PCOS- What works?

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.

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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.

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.

I'm going to completely disagree with you here.

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.

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.

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 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.

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!

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.

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).

Actually, there is no conflicting research on whether a VLCKD helps PCOS suffers. All currently-available research concludes it does.

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!

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.

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).

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.

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.

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.

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.

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.

It worked well in some cases, but not every case.

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...

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.

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. 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 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.

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: *

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!