PCOS Diet

Question: I was diagnosed with PCOS, so I have been trying to follow a low carb, high protein diet as my understanding is that the diet is similar to a diabetic diet. However, lately meat has been making me nauseous and I find myself gravitating back to carbs and noticing a difference in my PCOS symptoms. Any suggestions?

Answer: You are correct in that PCOS, Polycystic Ovarian Syndrome, is treated, in terms of nutrition, similar to diabetes because, like diabetes, it is an endocrine disorder associated with hyperinsulinemia and insulin resistance. Further, PCOS markedly increases the risk of developing type 2 diabetes. However, it is important to note that a diabetic diet is not a low-carb diet. A diabetic diet is a consistent-carb diet. There is a big difference. Our bodies, regardless of whether or not we have diabetes, are designed to use carbohydrate as our main fuel source, so even most diabetics, are still prescribed a diet with ~50% of calories from carbohydrate. The difference is that those carbohydrates should be evenly spaced with approximately the same carbohydrate eaten at approximately the same time each day. For most women, this will mean approximately 3 "carb choices" (or 45 grams of carbohydrate as 1 carb choice = 15 grams of Total Carbohydrate) at each meal with snacks being equivalent to 1-2 carb choices (15-30 grams of carbohydrate) per day.

Having said that, carbohydrate does promote insulin secretion, so high-carb diets should be avoided. The diets I see most commonly prescribed for PCOS are ~45-50% complex carbs with ~20% protein and ~30% fat (from mostly unsaturated fat sources). So, it is okay to have carbs in your diet as long as they are mostly complex carbs and are moderately and consistently spaced throughout the day. Further, if meat is making you feel sick, focus on non-meat protein sources such as reduced-fat cheese, eggs or egg-substitute (Egg Beaters, etc), nuts, beans, etc.

As a side note, several diabetic medications have been found to be helpful in individuals with PCOS. Metformin, for instance, has been found to help with insulin regulation of glucose, improve ovulation activity and lower the incidence of miscarriage.

As a resource, you may want to check out pcosupport.org which is full of useful information.

Good Luck!

If you have a question, please email me at mypersonaldietitian@gmail.com

A Cure for Diabetes?

Well, this is about as close as you're going to come. And I wouldn't call it a cure. But, I have been working with gastric bypass patients for the past 2 years and have seen many Type 2 diabetics have "resolution" of their diabetes following gastric surgery. In other words, they still have diabetes, but may come completely off their diabetic medications and manage their diabetes with nothing more than healthy lifestyle choices.

What is gastric bypass? Well, when most people say "gastric bypass," they are referring to Roux-en-Y, the picture shown here. However, there are currently several gastric surgeries available. At our facility, we offer four different procedures: the Roux-en-Y Gastric Bypass (RYGB), the Adjustable Gastric Band (AGB), the Vertical Sleeve and the Duodenal Switch. The Duodenal Switch, according to a 2004 study, had nearly a 99% remission rate of diabetes. However, this is the most drastic/invasive of all the procedures and is not done nearly as often as the other three. The most common of the four in the United States is the RYGB and, although the "remission rates" vary from study to study, overall, the numbers are approximately 90% of Type 2 diabetics (Type 1 diabetic are not similarly affected) will come off their medications entirely after surgery. And although, it may take up to 2 years for this to happen, many come off their medications within a few days or weeks of surgery. Although we do not know exactly why, the surgery in and of itself can lead to a resolution of hypo/hyperglycemia.

While nearly 50% of AGB patients may also have a "remission" of their diabetes, the remission seems to be directly related to the weight loss itself, and therefore the remission is not immediate like it often is with RYGB.

If you have diabetes and are interested in gastric surgery, the American Diabetes Association currently recommends considering bariatric surgery if 1) you have Type 2 diabetes and 2) have a Body Mass Index (BMI) of at least 35.