Reverse PCOS Naturally
In this episode of Hormones, Metabolism, and You, Dr. Cassie Smith sits down with Dr. Naji Abou-Ali, a UK-trained PCOS specialist, to explore the root causes of PCOS (Polycystic Ovary Syndrome) and the metabolic challenges that often accompany it, particularly insulin resistance.
Dr. Abou-Ali explains how lifestyle interventions, such as building muscle, managing stress, and adopting sustainable nutrition habits, can drastically improve outcomes—often outperforming restrictive diets or medication alone. Together, they question conventional approaches like birth control and metformin, while offering practical, holistic strategies that empower women to take control of their hormonal and metabolic health.
Whether you’re navigating PCOS personally or supporting someone who is, this episode offers a compassionate and science-backed roadmap to healing.
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Dr. Naji Abou-Ali is a UK-trained Internal Medicine Physician and a Member of the Royal College of Physicians. He specialises in PCOS, insulin resistance, and thyroid disorders, with a strong focus on helping women restore their health through a systems-based, root-cause approach.
His work bridges conventional medicine with a deeper understanding of how the nervous system, hormone system, and metabolic system interact. By addressing this full-body network, Dr. Naji helps patients heal from the root rather than just manage symptoms.
He is the founder of The PCOS Reset Academy™, a science-based program that helps women with PCOS lose weight, reverse symptoms, and improve fertility—naturally and without restrictive diets or birth control pills.
Through his growing platform on Instagram, Dr. Naji reaches hundreds of thousands of people with clear, practical insights on hormones, metabolism, and women’s health. His mission is to cut through the noise and provide real, sustainable solutions that work.
Blog/Transcription:
0:05 Welcome back to this week’s episode of Hormones Metabolism in You. I’m your host, Dr. Cassie Smith. I’m a
0:11 endocrinologist based out of Oklahoma City who now practices functional medicine. Today I have a very special
0:18 guest. You guys ask a lot about PCOS. So what I have done is I have found a PCOS
0:23 special expert from London. So, he actually has a PCOS reset academy and
0:30 has tons of followers on social media. So, I reached out to him and I asked him if he would please come on our podcast
0:36 to answer all your questions about PCOS. I also wanted to talk to him about the differences in treatment and the
0:42 differences in training in the UK versus the United States. So, Dr. Dr. Naji Abu
0:49 A Ali who is originally from Lebanon is a UK trained internal medicine physician
0:54 and a member of the Royal College of Physicians. He specializes in PCOS, insulin resistance, and thyroid
1:01 disorders with a strong focus on helping women restore their health through a systems-based root cause approach, which
1:07 is why I like him. Very much like modern indocrine, his work bridges conventional medicine with a deeper understanding of
1:14 how the nervous system, hormone system, and metabolic system interact. By addressing this full body network, Dr.
1:21 Naji helps patients heal from the root rather than just managing symptoms. So, I think you guys are going to really
1:27 like what he has to say. He’s the founder of the PCOS Reset Academy, and I’m going to link all that in the show
1:33 notes. It’s a science-based program that helps women with PCOS lose weight, reverse symptoms, and improve fertility
1:40 naturally and without restrictive diets or birth control pills. So, he feels the same as I do with birth control, that
1:46 it’s highly overprescribed, and we talk about that in this episode as well. Throughout his growing platform on
1:52 Instagram, Dr. Nigi reaches hundreds of thousands of people with clear, practical insights on hormones,
1:57 metabolism, and women’s health. His mission is to cut through the noise and provide real sustainable solutions that
2:03 work. Which is why again I really like him. And so we talk about all the things you guys wanted to know. What you know,
2:10 why does insulin resistance occur with PCOS? What are the best things you can do from a dietary guideline perspective?
2:17 You know, does exercise help it? What like we talked about lean PCOS and why
2:22 would leaner people end up with PCOS and insulin resistance? We talked about microising GLP1. So I know all you want
2:28 to talk about that. We talked about birth control. We talked about metformin. So so many good things. And
2:33 he gave us an insight and a perspective of how is PCOS managed and treated in the UK versus the United States and what
2:40 is their education like. So I think that you guys are really going to enjoy this episode. I loved recording it. So here
2:46 we go. So this week I have Dr. Naji. I found him on social media. And if you
2:51 guys don’t follow him, we’re going to link all his of his stuff in the show notes. But I found him because he has a
2:57 PCOS reset program and he talks very openly about PCOS and you guys know you
3:03 know I PCOS is very dear near and dear to my heart and so I brought him on because I wanted to talk to him about
3:09 this reset program and I gave you guys the opportunity on social media to ask me whatever questions you wanted to me
3:15 to ask him. So we’re going to go over all of that today. So thank you for coming on hormones metabolism and you.
3:22 Thank you. It’s my pleasure. So very nice to be here. You are based in London and we were kind
3:29 of chatting before we started recording. So you’re kind of going through this endocrinology training program in London
3:35 in the UK. Start by telling everyone like how did you why endocrinology? Like
3:41 why medicine? Why endocrinology? Let’s start with that. Oh, why medicine is um is a tough
3:47 question. It’s a long a long answer. But um to be fair, when I went into
3:52 medicine, my whole uh idea was like I really want to help people. Obviously, when you’re in school, you don’t know
3:59 what medicine is. And then even when you do premed, which is before medicine, you
4:04 still don’t know what medicine is. Then I went into medicine. I loved the knowledge. I loved the information. I
4:10 still want to help people, which I’m I’m very happy to be doing that uh now. But
4:16 I figured out that I really like how hormones connect to each other. I really
4:21 like how hormones play together. It’s like an interconnected game, you know,
4:28 each one affects the other. Like I became really passionate about lifestyle and how people can improve their their
4:35 health with their lifestyle. And I found that hormones and endocrinology is one
4:41 of the first places if not the first place to always start like balance your hormones. Like you cannot heal if your
4:48 hormones are not balanced. And honestly in traditional medicine um although
4:55 traditional medicine has a lot of positive sides and has a lot of benefits
5:00 to a lot of people especially in acute conditions but in chronic conditions I
5:06 think it’s still missing a big uh a big piece of the puzzle and this is where I
5:13 I’m like okay we do have a lot of information we do have a lot of
5:19 knowledge about the hormones, about these chronic conditions like diabetes, PCOS, thyroid, but this is not what we
5:25 do in in traditional medicine. We offer uh symptom treatment. So, I got really
5:31 passionate about this. And from there, I was like, okay, this is what I’m doing. I’m continuing into endocrinology. I’m
5:39 going to try to work on the root cause of these problems with my patients. And
5:46 this is what I do now. So, yeah. I love it. So, very much like the
5:51 philosophy we have at Modern Endocrine, which is we don’t want to just band-aid symptoms. We want to figure out what is
5:56 causing the actual problem. And the best way to do that, I think, you know, I might I might be biased, but is to do
6:02 endocrinology because it’s the study of hormones and how they’re all interconnected. 100%. I agree.
6:08 I think we’re a little we’re a little bit biased, both of us. We’re a little biased. It is. It is true.
6:14 So, I want to ask you because I talk about this a lot, too. Um, and I talked about this with my good friend Micole
6:19 McFersonson on a podcast recently. The training that we get in the US, whether it be PAs, nurse practitioners,
6:26 physicians, even endocrinologists, unfortunately, there is not any or very
6:32 little emphasis on your, you know, your nutrition or your gut or sunlight,
6:38 exercise, things like that. Do you guys have more of a holistic training approach in the UK or is it the same? Is
6:45 it just Not really. It’s um I would say it’s very similar in this um in this
6:51 perspective because we basically treat with medicine. I mean
6:58 okay this is our like this is what we’ve been taught in medical school and this is what we practice in um in our
7:05 fellowship and this is what like the consultants practice in their practice as well because I think there are many
7:11 reasons. One is like the time that’s provided to patients in uh in medicine
7:16 and uh you need to be like very evidence-based and very approved by the
7:24 uh like some of the organizations and institutions. But unfortunately we get zero to little
7:33 uh knowledge about nutrition, gut health, nervous system which is which is
7:39 for me like the main number one thing that anyone who wants to heal their hormones, their chronic conditions, even
7:45 their gut needs to start with. And this is what I like this is why my PCOS reset
7:50 program is a little bit like well known because of the nervous system approach. Unfortunately, it’s it doesn’t work like
7:57 that. For example, um let’s say I see a patient with with the thyroid or PCOS in
8:04 um in my modern medicine in the medicine clinic where I work my where I’m doing
8:09 my fellowship. It’s it’s I’m not even allowed to discuss um like anything
8:15 other than what we can provide for her. We have to provide we have to offer
8:21 birth control. We have to offer metformin and we we cannot like go
8:27 and talk about stress reduction or balancing like reversing insulin
8:33 resistance. Like you can say it okay lose weight or reverse insulin resistance but we don’t have the time
8:40 resources or even like uh permission to go further into that and like have a
8:47 holistic appointment with a patient. It doesn’t work this way unfortunately yet.
8:52 Yeah. So unfortunately, I’m hearing it’s very similar in London in the UK than it as it is here, unless you take more of a
9:00 functional approach and and you have a a private functional clinic, which is kind of what we were talking about. So, you
9:06 know, and and hopefully that’s where the world is going to go with people like you and people like me and, you know,
9:12 good providers out there. But you’re not you’re not telling me anything that’s
9:18 not shocking, unfortunately. So I kind of want to so I want to pick your brain
9:23 about a lot of things PCOS because you have this PCOS reset program and so I ask my listeners and they have a lot of
9:29 questions. So PCOS is really near and dear to my heart. So my listeners know this but like I got diagnosed with PCOS
9:36 whenever I was finally like 29. So it was a lot of struggling until then. And
9:41 then I had been on birth control my whole life which you were talking about which just wrecked my hormones and wrecked my gut and didn’t help anything.
9:49 Um, and so finally I figured all that in my early 30s and it’s taken like seven
9:54 years to get healthy after that. So talk to us about dietary or lifestyle changes
10:01 that you recommend for people with insulin resistance because we know insulin resistance is like a big part of
10:06 PCOS. Unfortunately, it’s a big part of just the world now because of the food that we eat. But and I don’t know what
10:14 it is. I have two questions. Number one, do you know what the incidence of insulin resistance is in the general
10:19 population in the UK? Because in the United States, it’s about 93%. It’s really bad. Do you know what it is
10:26 there? And and then secondly, what are some dietary or lifestyle changes that you recommend for insulin resistance?
10:33 I’m not entirely sure about the incidence of uh or prevailance of uh
10:38 insulin resistance in UK. I know that obesity is around 60% uh overweight and
10:45 obesity is around 60%. So I mean when you have obesity you you most likely
10:52 have insulin resistance. Um but to be fair just before we go into uh the
10:58 treatments because we we talked about PCOS and insulin resistance and insulin resistance is a is a very huge topic in
11:05 PCOS because um even in lean women with PCOS insulin resistance approaches 70 to
11:12 80%. And virtually all women with PCOS who are who have excess weight are
11:18 insulin resistant. So it’s it’s it’s very important and even for the
11:24 manifestation of PCOS symptoms you basically need some insulin resistance
11:29 like even if you have PCOS and you reverse insulin resistance completely
11:34 your your symptoms are going to you’re you’re going to notice a significant improvement in symptoms. Okay. Regarding
11:40 the dietary changes, um, for me, I’m not a person who likes restriction and um,
11:48 obsession. Okay. However, we have enough evidence to know that for PCOS and
11:56 insulin resistance, insulin resistance in particular, being in a calorie deficit first, especially if you’re in
12:02 if you’re uh, if you have excess weight, because the way to reverse insulin resistance is to melt your visceral fat.
12:09 So you need to melt the fat around your muscles, around your liver, around your pancreas. Uh this is the first step to
12:16 reverse insulin resistance. So you need to be in some sort of a calorie deficit, especially if you uh are if you have
12:23 excessive weight. So that’s the number one approach before anything else. In terms of dietary choices, a low insulin
12:31 lifestyle works really well with PCOS. And it’s it’s very important to note that it’s
12:37 low insulin not only low blood glucose or like stable blood blood glucose stable insulin levels uh because
12:46 hyperinsulinemia uh is a common cause for manifestation of symptoms in PCOS especially and we
12:54 know that everything we eat technically stimulates insulin but especially protein and carbs.
13:03 So, first a diet low in monossaccharides. So, simple carbohydrates.
13:09 That’s the golden rule for reversing insulin resistance and PCOS. Why?
13:14 Because monossaccharides, so we’re talking about starch, we’re talking about sugar. They lead to a spike in
13:22 blood sugar. They lead to a spike in uh blood gluc uh in blood glucose and in
13:27 insulin. And this this is a cycle that really wres havoc on on the body causes
13:35 inflammation and worsens insulin resistance. So that’s number one. Number two is low is
13:43 reduction of saturated fats. I know this is very controversial and some people will will be like will not agree with me
13:51 but I’ve seen all the studies. There are particular uh fatty acids that do not
13:57 help PCOS, do not help insulin resistance. In particular, palmitic acid, for example, that’s present in uh
14:05 fatty meats and in palm oil, for example, in very high concentrations. I
14:10 I don’t there’s nothing for me that’s restrictive or complete omission. For me, it’s reduction. it’s focusing on the
14:17 other stuff on the healthier stuff for insulin resistance and PCOS mostly the inflammatory stuff but the first two
14:24 golden rules is one avoidance of monossaccharides so simple carbohydrates
14:30 and second reduction of uh saturated fats okay I think I don’t know if you have any
14:36 no I think those are great places to start I’m assuming you probably have a whole section in the PCOS reset program
14:42 that talks about food choices of course and I think that’s something that’s very difficult for people because food is
14:47 such a cultural thing too, right? And so I I find a lot of times with PCOS that,
14:53 you know, in general if you have PCOS, a lot of times like a somewhat of a fasting window is is good too. You don’t
14:59 want to be snacking all the time. And so sometimes it’s hard because a lot of times you wake up hungry and then we
15:05 have really late dinners, especially you guys in Europe. I know you guys eat like crazy late. And so sometimes I tell
15:11 people too with PCOS just trying to find like a a 10-hour window a day that you’re going to consume your calories
15:16 and give your body a rest. I think that’s really helpful too. That’s what helped me kind of get started with
15:22 getting rid of some of my visceral fat and a lot of my insulin resistance. I think it’s a very good approach.
15:27 Yeah. But you also just one thing about uh just intermittent fasting about uh before we
15:33 pass through it. I mean I think I believe personally that most people do intermittent fasting incorrectly because
15:39 they skip breakfast and if you want to do intermittent if you want to do intermittent fasting like skip dinner
15:46 and I know this is very very unrealistic for most people like it’s not practical. So for me if I want to do a like a
15:54 fasting window 12 hours from dinner to to breakfast that’s all I ask for
15:59 and it and I agree with you and it is that’s true. I say this all the time. I feel the best when I don’t eat dinner or
16:04 I don’t eat a big dinner. What what I do is like I have a lot of soups like I love soup. I’ll have soup at like 4 or
16:12 4:30 and that’s like my dinner and then it’s easier to digest and I don’t eat later. But I completely agree with you.
16:18 I would prefer people eat a large breakfast, a medium lunch and a smaller dinner or skip dinner. Brunch is the way
16:24 to go people. Like that’s what you need to do. But I feel the best when I don’t eat dinner. So I completely agree. And
16:30 the other thing I was going to ask you two things. Number one, you mentioned lean PCOS, and I like that because I
16:37 talk about the six different types of PCOS in my book. So, explain to people how you can be lean but still have PCOS.
16:45 Well, I mean, PCOS is I think there’s a very uh there’s a lot
16:51 of misconception about PCOS. Like, for example, you don’t have insulin resistance because you have PCOS. It’s
16:58 basically you have PCOS because you have insulin resistance and you have some high androgen symptoms like uh facial
17:06 hair or or excessive body hair. And I think the terminology some people would wouldn’t agree but the terminology
17:13 really matters because PCS is the result of those symptoms. I
17:18 know there are genetic u like there are genetic predispositions. Yes, there is
17:24 some nervous system even changes but we have PCOS because we have these
17:29 symptoms. This is how the diagnosis comes by and the diagnosis requires uh so hyper androgen symptoms which is
17:36 basically excessive body hair some acne stuff like that and then uh missing or
17:42 irregular period and u cystic ovaries on
17:47 the ultrasound. And we know that insulin resistance is responsible for a lot of
17:52 the manifestation of symptoms regardless of what’s happening in the brain because initially for PCOS to happen in the
17:58 first place you need to have a G&R frequency pulsation uh alteration. So
18:05 basically G&RH is the uh hormone that gets secreted from the hypothalamus and
18:11 it regulates the pituitary gland to secrete LH and FSH which basically control ovulation and to for PCOS to
18:19 happen in the first place. we have an initial alteration in the G&R pulse
18:25 frequency and this favors high LH compared to FSH and this is what uh
18:31 stimulates the thea cells in the ovaries to produce more androgens causing the
18:37 symptoms and u prevents ovulation from happening. But many studies have shown
18:44 that without insulin resistance most of those symptoms even when you have the G&R altered pulse frequency most of the
18:51 symptoms don’t happen. Okay. So let’s start from here. Now uh when we have
18:57 insulin resistance you have more symptoms. However in lean in lean women so we’re talking about women without
19:04 excess body weight we do see at least some per periphery uh peripheral insulin
19:11 resistance. So even at the level of the ovaries uh the ov the ovaries have insulin insulin receptors and these uh
19:19 these cells may be ins resistant to insulin which may be contributing to the symptoms and they be may they may be
19:26 resistant to insulin at the levels of the muscles for example which is also causing uh high insulin levels in the
19:33 morning or insulin resistance in general. So what you’re saying is So what you’re saying is it’s more of like
19:38 a genetic issue where you have actual insulin resistant at the muscle level, at the liver level at you know it
19:45 doesn’t necessarily have to be just an atapost tissue in I’m not saying it’s a genetic there’s
19:50 always some genetic uh components factors that play a role. I’m saying insulin resistance I’m not saying it’s
19:56 purely genetic. I’m saying that in PCOS it may not be like central like liver
20:03 and uh pancreatic insulin resistance. It may be periphery at the levels of the
20:08 ovaries and at the level of the muscles. That being said, even in patients without PCOS who have insulin
20:14 resistance, they have some degree of insulin resistance at the level of the muscles. And this is like one of the uh
20:21 initial uh hits that insulin resistance take. Like this is how insulin resistance starts. It starts actually at
20:28 the level of the muscles usually even in patients without PCOS. So people are going to say well why why
20:33 do the muscles become insulin resistant? Is it because we’re not using them enough? Is it because we’re eating too
20:39 much? So why are why are muscles becoming insulin resistant? So excess calories is the is the number
20:45 one reason because this um you know your energy has to go the calories you consume are basically energy and they
20:51 have to go somewhere. So the first like they have to be stored somewhere you
20:57 know you cannot just they just don’t disappear. So usually they uh the excess
21:02 energy gets stored as fat especially if someone is not like doing a lot of uh
21:08 muscle lifting weightlifting muscle strength training and walking. So they’re not burning enough calories and
21:14 this excess calories gets stored as fat. And it’s very important to for people to
21:21 know that when fat gets stored, they get it gets stored. The excess energy gets stored all over the body. And muscles
21:27 like in between muscle fibers is one of the first places that fat gets stored. It doesn’t have to go in the liver and
21:35 around your tummy and in in your butts and legs for it to be stored. It can be
21:40 stored in your biceps and triceps and uh in your thigh muscles. And even if you
21:45 look like at MRIs of people with very excessive weight, you see how um the the
21:52 muscles look marbled and this is fat basically. You know, even a steak like
21:58 when you eat a steak, you know, I I don’t want to have like a very similar comparison, but a marbled steak is
22:04 basically this is fat in in the muscle, you know, and this is one of the main
22:10 causes of insulin resistance. This is what like this is what initiates the process of insulin resistance in most
22:17 people. So if you exercise a lot, can you out exercise a bad diet? Can you out
22:23 exercise this excess calories that you take in? And theoretically, yes. But practically
22:30 no. Because if you’re exercising even 2 hours a day and lifting weights and
22:35 running, you’re going to burn an extra, let’s say, 1,500 calories, which is most
22:42 people don’t burn 1,500 calories by 99% of people don’t burn 1,500 calories by
22:49 um by exercise, but you can literally have one meal at Five Guys and eat 2,000
22:57 calories. 2,000 calories per burger and fries and coke. So, what you’re saying then for our
23:04 listeners is that insulin resistance starts in the muscle. And although it starts in the muscle, it’s really an
23:10 issue of consuming too many calories. And so, we just need to be mindful of what we’re eating. And and a lot of it
23:15 is unfortunately today there are all these ultrarocessed very calorie dense
23:20 foods that people don’t even realize sometimes they’re consuming because they’re marketed as healthy or they you
23:26 know are changing the marketing and they’re really full of you know sunflower oil and lectin and just a
23:32 bunch of crap um that we don’t even realize that we’re eating. So that’s where nutrition is super important,
23:38 right? Like this is why we should teach this in medical school. That’s that’s very true. And the other thing other
23:45 than excess calories is even like with people who don’t eat too much calories
23:50 um not having enough muscle mass is a major is a major stimulator of insulin
23:57 resistance major factor because basically if you don’t have enough muscles even if you’re not eating enough
24:03 a lot of calories but basically your muscle is the sponge organ for the blood
24:09 sugar you know so it takes the blood sugar and it uses it like it stores
24:15 sugar as glycogen for its own use and uh use it for energy when it needs to be
24:22 used. So if you don’t have enough muscles, you don’t have this sponge is like is is you don’t have enough sponge
24:29 and this uh blood sugar stays in the in the blood and eventually also gets
24:34 stored as fat and when it start getting stored as fat you also have muscles. you
24:39 don’t have enough muscles in the first place, but you have fat. Even if you have a small uh uh arm, for example, or
24:47 small thigh thigh muscles, but they’re all filled with fat because you don’t have enough muscles to stores it as
24:53 glycogen and to grow. So not walking enough, not strength training because
24:59 you know if you think about it even our ancestors okay they didn’t go they didn’t used to go to the gym but you they used to work outside and in the
25:07 gardens and like lifting stuff all day long. So they never thought about this
25:12 and they also didn’t have the ultrarocessed foods that we have now. That’s why insulin resistance is now
25:19 much much higher than anywhere any time uh in history. So, do you think it’s
25:25 more of a calorie excess or more of a muscle deficiency? What do you think? It’s a combination. It’s combination.
25:32 Yeah. And I think, you know, it’s really important. I talk about this all the time, like muscle mass is so important. And so, unfortunately, women, a lot of
25:40 women live in this headsp space where from, you know, early 2000s, we want to be these tiny little skinny things,
25:45 right? Um, that’s so so so out. Like, that’s so out. What you want is to be
25:51 buff and lean and like so you want muscle. And so I think a lot of it too
25:57 especially with women is like we were kind of trained if you grew up in the 80s like me to do all the cardio cardio
26:03 cardio cardio cardio and like you know restrict what you eat. And really what you need to be doing is walking and
26:09 lifting a bunch of heavy things and eating good sources of of protein and and making muscle because it’s so true
26:15 the more muscle you have I mean I get so annoyed with my husband. so annoyed. He has like 6% body fat. He has so much
26:23 muscle. It’s insane. He eats whatever he wants. It just infuriates me. Pizza, muffins, like whatever he wants. And he
26:29 never gets an ounce of fat, but he’s got a ton of muscle, you know, and he doesn’t overeat. But the more muscle you
26:36 have, the more you can get away with even at, you know. Exactly. Yeah. Yeah. I think uh women
26:41 need to understand like there’s a massive difference because I actually did a post about this like a few days
26:47 ago. I mean if you go to a restaurant with your husband and let’s say like I don’t know you have
26:55 a difference like obviously there’s a difference uh in the average height between men and women initially and men
27:03 have more testosterone and naturally have more muscle mass and you go to a restaurant like any restaurant or a cafe
27:09 you’re going to get a croissant and a coffee he’s going to get a croissant and a coffee you’re having basically the
27:16 exactly same calories There is no difference. If if you go to a supermarket and get a ready meal, there
27:22 is no difference. There is no meal for men and meal for women. Meal for someone who’s 61 and meal for someone who’s 51.
27:31 And this is basically I think the average or no not the average height, but I mean this is this is what it is.
27:39 And um obviously men are not uh don’t have this fluctuation in hormones as
27:45 much as women on a monthly basis. Um, so cravings are more and that’s why it’s
27:50 much more difficult for women to maintain weight loss on their own. I completely completely agree.
27:56 Everyone’s meals are the same and and they’re massive. Is it better in Europe though? Like I’ve heard Yes. I’ve I’ve never been to the US, but
28:03 I I have a lot of people and they were there and they were like, “What are
28:08 those portions in the US?” Like, “How do the how do people eat that much?” Yeah. Yeah. I’ve heard it’s better. I
28:14 haven’t made it to Europe yet. We were supposed to go to Portugal last month. We didn’t make it. But maybe, like I said, I’ll come visit you in London and
28:22 compare. But the portions, especially, it’s lovely to visit. Yeah, it’s lovely to visit. Especially in Oklahoma, they’re massive.
28:28 So, okay. So, quickly, I want to ask you a few things, too. So, like, does PCOS increase my risk for type 2 diabetes? I
28:34 would say obviously yes. How can I monitor and decrease this risk? So,
28:40 would the answer to that be obviously fixing your insulin resistance? Reversing insulin resistance. Yes,
28:45 reversing insulin resistance. And one thing um I really focus on in PCOS and
28:52 this is from my experience with working with a lot of people with with with a lot of women with PCOS is cortisol
29:00 because cortisol I think is very underappreciated underrated hormone and
29:05 even without without having like we talked about uh consuming excess
29:10 calories and uh not walking and um not lifting weights not having enough muscle
29:16 mass These are the two main things. But the third thing is cortisol because whoever
29:23 knows about cortisol, cortisol first breaks down muscles. Okay, that’s number one. Second, it does store uh fat in the
29:33 visceral organs. So in and around your liver and around your pancreas and around your muscles and it raises blood
29:39 sugar and chronically it causes in it increases inflammation. All of those are risks for type two diabetes. on and all
29:46 of those are risk for insulin resistance. Calories and and muscle uh
29:52 muscle mass are very important. But if I would add one thing that’s equally
29:57 important for me because it also affects the mental health so much is balancing cortisol and managing uh chronic stress.
30:06 This is it. Go ahead. Yeah, I this is essential in other
30:11 words. Yeah. It also affects your sleep 100%. Insulin resistance cravings swelling
30:19 your cravings. Yes. And so cortisol is so powerful. We check if you have if you have chronically
30:25 elevated cortisol. The thing is we talked about uh calorie consumption and muscle mass. But if you have chronic
30:33 chronically elevated cortisol and it’s going to affect your sleep, so your cravings will increase. And chronically
30:40 elevated cortisol already breaks down muscles. You’re not going to be able to build muscles properly if you have chronically elevated cortisol because it
30:46 literally is catabolic. Like you’re going to break down your muscle. It’s going to break down your muscles because
30:52 it’s trying to protect you for like the body is thinking it it it needs protection. It’s in survival mode.
30:59 That’s why cortisol gets elevated. So that’s the these are the three most
31:04 important things. uh calorie consumption, muscle mass, and walking
31:09 and cortisone. Which is why for all the listeners, we talk at Modern Endocrine about all the ways to lower your cortisol naturally.
31:16 So, seeing the sunlight, making sure that you’re, you know, resting well and getting good sleep, making sure you have
31:22 good relationships, making sure you’re talking nicely to yourself, making sure you know you have all these outlets of
31:28 getting rid of stress because cortisol is so so powerful and I see it every day in life. It is extremely powerful and I
31:35 think modern life in general like modern life right now is just
31:40 it’s it’s literally like preparing everyone. It’s like a platform for
31:46 chronic stress, you know. I mean, there wasn’t a time in history where we were
31:52 bombarded with so much notifications, poor sleep, you know, situationships,
31:58 excessive work, and the stress of ultrarocessed foods, the the stress of
32:04 being sedentary. These these are physiological stresses. Blue light at night is a physiological stress. Even if
32:10 we we think we’re calm and we think that okay our relationships are doing well at the moment which also relationships are
32:17 struggling like never before but even if those are under control we have physiological stresses that are
32:24 elevating cortisol chronically because we wake up in darkness we sleep with with screens we barely walk in the
32:32 nature and our sleeping sleep is struggling so cortisol honestly I think
32:38 everyone needs to be monitoring or like trying to balance their cortisone.
32:44 I completely agree. The next question I have is my sister has PCOS and can’t lose weight. Please talk about that. I
32:51 think that that’s what we’ve been talking about. It’s we’ve got to lower our insulin. We’ve got to make sure that we’re working towards building muscle,
32:58 not eating in a calorie excess, and then monitoring and and evaluating our cortisol, right?
33:04 Um yeah, I I agree. The thing is most women with PCOS do know that to be honest. Uh they know that they have to
33:10 be in a calorie deficit because they’ve looked it up and it’s clear from science. But we have to acknowledge that
33:18 women with PCOS although if they are in a calorie deficit they will lose weight just any like any other woman with PCOS.
33:26 So there is no difference in metabolic rate between a woman with PCOS and women
33:31 without PCOS. So this means it’s not impossible for women with PCOS to lose weight. However, what what the
33:38 difference is that women with PCOS have a different hormonal profile that
33:45 increases their hunger, reduces their satiety, increases their cravings. Add
33:50 to that that they have usually insulin resistance and high cortisol which
33:56 increases inflammation um lowers sleep which worsens the cravings, worsen the ins worsens the uh
34:03 hunger and worsens the satiety. So it’s it’s not easy. I do understand her
34:09 sister. It’s it’s not easy for women with PCOS. Although they do have similar metabolic rates and they can indeed lose
34:16 weight just like any other woman with PCOS, it is more difficult and it’s not about willpower. It’s about the hormones
34:24 being uh in sync with each other and regulating insulin, regulating cortisol.
34:29 And most importantly, one thing I stress on is starting by adding rather than
34:36 restricting. Because I think this is the mistake most people make when trying to lose weight.
34:42 They start by restricting. Let’s get off bread. Let’s get off sugar, which seems
34:48 very sensible. It seems very reasonable. But when you do that without adding the
34:54 right stuff, you’re going to feel restricted. You’re going to feel hungry all the time. you’re going to feel cravings and your diet will fail after a
35:01 few days or you’re going to binge eat in the weekend. So focus start focus on
35:06 adding and then go from there adding the right stuff. Yes. And also you know a lot of people
35:13 with PCOS unfortunately their doctors aren’t helping them because if they’re giving them birth control that’s
35:18 increasing their cortisol as well. So like this was me right? So like yeah that this was me. So it’s like oh you
35:24 have PCOS let’s give you birth control. Well then that I see it all the time. I see it at least five times a week.
35:30 People on birth control, their cortisol levels are astronomically high. I speak to them about it. We get them off of
35:35 birth control and they come down. So like that’s the other thing is it’s not always your fault. Your provider
35:42 unfortunately sometimes is making your journey much more difficult in the way that we supposedly honestly birth control needs maybe
35:48 another episode on its own because we have so much to talk about birth control. But
35:55 um I think when I started my PCOS reset program, honestly, one of the my main
36:01 goals is to get women off the pill because not because I don’t like the
36:08 pill, because I’ve heard what women on the pill are telling me. And the main
36:13 reason actually women come to my program is because they either were told to
36:18 start the pill and they don’t want to start uh or contraceptive or they’re already on the pill and they want to get
36:24 off the pill. This is one of the main reasons other than losing weight and uh getting pregnant. But it’s the pill is
36:33 is another conversation. I know it has its uses. There are some uses. Uh we
36:38 can’t deny that. Yes. But honestly for
36:43 95% of people for 95% of women it’s prescribed unnecessarily.
36:49 I would say 99% of women it’s prescribed unnecessarily. But I mean some conditions like endometriomomas for example uh like you
36:57 want to shrink the endometrioma not to have surgery for example and some other
37:03 rare indications but yes I agree 90 at least 95% of women are put on the pill
37:09 unnecessarily. Yeah. Perfect. So a couple of other things I
37:14 for sure want to ask you. How can you lower testosterone and DHEA if you have PCOS? Now my understanding is lowering
37:22 your insulin right lowering your weight. That’s that’s the number one also um
37:28 increasing SHVG which is also affected by insulin but focusing on on liver
37:35 health as well while reducing your insulin is the proper way to uh lower
37:41 testosterone and very important thing I think these these are the things most people know about but we’re going to go
37:48 back to cortisol you know why because many people think that the androgens in
37:53 PCOS come only from the ovaries but in fact it’s 60 60% from the ovaries NPCs
37:59 60% in the ovaries 40% from the adrenal glands and the the hormone the androgen
38:05 in the adrenal glands is DHEA and DHEAS okay and DHEA and DHEA are stimulated by
38:14 ACT which is the pituitary hormone and when cortisol is chronically high your
38:19 body forms some sort of cortisol resistance like similar to insulin resistance
38:25 And from cortisol resistance, this stimulates ACT secretion that loses the
38:31 negative feedback and this stimulates the adrenal glands to secrete more DHEA and DHEAS which increases androgens and
38:38 leads to PCOS symptoms. Um so again insulin cortisol this is the way for
38:44 PCOS. Agree. And the last question I really want to ask you, can long-term micro
38:50 doing of GLP-1s offer sustained metabolic and hormonal benefits. So I
38:56 love micro do GLP-1s. We were sort of briefly talking about this. I have phenomenal success with PCOS when used
39:04 correctly. I think that that also helps a lot with you know just lowering your risk of diabetes. A lot of the things
39:10 we’ve talked about the way what’s the dose that you use? So it depends on the person. Um I start doses
39:17 as low as 0.05 milligrams of simaglutide 0.1 milligrams of simaglutide. I use
39:24 trespatide 0.0 or 0.5 milligrams 1 milligram. So very low doses. My goal in
39:31 using it is for people to not have symptoms to not even really know that they’re taking it. It just helps calm
39:37 down inflammation. I see CRP levels go down. I see in and we’re talking about inject
39:42 injectables as well. We’re talking about compounded peptides like micro doed peptides.
39:49 Um honestly I’m I’m a very big fan of GLP-1s in the first place for people who
39:54 have clinical indications for for people with excess weight um and like diabetes
40:01 uh PCOS uh with obesity. I think they’re very helpful. Um, I personally haven’t
40:07 had experience with micro doing. Maybe I’ll have to take some uh some advice from you about that. Uh, but I don’t
40:16 think there’s any reason not to be pro micro doing GLP1s. Uh, as long as it’s
40:21 done under medical supervision and side effects are monitored, I think it’s it’s a good idea. And what about metformin? Is a metformin
40:28 a plus or a minus for you with PCOS? So the thing is metformin is part of the
40:34 clinical indications like we sometimes use it to restore uh to try and restore
40:39 ovulation but the thing is metformin is working through insulin. It’s not like
40:44 magic. It’s just it’s not reversing insulin resistance. It’s just trying to improve temporarily insulin sensitivity.
40:51 And this is what this is what’s happening at the level of the body. So why not break the cycle from the root?
40:58 Why not tackle the problem from the start, from the roots, and just deal with it like properly instead of putting
41:06 a band-aid, another band-aid? Because now we’re giving metformin to try and regulate the uh to try and um restore
41:13 ovulation. We’re giving birth control pills to try and uh reduce androgen symptoms. We’re giving spironolactone to
41:20 try and further reduce androgen symptoms. and then we’re getting to a
41:26 patient who’s like 35 and wants to get pregnant and then we’re using let to try
41:31 and stimulate ovulation, you know, it’s just like why not properly treat the
41:37 root cause, you know? Correct. Because that’s not a very good business model
41:42 because wellare is not a good business model at least. Exactly.
41:48 I think I think the system does really need some type of hopefully people like
41:54 you and I and other people with who are adapting
41:59 um to the system and adopting a functional approach and really trying to heal people can have um an impact a good
42:07 impact on the system and on the medical system because it’s needed people are really struggling and suffering even
42:14 correct okay so So, I think that you’ve covered a lot of the questions I have. At the end of my podcast, I always ask
42:21 people three questions, so don’t overthink it. Very simple answers, but I want your answers to these questions.
42:27 So, the first question is, what is one food that’s most beneficial and why?
42:32 Extravirgin or oil. No competitor. Because e extravirgin olive oil, I mean,
42:39 I I am a little bit biased. I’m Lebanese, Mediterranean. But extra virgin olive oil, it’s high in
42:46 monounsaturated fat. It’s anti-inflammatory. It’s really heart healthy. And
42:52 everything like we’ve seen in every studies, the the more extravirgin olive
42:57 oil you have, like the healthier you are, you know? It’s I think it’s I think it’s like one of the healthy healthiest
43:04 foods in the world. And it’s it’s amazing source of fat. Even in cooking, some people are afraid to cook with it. It’s great for cooking. I love olive
43:11 oil. Uh I have a patient who brought me olive oil um back from where did she
43:17 where is she from? I can’t remember. Maybe it was Lebanon. But it’s amazing. So I I love olive oil. And then I I had
43:24 another patient who just brought me some olive oil from um from Greece. And so I’m excited to try that, too. So the
43:31 second question is, what is one thing that anyone can do for their health to improve their health that’s 100% free?
43:40 Meditation. Meditation. I get that a lot because it lowers your cortisol, right? Yes. Exactly. Anything that lowers your
43:47 cortisol is going to make you live a better life. Obviously, like exercise and sleep like are these are exercise,
43:53 sleep, and food are like basics, you know, but if you want to add anything that’s free, it’s meditation. No
43:59 questions asked. And the third question is, what is one thing you wish you would have known
44:04 about your health 20 years ago that you would have done differently?
44:09 Oh. Um, I think muscle mass.
44:14 I think muscle mass. I think that and sleep is my number one regret. Muscle mass and sleep. Okay.
44:21 Well, can you tell us Dr. tell everyone where they can find you. So,
44:26 like tell everyone, you know, are you on social media? How do they find your course? Do you have anything coming up
44:31 that we need to know about besides the fact of course and
44:37 Go ahead. say please I said besides the fact that maybe you and I are going to make a a clinic in
44:43 Dubai someday right yeah yeah someday hopefully um so you
44:48 can find me on Instagram uh it’s Dr. Naji Dr. full doctor d oct t o r.nagi
44:56 and um you can find my links there. You can message me and um I have a lot of
45:02 free guides. So yeah, feel free to reach out if you if you need to.
45:07 And you said you were thinking about a podcast. You don’t have one yet. Um do you have a website or anything a
45:14 website? It’s all linked to my to my Instagram. Okay, perfect. So we’ll make sure and
45:19 put all of his stuff in the show notes. I’ll make sure and tag him. We’ll do some collaboration on social media, too,
45:24 so you guys can find him really easily. But I’m super glad that you agreed to do this interview and we connected and
45:30 maybe we’ll have to have you back on and just talk about birth control. Yeah, maybe. Thank you so much for for
45:36 inviting me and having me here. It was really a pleasure to talk to you and hope we can talk soon as well.
45:42 Yeah. All right. Have a good day. You too. Bye-bye. If you’re somebody who’s struggling with PCOS or know
45:48 somebody who’s struggling with PCOS or insulin resistance, I hope that some of this information was beneficial to you,
45:54 please, please, please share this with somebody that you love, somebody that you know, and somebody this could be helpful for. I do think that we hit on
46:01 some really cool topics with PCOS. Again, we talked about lean PCOS, dietary lifestyle changes with PCOS, how
46:09 you can decrease your risk of developing type 2 diabetes if you have PCOS, you know, weight loss with PCOS, which is so
46:16 hard. And and Dr. Naji gave a lot of good pointers and tips with if you are
46:21 trying to lose weight, the reasons it’s so difficult with PCOS. And then again, testosterone, DHEA, great pointers with
46:28 why is it high, how do we lower it, micro doing, GLP1s, just how healthcare
46:34 is in general. I loved this conversation and I definitely think I’m going to have him back so we can just talk about birth
46:39 control. But if you did think that this was beneficial at all, please make sure that you share it. Leave us a review.
46:45 Make sure that you’re subscribed wherever you get your podcast so you’ll be notified every time we drop an
46:50 episode. I’m going to put his links in the show note and I’m going to put his links to his PCOS academy that he has. I
46:56 think it would be phenomenal for people to go through and I’m really happy that he did that to help people. If you have
47:02 any, you know, issues that Modern Endocrine can help you with. Just remember, we have licenses in 42 states
47:08 now. So, that’s super exciting. Just got licensed in New York. So, check us out. We would love to help you any way that
47:14 we can with your healthcare needs. And make sure you’re following us on social media. We have a lot of really exciting
47:20 things coming up towards the end of the year. Have a great week.
47:25 The information presented, including any materials discussed, referenced, or linked within this podcast, are for
47:32 general educational purposes only. Not the practice of medicine. No doctor
47:37 patient relationship is formed from you listening to this podcast or utilizing any of the information provided. I am a
47:44 doctor, but I am not talking to you as your doctor. The information provided is not intended to diagnose or treat health
47:51 problems or take the place of the professional medical care provided by your doctor. If you are experiencing any
47:58 health problems, including problems you believe have been touched upon in any respect within this podcast, you should
48:04 consult your doctor about the problems without delay. You may ask your doctor whether he or she believes the
48:10 information I have provided would be helpful to you, but you should still consult your doctor immediately and
48:16 follow his or her medical advice as your treating physician. I’m just here to provide you basic knowledge about the
48:22 issues we discuss so you are more aware of them and can better discuss them with your doctor. That’s why we call it back
48:29 to the basics. Join me on the next episode as we continue our journey.
Disclaimer:
The information presented including any materials discussed, referenced, or linked within this podcast are for general educational purposes only, not the practice of medicine.
No doctor-patient relationship is formed from you listening to this podcast or utilizing any of the information provided.
I am a doctor, but I am not talking to you as your doctor. The information provided is not intended to diagnose or treat health problems or take the place of the professional medical care provided by your doctor.
If you are experiencing any health problems, including problems you believe have been touched upon in any respect within this podcast, you should consult your doctor about the problems without delay. You may ask your doctor whether he or she believes the information I have provided would be helpful to you, but you should still consult your doctor immediately and follow his or her medical advice as your treating physician.
I’m just here to provide you with basic knowledge about the issues we discuss so you are more aware of them and can better discuss them with your doctor.
That’s why we call it Back to the Basics. Join me on the next episode as we continue our journey.