Shireen: Podcasting from Dallas, Texas. I am Shireen, and this is a Yumlish podcast. Yumlish is working to empower you, to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

In today's episode, we welcome back Sue Ellen Anderson Haynes to our podcast. September is P C O S Awareness Month, and we will be talking to Sue Ellen about some of the health problems associated with P C O S, how to manage it better, and what size of symptoms to look for so that you can talk to your healthcare provider about P C O S.

Sue Ellen is a registered dietician of over 14 years in a certified diabetes care and education specialist. She's the founder and CEO of 360 Girls and Women, a holistic wellness company for girls and women, and the co-founder of cultured at iamcultured.com, a digital healthcare app that connects registered dieticians to clients based on cultural alignment.

Welcome, Sue Ellen. 

Sue-Ellen: Thank you for having me today. I really appreciate. 

 Shireen: Absolutely. I think my first question should not be about your background, but it should be how are you managing, doing so many things ? 

 Sue-Ellen: Ah, well, it's just taking it step by step, day by day. But I've worked in the field for over 14 years, as you mentioned, and I spent a lot of my time with a variety of clients, but more specifically girls and women.

And my patients come to me seeking all types of concerns, anywhere from period pain to pain in their. In addition, I see a lot of girls and women with hormonal imbalances, such as those with fibroids, P C O S, chronic illnesses such as gestational diabetes, type two diabetes, hypertension, and so on.

So that is where I spend the majority of my work and my background just came from just experiencing and learning in different fields as I transitioned from different types of healthcare. I was into nursing and I transitioned to nutrition. So I have wealth of information and I wanna give back in this, help these, these women in these girls.

So that's my background in a nutshell. 

Shireen: Lovely. And for our conversation here today, we're largely looking at talking about P C O. As we know, September is PCOS Awareness Month in particular, looking to understand a little bit more about P C O S. So, according to the  CDC, P C O S affects nearly 5 million women in the United States alone.

It's a huge problem. Some of the health problems that can develop are diabetes, it's related to heart disease, sleep apnea, stroke, goodness. One, why doesn't P C O S get enough attention? And how are all of these sort of chronic diseases related?

Sue-Ellen: This is a great question about the P C O S and its prevalence.

This P C O S is a common hormonal disorder, and it affects not only the reproductive system, but the entire body. But how do we put this 5 million people into perspective? This would be like fill in the largest NFL stadium at full expanded capacity 50 times. And as we know, P C O S has many underlying concerns, which of today will discuss more so, insulin resistance.

 Shireen: Thank you for sharing that. And so help us understand how these different disease states are, are related, Sue-Ellen. Like why why are they related, Why is PCOS related to something like diabetes or heart disease? Like what, what I guess connects it.

 Sue-Ellen: Right. So P C O S, the majority of P C O S is driven by insulin resistance and insulin resistance.

In order to talk a little bit about insulin resistance, we wanna know what insulin is. So insulin is a hormone that helps us reduce our blood sugar. So basically, for example, when you eat a meal, let's say a sandwich, right? The body converts the carbohydrates to sugar or glucose and insulin move moves the sugar, from our bloodstream into our cells. Like our brain cells, our hearts, our red blood cells, and it fuels our body and provides energy.

So women with insulin resistance often have sugar cravings, brain fog, fatigue, weight management issues, and this ties into the type two diabetes issue and it ties into the heart disease. So if you are constantly, fatigued, you won't be able to exercise much in your weight typically, may be, you know, at a higher level for, for some woman with P C O S, and if you're having brain fog, this is related to the blood sugar staying in the bloodstream.

Your cells are not getting that energy that it needs. So you're constantly hungry, you're constantly eating, you're tired, and so your entire metabolism is being affected by P C O S. It's not just a reproductive issue issue, it's a metabolic issue. That's where the type two diabetes and the heart disease plays in in, in the role.

Shireen: Now, although it is not clear why women get P C O S, there are treatments available to ease the pain, can you talk about some of those treatments? 

Sue-Ellen: Right. So in terms of, you know, treatment is concerned as a registered dietician, I'm gonna focus a little bit more on the diet part of it. I don't really recommend medications and things of that, so there are probably some, probably remedies we could talk about later. But there's some risk factors for P C O S, which are, you know, type one, type two gestational, and in terms of getting medications, we have to look at the entire person because this person can come from a state of P C O S and type one, and they may be on a, a specific medication that you can't give one to the other.

So speaking with their healthcare provider is really important. It's a team approach. But let, getting back to the nutrition piece of things because I am a holistic women's health registered dietician, my approach is a little different. So I use nutrition as the foundation in my programs to address reproductive illnesses and chronic diseases, and I use integrative or functional means.

So basically what this means is, A lot of , A lot of patients don't come to me to get on medication, of course, because I don't prescribe it. They usually come to me because they're trying to get off some of the medication are actually being off birth control medication because there could be also P C O S induced birth from the birth control. And so a lot of women sometimes try to transition off of this, and when they come to me, my approach is a little different. I look at the entire person, of course, and I do a 360 evaluation, which includes looking at what they eat, how they eat, what they drink, how they move.

I address all types of holistic elements, including, you know, their hygiene products, menstrual products, what they use, their beauty product, what they clean their homes with because as we know, endocrine disruptors can, a researcher, they can interrupt our hormones. And so I do a really, I flush out their entire you know, wellness, system to kind of see what is going on in their home, what's going on in their diet, and that is the approach that I use In terms of nutrition and life lifestyle, I don't, I don't use medications.

 In terms of herbal remedies there are some different teas that I recommend my clients to take and sometimes supplementations, a lot of times they may be deficient in specific nutrients. B-6 is really important nutrient when think about P C O S and metabolism, fertility, women with P C O S have higher risk of infertility due to the menstruation part of it, which we'll talk a little bit later about, but these are my main approaches when I tackle the PCOS issues with my clients.

Shireen: Understood. And a lot of the women out there aren't even aware that they have P C O S, P C O S and elevated insulin levels could exacerbate androgen, which is a male hormone found in about 60 to 80% of girls and women. Can you talk a little bit about the relationship of that male hormone on P C O S and what that means?

Sue-Ellen: Yeah, so you know, as a healthcare provider, it is a major concern to me because, like you said, many women don't know the symptoms of P C Os, which may lead them to have lack of concern until major issues occur in the body, for example, not know the definition enough to identify if they are having regular periods can be a reason why some women don't go to the doctor until for the complications arise.

So P C O S can start anywhere from your first menstrual period and can develop later in life. Women may have different symptoms, but the two diagnosis have to be, the two diagnosis has to be made, has to be present in order for the person to be diagnosed with P C O. So again, many women don't know what irregular periods are, so let's get into that a little bit.

Irregular periods mean, could mean that your periods are longer than a typical period, which could be anywhere from three to seven days, right? So it's longer than the timeframe. And having less periods, for example more periods you are without periods for three months, or you may have fewer periods in a year.

That is also considered irregular, and again, this will interfere with getting pregnant or your fertility. And also there could be periods that occur more than 35 days apart. And this, again, will affect your fertility. Now you ask the questions about the, you know, the androgens, right?

 So what exactly are androgens? They are, they're group or male. A group of, excuse me a sex hormones, and in males if you have too little of this hormone, you'll have low sex drive and you could have breast development. This, this is in males, while in females, it's mainly to things like acne, facial hair, male pattern baldness and things of that sort.

So it could be very stressful and, you know, traumatic for women, you know, with P C O S. And the other diagnosis, so those are the two diagnosis. The third one is poly polycystic ovaries, right? So polycystic ovaries basically means that your ovaries are larger than normal, and, and around the edge of those ovaries there are like many molecules of immature eggs.

And so if a woman has two out of these three diagnosis, Three excuse me, two out of three of these things, the diagnosis must be made for P C O S. So it's really important that women pay attention to these three items and try to figure out if there are changes going on in their body to, if they are noticing some of these changes, they must right away get in contact with their healthcare provider, you know, book an appointment and get the help that they need.

A registered dietician is a team member, a women's health registered dietician is a team member that can help with managing symptoms of P C O S specifically, especially those who identify with the insulin resistant part, which is, like we said, about 70% of women with P C O S have this insulin resistant part, so a lot of it can be managed with nutrition and lifestyle, along with other whether it's medications or other things that the provider decides to do. And some providers actually do, they follow holistic path, more naturopathic and some provide medication. 

So whichever the, the patient decides to follow, I think is the best way to go.

As long as we give them that choice and the choices available for them to make. So I believe I answered your question.

Shireen: Mm-hmm. . And so what are, what are the, the symptoms that one should look for? Because it is so under diagnosed. What are the types of things, especially the the, our listeners here need to look for symptoms. What should they consider to say, Okay, if I have these symptoms, I need to go talk to my doctor.

 Sue-Ellen: Right, so to kind of review if you have, if you're having irregular period, your periods are, you're shorter or longer than usual, as we mentioned earlier, if you're having these, you know, male patterned baldness, if you're having facial, a lot of facial hair, and it is very unusual, acne and it's not going away and it just keeps coming up and you know, it's bothersome to you.

That's definitely a reason to, to seek out help. And some women in, during their menstrual cycle, they may have pain, regular period, sometimes may come with pain, some may not have pain. But those are the three symptoms you wanna definitely look out for.

Another symptom, as we mentioned earlier in the podcast, is if you're getting very tired, you're very tired, very sluggish, you're craving sugar that is a sign that your insulin levels are are not working, your insulin's not working the way that it should. And so your, when you eat your food, foods that have carbohydrates instead of insulin working well, right?

 And it takes the sugar that your food is digested, that digested, takes it from your bloodstream to your cells, it's now being stuck in the bloodstream and your cells are not getting enough.

So you continue to get, you know, cravings of sugar hungry and you know, lethargic, very tired because that means your cells aren't getting enough of that energy to glucose, so the carbs. So that is another sign. Those feelings are definitely, You know, they are in a broad category because a lot of people feel sluggish because they're not sleeping and a lot of people feel hungry cuz they're not eating proper meals.

So you definitely have to pay attention to all the other symptoms. Like I said, the, the keeping track of their menstrual cycle, they have a lot of apps out there that can track your cycle. You can make notes on how your, how your flow is, you know, when you last the time in the length of your cycles. So this is very important for women out there to be aware of their bodies and to keep track of it.

And so, I would say those are the basis of the symptoms that you should look out for. 

Shireen: And so as you learn about these things a patient comes to you, tells you, Yep. Diagnosed with P C O S. Now how do you as a dietician work with somebody who has P C O S, especially when it comes to nutrition, the types of foods that they can and can't eat?

Sue-Ellen: Right. That is a great question because, you know, we have to keep in, in mind cultural preferences. It, we, we always wanna keep that in the back of our mind when we provide nutrition recommendations. And, and going back to, you know, P C O S because it is a risk factor for type two diabetes prediabetes, gestation diabetes, that the, the community, the minority communities are at risk for diabetes.

Are recommendations, as I mentioned, must be culturally appropriate. So getting into those recommendations in terms of research shows that the majority of foods you should be eating to help, to help manage P C O S, and oftentimes put it in kind of in remission, is majority plant-based foods, the plant-based eating pattern.

So what does that mean? You need some protein, you need some healthy fat carbohydrates. You know where the majority of those carbohydrates are low glycemic. This is what's showing promising results. So the old school of thought was that, you know, making protein the star of your protein, Oh, sorry, protein, the star of your meal was the old school of thought.

However, too much protein can cause weight gain due to excess calories, but it also may affect the way insulin works if we're eating too much protein, especially if there's already insulin resistance occurred in the background. So now the new school of thought is that we need to add more fiber to manage P C O S a little, a little bit more.

To look to improve the way we manage P C O S. So, fiber is found in, you know, low calorie foods, low calorie foods, vegetables, very low calorie fruits, whole grains, low, low calorie, highly nutritious foods. These are the star players, which helps to reduce the spikes and blood sugars specifically when they're paired with nutrients like fat and protein at a meal.

So, So, for example, including cultural foods, right? That are low glycemic, could be like a yam. You know, these are yellow yams and or green bananas on these are ethnic foods that are actually low in, in glycemic index and they're very important to incorporate into someone's eating pattern if they eat these foods.

But we also want to allow for some foods that are somewhat moderate to high glycemic. And I want back up a little bit and explain what gly glycemic means. So basically it means how quickly your blood sugar rises after eating particular carbohydrate food. So white bread has a higher glycemic index than you would say brown.

You know, a whole grain rice, a brown rice. But this, this doesn't mean that we must take out foods that they enjoy in their culture such as white rice or corn, which are kind of moderately to high glycemic. What we can do is pair up these higher glycemic foods with foods that they enjoy, like maybe beans or, you know, avocados fats and proteins and making sure that, that that surge and blood sugar is, is, is not too high. It's inappropriate levels. And so we, we would want testing of blood sugars and things of that sort when we are matching up these foods to make sure it is producing you know, good response to what we're doing.

And if my clients also, they like to eat fruits and I like to eat fruits myself, like mangoes, pineapples. And some of these foods are considered, again, higher glycemic, meaning that they raise blood sugar very quickly. And so instead of taking them out, we wanna tell, you know, I usually educate and, you know, counsel, my, my clients can say, let's try to minimize them a little bit.

And let's pair them up with other nutrient other foods that they may be higher in fat so are a little bit higher and this balance and a little bit more protein to make sure that we don't get that surge and blood sugar, but also managing calories. That's the trick. Right?

 So that's what, that's why the work of a registered dietician is so important because we have to, we're managing the different nutrients in foods and the way they react in the body, and then also making sure that we're, we're, we're adding pleasure to you know, the client's meal, we wanna make sure they're enjoying their food and their cultural foods at the same time. So this is, these are some of the strategies that I would recommend, and these are some of the things that I've, I've, I've used and that have worked well.

 Shireen: And so with that, if you had to design a plate for somebody using some of these foods, let's say this person as of hispanic origin where we're based out of Texas. I'm gonna default to that, but if someone is of Hispanic origin, let's say they love eating Mexican cuisine, you mentioned avocado just a little bit ago. What, what kind of foods, how would you design that plate?

 Again, just focused on PCOS, focused on those, you know, low glycemic foods as fiber, which, like all those nutrient dense foods. What, how would you design that, that plate, for instance? 

Sue-Ellen: Great. So regardless of culture, but I'm gonna get to that example for a Pacific Mexican individual. But regardless of culture, you wanna make sure, you know your plate is balanced with veggies, protein, carbs, and fat. So if we, if I was talking with a client from Mexican descent, I would say, you know typical meal, depending on where you're from. And Mexico may be beans typically they eat beans and avocados. Maybe they may like to eat tacos. 

And so if we're eating corn tacos we may, we may which are a little, maybe a little bit on the moderate to higher glycemic index. We could pair them up with beans, add beans in the tacos. We can also add avocados with that, lots of veggies. So, Cucumbers, or whether they get tomatoes or whether it's that slaw, the cabbage slaw. Or whether it's a salad on the side or what another protein that they may enjoy if they want to add additional protein. But again, we don't want to make the protein the star of the plate. We wanna make it higher in, in fiber.

And so those beans, you're gonna really bulk up on the beans and bulk up on those veggies and you know, sprinkle a little bit avocado there, whether making a haystack or whether you're having two taco shells. So on that plate you'll have. The tacos, that, those are the carbohydrates you have, the beans, the protein and the carbs.

You have the avocado, which is a fat. You also also could have some, you know, tomato salsa there on the side. And then you'll have like some, some lettuce, a lot of lettuce tomatoes there to either add with the tacos or to eat additionally on the side of the plate. 

So that is a balanced meal. And because I am a plant based dietician, I, I default mainly just to you know, beans and cells and peas. But if you enjoy fish, you could have fish tacos or whatever other tacos you may enjoy. But I would say keep your protein sizes to the size of a deck of cards. You don't wanna overdo protein. Again, researchers showing that, you know, with additional protein, there's additional fat that comes with it higher calories, you wanna really bulk up on the fiber. 

That is what's really helping to lower insulin resistance or basically to make your insulin more sensitive so that it can lower blood sugar, move the sugar from the bloodstream into the cell so you don't feel lethargic. You don't feel like you're craving sugar, you don't feel tired all the time, and then your blood sugars won't spike after you eat a meal.

Shireen: Does this also help with a lot of like the cramping and the pain and all of that? So maintaining a diet, does it have an impact? P c o s in general. 

 Sue-Ellen: Right. So if you're, if you are eating these balanced meals as well, it also will help you in the reproductive area because multiple having polycystic varied syndrome or P C O S carries with the, the fact that, you know, your body's not able to, have a good blood flow and to have good response to stress and response to inflammation. And so while you're eating these foods in higher fiber rich foods, your body's able to digest it more, more efficiently, but you're able to have, with good digestion, you're able to have better blood flow in your body, in which is, which is helping with your hearts, right, Help with muscles, with your heart.

You're helping you to give your energy so that you may exercise. And as far as cramping is concerned and all those things, we know that the efficiency in magnesium and potassium and things of that sort can induce more cramping. And so if your diet is riched with, you know, Whole grains, which have a lot of magnesium and fruits and vegetables with have a lot of pa potassium.

 Your menstrual cramps will be less. And since we're on that topic of menstrual cramps women should not, you should not be having significant amount of cramping cramping to the point where a little uneasy, that's okay, but mental cramps where you're on the floor crying or you can't move in your bed, that is a major concern.

So you definitely wanna follow up with your, you know, provider if you're having those types of cramps. You definitely could be all the things going on besides P C O S. And definitely there could be nutrition, nutrient deficiency. You may be dehydrated when you're, when you're more dehydrated or you don't have enough fluids, especially water.

Your body tends to have more, more cramping sensation. So you know. Menstrual the menstrual cycle is such a difficult conversation to have. There's so many different components going on with having your, your period each month. But definitely having a balanced meal can help to lessen these symptoms or lessen these P PCs PMS symptoms and also to lessen symptoms of P C O S.

And, you know, there are other foods to balance hormone levels, which we can, I will talk about either here or next episode, but there are foods that to help balance your sex hormones. And so in addition to P C O S you know, there may be other things going on that the individual, individual may need to do more testing on the hormone tests and to make sure, you know, is it they're thyroid or other things that are going on with their in their body that's causing them to have other symptoms.Right. 

 Cause I mentioned that these symptoms that are, that are occurring, it could, it could be for other diseases as well. Other issues being tired, lethargic, having irregular periods as well. Could be other types of disorders that are not just P C O S. So I don't know if we wanna talk more about menstrual cycles, but , we'll, 

 Shireen: We'll maybe link up an article on the show notes.

And then if you, if you have some resources that you can share, absolutely we can, we can link that up. But unfortunately with that, we, we are a little short on time. Okay. But real quick for you, Sue Ellen tell us how people can connect with you and just learn more about your work. 

 Sue-Ellen: Right. So you could connect with me on Instagram at 360 Girls and women.com and well at 360 Girls and Women, Instagram and Facebook.

And then the website is 360 Girls and women.com. Or if you want to learn out more, learn about more what I'm doing with culture, you could find me at iamculture.com, and thank you so much for having me on your show today. I hope I was able to answer all your questions. 

Shireen: Absolutely. It was such a pleasure having you on.

Thank you so much, Sue Ellen, for your time. And to our listeners listening out there, if you like this episode, go to our Facebook, go to our Instagram. Let's start our conversation there and tell us, have you ever been checked for P C O S? What. What does it look like for you? And if you have, tell us about your journey.

Tell us your story again. Head over to Facebook at Instagram at Yumlish and then go over there and then tell us briefly if you have ever been checked for P C O S, what that journey has been like for you. Share your story with us. Again, we will see you after this episode. Sue- Ellen, it was an absolute pleasure having you on.

Thank you so much. 

Sue-Ellen: Thank you so much for having me.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media at Yumlish underscore on Instagram and Twitter and at Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective.

You can also visit our website, Yumlish.com, for more recipes, advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember, your health always comes first.

Stay well.

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