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PCOS dietitian surrey

What is Polycystic ovary syndrome?


Polycystic ovary syndrome (PCOS) is a very common condition, affecting approximately 1 in 10 women in the UK.


A diagnosis of PCOS is likely to be made in women who have 2 or more of the following:


1) The presence of fluid filled sacs known as follicles surrounding the eggs on the ovaries.


2) Irregular periods due to not ovulating (releasing eggs from the ovaries).


3) Higher levels of male hormones known as androgens (e.g., testosterone) which may cause physical signs such as excess facial hair.


What are the symptoms of PCOS?


If you have PCOS then you may experience some or all the below symptoms.


1) Irregular periods

2) Excess hair growth

3) Weight gain or difficult losing weight

4) Fatigue

5) Acne

6) Hair loss from head


Having PCOS can also increase your risk of developing type 2 diabetes and heart disease, particularly if you have high cholesterol, high blood pressure and/or carry excess fat around your middle.


Insulin resistance


Many of the side-effects associated with PCOS are because of insulin resistance. Insulin is a hormone that is released by the pancreas when we eat. Insulin allows the energy from our food to be used for fuel by moving the sugar from our blood into our muscles and tissues.


Most women with PCOS have a 35-40% decrease in insulin sensitivity which means that they must produce more insulin for it to do its job correctly. Unfortunately, insulin increases the production of the male hormone testosterone which causes a hormone imbalance and contributes to the above symptoms.


Weight loss


If you are overweight, then losing weight (even just 5-10%) is likely to help manage the symptoms of PCOS. Unfortunately, weight loss in PCOS can be more challenging for 2 reasons…


Firstly, research has consistently shown an association between insulin resistance and having a higher body fat percentage.


Secondly, women with PCOS are likely to have a lower basal metabolic rate (BMR, the number of calories burnt at rest). One study showed that BMR can be 14-40% lower compared with women who don’t have PCOS.


As we know, to lose weight we must be eating in a calorie deficit. Having PCOS means that to lose weight, fewer calories must be consumed, or more calories must be expended through exercise. Although the exact cause of this is not known, one study suggested that it may be due to lower lean body mass observed in PCOS.


Weight loss is not an easy thing alone, but when you add in the complications of PCOS, things get even harder. I can certainly empathise with women with PCOS who struggle with their weight. However, being armed with this information can help us to better understand how to tackle weight loss.


PCOS dietitian surrey


A healthy diet


The general guidelines for managing PCOS suggest following a healthy diet and this is certainly a good place to start.


Aim to have a varied diet, focusing on increasing your intake of fruits and vegetables and limiting your intake of foods high in fat and added sugar.


A Mediterranean style diet, high in omega 3 fatty acids, wholegrains and antioxidants has been suggested as one of the best diet types for managing PCOS.


Oxidative stress (antioxidant imbalance) has been associated with PCOS and therefore including plenty of antioxidant rich fruit and vegetables may be significant in symptom management.


If you are trying to conceive, it is especially important to make sure you are following a well-balanced diet.


As a starting point, try the following tips to help you improve the balance of your diet:


1) Base your meals on high fibre starchy carbohydrate

2) Eat a variety of different fruits and vegetables

3) Eat more fish, including one portion of oily fish per week

4) Cut down on saturated fat and added sugar

5) Eat less salt

6) Maintain a healthy weight

7) Aim for at least 6-8 glasses of fluid per day

8) Eat regular meal patterns


Low Glycaemic index


The term glycaemic index refers to how quickly your blood sugars increase after eating a particular food or meal. High GI foods cause our blood sugars to increase rapidly, whereas low GI foods do not (as illustrated below). The higher, our blood sugar levels, the more insulin we produce. As we know, PCOS is associated with insulin resistance which means that even more insulin is released and along with that comes the symptoms of PCOS.


By choosing low GI foods and limiting intake of high GI foods, insulin levels can be reduced and in turn symptoms are improved.


High GI carbohydrates include foods with added sugar and refined carbohydrate such as white bread.


Low GI carbohydrates include complex carbohydrates such as granary bread, boiled new potatoes, wholegrain cereals.


You can also help to lower the GI of a meal or snack by adding protein and fibre. Protein and fibre take a long time to be broken down into sugar so will help to prevent rapid increases in blood sugar levels.



PCOS dietitian surrey

Low carbohydrate diets


Many studies have shown that reducing carbohydrate intake can be a very effective method for improving insulin sensitivity, but carbohydrates, however, remain an important part of any diet. Carbohydrates are our primary energy source so without them we would likely feel low in energy and potentially quite hungry. They are also a rich source of fibre and micronutrients and usually quite an enjoyable component of the diet.


A low carbohydrate ketogenic (AKA keto) diet has been researched extensively and some research has linked it to reduced blood sugar levels and improved insulin resistance. This is however likely due to taking in fewer calories resulting in weight loss.


The standard version of a ketogenic diet recommends limiting your carbohydrate intake to 10% of your total energy and aims for 70% of total energy from fat.


One issue with the keto diet is that generally it is quite difficult to stick to due to the reasons mentioned above. It tends to work in the short-term but longer-term studies have shown reduced compliance and a tendency to regain any weight that was lost.

Another downside to the keto diet is that it is low in fibre, generally high in saturated fat and due to its restrictive nature may leave you lacking in some micronutrients. This is likely to increase the risk of certain cancers, heart disease and digestive issues. For these reasons, I would not recommend doing the keto diet long-term but for most people it would generally be considered safe to do in the short-term and may be a useful tool to help kick-start your weight loss journey. You should always consult with your dietitian or GP before considering a keto diet.


Reduced carbohydrate diets which allow for higher carbohydrate intakes than the keto diet have also been studied with some promising results.

A 2019 meta-analysis study involving 327 women with PCOS concluded that a reduced carbohydrate diet (45% of total energy or less from carbohydrate) combined with a reduced fat diet (35% of total energy or less from fat) was the most effective dietary method for improving insulin sensitivity and promoting weight loss.


Exercise


Exercise improves insulin sensitivity because it encourages sugar to move from our blood and into our muscles to be used for energy. Research has shown that high intensity aerobic exercise is particularly beneficial.


Given that individuals with PCOS are likely to have lower BMR’s, if you are trying to lose weight it would also be sensible to include resistance training exercise as part of your routine. Resistance training exercise helps to build muscle and having a higher muscle mass means your BMR increases, making it easier to lose weight.



PCOS dietitian surrey

Supplements


Vitamin D


Women with PCOS are at an increased risk of vitamin D deficiency. Vitamin D helps to reduce inflammation which is a contributing factor to the symptoms of PCOS. And although the mechanism is not fully understood, it has also been shown to improve regularity of periods.


Given that our main source of vitamin D comes from the sun and in the UK sunlight exposure is limited, I recommend taking a daily 10mcg vitamin D supplement. It may also be worth asking your GP to perform a blood test because if you are vitamin D deficient then you may need a higher dose initially to restore your levels to within the normal range.


Inositol


Inositol is a sugar alcohol (type of carbohydrate) which plays an important role in insulin sensitivity. Many randomised control trials involving inositol supplementation in women with PCOS have shown positive outcomes such as improved fertility, reduced insulin resistance and decreased testosterone production.


Vitamin E


Vitamin E has been shown to have antioxidant effects. More recent evidence has also shown that vitamin E can improve endometrial thickness in women with unexplained fertility. One study showed that combined vitamin E and omega 3 supplementation for 12 weeks resulted in significant improvement in insulin resistance and reduced testosterone levels in women with PCOS.


Dietary sources of vitamin E include plant oils such as rapeseed or olive oil, nuts and seeds and wheat germ (found in cereals and cereal grains). If you are unlikely to consume these foods on a regular basis then you may want to consider a vitamin E supplement.


Chromium


Some women with PCOS show reduced chromium levels which has been linked to insulin resistance and reduced testosterone. The recommended dosage is 200µg of chromium picolinate per day for 3 months to observe the benefits.


Zinc


Women with PCOS who do not eat a varied diet are at increased risk of zinc deficiency which has been linked to insulin resistance and high cholesterol. Studies have shown improvements in both factors by taking 50mg of zinc sulphate daily for 8 weeks.


As a first line approach I would not recommend zinc supplementation, I would encourage you to try and get enough zinc through diet. Dietary sources of zinc include meat, beans, pulses, nuts, wholegrains, and milk.


N-acetyl-L-cysteine (NAC)


NAC has antioxidant activity and, in many studies, has been shown to reduce inflammation and oxidative stress and consequently improve fertility and ovulation rates for women with PCOS. In most studies, the suggested dosage is 600mg per day.


Carnitine


A 2019 study involving 80 women with PCOS found that supplementing 3g of L-carnitine daily for 3 months showed significant improvement in insulin sensitivity and reduced BMI. More regular menstrual cycles and reduced presence of facial hair also occurred.


Supplements, the bottom line


In the first instance, I tend to recommend addressing diet before considering the use of supplements. As a second line approach supplementation is another tool that may also help to relieve some of the symptoms of PCOS. If you want to try a supplement, then always consult with your GP or dietitian first. I would also always recommend trying one supplement at a time, otherwise you won’t know which one has or hasn’t worked for you.



PCOS dietitian surrey


Sources


BDA. 2019. Polycystic Ovary Syndrome (PCOS). Accessed 1st November 2021. Available at: https://www.bda.uk.com/resource/polycystic-ovary-syndrome-pcos-diet.html


Bhasin, G., Wang, ET., Alexander, CJ., Pal, M., Azziz, R and Pisarska MD. 2013. Women with polycystic ovary syndrome (PCOS) have lower basal metabolic rates compared to eumenorrheic controls. Fertility and Sterility 100(3): 38-39.


Chmelik, M. 2015. N-acetyl-cysteine to treat polycystic ovarian syndrome? Natural medicine journal. 7(6). Accessed 1st November 2021. Available at: https://www.naturalmedicinejournal.com/journal/2015-06/n-acetyl-cysteine-treat-polycystic-ovarian-syndrome


Georgopoulos, NA., Saltamavros AD and Vervita, V. 2009. Basal metabolic rate is decreased in women with polyscystic ovary syndrome and biochemical hyperandrogenemia and is associated with insulin resistance. Fertility and Sterility 92(1): 250-255. Accessed 1st November 2021. Available at: https://www.fertstert.org/article/S0015-0282(08)01008-X/fulltext


Gunalan, E., Aylin, Y and Yilmaz. 2018. The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A critical review. J Turk Ger Gynecol Assoc. 19(4): 220-232. Accessed 1st November 2021. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250088/


Mavropoulos, JC., Yancy, W., Hepburn, J and Westman, EC. 2005. The effects of a low-carbohydrate, ketogenic diet on polycystic ovary syndrome: a pilot study. 2(35). Accessed 1st November 2021. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334192/ 4


Mohammadi, M. 2019. Oxidative stress and polycystic ovary syndrome: a brief review. International Journal of Preventative Medicine. 10(86). Accessed 1st November 2021. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547785/


NHS. 2019. Polycystic Ovary Syndrome. Accessed 1st November 2021. Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/


Paoli, A., Mancin L., Giacona, MC., Bianco., A and Caprio, M. 2020. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. Journal of translational medicine 18(104). Accessed 1st November 2021. Available at: https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-020-02277-0


Salehpour, S., Nazari, L., Hoseini, S., Bameni, P and Gachkar, L. 2019. Effects of L-carnitine on polycystic ovary syndrome. JBRA Assist Repod 14;23(4): 392-395. Accessed 1st November 2021. Available at: https://pubmed.ncbi.nlm.nih.gov/31294953/


Thakker, D., Raval, A., Patel, I and Walia, R. 2015. N-acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled clinical trials. Obstet Gynecol Int 817849. Accessed 1st November 2021. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306416/


Zhang, X., Zheng, Y., Guo, Y and Lai, Z. 2019. The effect of low carbohydrate diet on polycystic ovary syndrome: a meta-analysis of randomized controlled trials. International journal of endocrinology. Accessed 1st November 2021. Available at: https://www.hindawi.com/journals/ije/2019/4386401/

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Weight loss kingston


Don’t arrive famished


A common mistake people make is trying to eat less during the day leading up to going out for a meal…


Unfortunately, this results in your blood sugar levels dropping and increased hunger. The body’s “survival mode” kicks in and tells you that you need high calorie food to survive…


As a result, when you finally eat, you are most likely to choose high calorie options, refined carbohydrates and eat very quickly…


The consequence of this, is that you will probably consume more calories for that day than you would have done if you had just eaten your usual regular meals.


Eat mindfully


Mindful eating is about paying attention to your food and physical cues when you are eating. Those who eat mindfully are more likely to eat slower and experience a greater level of satisfaction from eating…


This often results in greater recognition of hunger and satiety, eating fewer calories and a reduced tendency to over-eat or binge eat.


Try the following:


1) Put your knife and fork down between mouthfuls.

2) Chew your food well.

3) Savour the first few mouthfuls as this is when your taste buds are heightened.

4) Check in with yourself after each course and ask yourself, am I hungry?

5) Reflect on how you feel after over-eating. Did you feel more satisfied? Did you feel comfortable? What will you do differently next time?





Get the balance right


Try to make sure that your meal includes a source of protein, a portion of starch and some vegetables or salad. This will help you to feel satisfied after your meal and to meet your body’s nutritional needs.


If your meal doesn’t come with vegetables or salad, then ask for some on the side. Commonly when we eat out, we are given 2 portions of carbohydrate for example, a burger bun and chips or naan bread and rice. Think about swapping one of these starch portions for some vegetables or salad.

If you only eat out occasionally:


Make satisfaction your goal


If you only eat out once a month or less, then 1 meal out is not going to make much difference to your weight loss journey, so you don’t need to worry so much about your choices. You can still however, try and apply the above suggestions.


Choose something from the menu you know you will really enjoy and give yourself full permission to eat it without feeling guilty.


If you eat out frequently:


When we eat out, we typically consume more calories than we normally would. This is because the food tends to contain extra fat and the portion sizes are often large…


If you eat out every week or more often, then you are going to have to have a think about your choices to keep you on track with your weight loss journey. The following suggestions may help…


Plan ahead


The good news is that many restaurants these days put their menus on their website so you can decide what you’re having in advance. Many will offer lighter options on the menu or even better will list the calorie content to help you with making an informed decision.


Don’t have the bread

Some restaurants will give the option to have bread or other “nibbles” before your starter or main course. A couple of slices of bread with butter before your meal is likely to add an additional 300 calories, which is a small meal on its own. As long as you don’t arrive feeling famished, then it should be easy enough to decline this. You will probably find that if you don’t have the bread, you will enjoy your main meal more because your taste buds are heightened in the first few mouthfuls of any meal.





Choose low calorie or no calorie drinks


If you were to have a couple of soft drinks such as coke or lemonade with your meal this would add approximately 250 calories to your meal. A pint of lager or large glass of wine would add about 200 calories…


Try and stick to low calorie soft drinks such as coke zero, diet lemonade or water. If you want to have alcohol, then try lower calorie options such as a single spirit with diet/slimline mixer or a glass of prosecco.


You don’t have to eat everything on your plate


Society tells us that we should always try and finish everything on our plate. Many of us were told growing up that leaving food on our plate is wasteful and should never be done…


In truth, if we eat something when we are not hungry then that food is wasted regardless of whether we eat it, or if it goes in the bin because it was more than our body needed. You can probably reflect on times when you may have eaten too much in one sitting, not wanting to waste food and you may have ended up feeling quite uncomfortable.


If you are presented with a large portion of food, then start by only eating half of what’s on your plate. After doing this, decide if you are still hungry. The chances are you will feel satisfied by eating only half, if this is the case ask the waiter to take your plate away as soon as possible. You can take the leftovers home with you to have the next day if you like.


Divide dessert


If you have had your main course and still feel hungry, then try sharing a dessert with someone else. If you don’t feel hungry but other people are ordering a dessert, then order a hot drink such as coffee or tea instead. You will save a lot of extra calories, whilst still feeling like you are having something enjoyable.





Plan to say no


You may find that the minute you tell others you are trying to lose weight, people feel the need to try and persuade you that it’s not necessary. They might say things like “it’s only this once” or “go on enjoy a dessert with me” …


Yes, their intentions are probably in the right place, they want you to enjoy yourself, but this is not particularly helpful when you are trying to lose weight. You might even find yourself eating or drinking things you didn’t really want or enjoy.


If you think that your friends, family, or work colleagues are likely to try and persuade you to have that extra glass of wine or tuck into a dessert then be prepared…


It helps to have a couple of phrases in mind that you will say in response. For example, you might say “that was delicious, but I am so full I couldn’t eat another thing” or “I had a big lunch earlier so I will stick to one course”.


Ask for sauce on the side


Sauces such as salad dressings, peppercorn sauce and mayonnaise are often very high in fat. Fat contains twice as many calories as carbohydrate and protein. Without doing much to the volume of your food you could be taking in a lot more calories than you realise…


By asking for your sauce on the side you can be in control of how much fat you are having.


Avoid fried options and creamy sauces


Instead of choosing fried foods which are high in fat, try to have grilled, steamed, or baked options where possible.


Choose tomato or other vegetable-based sauces rather than creamy of cheesy sauces. Not only will this help to reduce your intake of fat, but it will also add an extra healthy vegetable portion to your day.

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Updated: Oct 3, 2021


Weight loss nutritionist kingston


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