Welcome to The PCOS Nutrition Center Blog!
If you have PCOS & are looking to shed pounds, get pregnant, prevent diabetes or eat healthier, this blog is for you! Here you'll find a collection of blog posts about nutrition & PCOS that include breaking PCOS news & commentary, delicious recipes, supplements & nutrition & health tips. All entries are written by registered dietitians who specialize in PCOS & are science-based.
Keep in mind
The purpose of the PCOS Nutrition Center Blog is for education. The information included on the site is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider before altering your diet, changing your exercise regimen, starting any new treatment or making changes to existing treatment. The opinions of the bloggers are their own. To read our Disclosure Policy, click here.
Recipe and photo from, The PCOS Nutrrition Center Cookbook
Cauliflower Crust Pizza
If pizza normally leaves you feeling like you overindulged, you'll love this version with a crispy cauliflower crust. Over 100% of the recommended amounts for vitamins A and C are found in one serving of this tasty pie. Recipe from The PCOS Nutrition Center Cookbook: 100 Easy and Delicious Whole Food Recipes to Beat PCOS.
The Power of Sweat: How Short Bouts of Vigorous Exercise Can Improve PCOS
After I was diagnosed with PCOS in 2005, one of the first suggestions my doctor offered was to start exercising. I was glad that my doctor didn't solely rely on medication to treat my PCOS and that she thought lifestyle modification was an important part of my treatment plan. However, I was disappointed by the lack of good information on what exercise was best for PCOS.
Fortunately, recent medical studies have uncovered some valuable insights on what types of exercise can be used to help fight PCOS. A study conducted by the University of California San Francisco discovered that intense workouts may be better for managing PCOS than moderate exercise.
Breastfeeding and PCOS: Maximizing Success
I'll never forget the moment when I first learned that women with PCOS may have a difficult time breastfeeding. I had just given birth after days of labor only to have an emergency c-section. As soon as I was transferred to a hospital room, Terri, the hospital lactation consultant burst through the door. With her were piles of handouts and a contraption I had never laid eyes on before: a hospital grade breast pump. Immediately, Terri started telling me that because I have PCOS, I may experience a problem with breastfeeding. One way to minimize any risk was to start pumping milk-NOW!
What?! This was my tired and surprised response. See, at the time I gave birth I was halfway done researching PCOS for my first book, PCOS: The Dietitian's Guide. I had never encountered any information relating to PCOS and breastfeeding. That is until I met Terri. I knew that I wanted to breastfeed my baby even before I was pregnant and at that moment I faced the devastating thought of never being able to have that experience.
Our Best Posts of 2014
What a busy year 2015 has been for us! We've moved offices, published a PCOS Cookbook (now in print and ebook versions!), and presented at the PCOS Challenge Awareness Symposium.
We have a lot in store for the new year including a new program for women with PCOS, more recipes, a PCOS conference, and more science-based research on nutrition for PCOS.
Best wishes for a healthy and happy New Year!
PCOS And Non-Alcoholic Fatty Liver Disease (NAFLD): Treatment And Prevention
If you have PCOS and have been told by your doctor that you have a fatty liver, you aren't alone. Non-alcoholic fatty liver disease (NAFLD), commonly referred to as fatty liver, is highly prevalent in women with PCOS, affecting 15% to 55% of women depending on the diagnostic criteria used. NAFLD occurs as a result of excess triglycerides (fat) stored in the liver which causes inflammation and damage to liver cells. The liver isn't meant to store fat; its role is to serve as the detox organ for the body filtering out harmful substances.
NAFLD is a silent condition. Most women with PCOS won't know that they have it until getting blood results. Having fatty liver or NAFLD increases the risk of cardiovascular disease. If not treated, NAFLD can progress to more advanced stages of liver damage.
Boost Your Fertility Naturally
You have more control over your fertility than you think! While there's a lot of focus on eating well during pregnancy and your diet and lifestyle before you conceive can be just as important--not just for conception but for your child's future health too. Factors that can affect fertility include age, body weight, diet, tobacco smoke, stress, alcohol, exercise, chemicals in the environment, medications, and street drugs. And we're not just talking for moms here-—dad's diet and lifestyle count too.
Five Things Women with PCOS Should Know about FODMAPs
Over 40 million Americans have irritable bowel syndrome (IBS), and women with PCOS have more than their share. Symptoms of irritable bowel syndrome include excess gas, bloating, abdominal pain, diarrhea and/or constipation. If your doctor says you have IBS, you might want to consider the FODMAP approach to managing your symptoms. This evidence-based diet can help up to 75% of IBS-sufferers get symptom relief.
It's Halloween: Your Sugar High is Calling!
"Gretchen, oh Gretchen! It's Halloween, come on, I'm so tiny, just eat me. You deserve a treat. I'm only here once a year." Sound familiar when you substitute your own name?
A few M&Ms, an itty-bitty Butterfinger, those adorable little packets of candy corn, or whatever form of cheap sugar it is that you favor are probably calling your name – LOUDLY – right about now. If you haven't already succumbed repeatedly to the bowls scattered throughout many offices, or sneaking some out of the stash you intend to distribute tonight, or if you didn't full-on snag an entire bag of your favorites for yourself, which is even now lurking in your desk drawer. I know the drill. You've got that guilty laugh, don't you?
Introducing Ovasitol: The First and Only Combined Myo and D-Chiro Inositol Supplement in the U.S.
If you've been following our blog posts, webinars, or have been a nutrition coaching patient of ours, you know what a fan we are of inositol for managing cravings, improving fertility and insulin resistance in PCOS. Inositol is a nutrient found in fruits, beans, grains, and nuts and is also made by the body. While there are nine forms of inositol, MYO and d-chiro-inositol (DCI) types have been well studied in women with PCOS, both showing good results.
Combination of Myo-inositol and D-chiro-inositol: A First-Line Treatment for PCOS
Inositol is a member of the B-vitamins and a component of the cell membrane. Inositol is found in fruits, beans, grains, and nuts and is also made by the body. While there are nine forms of inositol, myo (MYO) and d-chiro-inositol (DCI) types have been well studied in women with PCOS, both showing good results. Angela Grassi, MS, RDN, registered dietitian and founder of the PCOS Nutrition Center, used the MYO supplement Pregnitude for over a year and blogged about her positive experience with it. Our patients who take MYO have seen a reduction in cravings and menstrual cycle regularity.
Berberine and PCOS: What to Know
Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder affecting approximately 8% of women of reproductive age. We all know about the variety of risk factors that have been associated with PCOS, including obesity, glucose intolerance, and dyslipidemia, which leads to a significantly increased risk for type 2 diabetes mellitus and cardiovascular disease. Insulin resistance is known to play a critical role in the pathophysiology of PCOS. Most individuals with PCOS are prescribed metformin as a form of insulin sensitizer for many metabolic and reproductive dysregulations. Currently researchers are looking at the benefits of berberine on fertility and insulin sensitivity in women with PCOS.
Highlights from the PCOS Awareness Symposium 2014
As I drove over the bridge to Lake Lanier Islands Resort just outside of Atlanta, I could feel the positive energy coming from the symposium. A pristine and tranquil location, it was the perfect meeting place for hundreds of women with PCOS to connect, learn and get empowered from PCOS experts.
Strawberry Coconut Breakfast Quinoa
For a new go to hot cereal, try quinoa for breakfast. This versatile and high protein whole grain provides a satisfying meal in the morning. The combination of coconut, maple, and strawberries makes this a creamy sweet dish.
Best Beverages for PCOS
Bored of drinking just water? Looking for a little flavor but without the calories and sugar? The Institute of Medicine recommends most adult women need an average of 9 cups of fluid each day. As with food, not all beverages are created equal, for taste and especially health. Here's our picks for the best beverages to drink if you have PCOS.
Mini Quinoa Kale Quiches
This recipe is our cookbook contest winner and is featured in The PCOS Nutrition Center Cookbook! We chose it because of its taste, creativity, ease, and versatility-these mini quiches can be a healthy snack, small breakfast when paired with fruit, an appetizer, or a side dish. Thanks to Maiah Miller for her submission.
View recipe and our interview with Miah Miller here
PCOS and Pregnancy: Preventing Gestational Diabetes
Pregnancy is an exciting time, especially because so many women with PCOS have been trying to conceive for years. Having PCOS and being pregnant, however, poses additional risks for women with the syndrome, especially for developing gestational diabetes mellitus (GDM), a condition of high glucose levels during pregnancy. Women with PCOS have an increased risk of developing GDM, regardless if they are overweight or not. Insulin levels significantly increase in the second and third trimesters of pregnancy as a normal part of pregnancy; the majority of women with PCOS already have high insulin levels.
Couscous Salad with Shrimp
This is what Anna Kavanagh had to say about her recipe submission: "This is the perfect salad for summertime when everyone else is eating potato salad. It's a tasty, healthier alternative to have at a cookout." We thought this was a great, easy dish which is why we chose it as our 2nd place winner.
Tower Garden Growing
The first time I saw a Tower Garden it was love at first sight. I was at a health seminar given by Dr. David Katz and behind him was a Tower filled with a bounty of fresh produce. It almost didn't seem real, the food looked that good. After finding out more about it and the convenience of growing fruits, vegetables and plants on a Tower Garden, I knew I had to have one.
The truth is I've wanted to grow my own food in a garden for years. Sure, I grow herbs each summer in pots and even tried out some small tomatoes (a lucky animal ate them before I even got to pick any), but I have been limited with how much I can grow due to space. The only area I have at my house to plant a garden with optimal sunlight is smack in the middle of my back yard where my kids play (good luck with any plants growing between various balls landing on them!) or on my front lawn. I also travel frequently in the summer and didn't want to have to bother my neighbors with the responsibility of watering my plants (a benefit of the Tower Garde is that water gets circulated continuously on a timer).
The Dirtiest and Cleanest Produce of 2014
For the past 10 years, the Environmental Working Group (EWG) has put out a list of the most pesticide-laden produce in the U.S. The list ranks 48 fruits and vegetables based on an analysis of 32,000 samples tested by the U.S. Department of Agriculture and the Food and Drug Administration. In the current list, 65 per cent of the samples tested positive for pesticide residues (this is after the samples were washed). Bad news for apple lovers: 99 per cent of apple samples tested positive for at least one pesticide residue.
Why am I so tired?
In today's fast-paced world, it's not uncommon for people to feel fatigued, and to chalk it up to simply working too many hours and sleeping too little. Women with PCOS may feel particularly more tired due to insulin resistance (resistant cells prevent glucose from supplying adequate energy). But what if you are not just tired but exhausted? All. The. Time. While minor lifestyle changes can boost your energy, sometimes there may be more serious underlying conditions that are draining you. Here are some surprising reasons you may be running on empty.
Spice up your eating: Cinnamon and PCOS
When you think of cinnamon, do you may think of foods like pumpkin bread, apple pie, spiced cider,
and pumpkin spice lattes? Well, recent research provides some welcome news: Cinnamon may help you better regulate your insulin levels and even lower your cholesterol.
The PCOS Nutrition Center Has Moved!
To meet the growing demands of our patients with PCOS, we have moved our offices! After 15 years on Lancaster Avenue in Haverford, Pennsylvania, we moved a mile away to Bryn Mawr. You can now find us at our new location 14 S. Bryn Mawr Avenue, Suite 204, Bryn Mawr, PA 19010.
The new office is conveniently located in the heart of Bryn Mawr, across the street from Ludington Library and between Bryn Mawr Hospital and Rt 30, next to PNC Bank. There is ample, free parking in front and back of the building. The building and office are handicap accessible. For directions, click here.
We look forward to seeing you!
PCOS Challenge Celebrates National Nutrition Month®
The current issue of the PCOS Challenge e-zine is dedicated to nutrition in honor of National Nutrition Month® and features articles and nutrition tips from dietitian nutritionists who work with PCOS. You can read the article I wrote titled 'PCOS Nutrition' which discusses how to best eat with PCOS, as well as my personal interview with PCOS Challenge founder, Sasha Ottey. Thanks Sasha for recognizing the importance of registered dietiitan nutritionists! You can read the complete issue here.
The 4 Best Supplements for Fertility
While no pill or drink can replace a healthy diet and lifestyle, emerging research has shown that taking certain dietary supplements can improve your fertility. Here's our list of the Top 4 dietary supplements women with PCOS should consider taking to improve their fertility.
Angela Grassi named one of 10 Incredible RDs Who Are Making a Difference by Today's Dietitian!
For the past five years Today's Dietitian has featured a Top 10 list of incredible registered dietitians that are making a difference and I am honored to have made the list this year for my work in PCOS (polycystic ovary syndrome)! You can read the full article about why they chose me here.
I'm often asked why I chose to work with women with PCOS and I'm quick to say that I have PCOS and like so many women, I was misdiagnosed even after seeing numerous doctors. Trusting my gut, I knew something was wrong when I blew up, gaining over 30 pounds out of the blue while exercising intensely and eating a healthy diet.
Coenzyme Q10 and Fertility
What is Coenzyme Q10
Conenzyme Q10, commonly referred to as simply CoQ10 is a vitamin-like compound and antioxidant which functions as a cofactor in numerous metabolic pathways, particularly in energy production (ATP for those of you that remember the Krebs Cycle). CoQ10 use is associated with reductions in blood pressure, cholesterol and pre-eclampsia. It has been demonstrated that CoQ10 can help with infertility in men and women by improving sperm and egg quality. CoQ10 may also boost energy and enhance the immune system, provide migraine relief and help with chronic fatigue syndrome. Taking a statin can deplete levels of CoQ10 requiring supplementation.
PCOS: Beyond Hormones and Hot Flashes
By, Angela Grassi, MS, RDN, LDN, founder of the PCOS Nutrition Center
One of the reasons I founded the PCOS Nutrition Center was to provide evidence-based nutrition information to dietitians, healthcare professionals and women with PCOS themselves. While PCOS in general is highly overlooked and under recognized, the condition has been largely ignored in women who are past the childbearing years. This is why I am so pleased to share an article I wrote in the February edition of Today's Dietitian titled 'PCOS in Aging Women: Beyond Hormones and Hot Flashes.'
In this article, I address how body composition and hormones change in women as they get older and how women with PCOS differ from non-PCOS women (you can read a previous blog post on the topic here). Most importantly, I call attention for the need for aggressive lifestyle intervention among women with this syndrome. While PCOS has largely been associated with infertility, constant high androgen and insulin exposure have lifelong consequences, which increase the risk of cardiovascular disease and diabetes.
Benefits of Resistance Training for Women with PCOS
Written by Lory Hayon RD,LDN,NASM-CPT
Many women avoid resistance or weight training, because they believe they will "bulk up" and therefore appear more masculine. Bulking-up is a true concern for women with Polycystic Ovary Syndrome (PCOS) because they already feel more masculine due to factors such as central obesity, infertility, male pattern hair growth and acne.
Resistance training, as defined by the American College of Sports Medicine (ACSM) "is a form of physical activity that is designed to improve muscular fitness by exercising a muscle or muscle group against an external resistance." Resistance training can help you burn more calories.
The external resistance, in weight training, may be weights, elastic bands, resistance machines and even one's own body weight. This external resistance stimulates skeletal muscle to react and adapt to the stressor. Adaptation is seen in the form of gained muscle strength, endurance or muscle size.
PCOS and Heart Health
Regardless if you are thin or not, women with PCOS have a higher rate of cardiovascular risk factors. These risks include elevated triglyceride (TG) levels (the blood storage form of fat), blood pressure, C-reactive protein (marker of inflammation and oxidative stress), total cholesterol and LDL cholesterol (the so-called "bad" type of cholesterol), and low levels of HDL (the "good" type of cholesterol that we should have high levels of). Studies show that as many as 70% of all women with PCOS have elevated levels of LDL cholesterol and low levels of HDL (1,2) both of which are strong predictors of cardiovascular disease.
Whether you have abnormal cholesterol levels or not, now is the time to take measures to improve your heart and your health. The following are some of the best ways to help your heart.
Water with Lemon, Please!
Drinking water with lemon shouldn't be reserved for just dining in restaurants. The juice from this yellow citrus fruit offers numerous health benefits from good digestion to cancer prevention. While not proven to accelerate fat loss (that's a myth) lemon juice is a healthy and low-calorie way to flavor drinks and food. Here are our top favorite benefits of lemon juice.
8 Surprisingly High GI Foods
Numerous studies have shown that women with PCOS who follow a low GI diet are able to improve their fertility, lower their insulin levels and improve other metabolic markers.
The glycemic index (GI), a numeric ranking of carbohydrates based on its influence to raise blood sugar after eating, is important for women with PCOS. Foods with a high GI break down quickly during digestion, causing a quick release of glucose into the bloodstream. This fast response results in excessive insulin production, contributing to weight gain and increasing diabetes risk.
In contrast, low GI foods contain carbohydrates that break down more slowly, resulting in a more gradual release of glucose into the bloodstream. The concept is for individuals to choose foods that have the lowest GI values in order to have less of a rise in glucose after eating, thus requiring less insulin to regulate blood sugar.
Should you Take a Multivitamin?
A recent report on mulitivitamins in the Annals of Internal Medicine grabbed the media's attention with its title 'Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements'. In this report, the authors concluded that based on the review of three trials, there was no clear evidence of a beneficial effect of supplements on all-cause mortality, cardiovascular disease, or cancer (1). Their message is this: "Most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided."
One of the most asked questions we hear from our patients at the PCOS Nutrition Center is whether or not women with PCOS should take a multivitamin, so I thought it would be helpful to write a blog post about the answer.
How to Eat for Better Fertility
Researchers know more than ever about the influence of nutrition on women's fertility. A healthy diet not only can improve the metabolic and reproductive factors associated with PCOS but egg development and ovulation too. Here are some clinically-proven ways to eat to improve your fertility and get your body ready to support a healthy pregnancy.
Angela Grassi, MS, RDN (left) & Judy Simon, MS, RD, CD
Food for Fertility: A Group Program for PCOS
I had the pleasure of interviewing Judy Simon, MS, RD,CD, CHES a dietitian and fertility nutrition expert at Mind-Body-Nutrition in Seattle, WA about her novel Food for Fertility Program. Judy is the chair of the American Society Reproductive Medicine (ASRM) NutriSig group and recently spoke at the Academy of Nutrition and Dietetics Food, Nutrition, Conference, and Expo (FNCE) with top fertility researcher, Dr. Jorge Chavarro, co-author of The Fertility Diet.
Judy created this 7 week program to help her patients who struggle with infertility by providing support, resources, and nutrition education to women. Most impressive is the group's zero drop-out rate, amount of women who got pregnant during the groups and the wonderful health improvements her participants experienced.
Click the image to view the video.
For more information or to enroll in Judy's Food for Fertility Program, visit www.mind-body-nutrition.com or call (425) 260-8783.
Fermented Foods: Top 5 Reasons to Eat Them
We are vigilant about germs. We sanitize our hands, sterilize our dishes, pasteurize food, and refrigerate and toss moldy or expired foods. But as it turns out, not all bacteria really is that bad for us. Our gut contains billions of helpful and harmful bacteria that we are exposed to even in utero. Antibiotics, essential for treating infections, affect the gut flora by destroying harmful and helpful bacteria. Genetics and environmental exposure can also alter our gut flora. The more beneficial bacteria we have, the healthier our bodies are which is why sales of probiotics are skyrocketing.
Why fermented foods?
Before refrigeration, fermenting food was a way people kept food from spoiling. Fermented foods are a natural way to improve and preserve a healthy gut flora. Fermented foods also have the ability to keep us healthy.
Interview with top PCOS researcher Dr. Lisa Moran
It was a thrill for me to interview Dr. Lisa Moran, BSc (Hons), BND, PhD, the leading diet and lifestyle researcher for PCOS. Dr. Moran is a dietitian and National Heart Foundation Research Fellow at The Robinson Institute, Discipline of Obstetrics and Gynecology and The University of Adelaide, Australia. She has written over 70 publications on PCOS.
I welcome you to watch the interview which discusses diet strategies, weight loss, exercise, and unique weight management challenges women with PCOS face.
Breaking PCOS and Infertility News From the American Society of Reproductive Medicine (ASRM) Conference
Excitement was in the air at the American Society of Reproductive Medicine (ASRM) conference which took place in Boston on October 12-16, as new research in PCOS and infertility was presented. Top experts in the fields of obstetrics, gynecology and reproductive medicine gathered from around the world to take part in this international conference that was shared with the International Federation of Fertility Societies (IFFS). Below are some highlights women with PCOS may be interested in.
Pregnitude Update Part II: Six month Follow Up
I've been taking the myo-inositol supplement Pregnitude (4 grams daily) for 6 months now. I first reported my experience and blood results in June after 3 months of using Pregnitude (you can read my post here). Back then I saw noticeable improvements in my HDL (the "good" cholesterol), hemoglobin a1C (Ha1C) and c-reactive protein (CRP) levels. I also reported how my hair was thicker than ever. These improvements were made with no change to my diet, medications, supplements or exercise.
Green Coffee Bean Extract and PCOS: We Spill the Beans
After Dr. Oz promoted its "magic" weight loss benefits on his show, millions of Americans were introduced to green coffee bean extract. And chances are, you've seen the ads, contests and promotions for green coffee bean extract targeting women with PCOS. We've received numerous requests from women asking us for our advice regarding the use of green coffee bean extract for helping with symptoms of PCOS, especially, if it causes weight loss. In this post, we spill the beans by examining the scientific evidence of green coffee bean extract for the management of PCOS.
Pesto: The Best Recipe & Tips
I first fell in love with pesto when I was backpacking in the Liguria section of Italy (just south of Genoa on the Mediterranean). As I was hiking between the towns of Cinque Terre, I spotted (and smelled!) someone eating linguini with pesto and I had to stop and try it. It was love at first bite! At least once a summer, I make a large batch of pesto out of the basil I grow and freeze it to use all year. I love pesto for both its health benefits and its versatility.
Swimming: More than a Workout
This picture was taken just moments before I dove into the pool. While I enjoy most forms of physical activity, swimming is my favorite. That's because it's so much more to me than a way to burn calories and stay healthy. Sure swimming works the entire body and offers numerous health benefits. It's also easy on the joints and best of all-you don't have to sweat.
But to me, swimming offers a chance to practice mindfulness, a way to be present in my body. When I swim laps, the only sounds I hear are that of my breath and the splashing of the water. No noise of kids whining or phones ringing. Play leads to creativity and when I swim, I am able to envision ideas and dream.
Is it Time to Dump your Scale?
How often do you check your weight? For my patient Hannah it was all the time. Like several times a day, every day. First thing in the morning after she went to the bathroom she would stand on her digital scale waiting to see what numbers would appear to tell her if it was going to be a good day or a bad one.
After she exercised, Hannah would get on the scale again to make sure nothing changed. Before reading her mail after work, she headed straight to the scale in her bathroom. One more time on the scale before bed too, just in case.
Hannah was being ruled by her scale. She couldn't trust anything she put in her mouth out of fear that it may make her gain weight. The scale limited her ability to make lifestyle changes that would improve her PCOS. In our nutrition counseling sessions together, Hannah made commitments that gradually limited the amount of time she spent on the scale, from once a day to once a week. Finally, she had enough of the scale controlling her life and took action: by throwing her scale away in her dumpster (see the picture above that she proudly texted to me).
Miss Philadelphia Opens Up about Having PCOS
by Angela Grassi, MS, RD, LDN
In April, at the age of 20, Francesca Ruscio, a woman with PCOS, was crowned Miss Philadelphia by blowing away judges (and her family) with her fantastic opera singing. When I first talked with Francesca before the pageant, she was bursting with energy and excitement at the potential opportunity to use her diagnosis of PCOS as a platform if crowned Miss Philadelphia. Now, several months after her big win, I sat down to talk with Francesca about what it's like to wear the crown and to be able to spread awareness of PCOS to a large audience and her upcoming Miss Pennsylvania competition.
Pregnitude: A First-Line Natural Treatment for all Women with PCOS
By Angela Grassi, MS, RD, LDN
Don't let the name of this product fool you: Pregnitude is a high-quality myo-inositol (MYO) supplement for all women with PCOS, not just those looking to get pregnant. Before I tell you why, I want to briefly discuss what MYO is and how it can improve PCOS.
What is Myo-Inositol?
A member of the B vitamins, MYO is believed to improve egg quality and acts as a secondary messenger involved in glucose utilization. It's believed that women with PCOS may have a defect in secondary messengers contributing to insulin resistance.
Acne: The Role of Dairy in the Nutrition Management for PCOS
Got acne? Don't get milk! This, according to new research published in the Journal of the Academy of Nutrition and Dietetics, showing a positive link between dairy consumption and acne (1). Acne is a common symptom of PCOS that can significantly affect quality of life in women of all ages.
The connection between dairy, androgens and insulin
In their review of 27 studies, researchers conclude frequent dairy intake as well as a high glycemic load diet (GL) contribute to acne. As the figure below shows (1), there are several ways dairy influences acne development:
1. Dairy ingestion can lead to increased insulin levels leading to increased cellular growth and acne.
2. Dairy products are carbohydrates which stimulate insulin growth factor 1 (IGF-1), resulting in high insulin levels. "Both skim and whole milk (but not cheese products) have a 3 to 6 fold higher glycemic-load compared with other carb foods". High insulin levels lead to increased androgens creating more sebum production.
3. Milk contains growth-stimulating hormones, including IGF-1 and dihydrotestosterone (DHT), which increases androgens resulting in higher sebum production and acne.
PCOS, Periods and Iron Loss
What are your periods like lately? While some women with PCOS may not experience a period at all, others may have several periods each month, prolonged bleeding, or heavy monthly flow. According to Dr. Shahab Minassian, Chief of Reproductive Endocrinology and Infertility at The Reading Hospital and Medical Center and IVF-Fertility Division of the Women's Clinic Ltd. in Reading, PA, women with PCOS can suffer from heavy uterine bleeding for numerous reasons. "Overgrowth of endometrial tissue inside the uterine cavity, which can cause heavy periods, is common. This overgrown tissue can also bleed irregularly causing dysfunctional uterine bleeding (D.U.B.)." Minassian adds "PCOS also puts patients at risk for endometrial polyps, which can also result from the overgrowth. These polyps can cause bleeding between periods as well as heavier flow during periods." Heavy bleeding associated with menstrual disturbances can increase a woman's risk for iron deficiency, or the more severe iron deficiency anemia.
New Name for PCOS? A Summary of the NIH Workshop on PCOS
The NIH Office of Disease Prevention held an important workshop on PCOS that took place December 4-5, 2012. Top researchers in PCOS from all over the world met for this 2 day workshop to present evidence-based information on PCOS and to clarify the following:
- The benefits and drawbacks of different diagnostic criteria
- The causes, predictors, and long-term consequences of PCOS
- Optimal prevention and treatment strategies
After the meeting concluded, an executive summary
was drafted. Here are some highlights from that summary and what it means for women with PCOS:
GMOs in Our Food: What you Need to Know and Why
I clearly remember the day I first learned about genetically modified food. I was sitting in on one of my nutrition classes and my professor was informing us that the U.S. had begun to genetically alter our food crops. This meant that we could have larger, perfect tomatoes. We could feed more people on less land. We could grow food all year round that was immune to drought and increasing climate change. What wasn't clear were safety concerns and what long-term effects were going to happen.
Now, 20 years later since the introduction of these foods, we know that GMOs impact our health. There are definite associations between consumption of GMO foods and the increases we are seeing in asthma, autism, allergies and sensitivities, skin eruptions, behavior problems and cancer (breast, prostate, colon). Yet, the USDA doesn't require safety studies for GMOs. An alarming new study shows that a variety of corn engineered by Monsanto has been linked to mammary tumors, kidney and liver damage and other serious illnesses in the first ever peer-reviewed, long-term animal study of GMO foods.
30 Interesting Facts About PCOS
1. Women with PCOS have higher rates of anxiety and depression than women without the syndrome.
2. Worldwide, PCOS affects 6% to 10% of women, making it the most common endocrinopathy in women of childbearing age.
3. Elevated insulin or insulin resistance are not part of the diagnostic criteria for PCOS but are seen in the majority of women with PCOS.
4. The diagnotic criteria for PCOS states that a women has PCOS if she has at least 2 of the following 3 criteria: a. Irregular or absent periods, b. blood tests or physical signs that show high androgens, c. Polycystic ovaries
5.The United States spends an estimated $4 billion annually to identify and manage PCOS.
6. Women with PCOS are at a higher risk of developing obstructive sleep apnea due to the influence of androgens affecting sleep receptors in the brain.
7. Women with PCOS can have monthly menstrual cycles and still have PCOS.
8. Despite its name, not all women with PCOS actually have cysts on their ovaries.
9. Characteristics of PCOS were first described in 1935 by researchers Stein and Leventhal.
10. There are at least 10 different phenotypes associated with PCOS.
Introducing PharmaNAC: A High Quality NAC Supplement
The antioxidant N-Acetyl-cysteine, also known as NAC, got some much deserved attention as a natural alternative to managing PCOS when a report published in the European Journal of Obstetrics, Gynecology and Reproductive Biology showed this derivative of the amino acid L-cysteine performed equally as well as metformin on improving weight, insulin, hirsutism, and irregular periods (if you missed our latest blog post about the benefits of NAC for PCOS you can read it here). Other added benefits of NAC include maintenance of good respiratory function, treatment of colds and to support a healthy immune system. I was surprised to learn that NAC is actually one of the highest selling over-the-counter supplements in Europe! That's why I am thrilled to introduce to you a great NAC product called PharmaNAC.
used with permission from USDA
What's Your Phenotype?
A phenotype is a unique set of characteristics based on your genetic makeup and influence of environmental factors. In a position paper published in Fertility and Sterility, the Androgen Excess and PCOS Society Task Force suggest that there at least 10 possible phenotypes of PCOS. The difference in phenotypes explains how the syndrome has so much variation in symptoms. For example, despite the core feature of PCOS being high levels of androgens, not all women with the syndrome have excess hair growth on their body while some women may have full-grown beards. Others have acne and some have none. Some women with PCOS are lean while others are overweight. A small percentage of women may have no symptoms of PCOS whatsoever. The classification of phenotypes also includes ovulation. The most difficult phenotype to treat may be the non-ovulatory hyperandrogenism group.
Rev Up Your Metabolism
Let's face the reality: The majority of us have sedentary jobs. Sitting all day in a chair does not help our waistlines and is hazardous to our health. A sedentary lifestyle is one of the main contributors to weight gain in America. A strong relationship exists between a lack of physical activity and increased levels of triglycerides, cholesterol, and overall, increased risk for heart disease. In an energizing closing session at The Weight Management Symposium which took place last month in Henderson, Nevada, Dr. Lenny Kravitz (yes, the Doctor) an Associate Professor of Exercise Science at The University of New Mexico, shared his tips with hundreds of dietitians on the best ways to increase metabolism and burn fat. Curious? I was too. Dr. Kravitz shared that one of the most effective ways to burn more calories and fat is by lifting weights.
What Happens to Women with PCOS as they Age?
Until recently, the focus on PCOS has been during the childbearing years as PCOS has been primarily viewed as a reproductive disorder. Questions about what happens when women with PCOS age have remained elusive. For example, does the syndrome get worse and if so, how worse? Or, does PCOS get better after menopause? Could PCOS simply disappear altogether? We now have the answers to some of these questions as researchers are now exploring what happens when women with PCOS transition through menopause. The news is good and not so good. Let's first start with the reproductive hormones.
What's Your Protein-To-Carb Ratio?
Do you have PCOS and been struggling to lose weight despite your dieting and exercise efforts? It could be your protein-to-carbohydrate ratio according to a study published in the American Society for Nutrition. During this 6-month trial, women with PCOS followed either a high protein diet consisting of 40% or more energy from protein and 30% fat versus a standard protein diet of less than 15% protein and 30% fat. Both groups received monthly dietary counseling and could eat as much food as they wanted with the guideline to reduce or avoid simple sugars. In addition, the high protein group was encouraged to eat whole grain bread products.
Should All Women with PCOS Eat Gluten-Free?
Are you thinking of changing your diet to one that's gluten-free? You're not alone. The number of gluten-free diet books and products available are exploding. Some gluten-free products claim to promote everything from better sleep, increased energy, weight loss and even thinner thighs and cleaner skin. Some gluten-free claims offer treatment for autism and rheumatoid arthritis. It's no surprise that the primary reason many buy gluten-free foods is a belief that they are viewed as healthier than other foods. Women with PCOS may particularly benefit from a gluten-free diet because the majority of the acceptable grains are low in glycemic index and won't spike insulin levels.
Wake Up! Time to Get More Z's
When was the last time you had a great night sleep? Are you too sleep-deprived to remember? Then this article is for you. Feeling tired is only one sign that you aren't getting enough sleep. The effects of sleep loss run deep; it can affect your long-term health and your weight. Sleep disturbances, including insufficient sleep, poor sleep quality, insomnia, and especially obstructive sleep apnea (OSA) , are considered independent risk factors for the development and worsening of insulin resistance. OSA has been found to be as much as 30 times higher in women with PCOS (click here for more info on OSA and PCOS). One study showed that just a 5-day period of sleep deprivation caused abnormal glucose tolerance and worsening insulin levels.
Obstructive Sleep Apnea and PCOS
Women with Polycystic Ovary Syndrome (PCOS) are at a higher risk for obstructive sleep apnea (OSA) according to findings presented at the 9th Annual Meeting of the Androgen Excess & PCOS Society. One report suggests PCOS women are 30 times more likely to have OSA (low slow wave activity, sleep loss, oxygen deficiency) than compared with controls.
OSA is an under recognized yet significant factor in the development of metabolic complications seen in women with PCOS. In fact, the more severe OSA, the higher prevalence of impaired glucose tolerance and high blood pressure. OSA contributes to weight gain and difficulties losing weight as it affects the sympathetic nervous system and hypothalamic adrenal axis.
Fish Oil Improves Mood
There's no question that women with PCOS suffer from more mood problems such as depression and anxiety than those without the syndrome. For some women, mood issues can be a result of dealing with all the problems PCOS brings: dramatic body image issues, fluctuations in blood sugar, loss of control over weight, difficulty managing the syndrome, infertility, and lack of support. Mood problems can also be brought on by hormone imbalances. There is some good news for the millions of women who struggle with mood problems: omega-3 fatty acids, particularly the kind that come from fish, may help manage mood.
Highlights from the Androgen Excess & PCOS Society's 9th Meeting
Last week, I had the pleasure of being one of 130 international experts in the field of PCOS who attended the Androgen Excess & PCOS Society's annual meeting in Orlando, Florida. Most years, this meeting does not take place in the U.S. The majority of PCOS experts in attendance were reproductive or pediatric endocrinologists, who treat patients and/or conduct research in the areas of androgen excess and PCOS. I was the only registered dietitian at the conference.
The pace of the conference was very quick, covering a total of 33 presentations in 10 hours. A Q & A session was held after every 3rd or 4th presentation followed by a brief discussion.
It was a very exciting day for several reasons. The first was that it was great to meet and put faces to the names of researchers whose studies I have read which has taught me so much about this syndrome. Secondly, it was thrilling to hear about the new research many of the physicians are conducting on PCOS for it is research that will give us more insight into treating this most complex endocrine disorder.
An Apple A Day Helps Keep The PCOS Away!
The cooler temperatures and the bright foliage are signals that Fall has arrived! This time of year is also about apples, making October National Apple Month. Did you know that there are 2,500 varieties of apples grown in the United States? Apples are a delicious and healthy fruit for women with PCOS. Here are some health benefits and fun facts about this crisp fruit.
Health Benefits of Apples
Apples are one of the most popular fruits around and with good reason: Apples are tasty, filling, portable, inexpensive and have a long shelf-life. One medium apple has only 80 calories and 5 grams of fiber. They are also a fat, sodium and cholesterol free food. Another benefit: Apples are a low glycemic index (GI) food -if you eat it with the skin on.
N-ACETYL CYSTEINE: A Natural Insulin-Sensitizer for PCOS?
New research shows women with PCOS who have insulin resistance may benefit from taking the nutritional supplement N-Acetyl Cysteine, also known as NAC.
NAC is both an antioxidant and amino acid (building blocks of protein). Specifially, NAC is a derivative of the amino acid L-cysteine, an essential precursor used by the body to produce glutathione. Glutathione is an extremely important and powerful antioxidant produced by the body to help protect against free radical damage, and is a critical factor in supporting a healthy immune system. NAC is widely sold in Europe as a treatment for the common cold and it has other numerous uses from being a treatment for bronchitis to removing heavy metals and environmental pollutants from the body. NAC has also been found to reduce inflammation, heart disease and most recently, insulin.
Used with permission from the American Dietetic Association.
Grocery Shopping Tips
Food shopping doesn't have to be a dreaded task. Use the tips below to select healthy and affordable food for an efficient and pleasurable grocery shopping experience.
Stick to the outer perimeter of the store.
This is where the protein-containing foods and fresh, unprocessed food like fruits and vegetables are located. Skip the middle isles as much as possible to avoid putting processed foods in your cart.
Don't shop when you're hungry.
It's totally true: when we're hungry our blood sugar gets low and everything looks great. Not only do you put more food in your cart, but you also end up spending more money. Try and shop soon after a meal whenever possible.
Look carefully at expiration dates.
Hate it when you get home from grocery shopping and find that one of the foods you just bought will expire the next day? When selecting a food product, look for one that has the longest expiration date of all the others on the shelf. This may require a bit of hunting through items but will ensure your food will be freshest the longest.
used with permission from the American Dietetic Association
The Power of Probiotics
Have you heard about probiotics? If not, you've probably seen it before: the TV commercial showing actress Jamie Lee Curtis enjoying Activia yogurt in beautiful settings across the globe. In the ad, Curtis remarks that she eats this yogurt daily for "digestive health". Yogurt, like some other dairy foods, is a probiotic or healthy bacteria, shown to have benefits on the digestive and immune systems. Interested? Here's what you need to know.
What are probiotics?
According to the World Health Organization and the Food and Agriculture Organization of the United Nations, probiotics are live microorganisms (microbes), which, when administered in adequate amounts, offer a health benefit on the host.
Our bodies naturally contain trillions of different microbes-over 100 trillion bacteria in our intestines alone. Some of these microorganisms are good and some not-so-good. Examples of microorganisms include bacteria, viruses, and yeast. Everyone has their own unique concentrations of microorganisms. Most probiotics are bacteria similar to those in our bodies. Friendly bacteria are important for proper maintenance of our immune system, for the digestion and absorption of food and protect us against bad bacteria that can cause disease. Probiotics assist the body's friendly bacteria to make it even more powerful.
Myo-Inositol Proves Better for Fertility than d-Chiro-Inositol
Inositol is a member of the B-vitamins and a component of the cell membrane. There are several forms of inositol with myo-inositol or d-chiro-inositol showing therapeutic value. The body converts d-chiro inositol from myo-inositol. There are many reasons women with PCOS may want to take this supplement as inositol has been linked to improved insulin, triglyceride and testosterone levels, as well as improved blood pressure, ovulation and weight loss.
PCOS & inositol
Only a handful of studies were conducted on myo and d-chiro-inositol and PCOS, all showing favorable results. It is believed that inositol increases the action of insulin in women with PCOS, thereby improving ovulation, decreasing testosterone, and lowering blood pressure and triglycerides. Another showed that myo-inositol may prevent gestational diabetes in PCOS women.
Cherries: The Sweet Way to Reduce Inflammation
Every year my family and I look forward to our vacation in Northern Michigan: long days, cool nights, clear blue water, and cherries. That's right, cherries! Traverse City, Michigan boasts itself as being the Cherry Capital of the World and it's no surprise. Situated on a peninsula at the 35th parallel, thousands of cherry trees grow fantastically well (along with wine grapes and peaches) with the optimal moisture, soil and temperatures from both the East and West Grand Traverse Bays. There is nothing like biking along the bay and stopping to pick and eat cherries.
According to the Cherry Marketing Institute, the average American eats about one pound of tart cherries each year(sweet cherries are the other type of cherries). The third week of July is when cherries are at their peak so run, don't walk, to your local grocery store or farmers market to enjoy the many nutrients and flavor of this sweet fruit while in season.
How to Make More Satisfying Meals
In a food rut or feeling blah about your food choices lately? You're not alone. Most people buy the same foods every week at the grocery store leaving the palate yearning for some fresh, new and tasty ideas. Here are some tips for making your meals more satisfying and enjoyable.
Shopping at your local Farmers' Market on a weekly or monthly basis gives you access to the freshest grown produce around. By eating what's in season you have an ability to expose your taste buds to a rainbow of nutrients, challenging you to expand the recipes in your personal cookbook.
Spice it up!
Don't be shy of adding flavor to your food. Spices, herbs, garlic and other seasonings add flavor and/or enhance the flavor of food. Grow some herbs in a pot, keep garlic on your staples list, and store dried herbs in your pantry for quick and effortless flavor.
No Tears Shed for PCOS: Polycystic Ovary Syndrome and Dry Eye
Looks like women with PCOS can add yet another symptom to an already long list of complications associated with PCOS: Dry Eye.
Dry eye is a common condition, affecting an estimated 9 million Americans. Typically, individuals with dry eye experience some or all of the following:
- vision problems
- burning or pain
- light sensitivity
- scratchy grainy sensation
- heavy or tired eyes
can make dry eye worse as they suck more moisture out of an already dry eye. Those with dry eyes know that the condition can affect the quality of life as dry eyes can impact your work and every aspect of your life. If not treated and managed, people with dry eyes can develop repeated eye infections that can eventually lead to scarring of your cornea and vision problems.
What the New American Food Icon Means for Women with PCOS
Say goodbye to the food guide pyramid and hello to MyPlate. Yesterday, the USDA announced the launch of the new food icon for Americans and it's a circle, not a triangle. MyPlate is a food icon with the intent to prompt consumers to think about building a healthy plate at meal times.
The new MyPlate icon emphasizes fruit, vegetable, grains, protein and dairy food groups (click on a particular food group on the plate for servings and suggestions) and provides the following recommendations:
- Enjoy your food, but eat less.
- avoid oversized portions.
Foods to Increase
- Make half your plate fruits and vegetables.
- Make at least half your grains whole grains.
- Switch to fat-free or low-fat (1%) milk.
Foods to Reduce
- Compare sodium in foods like soup, bread, and frozen meals • and choose the foods with lower numbers.
- Drink water instead of sugary drinks.
For more information about MyPlate visit www.ChooseMyPlate.gov.
Here are our pros and cons of this new icon and how it relates to PCOS:
Becoming a Critical Reader of Nutrition Information for Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder among women of reproductive age (more common than diabetes) yet so many women find themselves confused by the nutrition recommendations for the syndrome and don't know who to trust. Sometimes it seems as if every website out there for PCOS has conflicting nutrition information. Every doctor has a different opinion; every woman with the syndrome has their own views on what works or not and shares with others through social media outlets. Some individuals even try and make money off their unproven "theories" and try and sell products women with PCOS don't need.
As registered dietitians, sometimes we spend time in our nutrition counseling sessions for PCOS dispelling misinformation about diet for the syndrome and setting the record straight. These myths could be perceptions the client has acquired from health care providers, women with the syndrome themselves, family members or in most cases, the Internet. There's no question that media and Internet are the main sources where people get their nutrition information today. Unfortunately a lot of the information for PCOS is false and misleading and in some cases, dangerous.
It's Your Time!
I hope all the mother's and soon-to-be moms out there had a wonderful Mother's Day. Shouldn't Mother's Day be every day? Mothers have one of the hardest jobs in the world, if not the hardest. They also are caregivers and have a tendency to put their own needs behind those of others. One of these needs includes making their own health a priority. As one patient shares, "if a doctor told me my child needs blood work done, it would be done right away but for me, it would be done whenever I got around to it."
This week marks National Women's Health Week. The theme is "It's Your Time", encouraging women to make health a priority-now. The campaign empowers women to take steps to improve their physical and emotional health and reduce the risk of certain diseases. These steps include:
Why Weight Watchers May Not Be The Best Diet for PCOS
Unfortunately, by the time a lot of women come to The PCOS Nutrition Center, they have already tried (and failed) at least one diet. It's not uncommon to hear that many women with PCOS have a hard time losing weight on commercial diets, yet so many women continue to go back for more, failing one diet program and going on to the next one. Why do so many women with PCOS struggle to lose weight on these plans while their friends are dropping pounds on them? Commerical diet programs don't address the central cause of PCOS: insulin resistance.
Weight Watchers, perhaps the most popular commercial diet is one of these. We have had countless women in our office who have said that they have tried Weight Watchers but unlike their friends or family members who were also doing the diet, they weren't having much success at weight loss despite following the diet as prescribed.
There are several reasons why most women with PCOS won't have much success with the Weight Watchers diet:
New Metformin Warning: Mandatory Supplementation with Vitamin B12
Metformin, one of the most popular medications in the world, has been shown to cause a vitamin B12 deficiency. A vitamin B12 deficiency may be especially high among elderly individuals, persons who take a high dose of metformin and/or with long term treatment. A vitamin B12 deficiency is serious as it can cause permanent damage to the brain and nervous system. Here's what you need to know to avoid a vitamin B12 deficency if you take metformin.
Used with permission by the American Dietetic Association.
Have PCOS and Not losing weight? It could be your GI.
Do you have Polycystic Ovary Syndrome (PCOS) and are struggling to lose weight? You're not alone. As many as 80% of women with PCOS are overweight. The reason? High insulin levels, the central cause of PCOS. When insulin levels are high, it causes our bodies to store fat, usually in our bellies. Weight loss is difficult because it's hard to break down fat if your body is in fat storage mode. In order to lose weight, you have to lower your insulin levels. You can lower insulin by diet, exercise and insulin-lowering medications (metformin). If you have been taking insulin sensitizers and are exercising and watching your diet and still aren't seeing results it could be the types of foods you are eating.
Used with permission by the American Dietetic Association
Health Benefits of Eggs
Do you like eggs but aren't sure how they fit into the nutrition recommendations for PCOS? Well there is some good news: Eggs are a great diet component for women with PCOS. Not only are they are wonderful protein to include with meals and snacks but they are packed with nutrients that improve PCOS. Here's the scoop on what you need to know.
Eggs are a complete protein, which means it contains all the amino acids our body needs to maintain our muscles, eyes, nerves and tissues. The white of the egg contains most of this necessary protein. The egg yolk provides a good source of omega-3 fats, iron, folate, vitamins A, D, and E, thiamin, and choline. It is also in the yolk where you'll get lutein and zeaxanthin, important carotenoids for eye health including dry eye syndrome.
What the new 2010 Dietary Guidelines mean to Women with PCOS
Did you hear the U.S. Government came out with new diet guidelines? The newly released 2010 Dietary Guidelines for Americans (http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm) offer a practical roadmap to help people make changes in their eating plans to improve their health, according to the American Dietetic Association. Here are the highlights from these guidelines and what they mean for the health of women with polycystic ovary syndrome (PCOS).
Overall, the 2010 Dietary Guidelines are favorable for women with PCOS. The Dietary Guidelines encourage Americans to eat more:
- Whole grains
- Low-fat or fat-free milk, yogurt and cheese or fortified soy beverages
- Vegetable oils such as canola, corn, olive, peanut and soybean.
New Risks of Birth Control Medications in Teens with PCOS
Oral contraceptive pills (OCPs) have long been demonstrated as an effective treatment for Polycystic Ovary Syndrome (PCOS). Recognized for their ability to restore menstruation, OCPs can improve hormone levels, thus improving the unwanted side effects having too much testosterone can bring (acne, hair growth and thinning). Despite the benefits, a recent study indicates that OCPs should be used with caution in adolescents with PCOS. The reason? OCPs have been found to increase levels of C-reactive protein (CRP), a marker of inflammation and heart disease, in teens with PCOS. OCPs have also been shown to increase LDL cholesterol (the bad kind) in adolescents with PCOS. Elevated levels of triglycerides (the blood storage form of fat) and a possible increase insulin resistance have already been associated with use of OCPs.
These findings bring cause for concern because young women with PCOS are already at a higher risk for developing heart disease and are insulin resistant. High levels of insulin usually results in higher levels of triglycerides, commonly seen in PCOS. Because OCPs can not only raise triglycerides, but LDL and CRP levels, OCPs may not be the most effective treatment for teens with PCOS.
Quinoa: The Power Grain
Sure, you know the benefits of whole grains but did you know there are grains other than whole wheat? Quinoa, (pronounced KEEN-wa), is the powerhouse of grains and has quickly risen in popularity due to its excellent nutrition profile, texture and ease of use.
Quinoa seeds are small, flat and rounded, similar to that of sesame seeds. It has a nutty taste with a soft, crunchy texture. Quinoa provides all essential amino acids, making it a complete protein, and has approximately twice the protein as regular grains. Rich in B vitamins, vitamin A, magnesium, phosphorous, iron, fiber and calcium, this food is relatively high in unsaturated fat. Quinoa is technically not a grain but a fruit and is a great alternative to couscous or rice.