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.

Making a List and Checking it Twice....

Question: I know fast food isn't good for me, but I just don't have time to cook! I work full time and I'm tired when I get home, so I feel like I have to choose between fast food or cold cereal. And cold cereal gets really old really quick? Any ideas?

Answer: Two words for you: PLAN AHEAD!!! This is truly the key to eating healthy. We all lead busy, crazy lives. I have a 1 year old, a 3 year old and a job. I know the meaning of the word "busy!" But, we have dinner at home at the dinner table most nights of the week. Believe me - it's not that I have any more energy or time than you do, it's simply because I do one thing: Plan ahead. Where I live, the ads come on Thursdays. I save the ads because what is on sale will play a role in what we will have for dinner the following week. I sit down on Saturday morning and come up with meals for the week. Looking at items on sale will give me ideas of things to make and I will also look on-line, in recipe books or in my recipe file. I then write down every day of the week and put a meal next to it. I know making dinner 7 nights a week may seem daunting or unrealistic. And I agree. We usually have at least 2 nights a week that we deem as "fend" nights where we eat leftovers from the previous meals. And if you eat out one night a week, that's okay.... as long as the other 6 are at home. So, that really only leaves ~4 meals a week you actually need to prepare. Now, that's doable! Especially if you use your crock pot (check out http://www.crockpot365.blogspot.com/ for ideas), 30-minute recipe ideas and other short-cuts. I make my grocery list as I write down our dinner meals and then I add some staple items of thing we eat for breakfast and lunch (cereal, milk, fruit, bread, etc.) And whala! The grocery list is complete! I go to the grocery store with one rule: Buy ONLY what is on my list! This will save you both time and money. Now, every night, you know ahead of time what's for dinner. Start it in the crock pot before you leave for work. If you live with someone, have an agreement that whoever gets home from work first starts dinner. If you know in advance that you're going to get home late, have that be a fend night.

So, plan ahead! And then enjoy a home-cooked meal nearly every night. Your wallet and your waist-line will thank you!

Do some Artificial Sweeteners stimulate your appetite?

Question: I heard that some artificial sweeteners, such as Aspartame, can be counterproductive in that they may have the effect of stimulating your appetite. Is this true?

Answer: Probably not the answer your looking for, but I don't know. The reason I post this inconclusive response is because there is still a lot of ongoing research in regards to artificial sweeteners. No, it has not been conclusively shown in any reputable research study that I am aware of that it stimulates the appetite. But I am also not aware that it has been conclusively shown that it doesn't either. We do know that a couple studies have shown that people that consume artificial sweeteners on a daily basis can still weigh more than their counter-parts. However, this may be for several reasons. It could possibly be that artificial sweeteners make you crave the "real thing" and people end up consuming high-sugar items in addition to the calorie-free alternatives. It could also be because they eat more to "make up" for the fact that they, for instance, drank a diet soda instead of a regular soda. I think we should all be aware of the amount of artifical sweetener we are consuming, but my opinion remains that artificial sweeteners on the whole are safe and are a good alternative to high-sugar, high-calorie foods for those that are diabetic as well as those that are trying to maintian weight and/or maintain a healthy weight.

Is Truvia really chemical free?

Question: Is Truvia really Chemical Free? Is it better than Splenda and the other artificial sweeteners?

Answer: Yes, Truvia is free of chemicals. It is made up of 3 ingredients: Erythritol, Rebiana and Natural Flavors. Let me predict the next question. What is Erythritol and Rebiana? Glad you asked! Erythritol is a naturally fermented sugar alcohol and Rebiana comes from the sweet leaf of the stevia plant (shown here). I would have no hesitation consuming Truvia myself or recommending it to my clients and patients as a way of enjoying sweet foods without consuming all the calories!