308: PCOS + Chronic Skin Rashes w/ Jillian Greaves, RD

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PCOS (aka. Polycystic Ovarian Syndrome) is a complex issue impacting many out there that can cause specific skin issues!

So let this be a reminder that PCOS is not just a fertility disorder because it can + does impact the entire body in ways you might not even realize.

This is the first-ever episode to focus on PCOS and my guest today knows exactly how challenging it can be for women to just get a diagnosis.

We're going to dive into PCOS testing, PCOS root causes, the PCOS-gut connection and of course, the PCOS-skin rash connection that is often overlooked (with the exception of acne).

My guest today is Jillian Greaves. She's a Functional Dietitian and Women's health specialist, the owner of the private practice Jillian Greaves Functional Nutrition & Wellness, and the creator of the PCOS Root Reversal Program. Jillian provides comprehensive nutrition and lifestyle counseling to women, with a special emphasis on PCOS, hormone balance, and digestive health. Jillian helps clients identify and address the root causes of their hormone and digestive symptoms using advanced lab testing, personalized nutrition, and supportive lifestyle therapies as the first line of intervention. It's her mission to empower women to take back control of their health, reclaim their confidence, and experience life at its fullest potential.

Have you been diagnosed with PCOS? How have you managed symptoms? Let me know in the comments below!

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

In this episode:

  • What is PCOS + what body systems does it impact?
  • Common (and uncommon) PCOS symptoms
  • How to get a clear PCOS diagnosis? (It can be HARD!)
  • Conditions linked to PCOS (including insulin resistance + gut issues)
  • Classic skin problems that impact women with PCOS


“It's estimated that like 75% or more of women with PCOS have some degree of insulin resistance.” [08:15]

“Women with PCOS have been found to have higher amounts of BPA in their body when compared to women that don't have PCOS.” [16:15]


Find Jillian online | Instagram | Jillian's podcast

Check out Jillian's FREE GUIDE: Balancing Blood Sugar For Balance Hormones

Healthy Skin Show ep. 286: Is This Normal? (Rashes “Down There” + Hormones Edition) w/ Dr. Jolene Brighten

308: PCOS + Chronic Skin Rashes w/ Jillian Greaves, RD FULL TRANSCRIPT

Jennifer Fugo: 00:12
Jillian, I'm so excited to have you here. Thanks so much for joining me on the show. Thank you so much for having me. I'm really excited to be here. Well, as you know, you were the first guest ever to talk about PCOS, ever. We've never, I don't know if this, I'm not sure we've ever discussed this before.

Jillian Greaves: 00:32
I'm super jazzed to be the first person to talk about PCOS. We have a lot to dive into.

Jennifer Fugo
I know we do. So let's talk about what PCOS is, especially for listeners who are not quite familiar with that acronym. I think it's always important to ground the conversation. So what is PCOS?

Jillian Greaves
Yeah, great question. So PCOS stands for polycystic ovarian syndrome. And PCOS is a complex hormone and metabolic disorder that impacts an estimated one in 10 women in the US and potentially more. And PCOS is not a disease. So PCOS is a syndrome, which means it's essentially diagnosed by collection or a constellation of different symptoms. And it can really manifest differently in each individual.

Jennifer Fugo 01:32
And does this impact women, men, young girls? Like who ends up with PCOS?

Jillian Greaves
Yeah, so PCOS is a condition that predominantly impacts women. And it's most well known or talked about as a fertility disorder. So we often talk about it when it comes to fertility, because oftentimes with PCOS, women have irregular cycles or issues with ovulation. But ultimately, PCOS is something that impacts the body systemically. So it impacts the gut, the skin, the digestive system, the cardiovascular system. So it's really a systemic condition and not just a fertility disorder, although it can significantly impact fertility.

Jennifer Fugo
So what I'm hearing from you is that if you have been told or if you possibly believe you shouldn't just necessarily stop at the, I have a fertility issue. You should realistically start looking for other areas where there could be, in this case, say there are like comorbidities or conditions that can arise at the same time as something else that you're experiencing.

Jillian Greaves 02:59
Absolutely, I'd refer to it as that. And I'd also just highlight the fact that there's a lot of different symptoms that women can experience that are associated with PCOS. However, they're not often being given that information in terms of, hey, this might be connected to your PCOS and really all of these symptoms and systems in the body are interconnected. Oftentimes if I am working with an individual and we're talking about their digestive symptoms or their skin issues, and we tie it back to their PCOS, they're like, oh my gosh, I had no idea that these things were possibly, you know, kind of part of the PCOS dynamic.

Jennifer Fugo
So who diagnoses is that? So you said it was a syndrome. Is this a diagnosis that you're given by a doctor or is this something that you can work with someone and they or is there a test for this? Like, how do you find out or how do you figure out that you have PCOS?

Jillian Greaves 03:57
Great question. So typically either an endocrinologist, a gynecologist, or maybe a PCP is going to diagnose PCOS or investigate for a PCOS diagnosis. And really, PCOS is a diagnosis of exclusion and there is definitely some controversy over diagnostic criteria, but currently the most accepted you know, kind of diagnostic criteria is the Rotterdam criteria, which basically states that if you have two of the following three, then you qualify for a PCOS diagnosis. So those three things being absent or irregular cycles, ovulatory, so that would be ovulatory dysfunction, androgen excess confirmed either clinically or chemically, androgen excess. This category of hormones that we have, these androgens, are often elevated in women with PCOS, and this often drives clinical symptoms like cystic acne, head hair loss, unwanted hair growth. And then the third criteria being polycystic appearing ovaries, which essentially means having large numbers of immature follicles on the ovaries. So if you have two of those three, you meet the criteria for a PCOS diagnosis.

And I will say it can often be challenging for women to get that diagnosis. Some providers are not always willing to do some of that deeper investigative work to confirm the diagnosis. And oftentimes women might be on birth control. So we have no idea what their cycles look like, but they're experiencing all the classic PCOS symptoms. But we're not able to kind of fully evaluate you know, all of those pieces. So, you know, getting a diagnosis, I always say, is important and helpful if you're able to do that. However, if you experience a lot of PCOS-like symptoms and, you know, all of these things really resonate with you, you can still work on, you know, supporting the different factors that drive these symptoms, even if you don't have the label of, you know, PCOS as the diagnosis.

Jennifer Fugo 06:21
And actually, I just thought of a question that you're, as you're saying this, how would someone go about finding out if they have a more, you were saying a cystic appearance or a cyst-like appearance of the ovary? Is that, that requires certain tests to be run or, and I assume that means that the doctor has to be willing to run that.

Jillian Greaves 06:50
Yes. So that has, that has to be confirmed via ultrasound. So there does have to be that actual procedure that happens, which again, not all providers dive into and investigate, but I do think that if we suspect PCOS, it's important to have that full workup and to really understand what we're working with. And I wanna point out too that because PCOS manifests differently in each individual, not every woman is going to have those polycystic appearing ovaries. So you could have normal appearing ovaries and normal functioning ovaries, but you could still have PCOS, but sort of a different presentation of it.

Jennifer Fugo
I always think of the blood sugar issue associated, at least from what I've read with PCOS. Can you talk a little bit about the sort of, I guess blood sugar slash maybe metabolic type syndrome picture that sometimes I think can show up in those with PCOS?

Jillian Greaves 07:47
Yeah, absolutely. And I would say that blood sugar issues, specifically insulin resistance. So for anyone out there that's not familiar with insulin resistance, essentially this is when the cells in our body are resistant to the hormone insulin. Insulin being that hormone that helps usher glucose sugar into our cells to be used for energy. So a lot of women, it's estimated that like 75% or more of women with PCOS have some degree of insulin resistance. And the high levels of insulin are what stimulate the theca cells on the ovaries to produce excess amounts of androgen hormone. So the testosterone, and then we also have our DHEA, DHEAS, which is ovarian adrenal. But insulin is a big driver of androgen excess, and it's also a big driver to your point of metabolic issues that are associated with PCOS. So a lot of women will experience shifts with weight, a lot of rapid shifts with weight, without even changing anything with their diet or lifestyle. Inflammation is a big kind of classic characteristic of PCOS as well. And that chronic low grade inflammation dynamic, it's, you know, kind of like what, what came first, the chicken or the egg in terms of the insulin or the inflammation. And there's sort of that cyclical relationship there. But insulin resistance and blood sugar issues is super, super common in women with PCOS.

Jennifer Fugo 09:37
If someone thinks that they might be having blood sugar issues. And they think after listening to this, this might explain a lot. Is there a way that you recommend someone at least kind of, I guess, confirm that there could be an insulin resistance? If you're looking at one of your client's labs, is there a certain set of labs that… might help show this? Are they doing like one of the CGM, the continuous glucose monitors? I mean, I don't think most doctors are going to prescribe them if they don't think you have diabetes. So what, how does somebody figure out that they're having an insulin resistance issue in the first place?

Jillian Greaves 10:23
So typically, um, through a combination of you know, some basic blood sugar labs. So I'll always recommend right off the bat, you know, fasting insulin, fasting glucose, hemoglobin A1C, and using that information in conjunction with the actual symptoms an individual is experiencing. And oftentimes there's a lot of outward symptoms associated with that insulin resistance and blood sugar dysregulation. Even things like, you know, feeling really tired and lethargic after meals, feeling like you're riding a blood sugar roller coaster in terms of really erratic hunger, experiencing a lot of mood issues, anxiety, difficulty sleeping, frequent urination. So there's clinical symptoms that we can look at in conjunction with labs. And what I will say too is that I consider balancing blood sugar kind of step number one for anyone that is looking to support their hormones, support their gut, regardless of what their labs are saying. So I think for most women, it's going to be important to kind of build a supportive foundation, you know, with their nutrition and lifestyle that supports balanced blood sugar. And once we kind of get that foundation in place, we have labs, we assess clinical symptoms, that's where we can get a sense of, okay, you know, what is the degree of insulin resistance here? Do we need to bring in more micro strategies? Do we need to explore something like a CGM that would really tell us about that, you know, kind of personal glucose insulin response to different foods? So I never recommend a CGM for someone right off the bat. I think that more nitty gritty data is valuable, more valuable when we have a solid foundation in place with the basics, you know, meal frequency, meal composition and we're trying to really tweak and fine tune.

Jennifer Fugo
I was curious about if there is possibly, because you said there's a lot of other body connections that play a role in this. Is there any research that you've seen or that you work on with your clients that maybe has to do with connections within the GI track and what could maybe push PCOS forward to progress this syndrome?

Jillian Greaves
Yeah, so there's, I would say, I mean, gut health, digestive health is just a hot area of research, as you know, in general, but with PCOS specifically, this is a big area that is hot in terms of lots of research coming out, which is exciting, and gut imbalances are being investigated as kind of a root cause driver or dynamic with PCOS. And what research is telling us is that women with PCOS compared to women without PCOS tend to have more gut imbalances, specifically dysbiosis or just general imbalances with healthy commensal and bad or dysbiotic bacteria. And then also women with PCOS have been found to have more intestinal permeability. So a breakdown with that gut barrier that's so important for our gut health and our systemic health. There's actually been some small interesting studies that have been done that have looked at kind of microbial balance in the gut and the severity of PCOS symptoms and the severity of the excess androgens. And what research is finding is that when there is more of that dysbiosis and we have a lot of that inflammatory dysbiotic bacterial overgrowth, it is associated with higher levels of androgens and more severe PCOS types. And there was actually, I'm like forgetting all the details of the study, but there was a small study, animal study done that actually had animal models with PCOS that they did fecal transplants from, you know, non-PCOS animals and their androgen levels normalized with the fecal transplant, which is pretty wild.

Jennifer Fugo
Wow. That is wild. You're right. Wow. So interesting, the things that are on the horizon that could potentially be options for people. I was wondering, as we're talking about this, and I think it's worthwhile to ask, do you feel from either research or just from your clinical experience, like there could also maybe be a genetic component to this?

Jillian Greaves 15:14
Absolutely. There is. Definitely a genetic component to this. And we do know that fetal exposure to high androgens increases the risk of high androgens and PCOS in offspring. So there is absolutely a genetic component there. There's also a lot of research coming out in the realm of endocrine disruptors and the role in the development and the progression of PCOS. So there's a lot of different really interesting things that are coming to light that I think is just really helpful for supporting women with PCOS more effectively.

Jennifer Fugo
Yeah, you mentioned endocrine disruptors. Are there any big ones that you recommend clients at least be aware of or possibly avoid that could be helpful if you do have PCOS?

Jillian Greaves 16:13
Yeah, so I would say with endocrine disruptors and PCOS, the majority of the data that we have is around BPA and other, you know, BPs. So this is gonna be a chemical that's found or used in a lot of plastics. So women with PCOS have been found to have higher amounts of BPA in their body when compared to women that don't have PCOS. So I will say that's where we have a lot of data with some of the other endocrine disruptors that are common. There isn't as much research. So I think it's helpful to think about endocrine disruptors as a whole. But definitely I think plastics is where I recommend women start. And just sort of assessing what their exposure is. And I always like to point out and emphasize that we live in a world where we're not going to eliminate exposure to all of these things. And that's not the point. But you know, we can thoughtfully minimize our exposure and make some, you know, significant changes over time that really support our health. So, you know, drinking out of plastic water bottles, plastic food containers. I emphasize in particular things that are touching, you know, the liquids we drink, the foods that we eat and, you know, we're actually putting in our body. Um, the other thing that I, I call out a lot with endocrine disruptors and PCOS is phthalates or synthetic fragrance. And that can be a big issue as well. So assessing personal care products, cleaning products, and just making some swaps over time to kind of minimize the exposure there.

Jennifer Fugo
Do you also, are you on the camp? I mean, I just don't like to touch those receipts that you get. Do you feel like those two are better to say, forget it? I'm good. I don't need my receipt.

Jillian Greaves 17:57
I'm so glad you brought that up and I can't believe I missed that. So yeah, that's a big one and can be a fairly easy way to minimize our exposure. So yeah, asking for either declining the receipt, asking for an electronic receipt, definitely a great easy way to minimize exposure to those BP's. Yeah.

Jennifer Fugo 18:20
Let's talk a little bit about some of the skin manifestations of PCOS. I think that, you know, obviously the show is focused around skin. And as many of my listeners know, there can be other underlying factors that can absolutely be part of your picture, part of your journey that may, like maybe the skin issue is actually pointing to something, right? Pointing to something else going on under the surface. So what would be some skin manifestations of PCOS?

Jillian Greaves 18:51
Yeah, so the most kind of common skin manifestation is acne, typically cystic acne, and oftentimes that's around the jawline, and that's associated with the excess androgens that I was mentioning. There are other skin conditions as well that are really common in PCOS, so eczema being another one. Keratosis, Polaris is another one. I never say the name of the, this, right. You're probably going to laugh… anthosis, you know, I'm talking about… AN. I think it's Acanthosis nigricans. That may be it.

Jennifer Fugo
That is not a skin condition. I have a lot of experience with, and we have not mentioned on the show.

Jillian Greaves 19:43
Perfect (haha). I can say it however I want. Maybe people won't notice I'm butchering it. But anyway, the acanthosis nigricans, or AN as I like to abbreviate, is dark velvety skin patches. Darkening of the skin will often be behind the neck. That's probably the most common place we see it, but that's usually a direct product of insulin resistance. So that's a common one. Skin tags are another common one. Seborrheic dermatitis, another one. And really at the end of the day, when you think about kind of the core root causes or the dynamics that are commonly driving, you know, symptoms for women, it makes sense that women with PCOS are experiencing more skin issues, right? So we have the blood sugar and insulin issues. We have the gut imalances. We have the chronic low grade inflammation. And then, women with PCOS often commonly have cortisol and adrenal issues. And all of these things, as I know you talk about in a lot of depth in the podcast, can drive these conditions in a big way.

Jennifer Fugo
Yeah. I actually, as you were listing that out, I was also curious about melasma. Do you see melasma?

Jillian Greaves
I do. I will say. And, you know, I will say I do see melasma in PCOS, but just based on my clinical experience, I don't see it in a disproportionate way compared to non-PCOS clients that I work with. And this speaks to kind of the bio-individuality piece and kind of how PCOS manifests differently in each individual. Some women do have estrogen issues with PCOS and that's kind of part of their PCOS picture. That's where I tend to see more melasma. Other women don't have the same issues. So I would say I see it less, but I do see it.

Jennifer Fugo 22:00
So one question that someone might have is also, what is the difference between how your doctor would approach PCOS versus the more integrative approach? Is there a difference between the two? I mean, I guess let's just hear what is kind of the difference and is there a difference in how you can actually approach PCOS?

Jillian Greaves 22:28
Where do I begin with this one? So the conventional approach or conventional treatment for PCOS across the board is birth control. And I will preface this by saying, by no means anti-birth control, I am always respectful of any individual's decision, you know, in their autonomy to make a choice that feels really great for them. But pretty much across the board, birth control is kind of given out as the first line of intervention for treatment in our healthcare system. Alongside that, other medications like metformin for the blood sugar and ovulatory issues, spironolactone for some of the androgen issues are really commonly given out to women. And the conventional approach is focused on symptom suppression. So with the birth control, if we have irregular cycles, we're kind of shutting down the production of our own hormones and kind of putting a little bit of a band-aid on it. And again, it's not that there's never a time and place where these things would be appropriate, but through a functional medicine lens, we wanna understand more deeply what is preventing regular ovulation? What is creating these symptoms in the body? And the cool thing about PCOS is, as you heard me describe some of those root causes with blood sugar, gut issues, cortisol, inflammation, these things are highly, highly influenced by nutrition, lifestyle, nutraceuticals. So the approach that we take is really trying to understand those PCOS root causes and the imbalances that are driving symptoms and really supporting the body with the nutrition, the lifestyle, the nutraceuticals to bring things back to balance, which is a very, very effective approach. And that can also happen with or without some of these medications, depending on what the individual chooses is right for them. And I think the big issue I have with the conventional approach is that women are told this is your only option. And that is very frustrating.

Jennifer Fugo 24:30
So if they are told that, that doesn't sound like there's much hope, right? Because it's just like, I would assume too, it's very, you have to manage this. We have to manage this, you have to manage this. There's no hope, you're always going to be stuck with this. Is it possible to recover from this or go into remission or to possibly see it disappear as part of your health journey?

Jillian Greaves
It is 100% possible and I do not take that statement lightly. But it is very possible to address those root causes to support the body and get things to a place where the PCOS is essentially in remission, meaning we are not experiencing these chronic symptoms. We have, you know, regular cycles, regular ovulation with minimal symptoms. It is very, very possible to get to that place where we are not chronically dealing with symptoms, constantly preoccupied with thinking about PCOS and food and this and that. And everyone's journey will look a little bit different, but it's very, very possible. And I think it's just frustrating that women are not given that information, but I hope that provides a little bit of hope to anyone out there with PCOS that's struggling to know that there is so much opportunity to really eliminate and put those symptoms at bay so we're not experiencing them day to day.

Jennifer Fugo
I think that is really helpful for people to hear because when you don't know that there is a possibility of shifting things for yourself, it can be very depressing. You know, and that's what I find with chronic skin problems is that some individuals have just been told, sorry, you need to learn how to manage this. That's it. And they don't know that there are other ways to possibly address it or support their body. And to know that sometimes is just really, it's a really powerful place because now all of a sudden you realize there's hope. There's actually hope here. I want to make sure that everyone can find you. So first of all, Jillian has a great podcast that she co-hosts, it's called Your Body Has Your Back, and it's available on all podcasting platforms, correct? (Yes). Perfect, and we'll make sure to link that up. And then you can also find her over on her website. Jillian, can you share with us what that is and if there's any other places that everybody should connect with you?

Jillian Greaves 27:16
Yeah, so you can find me on my website at jilliangreaves.com. And you can also find me on Instagram, over on social media, hanging out there. And my handle is at JillianGreavesRD.

Jennifer Fugo
Perfect. We'll link to all of this in the show notes. That way people can find you. And thank you so much for being here and for sharing so much information in our inaugural PCOS episode. I appreciate that. And we'll have to have you come back sometime.

Jillian Greaves 27:45
Amazing. Thank you so much.

"It's estimated that like 75% or more of women with PCOS have some degree of insulin resistance."