How Sheri Overcame Distracted Eating and Lost 3 Pounds Without Dieting

As many of you know, I have started a new and exciting project on the PCOS Personal Trainer. About two weeks ago, five courageous women volunteered to join The PCOS Fit Revolution. Over the next eight weeks, the six of us (me and the five members of the Revolution) are going to use nutrition, exercise, mindset and lifestyle management as a way of overcoming PCOS. Plus, we are going to share this journey with the PCOS Personal Trainer online community.

We have made it through our first two weeks together, and it has been an incredible experience. This group of strangers has becomes a tight-knit and supportive community. Collectively, the Revolution has lost 17 pounds in two weeks, started working out nearly every day, and adopted several healthy lifestyle habits.

Do you want insider information and PCOS Fit Revolution strategies? You can get an inside look at our private Facebook group, discussions about Polycystic Ovary Syndrome and PCOS management tips sent to your inbox. Click here to join for free.

 

How to eat less without making yourself miserable.

If you want to lose weight and keep it off for good, you will probably have to learn to eat less food.

I know how you feel… that notion used to strike terror into my heart! My head would start swirling with memories of starvation diets, constant calorie tracking, and rigid meal plans.

Oh no, not this again. Is it even worth it?

I want to offer you an alternative. You can learn to eat less without making yourself miserable. In fact, there are several simple strategies that you can use to eat less while enjoying food more.

But you do not have to take my word for it! Today we are going to talk with Sheri, one of our PCOS Fit Revolution members, about how she started eating less without dieting.

How undistracted eating helped Sheri lose 3 pounds and 2 inches off her waist.

 

 

Sheri’s Tips for Undistracted Eating

  • Just try it for two weeks. It can be intimidating to commit to something indefinitely, but if you try undistracted eating for two weeks, you will not want to give it up. It grows on you quickly.
  • Leave your phone in another room. It can be hard to resist the temptation of a Facebook alert from your phone. Just leave it in another room so you can focus on eating for a few minutes.
  • If you are interrupted during your meal – don’t sweat it! Simply stop eating, attend to the matter at hand, and return to your meal once the distraction is eliminated.
  • Use your nice dishes. It is more fun to eat off a beautiful place setting. Treat yourself by busting out the fine china 🙂

Erika’s Pro Tips for Undistracted Eating.

  • Eat off a plate or a bowl, not a bag or a box. No matter what you are eating, make sure you can see it. Eating food you can’t see will make it difficult for your brain to process how much you are really eating.
  • Seek out distraction-free eating environments. If you are at home, eat at the kitchen table. If there is a television or another distracting electronic device in the kitchen, remove it or unplug it. If you are at work, leave your desk when it is time to eat. Your workspace is bound to be very distracting, so it is critical that you find an alternative place to eat. Head to a break room, a park bench or bring a picnic blanket to work.
  • Reserve time in your schedule to eat. Go ahead and add lunch to your work calendar so that meetings and other responsibilities don’t invade your meal time.
  • If your day is truly busy, just set aside 10 minutes to drink a healthy super shake. 10 minutes of undistracted eating is better than an hour of distracted overeating!

Do you want insider information and PCOS Fit Revolution strategies? You can get an inside look at our private Facebook group, discussions about Polycystic Ovary Syndrome and PCOS management tips sent to your inbox. Click here to join for free.

16 of Your Biggest PCOS Diet Questions Answered

There is a lot of confusing and complicated information on the internet about PCOS diets. I spent the weekend writing this huge blog post to answer the most common Polycystic Ovary Syndrome nutrition questions in plain language.

If you are looking for a way to start changing your nutrition now, sign up here to get my PCOS Plate sent to your inbox. The PCOS Plate is my simple guide to eating a nutritious PCOS diet, one meal at a time.

 

What is the best diet for PCOS?

Ok, so I think when most of you ask this question, you’re looking for a one-word answer like Paleo, Atkins, Ketogenic or ‘count calories.’ I’m not going to give you that type of answer! When it comes to PCOS diets, I’m agnostic.

I notice that people tend to cling to trendy nutrition fads like they’ve just joined a cult. They find the typically incomplete logic of the new plan flawless and are instantly devoted to its tenets. The problem with this strict adherence is that you eventually burn out or become disillusioned when you do not see the promised results — and you quit.

The End of DietingPCOS Diets

Women with Polycystic Ovary Syndrome need to move away from the diet mentality and start heading toward a lifestyle. You need to gradually start eating in a way that improves your health and never stop doing so.

“Yeah, ok Erika, but what’s healthy for women with Polycystic Ovary Syndrome?”

Science has not provided us with the perfect PCOS diet that will solve all of our problems, but we do know a few things for sure. Women living with Polycystic Ovary Syndrome become healthier when:

  • They eat enough protein to promote muscle growth and repair.
  • They meet their vitamin and mineral needs by eating plenty of whole, unrefined ingredients.
  • They eat a lower calorie diet when they need to lose weight.
  • They reduce their intake of refined, highly palatable junk food.

I know that this does not come close to answering all of your burning PCOS diet questions but keep reading — there’s more!

 

Should I count calories, carbs, protein or fat?

Nutrition expert Dr. John Berardi describes calorie counting as “outsourcing appetite awareness to the food-label gods.” Constantly tracking your food is no way to live. You should use food journaling as a way to teach yourself about nutrition and portion sizes. Your goal should be to develop healthy eating habits, so you won’t need to track your meals long-term.

I recommend journaling food periodically so that you can get an objective look at your nutrition. If you are just starting a PCOS diet, journaling your intake for 1-2 weeks can provide valuable insights that will guide your efforts. If you’ve hit a weight-loss plateau or are experiencing new symptoms like anovulation or low energy, a detailed nutrition journal might uncover a hidden cause.

 

How many carbs should I eat?

It’s no wonder that carbs are a huge topic of conversation when it comes to PCOS diets. Studies indicate that switching from a diet high in carbohydrates to a moderate or low carbohydrate diet can improve the ovulation, insulin sensitivity, and blood lipid profiles of women who have Polycystic Ovary Syndrome.

Just limiting the number of carbohydrates you consume each day is not the best strategy for women with Polycystic Ovary Syndrome, though. I think it is far more important that you focus on eating higher quality carbohydrates. Most women get their carbs from food products like commercially made bread, pasta, sweets, chips, and cereals. I believe this is problematic for several reasons.

The problem with highly refined carbohydrates:PCOS Carbs

  • Manufactured food products are low in nutrients and fiber, but high in additives, sugars, and calories. Basically, for every calorie of highly refined food you eat, you are receiving very little actual nutrition.
  • These food products tend to be hyper-palatable which means they are formulated by the manufacturer so that you will find it difficult to stop eating them. And – it’s more likely that you will crave them later. So, now you are consuming more calories than you need and getting a microscopic amount of nutrients at the same time.
  • Refined high-carb food products typically cause your blood sugar to spike. Thus, PCOS symptoms like insulin resistance, fatigue, mood swings and cravings become aggravated.

Instead of relying on packaged bread and pasta, try eating more whole, minimally processed carbohydrate-dense foods. They are more nourishing, promote feelings of fullness and tend to cause a gentle rise in blood sugar. Here is a list of the best carbs for a nutritious PCOS Diet:

Most women find that making the shift from refined carbohydrates to whole ones is enough to see positive results. If you think you need to take things a step further, you can aim to get just 40% (or less) of your calories from carbohydrates.

For example, if you consume 1600 calories a day, you want to get 640 calories from carbohydrates or 160 grams of carbs a day. You may find that consuming fewer carbs helps achieve a better result. I suggest starting with 40% and adjust after a 2-week trial, if needed.

 

How much protein should I eat?

Protein is important because it builds lean muscle mass, increases feelings of satiety, and helps to keep your blood sugar stable.

Most women do not eat enough protein. The first step in correcting this problem is to include a protein source with every meal you eat. Poultry, seafood, fish, meat, some protein powders, and eggs are all ideal protein sources. You can also get protein from dairy products and beans. However, these sources also contain carbohydrates so you need to take that into account.

The exact amount you need will vary depending on your activity level, preferences, and body composition. Most experts believe that between .75 grams to 1 gram of protein per pound of body weight is optimal. For example, a 150 pound woman needs 112-150 grams of protein each day.

If you are trying to lose weight, eating more protein might help. A recent study published in The American Society for Nutrition found that Polycystic Ovary Syndrome patients on a high-protein nutrition plan (40% of daily calories or more) lost more weight than women who consumed less protein. You can read more about this study at the PCOS Nutrition Center Blog. 

 

What about fat? How much should I eat and what types?

You should eat some fat with every meal. In general, it is pretty easy to consume adequate amounts of fat, so you probably are eating enough already.

Women living with Polycystic Ovary Syndrome should pay particular attention to what types of fats they are eating. If you have PCOS, you’re at risk of developing heart disease. One of the ways to protect yourself from heart disease is to get your fat from whole foods instead of highly refined sources like vegetable oil and margarine. Research indicates that eating high amounts of the hydrogenated oils, trans fats, and omega-6 fats found in processed foods puts you at risk for heart disease.

Here are some examples of healthy fat sources for a PCOS diet:

  • Avocados
  • Nuts, nut butter, and nut oils
  • Coconuts and coconut oil
  • Pasture raised meat and eggs
  • Fatty fish
  • Pastured butter
  • Olives and olive oil
  • Fish oil supplements (especially if you do not eat seafood)
  • Seaweed

Want to learn more about why vegetable oils are not so great? Read this article from the Holistic Squid.

 

How often should I eat?

Some PCOS diets suggest eating more frequently, and others suggest just one or two meals a day. The truth is the number of meals you eat and the timing of the meals is not that important. As long as you are not eating more calories than you need, it won’t make a huge difference whether you divide the total caloric consumption over three meals or four.

The key is to figure out what makes you feel your best and stick to that schedule. In my experience, eating at erratic intervals does not contribute to overall health. If your mealtimes are all over the place, start by eating three meals a day roughly four hours apart. Make adjustments and add snacks if you need them.

 

What about smoothies and juices? Are they good for PCOS?

PCOS diets should not incorporate fruit juice. Even freshly squeezed fruit juice is high in sugar and can cause spikes in blood sugar. If you are craving fresh fruit, eat the whole fruit! It will provide you with blood sugar-stabilizing fiber and you’ll probably consume fewer calories.

shakes-200x300If you need a quick meal on the go, you should make your own smoothie. Commercially prepared smoothies tend to contain low-quality ingredients and are high in calories. A healthy meal replacement smoothie will contain the following elements:

  • High-quality protein powder
  • A serving of veggies
  • A serving of fruit
  • A healthy fat like avocado, nuts, chia seeds or nut butter

 

Do I need protein powder?

No, you do not. You need to eat enough protein, but that does not mean you need a powder. I encourage women to meet their nutritional needs through whole foods whenever possible. Whole foods are more satisfying and are sources for a wide variety of other health promoting nutrients.

Protein powders are a good option for vegetarians and women that struggle to get in enough protein every day. Not all protein powders are created equally, though, and I strongly encourage you to be very selective when shopping for any supplement. Look for organic powders that are free of artificial ingredients and choose a brand that gets their product independently tested for quality. The PCOS Diva sells a very high-quality powder.

 

Should I avoid dairy products?

As far as I can tell as a lay researcher, there is a scant amount of medical research which suggests that PCOS diets and dairy do not mix. For example, a study published in the Journal of International Preventative Medicine concluded that “milk intake and prevalence of PCOS may be related in some way.” There is also some speculation that the hormones found in factory farm dairy could have an impact on Polycystic Ovary Syndrome. Tarryn from PCOS Diet Support has an excellent article on the hormones in dairy and PCOS. 

Also, women who struggle with acne often find relief when they cut back on dairy. If your skin is causing you problems, try avoiding dairy for a month and monitor the condition of your skin.

All in all, there is no definitive answer to the PCOS and dairy question. If you are concerned about the risks associated with consuming dairy, then stop eating dairy products. Milk and other dairy products are not an essential food so cutting them out will not negatively affect your health.

Personally, I cut out dairy products to avoid any possible risks. But if I do decide to indulge in some gelato or cheese, I do not stay up at night worried if I have done great harm to myself!

 

Will going gluten free help me lose weight?

It might. When women stop eating commercially prepared bread, pasta, cereals, and snack foods to avoid gluten, they tend to lose weight. I suspect that eliminating these hyper-palatable, high calorie, low nutrient food products is what causes weight loss in most cases. If you simply replace your morning bagel with a gluten free bagel, and your evening plate of Oreos with gluten free cookies, you will not lose weight. In fact, you might gain weight because some gluten free food products contain more calories than their gluten-containing counterparts.

Obviously, if you have Celiac disease or a gluten intolerance, you should cut out gluten. There’s lots of talk about a possible correlation between Polycystic Ovary Syndrome and gluten intolerance and Celiac, but there is no clear cut proof. You will not find any medical studies on gluten and Polycystic Ovary Syndrome. Having a healthy gut will improve your overall health, though. If you suspect you are intolerant of any foods, you should follow an allergy elimination diet (like the one in this article by Dr. Josh Axe) to uncover food sensitivities. 

The takeaway here is that you should get most of your carbohydrates from whole, plant-based sources. Most of these foods also happen to be gluten-free. If you decide to go gluten free, remember that gluten-free breads, noodles and snacks are not necessarily part of a healthy PCOS diet.

 

Should I eat soy?

To be honest, I don’t see much of an upside to eating soy. It bestows very little in the way of health benefits and it’s not particularly delicious. Like dairy, soy is not an essential part of a healthy diet so you can easily leave it off your menu and avoid any risk (no matter how small.)

When it comes to PCOS diets, the concern surrounding soy has to do with phytoestrogens. The phytoestrogens found in soy are similar to estradiol, a form of estrogen. These compounds have some estrogen-stimulating and estrogen-inhibiting effects. It is possible that the phytoestrogens in soy could imbalance our hormones more than they already are — yikes! However, you would need to consume a lot of soy to affect your hormonal balance.

If you choose to eat soy, I recommend that you limit yourself to a serving each day and avoid highly processed forms like soy burgers. To learn more about soy, check out this article by nutrition smarty-pants Ryan Andrews. 

Should I drink caffeine?

Starbucks_Coffee_Collage

I was about to start writing about the possible health benefits and risks associated with caffeine, but I stopped myself. I don’t think we know much at all about caffeine. For every study that says one thing, another study will contradict it.

If you drink caffeine, be reasonable about it. Limit yourself to one or two cups of tea or coffee a day. Do not drink caffeine after noon because it might disrupt your sleep. Sleep is incredibly important to your health — cappuccino is not! And whatever you do, don’t even look at an energy drink. Not only do they contain an obscene amount of caffeine, they’re also loaded with sugars or artificial junk your body does not need.

 

Should I drink alcohol?

First, set aside any buzz-worthy headlines about the health benefits of beer, red wine or any other adult beverage. For every upside to drinking, there is a downside. The health benefits are just not compelling enough to make a case for regular alcohol consumption.

Alcoholic beverages contain a lot of calories and not a lot of nutrition. For this reason alone, I recommend limiting yourself to just a few drinks a week, especially if you are trying to lose weight. We all know that alcohol lowers your inhibitions, and for some women, those lower inhibitions will trigger poor nutritional choices. Do you find that your beer always comes with nachos? Is your glass of wine followed by a huge plate of lasagna? If you answered yes, then alcohol might be sabotaging your efforts to lose weight.

If you enjoy the occasional drink, I do not think that you must give that up to be healthy. You can follow these rules to keep your PCOS diet on track while savoring a nice Pinot.

  • Limit yourself to one or two beverages.
  • Do not order specialty cocktails or blended drinks. Most are high in calories and sugar. Instead, choose a light beer, red wine, or a hard alcohol with soda water and lime.
  • Have a healthy, balanced meal before drinking. If you are eating dinner out, do not order a drink until after your food has arrived. This way, your buzz will not influence what you choose to order.
  • Metformin and alcohol do not mix. If you drink and take metformin, talk to your doctor about the dangers associated with this interaction.

According to the Polycystic Ovarian Syndrome Association,women who have Polycystic Ovary Syndrome are at risk for nonalcoholic fatty liver disease (NAFLD). If you were diagnosed with NAFLD, you should talk to your doctor about whether or not you should consume alcohol.

Should I cut out all sugar?

No, you do not need to cut out all sugar. That’s an oversimplified solution to a complex problem.

First, let’s talk about the difference between added sugar and naturally occurring sugars. Added sugars are put into products by human hands. For example, honey in your green tea or the 9.33 teaspoons of sugar found in a can of coke. Naturally occurring sugars are in whole foods that also contain water, fiber, vitamins and nutrients. You don’t need to actively avoid naturally occurring sugar! For example, don’t decide to stop eating carrots because they have more sugar than other veggies. No one has ever become obese by eating too many carrots!

I think any good PCOS diet will limit added sugars. There is a correlation between being overweight and having a diet high in added sugars. The American Heart Association recommends women limit themselves to 100 calories of added sugar per day (that’s 25 grams or 6 teaspoons). The average person consumes around 19 teaspoons of added sugar a day. So there’s a good chance you, too, are eating too much added sugar.

4 Ways To Avoid Added Sugars

  1. Pass on sweetened beverages like soda, juices, teas, and specialty coffee drinks.
  2. Say “no, thank you” to packaged snack foods. Nearly every manufactured food product under the sun has added sugars, even savory foods like chips.
  3. Make your condiments. Manufactured salad dressings, sauces, nut butters and sandwich spreads often contain added sugars.
  4. Make your desserts from scratch. If you are going to indulge in a treat, make it from scratch so you can control how much sugar is added to the batch.

Try keeping your daily consumption of added sugars very, very low. This way, when you go out for a birthday dinner, you can enjoy a small slice of cake completely guilt free! When your diet, on the whole, is very low in added sugar, a rare splurge will not do much damage.

If you are struggling with sugar cravings, read my article on The Cakewalk System to learn how I kicked sugar cravings to the curb. Looking for more tips on how to cut out sugar? Check out this handy article by holistic nutritionist Erica Mesirov. 

 

What foods absolutely do not belong in a PCOS diet at all?

Hmm, I can’t think of any. A healthy diet is not really about cutting out certain foods. Eating a healthy PCOS diet is about filling your plate with plenty of delicious, satisfying and nutritious foods – so many in fact that there is not much room left in your life for the junk!

The idea that you can never ever have certain foods again is not a productive or healthy way of thinking about nutrition. Strictly eliminating certain types often causes people to fetishize that food. Fantasizing, craving and coveting foods are dangerous behaviors. Indulging in a slice of pizza every month is not nearly as destructive as binging or yo-yo dieting because you can’t tolerate the strict diet you’ve put yourself on.

 

I know I need to change the way I eat. Where do I start?

Begin with the basic building blocks of a nutritious PCOS diet and master them. Most people fail to lose weight because they never turn the basic principles of healthy eating into daily habits. The infographic below is what I call my PCOS Plate. It is a simple concept, but it works. If you can make eating this PCOS plate a lifelong habit, you will not need to buy another PCOS diet book ever again.

PCOS Diet

 

Complex diets are very appealing and they can deliver impressive results in the short term. But, eventually, most people fall off the wagon and all their hard work fades away.

I am begging you to try something different. Slowly start making your meals look more like the PCOS Plate. Take it one small change at a time and once 90% of all your meals look like this, message me and tell me how you feel!

Warning: The PCOS Plate is simple, but it is not easy. It will take time, consistency and practice to make the PCOS plate your habit. Remember to be patient and kind to yourself as you take this step by step, one day at a time. Sign up here to get my PCOS Plate plus PCOS diet meal ideas sent to your inbox

Getting Pregnant With PCOS: What a Fertility Specialist Wants you to Know

A few months ago I started getting more and more emails from young women wanting to know more about getting pregnant with PCOS. They were not interested in getting pregnant just yet, but they were eager to learn more about what they could expect from the process of trying to conceive (TTC) with PCOS.

Dr. Marc Kalan

To be honest, I did not have an answer to most of these questions, but I knew who would. I first met Reproductive Endocrinologist Dr. Marc Kalan when he invited me to his Los Angeles fertility clinic to talk about PCOS and Exercise. I had reached out to many of LA’s top fertility doctors in the hope of getting an interview. Dr. Kalan was the only doctor to get back to me. He even joined me at the gym for a quick workout!

Right away I noticed that Dr. Marc has a remarkable ability to present complicated information in a clear, non-threatening way. He can talk about delicate subjects, like infertility, with the perfect blend of honesty, empathy, positivity, and expertise.

I am very excited to share our recent conversation with you… so let’s get to it!

If you would like to listen to a recording of some of the interview with Dr. Kalan, click here to get an MP3 sent to your inbox.

 

I speak with many young women who have PCOS and know they would like to start a family someday. What can young women do to improve their chances of successful pregnancy later in life?

If you already have a PCOS diagnosis, there are several things you can do to get ahead of the curve so that you have the best chance of getting pregnant. The first is weight management. Maintaining a BMI below 30, ideally a BMI of 25, will make becoming pregnant and having a healthy pregnancy much easier.

Next, you should track your menstrual cycles. You don’t need to do this continually, but every so often you should track your cycles for a few months so that you have a general idea of how often you are ovulating.

Go to your general practitioner for yearly check-ups. Each year ask to be screened for diabetes, metabolic disease, and thyroid disorders. It is better to diagnose and manage these issues early so that you and your OB-GYN or Fertility Specialist are not surprised by a medical condition once you are ready to TTC.

Stay up-to-date on your vaccines. Common viruses like Chicken Pox or Whooping Cough can be devastating to a pregnancy. It is best to be immune to these viruses well before you try to get pregnant.

 

When should women with PCOS see a Fertility Specialist?

That depends on two variables: age and your cycle.

This is why Dr. Kalan recommends that you track your cycles before you are TTC. If you do not ovulate regularly, it is highly unlikely that you’ll conceive without some medical intervention to help you ovulate. If you already know that your cycles are irregular, you can save yourself much frustration by consulting with a specialist as soon as you are ready for that bundle of joy.

As I am sure your mother or some nosey relative has told you, age affects your fertility. Dr. Kalan has some guidelines to help you factor age into your fertility equation:

  • If you are younger than 32, have PCOS and regular cycles, Dr. Kalan recommends consulting a specialist after 3-6 months of trying on your own to get pregnant.
  • If you are 32 years old or older, have PCOS and regular cycles, Dr. Kalan recommends consulting a specialist after only three months of trying. Older women are under tighter time constraints, so it is best to get help sooner rather than later.

 

What can a woman expect from her first appointment with a fertility specialist?

When Dr. Kalan meets with a patient for the first time, he focuses on gathering and giving information. He wants to learn all that he can about your health history and then explain your treatment options.

During the first visit, a Fertility Specialist will want to get an extensive health history. You can prepare for your visit by coming with some of this information on hand:

  • Bring medical records from your general doctor (including vaccination records). If you have tracked your cycles, bring that information with you.
  • Write down approximate dates for when certain health events happened, like your first period, and when you were diagnosed with any chronic conditions, like PCOS.
  • Have your family’s health history at hand. Does PCOS, diabetes, infertility or miscarriages run in your family? You might need to ask an older relative about some of this.

Next you can expect a full exam. The exam will probably include:

  • Blood tests to check your sex hormone levels, thyroid, and Diabetes risk.
  • A trans-vaginal ultrasound of your ovaries to evaluate your cysts.
  •  A physical exam to see how other PCOS symptoms present for you. For example, hair growth and acne patterns.

After Dr. Kalan has gathered all of this information, he likes to sit down with his patients and have a long conversation about their treatment options. Selecting a treatment plan for infertility can be an intensely personal decision as finances, social support, religion and your unique health history can all factor into the decision.

 

What qualities will an ideal fertility patient have?

Self-knowledge is an important asset for any woman about to start fertility treatments. Ideally, a patient will know exactly what PCOS symptoms she has and will be able to share with her doctor all the steps taken to manage her symptoms.

Women need to understand that any fertility treatment will require more than just taking a prescription or undergoing a procedure. Lifestyle will play a huge role in how well a given fertility treatment will work.  An ideal patient will come to her specialist motivated and prepared to make changes to her lifestyle to maximize the results of her treatment.

If you have a spouse or partner, they should be involved in the process too. Men, in particular, have a hard time understanding what a complicated and involved process TTC with PCOS can be. One way to get your partner engaged is to make sure they are informed. Dr. Kalan recommends that partners attend fertility appointments along with the patient.

 

Should you exercise while TTC?

Yes, patients can and should exercise while undergoing fertility treatments. Regular physical activity improves fertility in most women. Dr. Kalan explained that, in an ideal situation, a patient will already be following an exercise program when they come in for their first visit.

For patients who are not physically active, Dr. Kalan advises against simultaneously starting a rigorous new exercise program and fertility treatments. The stress of making these two changes at once might become overwhelming. In some cases, Dr. Kalan will delay treatments for a month so that a patient can start a moderate exercise program before they begin fertility treatments. However, that decision needs to be made on an individual basis as time might be a factor in your treatment plan.

 

What fertility treatment options do women with PCOS have?

The treatment that Dr. Kalan most commonly uses for women with PCOS is a combination of ovulation induction and intrauterine insemination (IUI). Dr. Kalan will prescribe a drug like Clomid or Letrozole, which will cause women with PCOS to ovulate. Once the patient is near ovulation, Dr. Kalan will perform IUI. IUI is the process of directly injecting sperm into your uterus. It is possible just to use ovulation and intercourse to conceive, but IUI increases the likelihood of getting pregnant.

Invitro Fertilization (IVF) is also a treatment option for women with PCOS.  IVF involves stimulating ovulation, removing eggs from the woman’s ovaries via a surgical procedure and letting sperm fertilize the eggs in a laboratory. The fertilized egg is then implanted in the patient’s uterus.

A third, less common treatment option is a surgical procedure called ovarian drilling. Ovarian drilling is a laparoscopic surgical procedure where the surgeon will use a laser to puncture the ovary 4 to 10 times. 60% of women who have this procedure will begin to ovulate on their own. However, there are risks associated with ovarian drilling. One common complication is early menopause.

If you would like to hear Dr. Kalan explain these three treatment plans in detail, click here to get a recording from our interview sent to your inbox.

 

Are there any long-term side effects associated with fertility treatment?

In the 1980’s two studies linked Clomid use to ovarian cancer. The studies found that women who had fertility treatments were more likely to have ovarian cancer. Later, these studies were reevaluated and debunked. Further investigation discovered the link between being anovulatory and ovarian cancer was to blame. Women who sought fertility treatments were more likely to be anovulatory and, therefore, were more likely to seek fertility treatment than other women.

The bottom line for women with PCOS: fertility treatments seem to reduce the risk of ovarian cancer later in life. Anovulatory women are in greater danger of developing ovarian cancer. Fertility treatments cause anovulatory women to ovulate, therefore reducing their ovarian cancer risk.

 

Will taking Metformin increase my fertility?

The studies on Metformin and fertility have not brought a conclusive answer to this question, but the results suggest that Metformin can be very useful during fertility treatments. This is especially true for women who are insulin resistant.

Insulin resistance can trigger a series of hormonal and metabolic imbalances that will make getting pregnant more difficult. Metformin is a safe and effective means of correcting insulin resistance. Before prescribing Metformin, Dr. Kalan will evaluate a patient’s insulin sensitivity (through lab work) to determine whether Metformin will improve her chances of conception.

Dr. Kalan pointed out that Metformin is not the right course of treatment for every woman with PCOS. Physicians should assess a patient’s insulin sensitivity and goals before prescribing Metformin or any other insulin-sensitizing drugs.

 

Is Metformin safe to take during pregnancy?

Metformin is safe to take during pregnancy. In fact, Metformin is an extremely useful treatment for women who are diabetic or become diabetic during pregnancy.

 

Should every woman with PCOS take Metformin?

Metformin is a safe, worthwhile treatment option for women who have PCOS and insulin resistance. If you do not have insulin resistance, Metformin will not be of much use to you.

That being said, many women with PCOS do have insulin resistance, even some lean women. You and your physician should thoroughly evaluate you insulin sensitivity, and use that information to create a treatment plan. Dr. Kalan suggests PCOS patients get Hemoglobin A1c, fasting blood sugar, fasting insulin levels and 2-hour glucose tolerance tests to evaluate their insulin sensitivity. 

 

Will the long-term use of birth control pills damage your fertility?

Dr. Kalan explained that birth control pills will not diminish your fertility. However, time will. All women experience a decrease in fertility as they age. If you come off birth control pills after several years and have a difficulty conceiving, age is the likely culprit.

Dr. Kalan says that birth control pills can be a safe and effective part of a larger PCOS treatment plan. They can help women with PCOS manage their symptoms and regulate their cycles. Dr. Kalan recommends that women periodically go off birth control pills so that they can evaluate their natural cycles. In some cases, PCOS symptoms can decline as a woman ages and birth control may no longer be necessary to control her cycles and symptoms.

If you smoke, you should talk to your doctor about possible health risks associated with smoking and the use of birth control pills.

There you have it, ladies! What to expect when TTC with PCOS. I hope you feel informed and encouraged by Dr. Kalan’s tell-all.  If you live in the Los Angeles area and are ready for that bundle of joy, get in touch with Dr. Marc Kalan and his colleagues at the Pacific Fertility Center I am confident you will receive the top-notch care you deserve. In case you have not noticed, I’m a fan!

Pacific Fertility Center has locations in Los Angeles, Glendale, Encino, and Bakersfield California.

 

Expert Advice: Fitness Should be Part of Your PCOS Treatment Plan

Mark Perloe MD
Mark Perloe MD

I met Reproductive Endocrinologist and highly regarded Polycystic Ovarian Syndrome expert Dr. Mark Perloe when he presented at the PCOS Challenge symposium. Before he took to the stage, the woman seated to my right turned to me and said, “My fertility doctor is speaking next. He’s really great. I had my last baby over ten years ago, but I still see him because he really gets PCOS.”

I was immediately impressed. In all my time as a PCOS patient and advocate, I had never heard a fellow Cyster rave about her medical care. As Dr. Perloe gave his presentation on creating a treatment plan for PCOS, it became clear he is a compassionate, enthusiastic, and knowledgeable advocate for women living with PCOS.

On Sunday Dr. Perloe and I had a great conversation about PCOS and weight loss, and I am eager to share what I learned with you.

Why women with PCOS have trouble with their weight

The insulin resistance that is characteristic of PCOS promotes weight gain. It is still unclear exactly how PCOS and insulin resistance are linked. Recent research suggests that our genetics play a role. Insulin is the hormone your body uses to deliver energy (in the form of glucose) to your cells. When you are insulin resistant, normal amounts of insulin are inadequate to produce a normal response from your cells. As a result, the excess glucose that remains in the blood stream is sent to the liver. The liver converts the excess glucose into fat and stores it throughout the body. Thus, women with PCOS tend to gain weight easily.

The relationship between insulin resistance and weight gain is not easy to understand! Dr. Perloe has made a great explainer-video on the subject. Click here to get some of Dr. Perloe’s best video tutorials sent to your inbox.

It can be easy to feel frustrated; like the cards are stacked against you when it comes to losing weight. But Dr. Perloe is very optimistic when it comes to weight management and PCOS. He’s a man with a plan!

The three point plan for PCOS weight loss: a low GI diet, insulin sensitizers, exercise.

Dr. Perloe won’t tell you that losing weight with PCOS is easy. For that matter, neither will I. He believes that managing your weight and health when you have PCOS takes a life-long commitment, but there is a clear and research-based approach to ensure that you look and feel you best.

A Low GI Diet

GI, or the Glycemic Index, is designed to measure how quickly a type of carbohydrate is digested and absorbed into the bloodstream. A low GI score indicates the food is digested and absorbed more slowly. Examples of low GI foods include beans, unprocessed whole grains, nuts, seeds, vegetables and, of course, food that do not contain carbohydrates like animal proteins and oils.

The goal of a low GI is to get the majority of your calories from low-GI food so that you have a steady rise in the level of glucose in the blood, which in turn leads to a small and gentle rise in insulin.

Insulin Sensitizers

Insulin sensitizers, like metformin and inositol supplements, plus a low GI diet can correct PCOS-related insulin resistance. Dr. Perloe has seen great results with both the supplement Ovasitol and generic metformin. However, you and your physician should work together to find the right dosages of metformin or inositol for you.

Exercise

Dr. Perloe wants you to hit the weight room ladies. Why? The majority of the glucose you ingest from food will be used by and stored in your skeletal muscle. Progressive strength training increases the size of skeletal muscle and enhances that muscles’ ability to manage glucose. Medical research has demonstrated that the adaptations created by progressive resistance training will increase insulin sensitivity and your metabolic rate (the amount of calories you burn at rest).

Don’t be a cardio queen

Dr. Perloe cautions women against doing long bouts of cardio exercise. The traditional thinking that “the more calories you burn, the better” will not serve PCOS women well. Over time, large amounts of cardio can reduce your muscle mass thus slowing down your metabolism. Shorter, high-intensity cardio does a much better job of improving your cardiovascular health and insulin resistance.

Dr. Perloe tells his patients to do just two 20-minute, high-intensity cardio sessions a week and to strength train two or three times a week on nonconsecutive days. When you strength train, select exercises and resistance levels that challenge you and train each major muscle group once a week.

Will lifting heavy weights increase your androgen levels?

I get asked this a lot, so I decided to put this question to Dr. Perloe.

The answer: No, quite the opposite. We know that insulin resistance and obesity exacerbate hyperandrogenism in women with PCOS. Strength training is a proven method of managing insulin resistance and obesity. Improved insulin sensitivity and weight reduction will ultimately improve hyperandrogenism.

Should you work out if you are trying to conceive?

Absolutely. The majority of women who follow Dr. Perloe’s three-point plan can conceive without any further fertility treatments. How cool is that? In fact, women who are physically active give birth to healthier babies. Check out the post I wrote for With Great Expectations (an excellent blog for anyone TTC) to learn more about how exercise can prepare you for motherhood.  

However, once you are pregnant, you should reevaluate your exercise program and consult your OB-GYN. Dr. Perloe says expectant mothers should reduce their exercise intensity so that they can pass the talk test: you should be able to hold a conversation while exercising.

If there is one thing I took from my Sunday afternoon chat with Dr. Perloe, it’s that PCOS is not a lost cause. We have smart and compassionate advocates like Dr. Perloe and information on our side. It is our job to use the tools available to our advantage!

Would you like to hear more from Dr. Perloe? Click here to get some of Dr. Peloe’s best video tutorials sent to your inbox.

If you live in the Atlanta, Georgia area and are looking for a wonderful fertility specialist, you can get in touch with Dr. Perloe by visiting IVF.com.

How to beat PCOS Fatigue

PCOS FatigueBeing tired is the worst. In fact, the only thing that is worse than being tired is when you realize you are tired of feeling tired all the time.

Fatigue is a vague symptom and therefore, it does not get much attention from PCOS experts. But if you ask one of the many women living with PCOS (including me) -fatigue is one of the most troubling symptoms of Polycystic Ovarian Syndrome.

The fatigue I am talking about is different from boredom or being sleepy after a night of Netflix binging. It is a truly physical sense of exhaustion, where you might want to do something, but you just feel too worn out to make it happen. I’ve turned down wine nights with the girls and procrastinated on writing a blog post because fatigue has reared its ugly head.

Today I am going to give you a practical approach to managing fatigue.  But first I want to tell you to go to your doctor and get a check-up. In case my Lululemon crop pants did not tip you off- I’m a personal trainer and not a physician.

Chronic Fatigue could indicate that you have another medical condition. Some the conditions common to PCOS women include:

  • Thyroid Disease
  • Auto Immune Conditions
  • Sleep Apnea
  • Diabetes
  • B-12 deficiences (linked to long-term metformin and birth control pill use)

So go to your doctor and rule out all of this stuff.

My perspective on PCOS and Fatigue

At the center of PCOS is a hormonal imbalance. Our bodies are already dealing with some level of hormonal dysfunction. Therefore, we’re probably more vulnerable to other environmental stressors like a poor diet, sleep deprivation, and unmanaged stress. I believe that fatigue is one way that your body communicates to you that something in your environment is not good for you.

Better nutrition, good sleep hygiene, and stress management can reduce PCOS fatigue. Yep, I know this is not novel or cutting-edge information. But the truth is that if you manage these areas of your life better, you will feel like the energizer bunny.

Click here to get my video diary of how I manage fatigue and a library of helpful fatigue fighting resources like podcasts, and articles from experts.

 

Blood Sugar Imbalances

Spiking and plummeting blood sugar levels will make you feel fatigued.

This might be the cause of fatigue if:  

Your fatigue seems to come and go in waves and can be remedied by eating or if you feel especially low after eating.

Action Steps:

Eat balanced meals. Eat healthy sources of proteins, fats and carbohydrates with every meal. Do not get caught up in the exact gram amounts of each macronutrient. Instead, use this simple diagram to plan meals:

The PCOS Plate

 

Eat breakfast within 90-minutes of waking up. Not eating until lunch may seem like a good way to cut back on calories, but it could negatively impact blood sugar regulation. Researchers at Tel Aviv University found that skipping breakfast triggers major blood sugar spikes and impairs the insulin responses of type-2 diabetics. Much like type-2 diabetics, women with PCOS have impaired insulin response so eating breakfast is probably in our best interest too.

Eat about every four hours. I do not believe that constantly snacking throughout the day is a good way to balance blood sugar. However, you should eat at regular intervals. About every four hours over the course of the day. This means that you will probably need a small balanced snack between lunch and dinner.

Supplements that can help:

Inositol and cinnamon have been shown to help with blood sugar imbalances. Talk to your healthcare practitioner about finding the right dose for you.

Sleep Deprivation

Sleep deprivation is associated with a laundry list of health problems including insulin resistance, being overweight and feeling fatigued.

This might be the cause of fatigue if:

You get less than 8 hours of sleep each night, you have trouble staying asleep, or you wake up tired after a full night of sleep.

Action Steps

Ruthlessly prioritize sleep. There are few things in life more important than getting enough sleep. Sleep is not a luxury- say that again out loud- sleep is not a luxury. If you have over-scheduled yourself to the point that you can’t get into bed 8 1/2 hours before you need to wake up, it is time to start saying no to unnecessary commitments.  If you are living with an infant- hang in there! But the rest of you need a reality check if you don’t have enough time to sleep something is wrong with your priorities.

Go to bed and wake up at the same time every day. If you want to recover from sleep deprivation, you will need to get on a sleep schedule. For the time being, skip late nights out with friends and sleeping in on Saturday. In the future, you may be able to get away with the occasional deviation from your sleep schedule but until you’re fully recovered it is best to go to bed around 10 pm and wake after 6 am. According to Nutritionist Chris Sandel, the phase of sleep where your body repairs itself occurs between 10 pm and 2 am so you do not want to miss out on that restorative process by being awake late into the night. Click here to listen to Chris’s fascinating podcast about sleep. 

Manage your light exposure. Natural sunlight exposure helps humans sleep well. One way to improve your chances of getting a good night’s rest is to go outside a few times a day and enjoy the sunlight. Plus sunlight helps you make vitamin D.  Note: Some research has found the women with PCOS are low in this important vitamin.

On the other hand exposure to the blue light emitted by electronics can cause sleep disruptions. In fact, the American Medical Association states that exposure to excessive light at night, including extended use of various electronic media, can disrupt sleep or exacerbate sleep disorders. One way to lessen the effect of blue light on sleep is to download a program called F.lux. F.lux is a software program that changes the light admitted by your electronics so that it mimics natural light.

 

Starbucks_Coffee_Collage

Do not consume any caffeine after 2 pm. You may not feel like that 4 pm caffeine boost affects your sleep, but it might be reducing the quality of your sleep without you even knowing it. For example, one study found that test subjects who consumed caffeine 6 hours before sleep experienced a less restful night without even knowing it. The caffeinated subjects reported that they slept well but electronic sleep monitors told a different story:  total sleep time, and sleep efficiency significantly deteriorated when they consumed caffeine 6 hours before bed. 

Give your bedroom a makeover. Make sure your bedroom is a hospitable sleep environment. High-quality mattresses, pillows, and linens are a wise investment. Hang up blackout curtains if your windows let in a lot of artificial light at night. Keep the room cool and free of distractions like televisions and computers.

Supplements that can help:

Melatonin has been shown to help with insomnia and improve sleep quality. Talk to your healthcare practitioner about finding the right dose for you.

Stress overload

I know we would like to avoid stress altogether, but that is simply an unrealistic expectation. Stress is part of life and stress only becomes detrimental to our health when we let it consume us.

This might be the cause of fatigue if:

You feel tired but wired. You have trouble relaxing or have unexplained body aches.

Action steps

New-Years-Resolutions-600x406Evaluate your commitments. Ok superwoman, take a look at your day planner. Have you set aside time for self-care? If not, that is a warning sign. Living well with PCOS requires that you set aside time for exercise, sleep, meal prep, and restorative activities like seeing a therapist, getting a massage, or just watching the grass grow.  

If you have not left space in your life for well, you then it is time to gracefully turn down obligations or responsibilities that are a choice. You do not have to be PTA president and the chairwoman of a local charity- you want to be all of these things. But if you’re feeling fatigued enough to read a blog post about fatigue it is time to reevaluate your commitments.

Practice Mindfulness. Do you have racing thoughts or strong emotional responses to stress? Your reaction to a stressful situation may not just be mentally uncomfortable; it might be physically exhausting too. Simply put- “feeling stressed-out” can stimulate a hormonal response in your body. If you are chronically saturating your body in stress hormones, you could start to experience fatigue.

Mindfulness practices like meditation, mindful walking, and breathing exercises can help you improve your reaction to stressful situations. Just 10-minutes a day of mindfulness practice can make a dent in your stress levels. To get started try these yoga breathing exercises from yoga instructor Caren Baginski:

Include parasympathetic exercise in your program. Short high-intensity exercise is ideal for addressing the metabolic aspects of PCOS. Ideally, you should balance out these intense workouts with exercise that stimulates your parasympathetic nervous system.  The parasympathetic nervous system is the division of your nervous system that shuts down your “fight or flight” responses to stress and allows you to rest and recover.  

Walking, gentle yoga and Tai Chi are just a few forms of exercise that fall into this category. I recommend you get in 2-3 sessions of parasympathetic exercise every week. To recover from chronic stress, you may even need to cut down on intense exercises in favor of parasympathetic exercise.

Supplements that can help:

Ashwagandha has been shown to reduce symptoms of stress. Talk to your healthcare practitioner about finding the right dose for you.

I know from personal experience that fatigue is about more than feeling sleepy. My fatigue cast a shadow over every aspect of my life; my marriage, my work, and social life.  If you want to hear more about my personal struggle to manage fatigue, click here, I’ll send my video diary to your inbox.