26 March 2015 Women: Should PCOS Be on Your Radar Screen?

Struggling to lose weight is one thing. Struggling to lose weight while also dealing with embarrassing issues like acne, unusual body hair growth, irregular menstrual cycles, infertility and balding could be something else entirely. It could be PCOS.

PCOS, or Polycystic Ovary Syndrome, has been afflicting women for a long time. According to registered dietitian Angela Grassi, MS, RD LDN, founder of the PCOS Nutrition Center, PCOS was first recognized as a distinct medical problem when it was linked to irregular periods and high testosterone. In the 1990’s, the connection to insulin resistance was recognized. Now it’s considered an endocrine disorder with reproductive consequences.

Grassi is an acknowledged PCOS expert. She dealt with the problem herself, and eventually wrote a handbook for dietitians who work with PCOS clients. Her latest book, the PCOS Nutrition Center Cookbook, is aimed at women with the syndrome who want to use diet and nutrition to manage their health. She has also published The PCOS Workbook, to help women learn about the syndrome and the lifestyle changes that can help alleviate symptoms.

I spoke with Grassi recently. We discussed PCOS in general, as well as her new cookbook. One key point she made, which should be of interest to all women: PCOS is very common, affecting roughly 1 in 10 women of childbearing age. Here is a summary of my interview with her:

A diagnosis of PCOS is made if a woman has 2 of 3 criteria:

  1. Irregular periods, caused by hormonal imbalance. This could mean skipped periods (8 or fewer cycles per year), or more than 1/month or prolonged heavy periods.
  2. Signs of higher testosterone or other androgens. This can be documented with a blood test for elevated male hormones. Body signs of elevated androgens include acne, extra hair growth on body and balding.
  3. Cysts on ovaries. Ultrasound can detect the characteristic very tiny cysts, which look like a string of pearls. But not all women have cysts, so the name polycystic ovary syndrome is a something of a misnomer. And not all cysts mean PCOS. Larger cysts are not characteristic in PCOS. The classic finding, the small string of pearls cysts, are a result of the hormone imbalance, not the cause.

Grassi knows from personal experience that it’s common for women to go to several doctors, who can’t figure out the explanation for their symptoms. Reproductive endocrinologists are now perhaps best prepared to recognize it, because PCOS is the main cause of ovulatory infertility.

Lifestyle changes, including diet and nutrition, are a recommended treatment approach. So is it possible to control PCOS entirely with lifestyle? According to Grassi, it’s possible for many women. But some women are extremely insulin resistant; their bodies are programmed to produce higher levels of insulin, so they might need assistance with medications. And doctors do need to address symptoms as necessary, such as to regulate periods. Birth control medication may be necessary for that. Medications may be indicated to normalize testosterone.

Grassi’s workbook and cookbook are intended to help women transition to the food and nutrition principles she believes will help alleviate PCOS symptoms. While there is no standardized PCOS diet, the basic goal is to improve insulin resistance. Grassi has compiled some common sense guidelines:

  • Avoidance of added sugar
  • Emphasis on fiber from fruits and vegetables, whole grains and beans
  • Healthy fats such as nuts, avocado and healthy oils to improve inflammation
  • Modest portions of carbohydrates, to help moderate insulin
  • Weight loss, if overweight (no everyone with PCOS is overweight)
  • Regular physical activity

Women with PCOS report higher cravings for sweets and sugary foods, likely related to high insulin levels. Grassi believes that women really need to understand the role insulin plays in PCOS development, and how food, and sugar, affects insulin. With this understanding, it’s easier for them to make the beneficial food choices, such as cutting sugar intake, that help reduce insulin. The recipes in her cookbook avoid sugar.

What about the natural sugar in fruit? Are women afraid to eat fruit? Yes, Grassi agrees, there is lots of confusion about that. Natural sugar in fruit is different from the added sugar in processed foods. Plus fruit is loaded with fiber, nutrients and antioxidants. So the benefits definitely outweigh fears.

I found it interesting that Grassi does not overemphasize protein, the way many fad diets do. She agrees that it’s important to have protein at every meal, because it can help stabilize blood sugar, enhance satiety and reduce cravings. Healthy fats can also accomplish those goals, so protein isn’t recommended at the expense of other important foods. Her recipes include lean meats and fish, as well as a section on vegetarian entrees that emphasize beans.

In fact, the PCOS diet guidelines look a lot like a Mediterranean style diet: whole foods with a focus on plant foods, including beans, nuts, healthy vegetable oils, vegetables and fruits. It’s a diet that’s beneficial for everyone trying to lose weight or improve disease risk, not just women with PCOS.

For more information on PCOS, check out this previous MyNetDiary blog post.

Donna P. Feldman MS RDN

Nutrition journalist at Radio Nutrition

Co-host: Walk Talk Nutrition podcast.

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Disclaimer: Please note that we cannot provide personalized advice and that the information provided does not constitute medical advice. If you are seeking medical advice, please visit a medical professional.

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Other Health Issues/PCOS (Polycystic Ovarian Syndrome)

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