Diet and PCOS – new information

One of the nicest things about working from home is that I’ve been able to take time to study. I love to learn and I’ve been having such a great time exercising my brain with the tutoring lessons that I figured it would be nice to take some courses myself. I discovered Future Learn through a link on Facebook that a friend sent me for a course that she thought I might enjoy. I signed up for that one and a whole bunch of others that I’ve slowly been working my way through and I’ve loved it.

The one I wanted to talk about today is Food as Medicine, which is run in conjunction with Monash University, who are pretty much global leaders in food science and are responsible for the discovery and design of the FODMAP diet, which has benefited thousands of people the world over who suffer from IBS and other digestive issues. I’m actually pretty devastated that I can’t afford to upgrade to get the official certificate of qualification from the university upon completion of the course because it would be a great thing to have on my CV as someone who wants to speak about PCOS and all of the other stuff that goes with it. It’s not actually that expensive – anyone can do the entire course for free but to get the official certificate and unlimited access to the course material costs £62. For the amount of information they impart, that’s more than reasonable. But yes…setting up a new business and trying to downscale means no luxuries for me.

I digress. The reason I wanted to talk about what I’ve been learning on this course is that an awful lot of it so far (I’m currently halfway through week 2 of the course) is relevant to women who suffer from PCOS and the choices we make in terms of diet. A lot of it goes against current dogma for the treatment of PCOS at home, including the use of supplements, and the arguments surrounding “low carb” diets. I thought it might be of benefit to some of you to summarise some of what I’ve learned to date.

The first thing was about the make-up of diets and what we should be consuming in terms of food diversity. We covered a lot of topics about phytonutrients and macro and micro nutrients, but the long and short of it is that in order to obtain all the vitamins, minerals and other things that we need, we should be eating an absolute bare minimum of 20 different foods per day. By “different foods” they mean ingredients so, as an exercise, they asked us to write down everything we had eaten over the course of a day. My obsession with homemade granola got me off to a good start by the time I’d counted all the different nuts and seeds and things I’d put in. I’d also had a pretty healthy lunch that day with a mix of pickles and salads and so on. Dinner had been pretty basic but even that added up to a decent amount by the time I’d counted the different veg, all the herbs and spices I’d used as well as cooking oils etc. It was reassuring to note that with a count in the mid-fifties, I’m in the group of people who eats a diet that’s considered “excellent” and diverse enough to provide me with just about everything I need. A “good” diet falls in the mid-thirties to mid-forties range and, as I said before, a bare minimum would be around the 20 ingredients mark. I’d really encourage you to take a good and honest look at your diet and how you eat and try writing down everything that you eat for a day or two to see how you score on this range. It’s all well and good to talk about eating specific things for specific minerals, but it’s no good if you’re just adding singular things to an otherwise unhealthy regime.

One of the things that they keep reinforcing over and over again is that so much of food science is flawed because scientists want to try and study things in isolation and in terms of food this is the worst model imaginable. They quoted an example of an antioxidant food that was being studied in terms of cancer prevention. In one study in one of the Scandinavian countries, they found no benefit at all from it. A similar study in Greece found that it had significant preventative benefits. The reason for the difference, they concluded, was that most antioxidant compounds are fat soluble and the average Greek diet has a much higher oil content than the average diet in the first country the study was carried out in. It wasn’t that the compound wasn’t working in the first study; it was that the participants weren’t actually absorbing it. This is why the Mediterranean diet seems to work so well – not only is it full of antioxidant and nutrient rich foods, it’s high in oil content with olive oils and fatty fish, allowing all of that goodness to be absorbed in the gut.

In conclusion to this portion of the course, they explained that a healthy diet should be full of diversity and contain a reasonable amount of healthy unsaturated fats, such as those you’d find in oily fish, certain cooking oils, things like avocados and so on. The idea that a low fat diet is the best way to lose weight and get fit is actually damaging in terms of the micronutrients your body needs.

They also discuss what they call the “fad” of low carb, high protein diets. In the early stages of the course they describe this diet as completely pointless because one gram of carbohydrate provides exactly the same energy as one gram of protein – 17kj or the equivalent of 4 calories. By replacing carbohydrates with proteins you aren’t gaining anything except excess burden on your kidneys. They did qualify this much later in the course when discussing the thermic cost of food, which is the amount of energy required to digest it. For protein, approximately 20-30% of its energy intake is required to digest it, whereas for carbohydrates it’s only 5-15%. So overall, the net calorific intake for protein is less than that of carbohydrate for the same volume of food, but it’s certainly not ideal, especially considering the extra burden that it places on the kidneys. The sum of this knowledge is that high protein isn’t the healthy way to go.

While I have never advocated for a high protein diet, or seen it advocated for specifically for women with PCOS, I have always advocated for a “low carb” diet to manage blood sugar and insulin resistance, with the decrease in “carbs” being made up for by an increase in vegetables. The most eye opening thing about this for me is the knowledge that at least half of your carbohydrates should come from vegetables. This idea we have as a society that carbs are basically your pasta and rice and potato and bread etc, i.e. all the white and starchy things, is patently wrong. A diet high in vegetables is not “low carb”. It’s complex carb rather than simple carb. As such, I will do my very best to not refer to it as low carb again because it’s misleading. It’s a diet low in simple starchy carbohydrates. By reducing those and increasing vegetables, you are not decreasing your carbohydrate intake; you’re simply making it take longer for your body to digest the same amount of carbohydrates, resulting in the stabilisation of blood glucose levels.

To summarise all of the above, every country has different guidelines but the current recommended daily amounts as given in Australia (where Monash University is located) are that, of your total food volume, 15-20% should be protein, 45-65% should be carbohydrates (at least half of which come from vegetables) and 20-35% should be healthy fats.

There was then an interesting debate entitled “Farmer vs. Pharma” where they discussed the usage of supplements. The bottom line of the debate was that if you are eating all the right things, there shouldn’t be a requirement to take any kind of supplement because you should be getting all your vitamins and minerals from your food. Notable exceptions were probiotics and prebiotics because scientists have seen a drift towards gastric issues being caused by much cleaner and more sanitised standards of living, leading to a decrease in the introduction of bacteria to the gut flora. They also stated that there are certain cases where they would advocate for the usage of omega oil supplements from sources other than fish (such as seeds) because the requirement to eat oily fish is leading to a collapse in fish stocks. There was also a discussion around poverty – that perhaps a multivitamin was a reasonable option for those who cannot afford to buy fresh produce in the diversity and volume required to have a healthy diet. They then rounded up by saying that unless there was a “physical or physiological reason” to take a supplement, there wasn’t much point. I felt like this was a bit of a cop out because the example they touted was that a person might have anaemia and would need to take an iron complex under medical advisement. With regard to PCOS, I’ve read a tonne of studies about how using certain supplements such as Chromium and B complexes are beneficial to women with the syndrome. This is clinically supported. I don’t know where this falls on the spectrum of debate, but I suspect this comes under the broad stroke of “physical or physiological reason” to take supplements. I don’t know and it’s something that will require more research I think. I interpreted what they said as meaning that a person would have to have impaired uptake for whatever reason, so the person with anaemia actually has some kind of malfunction with their iron absorption rather than that they’re not eating a full and proper diet. Unfortunately, the mechanism of PCOS is so little understood and the metabolic disorder is so wide ranging that I suspect we simply don’t know if there are mechanical reasons why supplements may help. It was also interesting to note that in a later module where they discussed fibre, they mentioned that the current guidelines are that an adult should eat 30g of fibre every day to maintain a healthy gut but that the vast majority of people are only eating 20g per day, even those with a varied and “healthy” diet. If it’s the case for fibre, then I suspect it may also be the case for other important nutrients that the body requires. We simply don’t eat the right things in the right volumes, even though we know the science.

The final part of the course to date that I felt was relevant to the topic of PCOS was a module about foods and inflammation. I’ve discussed before on the blog that there’s a leaning towards the assumption that a lot of the metabolic disorder and the syndrome of PCOS in general is related to chronic low-level inflammation in the body and that therefore it makes sense to eat an anti-inflammatory diet. They reinforced that idea and strongly emphasised how important it is to eat anti-oxidant foods, most of which are fruits and vegetables. They also pointed out that the majority of anti-oxidants are fat soluble, repeating again how important it is to make sure you’re eating healthy sources of unsaturated oils, such as nuts and seeds and fruit. They stressed several times that an anti-inflammatory diet will only work on a baseline of a healthy and varied diet. You can’t eat processed rubbish and think you’ve balanced it out by having a turmeric and ginger smoothie at the end of the day. That’s just putting a band aid on an amputation. You need to eat well and then amplify the benefits by adding in specific anti-inflammatory compounds like curcumin (turmeric). The final thing of interest that I learned in relation to inflammation and diet was that we should avoid high fructose content products. The theory is that they cause inflammation by promoting the formation of pro-inflammatory compounds in the body. They didn’t specify what “high fructose content” was in real terms, but they did use the examples of fruit juice and anything sweetened with high fructose corn syrup. I plan to do a bit more research around this and will report back with any findings, but it may be time to consider passing on the morning glass of fruit juice.

I have a lot left to learn and the next module is diet and fertility, so I expect there will be a lot of relevant information in that module to come back to you with. I’ll write again in a few days but until then, I hope this has been both helpful and interesting!

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