PCOS and diet part 600, a summary of sorts

PCOS and your diet are huge.  Your doctor might tell you that the food you eat doesn’t matter, and that it’s all a matter of “hormonal regulation” or “ovarian dysfunction,” — but we all know that those these are a function of poor diet and lifestyle, too.  Food’s a big deal.

In general, if you are overweight and have PCOS, chances are good you suffer insulin dysregulation of some sort, and you’re going to want to consider diabetes-type diets and treatments.  Lower carbohydrate (usually, specifically HFCS), higher fat, some intermittent fasting if you’re up for it, and exercise.

In general, if you are thin and have PCOS, chances are good your testosterone is sky high and your estrogen is locked in a cellar in the basement.  Erm– that’s not exactly true.  PCOS is hugely complicated, and no one really understand why so many thin women suffer hormonal dysregulation.  I would chalk it up, I think, to -poor diets and to stress throughout life, to -in-womb and infancy nutrition, to -nutrient and hormonal profiles at the time of menarch, and to -weight fluctuations and food in the adult years.  Generally– generally!–the important things to hit here are limiting phytoestrogens (overweight PCOS patients need to watch out for this as well), limiting stress, increasing thyroid activity via whichever mechanism is appropriate to you, probably one being eating carbohydrates, and making sure you aren’t exercising too much or are underweight.  If you were ever heavier at a point in your life, and you menstruated then, do a little Aristotle:

Syllogism EG:

1)  Heavy Stef menstruates.

2) Thin Stef does not menstruate.

3) If thin Stef wants to menstruate*, she should become Heavy Stef.

 

No, it’s not that easy; it’s not that simple; putting weight back on doesn’t account for other factors like stress and wear and tear from earlier parts of your life and from basic ovarian sluggishness that might not ever go away.
I’ve talked a lot on here about particularities of different foods and how they affect our hormones.  And they do.  It’s amazing, but I really do break out if I eat a couple bowls of oats, since oats contain phytoestrogens.  I really do wake up in the morning with angry, painful cysts if I consume cream or milk.  When your hormone systems have become so sensitive, tiny disruptions to it from food really are noticeable.

BUT: They would not be noticeable if other things were in line.

The estrogens produced in our bodies is approximately a billion times stronger than those we eat in foods.  This is why most people don’t have PCOS.  Why we do have PCOS is that there’s something funny going on in our metabolisms.  The goal is to FIX these metabolic problems.    Diet is one of the most important mechanisms by which we can do that.  But the point is not to micromanage with foods but instead to holistically fix the metabolic problems.  Generally get your food in line.  Eat real shit.  Be an appropriate weight.  Don’t over exercise.  Don’t stop yourself from eating if you’re hungry.  

Foods important.  But it’s only important in the role it plays fixing everything else.  Don’t use food perfectionism as a scapegoat because you don’t want to look at bigger issues.

 

 

*I just typed masturbate…considering PCOS killed my sex drive, I guess that would be an appropriate word here, too.

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08

03 2012

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  1. Janknitz #
    1

    I’m late to this party, having just discovered your blog through your interview with Jimmy Moore (great interview!).

    I have PCOS, and personally I don’t agree with you on two issues. You have said that there are two types of women with PCOS–”thin and obese” and you think there are different mechanisms at play for each. As a former thin “cyster”, now quite obese, I think that it’s a continuum. Thin cysters may eventually become obese because their insulin metabolism* is very messed up (what Mary Vernon terms “metabolically fat”). Just because you are thin now doesn’t mean you always will be (and I know you work very hard to stay thin), and it doesn’t mean that you don’t have severe PCOS.

    The insulin is the second issue i think you missed–you have a whole post on hormone influences in PCOS that gives only the merest nod to insulin’s role in PCOS. Personally, I think it’s the root cause, but acknowledge it may be a chicken and egg thing–PCOS causes insulin resitance, insulin resistance causes PCOS. Whichever is true, treating the insulin resistance absolutely improves the PCOS.

    Many people think that obesity causes PCOS. I’m here to tell you that I had very severe PCOS when I was thin for the earlier years of my adult life (until about age 30). I had extremely irregular periods and severe acne. After years of useless low tech fertility treatments, I had to turn to IVF (two cycles) to conceive my first child (this was 20 years ago, before the connection between insulin and PCOS was well understood). I didn’t start packing on the weight until I was on all sorts of fertility meds. After the birth of my first child, the weight came on like gangbusters–I quickly went over 200 lbs (I’m 5’3″). My PCOS was just as bad before the weight as after–perhaps even worse before the weight–I had somewhat more regular periods after my first child (5 or 6 a year instead of 2 or 3).

    I think there is a very small subset of people who mess up their metabolisms so badly with obesity that they acquire PCOS, but I don’t believe that most PCOS is caused by obesity (poor diet, yes, but not the obesity itself). Unfortunately, most people draw the conclusion that obesity is THE cause of PCOS or a majority of PCOS. I think that’s an erroneous conclusion. I think that most women with PCOS become obese because of their metabolic issues, not the other way around.

    I think insulin/leptin has a huge role in this. I went on a low carb diet and Metformin at the age of 40. I was trying to improve my health, pregnancy was the farthest thing from my mind. Within a month of starting that regimen–with only about 4 lbs of weight loss, I had my first ovulatory period (ever, in my life, without fertility drugs!). 6 months later to my utter surprise (and great joy) I was pregnant! Weight loss, in and of itself, had nothing to do with this. Fixing my metabolic issues with a low carb diet and Metformin did. It’s absolutely about the insulin levels, IMHO.

    I agree with you that thyroid has a role to play in this, and that “starvation” mode will reduce your body’s production of T3, downregulating the metabolism even further. But I don’t necessarily agree that increasing carbs is the fix that is needed, particularly for women with PCOS whose insulin metabolisms are very impaired.

    In my own personal experience, I seem to be finding that increasing CALORIES (mostly from clean fat sources) is improving my weight loss. When I eat too few calories, weightloss stops. I do think that T3 is the reason–TSH is slightly elevated and T4 is normal (my HMO won’t test for T3 or rT3, so I’m trying to make some educated guesses), but eating sufficient CALORIES, not increasing carbs, seems to get the weightloss moving again for me. I’m currently at 211 lbs and I have to eat at least 1600 calories in a day to see the scale move down. Fewer calories either stalls me out or even causes me to bounce up and down a few pounds without really losing (I did that for 9 MONTHS before I recognized what was happening).

    I monitor my own BG’s, and I can tolerate a little of the “safe starches” as long as I keep my overall carb intake within 20 to 30 grams net. But if I eat over that 30 gram limit, my blood sugar climbs–and one can surmise my insulin levels as well. So increasing my carbs to 100 or more is not a viable option for me, and at this point I don’t find it necessary.

    *Finally, I have an unproven,unscientific, personal theory that there are really three types of PCOS. The insulin resistant type, the adrenal impairment type, and the very small subset of people with obesity-induced PCOS.

    It seems like you may fall into the “adrenal type” and insulin resistance is not such a big issue for you. You may be able to tolerate more carbs as a result. Maybe cysters in this subgroup do NOT need to limit their carbs, and it isn’t all about the insulin for them.

    The “obesity induced” type may simply “cure’ their PCOS by losing weight–again I don’t think many cysters are really this type and it’s hard to sort out becuse if the weight reducing diet happens to controls carbs (even Weight Watchers does this to some extent), it’s hard to tell if it was the weight loss or the reduction in carbs that makes the difference.

    But I firmly beleive that those of us with the insulin resistant type of PCOS MUST keep carbs low.



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