DIET IN PCOS

Approximately 50 – 60% of women with PCOS are obese. It has been shown that losing even 5% of body weight can lead to an improvement in skin, regularity of menstrual cycles and decreased insulin levels.However many women with PCOS experience difficulty losing weight, possibly due to high insulin levels promoting fat storage.

The standard low fat high carbohydrate weight loss diet may not be the best approach for women with PCOS. High intakes of carbohydrates, especially refined carbohydrates (ie. sweets, white bread, white rice, etc.) will quickly turn to sugar and cause elevated levels of insulin. Since high levels of insulin can cause a multitude of problems for women with PCOS, a better diet would be a low glycemic index diet.

This is a diet that includes foods or combinations of foods that do not cause a rapid rise in blood sugar.

Dr. Walter Futterweit, clinical professor

of the Division of Endocrinology of the Mount Sinai School of Medicine, has been working with women with PCOS for 25 years.

He suggests that non-obese women with PCOS who get regular periods eat a balanced diet, moderate - not excessive intakes of carbohydrates (approximately 50% of calories), and select complex unrefined carbohydrates over refined carbohydrates.

An obese insulin resistant woman should consume a diet that is 40 % carbohydrates or less, depending upon the degree of insulin resistance. These are only guidelines – the diet should be tailored to fit the individual person.

I would suggest starting with a diet that is 40 % carbohydrates and work your way downward if need be. Some subjective indicators that the diet is “working” are: decreased cravings and increased energy levels.

Some objective measures that the diet may be working are: weight loss, decreased insulin levels, regular periods. Clearly, this is an area that needs to be researched.

Hazards of Low Carbohydrate Diets That Are High In Saturated Fat
Several of the popular low carbohydrate diets contain as much as 60% of calories from fat, much of it saturated. I do not recommend these diets as saturated fat has been linked to hear disease.

These diets could be especially dangerous for women with PCOS, as they already have an increased risk of heart disease. In addition, these diets are low in fiber, vitamins, minerals and disease fighting phytochemicals. Remember that this is not a temporary diet – it is one that you will need to follow long term! Therefore you will need to make it as healthy as possible.

Calculating Your Caloric Needs

Since the majority of women with PCOS are overweight, calories are very important. For weight control, remember – all calories, whether from fat, protein or carbohydrate, in excess of your body’s needs, will turn to fat. In order to lose weight, you must stay within your calorie goal.

Dietary Recommendations For PCOS

The following recommendations can help you plan your diet. The bottom line is that you need to find a diet that works for you and one that you can live with.
Do not eat carbohydrates by themselves. Instead, combine them with a protein and / or fat
Try to select lower glycemic index foods as they will cause a slower rise in blood sugar. (Glycemic index is an indicator of how rapidly the food turns to sugar in the blood). The lower glycemic carbohydrates tend to have more fiber than the higher glycemic foods. For example, bran cereal (10 gm fiber/1/2 cup) has a lower glycemic index than cornflakes (1 gm fiber/1/2 cup). In other words, select breads, grains and cereals that are as unprocessed as possible.
Do not take your carbohydrate levels so low that you induce ketosis. You can test for this by purchasing ketone test strips at a pharmacy.

Eating less than 40 grams of carbohydrate a day may induce ketosis.
Space the carbohydrates out during the day.

This will cause less of rise in blood sugar and insulin peak as compared to eating all carbohydrates at one meal. (Note – the Carbohydrate Addicts Diet recommends eating all the carbohydrates at one meal. If this diet helps control food cravings and is promoting weight loss – keep it up! )
Avoid those carbohydrates that trigger more hunger or cravings (ie. pasta triggers craving for some people).

Suggested vitamin / mineral supplements:

calcium 1000 mg – 1500 mg (take two – three 500 mg pills a day and be sure to space them out as you can only absorb 500 mg at a time.)
multivitamin with minerals (make sure it contains folic acid 400 mcg if trying to get pregnant)
Drink at least 8 cups of noncaffeinated fluid as a low carbohydrate intake can cause dehydration.
For heart health, limit foods high in saturated and trans fats (ie. fatty red meat, whole milk dairy, butter and stick margarine, chicken skin, fried foods, rich desserts, etc.).

Select mainly monounsaturated fats (ie. olive oil, canola oil, nuts) and omega 3 fats (fatty fish such as salmon and bluefish, flaxseed, nuts) as these fats are heart healthy.

Exercise on a regular basis.

Benefits of aerobic exercise:
burns calories and aids in weight control
lowers blood pressure
raises HDL cholesterol
may improve insulin resistance (this is proven in type 2 diabetics)
Benefits of resistance training:
builds lean mass which will speed metabolism
helps prevent osteoporosis
If on a very low carbohydrate diet, check with your MD regarding a potassium supplement
If constipation is a problem, try a natural fiber supplement such as sugar free Fiber all or Metamucil (may have about 2 grams of usable carbohydrate per dose). Be sure to drink plenty of fluids as well.

For those women who are interested in counting grams of carbohydrate:

a. Suggested carbohydrate intake:
Calculate your caloric needs, whether it be to maintain or lose weight.
Multiply your caloric needs by .4 (this will be a diet that is 40 percent carbohydrate) and then divide by 4 (carbohydrate has 4 calories per gram)
If you are obese and insulin resistant, then you may need less that 40% from carbohydrate. Check with your MD or nutritionist.
For example:

If your caloric needs to lose 1 ½ pounds a week is 1425, then multiply that number by .4and divide by 4 (1424 x .4 = 569 divided by 4 = 142 grams of carbohydrate per day).

b. Count total grams of carbohydrate – not just grams of sugar. All carbohydrates eventually turn into sugar in the blood.

c. To count “effective” grams of carbohydrate, subtract the grams of fiber in a food from the total carbohydrate content. For example, 6 whole wheat crackers might have 15 grams of total carbohydrates and 3 grams of fiber. The effective grams of carbohydrate would be 12 grams. This is what you count when you are adding up your grams of carbohydrate.

TESTS

PCOS is to some extent a diagnosis of exclusion. There is not a specific test that can be used to diagnose PCOS and there is not widespread agreement on what the diagnostic criteria should be. Your doctor will do tests to rule out other causes of anovulation and infertility.
He will usually order a variety of hormone tests to help determine whether hormone overproduction may be due to PCOS, an adrenal or ovarian tumor, or an overgrowth in adrenal tissue (adrenal hyperplasia).
Ultrasounds are often used to look for cysts in the ovaries and to see if the internal structures appear normal.
Your doctor will be looking for a combination of laboratory results and clinical findings that suggest PCOS. If you are diagnosed with PCOS, your doctor may order tests such as lipid profiles and glucose levels to monitor your risk of developing future complications such as diabetes and cardiovascular disease

Laboratory Tests

FSH (Follicle Stimulating Hormone), will be normal or low with PCOS
LH (Lutenizing Hormone), will be elevated
LH/FSH ratio. This ratio is normally about 1:1 in premenopausal women, but with PCOS a ratio of greater than 2:1 or 3:1 may be considered diagnostic
Prolactin will be normal or low
Testosterone, total and/or free, usually elevated
DHEAS(may be done to rule out a virilizing adrenal tumor in women with rapidly advancing hirsutism), frequently mildly elevated with PCOS
17-ketosteroids (urine metabolites of androgens, used to evaluate adrenal function) elevated or decreased?
Estrogens, may be normal or elevated
Sex hormone binding globulin, may be reduced
Androstenedione, may be elevated
hCG (Human chorionic gonadotropin), used to check for pregnancy, negative
Lipid profile (low HDL, high LDL, and cholesterol, elevated triglycerides)
Glucose, fasting and/or a glucose tolerance test, may be elevated
Insulin, often elevated
TSH (Thyroid stimulating hormone)
some who have PCOS are also hypothyroid

Non-Laboratory Tests

Ultrasound, transvaginal and/or pelvic/abdominal are used to evaluate enlarged ovaries.
With PCOS, the ovaries may be 1.5 to 3 times larger than normal and characteristically have more than 8 follicles per ovary, with each follicle less than 10 mm in diameter.
Often the cysts are lined up on the surface the ovaries, forming the appearance of a "pearl necklace." These ultrasound findings are not diagnostic.
They are present in more than 90% of women with PCOS, but they are also found in up to 25% of women without PCOS.
Laparoscopy may be used to evaluate ovaries, evaluate the endometrial lining of the uterus, and sometimes used as part of surgical treatment.

INTRODUCTION OF PCOS

Polycystic ovary syndrome (PCOS) is a health problem that can affect a woman's menstrual cycle, ability to have children, hormones, heart, blood vessels, and appearance.

With PCOS, women typically have:
high levels of androgens. These are sometimes called male hormones, although females also make them.
missed or irregular periods
many small cysts (sists) in their ovaries. Cysts are fluid-filled sacs.

About one in ten women of childbearing age has PCOS. It can occur in girls as young as 11 years old. PCOS is the most common cause of female infertility (not being able to get pregnant).

CAUSES OF PCOS

The cause of PCOS is unknown. Most researchers think that more than one factor could play a role in developing PCOS.

Genes are thought to be one factor. Women with PCOS tend to have a mother or sister with PCOS.

Researchers also think insulin could be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store.

For many women with PCOS, their bodies have problems using insulin so that too much insulin is in the body.Excess insulin appears to increase production of androgen. This hormone is made in fat cells, the ovaries, and the adrenal gland.

Levels of androgen that are higher than normal can lead to acne, excessive hair growth, weight gain, and problems with ovulation.

SYMPTOMS OF PCOS

Not all women with PCOS share the same symptoms. These are some of the symptoms of PCOS:
infrequent menstrual periods, no menstrual periods, and/or irregular bleeding
infertility (not able to get pregnant) because of not ovulating
increased hair growth on the face, chest, stomach, back, thumbs, or toes—a condition called hirsutism.
ovarian cysts
acne, oily skin, or dandruff
weight gain or obesity, usually carrying extra weight around the waist
insulin resistance or type 2 diabetes
high cholesterol
high blood pressure
male-pattern baldness or thinning hair
patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs
skin tags, or tiny excess flaps of skin in the armpits or neck area
pelvic pain
anxiety or depression due to appearance and/or infertility
sleep apnea—excessive snoring and times when breathing stops while asleep