Q: I have Polycystic Ovary Syndrome (PCOS) and need to lose a couple of stone in weight. I’m finding this very hard. My doctor has suggested that I limit my carbohydrate intake. Is this the right thing for me to do?

A: I’m not surprised that you are finding it hard to lose weight as many women with PCOS do. I hope your doctor has explained to you that PCOS is caused by an imbalance in several sex hormones and this imbalance not only triggers symptoms such as irregular or no periods, facial hair, acne, and infertility, but also makes weight loss more difficult.

 

Many women with PCOS suffer from insulin resistance which is a condition in which the body resists the effects of insulin and so produces more to compensate. These constant high insulin levels keep blood sugar levels low, which in turn often prompts cravings for sugary foods and unfortunately this means that it is easier to put on weight – and harder to lose it.

 

There’s even more bad news, I’m afraid. Insulin resistance also increases the risk of longer-term health problems. For example, women with PCOS and insulin resistance are more likely to develop diabetes or have a heart problem.  Fortunately, the good news is that with weight loss the risk of developing problems like this can be dramatically reduced.  In fact, studies have shown that losing between just five and 10 percent of body weight is enough to ease symptoms of PCOS, reduce the risk of getting diabetes and heart disease, and improve fertility.

 

The reason your doctor has advised you to take notice of your carbohydrate intake is that he or she is trying to help you combat the effects of insulin resistance and keep your blood sugar levels balanced. If your blood sugar levels are balanced it is much easier for you to lose weight because you feel fuller for longer.

 

My advice is therefore to limit your intake of sugary and refined carbohydrates foods made from white flour and to replace them with wholegrain carbohydrates such as brown rice, oats and whole wheat pasta. Studies also show that eating healthy protein together with your carbohydrates can help to keep your blood sugar levels balanced.

To keep your blood sugar levels, your weight down and your symptoms at bay it is also extremely important that you eat little and often and don’t leave long gaps between meals.

 

As far as supplements the following may prove helpful:

• Chromium: low levels of chromium can trigger insulin resistance. Chromium is a well researched treatment for overweight women and studies have shown it can help control cravings and reduce hunger. Take 200 mcg a day.
• B vitamins: A 2003 study also found that vitamin B supplementation not only boosted weight loss but improved ovulation. Aim for 50 mg of each B vitamin a day, as a vitamin B complex. 
• Zinc is crucial for appetite control, hormone balance and for insulin regulation. Take zinc at 30 mg per day.
• Magnesium: There is a strong link between magnesium deficiency and insulin resistance so women with PCOS should aim for 300 mg of magnesium citrate per day.

 

Finally, don’t forget that exercise is important for everyone who needs to lose weight but it is especially important if you are overweight and have PCOS, as weight gain just makes your symptoms worse. One of the best ways to keep your blood sugar levels in balance, lose weight and reduce your symptoms of PCOS is to combine a healthy diet with a regular exercise programme. Aim to exercise at least five times a week for 30 minutes.

 

Whatever you do don’t try to crash diet in an attempt to lose weight as this will just slow down your metabolism or fat burning. On this programme you might find you lose weight more slowly than you think you ought to, but if you follow my advice you should still see those pounds gradually drop off and your symptoms ease or even disappear within three months.

 

(For more detailed information on PCOS see my ebook on PCOS)

PCOS or polycystic ovary syndrome is the most common hormonal disturbance among premenopausal women, affecting as many as one in five women. It is the leading cause of infertility due to lack of ovulation.

Symptoms of PCOS, which vary from the mild to the severe and from woman to woman, include:

 

• irregular periods or lack of periods
• irregular ovulation or no ovulation
• reduced fertility; difficulty in becoming pregnant
• excess facial and/or body hair (hirsutism)
• oily skin, acne
• being overweight, rapid weight gain; difficulty in losing weight

In addition the condition has long term health conditions and is associated with an increased risk of developing obesity, diabetes and heart disease so if you suspect that you may have PCOS it is important to see your doctor for full investigations.

 

No definite cause has been established, but it has been suggested that the problem stems from the ovaries, which are unable to produce the hormones in the correct proportions. This in turn gives the message to the pituitary gland that the ovaries are not working properly and this gland then releases high levels of LH. But PCOS also seems to affect a number of other different kinds of hormonal pathways in the body. Problems with the thyroid and adrenal glands may make some women more susceptible to PCOS. Problems with insulin (insulin resistance) have also been implicated, and PCOS does seem to run in families.

 

And it may even be more complicated than that. Sometimes it is not just the amount of hormones produced by the body that can cause an imbalance. Scientists have found that some women are simply unable to deal effectively with the hormones, which can be the root of the problem. Sex hormone-binding globulin (SHBG) is a protein produced by the liver that binds sex hormones, such as oestrogen and testosterone, in order to control how much of them are circulating in the blood at any one time.

 

It appears that overweight women have much lower levels of SHBG in their blood, which results in more circulating testosterone and increasingly bad PCOS symptoms, such as an excess of hair, which is one of the most distressing symptoms.

 

So, it appears that PCOS is a bit of a ‘chicken and egg’ situation. Do the high levels of androgens (male hormones) create the weight gain or does the weight gain cause the hormone imbalance? It is also known that women with PCOS are more likely to have problems balancing blood sugar, and they can be insulin-resistant. Insulin-resistance happens when insulin levels are high (hyperinsulinaemia), but that insulin cannot transport glucose into the cells. This, in turn, leads to high levels of blood glucose (sugar). And again, back to the chicken and egg, does the weight gain cause the insulin resistance or does the problem with insulin cause the weight gain?

 

Excess insulin lead to an increased appetite, which can cause overweight. The more circulating insulin, the more the ovaries produce testosterone and so the cycle continues. It’s extremely difficult to know which problem is the cause and which is the effect.

 

From the medical perspective, PCOS is often treated with oral contraceptive pills (which also contains an anti-androgen) are used to decrease excess facial and body hair. Medications such as clomiphene can be used to induce ovulation and diabetric drugs like metformin may also be used. 

However, a significant number of women have found that they can beat their symptoms and avoid medication through diet and lifestyle changes.

Until recently, diet was not thought of as an important adjunct in treatment. However, since the fairly recent discovery regarding the role insulin resistance play in PCOS, many experts now believe that diet should be an essential part of the treatment plan. It is believed that diet, along with regular exercise, can help reduce insulin resistance, which can not only help erratic periods, hirsutism and acne, but may decrease the risk of heart disease and diabetes as well. Dozens of medical studies have shown that eating the right kinds of foods can help beat symptoms and reduce the risk of infertility, diabetes, and heart disease.

 

The right diet is so important because nutritional deficiencies can upset blood sugar and hormonal balance and make symptoms worse. A healthy diet also plays a vital role in weight management and numerous studies show that weight is a significant factor in determining how severe symptoms of PCOS are. The more over weight a woman is the worse her symptoms tend to be.

 

It seems that a balanced, nutritious, whole food, low glycaemic diet, according to the PCOS diet guidelines below, has the most positive effect on women with PCOS, easing their symptoms and reducing the long term health risks. If you’ve been diagnosed with PCOS, think of the changes not as PCOS diet rules but as guidelines for a lifetime of healthy eating to ensure your body gets all the nutrients it needs to beat your symptoms and boost the quality of your health and your life. And if you haven’t got PCOS think of the diet rules as guidelines for a healthy diet that can reduce your risk of blood sugar imbalance, hormonal problems, irregular periods, weight gain and premature ageing.

 

PCOS Diet Guidelines

 

Eat more often: When you fast for long periods your body thinks starvation is on the horizon and responds by doing the best it can to hold onto every calorie by reducing your metabolic rate, and preparing to store fat. Long gaps between meals also creates low blood sugar levels, which makes you crave sugary foods and snacks – the very foods that cause a surge of insulin into your bloodstream and add to the likelihood of blood sugar imbalances which can make symptoms of PCOS worse. Women with PCOS should aim to have a hearty breakfast followed by a mid morning snack, a healthy lunch, a teatime snack and then a light supper.

 

Go for whole foods: Whole foods are bursting with goodness because they’ve had none of their nutrients or fibre taken away and no chemicals have been added. Whole grains are a good example of a whole food that science has shown to have protective health benefits – from heart health to bowel health. As well as being packed with antioxidants that can prevent disease and premature ageing and other nutrients your body needs for good health, whole foods contain plenty of fibre, or roughage, which has a stimulating effect on the digestive system. A diet rich in fibre is particularly therapeutic for women with PCOS because fibre is thought to prevent excess hormones from being reabsorbed into the blood.

 

Fresh vegetables, fresh fruits, wholegrain cereals and breads, legumes (peas and beans) fresh fish, nuts and seeds are all whole foods, so eat more of them. Legumes, such as peas and beans (great in soups, stews, casseroles and dips like hummous), are a good source of fibre for blood sugar control. Research has suggested that they may be important for lowering cholesterol and preventing cancer. Legumes, along with soya, grains and most vegetables, are also a good source of hormone balancing phytoestrogens.

 

Drink plenty of water (six to eight glasses a day) to help whole foods digest and pass through your system. And if you aren’t used to a whole food high fibre diet you need to introduce it slowly to give your digestive system and your bowels time to adjust.

 

Cut down on sugar: Eating refined sugar has been linked to many health problems, from diabetes to heart disease, obesity and cancer and, of course, PCOS. Sugar has no nutritional value but lots of calories and it goes straight into your bloodstream where it raises blood sugar levels, stimulates the release of insulin, triggers PCOS symptoms, contributes to weight gain and depresses the immune system so you’re more likely to get constant colds.

 

Sugar does have one thing going for it – it gives you energy but only as a quick fix, it is not long lasting.  Your body gets plenty of sugar, which is long lasting from whole foods such as fruits and unrefined carbohydrates such as grains. You don’t need to get it from the sugar bowl or from cakes, sweets and pastries.

 

Make the GI work for you: The glycaemic index was originally designed for people with diabetes to help them keep their blood sugar levels under control. Since improvement in PCOS symptoms is associated with blood sugar balance the glycaemic index can be a very useful tool for women with PCOS. There are plenty of books and websites which list the glycaemic value of various foods but in general foods that have a high glycaemic index tend to be white, high in sugar and additives and foods that have a lower glycaemic index tend to be fresh, low in sugar, additive free and high in fibre (you’ll be doing this already if you’re choosing whole foods).

 

Cut down on salt: The next stage on the PCOS diet is to cut down on salt. Instead of adding salt to your food add herbs, spices lemon juice for flavour. A diet high in salt can increase your already higher risk of high blood pressure and cause fluid retention. Be aware that salt is a hidden ingredient in many foods, in particular processed and pre packed foods so once again you need to read the labels and check the salt (sodium) content. To find out how much salt is in a food, multiply the sodium content on the label by 2.5. You should aim for less than 5g of salt a day.

 

Eat the right fats: Saturated fat is a bad fat and should be reduced. You get saturated fat in dairy products and red meat. These animal fats are not good because they can cause the production of unhealthy prostaglandins that can trigger blood clotting and hormones that can upset your digestive, immune and hormonal systems. If that wasn’t enough saturated fats can interfere with the absorption of other nutrients and stimulate oestrogen production.  In addition to saturated fats you also need to avoid hydrogenated fats and oils, in the form of fried, oxidised or hydrogenated fats found in margarines, vegetable shortenings and many processed foods and fast food snacks as well as cakes, sweets and biscuits. These vegetable oils contain transfatty acids that can increase your risk of diabetes and heart disease.

 

But you shouldn’t avoid fat altogether – because the right fats can protect your health. Unsaturated fats (polyunsaturated and monounsaturated) have a protective effect on the heart and are found in olive oil and foods such as avocados but the most beneficial fats for women with PCOS are the Omega 3 essential fats and to a lesser extent the Omega 6. You can find both these fats in oily fish, nuts and seeds. Every single cell in your body needs these essential fats (EFAs) to maintain a cell wall so that it is flexible enough to take in nutrients and push out toxins. Your body needs them to balance blood sugars, regulate sex hormones and beat symptoms of PCOS.  (For more information on PCOS see my book ‘Nutritional Health Handbook for Women’ or download an ebook on PCOS from www.naturalhealthpractice.com.  A good Omega 3 fish oil supplement I use in the clinic is called Omega 3 Plus, see the Resources Page).

Q: Our daughter is 19yrs old and tends to binge eat when she is angry or upset.

She also has polycystic ovaries. I have read this can cause mood swings.  She also has a birch allergy to specific fruits and vegetables when eaten raw and all kinds of nuts. 

Can you please make any suggestions on diet that can help? She also appears to have an intolerance to milk which makes her sick.

A: Unfortunately at the moment your daughter is trapped in a vicious cycle.  The kind of food that she probably eats when angry or upset eg sweets, cakes, chocolate, biscuits etc are a major problem for women with PCOS as this causes more blood sugar imbalances which then exacerbates the PCOS. 

 

In each menstrual cycle, follicles grow on the ovaries. Within those follicles eggs develop, one of which will reach maturity faster than the others and be released into the fallopian tubes. This is known as ovulation. The remaining follicles (sometimes hundreds) will degenerate. In the case of polycystic ovaries, however, the ovaries are much larger than normal, and there are a number of undeveloped follicles that appear in clumps, rather like a bunch of grapes. Where the problem starts, however, is when the cysts cause an hormonal imbalance, leading to a series of symptoms.

 

There can be a tendency to be overweight, have no or very few periods, be prone to acne, grow heavy body hair, often on the face, breasts and inside of the legs, and be susceptible to mood swings.

 

Women with PCOS are more likely to have problems balancing blood sugar, and they can be insulin-resistant. Insulin-resistance happens when insulin levels are high but that insulin cannot transport glucose into the cells. This, in turn, leads to high levels of blood glucose (sugar).  Excess insulin leads to an increased appetite, which can cause overweight. The more circulating insulin, the more the ovaries produce testosterone and so the cycle continues.

 

The key to your daughter’s problem is to get her blood sugar in balance; this is explained in my book ‘Nutritional Health Handbook for Women’ and describes the foods to eat, what to avoid and supplements that can be useful.  There is also an ebook on Polycystic Ovary Syndrome available from www.naturalhealthpractice.com.   Your daughter may also benefit from speaking to a counsellor regarding how she reacts when she gets emotional in order to break the cycle of binge eating.