It’s been a while since my last blog post, and in the mean time, i have set up a podcast and moved a fair amount of my coaching online, which has taken up most of my time. If you’d like to listen (and hopefully learn) the link for the podcast is here.
In this article, i am going to delve into the realm of Polycystic ovary syndrome (or PCOS) for short. This is an endocrinological condition affecting between 6-21% of women (so it’s actually very common, if not the most common endocrine condition presenting in the female population) , with a greater prevalence in overweight or obese populations.
The condition is characterised by 3 things:
- Hyperandrogenism (increased levels of testosterone, leading to excess facial hair growth/hirsutism, acne)
- Polycystic ovaries, which can affect reproduction, ovulation and in some cases lead to infertility
- Oligo/anovulation – infrequent or no ovulation (egg production)
Increased insulin resistance is also a key metabolic symptom ( although not all individuals with PCOS echibit this) in addition to those mentioned before and can lead to increased risk of developing Type 2 diabetes and cardiovascular disease, as well as having an impact on the hirsutism or hair growth. This occurs as a result of an increase in androgens (testosterone) as a result of increasing and enzyme called 5-alpha reductase (i wont go into the details here as its complicated and pointless unless you have a good grasp of endocrinology already).
As a result of these effects, often mental health is affected leading to increased prevalence of anxiety and depression in this population.
For those women with PCOS, lifestyle change is a key aspect of the treatment pathway, with exercise, weight loss, improvements to nutrition and the resultant improvement in insulin sensitivity often having a pronounced, positive effect on symptoms.
Lets start with the Nutrition, then i’ll delve a bit into the supplements and exercise side of things, and ill finish talking a bit about the medications that can be used to help so that hopefully you can go away from this podcast feeling in a better position to manage your PCOS, or at the very least, ask the right questions that will enable you to get the help that you need.
The Nutrition side:
From a fundamental nutrition point of view, weight loss is almost certainly going to be beneficial if you are a PCOS sufferer and are overweight/obese. The challenge that is posed by having PCOS and trying to lose weigh is greater than normal as the condition can negatively impact your basal metabolic rate by up to 40% (max. observed). This doesn’t mean that everyone with PCOS will be affected to this degree, but it’s worth being aware of in the event that you are trying to lose weight and aren’t getting anywhere (More on this in a minute).
From a Food point of view, there are currently no set rules that we can follow, what we know so far is that Carbs and Fats are equivalent, neither is more beneficial that the other, and protein is either neutral or positively beneficial, with a low-GI (glycemic index) diet also potentially promising.
A couple of examples of Lower GI foods include certain fruits and veg, pulses, whole grain foods such as porridge oats.
It is likely beneficial to maintain a relatively high protein intake when trying to lose weight (irrespective of PCOS) to minimise muscle loss through the process, but additionally in PCOS there is some data to suggest that there may be increased protein oxidation, especially overnight, meaning that a higher intake is possibly beneficial to help further minimise muscle loss. This increased protein oxidation appears to be as a result of decreased metabolic flexibility (the ease with which the body can switch energy sources, i.e. from utilising fat to carbs to generate energy). Theoretically if we can improve our metabolic flexibility, we should be able to decrease the amount of protein used at night in favour of fats or carbs present in the body. We can achieve this by implementing some nutritonal strategies around our training such as a ‘train low (carb)’ approach or a ‘recover low’ approach, which will encourage the body to utilise more fat for energy during or after exercise. Things like fasted training for example, having low cab meals pre-bed, eating a lower CHO diet for a time, or periodising your carbohydrate intake will also have this effect. This may sound confusing, but this in reality is where having a coach comes into its own, to take the confusion away and plan anything like this in for you at the appropriate time.
That being said, its important to remember that the presentation of this condition will differ based on the individual, so blanket statements are rarely accurate across a population. There will (as with any diet) be a fair amount of trial and error once you begin the weight loss process or embark on a process of lifestyle change. Recording your progress, or lack thereof and any adjustments that you make will be beneficial long term to help inform positive decision making. Remember its a win or learn process, every step forwards or backwards teaches us something that can be used to positively inform our decision making as we progress. Lack of progress isn’t a sign to give up, but to adapt appropriately.
It’s also worth noting that if you are someone that has been trying to lose weight for years and has tried diet after diet with no luck, it may not be the best time to start trying to lose weight again. It can be a fairly psychologically demanding process. We want to achieve results that last, and that means starting from a good place and having a good understanding of your situation and how you can adjust to progress to end up with a positive experience this time and develop a good relationship with food along the way.
The whole process can me made more problematic by the potential for decreased BMR (basal metabolic rate) as this can make an already tough process harder still. If you are impacted by this, the effect is to have to reduce the amount of food that you need to eat to get a result, or compensate with a combination of lower intake and higher oputput (i.e. more exercise).
N.B. if you think of any questions as you’re reading, don’t forget that you can just e-mail me at email@example.com and ill get back to you.
Lets move on to supplementation:
There are several supplements that have been seen to have a positive impact on PCOS, and several of these also have a postive impact for the wider population as well (Vit D, Omega 3 for example). Listed below are the currently evidence backed supplements, along with a recommended start point if you wish to try them.
- Increasing omega 3 supplementation can be beneficial in PCOS, and has been seen to have beneficial effects regarding decreasing BP, lowering triglycerides and lever fat content. Aiming for 2-3G daily of EPA and DHA combined either through supplementation or eating more oily fish. If you happen to be vegetarian or vegan, an algae based supplement is also available to purchase with the same effect.
- Vitamin D supplementation is potentially beneficial, as low Vitamin D has been linked to increased prevalence of T2DM (type 2 diabetes mellitus) and decreased insulin sensitivity. Increasing vitamin D can help with improving insulin sensitivity, helping with depressive symptoms and improving immune function compared to a deficient state. Supplementing with 1000-2000 IU a day may be beneficial, but i would recommend discussing with a GP after getting your levels tested, as a lager dose may be required. I wouldn’t recommend going higher than 3000IU daily without a test. For reference, levels above 75nmol/L (30ng/ml) are what we are looking for here. Ideally this supplement is taken with food, and if you miss a day, you can double up the next day, or even take a weekly dose at one time. Vitamin D is a fat soluble vitamin so can be stored in the body as opposed to being excreted via the urine as is the case for Vitamins B and C (just a point of note, and especially with the vast majority of medications, this would be the exemption to the rule when it comes to double dosing. Normally missing a dose is NOT, i’ll repeat, NOT a cue to double dose the next day). But in this specific case of vitamin D its fine to do so.
- L-carnitine has been seen in one study (Sami eat al 2016) to have a positive impacts on weight loss and insulin levels at a dose of 250mg for 12 weeks, minimal if any side effects at this dose and it’s cheap, so its worth a try! If you see benefits after 12 weeks, keep taking. Best taken daily with your highest carb/protein meal.
- Inositol – the evidence fo this supplement is continually building and its benefits are looking increasingly positive. A dose of 2-3grams twice daily (or 4-6g once a day if its easier and you don’t get any side effects. It is well worth trying for 6 months and if effective continuing long term. For a very inexpensive supplement, and very good side effect profile (only mild gastro-intestinal disturbances usually at dose over 10g/day) it is something that i would recommend. Positive effects include improvements to ovarian function, decreasing testosterone levels and decreasing insulin levels. Other benefits of this are that its safe to take whilst pregnant, with concurrent metformin and can help with IVF.
From a training perspective:
Exercise, such as resistance training (lifting weights) and higher intensity exercise is generally preferential, but anything that gets you moving more will have a positive impact. If we can utilise exercise to improve insulin sensitivity and help to retain, if not build more muscle, as well get stronger, you will see more physical benefits in addition to the other, usual health benefits associated with increasing exercise.
Exercising more is also a potentially useful way of aiding weight loss due to the extra calories burnt (just remember that this often isn’t as many as you think!). But, essentially it’s a really important aspect for everyone, but especially those with this condition for a host of reason
The overarching theme with all of this, is that in order to be able to improve, consistency is going to be essential. However going into the process understanding that having PCOS is likely to make the challenge greater than normal may enable you to stay positive if progress is slower than you’d like, and keep adapting until you see a positive outcome.
Finally, the medication:
From a medication standpoint, often Metformin is prescribed (off-licence in the UK) to help improve insulin sensitivity, it is a commonly used drug into treatment of T2DM but a has also seen to be beneficial in PCOS. It can also have a positive effect on the menstrual cycle regularity and fertility in some cases. This being a prescription only medication, it should only be initiated by the GP, but it is worth nothing that a common side effect in GI upset after taking, so it should be taken with or just after food to minimise this.
Hormonal contraceptives are also sometimes prescribed to help manage the menstrual cycle, and again this is something that you would need to discuss with your GP as to whether this is individually relevant or appropriate for you.
Finally, a supplement called Berberine has sometimes been used (in the US more than UK I believe) and has been seen to have positive effects. It is something that has been taken from traditional medicine, but isn’t widely used and as a result there is a significant lack of safety data currently, making it a last line option in some cases. I have included this in the drug section as it is another one that i wouldn’t recommend without seeking consultation with your GP or specialist due to the lack of data around use in this setting, and the potential for undesirable interactions or effects if implemented without proper supervision.
Looking at the NICE guidance for PCOS treatment, Lifestyle intervention is the first line option, and one that can be extremely powerful in condition management if approached sensibly, with medicinal interventions only used if and when required after lifestyle intervention has been attempted.
To round up:
My top 3 tips from what i have just discussed, that hopefully you can take away and implement if appropriate are:
- Start exercising, with a preference for resistance training where possible, and high intensity work where appropriate – for most people resistance training would be a sensible start point.
- If you are overweight /obese, weight loss will almost certainly have a positive impact on your PCOS, potentially improving fertility, and decreasing insulin sensitivity and the associated issues with that.
- Consider eating a bit more protein, include more low GI foods in your diet and definitely consider trying Inositol as a supplement as a dose of 2g twice a day initially. You can buy this from most supplement stockists, I know My Protein sell it for example.
If you have any questions off the back of what i have spoken about today, please feel free to e-mail me on firstname.lastname@example.org or DM me on Instagam @jamesleept
DI hope that you have found this interesting and that it has helped to clear up any confusion or even the condition itself for any of you listening who suffer or wanted to know more.