Treating and Managing PCOS with Diet

Before we get started, I want to suggest that those who are really interested in making these changes wait until the end of the series to begin. There is quite a bit of information I want to bring to you, and it is going to take several posts to get it all out. Please read them all, as they will all have good information, and will build upon each other. 

PCOS, or Polycystic Ovarian Syndrome, is an all too common condition affecting women. It is characterized by the abnormal growth of small cysts on the ovaries, caused from the inability to ovulate. While the cysts are benign, they represents a hormone imbalance. This disruption of the normal flow of reproductive hormones can cause:

• Irregular Menstruation Cycles or Amenorrhea (Lack of Ovulation and Menses)
• Pain with Ovulation
• Dysmenorrhea (Painful Periods)
• Infertility
• Cysts on Ovaries
• Hirsutism (Abnormal Hair Growth)
• Hair Loss (Similar to Male Patterned Baldness)
• Excessive Weight Gain
• Acne
• Acanthosis Nigricans (Patches of darkening and thickening skin, usually on the back of the neck or thighs, usually a sign of insulin resistance)
• Insulin Resistance
  

If left untreated, those with PCOS are more likely to develop:

• Type 2 Diabetes
• Hypothyroid Disease
• Cardiovascular Disease

PCOS is the most common cause of infertility and reproductive disorders in the US. At last estimate (that I have read) 1 in 15 women is diagnosed with PCOS. PCOS is often difficult to diagnose, and in many cases the only symptom is irregular menstruation.

Diet and Managing Polycystic Ovarian Syndrome (PCOS)

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The most common treatment method given to women is Medication! Rarely, sadly, is any other form of treatment considered, especially diet. More women that I can count come into my office with stories of Birth Control Pills, Clomid, Metformin and others. These medications do serve a purpose, don't get me wrong, but more often than not they cause women to feel worse and can actually make symptoms worse by depleting nutrient reserves necessary for normal hormone function.

I came across this study awhile back that I found helpful:

A research study done by the Research and Clinical Center for Infertility compared diet and lifestyle modification against common western treatments of Clomid (for ovulation) and Metformin (for insulin resistance). The study took 343 women with symptoms of obesity and infertility with PCOS and assigned them to 4 different treatment groups. 1) Clomid 2) Metformin 3) Clomid + Metformin 4) Lifestyle and Dietary Modification. Results were that those who received the dietary and lifestyle modification had an increased rate of pregnancy as compared to those who only received medical treatments. Clomid group - 12.2%; Metformin froup - 14.4%; Clomid + Metformin group - 14.8%; and Dietary and Lifestyle group - 20%. Lifestyle group also had a significant reduction in waist circumference, total androgen and lipid profile.

Why is this? Because diet and lifestyle is the foundation of health. You can mask and force certain bodily functions with medications, but if you do not change your daily routines of diet and lifestyle, the condition is never fully treated, only hidden under the cloud of chemicals.

In all cases, diet must be changed. I have never seen a client with PCOS eating a healthy diet….sorry, I haven't. Most are craving sugar, eating processed foods, and including dairy (we will talk more about this later), all of which make symptoms worse. Many are really trying, don't get me wrong, but most are either cheating too often, or are having a hard time navigating and establishing the necessary changes.

Basic Principles of Managing Polycystic Ovarian Syndrome (PCOS) with Diet and Lifestyle

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So now that you are aware that diet MUST BE CHANGED IN ALL CASES, let's begin.

These are MY principles. These are the rules that I have established for my clients with great success. They are based in Traditional Chinese Medicine, Modern Nutrition, and Research. This is a basic list, and I will address these in upcoming posts in more depth.

• CUT THE CRAP: Ouch, strong choice of words, but seriously, cut it out. Packaged chips, cookies, sodas, gatorade, vitamin waters, nitrates, fake sweeteners, cut it all out…honestly everyone needs to cut this stuff out of their diet, NOW. Many of the following principles relate to bad food quality and choices, preservatives, additives, sugar intake, etc..
• EAT LOW GLYCEMIC FOODS: I am going to talk about this in much more depth tomorrow. I am not a fan of the GI values in general. They are very confusing, and honestly not very reliable. It is based on human trials, and there is really not a ton of resources out there. Many foods do not have a value yet, and the databases are rich in packages foods. BUT, that being said, those with PCOS need to keep their sugar levels down…no doubt about that. Many with PCOS either have insulin resistance or if not yet, will, and insulin resistance if not managed will lead to Type 2 Diabetes. Which is all too common in PCOS patients. I prefer using the Glycemic Load values, as they can change based on foods that are combined together, and how much is consumed at each meal. Research also links QUANTITY of food consumed at one sitting with increased levels of insulin, even if they are low GI…see eating smaller meals.
• BALANCE CARBOHYDRATES WTIH PROTEIN AND FAT: Most women with PCOS do better on a higher fat and protein diets. This does not mean all fat/protein. There needs to be a balance of quality vegetables and whole grains with good quality dietary fats and proteins.
• EAT SMALLER MORE FREQUENT MEALS: Those with PCOS are, again, prone to insulin instabilities. They tend to spike and drop in blood sugar levels very easily. Eating 3-6 smaller meals per day that are balanced with carbohydrates/proteins/fats will help keep these levels stable and limit the amount of spikes and drops. Like I mentioned above, research also links the size of meals with an increase in insulin resistance (even when the meal is balanced and not high in sugar). This is because the strain of digesting large portions is difficult on the system (stomach, intestines, gallbladder, and pancreas). Smaller meals are not only easier, but the body is able to absorb more nutrition from it. Become a Hobbit..2nd breakfast anyone…breaking up lunches into 2 smaller portions can help accomplish this, or keeping a snack bag of friendly snack options. 
• STAY HYDRATED: Staying hydrated keeps our body working properly. The majority of our body is fluid. When we become dehydrated that fluid can become thick and congeal. Our skin and organs become brittle, and course…not soft and pliable as they should be. Our blood becomes too think to circulate properly, and our tissues and organs become malnourished.
• AVOID DAIRY AND DAMP PRODUCING FOODS: This is partially based in TCM theory and modern research. Dairy in TCM is a phlegm producer, which means it gums up the fluids. Cysts are basically phlegm filled sacs (pus, which is visible phlegm.) How does this correlate into modern nutrition and research? Dairy is high in Estrogens, naturally, and those with PCOS have abnormally high levels of Androgens (Estrogens). These dairy Estrogens exasperate the PCOS condition.
• AVOID OTHER PHYTO-ESTROGENS: This one can be a bit tricky. Not only is phyto-estrogens found in foods (soy, conventional meats with added hormones), but also in the home and body products we use. Pesticides, Fertilizers, Plastics, Dryer Sheets, Fabric Softeners, Parabens, Phthalates, and many others. Start by eliminating it within your foods, and slowly start changing your lifestyle products.
• GET A FOOD ALLERGY TEST: Any allergy causes inflammation in the body. Food allergies cause internal inflammation. This can be limited to the digestion, but it can also cause systemic issues (asthma, thyroid, joint, reproductive, etc…). We often think of the the most common food allergens (dairy, gluten, eggs, soy, etc…) but I am often surprise by the number of odd food allergens that pop up as significant inflammation producers….for me it is PEARS! Once you know foods that you are reacting too, these must be removed to completely reduce inflammation in the body. (many of the low reactive foods can later be added back in once symptoms are regulated).
• ELIMINATE CAFFEINE: Please don't' start sending me death threats…remember I'm doing this with you right now, and I am a coffee addict! A study from "Sterility and Fertility" stated that women who drank 4-5 cups of coffee per day had 70% more estrogen during the follicular phase of the menstrual cycle (the week right before ovulation, which is a very important time for those trying to conceive). As I mentioned above, elevated estrogen is already an issue in PCOS. Sadly, it is also known to increase insulin levels. This does not mean no coffee EVER!
• EAT REAL FOOD: What other kind of food is there, right? What I mean is, eat food in its natural form. WHOLE FOODS: whole grains (not ground "whole grain" breads, pastries…those are just sugar), but pearled barley, quinoa, wild rice, etc…eat vegetables as a whole, not juice (pure sugar). Eat meat raised naturally, not with additives. This is an easy way to immediately reduce exposure to excess sugars, fillers, estrogenic preservatives, and increase the amount of available nutrients.
• GET ACTIVE: Last but not least, shake it girl! Get out and exercise, walk, dance…just MOVE! I am not one for organized or routine exercise (as my husband can attest to). But, I try to lead an active lifestyle. I walk wherever I can, I bike whenever I can, I love hiking, and being outdoors. Find any excuse to increase the amount of time you spend walking outside. Its amazing what the movement, fresh air, and sunshine can do not only for your health, but your spirit. I'll give you some more tips for getting up and moving in future posts. For now, know that movement increases circulation, it get the organs and muscles energized. If you don't use it, you lose it! Activity also aids in weight loss, which is an issue for many women dealing with PCOS. 

Breakfast #1: Baked Eggs with Spinach and Prosciutto

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• 1 cup raw baby spinach
• 1 slice prosciutto
• 2 eggs
• 1 tsp avocado oil
• S/P/G to taste

GI: 11
GL: 0
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Super easy breakfast that can be changed up by changing the veggies used. Can be a great way to use leftover veggies. What I did this morning was grease a small dish with oil, added the raw spinach (could use frozen or pre-cooked, I like the crispiness of the cooked raw), and torn prosciutto, topped with two eggs and seasoned. Baked at 400 until eggs were cooked to desire.

I was going to add nutrition data on here, but honestly I don't believe in counting calories. Quality and nutrient density matter much more. What I will do is add the GI and GL for each of my meals.

Lunch #1: Cilantro Lime Slaw with Crockpot Pork Carnitas

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​Cilantro Lime Slaw

• ​3/4 cup shredded cabbage
• 1/4 cup julienne cut jicama
• 1 small red radish, julienne cut
• 1/4 cup red bell pepper, julienne cut
• 1/4 cup carrot, julienne cut
• 1/4 cup chopped cilantro
• 1/2 lime juiced
• 1 tbsp Avocado Oil
• 1/8 tsp cumin
• 1/8 tsp chili powder
• S/P/G to taste

Makes 1 serving

GI: 35
GL: 4

Put all ingredients in a bowl and mix, let set for an hour to marinate flavors

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Crockpot Carnitas

• 3-4 pounds pork roast
• 1 orange, quartered
• 1 lime, juiced
• 10 cloves garlic
• S/P/G/Cumin to taste
• 1/4 cup chopped oregano

Makes up to 16 servings (4oz)

GI: 40
GL: 0-1

Crockpot on High 5 hours.
Cut pork into 2 inch chunks, and coat with salt, pepper, garlic powder, and cumin, and add to crockpot. Cut orange into quarters and arrange in crockpot around pork (with skin on). Add garlic cloves, squeeze lime juice over pork, and sprinkle with oregano.

Snack #1: Cinnamon Apple and Cashew Butter

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I really don't feel I need to write down a recipe for this, it's just 1 apple sliced, sprinkled with Cinnamon, and 2 Tbsp Raw Cashew Butter. 

​GI: 34
​GL: 11

Dinner #1: Oven Fried Chicken Legs with Cauliflower Puree, Asparagus, and Raspberries

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Oven Fried Chicken Legs

• 5 Chicken Legs
• 2 Tbsp Olive Oil
• 1 cup Almond Flour
• 1 Tbsp Paprika
• S/P/G to taste

​Makes 5 servings

GI: 18
GL: 1

In a bowl mix almond flour, paprika, salt, pepper, garlic powder…taste and re-season if needed. Coat chicken in olive oil, and dredge into coating. Put on a baking sheet and cook at 400 until cooked through, rotating occasionally. 

Cauliflower Puree

• 1 Head Cauliflower
• 3 Tbsp Chopped Chives
• S/P to taste

Makes 4+ Servings

GI: 32
​GL: 2

In a large pot, add chopped cauliflower and cover with water. Boil until soft, and drain. Either add to a food processor and puree, or use an emulsion tool. Season to taste with Salt and top with chives. 

Yes this cauliflower puree is purple, it's not your screen. My girl's picked purple cauliflower this week. Not the most appetizing puree color though.

Roasted Asparagus

• 1 pounds Asparagus
• Drizzle of Olive Oil
• Sprinkle of Fresh Thyme
• S/P to taste

Makes 4 Servings

GI: 32
​GL: 0-1

Trim asparagus, coat in oil and sprinkle with Thyme, salt, and pepper. Roast at 400 until tender crisp.

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PCOS Nutrition Part 1: Basic Dietary Principles
PCOS Nutrition Part 2: Avoiding Dairy
PCOS Nutrition Part 3: Sugar
PCOS Nutrition Part 4: Glycemic Index vs. Glycemic Load
PCOS Nutrition Part 5: Building Your Meal
PCOS Nutrition Part 6: Understanding Hormones
PCOS Nutrition Part 7: Fat Soluble Vitamins
PCOS Nutrition Part 8: Increasing Dietary Fats
PCOS Nutrition Part 9: Top 10 Foods for PCOS
PCOS Nutrition Part 10: Tips for Implementing the PCOS Diet