Macro ratios

pyramid918

Okay okay okay... Not that I want to get in to anything with you guys but I've been suffering from PCOS for years and decided to run an experiment. Initially I kept a very healthy, clean, organic and balanced diet while exercising daily and keeping under my daily calories. While in this state of glucosis, I lost around 10 pounds in two months. I then switched to a ketogenic diet, (which I suggest you read about since your initial reaction might be incorrect,) maintained my workouts, calorie intake, and organic/clean diet but moved my macros to 70% fat 35% protein and 5% net carbs. In a state of ketosis, I have lost 20 pounds in just under a month. Your body and brain can run quick efficiently on fat alone once you remove the sugar from your system. In this last month alone I've lost 3% of my body fat and my muscle mass increased 1%. My cholesterol levels have shown a great increase in HDL (the good one) and the LDL size has changed from small (bad) to large (good). My brain isn't fogged and my workouts remain intense. All of this was suggested and monitord by my endocrynologist and my physician. There is NO blanket solution to weight loss but I wanted to show you that a ketogenic diet is an effective and healthy way to combat inulin and carbohydrate resistance.

pyramid918

Oh, and most if not all all of my carbohydrates come from vegetables (of which I love and eat often).

Dragonwolf

I didn't read through all of the responses, because it seemed to be a lot of arguing. Here are my thoughts on some of the information sort of presented here, and hopefully some answers to your questions. I apologize if there isn't a lot of cohesion between sections. At that level, it's a little stream-of-consciousness, so there isn't much lead-in between them. The content under the headings should be more structured.

Dropping carbs can kill carb cravings

Sounds paradoxical, but it is true. "Have not, want not," basically. This is because sugar can have an addictive effect on the brain (stimulates the reward center, reinforcing the behavior). It doesn't necessarily work for everyone, but I've seen a number of people with issues with binging overcome it by dropping their carbs and increasing their fats, and have even experienced the phenomenon of killing carb cravings by reducing carbs first hand.

I have a friend who overcame her binge eating disorder with a ketogenic diet. She finds that if she gets more than 10% of her calories from carbs (any carbs, even fruits), she starts having issues again. Those issues are gone when she sticks to under 10%. Not everyone has this low of a threshold, but if you're still struggling, it might be worth trying a larger decrease. Just increase your fats to provide the fuel your body needs.

The brain doesn't run on fat, but the body can make the glucose it needs

Cat is right when she mentioned that the brain can't run on fat. In fact, it's the only organ in the body that needs glucose to run. But here's the catch -- the body can make the glucose necessary to fuel the brain. The brain can also function well when part of its fuel is from ketones, and the rest of the body can run just fine on ketones. Ketones are a fuel source that comes as a byproduct of burning fat.

Low carb, high fat is not dangerous

The Inuit and countless people with neurological issues can testify to this.

The Inuit traditional diet is nearly devoid of carbohydrates, yet the "diseases of civilization" were basically non-existent until their diets were "Westernized." Their diet didn't "destroy their organs," and no, they're not special snowflakes. They're human beings, just like the rest of us. Weston A. Price found that they, as well as the isolated people of the Masai, Gaelic, and Swiss regions, had varied diets and were arguably more "primitive" than his patients in Ohio, and yet, they were far healthier. No toothbrushes, yet not cavities. That's unheard of in the West! Why? What did they all have in common? High fat diets. In fact, fat was so valuable, the groups that hunted land animals went out of their way to get the fattiest ones they could find. When meat preservation methods were found, the big hunts would happen in late fall, when the animals were the fattest.

A ketogenic diet (very low carb, high fat, moderate protein) has been proven to improve neurological function, not impair it. In fact, it was initially created to reduce the number of seizures in epileptics. It has also shown promise in helping and preventing neurodegenerative diseases, such as Alzheimer's and Parkinson's, as well as other neurological-based issues, such as Autism and migraines, and some tangentially related issues, including cancer and stroke. The ketogenic diet has been used since the 1920s, so it's anything but new and untested.

Also, you'll get many people (yes, even doctors) who think that the state of ketosis is a bad thing. They're confusing it with ketoacidosis, which is very much a bad thing. Ketoacidosis is the ketone version of hyperglycemia, basically. It's a state of too many ketones in the blood. However, this is quite rare, and generally only happens in Type 1 Diabetics and Type 2 Diabetics who are insulin-dependent. This is because ketones are regulated by insulin. The difference between ketones and glucose is that ketones are largely generated from internal sources (ie - stored fat), while glucose is largely obtained through external sources (ie - food). This means that when the organs get the signal that there's enough ketones, the body simply stops making them and stores any fat from food. This differs from glucose, which the body tries to force into glycogen before storing it as fat.

Not all carbs are created equal, but they do have their own issues

As was also mentioned, the sugar in fruit isn't the same as the granulated sugar in your pantry. However, that doesn't mean the sugar in fruit can be completely disregarded. All usable carbs, though, will elevate blood triglyceride levels.

The primary sugar in fruit is fructose. Unlike glucose, the body can't use it directly (so it doesn't raise blood glucose levels). Instead, it get shipped to the liver, where it's converted to glucose and triglycerides (fat). Fructose, specifically, has been found to be a contributor in non-alcoholic fatty liver disease (probably due to the insane amounts the typical Western diet has).

Glucose, another primary component of many carbohydrate sources, can be used directly, however it's toxic in high amounts. This is why the body uses it before anything else. Too much sugar in the bloodstream (hyperglycemia) causes nerve damage (neuropathy), anxiety, impaired brain function, and cardiovascular issues (which can lead to heart attack, stroke, and/or limb necrosis), among other things.

Fiber is a sort of special carb, because our body doesn't actually use it the same way. Instead, it's used as "filler" in our bowel movements, and to feed the flora we have in our gut. What the flora don't use gets excreted.

Most other carbs will eventually break down to one or more of the above three, or a couple of other monosaccharides (ie - galactose, a component of lactose, the sugar in milk). Yes, even the "complex carbs" will eventually become glucose. They just do so at a slower rate (which, when you're insulin resistant and at risk for elevated blood sugar, may or may not be a good thing).

From whole foods, all carbs are complex carbs. You will almost never find a whole food with a lot of sugar that doesn't also have a lot of fiber. This is why whole foods beat processed any day, even in cases where the amount of sugar is comparable.

Fat is healthy and essential

Contrary to what we've been led to believe, our bodies need fat. The sources I've seen point to a minimum of .35g/lb of total body weight (though, admittedly, I haven't yet found the original source for that number, though the WHO does recommend 10-20% of calories be fat as a minimum).

Fat is required for:

- Hormone regulation
- Absorbing and using Vitamins A, D, E, and K
- Vitamin D production (cholesterol is actually a precursor to Vitamin D)
- Cell building and repair (our cell walls are made from fat)
- Control cell function
- Regulate inflammation
- Nerve cell function
- Healthy skin and hair
- Prevent gallbladder issues

Like Carbs, Not All Fats Are Created Equal

Trans fats are bad, hands down. Hydrogenated oils are trans fats. I think everyone can agree there. If there's one thing you get out of all this, let it be that. Avoid hydrogenated and partially hydrogenated fats like the plague.

I think everyone agrees that monounsaturated fats are good, too. So if all else fails, go for those. You pretty much can't go wrong with them.

From there, it gets a little fuzzier. Polyunsaturated fats are often held on a pedestal for their virtues, but too much Omega-6 and too little Omega-3 has the reverse effect. Omega-6 and Omega-3 use the same channels, so one will take over the other. Ideally, you want a 1-to-1 balance, though 2-to-1 (6-to-3) is considered acceptable, too. The problem, though, is that unless you eat a ton of fish, your Omega-6 to Omega-3 ratio is probably more like 500:1. Seeds, nuts, and their oils are almost entirely Omega-6 in their polyunsaturated content. At those levels, you end up with increased inflammation, and increased inflammation is a risk factor for cardiovascular disease.

Saturated fat has gotten a bad rap in the past few decades. The truth of the matter is, though, that it's not bad for you. In fact, when you look at the science, itself, you'll find that the science is pretty clear -- there's no strong evidence that links saturated fat intake with cardiovascular disease. Even more, as Dr. Peter Attia points out ( https://player.vimeo.com/video/45485034 ), political matters have caused quite a bit of publication bias and disparities between what the studies actually find and what's released to the public.

Low Carb is Not Bad, but Low Carb, Low Fat Is

Unfortunately, the low-fat mantra is so ingrained that many people who try to lower their carbs increase their protein. This is very bad. In fact, there's a name for what happens when you have too much protein and not enough fat or carbs -- Rabbit Starvation. Actually, there are a couple of names, it's also known as protein poisoning, or "mal de caribou."

Simply put, protein is not fuel, carbs and fat are. You can get by on the bare minimum fat and get all of the rest of your fuel from carbs, or you can get all of your fuel from fat and nothing from carbs, but you cannot severely reduce your consumption of both. If you do, you'll end up crashing and burning in a miserable sort of way. The body reinforces the fact that protein is not fuel by causing cravings for fat and/or carbs, that can only be satiated by fat and/or carbs, when you're in a state of Rabbit Starvation. If you decrease one fuel, you have to increase the other.

Arctic explorer Vilhjalmur Stefansson wrote this:

The groups that depend on the blubber animals are the most fortunate in the hunting way of life, for they never suffer from fat-hunger. This trouble is worst, so far as North America is concerned, among those forest Indians who depend at times on rabbits, the leanest animal in the North, and who develop the extreme fat-hunger known as rabbit-starvation. Rabbit eaters, if they have no fat from another source—beaver, moose, fish—will develop diarrhea in about a week, with headache, lassitude and vague discomfort. If there are enough rabbits, the people eat till their stomachs are distended; but no matter how much they eat they feel unsatisfied. Some think a man will die sooner if he eats continually of fat-free meat than if he eats nothing, but this is a belief on which sufficient evidence for a decision has not been gathered in the North. Deaths from rabbit-starvation, or from the eating of other skinny meat, are rare; for everyone understands the principle, and any possible preventive steps are naturally taken.

What's That Mean For You?

Well, for one, your reservations for increasing fat are very likely unfounded. You'd probably also fare better, if you try low carb again, to increase your fats, instead of protein. A low carb, moderate/adequate protein, high fat diet has been a very effective and sustainable way of eating for a lot of people with PCOS, so I recommend not discounting it too easily, especially if your blood tests have shown that you're insulin resistant. I highly encourage you to check out Dr. Peter Attia's blog, or at least his "About Me" section ( http://eatingacademy.com/my-personal-nutrition-journey ), to see how a ketogenic diet helped reverse his insulin resistance. I also made a couple other, rather lengthy posts in this forum and in my blog, about PCOS, Metformin, and the liver, that I encourage you to read (this one is really long already).

On a side note - bananas are touted for their potassium content, but really, they're pretty mediocre. Dark, leafy greens, avocado, salmon, acorn squash, and white mushrooms beat out bananas gram-for-gram when it comes to potassium content.

My recommendations are multifactoral. First, here's the macro breakdown:

Protein - about 1g/lb of lean body weight. Getting that or a little more is especially important if you're working out. You want to retain muscle, so that you look good at your lower weight, and so you can keep losing weight without having to slash calories too much.

Carbs - Depends largely on your goals, but I've found 100g to be a good starting upper limit. It gives a lot of the benefits of lower carb eating, while still allowing for higher carb items like potatoes or ice cream or whatever. You'd be amazed at how much you can have on even less than 100g of carbs when you limit the things that have a lot of carbs and not a lot of nutrition.

Fat - Fill in the rest with fat, but try to make sure it's at least .35g/lb of total body weight. If you can't get that minimum and you have a pretty low carb number, you're probably not eating enough. If you have an adequate intake level and lower carb setting, then this may be a pretty high number and percentage. That's a good thing if your goal is lower carbs.

Give a given setup a solid month before trying to change. Especially when it comes to playing with carb levels, you really have to let your body adjust to really see what it will do with what you give it. If you find yourself hungry all the time and you're eating enough food, then drop carbs and increase fat. If you find yourself having to force feed yourself in order to get the amount of food you need, try increasing your carbs and dropping fat. The goal is to eat enough to fuel your body properly, while being able to lose weight without starving yourself and without having to fight your body every step of the way. It may take a little tweaking, but it can be done.

Next, I've found that what we eat is at least as important as how much we eat. Therefore, I recommend the following:

- Limit or eliminate grains, especially gluten grains. There is a pretty strong correlation between PCOS and gluten sensitivity (so much so that some doctors find as much as 85% of their PCOS patients are gluten intolerant). There is also evidence to suggest that endometriosis symptoms can be improved by removing gluten and wheat. I personally just keep all grains to a minimum, so I don't have to remember which ones have gluten in them or are typically contaminated. Grains don't contain anything that can't be found, usually in higher quantities and more bioavailable forms, in other foods, so you can safely cut them out entirely and not really worry about lack of nutrients, provided you eat a decent variety of food.

- Limit or eliminate dairy. Casein, a protein in milk, is highly insulinogenic, meaning it triggers an insulin response. All protein does this, and of course, glucose carbs do, as well. Casein, however, does it more than other proteins. It makes sense, if you think about it -- milk is primarily for a baby animal. Insulin is a growth hormone. 1 + 1 = 2. Insulin, however, is something we need to keep from going up too much. Additionally, casein is cross-reactive with gluten. That's why people who go gluten free will often also go casein free. At the very least, drop the casein-containing dairy items from your diet (butter may be okay, since it is almost entirely just the fat, but if you find it causes problems, you can try ghee, which removes the remaining proteins and sugars from butter, or just switch to other fats, such as coconut oil or lard, for cooking).

- Avoid unfermented or all soy. The phytoestrogens in soy are especially bad for us, since our bodies are already out of whack. The fermentation process helps neutralize the endocrine disrupting compounds, so if you like soy, stick with the fermented varieties. Personally, I just stay away from it altogether as much as possible.

- Avoid or properly cook legumes and white potatoes. Legumes are particularly high in certain phytochemicals, as are potatoes, when not properly handled. Legumes should be soaked and/or sprouted, and cooked thoroughly. Potatoes should be kept a cool, dark, dry place to avoid sprouting and also cooked thoroughly.This handling helps break down those chemicals, so that our liver doesn't have to deal with them.

- Avoid refined sugars and limit all starch. The refined sugar is pretty obvious, but starch falls into that, too. Starch is a relatively simple carbohydrate, so it breaks down into glucose quickly and easily. It's not as bad as refined sugar, but if you're insulin resistant, then it's a good idea to limit it, too.

- Stick with whole foods. Doing the above, and eliminating grains, milk, and soy, pretty much begs this one, but I'll say it anyway. Whole foods give us the most nutrition by pretty much any measure. Even the sweeter foods, like your banana example, naturally mitigates its sugar impact with fiber, especially if you can find heirloom varieties, or other varieties that aren't bred for sweetness to the exclusion of nutrients.

Hopefully this helps you more than the arguments that have arisen from your original post. If you have more questions or concerns, feel free to ask either on here or in a PM.


Sources:
http://journeytoforever.org/farm_library/price/pricetoc.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321471/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/
http://site.matthewsfriends.org/index.php?page=other-uses-of-the-ketogenic-diet
http://articles.mercola.com/sites/articles/archive/2003/10/25/carbs-triglycerides.aspx
http://www.ncbi.nlm.nih.gov/pubmed/11584104
http://care.diabetesjournals.org/content/27/10/2335.long
http://ag.arizona.edu/pubs/health/az1126.html
(The limits of scientific evidence and the ethics of dietary guidelines -- 60 years of ambiguity; Dr. Peter Attia)
http://www.bmj.com/press-releases/2013/10/22/observations-saturated-fat-not-major-issue
http://blog.cholesterol-and-health.com/2010/01/saturated-fat-is-not-associated-with.html
http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract
http://www.medbio.info/Horn/PDF files/rabbit starvation.pdf
http://www.healthaliciousness.com/articles/food-sources-of-potassium.php
http://www.thesavvyceliac.com/2009/11/02/is-pcos-a-symptom-of-a-gluten-sensitivity-or-celiac-disease/
http://www.pcosdietsupport.com/diet-tips/pcos-and-gluten/
http://www.everydayhealth.com/womens-health/essentials-of-endometriosis-diet.aspx
http://www.glutenfreesociety.org/gluten-free-society-blog/gluten-and-endometriosis-is-there-a-connection/
http://eatingacademy.com/my-personal-nutrition-journey

Extra Reading:
http://eatingacademy.com/
My blog and other posts in this forum group.

Lizabelle1212

For what it's worth, I would listen to Dragonwolf over the crazy high-carb lady.

Also for what it's worth, my weight loss is much more successful when I limit my carb intake to around 100g/day. I aim for macro ratios of 50%fat/25%protein/25%carb - I sometimes switch up the protein and carbs to be 30% protein and 20% carbs, but find that not as easy to maintain.

However, you will not find one correct answer, because unfortunately there isn't one correct answer. There is arguing because, to add to the already long list of crappy things about PCOS, it affects every woman differently. Some have the related insulin resistance while others do not, some have messed up (or nonexistent) cycles, others have periods that come like clockwork each month (like myself) even without the help of metformin or birth control. As annoying as it sounds, it truly is just a game of trial and error until you find what works for your body - and what "works" is not only what's healthiest and results in the best weight loss, but what is also the most sustainable for you. A diet (and I say "diet" meaning your eating habits) isn't worth crap if you can't maintain it for the rest of your life.

mjrose514

Wow I know this is an old thread, but dang lol. No wonder we're all so confused. What makes it harder is when you have multiple people trying to donate their time to help you, but the information is on the opposite ends of the spectrum.... I wish I could just be normal lol.

autumnebone

Everything that I've read (namely USDA and NIH) says that you need at least 130 grams of carbs per day for normal brain functioning. So that's what I aim for 130g at least. I try not to go over 150g, and I have lost 23lbs since May 8 with two "plateaus" that lasted several weeks each. I also take apple cider vinegar with my tea or in my water, since I read a few research studies that claimed it lowers blood glucose levels. i lost a significant amount of weight several yrs ago by adding ACV to my morning and evening tea, and I had not changed my diet or exercise habits at that time.

Dragonwolf

Everything that I've read (namely USDA and NIH) says that you need at least 130 grams of carbs per day for normal brain functioning. So that's what I aim for 130g at least. I try not to go over 150g, and I have lost 23lbs since May 8 with two "plateaus" that lasted several weeks each. I also take apple cider vinegar with my tea or in my water, since I read a few research studies that claimed it lowers blood glucose levels. i lost a significant amount of weight several yrs ago by adding ACV to my morning and evening tea, and I had not changed my diet or exercise habits at that time.

Needing a certain amount and needing to eat a certain amount are two completely different things. See my post on the first page for details on that and references.

In short, the body can make the vast majority of the energy the brain needs, so you don't need to eat 130g of carbs a day.

If it works for you, then by all means keep going with that, just don't do so under the mistaken idea that you have to eat that many.

TwizzleBit

^^^^^This recommendation goes for all of you! I cannot believe any of you can be happy/healthy eating that little amount of carbs and that high amount of fat! Good fats are great for you, but in such large amounts you are likely damaging a lot organs, and carbs are the only nutrient that is available for use by your brain! Less than 30% of your day from carbs no only reduces energy but leaves your brain with no nutrition. You probably get a foggy feeling in the afternoon/evening, or cant remember certain things, can't perform memory, comprehension, "tasks" as well. That is scary. Up your carbs for the love of god, but make it the right carbs. Carbs are fine for women with PCOS as long as it is proper ones for the diagnosis!

I don't think that's accurate. I will tell you for a fact that eating healthy carbs that come from fruits, vegetables, and legumes did me no favours when it came to my yearly blood tests.

I had normal blood sugar by cutting out most carbs and eating only a few new potatoes every so often (they have less carbs than standard potatoes), but when I added more fruits for variety with my meals (for example, apple, orange, and a banana or plum) it caused my fasting blood sugar to basically double.

By it doubling, it brought back my insulin resistance, which was under control without so many carbs, regardless of the source.

Since I've started Keto and ultra low carb, I've had tons of more energy and it has educated me that my body can't deal with dairy and wheat products. I'm eating less than 10% carbs per day (less than 40g). I feel better than I ever have on a low cal/low carb/low fat eating plan.


I'm interested to see how my next lot of blood tests come out.

jogami

I set mine at 50% fat, 25% protein and 25% carbs. I am very liberal with my oils (only avocado oil, coconut oil and olive oil) and my food tastes better than ever. I am on the paleo/ primal lifestyle and I've never felt so good. Neither has my skin hair and nails. I eat alot (from 1200 to 1600 cals a day) and I find the increase in fats and decrease in protein and carbs has done me wonders! And I've managed to lose 6kg in 2 weeks!

Oh and I don't have the pain and bloating that comes with pcos! I would be curious to know how I look inside!!