041: Is PCOS Causing Your Adult Acne & Weight Gain? w/ Robin Nielsen

I am delighted to have my good friend and fellow wellness advocate Robin Nielsen on Couch Talk this week. Robin is a functional nutritionist, board certified in holistic nutrition with 13 years of clinical experience and specializing in hormone balance.

She is also my co-founder of Sexy Younger You program, and now she organizes a fabulous PCOS (Polycystic Ovary Syndrome) conference. During this talk, we discuss PCOS and it’s symptoms.


 PCOS min. 3.17–8.40  Robin’s personal story of how she decided to fight against her weight gain and persistent acne – PCOS symptoms
min 12.04–15.53 Androgen excess symptoms
min. 15.53–19.08 The ovarian cysts
min 21.49–22.32 The PCOS bucket
min. 22.35–25.03 The free PCOS Summit conference


Androgen Excess As The Main Reason Why We Get Acne And Put On Weight

Dr. Anna Cabeca:

In today’s Couch Talk, we're going to talk about androgen excess and the symptoms that relate to it:

  • Thinning hair
  • Weight gain
  • Acne breakouts.

Androgen excess is an issue that starts even as early as when we start our periods and menarche (our first menstruation). That’s why young girls might experience acne and weight gain occurring rapidly.

If we have that history (of androgen excess), we also have a more challenging time in the perimenopause, menopause, and during this transitional time period. So as a physician working with women who have these symptoms and issues (the hair loss, adult acne) I want to ask:  

Why is that even fair?

I'll address those issues today with a special guest that I'm really honored to introduce — Robin Nielsen.

Many of you might know, Robin and I go way back. She's one of my dearest friend and colleague. We met back in 2011 at the first Mindshare event, where people get together to integrate, collaborate, and promote health and wellness.

Robin is a functional nutritionist. She's board certified in holistic nutrition with 13 years of clinical experience and specializes in hormone balance. Her goal is to help women grow younger, no matter their age.

That’s why she founded Insulite Health and PCOS.com, which is the world's most comprehensive company offering natural support to women with PCOS, specifically to empower their health, their bodies, and their lives.

We co-founded Sexy Younger You summits together and had 3 amazing summits and programs. Currently, she's hosting another summit right now.

>>> Check out the PCOS summit <<<

She's had the pleasure to have interviewed over 150 worldwide health experts on strategies for aging well and balancing hormones.

She is a past president of the National Association Of Women Business Owners at Silicon Valley and the National Association Of Nutritional Professionals, and her wellness retreats have been featured on CBS. Robin is also a mom of two children and is married to her fabulous husband, Eric.

I’m so excited to have you here Robin, to talk about androgen excess and certainly so much more.

Can you tell our audience, for those that don't know you yet, what brought you to this arena?

mighty maca

PCOS And Acne: A Personal Story

Robin Nielsen:

I didn't know it, but I actually had PCOS my whole life. PCOS stands for polycystic ovary syndrome and I had most of the symptoms of it for so many years. My main symptom was persistent acne.

So persistent acne is a great indication that you have something called androgen excess, which means that your body produces too many male hormones or testosterone.

In my case, it was really from DHEA. There are a lot of ways that we can have too much testosterone, but I didn't have the menstrual irregularities. I had the persistent acne and I could gain five pounds in a day.

I'm kind of a small person so that was a really big deal for me. It was really hard to lose weight, so I learned to under eat and over exercise.

I thought that must be the solution. So if I wanted to release that five pounds that I gained the previous day, I just didn’t eat and then I'd have to go for a run to see if I could get that off.

And that was a horrible way to live.

Because what ended up happening was that I became really nutrient deficient. I had arthritic symptoms in my hands and I was just 20 years old, so I really feel like a lot of my symptoms were kind of PCOS symptoms.

On top of that, I was super irritable. I realized at the time that I wasn't feeling great, but I didn't know that I could fix it. I thought, “Oh, this is just me, I'm just, I'm just the B word.”

But that's not true.

It’s Not Your Personality – It’s Hormones

Dr. Anna Cabeca:

Yeah, you're not alone in that. We feel like, “Okay, who is this person? What's going on? Help me!” And then to be told often, “You're normal, that's what we can expect at this time.”

That's really frustrating.

Robin Nielsen:

So frustrating. I grew up in a family where we didn't run to the doctor for everything.

I think that I went to the doctor for my acne but the only solution was antibiotics and I did take them just for a super short time when I was graduating from high school so I could feel a little bit good about myself during that time.

Because, you know, when you have persistent acne you become a social misfit.

I felt like I could be beautiful, but I just had this red inflamed skin all the time on my chest and my back as well. I couldn't wear a bathing suit and not feel completely embarrassed.

It completely changes your life and definitely it was not the life I had dreamed of. I was irritable, I had these huge blood sugar mood swings. Sometimes I was kind of depressed.

I was the queen of not eating breakfast because I thought it would make me fat and then I would go do my Jazzercise and then I would have a Mocha, a little bow tie pastry and, oh my gosh, talk about your blood sugar!

When I exercised then, I'd have my Mocha and my little pastry, because I deserved it. That was my thinking back then.

Cutting Out Bread and Changes That Followed

And then just by chance, I got to a point where I started to get angry about something. That's when really effective change can happen.

So I remember I was driving home from work one day and I had a kind of fat roll over my pants, and I said to myself, “That's it. I've had enough! I am doing something about this.”

So it was then that I actually decided to change my diet and the first thing I did was cut bread out.

It just was totally random, it was only because I ate bread all the time. I had my bow tie pastry for breakfast, maybe a sandwich for lunch, maybe roles for dinner. And I thought, if I just cut that out, I bet I can make some changes.

I didn't know how to cook, but I was the baking specialists. I could bake chocolate cakes and chocolate chip cookies. So I had to eliminate that. And once I did, it was so crazy how the inflammation started to go away.

The arthritic symptoms in my hands started to go away. My face started to clear up. Some really cool things started to happen. There was a lot more work to do, but that was my first, “Aha! I can do this myself.”

And of course, constipation that I had for years and years, and have no idea that having a bowel movement every few days wasn't normal. I mean, who talks about that?

Dr. Anna Cabeca:

Right. I used to ask the question among my patients, “Are you constipated?” Their answer being, “No.” And I'd ask, “Well, do you have one or two bowel movements a day, or more?”

“No, I have one every week.” Well, that's constipated!

What was the time period we are talking about? 80’s, right? The high carb movement time period, right?

Robin Nielsen:

Yeah, it was so interesting because it was when you know, those mocha coffees first came out.

So it was when the sort of barista movement started, maybe that's when Starbucks started, I don't know, but we had this great little coffee place where we lived in San Carlos. And I looked forward to it every day.

Little did I know that all that sugar was keeping me stuck.

And the same thing about don't eat fat, right? I knew protein was good for me, but I certainly didn't know that fat was good for me. And so, sugar. No problem. You know, sugar is okay.

Dr. Anna Cabeca:

Yes. You were an early adopter of what I like to call going against the grains, not villainizing them, but seriously going against the grains. And you talked about your belly fat over your belt buckle, essentially the muffin top phenomenon. Why is that? That's a really big component now that we're seeing a lot, you know.

So maybe we can talk about that too as it relates to early sign or symptom of androgen excess.

How badly this extra fat contributes to estrogen dominant symptoms and so much more hormone imbalance. It starts at an early age. To understand the broad effects of this it's important to address these underlying reasons. We often see just the tip of the iceberg.

The Polycystic Ovary Syndrome Bucket

Robin Nielsen:

We experience a lot of these things but we have no idea that these things fall into what's called the polycystic ovary syndrome bucket.

We as women, know that we have these hormonal imbalances going on. Even in our 20s, so many women have hot flashes and we think of hot flashes as really a postmenopause thing or perimenopause thing. But that's absolutely not the case.

Hot flashes do not age discriminate. Women with PCOS have hot flashes in their twenties and they also have night sweats and they don't have periods. So many similarities.

I was talking to another physician about this and she brought up the exact same thing and I said, “wow, I'm not alone in this, right?” There is some validity to this. Symptoms of PCOS are:

  • Hot flashes
  • Weight gain
  • Alopecia
  • Hair loss
  • Acne
  • Skin tags

Dr. Anna Cabeca:

Skin tags in the areas where the skin rubs or connects. So the neck, underarms, sometimes in between the legs, or the lower abdomen area. Where there are folds of skin too. We often see these skin tags.

Robin Nielsen:

And that's where you see acanthosis nigricans, which is the dark velvety skin patches. They're definitely in the skin folds for sure. If you're starting to see those dark velvety skin patches, that's a real sign of androgen excess and not oscillating or a history of anovulation or infertility or irregular menstrual cycles.

So many women either have really frequent menstrual cycles or they just don't have any. And the menstrual cycle is really cool because it is a fantastic way for women to gauge how well they're taking care of themselves.

The Importance Of Regular Menstrual Cycle

Dr. Anna Cabeca:

Yeah, absolutely. You know, how well are the hormones balanced? What's going on? Are we ok or not ok? So these early signs and symptoms can really tell us a lot about what's going on.

Let's get to the underlying root cause of the symptoms and how we'll address that.

Robin Nielsen:

Yeah. And it's super frustrating, not to have a regular menstrual cycle because even though I have to say postmenopause: it's not nice not having one when you're supposed to have one.

It's really important that you do have one because that's an indication that your body is functioning as it should. Women just worry so much when they don't have a menstrual cycle because of potential cancer and increase in cancer risks can happen.

And of course, if you want to start a family that's a really huge deal and you just know something's not right. You're not in sync with the rhythm of the earth basically. That's a huge topic.

And then, of course, another symptom of PCOS would be lingering fatigue, lack of motivation, facial hair.

Facial Hair as Sign of PCOS

So again, that male pattern hair growth. That dark terminal hair that comes on your face and other places on your body. I've noticed it at times. I get a few dark hairs around my nipples, so I ask, “what am I not doing?”

Maybe if I become more insulin resistant, then digestive problems become part of the picture. And sometimes it can start there. There are a lot of root causes. Blood sugar problems for sure.

Something that you may not know that you have, is insulin resistance, but it actually causes a lot of these symptoms. The blood sugar swings that you can probably feel, which causes those intense cravings. And then just because you have it (sugar), the crash happens.

Ovarian Cysts

Robin Nielsen:

And then ovarian cysts. If you do an ultrasound with a doctor who really knows what she/he is doing, you might find out that you have ovarian cysts.

A lot of women exhibit all these symptoms so you could or not have these, but there's a very specific way to diagnose ovarian cysts because most women actually have follicles right on their ovaries at one time or another.

But the cysts are different. The PCOS cysts are different. If you'll look in the conference that is coming up, you'll learn all about that.

>>> Learn more about the PCOS summit <<<

Let’s talk about decreased libido. We talked about menstrual irregularities and depression, is a huge thing that happens.

And so if you've ever experienced any of these problems and maybe your doctor puts you on a birth control pill or put you on metformin to manage your blood sugar and spironolactone for facial hair and other things.

If that's the case, then you probably are a woman suffering from a condition called polycystic ovary syndrome.

Diagnosing PCOS Through The Ovarian Ultrasound

Dr. Anna Cabeca:

Thank you for sharing that. One thing that is so unfair — losing hair here, growing hair there.

I mean we can feel that, especially in menopausal transition, and we definitely don't want those to signal a hormone imbalance. I can see myself here.

If we're just looking at the ovary on the ultrasound, what we see as gynecologists when we're doing a vaginal probe ultrasound — we can usually see the ovary very clearly. That way we'll see a thickening of this entire luminal area between the follicles.

What you can see here is, a corpus luteum, a little larger follicular cyst, it looks like a corpus luteum and you'll see a lot of these all throughout the ovary. So sometimes I've seen as many as 20 or 30 larger follicles within a thickened ovarian stroma, i.e. within a thickened ovarian tissue.

That's a sign that this patient may have some type of ovarian resistance from insulin resistance or something else.

Typically I'm doing this when I'm diagnosing infertility or irregular bleeding or whatever reason that brought me to do the vaginal ultrasound. So it's important to understand that, we see these physical changes from the hormonal milieu, not the ovary. It's just the hormone communication system. And most of our women with androgen excess are the tribal women leaders.

They are the ones that are going to out-survive others in the tribe, they really have amazing genetics. I call my young teenage clients who come in with these early signs and symptoms, at the start of their period, “Pocahontas”. “You've got Pocahontas genes and so we need to honor you, by being in nature, being incredibly athletic, having that potential for endurance, etc.”

The Importance of Keto-Green™ Diet

Think of the Amazonian women, or Pocahontas for a visual idea, that kind of individual. So it's not like you're broken in any way. You're really optimized for strenuous situations in your life that also incorporate lots of fasting in your diet. Our ancestors over 10,000 years ago before the agricultural era have really adhered to really a keto-green diet.

So a lot of healthy protein, fats, things that could sustain them plus many greens, that they would use naturally, incorporated into their diet. So it seems to be a nice balanced diet that really honors your body.

Going against the grain, staying away from grains and unhealthy carbohydrates, sugars, all those things. Just optimizing the greens. The greens can really empower our clients, so that's really important. I know you go into nutrition at your summit and you talk about the different aspects of it.

>>> Learn more about the PCOS summit <<<

Robin Nielsen:

Yes, at the summit we are going to have many specialists that really focus on these key areas to optimize your hormones, etc. So I think it's really important to understand that if you have a painful abdomen or if you've experienced any of these symptoms that Dr. Anna and I have talked about — they're just symptoms of something else going on.

I call those something else, hormone deal breakers because they're really sort of wreaking havoc on your hormonal system. And there's, a whole list of them that I go over.

I have interviewed 47 experts. It's just incredible: all this information on hormone balance, fertility, what to eat, how stress plays a role, what your hormones are actually doing and more.

If you can relate to some of the symptoms that Dr. Anna and I talked about, then you kind of fall into this polycystic ovary syndrome bucket, right?

 >>> Do you have PCOS? Take the test here<<<

That's all it is, is a bucket and you don't need a diagnosis. You just need to know that something's not right and that you want to fix it.

Because I always say that, we ended up living the life that we didn’t dream we'd live. And you really want to turn that around so that you can live the life that you did dream of living. I hate being sick. It is such a lonely journey, people can give you sympathy, but that's about it.

So I wanted to really dive in and get to know as much as I could about what was going on and there was always an insulin resistant component.

Insulin Resistance

So a lot of women think that they cannot relate to this. They think, “I'm not insulin resistant.”

But what happens is, when we get testing done, fasting insulin levels are never tested. It's not a common test anymore. I think it used to be much more common along with all the other markers that we really need. And as a result, there's really no awareness around what's going on with our body.

So during this conference, you're going to learn all about your body — exactly what's going on — you'll be able to relate to certain practitioners and take home some incredible pearls of wisdom on hormone balance.

>>> Learn more about the PCOS summit <<<

So whether you have PCOS or not, it's all about hormones.

And Dr. Anna is one of our brilliant speakers at the summit and she's going to share more about doing Keto-Alkaline® (Keto-Green™) the right way. Because Keto is one of those things that you can do to heal. A lot of times, we go to these extremes to try to fix things and it ends up kind of making us worse sometimes, or it's not sustainable.

>>> Listen to Dr. Anna Cabeca’s presentation during the PCOS summit <<<


Dr. Anna shares how Keto-Alkaline® can really make you feel better, and how it's a lot more sustainable, as well as how to implement it correctly. So I'm very excited to share that interview with you.

The PCOS conference is free. As soon as you sign up you get three bonuses and one of them is, “What is PCOS and What is The Hormone Deal Breakers?” whether you kind of relate to polycystic ovary syndrome or not (I would have never related to it until I really started digging into this). What's really interesting in this, is it's a multifactorial condition. Basically where the female and male hormones are just out of whack.

Dr. Anna Cabeca:

That's interesting to me because what we're seeing right now is a trend towards women's androgenization and men's estrogenization. So we're seeing women with more androgens, and men with more estrogens. So the masculinization of women, the feminization of men, and all these things may really relate to hormone imbalance, right?  

So where's it all coming from? Endocrine disruptors. There's a part that's genetic, and there's a part that's our microbiome, but the research shows that 75 percent is in our control. So as we get the information and the knowledge to empower that balance, we can optimize our physiology so that we are balanced all the way through, physically.

Our health will be better, we will reduce our risk of cardiovascular disease, diabetes, and the list goes on when we're dealing with these underlying physiologic changes that ultimately result in inflammation or even dementia.

The other thing you talked about is that it's multifactorial and that is so important because there are many reasons, right? We just showed one with the ovaries, but you know, there's a genetic component and an environmental component.

In every case, every woman that I worked with that was receptive to making these changes in their life through lifestyle and nutrition improvement, every single of them improved. Every single one of them changed the trajectory of their life from being on the fast road to sickness — that fast road to debilitating disease — to the road to life improvement, energy, loving their kids, loving their grandkids, loving themselves.

Robin, you are just so good at conveying that information. You're are one of the best interviewers I've interviewed with. You're able to dig out really specific points that allow people to think, “Ok, I can implement that.”

So from this multifactorial cause, unveiling this multifactorial approach. There's a way to help everyone.

Do you want to talk about a couple of facts that you've gotten from your summit speakers or in your own life? Something that women who are signing on for this summit, can start implementing right away?

>>> Sign up for the PCOS summit <<<

The Importance Of Habits

Robin Nielsen:

What's really cool is that every speaker gives three simple tips to the woman who is just starting out on this journey because I want it to be super simple. So while that was a fantastic idea, there are now over 132 simple tips.

And they are unique tips! So you'll have 132 really simple tips. You can just take notes and just put them on your fridge and say: “Today I'm going to do that one.” And the really cool thing is that I really believe in the 5% solution.

The 5% Solution:

If you picture a sailboat heading over to Santa Cruz island out of Santa Barbara. And when I’m at the helm, I tell you: “Keep that compass at 85 or we're going to end up in Hawaii.”

So you keep it at 85. Well, if we switch that to 90, if we’re just not paying attention, now all of a sudden we’re going to end up on a completely different island or on our way to Hawaii.

So if you just make a 5% shift, just start one new habit that really supports you. Now all of a sudden your health just explodes.

There's this great book that I read recently and it was all about habits and I wish I could remember the name, but I can't. But if you look on Amazon you'll find it because it's super popular. It’s really a well-liked book and it talks about the habits of the most highly successful people.

The author talks about keystone habits and keystone habits are incredible. I'll just share one with you. This is not in the summit, by the way, so you'll get an extra keystone habit, which is: They found that if you want to lose weight, you need to pay attention to what you eat.

They did this study and they had a group of people who did not track what they ate or how they were feeling or anything else and they had a group of people who just kept track. They just wrote down what they ate and sort of how they felt that day and the people who wrote down what they ate, lost weight because they started paying attention.

They started noticing how they felt and what was happening, and what was going on in their lives and they just had this bigger awareness and it started kind of having a ripple effect on other things that they were doing in their lives.

The same thing, if you just make your bed every day, all of a sudden you become healthier, wealthier. Like all, these really cool things happen.

So it's these keystone habits and that's what I'm trying to share with you in this online conference.

What are some super simple things that we can do that’ll have this ripple effect?

You know, we can all go walking, right?

You and I were talking about how, if you can just eat your last meal before 7 pm, you're 50 percent more or you're way more insulin sensitive. Then after seven, like it drops by 50 percent. If you just go walking after a meal for 15 minutes, you decrease your insulin production and cortisol by 50 percent.

So it's a win-win, right? Cortisol and insulin go together. So of course if your cortisol's up, your insulin is going to be up because you've got to “run from that tiger”. So it's this whole complete picture and through all these amazing interviews you're going to have these crazy good insights.

Dr. Anna Cabeca:

I know, I love it. And plus you give the transcripts and everything else to the readers so they can start doing that faster. God bless. I'm one of those who likes to read, write and highlight. I seem to not be able to think or talk without a pen and paper.

Robin, tell our audience, how they get to your summit. And I want to thank you for coming on my Couch Talk today. There are so many issues because we may struggle with our own self-confidence and that's something we never want to give up.

You have to maintain that, embrace it. Because I say that, the holy spirit is within us. We have this beautiful spiritual energy within us. So we need to really optimize that energy and to do that we have to improve our physical health. Thank you for being with us today. Check out Robin’s free summit and info here:

>>> Sign up for the PCOS conference <<<

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Dr. Anna Cabeca

Dr. Anna Cabeca

Certified OB/GYN, Anti-Aging and Integrative Medicine expert and founder of The Girlfriend Doctor. During Dr. Anna’s health journey, she turned to research to create products to help thousands of women through menopause, hormones, and sexual health. She is the author of best-selling The Hormone Fix, and Keto-Green 16 and MenuPause.

Learn more about my scientific advisory board.