Insulin Resistance and PCOS: What Works—From Strength Training to Supplementation with Dr. Patil-Sisodia

You’ve been diagnosed with PCOS, handed a prescription, and sent on your way—but no one explained what’s actually happening in your body. Why does PCOS make it harder to manage weight? Why are cravings and fatigue so relentless? And what does insulin resistance have to do with it?

The truth is, insulin resistance plays a major role in PCOS—yet it’s often misunderstood or overlooked. When your body struggles to use insulin effectively, it can lead to inflammation, weight gain, and an increased risk of diabetes and heart disease. But here’s the good news: small, strategic changes can make a big difference.

In this episode, Dr. Komal Patil-Sisodia, a Triple Board-Certified Endocrinologist and Women’s Metabolic Health Expert, joins us to break down what really works. From movement and nutrition to key supplements, we’ll explore how to manage insulin resistance and take back control of your health. Plus, Dr. Patil-Sisodia shares insights from her new Eastside Menopause & Metabolism Clinic—a practice dedicated to helping women feel their best during perimenopause and menopause.

References

Season 1 of the Premium Podcast: The Obesity Guide: Behind the Curtain

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Eastside Menopause & Metabolism

Audio Stamps

01:08 - Today’s guest, Dr. Komal Patil-Sisodia, shares her journey to opening East Side Menopause and Metabolism, highlighting the urgent need for specialized care in menopause and metabolic health.

03:35 - Dr. Patil Sisodia explains insulin resistance, where weight gain, especially around the abdomen, makes it harder for the body to manage blood sugar.

08:25 - We learn the importance of movement in managing insulin resistance.

11:54 - Dr. Patil-Sisodia addresses myths around low-carb diets, highlighting the importance of food pairing to control blood sugar levels.

23:00 - We hear the benefits of strength training and find out why it is key for managing insulin resistance.

28:23 - Dr. Rentea and Dr. Patil-Sisodia discuss how PCOS presents a wide range of symptoms that can vary greatly between individuals. 

33:18 - While supplements can be beneficial for some, their effectiveness varies, and they should be used thoughtfully alongside lifestyle changes.

Quotes

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All of the information on this podcast is for general informational purposes only. Please talk to your physician and medical team about what is right for you. No medical advice is being on this podcast.

If you live in Indiana or Illinois and want to work with doctor Matthea Rentea, you can find out more on www.RenteaClinic.com

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Transcript

0:28

Welcome back to another episode of the podcast today. I am so excited that we have back Dr. Kamal Patil Sisodia. She is absolutely incredible. If you remember everybody, she came months ago and talked to us about perimenopause and menopause and how there are unique weight challenges with that. And what is happening with our hormone levels and hormone replacement therapy. Honestly, it broke the internet that episode. I mean that when I say it, it was like one of our highest listened to episodes. Everybody had, was just shocked to learn all of that. So I'm so glad that you're back. And this time we're going to be talking about insulin resistance and specifically a little bit more like honing in on PCOS. Can you start out real quick, just introducing yourself a little bit, because I'm so pumped that you have a clinic now, and I'm just so excited for you. So can you tell us? A little bit more about who you are, what you do, just if anyone's new. Well, first, thank you for having me back. I had the best time recording with you. That was actually the first podcast episode I had ever done with somebody. Yes, I had never done one. So, and it was so much fun. You made it so comfortable and so lovely. So I'm really excited to be back and chat with your listeners. I'm an endocrinologist by background, as well as an obesity medicine physician. And last year, I decided that I wanted to go and become certified in menopause care as well, because there is such a big gaping hole in the number of physicians and other providers out there who are actually providing this type of care to women. I guess, in my current daily practice, I work in two different settings. Now, I work in a traditional practice that I've been at for the last 10 years, and starting next month, I am opening my own clinic called East Side Menopause and Metabolism in Redmond, Washington, and I really want to focus on women who are struggling with their metabolic health as they enter perimenopause and menopause, because the long lasting implications of that. It's going to be something that affects your quality of life for years to come. And if you don't get started on working through some of those challenges now, it only gets harder with time. Doesn't mean we can't do things about it, right? There are great toolkits that we have, but My biggest message to women is get started sooner rather than later, and that's a challenge for a multitude of reasons, right? We're so busy with life, with work, with family, with whatever other activities and things that we're trying to do and get out into the world. We often tend to put ourselves in the back burner. So that's my background. Super excited to be here with you. I love that. You know, it's, it's so interesting when you bring that up. I often say we're going to take the moment to take care of our health or something's going to happen. And that's usually not so fun when you have a health complication occur. So I love what the focus of your clinic is on. So many women are going to need that. When you're listening to this, everybody, it will be in March, the clinic is open. So, so we will make sure to have the link in the show notes everything I'm. So many women are going to get helped by your clinic. I'm wondering today if we can dig a little bit into specifically insulin resistance and, how that comes into PCOS. I feel like this is a really. Misunderstood area because I think we've kind of talked about this before that I feel like when physicians say someone has PCOS They're like, here's your metformin. Here's your birth control. They're given absolutely no tools They don't understand what's happening. And so I'm wondering if we could just go through that a little bit I have a few questions that I prepared here. But of course we go wherever the conversation does Sure. So let me start with just describing insulin resistance to everybody because I think that's kind of the first thing that everybody wonders about whether you have PCOS or not, because it has implications for people who are male or female and have prediabetes and diabetes. And so insulin resistance, I always like to describe it as An assembly line that's gone out of whack. Your pancreas in your body is what's producing insulin and that insulin is being produced so that your body can process the carbohydrates that you're eating. So the starches, the sugars, whatever you're getting from your diet that needs to be processed. So it can either be used as an energy source or stored in your muscle or your fat tissue for future use, right? And if your assembly line in your pancreas is not working properly. All of these things start to go out of whack, right? And so the way that I describe it, and I'm totally going to date myself here, but my parents, when they came to this country, they didn't really let us watch much TV other than American movie classics and Nick at Night. So I Love Lucy was one of my favorite shows. And there is that iconic chocolate factory scene where Lucy and Ethel are working in the chocolate factory and they are You know, the assembly lines going at a great pace and they're able to wrap the chocolate up and send it to the end of the assembly line. Think about your pancreas working normally in that context, right? When the pancreas is working well, when it's making enough insulin to take care of the carbohydrates that you're eating, it's like Lucy and Ethel in the first five seconds of that clip, right? Like it's making good quality insulin. It's making enough insulin to keep your blood sugars normal. And then when things start to go haywire, that's when things start to break down. So in the pancreas specifically, we have these cells called beta cells, and beta cells are responsible for our insulin production. Well, one of the things that happens to us when we gain weight is that most people will gain weight around their middle. Right. And that weight that we gain around our middle technically is called visceral fat. And that visceral fat, instead of sitting under the skin, like it does on your arms or legs, sits inside your abdominal cavity and kind of packs around all of your organs inside your abdomen. And that fat is much more inflammatory than what you have in your arms and legs. And that inflammation creates what we call insulin resistance. So imagine And I'm making up numbers for the amounts of insulin because I don't think anybody actually really knows, but say you are at a normal BMI or a normal body weight. I don't love BMI, but you're at a lighter body weight for you and you eat a chocolate chip cookie, your pancreas may need to produce about four units of insulin to cover that chocolate chip cookie. If you gain 20 pounds, and a lot of that is visceral fat, your body now needs eight units of insulin to cover the same cookie. So are you understanding like the stress that's happening on the assembly line? Yeah. So the assembly line gets stressed and similar to that clip in I love Lucy, where. All of a sudden the assembly line is having to produce more insulin more quickly. The body can't make good quality insulin fast enough, right? And when you don't have enough, it can't get stored in your muscle or your fat tissue, and it just hangs out in your bloodstream. So you get this mismatch of blood sugar starting to rise because your body can't make enough insulin because it needs more insulin for the same food and that. In its totality is what I call insulin resistance. And a lot of patients will ask me, well, can I reverse insulin resistance? And really you can, but it's through losing that weight and losing that visceral fat. And you and I both know having done this for several years, both on a personal and professional level. It is really hard to lose visceral fat unless you are making lifestyle changes and taking a targeted approach and sometimes even using medication to help you get past that. So that is the concept of insulin resistance in a nutshell. Thank you for explaining that because I do think that that's It's a really good visual where I think everyone's going to really be able to follow that. And I think, it's a hundred percent what you're saying at this catch 22. Yeah, you need to lose the weight, but it's so hard to lose the weight when there's insulin resistance. I think one of the first questions I really had for you is, so we're hearing this term thrown around a lot, insulin resistance, let's say specifically with PCOS, things like that. But if we break it down, if we think about sort of insulin, it's kind of like the key to unlock a door, right? What do you think when someone has PCOS and they're insulin resistant, what could kind of be some of this? If we had to say WD 40 that can kind of unlock that door. Do you know what I mean? I'm trying to use an analogy, right? We're just all about analogies today. So I'm wondering like, what do you think could be some of those tools that are practical that people can do? I think that's a, I think that's a great question. There are so many different tools that we have in our toolkit. There are lifestyle changes that we can do just moving our bodies more. There are so many of us, myself included, where we are so much more sedentary than we used to be, right? In medicine, we do these virtual visits and I will sit there and feel like such a hypocrite at the end of the day. So I'll be like, Oh, you gotta get your steps. You gotta do this. You gotta do that. And I look at my watch. It's like, Oh, 900 steps today. Yeah. I know. But it's just an effort, right? I know that, especially depending on what your life looks like, it's a lot of intentional, not only effort, but time that needs to go into it. There is a reality. And so, okay. But so one of the, one of this being move more, are you a fan of saying, you know, I'll hear sometimes people say, okay, well, after the meal is best or in the morning with insulin resistance, are you a fan of any of that or what are your thoughts on that? I think that, if you can be intentional about walking after meals, there's probably a slight additional benefit to that. But at the end of the day, if you're choosing between walking after meals versus walking at all, I would pick walking at all, right? Any type of movement is going to help. Right, right. Just do what you can do. Because I love that study that shows that there are cardiovascular benefits to walking 11 minutes a day. That reduces your cardiac mortality by 33 percent if you walk 11 minutes a day. Doesn't say when. That we need to blast that. Like yeah. Right there. Gosh, how often do we say to ourselves, I don't have time, da, da. It's like, I think you have 11 minutes today. If you could live that much longer, I think you've got it. And I think you would want to do it if you knew. So thank you for sharing that. Oh, of course. Of course, and I know that intuitively I know that, but I still find myself on days thinking, Oh my gosh, I have this meeting and then I have this block of patients and then I have to go do this for my family and I need to cook dinner and everything is going in a whirlwind in my mind, but really, if you are intentional about finding that 11 minutes in your day. You can make a huge difference to your health overall, right? So movement, intentional movement, I think at any time is a good thing. We can talk about whether there's a mix of cardio or strength training. I think both are important to achieving optimal health. And so I don't think that you can pinpoint just one or the other. I really do think you need a combination of both of those things. And it doesn't have to be huge amounts of strength training, as we know from our friend, Dr. Ali Novitsky, even just 30 minutes a week broken up into chunks can be enough to just maintain your muscle mass. So When you break it down like that, it seems much more doable, as opposed to doing nothing at all. Completely, completely. And I think kind of piggybacking on this when we're talking about, okay, the movement, the strength training, I'm sure you're probably next going to be talking about nutrition. And one question I have is, And maybe you were already going to get into this. I feel like it's really like keto or bust, like you have to be low carb. Can you address that and just say what's myth versus fact about that? Yeah. So, you know, the keto diet was developed in the context of epilepsy. It was never really meant for the mainstream. Do people see results with it? Absolutely. If you're not eating carbs, you're going to drop weight quickly, but how long is that sustainable? Right. And if we know that our muscles are what drive our basal metabolic rate, meaning how many calories we're burning, sitting at rest and you're. Muscles need carbs in order to function optimally. It just doesn't sound like the best plan to me long term. Because what I have heard from a lot of my patients is they actually feel like they can't sustain their workouts as long because they're not eating enough carbs. Right. And to be truly keto, you have to be at less than, I think it's 50 grams of carbs per day. I would be a mean, horrible, angry person if we're allowed only 50 carbs per day, right? I don't think people understand there's carbs in broccoli, right? It's like people don't understand how it's truly in everything. And so I don't even know when people are doing quote unquote, keto, if they. Are doing keto. You know, it's interesting. I've seen some people really do it. And keto is one of these things where I think if you are, there's modified keto, which I know some people, will push for, and that's really keeping your carbs at around or under 120, but definitely over that 50 threshold. And it's different for everybody, right? We're all different shapes, sizes, muscle masses, right? Our body compositions are all different. So what works for you may not work for me, may not work for the next person. So you want to find what that balance is. I think being intentional about what carbs you consume is really important and the quality of those carbs. So I'm big with my patients for saying eat carbs from nature. Right? Those natural carbs are going to give you the most bang for your buck. They're usually, accompanied by minerals, antioxidants, as well as fiber. And so that is going to help regulate your blood sugar more than, you know, my vice is generally a cookie of some sort. Those don't really have much nutritional value. And I'm sorry, I don't love protein cookies because if I'm going to eat their I want it. Yeah. I don't want to have our protein and let's Have the cookie separately. Exactly. I think I was watching one of your TikTok videos where you were talking about the ratio of fast casual food and when you add extra protein to something it like completely wrecks the flavor. I was like, it ruins the ratio. I was like, eat the extra protein serving first and then eat the sandwiches. When you put the other extra egg weight in it, suddenly that sandwich is so disgusting. So yeah, everyone was like, I agree. I told, I heard that and I was like, yes, I feel seen. Yes, that is exactly it. So that's how I feel about carbs, right? And there is this concept of food pairing that is so important and so crucial to people who have insulin resistance. There, you can pair your food in a way that if you are eating your fiber, fat and protein portion of your meal first and then having the carbs, your blood sugars don't rise as quickly. I have a husband and wife, couple that comes to see me and for their health and for diabetes specifically. And I remember they came in one day and the wife was so angry. She said, we ate the exact same thing for dinner. My blood sugar shot up and his stayed totally normal and I was like, what do you mean? And she said, well, we had steak and potatoes. And I said, okay, well, what did you eat first versus your husband? And she said, well, I ate the potatoes first and he ate the steak first. And I said, well, there you go. Next time you have steak and potatoes, maybe eat some bites of your steak first and then eat the potatoes and see if it makes a difference. And sure enough, she messaged me a few weeks later and she was like, you're right. It works. Yeah, it's so nice, right? Because it's literally the same food people. It's the same food. It's just like the way in which you're eating it. And I think that is so empowering, but do you know, I've actually seen. I don't know if you've come across this, but I know that they did a study where basically they saw that women basically go more for carbs first and men for meat, for the protein. Yes. And I was just, I, this is, did we talk about this before? I don't think we did. Okay, this is something, once I learned that, I was like, oh, oh, I know where a lot of this came from. So there was that, but then also a nutritionist that I worked with in the past, she said how, basically men get more, fats from things compared to women. And so a lot of the time women are like constantly scrounging for snacks and things because we're not really like satisfied because we're oftentimes really trying to do these like really weird contortionist nutrition things. Anyway, sidebar, but I love that. So what you're suggesting is, which I talk about people all the time, start with, whether it be a protein, a fiber, start with that, and then do some of the carb, and I always tell people, tell me if you agree, we don't need to be absolutely 100 percent strict, like the whole protein's gone, and then we only have some carb, just have some of it, right? Right, some of it is fine. Legalistic, yeah. Yeah. Okay. So, I mean, I'll give you another example. I'm Indian. One of my comfort meals is lentils and rice, right? It's one of my favorite things. It reminds me of my childhood and of my mom's kitchen, but it is so high in carbs, right? One cup of rice has 50 grams of carbs. Even lentils, even though they have protein and fiber, have carbs in them so this is a big issue in the Indian community is our, Especially our vegetarian diets are so high in carb. So I was playing around with some, you know, I'm lucky because when the reps come into my office, I get to trial some of these sensor devices and things like that. And I don't have diabetes, but it's always interesting to me to see what will happen when I'm eating different types of foods. And so I made this meal for myself and I thought, okay, well, I'll sub half a cup of cauliflower rice for half a cup of the basmati rice that I usually use because the cauliflower rice only has five grams of carbs per cup. So I've cut the carbs in half there. I made the lentils and then I added some full fat Greek yogurt for fat and protein. And I ate this meal and I was kind of like looking at the continuous glucose monitor reading with one eye shut and one eye open. And sure enough, it just kind of gradually went up and then gradually came down and it all stayed like very normal, like there was no huge glucose spike and a crash afterwards. And the next day, I ate my vice of two Oreos and sure enough, it shot up and then it fell right back down. And to me, that was just such a telling thing. I was like, Oh, okay, well, this is how my body reacts to healthy nature based carbs versus something that's super and overly processed and is not good for my body. Right. And so that helps me be more intentional in what my food choices are. Yeah, I think this is such a good point. I'm a vegetarian. And so this is 100 percent what I'm up against that no matter if it's factor meals, or I love the Amy's Indian meals, there's so many things I love. But they're always too high in carbs. They're like 70 plus grams, and if I were to do that all, it just would not end well. So I usually have to do, it's exactly what you're saying. I do half of it and I start more with a protein or my own veggies or something else first. Yes. And then I still get to enjoy the taste and the flavor and everything of what I like, but it just doesn't work more of these processed foods when you're not balancing things. So this is so practical. I think this is going to be really helpful, for people to hear with nutrition. You know, and I think even for myself, right, like we're constantly learning, you and I both know in medical school that nutrition education was not at the top of the list of things that they taught us. So a lot of the stuff we've learned, we've had to go out there and learn on our own through courses through, practical everyday experimentation. Um, but I think we've found good tactics and, I work closely with a team of dieticians in my regular job and they have some great, insights into what people can do to really Re adjust what their meals look like. And to your point, sometimes it's as simple as changing the order of things. And when you eat that protein, fat, and fiber first, you're actually full more so. And I think you end up eating less carbs. At least I do. Oh, a hundred percent. I feel like I leave more stuff on my plate then. And also, I don't know if this is psychological, but I feel like your desire is upped when you start with the carb. This is just me. I get into this like pleasure zone of eating instead of. It really fueling my hunger, fueling my hormones. So it's very interesting, I've noticed that with time. I don't have as much emotional eating if I'm starting with the food that of course your desire is through the roofer. And that makes perfect sense, right? We know that sugar or carbs light up the same reward pathways in our brains that cocaine does. Oh, totally. So if you're starting with the carbs, it's all going to be pleasure based eating, right? I am so much the same way. I'm in an accountability group and one of the other physicians, she said how She had a bite of her kid's birthday cake. And then she's like, my little brain kept saying all weekend, you need more cake. It was like, yeah, normal brain. Yes. It is a potent, powerful effect. Right. And to go back to your point earlier about how, your colleague, who's the dietitian was saying that men tend to eat protein first, whereas women are scrounging for those snacks. I think that because of toxic diet culture and how. The food pyramid that we were all introduced to when we were growing up, it just messed up people's conception of what healthy snacks are, right? They were telling us to limit fats and be very generous with the carbs in our diet. What was it? Um and like one to two servings of fat, and there was no distinction between heart healthy fat versus not heart healthy fat. And I think that for a generation of people, it has really messed with their mindset around what a healthy snack is. I think women more so because we tend to be more susceptible to what this diet culture and what the has perpetuated. That we should eat like, look like, think like, talk, you know, all of those things. Yeah. Yeah, definitely. Yeah. Or even snacking in general, you know, like, I don't know. I don't remember. It's interesting. I don't remember growing up snacking being such a thing. I feel like it really, it became, yeah, I don't, yeah, I don't, I just don't, I mean, listen, I still had food issues, but it was constrained to meals. So, yeah, it's just interesting over time how these things, how they evolve. Absolutely. One thing, kind of going back to the movement part of things, you know, I really often think about, muscle sort of being like a sponge for glucose. Right. Yeah. And a lot of people with PCOS I find that they're intimidated by strength training or just not even with PCOS. I don't want to even Dog pile on that. Honestly, everyone usually is not really great with strength training. And can you kind of break down why building muscle is one of the best quote unquote medications for insulin resistance and maybe the minimum effective dose to see benefits if you would? Yes. So muscle mass is what is It's driving our basal metabolic rate, right? And one of the biggest things that I like to focus on is what is your body composition? Not what is your weight on the scale and your BMI because we know that body composition can be vastly different depending on how much muscle you're carrying. With the increase in muscle mass, you are burning more calories at rest. So it is really important to do that because if you are afraid of building muscle. And you just want to lose weight and you're losing muscle mass, but holding onto your fat, your body composition shifts in a way that's not favorable. And you will actually, it will be easier for you to continue to gain fat mass because you've lost all that muscle. And that is really, really hard to come back from, right? Unless you were intentional, in making sure that you're eating enough protein and you're doing that strength training. So really two things that go into building muscle. One is getting enough protein in your diet, which is hard for every single one of us, whether you're vegetarian or not vegetarian. I mean, I can tell you like the thought of choking down another chicken breast is not the most palatable on certain days, right? But we're trying to get in protein from all of these different sources and The second thing is that with the strength training, I think that there is a societal perception of, what people should look like, and for women, unfortunately, it is that long limbed, live look with not a lot of muscle mass, and I think that's so damaging, because it doesn't help your bones, it doesn't help your body composition, and as you get older, all of those So we can't be afraid of muscle because muscle is really what's going to protect us in the future. And when you have more muscle, you're burning off more of those carbs. So they're not getting stored as fat, which, you know, is. I wish more people realized that and took advantage of that, right? So you are, your blood sugars are actually going to be lower when you carry more muscle mass, when your ratio of muscle to fat starts shifting in a different direction, so that I think is really helpful. And then with the actual strength training itself, there are studies that have come out that have shown just 30 minutes of strength training a week. can be enough to maintain your muscle mass. Obviously, if you want to build and do more, a little bit more than that is fine. So usually I will tell my patients, two to three sessions of strength training during the week. You can start at ten minutes at a time, and then if you want to continue to build your muscle mass, you can increase that amount so that you are doing that. But if your goal is to lose weight, really the biggest thing is going to be trying to maintain the muscle mass. And when you lose some weight, Some muscle loss is expected, but it can't be the overwhelming part of the weight that you're losing. You want to see more fat loss versus muscle loss. I was just talking to someone in my 30 30 group and they had done phenomenal. And it was the classic, you know, like the first six months you don't lose any muscle because the body's like, okay, fine. I'm happy to release fat. I see in my practice again, I don't like BMI, but just, this is where I start to see this happen. I start to see. Under 30, but really 28 and under is sometimes where I see it, it go off a cliff as far as a lot of muscle loss compared to fat. And this person was like, yeah, that's exactly it. So the point is that, even when people are prioritizing all these things that it can still happen. So it's like, if you are not prioritizing it, you are really up a creek because even when you do it it can happen. So if you're not doing it at all. It's really a problem and I like how again we've stressed this a lot of times today that it's truly a few minutes. I mean, you hardly start by the time you're ending when it's 10 minutes, right? Like when you think like that, it's really not a lot of time. It's so quick, so I mean, imagine you're doing three 10 minute workouts, and then you're walking 11 minutes a day it's not a ton of time. And you don't have to do both of them at the same time, you can do your 10 minutes of strength training in the morning. And then you know, in the evening, when you are a little more free, you can go and take a walk somewhere, it doesn't have to be all together. I think that for me personally, the breaking things up is the only reason I get a lot of walking done because I'll do if I can get a big chunk in the morning. Okay. Amazing. But if not, like before we're speaking after lunch right now, right? Literally I had like 10 minutes before this call, it was like, just get up and walk back and forth. Like you can do this. Like I didn't need to get on a walking pad. I didn't need to do anything special. I'm a little bit more alert for you because I did it. It was after a meal. But. A million stars don't need to align for this to occur. And so I keep giving myself any little moment in my mind just write Mel Robbins, 1, get up and move, right? Let's just do this. Not think about it too much. So I love that you, that you went over that. Can you tell us a little bit about we were talking about a study before this call. Can you? Yeah. Share a little bit more about that. Yeah. So I was doing this deep dive into PCOS and the fact that women who have PCOS tend to have higher androgen, which, is been classified as the male hormone, which we know is not true because women have testosterone in their bodies as well. But they have higher levels of testosterone and interestingly, they have higher amounts of lean muscle mass. compared to women who don't have PCOS because of these higher testosterone levels. Now the interesting split happens in that there are some PCOS is kind of a spectrum, right? So we should back up and just talk about what PCOS is. So PCOS, and I hate the term polycystic ovarian syndrome because I think it's so misleading. Only 25 percent of people who have PCOS actually have cysts on their ovaries. So it seems silly to me to name a condition after the cysts in the ovaries when it only affects a quarter of the patients who have this condition. I'm glad that you bring that up because I almost don't even ask people that anymore. I'm so concerned with all the other symptoms because that's only what's showing up and not that. Yeah. Yeah. And so it's interesting because they have this Rotterdam criteria that they look at for, how you diagnose PCOS. And it really is that you would have symptoms of what we call hyperandrogenism, so high testosterone levels, and that can manifest as increased facial hair growth or body hair growth. scalp hair loss, facial hair growth, acne, things like that, that you will see with increased testosterone, right? So having a few of those symptoms is one of the criteria, having irregular periods or not regular ovulation. The third criteria is. polycystic ovaries, which, we know only 25 percent of people have. So really it's focused on that high level of testosterone and the lack of ovulation. Now we know women who have PCOS also have insulin resistance to some degree. And that is kind of an interesting topic in and of itself because the insulin resistance that happens with PCOS is. Almost like it has this loop effect with the testosterone that's being produced. So we know that those higher levels of insulin will go and act on the ovaries to produce more testosterone. The other thing that happens is when you have high levels of insulin that are circulating in your body, it actually knocks. testosterone off of the sex hormone binding globulin that it binds to and circulates around. So testosterone will circulate in your bloodstream in two ways. One is just free floating, and that's what's active and actually causing some of the symptoms. And then the reserve, which I always call like the savings account, that, that circulates. It's stored and attached to sex hormone binding globulin. And so does your estrogen and so does your progesterone. What your body is not using is usually stuck to that. So if you have this extra insulin around that's knocking it off the receptors, and then that same insulin is going to the ovaries and then making more testosterone, you're having this testosterone issue that is compounding because of the insulin resistance do you know, I did not know that insulin knocks testosterone, off the receptor. Yeah, these are some old studies, right? And we, again, the theories have changed over time. Initially, that's what they used to talk about. Now they talk more about the insulin effect at the level of the ovary. But I think both are probably true. Yeah. Yeah. So why do you think that insulin resistance isn't being put as part of the diagnosis? Is it because I feel like there's not a good definition of insulin resistance? Is it something that they can't like lock down? Yeah. I think the problem is there's not a good definition. And then you have this lean subset of PCOS that doesn't have insulin resistance. Right. It's so interesting for me to see, because I will see in the same family, there are All the female siblings have PCOS to some degree, or there'll be one that doesn't have it. One will be lean, one will be more in the subset that struggles with overweight or obesity. And it, it almost doesn't match because their experiences are so different in terms of their body. It's radical. In college, I had a really good friend that had PCOS, but no weight challenges. And when she went to the doctor, the doctor said, I don't believe you because if you had PCOS, you'd be overweight. I mean, I was just floored and I would, you know, obviously I wasn't even a physician yet, but that line just stuck with me and to think that there's all these other criteria, right? And so while things typically look in a certain clinical picture, like you're saying that subset that doesn't have it. So that's really interesting so the one thing that, that I need to get answered today, because I always wonder about that, okay? Yeah. There's so much buzz about supplements, so be it Inositol, Berberine, Magnesium, for PCOS, insulin resistance. Everyone's always throwing around, I have a combination supplement, all of that. Is there actually solid science behind that or is it just expensive urine? I would say probably of all of the ones you just listed, Inositol probably has the most data that's out there how it works for people can be highly variable, right? So it's one of those things that I will say, go ahead and try it. Let's see if it's helping and working for you and give it like a good three to six months because nothing ever works in one month. We know that, and if you're feeling like it's making a difference for you, then I think it's worth continuing or if we're seeing some true clinical improvement in terms of the periods getting more regular or, weight loss being a little bit easier, things like that, that I think that That is probably the one that has the most data behind it. I think, magnesium and all of these other things are important in general, right? There are studies that show people who have diabetes are magnesium depleted, so kind of makes you wonder, are people with PCOS and insulin resistance and plus minus pre diabetes on the same boat, possibly. So is there harm in replacing it? No, but there are side effects to magnesium, right? We know that it can cause sleepiness, it can cause diarrhea, you know, there's so many things and if you time it at night and it's helping you sleep, that's fantastic. By the way, sleep is another lifestyle change that I have been all in on recently. We are so bad at sleeping and With that interrupted sleep, if we never go into that deep REM sleep, our cortisol levels never get a chance to recover and come down. And when your cortisol levels are chronically elevated, you're going to, I mean, cortisol is a survival hormone, so it wants you to gain weight so that you don't die when you're trying to outrun the, ancient beasts that was chasing our caveman ancestors down. So unfortunately that cortisol really. Contributes to visceral fat gain. And I think when we are not getting good restorative sleep, that actually plays a lot into what happens on our weight journey and with insulin resistance, because of cortisol is never coming down. It's going to spike your insulin levels all day as well. Yeah. I was listening to a podcast the other day. I forget the exact name. Maybe we can link to it in the show notes. And it was an obesity medicine physician. And she was talking about how. Our obesogenic environment, basically just for people listening, the environment that sort of promotes weight gain, right? And she was talking about ultra processed food, less sleep, increased stress, decreased exercise, and that it leads to a higher weight set point. So you already had the genetics at play, but then you got stuck in an environment with all of this. And I think about how, yeah, it just really stacks the deck against ourselves. It's interesting. I work a lot with patients on this too. And I'm always like, look, sleep is the bottom of the pyramid. I'm like, if you don't have sleep, we're not doing anything else to start. We're working on sleep. But you would think I would first be like nutrition and movement. And no, because you're overly emotional. So your food relationship is going to be off. But then you're not thinking clearly when you don't have sleep. So you also can't be fresh. Like you can't plan things. But that's, yeah, that's like the first thing I work with people on. Can we do that? How can we change either your thoughts about the job or the job you have? How can we stop being so stressed? How can we take tech a little bit out of it? Cause you're overstimulated 24 seven. How can we change what's coming in the house? It's like, there's so many things that are not even a medicine, right. It's great. Yeah, it's that they're these little tweaks. And I see so many software engineers in my practice because we live in Seattle, right? Big tech area. And, everybody gets my soapbox about sleep. And, they're like, but I have to work these hours. And I have a 2am conference called to China. And, one day I asked one of them, I said, what, is the purpose of this tech? And the guy looked at me, he goes, to make somebody else a lot of money. And I was like, no, that's not what I meant. I meant on a philosophical level, the purpose of tech has always been to theoretically make human life easier. Right. And I, I don't know if you ever watched, and I'm going to age myself again, the Jetsons, the Jetsons did tech, right? They like, Mr. Jetson went to Work in the morning. He did his work with the help of whatever. He still went home and had dinner with his family. He had the crazy boss. He had the stressful environment, but all the tech in his life was helping him so that he could still go home and have dinner with his family, go to bed on time and then wake up the next day to be able to do those same things it wasn't like the, at least not in the episodes. I remember that the tech was waking him up in the middle of the night. Take, a conference call from across the universe, and the guy just kind of looked at me and he's like, well, that's not the way the real world works. And I was like, well, clearly the cartoons, right? It's so true though. I have the same challenges in my practice. And you know, what's interesting, I have this moment where I'm like. Look, you can keep doing the things the way you're doing it. I mean, my life is unaffected by what you're doing,, but it's not working. So, if that's not gonna change, are you then gonna take a nap in the middle of the day? Are you gonna start to eat only unprocessed food? Where else are you gonna get it back then? Because in some way, things have to change. Otherwise, they continue to deteriorate. So, I feel like Right. It's like this moment. I always say it's like when the foundation of the house cracks. Right. So like everyone knows it's like a disaster. If you're the slab that your house is on, has a break, right. But it's like this really big moment needs to occur when you're like, no, it's enough. I can't give my literal life to this company. It's just not going to work. That's a whole nother conversation. But thank you for just coming back to the supplements that it doesn't sound like that's gonna be the do or die. I just hear people talk about it in such a way where I'll tell you beyond antal, I do berberine in the clinic, and some people, again, they'll respond splendidly and others nothing. Right. And so it's, again, it's one of these scenarios where if insulin resistance is high, if we're not seeing the type of. weight loss that we would expect. There's a certain, clinical picture that we're used to. And so then I'll bring in some of these other things, but it's not first line for me. Normally it's not strong enough as the problem. I agree. And it's the same thing with I have a lot of patients who come to see me and they have diabetes and they'll ask about cinnamon supplements. I will tell you, I can count on one hand, the number of people that I've seen that that's helped. And it's been remarkable, actually, I've actually had to lower some meds. But the overwhelming majority of people who try it, it doesn't work for them. And then you worry about what is the toxicity level of taking an encapsulated concentrated cinnamon. I don't know that anybody's studied that. Because with supplements, they are not classified as meds by the FDA. They're classified as food additives. It's the same issue with turmeric pills that people are like, Oh, I'm taking turmeric to decrease my inflammation. Well, there are people who are getting liver failure from taking huge amounts of turmeric. I cook with turmeric. That's a very small amount, you can still get potent anti inflammatory effect from that. Why do we need to take it in a capsule? So I, yeah, I think the problem too, you know, my parents, are part owners with another physician in a nutraceutical company and incredible their products and the sourcing and everything. That's not the case for every company. And if you actually if you follow the trail, it was just really fascinating having grown up with seeing how this company was built and knowing behind the scenes, how incredible everything is. And the sourcing of these ingredients, like even there, there's shadiness afoot. If you're not batch testing. And so when you find these supplements where they're selling them at a really cheap price, I don't care how big the batch is. You're not using good ingredients. And so, all of this, it just gets really complicated. And so I think again, hopefully everyone that's listening, you're working with a physician or someone that knows what they're doing. Because I think nowadays, I think the thing that's my raw spot is that influencers have gone wild with these things. And I just feel like they're making bank. I'm taking advantage of people and all I want to do here is just let's actually talk about the evidence and we're not saying not to take any of these things, hell, I take a lot of them, okay, but Right. We all do, but let's have a logic, let's have a process, if it's not working after a few months, let's readdress. You don't have a whole medicine cabinet worth of stuff and you don't know what you're doing. I think that's really the main thing that I wanted to get out. Yeah. And I think the other thing, your point about the sourcing is so important, because there are certain companies of products that I will recommend online. Because I think that their sourcing is excellent, so if you're going to take the supplement, take it from this company. And I put that out there to my patients. I think the other problem with supplements and influencers is everybody starts everything all at once and then stops it very shortly, you're not going to know what's giving you the side effect. Do one at a time, right? Try it out for three to six months. See if it's making a difference. If it's not, let it go and then maybe move on to the next thing. But this culture and mentality around trying everything all at once and expecting a miracle. Our bodies don't work that way. They're not designed to work that way, and so that, that's my other pet peeve with the supplement industry. But just like you, I do take things, right? I take vitamin D. I take B12. I take a probiotic. I take these things that I have taken the time to test and make Either my level is low or, I'm not getting enough of those things. So I'm going to supplement it, or I'm going to, try this probiotic because I think it may help with X, Y, and Z. Right. But you give everything in that trial period. So yeah, to your point, not saying don't take supplements, just saying, be very mindful about one, where they're coming from, what it is you're using them for and whether you're using them appropriately for them. Clearly. So, okay, I've learned a ton, as always, and I know that everyone's going to want to know how can they find you, so can you tell us about where you are in social, what your website is, how people could see you in the clinic, if you can just tell us all of it. Yes, yeah. So, again, my name is Dr. Komal Patil Sisodia. I am based out of Washington State. My clinic, Eastside Menopausal Metabolism, will be opening in Redmond, Washington. In March of this year and my first day seeing patients is March 7th. I'm going to be doing it on Fridays, because I still have a whole other job and other things that I'm doing. But to me, this clinic was really, really important because I've seen so many of my patients hit that period in their life and, you know, for the women who. All of us, all of the women who have been gaslit through perimenopause and menopause into thinking that this is just the best it's going to get. One, that's not true. Number two, if you are entering that period with a metabolic condition already, you need a little bit more specialized attention to make sure those things aren't getting worse and intervention, either in the form of, lifestyle changes being treated for those things. Hormone replacement therapy is one tool if you are able to have it. We can look at all of those things and figure out what the best, position is moving forward for you. One of my big whys for doing this was I really watched my mom struggle to navigate the American health care system as an immigrant woman. And then also with the metabolic disease that runs in our family, how much harder it became during that time. And part of it is I see what the genetics are and I'm on a personal mission to change that trajectory for myself, but I know that we can change that trajectory for women if they put that time and attention into it early. So, and my social handle on Instagram and TikTok, you can find me at Dr. Patil Sisodia. spelled P A T I L S I S O D I A, and my website is EastsideMM. com. So feel free to reach out. I would love to hear from you. And thank you. I love this. You're going to change so many women's lives. I mean that because they're just, it's like safe beacon identified. You can come here. We are actually going to help you. I'm so glad that you came on today and we're going to make sure to link everything in the show notes. If everyone is. Listening and you're confused how to get to that. It's rentia clinic. com. You click on podcast and you'll see the episode right there. We'll have all the links and everything in there. If you're ever, catch the spelling and things like that. So thank you so much again for coming on. Oh, it's my pleasure. And thank you again for having me. I always have such a fun time when we get to chat like this. So.