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.

Prediabetes

Question: What is Prediabetes? What is the difference between Prediabetes and Diabetes? How do I know if I'm Prediabetic?

Answer: Prediabetes is defined as a fasting glucose of 100-125 mg/dl and/or a 2 hour post-prandial glucose (after eating) of 141-199 mg/dl. If you fall into the above category, you will likely be diagnosed with "impaired glucose tolerance", or prediabetes.

Most importantly, what can you do to prevent becoming diabetic and/or prevent becoming prediabetic? Lifestyle modification!

1) Make sure your blood pressure is well-controlled
2) Know the numbers of your triglycerides and cholesterol (lipids) and keep them within normal limits
3) Maintain a healthy weight (BMI of 18.5-25)
4) Exercise! Your goal should be to participate in moderate aerobic activity for 30 minutes per day, 5 days/week.

Defining Diabetes

Question: A family member of mine was recently diagnosed with diabetes. Can you explain, in a basic way, what exactly diabetes is and where to go from here?

Answer: Well, I could make about 1,000 different blog entries to answer that one question. Diabetes is a very complex disease and I'm a firm believer in treating the individual, not just the disease, so without knowing your family member, it is hard for me to tell you in a blog entry how to treat the diabetes. Rather, in answer to your question about where to go from here, I would tell you to make sure your family member has a fabulous Primary Care Physician (PCP) with whom he/she has a comfortable relationship. PCP's typically treat the diabetes until/if the diabetes gets into more advanced stages, at which time a referral may be made to an Endocrinologist. Further, I would highly recommend your family member consult a Registered Dietitian to get a specific meal plan. To find a Registered Dietitian near you, log on to the American Dietetic Association's website at www.eatright.org

But in answer to your first question in regards to defining diabetes, let's start with food. Your body changes much of the food you eat into glucose, which is then carry by the blood to the body's cells. Insulin, a hormone made in the pancreas, helps to move glucose from the blood stream into the body cells. Diabetes is the name of the condition when either your pancreas doesn't produce insulin at all (Type I) or your pancreas is not producing enough insulin or the insulin it's producing isn't working sufficiently (Type 2). Either way, the result is high blood sugar, which left untreated, can have devastating effects. However, when properly treated, you can have a long, productive and very happy and healthy life. Good luck!

For any further questions, please email me at mypersonaldietitian@gmail.com