Ruth: Yeah. So complex carbs could be like a brown rice, a cooked quinoa would be a good one, millet, amaranth, any of those grains. You could do a whole grain bread, whole grain crackers. You could do one of those high starch vegetables, which could be your complex carb. So if you wanted to do the potato, then have that as your carb instead of your vegetable. So those are a couple examples. What was the other one? Oh, protein rich snacks.
Dr. Taz: Protein rich snacks. Yeah.
Cory Ruth: Yeah. Yeah. So snacks are one of those things, we want to make it easy on ourselves, right? If we’re already cooking for breakfast and we’ve got dishes in the sink… We’re cooking. We’re prepping for lunch and dinner. Make it easy on yourself. Don’t feel like you have to cook something separate for a snack.
Cory Ruth: Protein rich snacks, you could do Greek yogurt. That’s a great one. You do plain unsweetened Greek yogurt, add some berries, some peanut butter, some flax or chia. That’s a really good snack. And there’s a lot of protein in Greek yogurt. You could do hard boiled eggs. That’s another really easy, quick source. You could prep those ahead of time.
Cory Ruth: You could do edamame, steam it with a little sea salt. You could do a cheese stick. You could do some grilled chicken wrapped in… Sometimes I’ll do a sliced deli turkey and wrap it into a spear of cucumber or red pepper. That’s an easy thing to put together. Protein bars, there’s a million, billion out there. But there are some that I like to recommend as far as quick, easy protein .
Dr. Taz: So I’m going to poke. What are your… Because I’m thinking about my daughter too, at the same time. What are your favorite protein bars? And she’s playing sports all the time, so she could carry a protein bar. She could do the little turkey sandwich of some kind, she could do… She can’t do a lot of nut stuff because there’s so much sensitivity amongst kids with nuts and stuff like that. What else would you recommend her doing?
Cory Ruth: So besides a protein bar or what ?
Dr. Taz: Yeah. And well, what are your favorite protein bars and what else would you… What other non-nut ways can she get that protein in?
Cory Ruth: Yeah. So protein bars, I’m trying to think of non-nut protein bars too. That’s tough. I would’ve to-.
Dr. Taz: It’s hard. I know.
Cory Ruth: RX bars, they are awesome. They are made with egg whites. So they’re a really clean source of protein. You’re not getting into the isolates and all those things. So RX bar or Gain has some great ones. Love Good Fats is another favorite macro bar, Epic. They usually make meat ones. So like a chomp.. if she eats meat, chomp stick, like an Epic Bar. There’s bison, venison, and they’re really clean ingredients, high protein, so boom done.
Dr. Taz: Gotcha.
Cory Ruth: Yeah, those are really good. There’s something that I discovered recently called Bada Bean Bada Boom. And they’re actually roasted faba beans, and it sounds weird, but they have like 20 different flavors that are amazing. And they’re crunchy, so you get that chew, they’re individually wrapped, so you’re not going to overdo it on the portion. And they’re high in protein and high in fiber. So you’re not going to be spiking any blood sugar while you’re in between meals. You’re really keeping things steady Eddie, which is why I like protein rich snacks. And I’m not a huge fan of intermittent fasting for women with PCOS.
Dr. Taz: Yeah, I tried… I like intermittent fasting every now and then, but honestly it didn’t work. I think what really works, I actually protein load in the morning, almost 25 to 30 grams and that’ll keep me stable for a while before I get hungry again. And the days I don’t get that I definitely feel like my blood sugar is all over the place for sure. You know? So I have to ask you because I think I’ve had somebody on, I can’t remember, but I think I’ve had somebody on who was a big advocate of keto for something like PCOS. What’s your thought there?
Cory Ruth: Yeah. So same thing with removing carbs. The reason why we… We do have some research, right? That says keto can be helpful for women at PCOS. The problem with some of those studies is that they were barely completed by any of the participants because it is so restrictive. There was a small sample size. Most of them didn’t complete it, and it is really hard. It’s really hard from an everyday typical person standpoint to adhere to that restrictive of a diet.
Cory Ruth: And like I mentioned, PCOS is something we have to keep going with as far as management. So I’d rather have somebody use something or go for something that’s more sustainable and not have to get on and off the diet trend train.
Cory Ruth: So, and also with keto a lot of times… And there’s different forms of keto. People have argued with me about that, and that’s true. But classic keto, you’re very low in fiber, and fiber is so important for blood sugar management, obviously digestion, but we really… We want to be getting that fiber and we want to be getting in those foods that give us that fiber because a lot of the time those foods are packed with antioxidants, anti-inflammatories, different phytonutrients that are all helpful from a hormonal and PCOS standpoint. So that’s… I tend not to get into keto in my practice.
Dr. Taz: Gotcha. And we talk a lot about diet, and how it links back up to hormonal imbalances. One of the biggest connections between your diet and hormone imbalances is again the insulin component, and then the androgens and how the androgens spike in relationship to what blood sugar is doing. How can women identify that they’re having hormone symptoms that may be specific to PCOS? Is there something that they can look for?
Cory Ruth: Yeah. So if someone is experiencing irregular periods, and when I say that, I think a lot of women think that they… Their period just goes missing, and it’s gone. And that’s true for a lot of women with PCOS, but there’s no clear PCOS period pattern. Some people can go months and months and months without having any bleeding. Some people are bleeders. They’ll bleed all the time. They’ll spot intermittently. They’ll have random periods here and there. And some people will just ovulate irregularly versus not at all.
Cory Ruth: So, there’s different patterns. If you’re not having a normal period, every… Whatever we define as 21 to 35 days, I would definitely consider PCOS for sure, to get that looked into. There’s other reasons that they can cause that, but…
Cory Ruth: And then those androgen excess symptoms. So that would be facial and body hair growth, hair loss on the head, your hair thinning, hair shedding, and then acne. And then a lot of complaints from client patients about fatigue. This is not part of the diagnostic criteria, but we just see that a lot. We see a lot of fatigue, cravings. We see a lot of mood issues and that all make sense, if our hormones are all over place, we’re not ovulating, everything’s in disarray.
Cory Ruth: So we can see that a lot. So pay attention to those things. You can also obviously get lab work done and get things tested, get a pelvic ultrasound to see if you have polycystic ovaries. Pain is not a symptom of PCOS. That’s a huge misunderstanding in the PCOS world. You can have ovarian cysts that can rupture and cause pain. But the cysts that are on our ovaries are just basically tiny immature underdeveloped phone calls. So they’re not going to be causing you persistent pain. So I think that’s something that women get a lot of… There’s a lot of confusion around that too.
Dr. Taz: And I think I would add you don’t have to have cysts to have polycystic ovarian syndrome. So many people think, “Well, I don’t have cysts. I had an ultrasound.” I’m like, well, it’s, again, metabolic. It’s more looking at all these other patterns that you have to pay attention to. Let’s take just a couple minutes to talk about your program. You’ve gotten folks pregnant. You’ve helped them reverse PCOS or at least manage it more efficiently. What’s worked? And tell us a little bit about what you’re doing.
Cory Ruth: Yeah. So my program Get Pregnant with PCOS, I’ve been running that about probably several times a year since 2019. And that program is specifically focused around fertility. PCOS is the leading cause of infertility. So really addressing… And the reason why is because of that ovulation piece. So it’s helping women to mitigate their symptoms when it comes to PCOS and also to maintain consistent regular ovulation and get pregnant. So one of my favorite parts about that program is the cycle tracking piece. So if we think about the education that we’re given, at least here in the US, when it comes to our periods when we’re younger, it’s pretty minimal. And a lot of us don’t even remember what the heck it is by the time we are ready to conceive, and we get off birth control, and then we discover I have no period, or I have PCOS.
Cory Ruth: So it really helps them to understand, what is my fertile window? When is actually… Because we can’t get pregnant every day of the month or every day of our cycle. So when is that time to have intercourse and optimize that so that conception can happen. So it’s focusing on dietary changes when it comes to fertility and PCOS. There’s pieces on what foods may be more helpful when it comes to ovulation and egg quality, there’s a sperm health section. So it’s everything. It’s the dietary piece when it comes to balancing blood sugar, introducing… There’s no magic superfood that can get someone pregnant, but overall optimizing dietary patterns for better fertility with PCOS so the dietary component and then also the exercise and movement piece. That’s huge.
Cory Ruth: A lot of us are really sedentary. We get really gung ho about a hardcore workout program. We get burnt out and then we stop. I see that all the time. So it’s helping women to discover what is a sustainable movement routine that’s supportive of PCOS about blood sugar, my adrenals. So it’s helping them to develop that plan, something maintainable. There’s a digestion piece, there’s a stress piece, there’s sleep, gut health, and then there’s also libido section, which I like to throw in there too. It’s always helpful and fun to add that in there. So it’s really a comprehensive program, and it’s been super, super successful. It’s my little baby. And then I have my PCOS Boss Academy, which is focused specifically on PCOS symptom mastery and weight loss.
Cory Ruth: So there’s a big weight loss need in the PCOS community because a lot of us, when we want to lose weight, we’re just given the eat less, move more advice. Helpful, but only to a certain degree. We need more, we need to understand how to eat, how to eat while also paying attention to our blood sugar because there’s definitely healthy and not healthy ways to lose weight and that can impact our PCOS. So it’s really giving women a customized, individualized prescription.
Cory Ruth: And I help them to create certain calculations. I help them learn how to track their… First of all, figure out their macros. How many calories do I need? How do I track that to make sure that I’m on track? How do I eyeball and visualize what needs to be on my plate? How do I create my breakfast, lunch, dinner, and my protein rich snacks?
Cory Ruth: So giving them that customized plan, I have the movement component in there, gut health, digestion. I do have a cycle tracking piece that isn’t related to fertility, but helping women understand what’s happening with my cycle, and to start ovulating, even if fertility is not on the radar. So it’s a really wonderful program too. And I’ve been running that one for a couple years and it’s been super successful as well.
Dr. Taz: Wonderful. Well, so glad that you’re out there spreading the message and offering women tools for support and health. Again, I continue to maintain, this is one of the most gaslit women’s health issues that I see over and over again in practice. And unfortunately the dialogue and the discourse, I think conventionally or traditionally still hasn’t changed that dramatically. There’s some early discussions, and we get encouraged by things like reports from the Society of Endocrinology, but the actual practice and delivery of that still has a long way to go.
Dr. Taz: So grateful that the world has resources that they can turn to and get answers because I know for me, it was an absolute struggle. So thank you so much for reaching out today and sharing some of your wisdom and expertise with us. We appreciate it so much. If folks listening or watching want to get a hold of you, what’s the best way for them to do that?
Cory Ruth: Yeah. So probably I’m mostly on Instagram. That’s the platform that I’m on the most. It’s TheWomensDietitian, that’s my handle.
Dr. Taz: Awesome.
Cory Ruth: And that’s the same all around. So TikTok, same thing, my website, www.thewomensdietitian.com. And you can find me there, and I’m happy to chat with you. Send me a message, send me an email, and we can talk about what the direction might be for you to go, if you’re looking for PCOS care.
Dr. Taz: Wonderful. Well, thank you again, and thank you everybody for watching and listening to this episode of Super Woman Wellness, remember to rate and review it and share it with your friends. And I will see you guys next time.