PCOS and diet, part 1

The approach to food and lifestyle with PCOS is something that requires a two-pronged attack. Today we’re going to cover half of it and then tomorrow I’ll revisit the topic.

So you’ve been diagnosed with PCOS and I can guarantee that almost the first thing out of your doctor’s mouth when discussing treatment options was “lose weight”. It’s standard. A significant proportion of women with PCOS will be overweight, the majority of those measuring in the obese spectrum. The reason for this is because a major player in the syndrome is insulin resistance.

When you eat sugary foods, your body produces insulin. This encourages the cells to take in the sugar from the blood and use it for energy. When your cells are resistant to the insulin, the sugar remains in the blood stream, giving you high blood glucose. This in turn causes more insulin to be created until you also have high insulin levels in your blood. The insulin then turns the glucose into fatty acids and deposits them in adipocytes (fat cells). Worse, it then inhibits (prevents) the breakdown of fats from the adipocytes, meaning that once you’ve laid down all that fat, it’s incredibly difficult to remove it.

How do we deal with that in terms of dieting? The obvious and immediate answer is to cut out sugar. You need to stop eating anything that contains processed or added sugar. I know this sounds like a harsh measure but you have to try. Part of the problem with this yo-yo of blood glucose levels and hyperinsulinaemia is that you actually physically crave sugar and it will make it very difficult in the early days. The good news is that as your blood sugar stabilises, the cravings will fade away. You will also find that the less added sugar you eat, the sweeter natural sugars will taste. My boyfriend laughed so hard at me getting practically orgasmic the first time I ate mango a couple of months after I stopped eating sugar because it just tasted so good.

Unfortunately, that in itself is not enough. Your body is designed to turn food into energy and so it will easily break down most carbohydrates, especially processed or “white” ones, into sugars. That means your starchy and over-processed carbs also need to go out of the window, to be replaced with complex and harder to digest carbs. So replace your processed and milled white rice with the brown, red or black rice. Replace your processed fries with boiled new potatoes. These will take much longer to break down in your system, meaning that the sugar is released much more slowly into your blood stream.

A really good measure of this is the glycaemic index. Low GI foods are better for you than high GI foods because they will help maintain a low and stable blood sugar.

There’s an issue with the volume of carbs that we eat too. The tendency is to have a plate of pasta with a spoonful of sauce, or a plate of rice with a spoonful of curry. We dollop mashed spuds onto our plates with abandon. And all that carbohydrate is just sugar in another form, waiting to cause havoc on our bodies. The advice I always give is to view your plate as a disc and cut it into four quarters, like a pie chart. 1 quarter of your plate should be carbs. 1 quarter of your plate should be proteins (meats, fish, eggs etc). The 2 remaining quarters (or 1 half) should be made up of mixed vegetables, the more variety the better. When I was first learning about this, I was pretty rigid about the set up of my plates and quartered everything for a solid month. After that, when I was fairly sure I had a good grasp of the volumes involved, I began making more complex meals where carbs were mixed with veg and veg was mixed with protein. It’s a question of familiarity.

I have read some interesting articles lately on the benefits of intermittent fasting, such as the 5:2 diet, for improving insulin sensitivity. Unfortunately I have yet to see any actual factual clinical studies and while anecdotal evidence amongst the diabetic and PCOS communities is promising, I haven’t seen any studies carried out long term (longer than a year) in any great number of patients. I raise it here purely because the initial data is promising and it’s something worth looking at, but I don’t feel I can personally recommend it without a) having done more reading on it, b) having seen serious clinical trials on it, and c) having tried it myself.

That’s it for today in terms of the insulin resistance part of the diet. Tomorrow we’ll be looking at new evidence about one of the main causes of PCOS and how that too can be managed with diet and lifestyle changes.

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