Case Study: Rachel’s PCOS Story
As a functional nutritionist, clients come to me with diverse symptoms that affect their daily lives. I focus on getting to the root cause of their symptoms through personalized testing and restoring balance in the body.
This post is about one of my clients, Rachel (name changed for confidentiality), and the ways lifestyle changes, nutrition, and supplementation support changed her health outcome.
Starting Point: PCOS Diagnosis
Rachel, a 33-year-old woman, came to me feeling frustrated and stuck in her body. She had been diagnosed with Polycystic Ovary Syndrome (PCOS) two years prior by her OB-GYN after experiencing:
Irregular menstrual cycles (ranging from 40-60 days)
Weight gain and weight loss resistance
Acne
Painful periods
Like many women, she was prescribed oral contraceptives as a first-line treatment to regulate her cycle and manage symptoms. The pill completely stopped her period, and her symptoms persisted–Rachel wanted to get to the root cause of what was actually happening to her body.
Alongside hormone-related symptoms, Rachel also reported:
Chronic bloating and constipation
Intense cravings for sugar and refined carbohydrates
Fluctuating energy throughout the day
To read more about PCOS, read my previous blog, “PCOS: Diagnosis, Causes, and Ways to Combat It Naturally.”
Rachel’s Intake
When Rachel first came to me, I could see how debilitating and exhausting her health had become in her daily life. To remedy her all-encompassing symptoms, we needed to dive beneath the surface.
Comprehensive Lab Testing
To better understand Rachel’s physiology, we ran a full functional panel, including:
Key Findings
Gut Health & Digestion
Low pancreatic elastase → impaired digestive enzyme production
Elevated fecal fat → fat malabsorption
High beta-glucuronidase → increased estrogen recycling
Low commensal bacteria → reduced anti-inflammatory, protective gut flora
Metabolic Health
Insulin: 18 (elevated — indicating insulin resistance)
Nutrient Status
Vitamin D: 30 (suboptimal)
Vitamin B12: 400 (low-normal, not optimal)
Hormones
Elevated DHEA-S (380) → adrenal-driven androgen excess
Low progesterone in the luteal phase (0.8) → impaired ovulation
Elevated morning cortisol → stress response dysregulation
Based on Rachel’s results from my Hormone Health Intensive and Gut Health Intensive, her case highlights a common but often overlooked pattern of PCOS: insulin resistance.
1. Insulin Resistance Driving Hormone Imbalance
Her elevated insulin levels were a key driver behind:
Androgen excess (contributing to acne)
Weight loss resistance
Blood sugar crashes → cravings + energy fluctuations
This aligns with what I often see in insulin-resistant PCOS, where metabolic dysfunction impacts ovarian signaling.
2. Gut Dysfunction Impacting Hormones & Metabolism
Rachel’s stool test revealed significant digestive and microbiome imbalances:
Poor fat digestion → impaired absorption of fat-soluble vitamins (like vitamin D, E, A, K)
Elevated beta-glucuronidase → re-circulation of estrogen instead of proper detoxification
Low beneficial bacteria → increased inflammation + reduced metabolic support
Our gut and hormones play significant roles in one another. Their connection is critical and plays a role in estrogen metabolism, blood sugar regulation (very important for insulin resistance), and inflammation.
Alongside the results from the hormone and gut tests, other factors were also driving Rachel’s symptoms.
3. Adrenal Involvement (Stress + Androgens)
Her elevated DHEA-S and cortisol patterns pointed to an adrenal issue, as chronic stress and blood sugar instability can greatly impact hormone production and release. This explains her low luteal progesterone and irregular cycles.
4. Nutrient Deficiencies Worsening the Cycle
Her results also showed suboptimal vitamin D and B12 levels, which further allude to her insulin resistance, fatigue, and disrupted hormone signaling.
Rachel’s Protocol:
Nutrition Foundations
We prioritized a whole foods, anti-inflammatory approach centered on stabilizing blood sugar and reducing inflammation:
Protein- and fiber-focused meals to support satiety and insulin balance
Eating within two hours of waking to regulate cortisol and blood sugar rhythms
Increased intake of cruciferous vegetables (broccoli, cauliflower, arugula, Brussels sprouts) to support estrogen metabolism and help reduce elevated beta-glucuronidase
Limiting sugar, refined carbohydrates, and fast food to improve insulin sensitivity
Emphasis on hydration and increasing daily water intake
Eating Hygiene & Nervous System Support
We also addressed how Rachel was eating — a commonly overlooked piece of digestion and hormone health:
Slowing down and chewing food thoroughly
Stepping away from work or distractions during meals
Taking a few deep breaths before eating to activate the parasympathetic (“rest and digest”) response
Movement & Exercise
Instead of jumping into intense workouts (which can backfire with cortisol dysregulation), we built a sustainable foundation:
Daily walking to support blood sugar, stress, and metabolism
After one month: added strength training 2–3x per week with a personal trainer
Focus: building lean muscle to improve insulin sensitivity and metabolic health
Targeted Supplement Support
Based on her labs, we implemented strategic supplementation to address deficiencies and support key systems:
Magnesium glycinate → nervous system support, blood sugar regulation, and hormone balance
High-quality multivitamin (with vitamin D3 & B12, chromium, zinc, etc.) → replenishing nutrient deficiencies
Digestive enzymes → improving breakdown and absorption of nutrients (addressing low pancreatic elastase)
Broad-spectrum probiotic → restoring gut microbiome balance and reducing inflammation
Inositol → a well-researched compound for women with Polycystic Ovary Syndrome that supports:
Ovulation
Insulin sensitivity
Reduction in hormonal acne
N-Acetyl Cysteine (NAC) → supports glutathione production (the body’s master antioxidant), aids in liver detoxification pathways, and has been shown to improve insulin sensitivity, ovulation, and inflammation in women with PCOS
Results: A 6 Month Overview
Targeting the root causes of issues is not a quick fix, but Rachel committed to the process of healing her body through nutrition, lifestyle changes, and supplemental strategies with ongoing check-ins and adjustments with me.
2–3 Months:
Regular bowel movements (1–2x daily)
Significant reduction in sugar cravings
Improved appetite regulation
Early shifts in weight management
4 Months:
Noticeable improvements in energy levels
Reduced bloating and digestive discomfort
Continued progress in gut health
6 Months:
More regular menstrual cycles
Improved skin clarity
Better metabolic resilience and overall well-being
Key Takeaways
PCOS is not just an ovarian condition — it’s deeply connected to metabolism, gut health, and stress physiology
Irregular cycles are often a symptom, not the root cause
Gut health plays a major role in hormone detoxification and inflammation
Insulin resistance is one of the most common (and overlooked) drivers
Supporting the body requires a whole-system approach — not just symptom suppression
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