What is PCOS?
PCOS stands for Polycystic Ovary Syndrome. It’s an endocrine (hormonal) disorder characterized by infrequent or absent periods, multiple cysts on the ovaries and high levels of androgens (such as testosterone and DHEA-S), which for some people leads to excess facial and body hair, hair thinning or male pattern baldness and acne. Many PCOS patients have insulin resistance, which means that your body isn’t able to properly absorb and process sugars and other carbohydrates, which leads to weight gain. Other complications include depression, self-esteem challenges, type 2 Diabetes, high cholesterol, heart disease and difficulty becoming pregnant.
It’s important to know that there is a wide range of severity of the condition- some patients with PCOS have only slightly irregular periods as the only obvious symptom, while others may have never before gotten a period on their own and have every other symptom such as unwanted weight gain, excess body hair and acne.
PCOS can’t be diagnosed by just one symptom or test alone, but instead doctors look for the presence of several signs and symptoms together. Not all PCOS patients have acne, excess body hair or obesity, but all will have high levels of androgens (testosterone and DHEA-S) and irregular or absent periods. Many times a woman is first diagnosed with PCOS because she is unable to become pregnant due to lack of consistent ovulation.
The usual treatment for PCOS includes hormonal birth control pills to artificially “regulate” cycles and reduce androgens, a drug called Metformin for insulin resistance and statins for high cholesterol. Many women are also given Spironolactone to lower testosterone. For women trying to become pregnant, treatment includes drugs to induce ovulation such as Clomid or injectible gonadotropins.
How Can I Manage PCOS Naturally?
While the condition can’t be cured, there’s a lot you can do to manage symptoms of PCOS- including acupuncture, herbs and dietary adjustments.
- For PCOS patients with unwanted weight gain and higher levels of adipose (fat) tissue, a 5-10% reduction in weight can dramatically help regulate cycles. Because so many of these people have some degree of insulin resistance, one of the most important things you can do is to adopt a low glycemic index diet. This means focusing on foods which don’t raise your blood sugar very much- such as plenty of vegetables, protein and healthy fats. Research shows that adopting a diet of 30-40% carbohydrates and 25-30% protein can result in a loss of abdominal fat, reduce androgen levels (testosterone) and improve insulin sensitivity. You should work with a registered dietician on making these dietary changes.
- Not all PCOS patients should adhere to the above recommendations- for those who have a leaner body type, weight loss can make things worse. We don’t have as much research on dietary recommendations for this “type” unfortunately, but we do know these people tend to have less insulin resistance so cutting a lower carb diet doesn’t always help. Again, before making any major dietary changes, please consult with a registered dietician!
- My patients typically receive acupuncture every other week, and most take herbal medicine as well. Each patient is given a different treatment protocol to correspond with their unique symptoms and history. I have found that even if herbs and treatments don’t get a patient ovulating every month on the dot, periods do start to happen with more regularity and we end up seeing a ripple effect with decreased acne and improvement in other symptoms.
- There are SO many supplements out there to sift through! The one supplement that has the strongest evidence for helping both “types” of PCOS patients is inositol. It comes in 2 forms- D-Chiro Inositol and Myo-Inositol. The studies that show a benefit from taking this supplement had people take it in a 40:1 ratio of Myo-Inositol to D-Chiro Inositol.
- Exercise and resistance training can help especially if insulin resistance is present.
By making these changes, it’s very possible that your periods will become more regular, your acne will decrease and you’ll be better able to lose any unwanted weight. Keep in mind that a diet of unprocessed foods is best. Keep reading for more tips on eating healthfully when you have PCOS!
How Can I Transition To A Lower Carbohydrate Diet?
I asked Nancy Campbell, culinary nutritionist and owner of Radiant Health NYC to give some tips on how to transition to a low sugar/low carbohydrate diet. You can get more information at her website, www.radianthealthnyc.com.
This work is as much about embracing change with empathy as it is about creating structure in your life. My approach to curbing carb intake approaches both equally and can be summarized as “Slow. Know. Grow.”
SLOW – Due to insulin resistance, people with PCOS are more sensitive to the effects of sugar than most people and it can affect hormonal dis-regulation to a greater degree. The approach you take will depend on your sugar “habit”. Regardless of how much sugar you consume through the day, start smart and start slow. Commit to removing sugar from one category of your diet over a designated and finite time frame. Categories can be broken down into drinks (non-alcohol), alcohol, meals – breakfast, lunch, dinner, snack, fruit, and “treats.” By having healthy snacks and herbal teas at the ready or doing something “sweet” for yourself that has nothing to do with food you can mitigate the withdrawals. Massage anyone?!
Keep in mind that fruit can be a tricky food for some PCOS sufferers. Fruit juice, while no sugar has been added, is loaded with natural sugars and it lacks the fiber that slows sugar absorption in our blood stream. Instead of juice, focus instead on whole fruits such as berries, pears, and apples.
KNOW – When making any dietary shift, you need to know how you are bringing good food choices to your plate. Removing carbs can be tricky in our carb laden American diet especially when eating out. This necessitates meal planning strategies that support you in having food at the ready. Three of my favorite tricks are:
- Never cook for one meal! You are spending the time, the energy, and the resources to put something together. The effort it takes to cut a few more veggies, roast a little more chicken and assemble a few more servings is so much smaller than the effort it takes to do it all over again the next day.
- Pack and carry. I can’t encourage this enough. You’ve got to think like a Girl Scout. Packing meals and carrying snacks for your day is crucial to ensuring you a) don’t make bad choices; b) have healthy choices at the ready when you are hungry; c) can eat steadily through your day to ensure you keep your energy crashes (and carb cravings) to a minimum.
- Have 2-3 one-pot meals you love! Firstly, a one-pot meal is a complete meal balanced with protein, veggies and fat that is assembled in “one-pot,” essentially. You also eat it all together. This could be a noodle free lasagna, beef or chicken stew, or stuffed winter squash.
GROW – The idea that you will be completely deprived without the sweetness of sugar or never satisfied without starchy carbs is simply not true. It will take your body some time to shift. By your body, I mean your palate, your brain and the balance of your gut bacteria. So, do the work, stay the course and GROW out of the idea that you are somehow being punished. By embracing the potential of health and vitality of your body you will see the reduction of symptoms that you so deeply want for yourself! So, run! Leap! Build a dedicated practice of taking care of yourself and your body will undoubtedly return the favor.