Whether it affects you or someone close to you, Polycystic Ovary Syndrome (PCOS) is a challenging medical condition that requires ongoing management. The good news is that lifestyle factors, in particular nutrition, hold the potential to positively influence health outcomes and empower those with PCOS. It’s time to change the way we look at disease and come to be invigorated by the choices we make each and every day. This can all start with what we put into our mouths!
What is it?
PCOS is one of the most common medical conditions in young women. In fact, 1 in every 8 women of childbearing age is affected and unfortunately, many cases remain undiagnosed. In a nutshell, PCOS involves an imbalance of one or both of the following hormones:
· Testosterone (the male sex hormone) is higher than it should be
· Insulin (the hormone that helps to store energy after we eat carbohydrates) is higher than it should be.
What are the symptoms?
Women may experience some (not necessarily all) of the following symptoms:
· Lack of or irregular periods
· Struggling to fall pregnant
· Loss of hair from the head
· Excess growth of body hair
· Deterioration of mental health
· Difficulty in losing weight
At least two-thirds of women with PCOS also have insulin resistance, hyperinsulinemia and metabolic dysfunction. These characteristics are very similar to those experienced in Type-2 Diabetes and so the mechanisms to treat and manage the two conditions often overlap. But what exactly is insulin resistance and what can be done about it?
Consider this scenario. You are the manager of a small business that employs five staff members. Your workers are given set workloads and their daily performance is outstanding. You decide to give your workers greater workloads because you want to get the most out of them, as any good business manager would. Your workers accept the challenge and continue to work as quickly and efficiently as they can. However, work begins piling up on their desks and the workers are starting to tire. You now must make the following business decision: Do you (a) employ new workers to keep on top of this greater workload? Or, do you (b) dial it back and inform your clients that deadlines will have to be extended?
You’d pick (a) right? I mean who wouldn’t take the opportunity to grow their small business and employ more staff if the work is flowing in? But what if this small business is your body? The workers are your insulin and the workload is glucose (blood sugar). Picking option (a) would mean that you need a larger office to accommodate the larger number of workers. Would you choose to increase the size of your body just so you can accept a greater workload? No! If this small business is your body and the workload is incoming glucose, you would most certainly pick (b) – you’d dial that workload right back and restore the efficiency of the workers you already have.
In PCOS, your body IS this small business and your insulin is less able to do its job of removing glucose from the blood. If the amount of glucose coming into your body is not being controlled, then you will produce more insulin in attempt to overcome this inefficiency. High concentrations of insulin are thought to stimulate androgen production (e.g. testosterone) and exacerbate many of the associated features and side-effects of PCOS. Insulin is also a storage hormone, and having excess amounts floating around means that excess energy from the food we eat will be stored as fat. Over time, this can lead to unwanted weight gain and an increased risk of developing diabetes and/or heart disease. Therefore, it is of great importance that women with PCOS control the amount of glucose going in to their bodies and improve their insulin sensitivity.
The Good News?
Whilst PCOS can be very challenging to manage and may require medical intervention, it’s important not to underestimate the huge role that lifestyle modifications such as diet and exercise play in managing the condition long term. Here are four of the most important lifestyle tips to help you better control your blood glucose levels, improve your sensitivity to insulin and manage your PCOS.
Reduce your sugar intake. In light of what we have discussed, it is important that you be mindful how much sugar is coming in through your diet to minimise the workload of insulin. The World Health Organisation (WHO) recommends that adults reduce their added sugar intake to less than 6 teaspoons a day (~25 grams) for optimal health outcomes. To put this into perspective, 1 tablespoon of tomato sauce can have around 1 teaspoon (4 grams) of added sugars, and a single soft drink can have around 10 teaspoons (40 grams)! It must also be recognised that ALL forms of dietary carbohydrate are metabolised into glucose in your bloodstream. So whether it is carbohydrate from pure white table sugar or carbohydrate from wholegrain bread, your body is going to have to deal with the incoming glucose. In respect, reducing your sugar intake involves being mindful of the amount of total carbohydrate you are consuming each day in order to avoid unnecessary spikes in blood glucose and keep insulin levels low. Carbohydrate sources that have a minimal to low impact on blood sugar include foods like green leafy and cruciferous vegetables (spinach, kale, cauliflower, green beans, Brussels sprouts), pumpkin, fresh berries, nuts, seeds and natural yoghurt.
Choose whole foods that are minimally processed, such as fresh fruit and vegetables, nuts and seeds, fish, milk, cheese, yoghurt and lean meats. When purchasing packaged foods, flip over to the Nutrition Information Panel and choose products that have less than 5g sugar per 100g. It’s also a good idea to check the Ingredients List to see if sugar has been added to the product. A lot of the times it will be, even when you don’t expect it! Click this link for extra help with reading food labels: https://www.eatforhealth.gov.au/sites/default/files/files/eatingwell/efh_food_label_example_130621.pdf. Aiming for 5 serves of vegetables and 2 serves of fruit everyday is a great challenge to help you displace processed, packaged food and surge you closer toward meeting your nutritional requirements. Another great tip is to fill at least HALF your plate with non-starchy vegetables at dinner time.
Do not fear fats! This may be the most important point of all because it has been engrained into our minds that fats are the devil however fats are an essential component of our diets and adding high quality fat to your meals actually slow the release of glucose from carbohydrates into your bloodstream – a major priority in PCOS! When choosing fats, go for those that are closest to their natural state, steering clear of cheap vegetable oils and packaged foods that have been overly processed and contain unstable fatty acids that can cause damage in your body. When purchasing fats and oils, check the label and avoid products that have been “refined” or “hydrogenated” as this tends to mean that trans fats are present. Natural, stable fats can be sourced from foods such as avocados, oily fish (mackerel, salmon, tuna), grass-fed meats, farm fresh eggs, nuts, seeds, nut butters, nut oils, olive oil, organic butter.
Last but not least… Exercise! Exercise is key to a healthy lifestyle and PCOS management as it can improve your muscles’ sensitivity to the hormone insulin. Increasing your total muscle mass will mean that your body has an increased capacity to clear glucose from the blood. Australian adults are recommended to do physical activity for roughly 20-40 minutes every day, depending on intensity. Remember – physical activity is not just running on a treadmill or pumping weights at the gym, but can include a variety of activities like dancing, swimming, walking your dog and carrying your heaving shopping bags around too (there’s another excuse to go shopping if you needed one)!
So now you should be sitting up a little taller and feeling a little more positive about what you can do when it comes to PCOS lifestyle management. The strategies provided are a broad guide to get you started, and we strongly recommend that you visit a qualified Accredited Practicing Dietitian (APD) if you are seeking more tailored, individual advice.
This article was co-authored by Melissa Meier and the original version can be found at: http://www.thebitingtruth.com/nutrition/pcos-diet/. It was updated by Jessica Turton on 14/12/2016.
Barbara A. Gower. 2013. Favourable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOS. NIH Public Access.