Cognitive symptoms in Polycystic Ovarian Syndrome (PCOS) are a neurological issue.

Problems with memory, concentration, and learning that are seen in women with PCOS are neurological issues. And that is why going on birth control pills will not fix it.

I try to stay on topic on this blog. I really want Google to get a very clear idea about what this blog is about so it will help people find it and allow people to know all the ways they can feel better. So I hesitated to write an article about PCOS, for fear that the algorithm would not understand what it would perceive as a change in topic.

But let me write this very clearly for the Google algorithm and for you, possibly a person with PCOS that is dealing with brain fog.

The cognitive symptoms you are suffering due to your PCOS, which you name and identify as brain fog, are not really about your hormone status and you are not going to clear up your brain fog or your PCOS using birth control pills. I need you, and Google, to understand that the brain fog you are experiencing is due to an energy deficit happening in your brain.

And it can happen at a very early age when you have PCOS. Nobody in their 20s and 30s should be dealing with symptoms of brain fog.

Let’s discuss why brain fog comes with PCOS

PCOS and Insulin Resistance

If you are doing any of your own research about your PCOS, then you know that it develops in a state of insulin resistance. Insulin resistance is a state that can create many different chronic diseases for many people and how those diseases manifest likely have something to do with genetic predispositions and/or where tissue-specific insulin resistance develops. A little known fact is that insulin is the master hormone that exerts effects on sex hormones and specifically, the conversion of some hormones into other hormones. It is this that goes awry in PCOS.

Shaikh, N., Dadachanji, R., & Mukherjee, S. (2014). Genetic markers of polycystic ovary syndrome: emphasis on insulin resistance. International journal of medical genetics2014. https://doi.org/10.1155/2014/478972

For those that are new to their understanding of insulin resistance, the basic premise is that because of a lifetime of highly processed foods, or even just eating more carbohydrates than our current metabolism can handle for whatever reason, an important part of our cells break. The insulin receptors. It is the job of insulin to push glucose into cells to be turned into fuel. But when there is chronic amounts of glucose in the blood, which keeps insulin constantly turned on and high, the receptors become desensitized. Glucose cannot be pushed into the cells appropriately and used. This leaves dangerous and inflammatory levels of blood glucose hanging around and doing significant damage to tissues as the body struggles to clear it.

I need to get through to you how much your body does not like excess glucose in your bloodstream. It literally only wants a teaspoon’s worth at any one time. Your body will store glucose in certain tissues like muscles, the liver, and a little bit in the kidneys. But if you are not a vigorous exerciser who depletes these stores and can sink extra glucose into muscle, it’s just hanging out in your bloodstream. Yes, your brain uses glucose but in a small amount. A much smaller amount at any one moment than the sugary beverage you just drank provided, or all those corn chips you had that were made into glucose immediately after eating. No, the fiber you imagine was in those corn chips does not slow down the rate of it being made into glucose to any appreciable effect. It hit your bloodstream like a bomb.

If you are a savvy reader, you may be saying wait a minute! Glucose transport into the brain is mostly independent of insulin. How can I get insulin resistance in the brain, exactly?

The exact link between insulin resistance and glycose hypometabolism in the brain is unclear, but boy oh boy does it matter for synaptic activity, brain metabolism, and neuroinflammation levels. All of which likely contribute to a state of hypometabolism causing cognitive symptoms in women with PCOS.

Let me show you.

Arnold, S. E., Arvanitakis, Z., Macauley-Rambach, S. L., Koenig, A. M., Wang, H. Y., Ahima, R. S., … & Nathan, D. M. (2018). Brain insulin resistance in type 2 diabetes and Alzheimer disease: concepts and conundrums. Nature Reviews Neurology14(3), 168-181. doi: 10.1038/nrneurol.2017.185

Do you see all the parts on the above image that read “IR”? IR, in this image, is referring to the presence of insulin receptors. The functioning of all these parts can become insulin resistant and as a result, can fail to access energy from glucose. These are all very important accessory functions for brain health, maintenance and function.

I could write a blog article easily on the importance of every single one of the structures and functions mentioned in this image. You need these to work properly to support the functioning of your brain. And I want you to know this so that if you read something on the internet that talks about how the brain doesn’t use insulin to uptake energy, you understand that that statement is woefully short-sighted about the need for functioning insulin reception within the blood-brain barrier and neuronal cells in the brain.

You can see from this excellent image, that if these neuronal structures that rely on healthy insulin transporters are not getting energy, the neuronal structures that make the cell work is going to fail to uptake energy in a healthy and sustainable way. Bottom line.

Brain Hypometabolism – why you have brain fog

And so here is how the cognitive symptoms you are experiencing in PCOS are neurological and not hormonal per say. Your brain is becoming insulin resistant, and you are beginning to become less able to utilize glucose as a fuel source. And that is why you are having brain fog, problems remembering, and possibly even mood issues that are not a direct effect of your hormone disruptions.

A brain awash in glucose that cannot push it into cells is a brain on fire with neuroinflammation. Neuroinflammation causes neurotransmitter imbalances, uses up crucial micronutrients constantly trying to repair the damage of this state and sets off a cascade of neurodegenerative conditions that will compound your cognitive symptoms. This affects your mood and directly perpetuates feelings of anxiety and depression, independent of your testosterone and other hormone levels.

If you would like to learn how neuroinflammation contributes to depression, you will want to read the below blog post:

It is really all very connected.

Why haven’t I been told this?!

I don’t know why we don’t tell women this. I don’t know why we don’t use diet and lifestyle to treat PCOS (and the brain fog it causes) as the underlying root cause of insulin resistance in mainstream medicine. But the issue of brain hypometabolism in women with PCOS is well documented.

The average age at which brain hypometabolism has been seen in women with PCOS is quite young with an average age of 25 years old and the reduction in the brains’ ability to use glucose was reduced between 9-14%.

That does not sound like much. But it is a devastating number for the brain. Especially when you consider that up to 40% of all the energy your body makes is used in the brain. Brains are devastated by energy deficiencies.

Our results show that untreated normal weight women with PCOS had lower regional brain glucose uptake in a pattern that resembles that seen in older persons and, to a lesser extent, in early AD [Alzheimer’s Disease]. 

Castellano, C. A., Baillargeon, J. P., Nugent, S., Tremblay, S., Fortier, M., Imbeault, H., … & Cunnane, S. C. (2015). Regional brain glucose hypometabolism in young women with polycystic ovary syndrome: possible link to mild insulin resistance. PLoS One10(12), e0144116. https://doi.org/10.1371/journal.pone.0144116

Brain scans that measure the uptake of glucose for fuel in the brain found that women with PCOS had decreased brain energy metabolism in the frontal, parietal and temporal cortex. And while these women were given cognitive tests that determined their function as “normal”, the women not only showed this decreased ability to uptake fuel in these brain areas using imaging techniques but were also complaining that their working memory was feeling impaired.

And this is one of the reasons why in my work with women who have brain fog, we work to allow them to validate their own experiences. You know your brain.

I don’t care if a woman’s cognitive tests came back normal, or their doctor said there was nothing to worry about. It doesn’t matter if their doctor said it’s “normal aging” (which I would hope they would not as we are talking about women in their 20s who have PCOS and symptoms of brain fog!).

Women know themselves. You know yourself. You know when your brain feels good and you know when it is not functioning as well as it once did. It might be that your brain has never felt great and you know it should work better. That’s valid. You get to pay attention to it and you have a right to know all the ways you can make it feel better. And that is what this blog post is all about.

How do I fix my brain when I have PCOS?

We have to change your brain fuel away from glucose and to ketones.

Ketones are able to go directly into starving brain cells and be used as an alternative fuel source to glucose. There are a few parts of your brain that will always need access to glucose. But you do not need to eat glucose to fuel those small parts of your brain that use glucose. Your liver is able to make all the glucose you need to fuel those parts of the brain through a mechanism called gluconeogenesis.

When you give a brain ketones to burn directly for fuel, the areas of glucose hypometabolism wake up and start to function again. Suddenly the neurons in your brain can make more cell batteries (mitochondria) and can use all that wonderful energy to think, remember, focus and feel. The neurons will have the energy to repair neuronal damage. And all the little cell parts and functions you saw in the wonderful image above happen to love ketones for fuel. They are able to either upregulate the function of those structures or just be taken in and used for fuel easily, bypassing those broken insulin receptors.

There are two ways to get ketones to rescue your cognitive function.

  • Consume substances that provide ketone fuel (e.g., MCT oil and/or ketone salts)
  • Restrict carbohydrate consumption enough that your insulin levels fall enough that you can make ketones out of dietary fat or your body’s own fat stores

Here is what you need to understand if you have PCOS and you want to heal all the symptoms, not just your brain fog. I know if you have PCOS that you have a whole lot of other really difficult symptoms to live with other than brain fog. And to treat those symptoms, you are going to have to choose a dietary therapy. Because the root cause is insulin resistance and in order to heal and feel kick-ass and amazing (which you deserve!) you will need to heal your insulin resistance. And the ONLY way to do that, my friend, is to restrict your dietary carbohydrate intake.

But I have an eating disorder! I can’t restrict!

If you have been diagnosed with active anorexia, then you are correct.

But here is the thing. Some of you with PCOS are suffering from weight gain or may even be technically obese. You may be in psychotherapy for the mood disorder component of your illness. You may have a therapist that is telling you that it is dangerous for you to restrict anything. That you need to focus on body positivity and use intuitive eating, and they may have diagnosed you with binge eating disorder or even bulimia. And so you believe that a diet that produces ketones using therapeutic carbohydrate restriction may be dangerous to you or off the table because you would have to restrict or reduce the non-essential macronutrient of carbohydrates.

But I am telling you that you need to get a second opinion.

Symptoms of binge eating disorder often happen as a result of insulin resistance because of other hormonal factors (e.g., Leptin resistance). And you have the right to know that binge eating disorders and even bulimia are being successfully treated by well-trained eating disorder specialists all over the world using ketogenic diets. It is just taking a lot of therapists and psychologists a really long time to understand and marry psychology and nutritional biochemistry into a treatment that considers both.

There is a great free webinar from a wonderful organization that literally trains functional psychiatrists about it here:

So don’t click off this page before you do your research. Find a low-carb informed doctor, psychiatrist, or therapist from one of the sites on the resources page.

Once your brain gets an uptake of those sweet, cognition rescuing, neurotransmitter balancing, inflammation-busting ketones you’re going to seriously thank me.

If you want to just try MCT oil and/or ketone salts to upregulate your brain energy metabolism, you can definitely try that. But I want you to understand that this is not going to stop your other difficult symptoms, which include the following:

Polycystic Ovary Syndrome PCOS Symptoms. Vector Set of icons

Those symptoms are all about insulin resistance in other tissues and also the effect chronically high levels of insulin have on the dysregulation of your sex hormones.

And for those to get better, you must get chronically high insulin levels down. Exogenous ketones (e.g., MCT oil and/or Ketone Salts) are not going to balance your hormones. They are not going to reduce or make skin tags disappear. They are not going to be able to do the work needed to make your periods less awful and painful. There is a treatment for PCOS and it is a ketogenic diet.

So yes, try some exogenous ketones and see if your brain feels better. In my clinical experience, this is a hit-and-miss sort of intervention without the dietary change. Some people feel a bit more brain energy, and some feel nothing. It’s hard to get the dosage right sometimes. And in my experience, the exogenous ketones do not work as well in a highly inflammatory environment, as the one that is being created through dietary and lifestyle choices.

Just please don’t try exogenous ketones and then decide that a ketogenic diet is not the answer. MCT oil and Ketone Salts are not comparable to a ketogenic diet. There are effects using therapeutic carbohydrate restriction (aka ketogenic diets) that you are not going to get with exogenous ketone supplementation alone. And you owe it to yourself to experience a brain that has upregulated energy, reduced inflammation, and better-balanced hormones and neurotransmitters. Everyone deserves to know what it feels like to have a brain that works optimally through nutritional and functional psychiatry practices that include a well-formulated ketogenic diet and personally optimized supplementation and lifestyle factors.

You deserve to feel so much better than you do.

And if the idea of a ketogenic diet sounds just too daunting, know that I have a program to help you through all the ups and downs and considerations of such a lifestyle change to treat brain fog. I help women reverse their brain fog all the time, regardless of the reason or the diagnosis they have been told is the cause.

If you want to learn more about my program please sign up for my email list here:

You can also contact me here to learn more about all the ways you can feel better! Rescue your cognitive function now. You need a well-functioning brain to live your life to the fullest and to be emotionally present and your best self for your important relationships.

I promise you it is possible.


References

Arnold, S. E., Arvanitakis, Z., Macauley-Rambach, S. L., Koenig, A. M., Wang, H.-Y., Ahima, R. S., Craft, S., Gandy, S., Buettner, C., Stoeckel, L. E., Holtzman, D. M., & Nathan, D. M. (2018). Brain insulin resistance in type 2 diabetes and Alzheimer disease: Concepts and conundrums. Nature Reviews. Neurology, 14(3), 168–181. https://doi.org/10.1038/nrneurol.2017.185

Castellano, C.-A., Baillargeon, J.-P., Nugent, S., Tremblay, S., Fortier, M., Imbeault, H., Duval, J., & Cunnane, S. C. (2015). Regional Brain Glucose Hypometabolism in Young Women with Polycystic Ovary Syndrome: Possible Link to Mild Insulin Resistance. PLOS ONE, 10(12), e0144116. https://doi.org/10.1371/journal.pone.0144116

Del Moro, L., Rota, E., Pirovano, E., & Rainero, I. (2022). Migraine, Brain Glucose Metabolism and the “Neuroenergetic” Hypothesis: A Scoping Review. The Journal of Pain. https://doi.org/10.1016/j.jpain.2022.02.006

Jarrett, B. Y., Vantman, N., Mergler, R. J., Brooks, E. D., Pierson, R. A., Chizen, D. R., & Lujan, M. E. (2019). Dysglycemia, Not Altered Sex Steroid Hormones, Affects Cognitive Function in Polycystic Ovary Syndrome. Journal of the Endocrine Society, 3(10), 1858–1868. https://doi.org/10.1210/js.2019-00112

Moran, L. J., Misso, M. L., Wild, R. A., & Norman, R. J. (2010). Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Human Reproduction Update, 16(4), 347–363. https://doi.org/10.1093/humupd/dmq001

Myette-Côté, É., Castellano, C.-A., Fortier, M., St-Pierre, V., & Cunnane, S. C. (2022). Ketogenic Diet: Emerging Applications. In Ketogenic Diet and Metabolic Therapies: Expanded Roles in Health and Disease (2nd ed., pp. 169–197). Oxford University Press.

Ozgen Saydam, B., & Yildiz, B. O. (2021). Polycystic Ovary Syndrome and Brain: An Update on Structural and Functional Studies. The Journal of Clinical Endocrinology & Metabolism, 106(2), e430–e441. https://doi.org/10.1210/clinem/dgaa843

Polycystic Ovary Syndrome (PCOS). (2022, February 28). https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos

Shaikh, N., Dadachanji, R., & Mukherjee, S. (2014). Genetic Markers of Polycystic Ovary Syndrome: Emphasis on Insulin Resistance. International Journal of Medical Genetics, 2014, e478972. https://doi.org/10.1155/2014/478972

Université de Sherbrooke. (2019). Brain Metabolism in Women With Polycystic Ovary Syndrome: A PET/MRI Study (Clinical Trial Registration No. NCT02409914). clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT02409914

Zhu, H., Bi, D., Zhang, Y., Kong, C., Du, J., Wu, X., Wei, Q., & Qin, H. (2022). Ketogenic diet for human diseases: The underlying mechanisms and potential for clinical implementations. Signal Transduction and Targeted Therapy, 7(1), 1–21. https://doi.org/10.1038/s41392-021-00831-w

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