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If you’ve been told you have PCOS (or you suspect you might), you’ve probably been left with more questions than answers. It’s one of the most misunderstood conditions out there, and far too many people are misdiagnosed, under-treated, or given the same tired advice: “just lose weight” or “take the pill and see.”

In a recent conversation on the podcast with endocrinologist Dr Sabrina Huq, we cut through the noise and talked about what PCOS actually is, how to get properly diagnosed (including the key lab tests), and why spotting it early can change your long-term health, including your chances of a healthy, natural pregnancy.

In this blog post, I’m sharing the main takeaways from our conversation, including Dr Huq’s practical approach to managing PCOS through food, movement, sleep and stress.

What PCOS Is (And Isn't)

First things first: the name is misleading. Polycystic Ovarian Syndrome suggests you need cysts on your ovaries to have it, but that's not true. In fact, you can be diagnosed without ever having a pelvic ultrasound showing those characteristic "cysts" (which are actually immature follicles, not true cysts).

To get a proper PCOS diagnosis, you need two out of three criteria:

1. Irregular periods
2. Clinical signs or blood tests showing excessive male hormones (like testosterone)
3. Multiple immature follicles on a pelvic ultrasound

The key point Dr Huq emphasized: you only need two of these three. So if you have irregular periods and elevated testosterone, that's enough—even without the ovarian findings.

It's also important not to diagnose PCOS too early. It can take up to eight years after a girl starts her period for her cycle to fully mature, so we're typically looking at late teens or early twenties before making a clear diagnosis.

The Labs You Actually Need

If you suspect PCOS, don't try to self-diagnose. Dr Huq stressed that while social media makes it easy to think you can figure it out yourself, there are serious conditions we need to rule out first, including endometrial cancer and adrenal issues.

Here's what should be checked:

• Fasting glucose and fasting insulin (to look for insulin resistance)
• Hemoglobin A1C (though this can be inaccurate if you have heavy periods or iron deficiency)
• Testosterone levels—specifically free or bioavailable testosterone, not just total
• Thyroid function
• Prolactin levels

One critical note: if you're on birth control pills or any hormonal contraception, testosterone blood tests won't be accurate. You'll need to stop hormonal contraception for a couple of months before getting tested.

Why Early Diagnosis Changes Everything

PCOS affects one in five women, and it hits at the most vulnerable time in your teens and twenties, when you're already dealing with enough. But here's the good news: if caught early and managed well, you can absolutely have a healthy, natural pregnancy.

Beyond fertility, early diagnosis helps you avoid long-term complications like type 2 diabetes, heart disease, and endometrial cancer (which can develop when periods are skipped for months at a time).

The Diet Approach That Works

Dr Huq's approach to nutrition is refreshingly practical. She's moved away from just referring patients to dietitians and now does the counseling herself because she found it made a bigger difference when she worked closely with patients on their food choices.

Start with breakfast

About 90-100% of her PCOS patients skip breakfast or only have coffee. But for a healthy metabolism, you should wake up feeling hungry after your longest sleep period. Skipping that first meal sets you up for blood sugar issues all day long.

A good breakfast example:

• Half cup of old-fashioned oats (not instant)
• Whole milk or almond milk 
• Greek yogurt or egg whites
• Chia seeds, flax seeds, berries

It doesn't have to be complicated. Boiled eggs prepped the night before, or a simple egg white omelet with spinach works perfectly.

Focus on whole foods

The key is eating foods in their whole form as much as possible. That means avoiding:

• Liquid carbs and sugars (smoothies, juices, protein shakes in plastic bottles)
• Ultra-processed foods
• Anything that's been through a blender

Why? Because liquid or blended foods cause massive insulin spikes. And with PCOS, every insulin spike sends excess insulin to your ovaries, which then produce more testosterone.

Food ordering matters

This is something endocrinologists have known for years: eat your fiber and protein first, then carbs. Think of it as "layering your stomach" by coating it with fiber and protein before adding carbohydrates. This significantly reduces blood sugar spikes.

Movement That Makes a Difference

Dr Huq's exercise recommendations are surprisingly simple and sustainable.

Post-meal movement (10-15 minutes)

After every meal, move for just 10-15 minutes. That doesn't mean you have to go out for a run. It can be:

• Walking around your house
• Doing calf raises at your desk
• Light stretching

Those few minutes make a huge difference in how your body handles the meal you just ate.

Strength training (3x per week)

This is non-negotiable for PCOS. But it doesn't mean becoming a bodybuilder or even going to a gym. Start at home with:

• Planks
• Wall pushups (progress to desk pushups, then floor pushups)
• Squats

Just 10 minutes, three times per week, with 1-2 days rest in between. Your muscles have memory for about 48 hours, so this frequency keeps them engaged without overdoing it.

And forget about jogging if you hate it. Walking works just as well, and it's far more sustainable long-term. 

Why Sleep and Stress Matter

Many women with PCOS have undiagnosed sleep apnea, which interferes with weight loss and causes hard-to-treat high blood pressure. If you wake up tired or fall asleep during the day without meaning to, get checked for sleep apnea.

And when it comes to stress, although you can't eliminate it, you can control how it affects you. Dr Huq's approach is simple: if you can do something about a stressful situation, do it. If you can't, let it go and distract yourself with other things.

The Endocrine Disruptor Issue

This is something Dr Huq is passionate about, especially for women trying to conceive. Endocrine-disrupting chemicals are everywhere:

• Plastic containers and bottles (especially when heated)
• Takeout containers (even cardboard is often lined with plastic)
• Fragrance plug-ins, candles, and air fresheners
• Hand sanitizers (soap and water works better anyway)

Simple swaps:

• Use glass containers for storage and reheating
• Limit takeout to once a week max
• Skip the fragrances
• Use soap and water instead of constant hand sanitizer

Is it hard to avoid all plastics? Absolutely. But doing what you can makes a real difference.

The Supplement Reality Check

Dr Huq takes a measured approach to supplements. Here's what she recommends:

Worth taking:

• A prenatal multivitamin (even if you're not planning pregnancy)—look for NSF or USP certified brands
• Vitamin D—but only after checking levels (she's seen dangerously high levels above 120)
• Iron/ferritin—especially if planning pregnancy or dealing with hair loss

Her vitamin D target: 30-50 ng/mL 

What about inositol? If patients are already taking it, she doesn't necessarily stop it. But if they show insulin resistance, she switches them to Metformin because it's more regulated and we know exactly how it works.

When Medications Actually Help

Metformin This is Dr Huq's go-to for insulin resistance in PCOS. It's well-studied, we know the proper dosing, and it can be continued until you get a positive pregnancy test.

GLP-1s While GLP-1s can be helpful, Dr Huq worries about putting young patients on medications they won't be able to afford long-term. If someone tells her they can only afford two months, she won't prescribe it because weight cycling (losing then regaining) is actually worse for your health than maintaining a stable higher weight.

The good news is, diet and lifestyle changes really can make a huge difference. And Dr Huq sees it with continuous glucose monitor data all the time.

Signs You Might Have Undiagnosed PCOS

Watch for these red flags:

• You've needed Accutane multiple times
• You have a history of restrictive eating because you gain weight easily
• Dark patches on your skin
• Frequent yeast infections
• Excessive hair growth or hair loss
• Acne that doesn't respond to typical treatments

If any of this sounds familiar, it's worth getting properly evaluated.

The good news: PCOS is manageable

PCOS can feel relentless when you don’t have clear answers. But with the right diagnosis and the right support, it’s absolutely possible to reduce symptoms and protect your long-term health, especially when it’s caught early.

If you want a simple place to start, focus on the fundamentals that make the biggest difference:

• Get properly assessed with the right lab work 
• Build consistent meals around whole foods and don’t skip breakfast
• Move after meals and include strength training regularly
• Prioritise sleep and take stress seriously (it shows up hormonally)
• Reduce endocrine disruptors where it’s realistic 
• Work with a clinician who understands PCOS and won’t brush you off

If PCOS has made you feel like your body is “fighting you,” the full conversation with Dr Sabrina Huq is a must-listen. We unpack how metabolism, stress and sleep interact with PCOS symptoms, and how to approach food in a way that supports your hormones, 

 

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.   

 

 Welcome back to the podcast everybody. I'm so excited. We have Dr. Sabrina Huq on she's an amazing endocrinologist that I have now known for a little period of time, but oh my gosh, is she knowledgeable? And frankly, when I was seeing more of the work that she was doing.

I really was like, Hey, can you come on the podcast? Because I think that there are a lot of endocrine conditions that I'm gonna say specifically women, not that men are not included in this conversation, but for women today is who we're gonna focus on with PCOS. I think that's just a really misunderstood area.

Can we start out with you just briefly introducing yourself? Tell us about your clinic a little bit, how you help people, and then I have so many questions for you. Sure. Sabrina. Huq I'm an endocrinologist, so I see adult patients and I'm also board certified in obesity, medicine and internal medicine.

And I also do a lot of menopause treatment. I'm originally from Bangladesh. I can't pronounce it any other way. It's a little country near India, but I grew up in Middle East in, Abu Dhabi. And then I went from medical school to India and then I came here. I did my residency in Montefiore Bronx, and then my fellowship at Henry Ford in Detroit.

But I love New York. I love the diversity of it, and because I speak multiple languages, it's where I feel like New York City's as diverse as I am. My clinic right now, it's a adult private practice in endocrinology. I see a lot of diabetes. PCOS. Obesity, menopause and I use a lot of continuous glucose monitor in my patients and I feel like that gives me a lot of information that is also helpful for my PCOS population.

Overall I've been very privileged. I learn from my patients every day and I think we are able to make some real difference in people's lives. Oh, thank you for that introduction. I did not know all this about you, and I find that, when you have all these experiences, what we know is so much better at the end of it.

I wanna shift gears to talking about PCOS. Can we start out with you just first defining it? 'cause I think that people really don't understand what it is. PCOS stands for polycystic ovarian syndrome. The name's not really accurate because we get the impression that we have to have multiple cysts in our ovaries and also .

What we're looking for is not really cysts in ovaries. We're looking for multiple immature underdeveloped follicles, and the follicles have to be a certain quantity, but the name is not really accurate because someone does not have to have. A pelvic ultrasound to get a diagnosis of PCOS. And even if someone does get the pelvic ultrasound, they don't actually have to have the cysts in the ovaries or the immature follicles in the ovaries.

So the name can be misleading in that way. But, because the PCOS terminology, the name has been very commonly used, it's still being used often. What it really means is we want to make sure that someone needs two out of three criteria, and that we rule out other hormonal issues. So the two out of three criteria is number one, irregular periods, and also clinical signs or blood tests that show excessive male hormone levels.

Female patients have male hormone levels. All females have male hormone levels and males have female hormone levels, but we don't want to see excessive amounts of male hormones in a female body. We also look for the pelvic ultrasound. If it does show the multiple follicles, then that counts towards the diagnostic criteria, but it doesn't have to be present.

Okay. Can a woman have PCOS if she. Let's say that we don't have the ultrasound, and they don't have irregular periods. Is there still a version that they could have? Yes. That's a really great question. So we want to think about what normal periods are, so when a girl hits puberty, we start off with breast development and.

Within two years of breast development, we would expect a normal puberty girl to start having periods. Hmm. So if a girl does not start having periods two years after breast development, then that's something for moms to bring up to their physician, or that's something for the teenage girl to talk about, to bring it up as something to be concerned about.

Early teenage years, we should not be labeling someone with the diagnosis of PCOS because it still takes time for the menstrual cycle to mature. It can take up to eight years actually. So we have to make sure that it's an adult female patient that we are seeing for PCOS before we label them as such.

So probably late teens, early twenties, we can be clear on the diagnosis. Okay. That's really good information because I feel like I know I don't see kids, so maybe that's why I'm like, oh, great to know. 'Cause I feel like I'm seeing girls online at a really early age being like, I have PCOS and I'm sitting there like, you're 14.

How are you saying that right now? So I think this gives us some really good context. Yeah. And, it's always good to know what normal periods look like so that we know what an abnormal period should look like. Normal periods, the cycle length is usually about 21 to 35 days. At each person has their own type of normal for them.

Let's say for someone, they're getting their periods every 30 days. That means every 30 days, within two to three days of that 30 days, you expect to get your periods. So it cannot be 21 days, one month. And then 30 days the next month for the same person. For the same person, the period cycle length should stay constant.

There are a lot of great apps that are present nowadays. I use, FLO, that's flow. That's the one that I recommend to my patients. You don't need a super complex version. You just need to keep track of your cycles from month to month. And I think of it as like a vital sign like, when we take blood pressure, when we take height weight, keeping track of your cycle length is your vital sign that you keep track of, and this will help you in your teenage years. This will help you when you're trying to see whether or not you have regular periods. This will help you when you try to conceive, when you try to plan a healthy pregnancy.

And this will also help you during perimenopause and menopause. Yeah, I love that you bring up the full arc because I find that when women wanna get pregnant now, they suddenly become concerned, like now they're like, oh, I was never seeing how many days we're in between periods. And I like what you're saying, you should actually always have an understanding of this,, just going forward.

I know you said, rule out other endocrine conditions. What labs do you think are super standard, like we need these , to understand PCOS and then this to understand that it's not something else.

Yeah, that's actually a very important question because nowadays in social media, we see diagnose yourself and then maybe we give the impression that you don't need to see a doctor, but it's super serious. To make sure that you don't have scary things, because scary things can happen. So especially if you're missing periods, you're skipping periods for months and months entirely.

It does increase the risk of endometrial cancer, and that can happen in younger patients too. So if you're going for months and months without periods, your uterine lining, the lining inside your uterus builds up and it's not supposed to be there. So those cells start changing. It can lead to bad things.

Mm-hmm. Especially if you have missed your periods for three months, for four months, make sure you see your doctor before you, and you probably do have the diagnosis of PCOS. But it's also important to make sure we're not missing these rare issues. The other thing that we worry about, especially in endocrinology, is sudden change in symptoms.

That means you're suddenly developing within a period of months, you're developing, deepening up your voice, you're developing excessive hair that you had not noticed before. That could be something as serious as adrenal cancer. So we want to make sure that we keep an idea of the timeframe. You want to make sure that you are seeing somebody before you self-diagnose yourself.

We also want to rule out things like abnormal thyroid issues. We want to rule out excessive. Prolactin hormone levels. We want to rule out Cushing syndrome in rare cases, but typically thyroid and prolactin. But we also want to make sure we're not missing the serious things like endometrial cancer and adrenal issues.

Yeah. Okay. That's so good. When you have diagnosed someone with PCOS, what are things that you commonly educate on that they need to know about having PCOS or just things that they might need to consider for the future? Like maybe we take the perspective that this person's like 20, 25 years old, maybe they're not married yet, they don't have kids yet.

Just giving a picture of what kinds of things would you be telling them about. The earlier we diagnose someone, the better it is and it makes the whole process a lot easier for patients. So PCOS at its core, is multifactorial. Genetics can play a role, but genetics are not destiny and epigenetics also plays a role.

It's the environment that your mom was in when she was pregnant with you. It's your environment. Your dad's health also plays a role. It's your environment when you're growing up, how much endocrine disrupting chemicals you're exposed to. What kind of messaging you get, the stress. All these things do play a role.

Metabolism plays a huge role in PCOS. So metabolism means anything that you've taken from the environment. It includes food, the chemicals you're exposed to, the air that you breathe, the kind of population that you're exposed to. All these things play a role and because so many things play a role, if we know which aspects to change, we can have a really good control of our health.

And PCOS. Ideally I want anyone who's diagnosed with PCOS to know that if they can control their metabolism early on, they can have a healthy pregnancy. One of the biggest misconceptions that I see, and one of the most common concerns that patients have is, will I be able to get pregnant?

So if we diagnose someone early enough, they probably can get pregnant naturally and they probably will have a healthy pregnancy. That's amazing. Let's say that they're having trouble,, their blood sugar's starting to go up, insulin resistance, things like that.

What kinds of things are actually helpful for them to look at as far as either lifestyle or medications? Just all of it. First we want to take a look at whether insulin resistance is there, and we often think in medicine that it has to be in a flow chart way, but we're not textbooks.

For example, I see patients with pre-diabetes without the lab tests showing insulin resistance. So anything can happen. We should not say that, we should only check insulin. We should not check the HB one C. We have to check a combination of things to make sure we're not missing something.

Typically I look for insulin resistance in the form of fasting glucose and fasting insulin. The hba one C, the average hemoglobin A1C blood test that we commonly do. One thing to keep in mind is that if someone is having heavy periods or if they have iron deficiency anemia, the hemoglobin A1C may not be accurate.

The other test that we do is, , we check. Hormone levels like testosterone, , levels. When we check testosterone levels, we also want to make sure that we get the free testosterone or the bioavailable testosterone because we really want to check if the active form of testosterone is abnormal. Sometimes the total testosterone can look normal, but the active testosterone is abnormal and we won't really know unless we know that we have to look for it.

The common thing that I see is. Birth control pills are very commonly used, but if someone is taking birth control pills or if they have any other form of hormonal contraception, then we cannot use blood tests for testosterone to diagnose someone with PCOS at that time. There's also a misconception that, okay, I'm on birth control pills anyway.

What's the point in, knowing whether or not I have PCOS? It doesn't really work that way. Birth control pills will probably not. Treat you fully for PCOS and it's super important to know whether or not you have the diagnosis because you want to know that if you stop birth control pills, what will your testosterone levels look like?

Will your periods become abnormal again? So definitely having a clear diagnosis is super important. So what do you do with the labs if they're already on birth control? What approach then do you take to confirm it? I ask patients to stop their birth control pill., But I always discuss with, them, and we always make sure we have a pregnancy plan in place and I typically ask them to stop it for about a couple of months before repeating their blood tests.

That was like my next question. I was like, how many months? Okay. When you're saying, fully get it treated, what types of treatment do you typically, either you use or you see used often. It depends on what their blood tests look like and what their overall health looks like.

If I see signs of blood tests showing insulin resistance, like fasting glucoses, textbook is different than real life. Textbook is different compared to clinical practice, as you know, you know. So what I look for is fasting blood glucoses. If I see them starting to creep in the nineties.

That's actually a good sign that they're starting to show borderline diabetes, even though, in textbooks we say we see 100 to 1 26. I'm gonna stop there for a second. 'cause that's actually really interesting because I feel like I'm so used to using the hemoglobin A1C, and I do look at impaired fasting glucose in the morning.

But I guess I just wouldn't say, oh, that this is, the nine. I don't know. That's just really interesting. I always feel like it has to break the a hundred. Yeah. Okay. Yeah. And in our minds, because we read guidelines, so because we want to stay evidence-based and we think of it as a finite number.

Mm-hmm. But it's actually a spectrum. I look at it at, in, different aspects and different angles. If I see fasting blood glucose is in the nineties, then I want to make sure that I get to the oral glucose tolerance test, which is the 75 gram glucose lowering, glucose test. And then we get the fasting glucose, we give them the 75 grams glucose load, and then we check the glucose again in a couple of hours to see what the peak has been because.

Oftentimes the glucose load or the postprandial glucoses start becoming abnormal before the fasting glucoses show up as abnormal. Yeah, and that makes a huge difference, especially nowadays with the GLP ones commonly in the market. Because if we see that the oral glucose tolerance test shows an abnormal glucose in the level of the.

Diabetes range, someone can qualify for GLP one agonist medications and that can be life changing for someone with PCOS. Yeah. I think that was something when the meds first came out, 'cause so many people were getting on them without labs 'cause quote unquote, you didn't need labs before you started, but then you really didn't understand how sick they were metabolically.

And then they already were treated at that point. And so going back, let's say that someone was on a GLP one, but they know, historically sugars were high, but they never really got it confirmed. How long would they have to hold the GLP one to do an oral glucose tolerance test to have it be accurate?

I'm going to use the scenario of nowadays we start, for pregnancy planning, we recommend patients to stop GLP one, two months beforehand. Mm-hmm. So I would assume two months should be enough because GLP one. We know that it's dosed weekly, the more common ones, and three to four half lives, or four to five half lives.

So two months should be a good amount of timeframe. Yeah. Amazing. Alright. So you talked about, how sick they are dictates what we do. So let's say that they are starting to have those impaired sugars. What type of conversations do you have with the patient? Then what you're talking about here, where the sugars are starting to be elevated.

This is my favorite part about seeing all my patients. I love starting from the basics. If it's diet resistant blood pressure, obesity, PCOS, you know, in our guidelines we see how diet, lifestyle first. And then we skip that part and we jump to medications. Yeah. I like to go back to the diet lifestyle and I like to start with that.. I've grown a lot as a clinician, as I've been practicing medicine, and especially now with CGMs, continuous glucose monitors. What I started noticing was initially when I would practice medicine, I would give them a referral for a dietician or a nutritionist, come back, not much change, adjust medications, not a huge change.

Yeah. But then what I started noticing is when I started doing the diet and lifestyle counseling myself. Huge change in the CGM glucose monitors for both my PCOS patients, my diabetes patients, my weight loss patients. Can I tell you why I had the same thing happen in my clinic? Because in the beginning when I started my clinic years ago, I had dieticians

and I thought, okay, they'll meet monthly with me and monthly with them. And they were only coming to me and I was like, wait a minute, I mean, if registered dieticians are listening, you are not all created equal. But what I learned over time was I was doing much more of it closely with them and we were getting so much further.

So I love hearing you say that too 'cause it makes me not feel as, out there with saying that. Yes. And I would find myself begging patients, please go to the dietician, please see the nutritionist, but., It takes a lot for a patient to show up to the doctor's office. We don't make it easy.

Yeah. Oh, totally, so I go over diet, lifestyle counseling. One thing that I see very commonly, most patients, probably 90 to a hundred percent, my patients with PCOS. Often skip breakfast. Yeah. By skipping breakfast, what I mean it might be coffee or it might be nothing, and that kind of sets the tone.

For the rest of the day, we want to focus on whole foods, so skipping breakfast, probably not a good sign of a healthy metabolism. So for a healthy metabolism, when you wake up in the morning or whenever after you've slept your longest period of time, you're supposed to feel hungry you're supposed to have that hunger.

Yeah, so you start off your day, have a good breakfast. The other thing that I talk to patients about is. The difference between processed food and not so processed food. We all process food in some way. Just taking food, washing it, chopping, it is processing. But we don't want ultra processed food.

We don't want food like substances in our diet. We want to eat whole foods in their whole form as much as possible. What I notice, especially because I. I have a lot of data with continuous glucose monitoring, is that whenever we eat liquid sugars or liquid carbs or liquid foods of any kind or anything that has been through a blender, like your smoothies, your green juice, your juice, your protein shakes, your milkshakes.

Insulin spike. Mm-hmm. Each time that insulin spike occurs, the excess insulin goes to the ovaries in our PCOS patients, and it makes the ovaries put out more testosterone. So we want to make sure that we are eating whole foods in their whole form. Yeah. So it can be something like, healthy carbs like oatmeal, but the actual old fashioned rolled oats instead of instant oats.

That has been like steel cut. Not oat milk because oat milk is not really oat oatmeal in its whole form. We want to really pay attention and. Really look into what's processed, what's not processed. We want to look at labeling, processed food, has a lot of marketing done on their behalf. I tell my patients to think about like the men and women in SOS who are sitting in a conference room planning on how to make patients overeat on soda over eat, on diet soda.

Yeah. Over eat the chips, how crunchy they are. It's a huge marketing industry that makes us eat and makes us crave all these processed foods that are actually harmful to us. Yeah, I was talking to another physician friend of mine and I was talking about how I find that, physicians and therapists in the addiction space, I just find it fits so well with what I'm doing.

And then we were talking about, yeah, that the food industry wants you to get addicted to the food. So it's like, of course we need the same strategies to get off other substances that might be happening. Same thing with food. I wanted to ask you what is a breakfast or two?

You're like, this is a great combination. Or maybe something that you like, again, not that it's like perfect, but I always like to get your thoughts on that. Yeah I actually talk to my patients a lot about food. I never thought that I would be doing this, when I started endocrinology.

But, for example, we want to think about a good. Lean protein with high fiber breakfast, so a balanced meal. Carbs are great, but carbs are great in combination with other foods. So if you want to do quick breakfast, it can look like something, like a half cup of oatmeal with, some whole milk. If you like to drink milk, I would say avoid the 2% milk or the fat free milk because those are more processed and it takes out the nutrition.

From all that processing. Have a cup of oatmeal with whole milk or with almond milk, not oat milk. And also you can add in some Greek yogurt. You can have your egg whites. You can add some chia seeds, flax seeds, berries. Just whole food. And it doesn't have to be super complicated. It can mean boiled eggs that you boil the night before it can mean just egg white omelets with a whole bunch of organic spinach, but doesn't have to be complicated, but you have to. Plan ahead. So you make it easy for yourself when you're in a rush. In the morning, I what you're mentioning, literally this morning it was half a cup of oats, home milk, frozen blueberries.

So I'm like what you're saying and I do a lot of chia just like in water sometimes with meals if the fiber's not high enough, but, okay. I love that you brought this up 'cause it's simple, right? And also the fact that you're talking about the using the whole products. 'cause I talk to people about this too.

People are always trying to get the lowest calorie Greek yogurt. It's like, yeah, but then you have no fats in it and you're constantly scrounging and feeling horrible so we need you to actually feel normal. We need hormones to be regulated. So, I love that you're talking about that as well.

I have another question that seems unrelated, but, I have a really nice, person that wrote me and asked me this, I know you're gonna probably not be a fan of it, but what are your thoughts about all these products where it's like, it's a peanut butter cup, but they put protein in it, right?

I call 'em like Franken Foods, but do you think it's , okay, that's a better for you option? Or you like just don't even waste your time? , What's your thought on that? I don't have a hard and fast rule really. I'm more like, okay, if you find yourself having cravings throughout the day, I want to make sure you're not skipping meals.

Because if we're skipping meals, our brains and our minds we're really intelligent. We're built, we're very intelligent beings. If we're not feeding our minds, we're not feeding our brains. Then our brains and our minds, we need energy, so it makes us go out and eat food. Yeah. We want to make sure we're fueling throughout the day we get enough protein.

And then if despite that you're still having cravings, you still want to eat something, have it, but have your whole meal first. So have your protein, have your healthy fiber, and then have whatever you're craving. I'm not a fan of deprivation. I don't say never do this or never do that. But get your real food in first so you can, feel like, okay, I can have this.

I don't feel deprived. We lower stress. Stress does not help anything. Stress does not help any hormones. Yeah. Definitely, it kind of reminds me of, I always say delay, don't deny. . Because once you have that whole based meal, you just feel different. You're not even thinking the same thoughts anymore about what you want.

Right. What are your thoughts on, best times to exercise or certain things you're like, I want everyone to do this. What are your thoughts on that? Yeah. So couple of, exercises and exercise times that really help patients who are suffering from PCOS. One is after you eat your meals, the 10 to 15 minutes after you eat your meals is super .

Important. So we want to make sure that you're not just sitting in one place, that you're not just watching tv, you're not just at your desk, rushing. You're not falling asleep. Those 10 minutes after you finish eating. We just want to move. It doesn't mean, going and running it can mean just going for a walk inside your house or it can mean if you're sitting at a desk doing some, cal phrases, pushing up on your feet just doing some stretches, but any little movement counts.

Those, 10 to 15 minutes after you finish eating. The other type of movement that really helps in patients with PCOS, insulin resistance and other types of metabolic issues is weight training or strength training. Strength training does not have to seem very overwhelming. It does not mean going to the gym. Few of my PCOS patients, it's better nowadays. But it used to be like, patients would come to me thinking that they would become bodybuilders if they start doing weights, but. Bodybuilders, I wish very hard. Right? It's a full-time job. It takes a lot to actually put on that amount of muscles.

It's not easy. Yeah. So no one will accidentally become a bodybuilder or a weightlifter. . The strength training that really helps is three times a week with one to two days gap in between because our muscles have muscle memory. Our muscles remember the workout couple of days, about 48 hours after we work them out.

So it can mean doing planks at home. It can mean doing pushups, it can mean doing squats. Pushups can be from varying grades. We can use the wall, then we can use the desk, then the actual floor pushups. But. If you make strength training a part of your life, it can really sustain you lifelong.

Yeah. Do you have a, this is the minimum amount that I expect from you? Or , how do you do that with people? Just 10 minutes, three times a week. At home, start at home, all the things you're saying. I'm like, I'm so glad I'm not wrong. I mean, I see it clinically like I'm following the body composition.

But exactly what you're saying in fact, I just had someone earlier today and they were saying, I don't feel the motivation to, and I was like, first of all, you're never gonna feel that No one's like, yes, that's go do strength training. It's not necessarily fun on the body. But it's interesting, I was looking at this, study from a few years ago, and this is gonna be totally kept and obvious, but they basically showed that people that had a routine, those were the only ones that really kept up with things.

'Cause they had less decision fatigue, right? It was gonna happen that time in the week period. They didn't need to like it constantly redecide. And what I see with strength training is that. If it's a walk, someone will have a scheduled time, but with strength training, they just leave it up in the air.

Like, I'm gonna get inspired during the week when to do it. It's like, that's not gonna happen. Yeah. And that's such a good point. And I make it a point with my patients to bring it up each and every time. I find that if I nag them just the right amount of time, at some point it'll be the right time when they needed to hear it.

I have patients who do squats when we, when they brush teeth, because. The whole day goes by in a rush. So anything that you do at any point in time really helps. The other misconception that I see when it comes to exercise and PCOS is we think that we need to jog or we think we need to go for a run.

It doesn't have to be that way if you do just plain, simple walking, but just move your body any amount that you can every day. It counts. Yeah. And people have lost weight and they've kept it off with walking and strength training alone. You don't have to jog even. You can just walk. Yeah, I think you know some about my journey, but it's been six plus years of me just every year working on this.

And walking is my thing. It's my jam. Everyone that listens, knows they're probably sick of hearing it, but it's sometimes in my head as I've lost more weight, I've been like, oh, well, should I jog or should I this or that? Because back in the day in college, I had a trainer and I got to the place of running a few miles.

. But I hated every single minute of it. But that's what that trainer wanted from me. . Then I'll try to do these little running intervals and then inevitably I get hurt and I don't like it. And I'm like, you don't need to do this. The walking is just fine. Yeah. And forget that. Yeah. Right. And to your point, exercise should feel low stress to your body.

I don't want anyone to exercise to the point that they can't work the next day, that they cannot go to school the next day where their knees hurt so much. Mm-hmm. Walking really works. You don't have to put excessive strain on your joints. It doesn't work that way. And we want to make it a part of our life so that we see someone has good health 10 years down the line, 20 years down the line.

It's not about losing weight in a month or two by trying a super low carb or super low calorie or a keto diet, and then regaining that weight. Definitely. Any other lifestyle things with sleep or, I know you mentioned stress being a concern as well. Anything else that goes in the lifestyle category?

Yeah, so stress management is, key. We have to make stress part of our lives. The solution cannot be escaping stressful situations. We just have to remember that stress will always be a part of our life, but it's in our control. We can choose, how it affects us.

So stress can be there, but we don't have to internalize it. I discuss stress management with my patients too. And what we talk about is that, okay, if you're in a stressful situation, can you do something about it or it's out of your control? Because we cannot control other people, okay? If it's not something you can do anything about, you just have to let it go.

Distract yourself with other things, and then you'll find yourself forgetting it. Sleep is extremely important. A lot of women with PCOS have sleep apnea that's undiagnosed and it really interferes with their weight loss journey. It causes, high blood pressure that is hard to treat, which leads to pregnancy complications like, having to need.

Blood pressure medications during pregnancy. Mm-hmm. So for PCOS patients, it's very important to make sure that if you have sleep issues, you wake up feeling tired, or you're falling asleep without wanting to during the day, then you have to get that checked out and make sure that we're not missing obstructive sleep apnea.

The, other thing that I see often is, in terms of endocrine disrupting chemicals, we talk about this a lot. That's another reason not to drink these protein shakes that we get in plastic bottles or getting, you're killing me. I know. I've been trying to break the habit, but Fair life is so good.

Oh, okay. Oh, I'm sorry. No, no, no, no. But wait, okay, so plastic, right, and I feel like if it's heated, it's even worse. What other endocrine disruptors do you see commonly?, Another reason not to get takeout so often. So all these takeout boxes, plastic, even if it's cardboard, it's lined with plastic.

I know process. So takeout is maybe once a week, just to relax with your family. But it should not be only about the food, it should be about the relaxation. It's about socialization. So all these things really add up. For my patients, especially when they're trying to get pregnant, I make sure that we , cover all these things, use glass containers, reheat food in microwaves, using glass containers.

Don't use all these fragrances, and then plug and spray, and then fragrance, , candles, like so much exposure that we don't really need. I know, I have a stepdaughter that's 14 years old and. She smells fabulous, but I'm like, oh my God, this is gonna destroy you. How can I broach this topic without sounding like I'm trying to control you, but I care about your future.

You know? I don't think people realize all this, I find it really overwhelming because I even grew up in a family where my mom did,, glass for us with all the things. This was like a physician household, so they were doing all this before we even knew about all this kind of stuff.

But I have found that it's like, do you not use a Ziploc bag? There's just so much that I'm trying these things, but it's really hard. It's more effort, you know? 'cause you've gotta actually wash the dishes and, I don't know, it's harder, I think. It is hard, but it makes a real difference.

So with the Ziploc bags, I was much better about these endocrine disrupting chemicals when I didn't have kids. Yes. But that's, thank, it's kind of impossible, avoiding plastics, impossible, avoiding all these extra things that just creep up into our lives. Right. But it's not that one thing or that two things.

It's like, how much better can you do? Yeah. And instead of using just hand sanitizers, alcohol, killing all our germs, killing all, all the bacteria, just soap and water works really well. Yeah. That's why soap and water for all these dangerous infections that we get in the hospital system. Yeah. Like with the c diff, yeah.

Yeah. So we say soap and water is the best thing. Better just to do it. As much as possible. And we talk about washing dishes, right? But, even those little, little movements throughout the day, they build up towards increasing our activity levels. Yeah. That helps to just burn more calories in the long run.

I actually have a question still about with endocrine disruptors. So I had someone online ask me, well, how can I tell if it's getting better? How can I tell what's affecting me and if it's getting better and i'm wondering what your answer is and can you recheck opin levels? Is there anything that you can actually check to see if it's getting better? That's a good question, but I don't know much about whether there's actually an objective test. I don't think so, but I think there are a lot of things that. We don't know much about. Yeah. But we do anyway. So it's just about doing as much as possible in every area.

Stress management definitely plays a big role. Endocrine disrupting chemicals more, especially in a. Women's lives when they're trying to plan a pregnancy because we want to avoid all those unnecessary exposures. But in terms of objectively measuring, I don't know. But PCOS population specifically, I would say just cycles coming back at regular intervals is a really good sign.

Yeah. So if someone's periods are coming back at regular predictable intervals, we can do a day 21 progesterone to see if they're actually ovulating. Love it. Yeah. It's not so cut and dry as nothing it. Right. Right. And the more we study the more we know, the more we don't know. That's what I say too.

I always say the smartest I ever felt was. Junior year of high school, I was in AP biology and I was like, I know everything. And then after that I kept learning, but I was like, I know nothing. I know nothing. So, yeah, I love that, you just said that, I wanna shift to talking about what are your thoughts on supplements

because I think like the minute that PCOS patients, they're often told this long list, be it like antal, burberine, you name it, so are there any of these that either you see clinically with your patients or there's actually a good evidence base behind it where you actually do tend to use these things with them?

Yeah. My approach is probably not what we see commonly, from other people just because, for example, with BIOTIN supplements, a lot of people are on BIOTIN for their hair and for their nails does not work as well for their hair. But with biotin I see that it interferes with thyroid blood tests.

Yeah, we know about that. But we don't know about other newer supplements on the market, whether they can interfere with the testing, whether it can interfere with things. And also supplements don't just come in their pure form. There's always fillers added to it. There's manitol, there is, pectin and different things.

Are added to that supplement. So it's not as pure as we think the way it looks like on a shelf sitting there with multiple labels on it.. So for people with P-C-O-S-I tell 'em to take a prenatal. That is NSF. National Sport Foundation or US. or, PTF certified just because we know that prenatals have to be taken three months before planning a pregnancy, but at even at other times, it can be good as a multivitamin.

Yeah, so a prenatal vitamin, even if you skip it two, three days a week doesn't matter. At least you've been taking it for a long time. The other thing is we want to make sure we don't miss a vitamin D deficiency. We want to put levels of vitamin D because vitamin D is a prohormone effects helps your other hormones work better too.

So with vitamin D, it's important to check levels because I have seen levels of 99, so, super high levels too. And when we get into dangerous high vitamin D levels, it can actually lead to bone issues like bone fractures. So we're talking about someone earlier today. Their vitamin D was over 120 and I said, this is an emergency.

Like this is immediately, this needs to change. So it's just interesting I think, some, , practitioners are really pushing the levels and I get that, , in the functional land there can be some variety in that. But then I like that you bring up, at some point it's actually dangerous.

Where do you typically like to get it to? I'm pretty conventional in that like 30, I'm happy. Okay. 30 to 50, I'm happy. Yeah, definitely. Are there any supplements that you are recommending beyond the multivitamin? Yeah, ferritin is another thing that I keep an eye on just because it has to do with hair health and also if a woman is planning pregnancy, we want to make sure that we.

Replenish her iron stores before planning a healthy pregnancy because we want to avoid complications as much as possible. , Whenever a patient comes to me, PCOS or otherwise, but especially PCOS. I ask them what their goals are, and no matter what their goals are, I want to see what their health looks like, or I want them to be at a really healthy level 10 years later, 20 years later.

It's not about just two months later or three months later, okay, you got pregnant. Fine. Good for you. Congratulations. Because your health, during your pregnancy matters. Your health after pregnancy matters too. Yeah, so. Because we want to plan your health in the long run. It really matters how we manage your nutrition, how we manage your day-to-day living, how we manage your activity.

Yeah. Yeah. I had a, coach that I worked with a few years ago and, I was thinking, oh my gosh, this is taking so long. And she was like, Matea, look how young you are., You might have had this 30 whatever years. You still have maybe 60 in front of you. She's like.

Even if it took you five, 10 years,, it's not an if, it's a when. And once I had that perspective shift, like what you're talking about, the 10 years, I think that's so important because everyone is so narrowly focused on a few months or half a year or a vacation, and it's like, but really I care that you don't have a bone fracture at 80. That's what I'm invested in for you. You do things a lot differently when you're not so urgency focused. It's actually overall health. Yeah, and we see that in clinical medicine too, because we see that sure, you lost weight in the short run with restricting your calories, depriving yourself, but then when you regain that weight back, it actually.

Gets, deposited in our organ systems. Around our organs, around our liver. And that's actually more harmful to our health in the long run. Yeah. Yeah. That's so depressing to me with the regain that you can get back to the same weight, but now you have more visceral fat. It's so sad.

I've talked about that because, with the yo-yoing, people, a lot of the time they wanna use a medication short term and I'm like, that makes absolutely no sense if we're using this for chronic weight management. 'cause it's a treatment, not a cure. Right, so, any other supplements that you use with people?

Ferritin levels, taking a look at their iron level., I like to look at that. A lot of, PCOS patients when they come to me, they're on inositol. If they're on  inositol. I don't necessarily take them off of it, but if they do show signs of insulin resistance, which. Many of them do. Most of them do.

Then I take them off of it and place 'em on Metformin, just because it's more regulated. We know what dose works, we know what, how to up titrate it. Mm-hmm. And also, we know that we can continue metformin until someone gets pregnant. But then I take patients off of met Metformin when they actually get pregnant, when that test comes back positive.

Okay. Yeah. I was actually gonna ask you about Metformin, what your thoughts were on that. And by the way, this is unrelated, but you said you do a lot of CGM. Do you have, and we're not like endorsing anything, but do you have a brand where, you find it to be more affordable or better quality?

Is there one that you typically write for, or is it just what the insurance will cover? In my experience, both brands are the same. There's no perfect brand actually. All brands can have a false positive, false negative, super important to counsel patients that not to get freaked out with a low blood sugar because especially, if we don't do it the right way, if we don't talk to them the right way, as soon as they see that low blood sugar.

The machine sends off an alarm and then we're eating like sugary foods, you know? Right. So we want to make sure that we tell patients that even someone with normal blood sugars can have a low sugar on A CGM. When I wore a CGM, my blood sugar was in its forties, but I felt Okay. So it depends on how you feel. So there's not a brand where you typically work with it? No. Okay. No, I don't recommend a specific brand, but I make sure that I tell them that, if you put too much pressure on it, the number can be off. If, you get exposed to a very hot shower.

The number can be off. But if you do feel symptoms of a low sugar, important to double check with a capillary blood sugar. Mm-hmm. And that's if someone has, type two diabetes. But if you don't have a diagnosis of type two diabetes, just bring it up with your doctor. Don't just eat food if you see a low blood sugar.

Yeah. And if anyone's listening, they don't know capillary, she's pointing to her finger. So a blood stick. Right?, I did wear a CGM and to me sleep was so annoying. I tend to be a side sleeper and I'd be like, it hurts when you're like on that. And then of course, the readings look wonky 'cause of that.

But. I loved the knowledge that it gave me, but it made me also like very hypersensitive to, I don't want this to jack it up, and I don't want this to ruin it. And while I like the knowledge, I just found,, I'm so impressed by people long-term that can wear it unless it's like an actual diabetes, but for just a knowledge standpoint, to me, I found more than two weeks was just really hard to take on.

I don't know if any other people find that. So, I actually tell patients to just wear it for five days and pay attention to a couple of things. So I want them to pay attention to whether coffee, tea, if they drink that regularly, if that spikes their sugar. Because for some people, even if they drink black coffee, some of us are just more stress prone.

I call it sympathetically prime to. Sympathetic nervous system. Yeah. So if we're like that, then even black coffee can increase our blood sugars, spikes. So that's one thing that I want people paying attention to. I want people to pay attention to when they wake up in the morning, if they're super stressed.

Corts all spike. That can itself. Create a huge spike in the blood sugars. The other thing that I want, people to pay attention to, when they're using a CGM is if someone does not have borderline diabetes, then your peak blood sugar would not be that high. So if you're seeing numbers in 1 61 seventies after you're eating, that probably means you have borderline diabetes or even type two diabetes.

So we want to know. For normal population what the number should look like so you don't, miss underlying medical issues. What is an acceptable peak post meal, like 30 minutes post meal or, 15, 30 minutes in there If someone has a normal response. That's an excellent question.

CGMs, we don't have that much data in a normal population, but from what I see, it's the change that matters. Okay. So for someone with totally normal insulin response to food, probably the change should not be more than 30 points. An ideal person, an ideal glucose response. Let's say if you go all the way from 70 to one 30.

That's not normal. That means that your body's having to put out excess amounts of insulin. Yeah. Yeah. I know that we didn't mean to talk about this, but people ask me so often about it that I'm glad we're having the conversation. Because I did the Zoe test back in the day. I don't know if you're familiar with the different cookies and stuff like that.

And it was insanity if I did not have the right amount of protein and fiber first, like the food ordering, I mean. It was wild and so it really helped me realize these morning walks matter so much. The way I'm eating there was almost no spike at all when I'm eating Very balanced.

Which is that normal to just almost be like flatlined? This is something that endocrinologists have known about for many, many years. Now there's, with social media, different things, trend at different moments. Totally. You know, fiber and apple cider vinegar and I don't know, whatnot.

Yeah. But in endocrinology, we have always been telling our patients who need mealtime insulin to eat their fiber and protein first and then eat the carbs. . We think of it as layering the tummy. Yeah. So coat your tummy with fiber, coat your tummy with protein, and then put the carb on top.

Yeah. Yeah. I do that with patients too, and I find some of them, that makes all the difference. Like before even adding a medication, some people already can have, a really big response with just that. Do you think there's anything that is like a must know? With PCOS that we missed, because I know we've talked a good amount of time here, but do you think that there's anything else that's important that we didn't touch on?

So if any young females have tried Accutane multiple times, there's probably a undiagnosed PCOS somewhere there. Okay. If someone has, history of eating disorders, like they feel like they need to, restrict their food intake because they tend to gain weight very easily, probably undiagnosed PCOS.

Insulin resistance, dark patches, frequent candidal vaginal infections, probably undiagnosed PCOS. It's so common. One in five women can have it. And the hardest thing for me as a person and as a physician is that it affects women when they're at their most vulnerable age. You know, our teens, twenties, hard enough even without PCOS totally on top of that, you add in PCOS, self-esteem, self-confidence gets affected. That impacts your academic performance. That impacts your relationships. So if we treat it right, if we diagnose it at the right time, we treat it the right way. You can make better career decisions, you can make better decisions in your relationship choices.

This can really impact your life, but we have to diagnose you at the right time. And for that. Patients have to advocate for themselves. They have to know what normal periods look like. They have to pay attention to their body. If they start noticing things don't look right. They're growing hair, growing.

Acne, they need laser treatments multiple times and laser treatments don't work. They're noticing a large part in their. Here, bald spots. Make sure that you go get a full checkup, have your blood tests with you, make sure you're not on any hormonal medications before you go get your blood tests done.

Yeah. Oh God, this is so good. Can we just talk briefly about GLP ones and PCOS? So what do you see there, is there anything different compared to the normal response that you see?

Yeah. GLP one are one tool in our toolbox. Anytime I think about medications, I always want to make sure that someone has access to it in the long run. Mm-hmm. So let's say someone starts GLP one and they lose access because we're talking about very young patients, you know? Yeah. A lot of them are probably don't have that carry that diagnosis of type two diabetes.

Yeah. So. My go-to is not GLP one, just because I worry about their health 10 years down the line. And the worst thing that I can do for them is put them on medication that they won't be able to take a year later, two years later. Yeah. So I approach it from that point of view. The encouraging thing is, the really, really great thing is diet and lifestyle can really make a huge dent.

Mm-hmm. So we just have to get. People to pay attention to processed foods and marketing strategies that make us make unhealthy food choices. Mm-hmm. Mm-hmm. GLP ones definitely help, but, probably not the best choice in terms of access right now. It's so sad, because it is such a great tool, but I a hundred percent agree with you.

, People, sometimes I don't know, maybe it's controversial what we're saying, but it's like they think, oh, you don't wanna write it for me, you're withholding. It's like, no, you are actively telling me that you could only afford two months of it. That is not helpful. I'm hurting you more than, you know.

That's the whole where we took the Hippocratic oath, right?, But it's so sad that even has to be a decision, right? That's something that I always really grapple with, our system here in the us. That's why the information you're sharing is so important because you talk about weight cycling, you talk about how weight cycling is so unhealthy, and that's a real thing.

It actually matters. Yeah, I think people are just so obsessed we get so indoctrinated that your size needs to be smaller, and I can relate to this, we hear it, it's societal, but then at some point we have to build a stronger belief in our health and what's possible for us.

And that's like a hard. Bridge to gap to fill for people., do you think there's anything else that we didn't talk about? I think we've truly covered all of it. I think I, I think so too. But,, I find myself coaching my PCOS patients without.

And one thing that I tell my young PCS patients is that you have to stop listening to what other people say. You have to stop caring about what other people think about you. Yeah, you just focus on your health. Listen to yourself. Journal, weight train. Yeah, everything else will kind of fall into place. Oh, I love that you said that.

That's such good advice that everyone listening can, can benefit from. First of all, just thank you so much for coming on today. I know that everyone's gonna have learned so much. Can you tell us what's the best place for people to find you, whether it be, social or your website and just how people can find out more about you.

I am on TikTok and Instagram as Dr. Sabrina Huq, DR Sabrina, HUQ, and if you Google me, you'll find my clinic. I'm in Broadway, Woodside, Queens, New York. Awesome. Thank you so much again for taking this time. Thank you.