hey guys i'm abby sharp and welcome to
abby's kitchen and the beginning of our
new series called the fertility files
today i'm finally doing a video on a
highly requested topic
pcos i have been totally blown away with
the number of questions i get about pcos
here on the channel
which i think just goes to prove how
misunderstood
and complicated this condition really is
i myself was actually diagnosed with
pcos a few years ago and i was trying to
conceive my son
and that's the reason why we had to use
ivf but alas more on that later
today we're going to share the most
current research on pcos management
and we'll also be joined by weight
inclusive intuitive eating dietitian
julie duffy dillon who specializes in
pcos we're going to be talking about
whether or not weight loss is necessary
when it comes to pcos
as well as some evidence-based
recommendations for what to eat and what
to do when managing pcos
as a general disclosure remember that
the information you're about to see is
for
education and entertainment purposes
only and you should always seek advice
from your healthcare team for your
unique
case okay let's get into it first let's
define pcos
so pcos aka polycystic ovary syndrome
involves an imbalance in women's sex
hormones like estrogen
progesterone and testosterone leading to
the growth of ovarian cysts aka
benign masses if left untreated pcos can
lead to irregular
or absent periods infertility unwanted
hair growth on our face and body
acne alopecia pregnancy complications
and even cancer pcos can be diagnosed
when at least two out of the three of
the following occurs
number one the ovaries are polycystic
because either there are 12 or more
follicles on one ovary
or the size of one or both ovaries is
very high
number two hyper androgenism where
there's a high level of
androgens which are the male hormones
like testosterone or
there are symptoms of excess androgens
like acne or excessive hair growth and
three
there are issues with your period like a
lack of period
irregular periods or lack of ovulation
for me personally
i was diagnosed because i wasn't
ovulating at all and my ovaries were
slightly polycystic but of course
everyone is different so of course pcos
can look and operate completely
differently
depending on the individual and requires
a professional to diagnose
now let's talk about some of the
traditional management strategies for
pcos
starting with your diet so one of the
dietary recommendations that evidence
suggests may hold samaritan managing
symptoms
is a low glycemic index diet so a low
glycemic index diet or a low gi diet
consists of carbohydrate-based foods
that are slow digesting
and cause a gradual rise in blood sugar
and insulin plus of course a lot of
healthy proteins and healthy fats so
some examples of low gi carbs include
things like whole grain breads still cut
oats
bulgur sweet potatoes milk chickpeas and
lentils
so one study found that when women with
pcos followed a low gi diet
their menstrual regularity improved when
compared with individuals who were
following a standard healthy diet
this likely had something to do with the
fact that fewer blood sugar spikes and
falls
improves insulin sensitivity which in
turn may help improve
menstrual irregularity a more recent
2019 study
found that a low gi diet improved
menstrual irregularity in
80 of women with pcos however in that
particular study
the low gi diet was also energy
restricted
so it isn't clear whether or not the
change reported was because of the
energy restriction
the low gi diet any associated weight
loss
or some combination the researchers
however did suggest
that a low gi diet may delay the
absorption of carbohydrates
improving metabolic pathways and
reducing insulin resistance
now does the evidence suggest that low
gi needs to be low carb
not necessarily as these things are not
the same thing
however i did find a systematic review
examining a variety of diets in the
treatment of pcos
and it was found that a low-carb diet
was associated with a greater reduction
in insulin resistance
compared to a conventional diet having
said that as with a lot of research on
dieting
we don't know the long-term likelihood
of dietary adherence
and long-term improvements in health
choosing higher fiber
lower glycemic index carbohydrates
rather than cutting out carbs altogether
is typically a much more sustainable
approach for most women also
it doesn't mean you can't have higher gi
carbs
you really just want to focus on pairing
those carbs with lean protein
and healthy fats to help stabilize the
blood sugars further
now finally even though it's tempting
given the diet culture that we live
in you actually want to make sure that
you're eating enough
and eating regularly i'm going to chat
more about this with julie when i patch
her in
but in short when we let ourselves get
too hungry
our blood sugars plummet we get ravenous
and then we see
massive spikes when we do finally eat
restricting also sends us into that
binge restrict cycle
which ultimately can perpetuate
metabolic dysfunction next
let's talk about supplements and herbs
there are a ton
of supplements and herbs that claim to
eradicate pcos symptoms
but we really only have solid evidence
to support a few
first is inositol so inositol is really
number one here
it's a small molecule that is
structurally similar to glucose
and is naturally found in foods like
whole grains and citrus fruits
one 2016 systematic review found that
supplementation with inositol
improved hormonal and reproductive
disturbances in women with pcos
another 2017 meta-analysis found that
inositol improved the metabolic profile
of women with pcos
and reduced some of the high levels of
androgen hormones that cause a lot of
the symptoms and problems
finally the evidence also suggests that
it may improve pregnancy outcomes for
women with pcos undergoing ivf
next is omega-3s let's be real i think
most of us could probably benefit from
an omega-3 supplement
especially if we don't eat a lot of
fatty fish but one
2018 systematic review and meta-analysis
found that omega-3 supplementation in
pcos patients
helped improve insulin resistance and
reduce total cholesterol
triglycerides and ldl levels that's
pretty great
next is vitamin d so vitamin d
deficiency is actually very common in
women with pcos
possibly because of the metabolic and
endocrine disorders
that are associated with the disease so
it's often recommended to patients with
pcos to supplement with vitamin d
although admittedly the research on this
one is still
a little bit unclear one 2015 systematic
review and meta-analysis
found a positive association between
pcos
and vitamin d deficiency however the
studies did not find
that vitamin d supplementation had a
beneficial effect
that being said the researchers of the
study did recommend
larger prospective studies to further
assess the association between vitamin d
levels
and pcos treatment and in my
professional opinion
most people at least here where i live
in canada can usually benefit from a
vitamin d supplement
and that brings me to probiotics while
we're still not 100 sure about the
vitamin d alone
research has found that the combination
of vitamin d
and a probiotic supplement may be
effective at treating symptoms
one 2019 randomized control trial found
that vitamin d and probiotic
co-supplementation
improved depression anxiety and stress
scale scores in women with pcos
it was also associated with a reduction
in total testosterone
hair growth crp which is an inflammation
marker
and the oxidative stress marker mda when
compared with the placebo
and then finally i want to quickly touch
on some herbs that are commonly used
including maca root ashwanganda holy
basil
licorice chasteberry and tribulus
terestris
it's a big word i don't know so i feel
like i've just said a harry potter spell
i'm going to be totally honest but
there are lots of herbs that are often
recommended for treating pcos symptoms
however the research on their
effectiveness is pretty limited
many of these herbs carry some
antioxidant and anti-inflammatory
properties which is
probably why they're commonly
recommended for treating pcos
so research has shown that c-reactive
protein which is a marker for
inflammation
is typically higher in pcos patients and
that when
crp is reduced so are the metabolic
symptoms of pcos
so while it's totally possible that one
or a combination of herbs
may serve as a good adjunct to
traditional supplements and medication
they really should not be relied on on
their own to treat your pcos so we'll
discuss dye
in a little bit more detail later on in
this video when i patch in julie
but i also want to explore some other
evidence-based lifestyle changes for
pcos management
next is getting enough sleep and
reducing stress
so you guys know i need to take my own
advice here and chill
out but sleep and stress management is
so
key research has revealed that aligned
with my own experience
sleep disorders and insomnia are
significantly more common in women with
pcos
and getting a sleep when you're
struggling with already messed up
hormones
can totally worsen your pcos symptoms
okay number two is quitting smoking i'm
good on this front because i've never
smoked a day in my life
but smoking has been found to worsen
pcos symptoms
and even put someone at higher risk for
metabolic syndrome
so it's definitely recommended to avoid
or
quit smoking if you're already a smoker
number three is acupuncture
now there is some evidence that
acupuncture may influence ovulation
by affecting levels of various hormones
however its mechanism
is still not very well understood so
according to the cochrane database
there is currently insufficient evidence
to support the use of acupuncture
for the treatment of ovulation disorders
in women with pcos but
you know if nothing else a lot of women
myself included
find it really stress relieving and
therefore it may be a nice complement to
your traditional healthcare regime
personally i am a huge fan of
acupuncture and i think it's made a
really big difference in my fertility
journey
even if it is just the placebo effect
and number four
avoiding endocrine disruptors so over
the years it has been suggested that
endocrine disruptor chemicals like bpa
may contribute to the rise in pcos
some animal studies have found that bpa
exposure
tended to disrupt ovarian and
reproductive functions than females
while a 2017 systematic review and
meta-analysis
found that pcos patients had
significantly higher bpa levels
compared with a control group
researchers from the study believe that
bpa
might be involved in the insulin
resistance and hyper androgenism
of pcos however more quality studies are
definitely needed to explore this
association
now the last lifestyle change that has
always been recommended for the
treatment of pcos
is weight loss i've waited to mention
this one because while it's probably the
first thing a doctor will just tell you
to do
it's definitely controversial so first
of all
why is weight loss so universally
recommended i don't know i mean
maybe doctors think that weight loss is
easy i
i i guess it's easy to send somebody off
with that suggestion i hope that they
come back and change body
but i will say the general
recommendation is based on research
suggesting that obesity and abdominal
fat
can exacerbate pcos symptoms by
increasing insulin resistance
now while the mechanism is still not
perfectly understood
some research suggests that visceral
belly fat which is the fat around
organs to protect them may release free
fatty acids and inflammatory hormones
that may drive insulin resistance it is
important to note however
that not all women with pcos struggle
with insulin resistance
and some of us are actually quite thin
i'm i'm a good example of that right
here furthermore a lot of pcos experts
like julie duffy dillon
says that doling out universal weight
loss advice to women with pcos
could actually have some serious
dangerous effects
for one disordered eating is
significantly
more prevalent in one with pcos with 86
of patients with pcos presenting with a
subclinical eating disorder
while it's unclear why this is it may be
related to the shame that women carry
and the pressure that's been
placed on this population to lose weight
at literally any expense
also a 2017 study found that repeated
attempts at weight loss which resulted
in weight cycling
predicted binge eating in a sample of
one with pcos even if those women
were considered lean and i think that
this whole binge eating thing
is something that a lot of women who
have the condition
can probably relate to i also know that
research has found that
low calorie dieting increases cortisol
which is linked to insulin resistance
and weight gain over time
which may be another reason why weight
loss may not always be the lowest risk
option
for every woman with pcos i also want to
mention the fact that
long-term caloric restriction has been
linked with inflammation
and people with pcos already live in a
chronic pro-inflammatory state
now to discuss ditching the diet and
managing pcos i've invited registered
dietitian
julie duffy dillon who is an intuitive
eating and pcos specialist
welcome julie hey abby thanks for having
me on thank you so
much so first of all i would love if you
could tell me a little bit
why you believe that the blanket
statement to just gonna go lose weight
may be bad advice for a lot of women who
are living with pcos i think it's very
bad advice
for a number of reasons first of all
pcos
is passed down through families so we
know it has a genetic connection
and weight didn't cause pcos so why
would it fix it
that's a really big important thing to
keep in mind and we also know that diets
don't work for most people
it's going to work for some people but
very few so if it doesn't work for
most people why would it work for people
with pcos
and then the other part of it goes even
deeper and
research that has been recently
published has been exploring the
relationship with binge eating and pcos
and what they have found is that many
people with pcos experience binge eating
because
yoyo dieting or what we also call weight
cycling predicts binge eating
and there's a lot of complications with
pcos that people who have it will
understand this
there's so many different hormonal
issues going on
one in particular is high circulating
insulin plus those higher androgens like
testosterone and lower
um fancy hormone called cck or
cholecysteine kinan
those are really common in pcos and
those lead to really intense cravings
but then when you also eliminate foods
especially carbs and sugar
that will intensify those cravings and
you know i don't have pcos so i don't
know what these cravings are like
but i know when i have a craving it's
kind of like i want something sweet okay
so pcos cravings are different
they're primal every cell in the body is
screaming eat
and it's like someone who's been
drowning is finally to the surface and
breathing
gasping for air pcos cravings are the
same and so when we tell people
just lose weight it's basically telling
people like don't be so obsessed with
air you know
right right that's dope right because
yeah we need air to breathe and we need
food to live
and so people with pcos it's really
important to know that you don't have to
diet and
really i would say you shouldn't diet in
order to manage pcos
so in your experience like what are some
of the ways that intentional weight loss
diets can actually like
potentially worsen symptoms so
again for some people diets may work for
them
but for most people with pcos what ends
up happening is because diets don't work
for most people
people go on diets over and over again
to try to manage their weight because
everyone's telling to do that
and what weight cycling or that yo-yo
dieting is connected to
is higher insulin levels higher
testosterone higher cortisol
higher cholesterol and higher blood
sugar all things that
is also connected to pcos and so it's
like a double whammy basically
and then also people with pcos what
researchers have found rather
is that people with pcos have a chronic
pro-inflammatory state it's a really
kind of common experience that leads to
lots of fatigue and brain fog
and we've also connected that same
pro-inflammatory state
um to weight cycling and so again it's
like it's worsening the
symptoms with it i also think it's
important to shift it even to like
what's the experience it's like we're
like everyone just needs to lose weight
to treat pcos
what my clients have taught me is that
keeps them from going to the doctor
so if you don't go to the doctor as
often to get attention
for your health care needs well it's
obvious it's going to affect your health
too in a really negative way
even deeper than that having this
blanket statement basically teaches us
that
fat bodies are larger bodies or bodies
that people will call obese are
overweight
those bodies are bad and what we know
that that does is it's a form of
discrimination it's weight stigma and
weight stigma is also
connected to higher insulin levels
higher testos or not testosterone but
higher cortisol
and cholesterol and blood sugar so you
know the very things that weight is
supposed to be treating with pcos
it's just going to make it worse thank
you julie that was so
amazing what a great way to explain it
now a lot of women with pcos often
describe feeling
overwhelming cravings particularly for
carbs as we know
and this phenomenon occurs because cells
that have become
insulin resistant no longer are
responding to insulin so
the pancreas keeps producing more
insulin to compensate and since the
muscles aren't properly getting the
glucose that it wants
it's basically just kind of floating
around the bloodstream and the muscles
are effectively starving
and sending out more and more signals
for the
preferred source of fuel which of course
is sugar so it's that combination
of high circulating insulin and antigen
hormones
that tend to cause these primal cravings
that a lot of women
describe having so how do you suggest
that
women can respond to their cravings in
an intuitive way
without kind of worsening their pcos
symptoms by gaining more weight or
spiking their insulin or all of those
kinds of things
so i am so glad you asked me that
question abby this is a really important
thing to keep in mind with pcos because
people with pcos are taught to ignore
their cravings or trick them
or they should never listen to them but
carb cravings
are insight i think carb cravings are
the guideposts to help people understand
what they need to treat their pcos
when people have carb cravings they
should be listened to
respected and not shunned they're the
way that the person knows that their
their condition needs more attention
what i teach my clients that i talk to
with pcos
is that when they have a carb craving if
they can it's really
really important to experiment with
stepping back and noticing what was just
going on
have you been eating enough have you
been sleeping enough are you eating
enough protein
are you restricting too much are you
exercising too much
what is going on maybe you need to
change your medications have you
forgotten your supplements
it's a really wonderful way to know that
insulin is really high
and what can we do to help manage it it
may be a temporary thing
or you know pcos is this chronic
condition that we cannot
cure no matter what people say you
cannot cure pcos
and since it's chronic it's going to
change and get worse
and so there are times where carb
cravings will come out of nowhere with
people that i work with and i teach them
to just
lean into them lean into them if they
can and by doing this it'll help them to
navigate what they're doing i think
that's amazing advice and probably
advice that
most of my viewers with pcos have never
heard before
so it's definitely against the grain and
i think very much needed so thank
you for that that's a big question i get
i'm beginning a lot
so julie if we really should not be
recommending that women just
diet to lose weight what kind of things
do you recommend in terms of dietary
recommendations and interventions when
it comes to planning
and meals and snacks and those kinds of
things yeah so
i know many people with pcos are told
they have to diet
to help manage their pcos so when they
think about not dieting they're like
what do i do then
i don't even know how to eat without
dieting and there are so many things you
can do
that helps promote health with pcos and
food and
first and foremost i know this is going
to be surprising but make sure you're
eating enough
i think people think they need so little
food especially carbs and sugar
and i think it's really important to
make sure you're eating enough because
again that chronic pro-inflammatory
state
those muscles that you talked about that
were starving these are really important
things that our body needs to survive
and to help those cravings not be so
primal
and so after people are making sure
they're eating enough i also tell people
that they probably need more protein
when they experience pcos so i encourage
them to strategically experiment with
protein
especially first thing in the morning
and before bed and to see how that helps
their energy levels and cravings
and then another part with nutrition is
supplements there's a number of
supplements that people experiment with
with pcos
there is one in particular that has a
lot of research behind it it's called
inositol
i encourage everybody with pcos to talk
to their healthcare provider about using
it
it's one that can really help with that
insulin resistance that we talked about
before it gets to the cellular level and
what may be
a defect or a deficiency that's going on
with pcos and actually it's one of the
things that may replace metformin
eventually so keep your eye on like the
research with it it's really exciting
but besides that the other part of it
that i think is really good is to make
sure that
you're moving your your body in a way
that feels good
i think people with pcos think they have
to torture their body with exercise
and do it even when they don't feel like
it but a really good way to know
if you're kind of onto something like
onto the tools that are helping you
is when you start to crave movement when
you're like i kind of want to move my
body today
that's when you really can start
thinking about how can exercise fit into
the picture
and it may take time to get to that you
know making sure you're eating enough
for a couple months before you really
can
feel that craving to move again and it
will happen and then lastly
you know i know people with pcos tell me
julie it's a really hard sell to love my
body
um not i'm not getting respect because
of my body
i'm not getting really access to
reproductive medicine or i'm not getting
things that i need to take care of
myself
because of the way my body looks people
with pcos are taught that their body is
wrong
that they need to be smaller and people
in larger bodies are mistreated
and denied access to things like
reproductive medicine and so it can be
really hard to love your body
but if you can with pcos find a way to
respect your body
which may mean turning away from diets
treating it with care and compassion
those are things that we know in
research that helps lower cortisol helps
to lower inflammation helps to lower
triglycerides things that we associate
with pcos and it's not an individual
thing you know you can't fix it on your
own
but doing those things leaning towards
body respect is something that also
is something you could something you can
do without dieting that can really
help your health i love that advice and
you know also
just thinking about from my own
experience struggling with infertility
like
so often you feel like your body is
failing you and you're so mad at it and
you're angry
and you just so disappointed so i think
that
there is so much to be said for having
that compassion for yourself and for
for your body and what it is doing well
um and what it can
um you know provide you with uh and i
think that's really
great universal advice so that's
fantastic thanks for that julie
so of course i want to give a big thank
you to you julie for for joining us
today
i'm sure everyone has learned so much
from this conversation
and i would love for you to get some
more information about julie i've got
some contact information for
for her below so you can get her website
and her social media and follow her
and all of that stuff so thank you again
julie for all of your help today
thank you abby it was so great chatting
bye bye
that was awesome so thank you guys all
for watching this if you liked this
video
please be sure to give it a thumbs up
leave me a comment with any pcos
questions that you might have
julie has graciously offered to pop by
and help answer a few if
it's out of the scope for me but of
course always
subscribe to the channel and i'll see
you next time on abby's kitchen
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