PCOS- What works?
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While *some* doctors do prescribe a low-carb dietary approach for PCOS, after reviewing current guidelines and protocols (at-least in Canada and the USA), it's unlikey that most do. Many do prescribe metformin, however, even if there's no initial diagnosis of diabetes.Yes, most Dr's do demand a low carb approach to control the symptoms of PCOS along with metformin and / or other diabetes drugs if the woman has T2 Diabetes and not just Insulin Resistance.
Possibly yes, but in many cases can't even prescribe a low-carb diet. Most regulated dieticians in Canada and the USA actually can't prescribe a low-carb/moderate-protein/high-fat dietary approach as it goes against the advice of their regulatory boards. As a severe Type II diabetic my dietician suggested I eat 300g of carbohydrate a day while dieting. Yup, 300g. Because that is the prevailing wisdom and what her regulatory body says she has to abide by. And that's a CDE - Certified Diabetic Educator.Doctors are not dietitians (RDNs), either.
A dietitian will have more and better information on controlling or reducing the symptoms of PCOS through diet than an endocrinologist or a doctor would.
What's best is to TELL a dietician that after considerable research, you're going to eat low-carb/moderate-protein/high-fat and then have them assist you in preparing a plan around that approach that ensures you get enough vitamins and nutrients - rather than a minimum amount of carbohydrate.
There are dieticians that CAN advise a low-carb approach, but not many, unfortunately.0 -
I am pleased to see that strength training is seen as beneficial with pcos weight loss, this is an aspect I hadn't really considered as impacting. Personally I find that I do best when I have a 500 cal defecit with 4 meals a day and exercise to boost my metabolism. To me exercise is key. But I also urge you to get tested. You can reduce symptoms and hormonal imbalances to an extent with weight loss, but it is not easy and is not a cure all. The long term repurcussions are not ideal, so the sooner you get proactive about your health and weight the better. I had symptoms sine my late teens when I was a healthy weight and these continue to the present day, to an extent, but I have been helped by taking metformin. You will find a solution that suits you, but you need a diagnosis first. Be sure to get an understanding and informed healthcare provider.
Good luck with the weight loss. :-)0 -
I figured I'd chime in with my super advanced bit of knowledge on this subject... I'm kidding.
Actually I was diagnosed with PCOS last year. Turns out I'd had PCOS for years, never took care of it, and it, ultimately, helped led to uterine cancer. That's all in the past, and I'm getting healthy. My gynecological oncologist recommended low carb/mod protein/high fat and I'm astonished at how well it's worked! That with cardio and I'm kicking butt!
So far, following this plan regularly (and I mean regularly; I do think that's key), I've noticed a huge difference in how I feel and the PCOS symptoms (such as fatigue and hirsutism). There is a way to get past it!
Also, for those that don't think someone's body "makeup" has anything to do with losing weight, I'd like to point out that there are still many things about the body we don't know, don't quite understand, or can't fix, so let's hold off on generalizations pretty please. You are all super people and I'm very happy to be a part of the MFP brigade!0 -
What works for women with PCOS is low carb, higher fat, and moderate protein diet. Have reversed all symptoms with this diet. While monitoring calorie intake is important, a PCOS patient has to consider macronutrients as well. What works for normal women will NOT usually work for those with this condition.
Also, I recommend weight lifting.
Weight loss happens at a calorie deficit. PCOS or insulin resistance does not make one an alien:
calories burned > calories in means weight loss
It is impossible to not lose weight when at a deficit, regardless of whether you are eating 50% carbs or 20% carbs, PCOS or not.
Weight loss results in controlling PCOS, exercise results in controlling PCOS. Whether a low carb diet will help with the insulin resistance itself is up for debate and probably research (lots of conflicting info out there, most drs do not demand a low carb diet for this).
This is actually not true. Having IR makes it extremely difficult to lose weight. I have it myself and my endocrinologist has told me time after time that I most likely will not lose much weight unless I am eating 500-800 calories a day. Which is something he would never recommend for me because I only have 40 lbs to lose.
He is right. I didn't lose weight eating 1200 calories and I didn't lose weight eating 1750-1840 calories (recommended for my weight/height). The only time I lose weight is when I am eating less than 800 calories a day due to being sick and unable to tolerate much food.
Well, this may not be true for *your* individual situation, FatFreeFrolic. Generally, PCOS + IR women don't require such severe calorie restriction to see weight loss. It sounds like you have a pretty serious degree of insulin resistance, and I definitely do not envy you. Sub-800 calories has gotta be really, really tough. I'm sorry to hear that you are dealing with this.
I noticed I had to drop my calorie intake lower and lower and lower to lose weight and I had difficulty functioning below 1100 cals/day (sustained). I had really great results when I added both steady state and then HIIT cardio. We're talking 1-3 hr workouts 3-4x week at a moderate-to-high intensity (as close to my anaerobic threshold (AT) as I could bear - I was working on endurance). I could eat more (not a ton) *and* was seeing weight loss. I had to be careful with nutrient timing before/during/after exercise to avoid extreme blood glucose peaks/troughs, but it helped me get back to eating more calories (for me, 1500 on average) and not feeling like a zombie. Something to consider if you are looking for options that might help you "escape" the hell that is <800 cal/day. (I know it might not work as well for everybody, but I thought I'd share.) Good luck!!!
Edited to add who I was primarily addressing. Sorry.0 -
Hello all!
I hope not to sound silly on this topic as I have yet to be officially tested for it, but I was wondering what women with PCOS have done to break through and lose weight. I have delayed the testing as I've been afraid to hear it...
Just wanted to mention to the OP that I was tested via ultrasound after consultation with my OB/GYN. I was imaged in a prenatal ultrasound room and it was kinda peaceful. (Nothing like what I was expecting... I had so much anxiety by the time I finally got tested that I think I was expecting something out of a torture chamber. Ah, anxiety!) Knowing is so much better than not knowing. If you already suspect you have PCOS, then getting an answer might feel like a weight being lifted off your shoulders! Knowledge is both freeing and empowering. Good luck. :flowerforyou:0 -
Hello all!
I hope not to sound silly on this topic as I have yet to be officially tested for it, but I was wondering what women with PCOS have done to break through and lose weight. I have delayed the testing as I've been afraid to hear it...
Just wanted to mention to the OP that I was tested via ultrasound after consultation with my OB/GYN. I was imaged in a prenatal ultrasound room and it was kinda peaceful. (Nothing like what I was expecting... I had so much anxiety by the time I finally got tested that I think I was expecting something out of a torture chamber. Ah, anxiety!) Knowing is so much better than not knowing. If you already suspect you have PCOS, then getting an answer might feel like a weight being lifted off your shoulders! Knowledge is both freeing and empowering. Good luck. :flowerforyou:
I totally agree. Knowddge is power!0 -
Hello all!
I hope not to sound silly on this topic as I have yet to be officially tested for it, but I was wondering what women with PCOS have done to break through and lose weight. I have delayed the testing as I've been afraid to hear it...
Just wanted to mention to the OP that I was tested via ultrasound after consultation with my OB/GYN. I was imaged in a prenatal ultrasound room and it was kinda peaceful. (Nothing like what I was expecting... I had so much anxiety by the time I finally got tested that I think I was expecting something out of a torture chamber. Ah, anxiety!) Knowing is so much better than not knowing. If you already suspect you have PCOS, then getting an answer might feel like a weight being lifted off your shoulders! Knowledge is both freeing and empowering. Good luck. :flowerforyou:
I totally agree. Knowddge is power!
Not to be weird, weejo72, but we are so very totally twins - bangs, smirk & all! It's almost-but-not-quite freaking me out! Wish I had better selfies. :drinker:0 -
PaleoPath4Lyf, you don't need to be disrespectful. Your quote "Your not an Endocrinologist so stop trying to simplify what you have no clue about" is a prime example.
People do not have to have a MD/DO degree in order to be well informed regarding medical topics or to discuss them here in a public forum. The forums aren't to be used for giving official medical advice, but that doesn't prevent people from talking about their own viewpoints or experiences. You are welcome to disagree, but you shouldn't attempt to shut others out or kill the discussion.
It's OK to talk about PCOS from *all* perspectives - and that should *include* those who also have diabetes or insulin resistance, as well as those who do not or no longer do.
I'd like to politely remind folks that Diabetes Mellitus is not actually included in the diagnostic criteria for PCOS. It's a separate diagnosis. Some PCOS women have DM, but many do not. I've pasted the most recent medical definition for PCOS below. (I used Rotterdam, 2003, because it's a wider definition than NIH.)
In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met:
1.oligoovulation and/or anovulation
2.excess androgen activity
3.polycystic ovaries (by gynecologic ultrasound)
Please take note of what's NOT listed - insufficient pancreatic function/activity. Diabetes, insulin sensitivity, insulin resistance, and metabolic syndrome are separate conditions. Yes, they are *often* present in women with PCOS. PCOS women *may* develop insulin resistance. They *may* develop diabetes. They *may* develop heart disease. Or they *may* not. Yes, the likelihood is there. Yes, we should be very concerned. And yes, we should do something...
We should also acknowledge that there isn't a ONE-SIZE-FITS-ALL solution to such a multi-faceted problem like PCOS. We also need to remember that even the scientific/medical community hasn't fully figured out PCOS yet.
Excess androgen activity has a hell of a lot to do with blood glucose disorders and metabolic issues. They go hand in hand. Majority of women with PCOS benefit from blood sugar control. That's why the first line medications that are used to treat it (besides BCs) is usually an oral diabetes medication such as metformin.0 -
What works for women with PCOS is low carb, higher fat, and moderate protein diet. Have reversed all symptoms with this diet. While monitoring calorie intake is important, a PCOS patient has to consider macronutrients as well. What works for normal women will NOT usually work for those with this condition.
Also, I recommend weight lifting.
Weight loss happens at a calorie deficit. PCOS or insulin resistance does not make one an alien:
calories burned > calories in means weight loss
It is impossible to not lose weight when at a deficit, regardless of whether you are eating 50% carbs or 20% carbs, PCOS or not.
Weight loss results in controlling PCOS, exercise results in controlling PCOS. Whether a low carb diet will help with the insulin resistance itself is up for debate and probably research (lots of conflicting info out there, most drs do not demand a low carb diet for this).
Low carb diets helping with insulin resistance is not something up for debate, it's a scientific fact, and any doctor that deals heavily in related disorders will normally recommend a lower-carb approach.
There are some manifestations of PCOS that are not comorbid with metabolic syndrome.Such people can lose weight with a 50% carbohydrate diet or whatever. I'm NOT going to say that calories do not matter - because, in the end, calories do matter - but they are NOT the ONLY THING THAT MATTERS when dealing with this condition. Why in the **** would I want to give my hormonally messed up body the absolute WORST macro nutrient (worst meaning the one it can't handle well) to lose weight? I'm not going to struggle with a 50% carbohydrate diet for a year to lose a measly 20 pounds again, that's completely unnecessary. Biology isn't physics.0 -
What works for women with PCOS is low carb, higher fat, and moderate protein diet. Have reversed all symptoms with this diet. While monitoring calorie intake is important, a PCOS patient has to consider macronutrients as well. What works for normal women will NOT usually work for those with this condition.
Also, I recommend weight lifting.
Weight loss happens at a calorie deficit. PCOS or insulin resistance does not make one an alien:
calories burned > calories in means weight loss
It is impossible to not lose weight when at a deficit, regardless of whether you are eating 50% carbs or 20% carbs, PCOS or not.
Weight loss results in controlling PCOS, exercise results in controlling PCOS. Whether a low carb diet will help with the insulin resistance itself is up for debate and probably research (lots of conflicting info out there, most drs do not demand a low carb diet for this).
Low carb diets helping with insulin resistance is not something up for debate, it's a scientific fact, and any doctor that deals heavily in related disorders will normally recommend a lower-carb approach.
There are some manifestations of PCOS that are not comorbid with metabolic syndrome.Such people can lose weight with a 50% carbohydrate diet or whatever. I'm NOT going to say that calories do not matter - because, in the end, calories do matter - but they are NOT the ONLY THING THAT MATTERS when dealing with this condition. Why in the **** would I want to give my hormonally messed up body the absolute WORST macro nutrient (worst meaning the one it can't handle well) to lose weight? I'm not going to struggle with a 50% carbohydrate diet for a year to lose a measly 20 pounds again, that's completely unnecessary. Biology isn't physics.
Why I do not like giving (or reading) advice for anything other than "do things in moderation, talk to your dr" on the internet:
Scenario A: Woman goes to dr, has blood tests, confirmed prediabetic or diabetic, is given a nutrition and exercise plan, might or might not be low carb or low calorie or whatever, made for her needs, follows the plan made for her, goes on to live happily ever after.
Scenario B: Woman googles PCOS, self diagnoses with insulin resistance. Receives advice to go low carb, with no plan, ends up with a 10% carb, 60% animla fat diet she made up herself with the help of internet strangers. Woman in fact does not have insulin resistance, but has a kidney issue she forgot to mention to dr google, and she is damaging her kidneys even more.
Not saying of course that this is the scenario with the OP, but we are not her drs. We know nothing about her health, she did not even say she has PCOS. Even if she does have it, my dr's instructions, for my PCOS, are adapted to me, and are completely different than the instructions that poster X or Y got from their dr.
As on to whether a really low carb diet is controversial or not, there you go:
http://www.diabetes.org.uk/About_us/What-we-say/Food-nutrition-lifestyle/Low-carbohydrate-diets-for-people-with-Type-2-diabetes/
"Evidence exists suggesting that low-carbohydrate diets can lead to improvements in HbA1c and reductions in body weight in the short term (less than one year).
Weight loss from a low-carbohydrate diet may be due to a reduced calorie intake and not specifically as a result of the carbohydrate reduction associated with this diet.
Despite the short-term benefit there is a lack of evidence related to long-term safety and benefit of following this diet."
http://www.washingtonpost.com/lifestyle/wellness/qanda-i-have-prediabetes-what-should-i-eat/2013/11/05/70a3e868-4192-11e3-a751-f032898f2dbc_story.html
"The DPP encouraged participants to first get a handle on their fat consumption as a direct route to reducing total calories. How to do that? One way is to focus on how you prepare food. For example, limit the butter or oil used to saute vegetables, mash potatoes or scramble eggs. Next limit the fats and oils added to foods before eating, including butter, margarine, cream cheese, sour cream and salad dressing.
The next focus if need be? Further reduce total calories by looking at the types and amounts of carbohydrates you eat. “People think Americans eat vast amounts of carbohydrates. We don’t,” Davidson says. We get a bit less than half our calories from carbohydrates — though for many people that’s within the context of too many calories."
http://prevention.stanford.edu/word-pdf/Pre-Diabetes Recommendations.pdf
"1. Don’t eat too much carbohydrate at one meal or snack. Combine a carbohydrate
food with lean protein and unsaturated fat for “balanced” meals and snacks.
2. Try a lower carbohydrate breakfast. In place of fruit juice with toast and jam,
eat a slice of whole grain bread with peanut butter or with an egg white omelet.
3. Choose high fiber, unrefined, whole grain carbohydrates (for example, whole
wheat bread in place of white bread). You still must watch your portion sizes.
4. Eat a heart-healthy diet low in saturated fat, trans fat and cholesterol. Foods
high in unsaturated fats (e.g. olive oil, canola oil, nuts, avocado, fatty fish) can
be included. But remember that high-fat foods are high in calories."0 -
PaleoPath4Lyf, you don't need to be disrespectful. Your quote "Your not an Endocrinologist so stop trying to simplify what you have no clue about" is a prime example.
People do not have to have a MD/DO degree in order to be well informed regarding medical topics or to discuss them here in a public forum. The forums aren't to be used for giving official medical advice, but that doesn't prevent people from talking about their own viewpoints or experiences. You are welcome to disagree, but you shouldn't attempt to shut others out or kill the discussion.
It's OK to talk about PCOS from *all* perspectives - and that should *include* those who also have diabetes or insulin resistance, as well as those who do not or no longer do.
I'd like to politely remind folks that Diabetes Mellitus is not actually included in the diagnostic criteria for PCOS. It's a separate diagnosis. Some PCOS women have DM, but many do not. I've pasted the most recent medical definition for PCOS below. (I used Rotterdam, 2003, because it's a wider definition than NIH.)
In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to be present if any 2 out of 3 criteria are met:
1.oligoovulation and/or anovulation
2.excess androgen activity
3.polycystic ovaries (by gynecologic ultrasound)
Please take note of what's NOT listed - insufficient pancreatic function/activity. Diabetes, insulin sensitivity, insulin resistance, and metabolic syndrome are separate conditions. Yes, they are *often* present in women with PCOS. PCOS women *may* develop insulin resistance. They *may* develop diabetes. They *may* develop heart disease. Or they *may* not. Yes, the likelihood is there. Yes, we should be very concerned. And yes, we should do something...
We should also acknowledge that there isn't a ONE-SIZE-FITS-ALL solution to such a multi-faceted problem like PCOS. We also need to remember that even the scientific/medical community hasn't fully figured out PCOS yet.
Excess androgen activity has a hell of a lot to do with blood glucose disorders and metabolic issues. They go hand in hand. Majority of women with PCOS benefit from blood sugar control. That's why the first line medications that are used to treat it (besides BCs) is usually an oral diabetes medication such as metformin.
I didn't say anything that would disagree your statements above. Feel free to quote me where I said androgen excess was *not* associated with insulin resistance and an increased risk for developing diabetes.0 -
I am all for women being proactive and learning about their own condition (provided it is through reputable medical sites etc.) When I first got diagnosed (many years ago) there was not as much information as there is now.
I was very lucky that my own GP had an interest in the condition (in fact it was she who first unofficially diagnosed me) and once diagnosed formally she helped me work through various treatment options. She also helped me to petition my consultant to allow me to use Metformin (this is way before the uk medical society accepted the link between pcos and insulin resistance) which really helped.
Now, this is not a dig at all medical professionals, just a note from my personal experience, but I had a horrendous time with my gynae consultant originally. In the end I had to make a formal complaint about his attitude. He was woefully underresearched and disinterested after he discovered that I just wanted to feel better and have a good quality of life, and was not just looking to have kids. (I had hair loss, hirsuitism, absent periods, weight gain, depression, etc...)
It is funny because about 10 years after I was first officially diagnosed the gynae consultant brought medical students in to a consultation with me to use as an example of how well metformin can work for some women with PCOS. Yet I had had to fight him all the way to get on them in the first place.
Anyway, the moral of the story is, get educated, but most importantly find a medical professional who is knowledgeable and who you can build up a trusting partnership for your health as this is a lifelong condition. If you are able to manage it now, you will be protecting yourself into old age. If you don't then you could be setting yourself up for diabetes, increased risk of heart attack or stroke etc.
Now I am working on the final piece of the puzzle, weight loss, Hopefully by getting to a healthier weight it will be easier for my body to stay on a nice even keel.
If anyone with pcos needs a mfp buddy who understands the challenges feel free to add.0 -
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I totally agree. Knowddge is power!
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Not to be weird, weejo72, but we are so very totally twins - bangs, smirk & all! It's almost-but-not-quite freaking me out! Wish I had better selfies. :drinker:
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You must be gorgous too! Lol.0 -
Actually, there is no conflicting research on whether a VLCKD helps PCOS suffers. All currently-available research concludes it does.
Low-carb diets are used to control hormonal balance, in essence, I think we can agree.
A low-carb diet will never be as effective as weightlifting for this purpose, and if one is training with a significant volume and with significant weight, going low-carb or ketogenic makes muscle growth difficult and impacts on energy reserves. In short, VLCDs/KDs make arguably the most important facet of controlling the symptoms of PCOS unduly inefficient.
The most important thing for a woman with PCOS is to maintain a lifestyle, inclusive of diet and exercise, that is sustainable over her lifetime and gives her maximal health benefits.
The benefits of weightlifting whilst using a moderate-carb diet are many, in fact many more than a VLCD/KD will ever provide alone (inclusive of helping prevent osteoporosis, which is a problem for women in general but is exacerbated by PCOS), and therefore choosing a diet that is a barrier to optimal performance from the off without exploring a more moderate route is nonsensical.
If you're a female with PCOS unable to take up weightlifting for whatever reason, obviously a VLCD will be your go-to solution. Before that, attempting a moderate-carb diet with significant weight training is key.0 -
I'm going to completely disagree with you here.A low-carb diet will never be as effective as weightlifting for this purpose, and if one is training with a significant volume and with significant weight, going low-carb or ketogenic makes muscle growth difficult and impacts on energy reserves. In short, VLCDs/KDs make arguably the most important facet of controlling the symptoms of PCOS unduly inefficient.
You're only focusing on the insulin-resistance instead of the glycemic control issues that are likely present because of it. Interval training (whether it's interval repeats on a treadmill or strength/resistance-training) will improve insulin-sensitivity, yes. It will also help (during the exercise itself) control blood glucose.
However the exercise alone won't prevent post-prandial spikes in blood glucose that come from being insulin-resistant until AFTER visceral bodyfat loss. Whereas a VLCKD improves glycemic control almost immediately.
Also of note, going low-carb/ketogenic does not prevent muscle growth. It can inhibit insulin-secretion (which is an anabolic hormone, yes) but usually to NORMAL levels rather than being hyperinsulinemic. Also, if fat-loss is the concern, you're not going to be building muscle anyway as virtually ALL experts agree that (with the exception of very rare "noob gains") hypertrophy requires a caloric surplus, and doesn't happen in a deficit.
It also has no "impact on energy reserves" ... In fact, when keto-adapted you have a greater resource than a moderate-carb eater would.
There are literally 10's of thousands of ladies on MFP that would give anecdotal evidence that a VLCKD is something they can sustain over their lifetime. Your posts seem to indicate you don't believe that - or aren't 'sold' on the idea - but it's absolutely true.The most important thing for a woman with PCOS is to maintain a lifestyle, inclusive of diet and exercise, that is sustainable over her lifetime and gives her maximal health benefits.The benefits of weightlifting whilst using a moderate-carb diet are many, in fact many more than a VLCD/KD will ever provide alone (inclusive of helping prevent osteoporosis, which is a problem for women in general but is exacerbated by PCOS), and therefore choosing a diet that is a barrier to optimal performance from the off without exploring a more moderate route is nonsensical.
While I can agree with much of what you say, the idea that low-carb is 'nonsensical' is a very close-minded opinion, and doesn't reflect what the research shows on the effectiveness of the diet in treating insulin-resistance and PCOS as a whole.
It's important to treat the insulin-resistance, yes - but it's actually MORE important to treat the hyperglycaemia that results from insulin-resistance due to the the complications that can arise if left untreated.
Also, the diet isn't a "barrier to optimal performance". UNLESS you're an elite athlete (world-class level) that is a complete myth. As a keto-adapted "clydesdale" (over 200lbs) with spinal issues I can do sub 3-hour 100km bike rides, sub-hour 40km time trials ... and I lift heavy 3x a week and do both endurance cardio and HIIT another 3 days a week. Am I world-class, no. But I'm in the upper percentile for cycling performance in my age bracket despite my spinal issues and large stature.
Bottom-Line: If you have issues with glycemic control (and if you're insulin-resistant, you do), it's is critical to treat that symptom and prevent complications that result from it. A VLCKD does that immediately. Weight-training and a moderate-intake of carbohydrate may not, though they MAY help it after weight-loss occurs. This is the point I'm making.0 -
I think we're putting the cart before the horse a little here. Glycaemic control is not necessary unless one is prediabetic or diabetic. Like I mentioned previously, I have insulin resistance, and I do little to control my carb intake besides choose more whole sources. I have successfully managed to reverse my prediabetic condition by doing so (with the addition of weight training, it must be said). I've always averaged around 200g of carbs a day, and managed to lose over 100lbs doing so.
Whilst a VLCD/KD has been shown to work in polycystic women with IR, so too has the more conventional approach of calorie-control. It's really all down to how you feel on a specific diet and how much effort you will put into it.
I won't address the rest of what you said until that is cleared up, because otherwise we're talking through elbows about a different subject. Are you specifically talking about women with PCOS and diabetes?
ETA: I should specify that such extreme glycaemic control is not necessary. In general, even otherwise healthy individuals, would benefit from some degree of glycaemic control - stabilising their blood sugar levels with more whole sources of carbohydrate.0 -
I was recently diagnosed with poly cystic ovarian syndrome and my doctor has put me on a Low carb, High Protein diet to help lose the weight. I love the fitness pal app for keeping track of my calorie and nutrition but I'm unsure of how to set it up for my new diet needs. I currently have my calorie breakdown set to Carb 25%, Fat 30%, Protein 45%, I'm not sure if this is the proper percentages for my weight loss needs. My goal is to lose weight and help manage the symptoms associated with PCOS. If someone could help me figure out the healthy way to do that I would really appreciate the help!0
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If one is insulin-resistant AT ALL one must consider glycaemic control.I think we're putting the cart before the horse a little here. Glycaemic control is not necessary unless one is prediabetic or diabetic.
And how was your glycaemic control prior to when your weight-loss started to manifest? And what methodology were you using to test glycaemic control?Like I mentioned previously, I have insulin resistance, and I do little to control my carb intake besides choose more whole sources. I have successfully managed to reverse my prediabetic condition by doing so (with the addition of weight training, it must be said). I've always averaged around 200g of carbs a day, and managed to lose over 100lbs doing so.
The problem here is many people can be pre-diabetic and even diabetic without having it show on a fasting blood glucose, which is often the tests done to determine if glycaemic problems exist - whether in someone with PCOS or someone simply overweight. This is the standard in both the US and Canada currently - if fasting tests are elevated, then an HbA1c test is done to determine a better picture of overall glycaemic control.
The problem with this methodology is that the fasting serum glucose levels are often the LAST symptom to manifest with diabetes. Unless a person is getting regular HbA1c tests (roughly every three months) and/or doing post-prandial meter test (at at least two intervals, NOT just at the two hour mark) there is no way to accurately know if they have issues with glycaemic control.
You're making the assumption that people only have diabetes or pre-diabetes if diagnosed with it - And the problem comes in that many people DO have it without a diagnosis, even when under a physician's care. I've seen this numerous times now, including in PCOS women.
I hope I've clarified what I'm specifically talking about. And that's the assumption that just because someone isn't diagnosed with diabetes doesn't mean they don't have it, or at least the glycaemic control of someone with it.Whilst a VLCD/KD has been shown to work in polycystic women with IR, so too has the more conventional approach of calorie-control. It's really all down to how you feel on a specific diet and how much effort you will put into it.
I won't address the rest of what you said until that is cleared up, because otherwise we're talking through elbows about a different subject. Are you specifically talking about women with PCOS and diabetes?
Out of curiousity, WHERE do you get the idea a VLCKD is considered "extreme" glycaemic control? It's really not. It was the standard of care for 200 years and likely should still be. . .ETA: I should specify that such extreme glycaemic control is not necessary. In general, even otherwise healthy individuals, would benefit from some degree of glycaemic control - stabilising their blood sugar levels with more whole sources of carbohydrate.0 -
If one is insulin-resistant AT ALL one must consider glycaemic control.
Why do you say that? I'm very interested in your reasoning for such an absolutist stance.
ETA: I should point out that this question is with consideration that your definition of glycaemic control seems to be limited to low-carb/ketogenic diets.
In response to the other part, most recently I had my A1C levels tested when undergoing DDX for something that turned out to be gallstones/acute pancreatitis due to gallstones. I'd lost a lot of weight prior to that (and it was worse, uncontrolled basically, when I was unable to eat because it would result in pain) but the initial non-near-starvation weight loss was due to a calorie-controlled diet (at this point, carb heavy) and resistance exercise.
I'd had FPG and A1C tests before to test for prediabetes when diagnosed with PCOS, too.
I'm most certainly not making the assumption that prediabetes or diabetes are only in existence if you're diagnosed with it. In fact I've said in several ketogenic threads that I'm not a fan of invoking ketosis without supervision because diabetes is so very commonly undiagnosed, and DKA is nothing to play around with - however uncommon.
I see this a lot with proponents of low-carb diets, not to be offensive, but jumping straight to an extremely restrictive diet - which it is - is counter-intuitive to a healthy lifestyle. My mode of thinking is that you want to accomplish your goals utilising as wide a variety and as much food as is possible. Not just from a sanity and satiety point of view, but from a nutritive point of view. Unless you have to restrict a food group - and you most certainly do not by simply having PCOS - then you shouldn't.0 -
If you are insulin-resistant, you will - by it's very nature - have elevated post-prandial blood glucose levels when eating carbohydrate. There is no escaping this very-basic biochemical fact. As such, you must consider some method of control - and dietary control is by-far the simplest and safest.
Why do you say that? I'm very interested in your reasoning for such an absolutist stance.If one is insulin-resistant AT ALL one must consider glycaemic control.
First, let me address something: It is opinion that this diet is "extremely restrictive". I've been on it for 40 months now and do not find it so. There are thousands of people on MFP alone who wouldn't declare it so. It's obvious what you think of it, but it's your opinion, not fact. Sure, there's other MFP users that also think it's restrictive - but again, that's their opinion. I don't share your opinion - that doesn't make you correct.I see this a lot with proponents of low-carb diets, not to be offensive, but jumping straight to an extremely restrictive diet - which it is - is counter-intuitive to a healthy lifestyle. My mode of thinking is that you want to accomplish your goals utilising as wide a variety and as much food as is possible. Not just from a sanity and satiety point of view, but from a nutritive point of view. Unless you have to restrict a food group - and you most certainly do not by simply having PCOS - then you shouldn't.
Whether or not the diet is "restrictive" at all is up to each individual's interpretation of it. FYI while ketogenic I eat things like chocolate, cheesecake, ice cream, cake, and more and stay in ketosis. How is this remotely restrictive?
From a nutritive standpoint ... A ketogenic diet - done properly - is every bit as nutritious as any other diet - done properly. We eat an abundance of fresh vegetables, and most of us eat at least a little fruit (although there is no nutritive need when eating vegetables). We get important nutrients from meat, dairy, fruit, nuts, vegetables, oils and more. Most of us also (because we're health-conscious) take other supplements.
Again, you have very strong opinions, but they are only that.0 -
Actually, there is no conflicting research on whether a VLCKD helps PCOS suffers. All currently-available research concludes it does.Weight loss results in controlling PCOS, exercise results in controlling PCOS. Whether a low carb diet will help with the insulin resistance itself is up for debate and probably research (lots of conflicting info out there, most drs do not demand a low carb diet for this).
FYI physicians don't "demand it" for the simple reason that it's not currently an established primary-care protocol for PCOS. Just like a VLCKD diet is not yet an established primary-care protocol for diabetes mellitus. Though in both cases the research is clear that they are beneficial - and any physician that cares to invest the time to research the diet will come to the same conclusion. The problem is that unlike my own case (I work in research - and was on disability when I did my own research), most don't have the time.
My medical school spent about 25 hours on nutrition, and most still teach the prevailing wisdom of the lipid-hypothesis and diet-heart hypothesis ... Even though no research has ever proven either hypothesis, and considerable research concludes the opposite.
Thank you, Beefy. You are an awesome person for the research you've done and your efforts to help people understand.
Note from the "front lines" regarding what doctors do and don't do in the face of PCOS -- most of them are painfully ignorant of PCOS and its nuances. Far too many will simply prescribe Metformin (in some cases without a blood test and even with tests that indicate good insulin sensitivity) and the Pill and basically tell the patient "good luck." That is, of course, assumes the doctor even knows to test for PCOS and doesn't just say "oh, you're overweight because you're lazy, your periods are gone because you're too fat, and you're not losing weight because you're not trying hard enough." I kid you not, I had two doctors tell me that, including the one who had previously been the one to diagnose me in the first place!0 -
What works for women with PCOS is low carb, higher fat, and moderate protein diet. Have reversed all symptoms with this diet. While monitoring calorie intake is important, a PCOS patient has to consider macronutrients as well. What works for normal women will NOT usually work for those with this condition.
Also, I recommend weight lifting.
Weight loss happens at a calorie deficit. PCOS or insulin resistance does not make one an alien:
calories burned > calories in means weight loss
It is impossible to not lose weight when at a deficit, regardless of whether you are eating 50% carbs or 20% carbs, PCOS or not.
Weight loss results in controlling PCOS, exercise results in controlling PCOS. Whether a low carb diet will help with the insulin resistance itself is up for debate and probably research (lots of conflicting info out there, most drs do not demand a low carb diet for this).
This is actually not true. Having IR makes it extremely difficult to lose weight. I have it myself and my endocrinologist has told me time after time that I most likely will not lose much weight unless I am eating 500-800 calories a day. Which is something he would never recommend for me because I only have 40 lbs to lose.
He is right. I didn't lose weight eating 1200 calories and I didn't lose weight eating 1750-1840 calories (recommended for my weight/height). The only time I lose weight is when I am eating less than 800 calories a day due to being sick and unable to tolerate much food.
Well, this may not be true for *your* individual situation, FatFreeFrolic. Generally, PCOS + IR women don't require such severe calorie restriction to see weight loss. It sounds like you have a pretty serious degree of insulin resistance, and I definitely do not envy you. Sub-800 calories has gotta be really, really tough. I'm sorry to hear that you are dealing with this.
I noticed I had to drop my calorie intake lower and lower and lower to lose weight and I had difficulty functioning below 1100 cals/day (sustained). I had really great results when I added both steady state and then HIIT cardio. We're talking 1-3 hr workouts 3-4x week at a moderate-to-high intensity (as close to my anaerobic threshold (AT) as I could bear - I was working on endurance). I could eat more (not a ton) *and* was seeing weight loss. I had to be careful with nutrient timing before/during/after exercise to avoid extreme blood glucose peaks/troughs, but it helped me get back to eating more calories (for me, 1500 on average) and not feeling like a zombie. Something to consider if you are looking for options that might help you "escape" the hell that is <800 cal/day. (I know it might not work as well for everybody, but I thought I'd share.) Good luck!!!
Edited to add who I was primarily addressing. Sorry.
I think you're kind of actually on the same page as her, but using a different approach. Hyperinsulinemia keeps the body from utilizing fat stores. The key to losing weight in that circumstance is to force the insulin levels down, one way or another. The most "obvious" way is to reduce food intake. Of course, for anyone with hyperinsulinemia, this would require reducing to concentration camp levels, particularly at the usual, rather insane USDA macronutrient recommendations.
The other ways include low-carb, high-fat diets, your method of nutrient timing, and Metformin, among other things.
I had to go the medicine route, and will probably need it until I can drop my carbs low enough to lose weight without it. As it stands, just to maintain, I can't really have much more than 100g, because I'm like the person you responded to -- the only way I could get results was from dropping calories to sub-800, and that wasn't anywhere near enough to support the intense workouts 5 days a week I was doing.
My fasting insulin was 18. LabCorp's cutoff is 25. My hbA1C was 5.4. The cutoff is 5.6. So I wasn't even high enough to raise the suspicions of the less-informed doctors that I ended up dumping.0 -
If you are insulin-resistant, you will - by it's very nature - have elevated post-prandial blood glucose levels when eating carbohydrate. There is no escaping this very-basic biochemical fact. As such, you must consider some method of control - and dietary control is by-far the simplest and safest.
I just wrote out a fairly comprehensive response, but then my internet decided to drop out when I posted... and MFP doesn't save what has been typed. Too bad I can't remember it word-for-word.
As I said earlier in the thread, unrefined carbs with PCOS & IR also help maintain healthy levels of blood glucose - and is something that would benefit all people, not just women with PCOS. One does not have to go ketogenic or low-carb to accomplish unmonitored and unintuitive glycaemic control, particularly with IR.
Elevated blood glucose, full stop, is not a bad thing (notice you didn't quantify how elevated blood glucose must be before it is considered detrimental). It happens to everyone. Being insulin-resistant simply means your body doesn't respond as quickly to elevated blood glucose as a healthy individual's would, and that's why "slow carbs" that elevate your blood glucose slowly are recommended to combat this.
As insulin sensitivity improves, you can have more refined versions if you prefer to (though you'll probably find that the unrefined versions taste much better).
Before low-carb became the de-facto diet for PCOS, there was Low-GI... and it worked perfectly well with a calorie-controlled diet and exercise. I was actually turned onto a low-GI diet by a (BDA registered) dietitian who specialises in hormonal conditions here in the UK.
As to my opinion, yes... it's opinion. It's also your opinion that VLCD/KD is "best" or "superior" for PCOS sufferers. It is by no means fact, and shouldn't be touted as such... and I still hold the opinion that women with this condition (in fact, all people) should attempt to accomplish their goals eating as much and as varied a diet as possible, and remove food groups only when necessary.0 -
Just wanted to say thank you to the posters in this thread, your ideas have been incredibly informative to me. I really would love to find out if I'm insulin resistant but my GP refuses to run any tests 'because I'm a normal weight and clearly don't have as much of a problem as other pcos patients' :grumble: as such I try to keep my carbs under 100g a day, I personally find it quite hard, since I don't really like fatty products too much, but the scale did move a bit in the last month, so going to keep it up longer before deciding whether to stick with it.0
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Any serum glucose elevation above 140mg/dl or 7.8mmol/L is causing damage to the body, period. Even for a short period of time. This is universally-accepted by virtually everyone in medicine. It's the standard of care for the AACE - the American Association of Endocrinologists to maintain serum glucose levels below this at all times.Elevated blood glucose, full stop, is not a bad thing (notice you didn't quantify how elevated blood glucose must be before it is considered detrimental).
It's because it doesn't respond as quickly that damage can occur. It not only "doesn't respond quickly" but IR people also become hyperinsulinemic - because there is additional insulin released to try to deal with the glucose elevation.It happens to everyone. Being insulin-resistant simply means your body doesn't respond as quickly to elevated blood glucose as a healthy individual's would, and that's why "slow carbs" that elevate your blood glucose slowly are recommended to combat this.
As for "slow carbs" ... *IF* you can eat in a way that slows the digestion of carbohydrate to the point where you can keep all post-prandials under 7.8mmol/L (140mg/dl for my US friends) then sure, that's great.... If however you're creeping above that, you're damaging your body - but for a LONGER time period now due to the slower-digestion/absorption and longer periods of elevation. And unless you're testing at multiple intervals per hour, you have NO idea if this is happening or not.
It worked well in some cases, but not every case.Before low-carb became the de-facto diet for PCOS, there was Low-GI... and it worked perfectly well with a calorie-controlled diet and exercise.
Actually, research concludes it is a superior diet. Both individual RCT's and meta-analysis of different kinds of trials. And that is a fact.As to my opinion, yes... it's opinion. It's also your opinion that VLCD/KD is "best" or "superior" for PCOS sufferers. It is by no means fact, and shouldn't be touted as such...
Well, research disagrees with you. Research shows it's actually better to adopt a VLCKD first to control serum glucose and prevent damage, then lose weight (especially visceral bodyfat) through reduced calories and exercise, and THEN start reintroducing carbohydrate to a level that's well-tolerated by the body. And that is starting to become the worldwide standard of care - albeit slowly.and I still hold the opinion that women with this condition (in fact, all people) should attempt to accomplish their goals eating as much and as varied a diet as possible, and remove food groups only when necessary.
And BTW, never - at any time - have I suggested removing food groups. As mentioned, I occasionally eat grains (I'll have the odd piece of sprouted-grain or sourdough toast with butter, peanut-butter and no-sugar-added jam), I'll eat small pieces of cake, ice cream, chocolate, whatever ... as long as the serving size doesn't spike my blood glucose, AND it fits into my daily macronutrient profile. It's rather close-minded to think you have to completely eliminate these things in order to stay ketogenic.0 -
and I still hold the opinion that women with this condition (in fact, all people) should attempt to accomplish their goals eating as much and as varied a diet as possible, and remove food groups only when necessary.
Well, research disagrees with you.
Hmm, my endocrinologist is also a professor in a well known university. When I asked about a low carb diet for insulin resistance, she rolled her eyes and said something about stop googling and jumping to conclusions. When I asked whether the individual numbers, insulin resistance results etc needed anything to be done, the answer was that as long as you are exercising, have a normal weight, and hBA1C tests come back fine, change nothing.
I had several times consulted with the dieticians in the hospital for diabetes control (know some personally) and their nutrition plans never restricted carbs, or anything else. Restrict (but not eliminate) sugar, yes, distribute carbs throughout the day, yes, go to extremes never.
This is a quote from the nhs official site (http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Living-with.aspx):
"It is not true that if you have diabetes you will need to eat a special diet. You should eat a healthy diet high in fibre, fruit and vegetables and low in fat, salt and sugar."
Possibly some people need avoiding entire food groups, after all low carb, or low fat or low whatever exist for a reason. But claiming to have found the magic diet that everyone needs to follow, without even knowing the person's medical history, I do not get it. I have seen many people preach about the benefits of X or Y restrictions to control or even better prevent certain medical issues. I have never seen the actual research (as in advocated by the appropriate medical organisations, not by blogs, individual drs etc) supporting such views as universal cures.0 -
The problem for most is that the consumption of carbs is completely out of balance with level of activity. When the average consumption is 300g and sadly most of it comes from processed carbs, therefore the glucose gets in our blood faster and in higher quantity in our blood than vegetables. High levels of glucose are toxic and the body must use it for energy fast. You just need a small amount to be stored in the liver and muscles. LCarbers don't remove a food group, they just eat carbs in a smaller quantity as their main source is vegetables/ fruits and nuts. It can go up to 100 and for other reasons than weight loss under 50g. It is easy to drink 20 0z oz soda but more challenging when eating the same amount through nine cups of strawberries. What do you think? *
PCOS is due to a hormonal imbalance and yes people see results with LC (research estrogen)
Now re:diabetes. What's the name of your professor? Which university? Type 2 diabetes is a direct result of Western diet effect on insulin. There is no way around that. So take care when you spread misinformation.
Now LCarbing can be achieved through many ways:
IF
Ketogenic Diet
Carb Cycling.
My favorite is Ketogenic Diet. My hormone cannot be any happier, my fat cells are shrinking, blood results great and bonus: weight loss, clear skin, mental clarity, zen attitude, no cravings, hungry for nutritious things only and my muscles are preserved (moderate gym goer) and tons of energy.
Edit: *0 -
Now Re: weightlifting
Apologies as I did not go through all the posts before. Just one expression got my attention.
Just we are on the same page. Weight lifting in Keto is not about muscle growth but hormone balance (test and hormone growth) and maintaining LBM. It takes the same effort to maintain and to grow. Now if you are interested in growing a carb reefed is necessary once a week (I think?). What do the bodybuilders think?0 -
To the original poster, I suggest you get tested and remove all the conjecture. I was diagnosed years ago and my doctor at the time also had PCOS so she was very informed on the subject. Insulin resistance was also determined in my case, and one of components of my treatment was her suggestion to read "the insulin-resistance diet". Basically it teaches you how to balance your carbs with protein.
Bottom line, don't be scared - get tested, find out exactly what you are dealing with and go from there. You may or may not be insulin resistant. You won't know how to properly deal with this issue until you get tested and find out all the facts that are specific to you. Good luck!0 -
Any serum glucose elevation above 140mg/dl or 7.8mmol/L is causing damage to the body, period. Even for a short period of time. This is universally-accepted by virtually everyone in medicine. It's the standard of care for the AACE - the American Association of Endocrinologists to maintain serum glucose levels below this at all times.Elevated blood glucose, full stop, is not a bad thing (notice you didn't quantify how elevated blood glucose must be before it is considered detrimental).
More than 7.8mmol/L two hours postprandial is likely prediabetes.
Prediabetes and IR don't go hand-in-hand, though IR is a risk factor and a symptom of it. Chronic levels of blood glucose above 7.8mmol/L is damaging to organs. Peaks and troughs, even for sustained periods [read: hours], of blood glucose levels are completely normal. Like I said, it happens to everyone.
There is no need to be so alarmist. You do not have to diligently monitor or control your blood glucose with IR. You simply need to have a healthy diet and lifestyle.Actually, research concludes it is a superior diet.
I would like to see this research, because in my near 10-years of researching the condition I suffer from, I have never once seen a peer-reviewed study specifically targeting research on women with PCOS stating that a keto or low-carb diet is the best choice. (In fact, there have been studies that specifically say there is no clear one-size-fits-all dietary recommendation other than to assume a healthy lifestyle: http://www.andjrnl.org/article/S2212-2672(12)01925-9/abstract and http://humupd.oxfordjournals.org/content/19/5/432.short?rss=1)
I have seen studies that say keto/low-carb is best for people with diabetes, perhaps even to quickly reverse IR. Not for PCOS as an all-encompassing condition. So I'd be very interested to see what you've found that says otherwise.0
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