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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Don't be held hostage by Polycystic Ovary Syndrome - with the right diet and effective exercise, you can minimise its impact on your day-to-day life and future wellbeing. Packed with realistic advice from a qualified nutritionist, this guide takes you through everything from picking which treatments to try - and which to avoid - to thriving with PCOS superfoods and finding resources and support to help you stay positive and maintain your focus
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Seitenzahl: 526
Veröffentlichungsjahr: 2011
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Managing PCOS For Dummies®
by Gaynor Bussell
Managing PCOS For Dummies®
Published by John Wiley & Sons, Ltd The Atrium Southern Gate Chichester West Sussex PO19 8SQ England
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Copyright © 2007 John Wiley & Sons, Ltd, Chichester, West Sussex, England
Published by John Wiley & Sons, Ltd, Chichester, West Sussex
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About the Author
Gaynor Bussell is a Registered Dietitian, a Nutrition Consultant, and a member of various professional nutrition organisations, including the Nutrition Society and the British Dietetic Association.
Gaynor began specialising in women’s health after taking a short career break to have her two daughters. She worked as a women’s health dietitian for over six years at University College Hospital in London, specialising particularly in PMS, menopause, preconception health, eating disorders and, of course, PCOS. She also covered the osteoporosis clinic at this hospital. During this time Gaynor became dietary adviser to a women’s health charity.
Since then Gaynor has worked at various women’s health clinics including those at Hammersmith and Queen Charlotte’s. She was also the dietitian for a private residential eating disorders centre. Gaynor continues to see private patients who have women’s health issues and/or eating disorders. She also continues to work with various women’s health organisations and charities, and writes and gives talks on various aspects of women’s health.
Gaynor currently works as a consultant for the Food and Drink Federation (FDF) where her role includes acting as the interface on nutritional matters between industry and UK and EU authorities and sitting on a number of decision-making committees.
Author’s Acknowledgements
Thanks to the excellent team at Wiley, in particular Rachael Chilvers and Alison Yates who kept me encouraged and did not shout too much when deadlines were missed!
Thanks to my family: David and my two daughters, Sally and Jenny. Thanks guys about being good-natured and understanding about my ‘being on a roll’ so that dinner didn’t get served until 10 p.m., again!
Thanks to my work colleagues at the Food and Drink Federation who allowed me to take the time out to write the book and always took an interest in how things were coming along.
Finally, thanks to the team at Next Generation gym. You sorted out my mouse-strained shoulder and gave me excellent workout plans. It was great to go to you as a bolt hole when I needed to think, de-stress, and pound the life out of a treadmill!
Publisher’s Acknowledgements
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Contents
Title
Introduction
About This Book
Conventions Used in This Book
What You’re Not to Read
Foolish Assumptions
How This Book Is Organised
Icons Used in This Book
Where to Go from Here
Part I : PCOS in a Nutshell
Chapter 1: Sensible and Straightforward Solutions for a Difficult Condition
Understanding PCOS
You Know You Have PCOS Because . . . : The Symptoms
PCOS through Life Stages
The Three-Pronged Attack
Trying Out Other Stuff
Chapter 2: Knowing You Have PCOS
Overweight and under the Weather: Symptoms of PCOS
Detecting PCOS
PCOS through Life’s Changes
Part II : Taking Control of Your Diet
Chapter 3: Understanding the Important Bits about Your Diet
Benefits of Eating the PCOS Way
Fats and Oils
The Right Carbs Are Your Friends
Wholegrains and Fibre
Protein Power
Vitamins, Minerals, and Other Bits and Bobs
Alcohol and Other Bevies
Salt: Getting the Measure
Putting It All Together
Chapter 4: Eating the Low-GI Way: The Right Way for PCOS
The Basics about Low-GI Diets
Meal Planning the Low-GI Way
Other Advice for Healthy Eating
Chapter 5: Shedding the Extra Load
Deciding How Much to Lose
Before You Begin to Slim
Following a Low-GI and Weight Loss Diet
Food Addiction and Cravings
Dieting Do’s and Don’ts
When the Going Gets Tough
Part III : Recipes for Life
Chapter 6: Breakfast Like a King
Breakfast – Why Bother?
Tips for a Healthy Breakfast
Oh, What a Beautiful Morning! Simple and Quick Breakfasts
Berry Smoothie
Coffee Banana Smoothie
Mango and Peach Smoothie
Porridge with Berry Purée
Caribbean Porridge
Vanilla Granola Breakfast Trifle
Apple Muesli
Breakfasts to Relax and Enjoy
Baked Eggs and Mushrooms in Ham Crisps
Ham and Eggs on Sourdough Bread
Creamy Scrambled Eggs with Smoked Salmon
Scrambled Eggs with Spanish-style Hash
Apple and Raisin Oven Pancakes
Banana Walnut Pancakes
Carrot Breakfast Muffins
Blueberry Muffins
Apple and Prune Muffins
Chapter 7: Let’s Do Lunch
Tips for Lunch
Light Lunches: When Just a Bite or Two Will Do
Avocado Dip
Avocado with Prawns – Slimmer Style
Hummus Dip
Poached Pears, Cheese, and Walnuts
Stuffed Mushrooms
Packed Lunches
Tuna and Mixed Bean Salad
Sardine and Potato Salad
Salmon and Avocado Salad
New Potato, Watercress, and Bacon Salad
Lunches to Linger Over
Cheddar Onion Soup
Curried Vegetable Soup
Lentil Soup
Minestrone Soup
Split Pea and Ham Soup
Sweetcorn and Potato Soup
Bacon and Walnut Stuffed Sweet Potato
Creamy Mushrooms
Tomato Tortellini
Quick Pizza
Chapter 8: Snacks: Time for a Little Something
To Snack or Not to Snack
Suitable Snacks and a Few Yummy Recipes
Chocolate and Cherry Muffins
Tea Bread
Low-Fat Fruit Cake
Fruit and Seed Loaf
Fruit Bars
Fruit Scones
Chapter 9: Dining In and Eating Out: Main Meals and a Few Yummy Desserts
Sorting Out Your Main Meal of the Day
Bean and Vegetable Bake
Baked Bean Lasagne
Chunky Vegetable Cassoulet
Mixed Bean Hotpot
Vegetable Crumble
Mushroom Risotto
Brazil Nut Burgers
Curried Chickpeas
Homemade Pizza
Mediterranean Pasta
Herby Fish Cakes
Smoked Fish Pie
Kedgeree
Fragrant Prawn Curry
Tuna Lasagne
Tuna Pasta
Tuna Niçoise
Spicy Turkey Tacos
Chicken Curry with Dhal
Stir-fry Chicken and Noodles
Yellow Bean Stir-fry
Sausage and Chunky Vegetable Casserole
Bacon Risotto
Spaghetti Carbonara
Chilli Con Carne
Spiced Bean Bake
Cheesy Beef and Sweet Potato Bake
Beef Stroganoff
Pork Goulash
Desserts
Apple and Hazelnut Crunch
Pears in Chocolate Sauce
Apple and Rhubarb Crumble
Sherry Trifle
Cheesecake
Bread and Butter Pudding
Tips for Eating Out
Part IV : Other Helpful Stuff for PCOS
Chapter 10: Let’s Get Physical
Reasons to Get Physical
Ground Rules Before You Start
Not All Exercise Is the Same
Eating for Exercise
Chapter 11: Other Solutions: The Good and Bad
Eating a Vegetarian or Vegan Diet
Avoiding Alternative Diets
Supplements: Taking Care Not to Over Do It
Taking a Leaf from Herbal Medicine
Using Complementary Therapy in PCOS
Following the Current Medical Approach
Chapter 12: Balancing Mind, Body, and Spirit
Psyching-up for the Task Ahead
The Holistic Balancing Act
Talking About It
Fanaticism versus Staying in Control
Chapter 13: Preparing for a Baby
Maximising Your Chances: Things to Do Before You Conceive
Coping with Disappointment
Part V : The Part of Tens
Chapter 14: Ten PCOS Symptoms You Can Take Action On
Frumpy and Unfit
No Patter of Tiny Feet
Diabetes and Its Complications
The ‘C’ Word: Cancer
Acne
Tired all the Time
Heart Disease and Stroke
Depression: Being a Miserable Old Cow
Hirsutism: The Bearded Lady
The Balding Woman: Hair Loss
Messed Up Periods
Chapter 15: Ten Rules for Spotting a Bad Diet
It Excludes Certain Foods
It Only Lets You Eat A Few Foods
It’s High in One Particular Food Element
It Has Too Much Protein Power (Combined with Low Carbs)
It Relies on Taking a Supplement or a Particular Substance
You Have to Eat Loads of a Particular Food
It’s Very Low in Calories
It Has Strict Rules on What You Can and Can’t Eat
Your Family and Friends Wouldn’t Touch It
You Can’t Follow It for Life
Chapter 16: Ten Reasons to Follow a Low-GI Diet
It’s an All Round Healthy Way to Eat
It’s Flexible
It Helps to Control Blood Sugars
It Staves off Hunger Pangs
It Keeps Your Metabolism Going
It’s Good for Your Heart
It’s the Best Diet for Diabetics
It’s a ‘People Friendly’ Diet
It’s Bowel Friendly
It’s the Best Diet to Follow for PCOS
Chapter 17: Ten PCOS Superfoods
Wholegrain Breakfast Cereals
Wholewheat Pasta
Sweet Potatoes
Beans
Lentils
Nuts and Seeds
Berries
Yoghurt
Green Vegetables
Sardines
Chapter 18: Ten Places to Go to Get Further Information and Support
Verity
Women’s Health Concern
Infertility Network (INUK)
Diabetes UK
The British Dietetic Association
NHS Direct
Women’s Health.gov
iVillage
Weight Loss Resources
Polycystic Ovarian Syndrome Association
: Further Reading
Introduction
When you’re diagnosed with polycystic ovary syndrome (PCOS), you may feel pretty low – PCOS isn’t a nice condition and doesn’t yet have a cure. However, the good news is that you can keep the symptoms more or less completely at bay. This doesn’t happen simply by taking a pill or two; you have to put in the effort yourself, and you aren’t going to see results overnight. That’s not a message that everyone likes to hear in today’s instant gratification society. The rewards are huge though – you get your life back and you feel so fit and well that you don’t want to return to your old lifestyle.
Put simply, you need to live a healthy life to keep PCOS under control. Lose any excess weight, get fit, tone up, and eat food that’s going to do the best for your body. All this doesn’t need to be dull and boring: Being physically active can be fun and it certainly lifts the mood and gives you a buzz. Have a peek at the recipes in this book and you soon realise that the diet for PCOS is tasty, easy to make, and sure to be liked by your friends and family, too, so no excuse for social exclusion!
About This Book
When you’re first told that you have a particular medical condition, you’re given a whole heap of advice from different people, including your friends and your Aunty Nelly! And, more than likely, different bits of advice are contradictory. You may have looked up PCOS on the Internet, or leafed through a few books about it. You may even have read articles about it in popular magazines, or read about some celebrity who cured herself by eating nothing but peanut butter sandwiches. Well, what’s a girl to do?
This book gives you down-to-earth and up-to-date advice. It tells you what’s worked and what hasn’t for PCOS sufferers, and takes you through what you can be doing for yourself to help reduce your PCOS symptoms, mostly in the area of diet and exercise. I also briefly cover the medical treatments available for PCOS, but only so that you’re aware of what’s available and what route your doctor or specialist may want to take you down.
Conventions Used in This Book
The following conventions are used throughout this book to help keep things consistent and easy to understand:
All Web addresses appear in monofont.
Both metric and imperial measurements appear in the recipes. Follow either system – just don’t switch halfway through a recipe or it’ll end in tears! American measurements are also included (as cups). For certain ingredients that are known by more than one name, both names are used with one in brackets, such as ‘courgette (zucchini)’.
All the recipes are followed by the nutrient breakdown per serving.
A little tomato symbol next to a recipe means that it’s suitable for vegetarians.
The following terms are used as a shortened abbreviation:
• ‘Calories’ is used to mean kilo calories (kcals).
• ‘Carbs’ is used to mean carbohydrates.
• ‘Sat fat’ is used to mean saturated fat.
Nutritionists commonly use metric terms such as gram (g), milligram (mg), and microgram (mcg) to describe quantities of protein, fat, carbohydrate, vitamins and minerals, and other nutrients. This book does as well.
What You’re Not to Read
If you want to get straight to the nitty-gritty, and extract all the vital bits as quickly as possible so you can make a start on what you need to do, you can skip the following bits and still accomplish your goal:
Text in sidebars. These shaded boxes appear here and there throughout the book. They share anecdotes and observations, but aren’t essential reading.
Anything with a Technical Stuff icon attached. This information pumps you with a few more technical facts or background about a particular subject, but isn’t essential reading if you don’t want to know the why, but just the how!
Of course, when you’re ready (and have the time or curiosity to spare), remember that these pieces of info are well worth dipping into.
Foolish Assumptions
Every For Dummies book is written with a particular reader in mind, and this one is no exception. So, I made the following basic assumptions (rightly or wrongly) about you:
You’re not a doctor so don’t have the technical understanding about the PCOS condition, but you are interested in getting a basic understanding of it.
You have the condition, and you want to know how to reduce your PCOS symptoms so that you can improve your quality of life.
You’re confused about the right dietary and exercise route to take to get you on track to reducing your symptoms.
You’re dissatisfied with quick fixes, fads, and wonder diets and treatments and need a realistic alternative that works.
You want straight talking, understandable information. You want to know enough to help yourself to feel better, but don’t need to become an expert on PCOS.
You don’t want to spend hours digging around for information but want a one stop shop that’s going to cut to the chase but not mislead you.
How This Book Is Organised
The great thing about For Dummies books is that you don’t have to read them all the way through. You can simply turn to the bit you want – a chapter, a section, even just a paragraph. The table of contents and the index help you out. This section gives you an idea of what lies ahead.
Part I: PCOS in a Nutshell
When you’re initially diagnosed with any condition, the first order of business is getting a good enough understanding so that 1) you’re not terrified or panicky and 2) you can make good decisions about how to take care of your health. So in this part, I give you basic information about PCOS: what it is, what causes it, what symptoms may accompany it, what changes you can expect as you age, and – most importantly – how you can take control and manage it.
Part II: Taking Control of Your Diet
Your diet can really help to control symptoms of PCOS. This part covers following a balanced low glycaemic index (GI) diet, whether simply to control PCOS or also to lose weight. As many PCOS sufferers tend to be overweight, this part is full of helpful and practical tips to keep the weight off.
Part III: Recipes for Life
Part 3 is very practical, explaining how watching the calories and the GI gets translated into actual meals and recipes. You don’t need to look at another recipe book with these chapters! As well as tips and advice, the recipes cover breakfasts (Chapter 6), lunches and starters (Chapter 7), snacks (in Chapter 8 and, yes, they are allowed!), and last but not least dinners and puds (Chapter 9). The recipes also include some indulgent ones and meals you can safely serve up at a dinner party.
Part IV: Other Helpful Stuff for PCOS
This part looks at other ways that you can help to reduce your PCOS symptoms, including the importance of physical activity. When you have PCOS you may well be tempted to try all sorts of other ‘cures’ that you find out about. Part 4 sorts out the good from the bad, and points out the downright ugly of these so called ‘cures’. PCOS is often accompanied by psychological problems such as depression, loss of control, and stress, so this part helps you find the right balance between body, mind, and spirit. Finally, this part gives you some really down to earth advice on what to do to ensure that you maximise your chances of getting pregnant and having a beautiful bouncing baby.
Part V: The Part of Tens
This part contains five lots of ten tips, which form a quick reference guide. Most of these tips are mentioned throughout the rest of the book, but this part brings them all together as a handy reference. You can find tips on the PCOS symptoms that you can diminish by using the advice in this book; how to distinguish the good diets from the bad; good reasons for following a low-GI diet; and ten superfoods you can incorporate into your diet to help reduce your PCOS symptoms. Finally, Chapter 18 lists ten organisations that offer support and advice to people like you who have PCOS or have a close friend or relative with it.
Icons Used in This Book
Icons are a handy For Dummies way to catch your attention as you slide your eyes down the page. The icons come in several varieties, each with its own unique symbol and meaning.
Your understanding of the health and diet world may be riddled with myths or old wives tales. Some of them may be based on truth, but most came from another planet and don’t apply to human beings living today on earth. This symbol means that the myth has been exposed for what it is!
This symbol marks the place where you can find explanations of the terms used by nutrition experts. Skip them if you like, but expanding your understanding is always good, if you have the time!
This icon draws your attention to an important point to bear in mind about dealing with PCOS.
These details add to your understanding of PCOS. You can get on in life perfectly all right without them, so skip them if you want to, but try a few first – they may give you some facts that may help you to answer the questions in obscure quiz shows!
The Tip icon does exactly what it says – cherish these little nuggets because they’re there to make your life a little easier.
This icon points to certain pitfalls or things that may actually harm you. Ignore at your peril!
Where to Go from Here
Where to go from here? Wherever you like, and you certainly don’t need to read from cover to cover, unless you like to follow tradition! You can dive right in anywhere in the book, because each chapter (and even each section) delivers a complete message. The table of contents is detailed enough to help you to pinpoint the area you want to know about, and you can use the index. If you want to know more about exercising to achieve weight loss, go straight to Chapter 10. If you want a healthy but tasty recipe for dinner tonight, jump to Chapter 9.
If you’re really not sure where to start, read Chapter 1, which gives you all the basic information about PCOS and helps you to decide which area you want to home in on first.
Part I
PCOS in a Nutshell
In this part . . .
This part gives you an overview of everything PCOS-related, and helps you to identify whether you have PCOS by listing all the symptoms.
In this part you get some straight facts about your condition, how it plays out in your body, how it changes when you change (such as when you get older or heavier) and how you can start to tackle it.
Chapter 1
Sensible and Straightforward Solutions for a Difficult Condition
In This Chapter
Understanding PCOS and its symptoms
Looking at treatment options
Working out what you can do to help yourself
This chapter is a great place to start to get on the right course if you suffer or suspect you suffer from PCOS, or if you have a friend, relative, or partner with the condition and you want a quick overview of the most important things you need to know about it.
This chapter gives an overview of the entire book; so in one chapter you get a feel for what PCOS really is and what its symptoms are. Most importantly you get an overview of treatments that are aimed at reducing the symptoms, mostly looking at what you can do for yourself.
Understanding PCOS
PCOS is the most common ovarian function disorder in women during the period of time before the menopause arrives. An estimated 20 per cent of women have polycystic ovaries (PCO), but despite having small cysts on their ovaries, they don’t have any symptoms of PCOS. For actual PCOS, where definite symptoms are present, the incidence in women is as high as 5–10 per cent and the rate appears to be increasing.
Defining the condition
According to the American Society for Reproductive Medicine, PCOS is defined by having any two of the following signs and symptoms:
Lack of ovulation for an extended period of time (which probably manifests itself as the stopping of your monthly period).
High levels of androgens (male hormones).
Many small cysts on the ovaries (normal ovaries have 5–6 follicles (cells), whereas polycystic ovaries have ten or more).
The hormones involved in controlling periods, and ultimately reproduction, are produced in the pituitary gland located in the brain. In PCOS two of these, called luteinising hormone (LH) and follicle stimulating hormone (FSH), are produced in proportions that are off kilter. The imbalance of these two hormones is thought to prevent the follicles in the ovary from developing properly: They tend to remain small and don’t mature enough to release an egg. As a result, a string of small follicles forms on the ovary giving rise to the characteristic polycystic ovary.
Trigger factors
PCOS is often described as being a condition of hormone imbalances and probably has a genetic basis, so you may inherit it from a parent. You are more likely to develop PCOS if:
You have a relative with PCOS (female relative of course!).
You have a relative with type 2 diabetes (male or female).
Your father went bald prematurely (yes, honest, it’s true!).
Obesity is also believed to act as a trigger to PCOS in women with a genetic pre-disposition.
You Know You Have PCOS Because . . . : The Symptoms
The symptoms of PCOS vary from woman to woman and can be present in any combination. They can also change over time and so, if you have PCOS, your symptoms are likely to be different from someone else you know with PCOS.
The most common PCOS symptoms include the following:
Weight gain, especially around the tummy.
Increased hairiness on the face and other regions (called hirsutism).
Male pattern baldness or thinning hair.
Oily skin with acne.
Absent or irregular menstrual cycles which leads to infertility.
For detailed information on the symptoms of PCOS, go to Chapter 2.
Weight gain
Not being able to control weight gain is often the most distressing symptom in PCOS, and unfortunately the rate of obesity in women with PCOS is 50 per cent. If you have found that you are gaining weight easily, you are likely to find that it tends to go on around your middle, a condition that your doctor or specialist calls ‘central adiposity’.
The symptoms of PCOS are more severe if you gain a lot of weight; as you lose weight, the symptoms diminish. If you are an overweight woman with PCOS even a modest weight decrease of 5 per cent leads to:
A decrease in your insulin level.
An improvement in your menstrual cycle (or acts as a trigger for it to start again).
Reduced testosterone levels leading to reductions in hirsutism and acne.
Emotional manifestations
If you have PCOS you are more likely to suffer from depression, anxiety, irritability, and mood swings. In fact it can seem as if you have premenstrual syndrome (PMS); the difference is that in PCOS, the symptoms don’t just appear before a period.
The emotional symptoms that accompany PCOS may be due to one, or all, of the following:
Hormone disturbances.
A host of upsetting symptoms caused by PCOS.
The stress of living with a long-term medical condition.
Another emotional manifestation of PCOS is the tendency toward eating disorders. A link exists between having an abnormal eating behaviour and PCOS. Binge eating and bulimia is more common than in the general population: 1 per cent of women have bulimia in the general population, whereas 6 per cent of women who have PCOS are bulimic. Go the section ‘Looking after the inside’ for basic info on dealing with an eating disorder; for detailed information about these disorders and PCOS, head to Chapter 2.
Insulin resistance
You may be told that you have insulin resistance if you have PCOS, but this is not something you can see, although it does lead eventually to physical conditions such as diabetes and heart disease. Insulin resistance, with the resultant high level of circulating insulin, is very common in PCOS. This condition is due to the muscles becoming resistant to the action of insulin, so that more insulin has to be pumped out to have any effect. Insulin resistance is more likely if you gain weight.
One of insulin’s functions in your body is to help your cells take up glucose which is used to create energy. If you’re insulin resistant, not only do you end up feeling tired and lacking in energy, but also, because your cells can’t utilise the glucose in the blood, blood sugar levels rise, resulting in type 2 diabetes. Type 2 diabetes is known as a silent but deadly condition because its symptoms can go unnoticed for many years, by which time damage to the eyes and kidney may have occurred and risk factors for heart disease increased.
Insulin resistance also leads to the development of abnormal levels of fats in the blood with rising levels of harmful cholesterol increasing your chances of having heart disease or a stroke. Again you don’t know you have high cholesterol unless you have a blood test.
Insulin resistance is the root of most symptoms in PCOS. When insulin resistance is present, normal amounts of insulin are insufficient to bring down blood glucose levels, which are a result of consuming carbohydrates. Your pancreas has to make even more insulin to compensate, which leads to a rise in the amount of insulin circulating through your body. High insulin levels mean that:
Your body stores more fat resulting in weight gain.
Your ovaries produce more testosterone which has an adverse effect on the reproductive hormones that control the formation of follicles in the ovary. The result is that your menstrual cycle may become irregular or your periods may even stop altogether.
Extra testosterone causes more free testosterone to circulate in your body causing acne and hirsutism.
Metabolic syndrome (syndrome X)
You may well ask what on earth this syndrome is. Here’s a quick definition: Metabolic syndrome is a cluster of conditions that often occur together, including obesity, high blood sugar, high blood pressure, and high levels of harmful blood fats, and it puts you at an increased risk of getting heart disease and type 2 diabetes.
If you have PCOS, you have an eleven fold increased risk of getting metabolic syndrome. (Fortunately, your risk of getting it decreases if you put into practice some of the advice in this book!). The diagnosis of metabolic syndrome (also known as syndrome X) is made when you have at least three of the following going on in your body:
Abdominal obesity (excessive fat tissue in and around the abdomen).
Abnormal blood fat levels, which includes high triglycerides, low HDL cholesterol (good cholesterol), and high LDL cholesterol (bad cholesterol). These together cause plaque build-ups in the artery walls.
High blood pressure.
Insulin resistance where the body can’t properly use insulin and more is pumped out to compensate.
An increase in certain substances in the blood which increase the likelihood of blood clots.
A rise in substances in the blood (with complicated sounding names such as C reactive protein!) that cause inflammation leading to an increased risk of damage to the artery wall and an increased risk of cardiovascular disease.
PCOS through Life Stages
Unless kept in check, PCOS can have an influence on each of your reproductive stages throughout your life. PCOS may be diagnosed at different life stages; for some women it may not be diagnosed until the menopause. At different life stages, the symptoms that lead to a diagnosis of PCOS can differ. Table 1-1 lists what kind of symptoms can be expected at each life stage.
The Three-Pronged Attack
Unfortunately no cure exists for PCOS, but you can control the symptoms so that the effect of PCOS on your body is minimal. Basically treatment involves the following:
Improving insulin sensitivity. This improvement prevents the whole cascade of later problems such as developing type 2 diabetes and abnormal blood fat levels which can give rise to heart disease.
Restoring normal ovulation and hence fertility.
Stopping the male hormone, androgen, levels in the blood from rising.
Treatment of PCOS therefore involves the three-pronged attack of:
Diet: using a weight control diet if necessary with low-GI advice.
Exercise: encouraging you to be more physically active on a day-to-day basis and throughout the day.
Emotional well-being: If you lack motivation, or are moody and/or depressed, you need to also incorporate some techniques for mood lifting and motivation.
Even if you are normal weight, research has shown that if you have PCOS, you still have a tendency to have raised blood concentrations of insulin compared to women without PCOS of the same weight. Eating a low-GI balanced diet and being physically active is therefore important, even if you don’t have a weight problem.
Treatment should be tailored to you and the symptoms you are experiencing, but it should also take into consideration whether you are aiming to get pregnant or not.
If you are not imminently planning a baby, treatment needs to focus on:
Correcting abnormal hormone levels.
Reducing weight (or maintaining a healthy weight if you aren’t overweight).
Managing cosmetic concerns, such as increased hairiness where you don’t want hair, and the loss of hair on your head where you do want it!
If you’re hoping to get pregnant, treatment needs to focus on:
Reducing weight, as a healthy diet with increased physical activity allows more efficient use of insulin and decreases blood glucose levels and may help you to ovulate more regularly.
Promoting ovulation with ovulation induction medications.
Maximising your health before you conceive and normalising blood sugar and blood insulin levels also make sure that, if you do conceive, there’s less risk of miscarrying or having a baby that develops problems.
Diet under the spotlight
The high insulin level commonly found in PCOS sufferers is to blame for the tendency to gain weight and the inability to lose it. That’s why, when you have PCOS, your diet is of vital importance because you have to balance several factors: calorie intake (to avoid excess weight gain), carbohydrate intake (to stabilise blood sugars), and so on. Therefore, a PCOS-friendly diet helps you to:
Lose weight to get to a healthy weight, or to maintain a healthy weight.
Reduce insulin resistance and the risk of developing type 2 diabetes.
Reduce the risk of cardiovascular disease.
Ensure a balanced and nutritionally adequate dietary intake.
The following sections explain the basic components of the low-GI diet and what you need to know to lose weight (or maintain a healthy weight). For detailed information on the low-GI diet and how to lose weight successfully, head to Part II.
Know your GI (glycaemic index)
Insulin resistance (a key symptom of PCOS) results in high circulating blood levels of insulin, especially when you eat carbs that break down very rapidly resulting in glucose entering the bloodstream very rapidly (glucose is the most common breakdown product of starchy and sugary food). To avoid stimulating a high release of insulin, you want to avoid the foods that result in the biggest increases in blood glucose. That’s where the glycaemic index (GI) comes in.
If you have PCOS, you need to eat meals based on low-GI foods, with medium-GI foods taken in moderation and high-GI foods eaten only occasionally. Table 1-2 lists a few examples of low-, medium- and high-GI foods (for more detailed lists, go to Chapter 4).
The glycaemic index (GI) is a method of expressing the glycaemic response of individual foods in relation to the glycaemic response of glucose. Glucose is given a GI of 100 so that other foods are given appropriate numbers relative to this. For example, spaghetti is given a GI of 41. Only carbohydrate containing foods can have a GI value, so for example meat, cheese, and some green vegetables aren’t given a GI value.
Diets to avoid
Avoid diets that restrict the intake of certain groups of foods or ban them completely. Avoid diets that advocate you take certain supplements too. Such diets are likely to be unbalanced. Low-carb diets are often advocated in popular books and Web sites for PCOS. These diets aren’t recommended because they:
Are high in fat and so are likely to raise your cholesterol level, putting you at a higher risk of heart disease.
Tend to be high in protein which may put you at a higher risk of kidney problems, especially if you already have diabetes.
Cause you to produce more ketones from the breakdown of fats. As well as making you feel awful and causing your breath to smell, if you do fall pregnant, you can damage the baby with such high ketone levels in the blood.
Balanced eating
Watching the GI value of food shouldn’t be the be-all and end-all of eating for PCOS. Here are some other diet bits you need to keep an eye on:
Establish a pattern of regular meals and snacks.
Avoid low-carb diets as they don’t do your overall health much good.
Eat a varied diet to ensure that you have the complete range of vitamins and minerals that your body needs.
Fat is twice as high in calories gram for gram as carbs or protein, so don’t pile on the spreads, oils, butter, cheese, or mayo, and avoid pastry. The fat you do eat should be the unsaturated type.
Salt and alcohol intakes should follow healthy eating and drinking guidelines (see Chapter 3 if you’re not sure what the guidelines are).
Don’t forget to include some oily fish (like mackerel and sardines) in your diet every week.
Your requirement for calcium may be higher than expected because of PCOS; so if you’re concerned that you don’t have much milk, milk products, or alternatives such as calcium fortified soya products, you may need to take a calcium and vitamin D supplement.
Weight loss practicalities
You can measure your weight in three ways:
Body mass index (BMI). You need to aim for a normal Body Mass Index of between 18.5 and 25. BMI is covered in Chapter 5.
Body fat percentage. This measurement should be around 20–30 per cent. (You can buy scales for home use that measure this for you.)
Waist circumference. For women, a waist circumference measure over 80 centimetres (31.5 inches), regardless of your height or body type, indicates an increased risk of developing heart disease, diabetes, blood pressure, and other related diseases.
If you want to lose weight, you should be aiming for a calorie allowance of around 1500 cals a day, which should allow you to lose about half a kilogram to one kilogram (1 to 2 pounds) a week, depending on how active you are. You also need to make sure that your portion sizes are reasonable – use a smaller plate so that you can’t actually serve yourself a meal that is overly large. A healthy dietary plan involves having three meals with two small snacks. For great tasting low-GI recipes, go to Part III.
Get physical
The good news about getting more active is that it offers huge benefits to symptom reduction in PCOS. The benefits extend well beyond PCOS and into many other areas from cancer prevention to lifting moods.
Benefits of exercise
The reasons to exercise if you have PCOS (and for general health) include the following:
Helps maintain weight loss and allows you to have a few more calories while on a weight loss diet.
The ideal combination is to lose weight by following a sensible weight control diet along with a minimum of half-an-hour physical activity a day.
Improves the relative mount of muscle to fat and improves overall body shape.
Improves insulin sensitivity.
Increases the levels of good cholesterol in the blood (HDL).
Reduces blood pressure.
Decreases the risk of developing heart disease and diabetes.
Improves bone density and so reduces your risk of developing osteoporosis (brittle bones).
Improves your psychological health, such as self-confidence, well-being, and self-image.
To maximise the advantages of doing exercise you need to combine aerobic exercise (which causes you to get a bit breathless) with some resistance training (such as lifting some weights), and some stretching and flexibility work to maintain joint and muscle strain-free movement. Chapter 10 explains what you need to know.
Tips for exercising success
There’s a high drop out rate among people who take up exercise. To avoid this drop off yourself, and make sure that you reap the maximum benefits from exercise, plan ahead and bear a few things in mind:
Don’t be too ambitious or you’ll never keep it up!
Plan to do exercise that fits into your lifestyle and that you enjoy doing.
If time is a barrier, incorporate exercise into your daily routine. For example, if you normally pop to the shops most days to top up on your food shopping, think about walking or cycling there instead.
You don’t have to join an expensive gym: Do exercise you can perform from home, or just go out for a brisk walk, cycle, or jog.
The amount of moving about you do throughout the day is as important as any formal exercise session you undertake. So think about how you can build in more activity throughout the day.
Looking after the inside
Knowing about what wonderful results can be achieved by diet and exercise is all very well, but if you are unable to take the advice due to an overload of stress, anxiety, or depression, having an encyclopaedic knowledge of PCOS is going to do you a fat lot of good. In order to be able to act on your knowledge about what you should do, you need to feel fired up, ready for action, and on a fairly emotional even keel.
An important key to getting well is to treat yourself kindly. Recognise that PCOS is a major stressor in your life and give yourself permission to work through the feelings associated with it. If you are to diminish the symptoms associated with PCOS you must also recognise the emotional effects of PCOS.
PCOS often leads to feelings of anxiety, low self-esteem, and loss of control. The emotional effects of PCOS can start in the teenage years when the symptoms such as weight problems, excess facial or body hair, and acne, start to emerge. To make matters worse, the journey to a diagnosis can be long and painful. Once a diagnosis is made, it can be a relief to know that the symptoms aren’t just in your mind. But then you’re left with the stress of knowing that you have to cope with a long-term condition. Empowering yourself by knowing what PCOS is about and what you can do about it so that you are in control can help to lessen the emotional frustrations.
Dealing with emotional symptoms
One of the best ways to deal with the emotional fallout of PCOS is to find support from people who understand what you are going through. Online support groups, national associations with local chapters, group meetings, and many other ways are available to get to know people who are struggling with the same problems you have. When you feel isolated you are more likely to experience depression. If the depression is serious you may need to see a counsellor.
Chapter 12 explains in more detail the effects of PCOS on your emotional well-being and offers strategies and advice on how to avoid or ameliorate the most common emotional pitfalls.
Mood and motivation
Vicious circles are common in PCOS. Getting into shape and reducing the symptoms can seem such an uphill struggle that it may seem easier just to give up and give in. But in doing this you feel more and more depressed and feel that extreme actions are required. However extreme actions just set you up for failure once more and the circle continues. To offset a complete relapse you should bear the following in mind:
Tripping up from time-to-time is inevitable. When it happens, pick yourself back up and set yourself back on the road.
Start things gradually.
Make sure that the changes you make can be incorporated easily into your lifestyle and that you can keep them up long term.
Set yourself smaller mini goals along the way and reward yourself with something other than food each time you achieve a mini goal.
Keep a food diary and an exercise diary. If keeping a diary permanently is too much, just fill it in for a week initially, and then from time-to-time when you feel your resolve is slacking. Include keeping a track of your moods too. A diary can remind you what you were doing when things were going well, but it can also help bring things to light when things aren’t going so well.
Eating disorders
If you have a distorted pattern of thinking about food and behaving around food, you may have an eating disorder. If you have an eating disorder you’ll also have a pre-occupation and/or obsession with food and your use (or indeed non-use) of food is likely to be out of control.
Any eating disorder requires professional help and usually cognitive behavioural therapy (CBT) is given. Acknowledging what the triggers are to this behaviour is important – they are frequently mood-based, especially feelings of low self-esteem. CBT is given alongside dietary advice aimed at restoring normal meal patterns of three reasonable meals a day plus snacks if appropriate. This restoration of regular meal patterns is to break the cycle of bingeing then purging or starving.
Trying Out Other Stuff
Paying attention to your diet, your exercise levels, and your emotional health are things that you can do yourself, with a bit of support from friends, family, and some relevant experts such as personal trainers and dieticians. However, there may be times when you feel this just isn’t enough and you may have to get extra support, as outlined in the following sections.
Medication
As well as taking on board the diet, exercise, and motivational advice in this book, it may be that your doctor feels you also need some medication to help reduce your symptoms, as not doing so quickly can put you at risk of developing other diseases such as diabetes, heart disease, or possibly even endometrial cancer (cancer of the womb lining).
You should only take medication that is prescribed by your doctor or specialist especially for you.
For insulin resistance
Although not favoured by all doctors and PCOS experts, many still use metformin, an insulin sensitising drug, to treat PCOS. The drug seems to help with the following PCOS symptoms:
Menstrual regularity and so improvements in fertility.
Androgen level reduction leading to reduction in hirsutism and acne.
Weight loss.
For acne and hirsutism
If you have hirsutism and/or acne, you may be prescribed a combined oral contraceptive pill containing the anti-androgen, progesterone. ‘Yasmin’ and ‘Dianette’ are two examples of pills containing progesterone. If a contraceptive pill is not required, you may just get prescribed some anti-androgenic medication such as ‘Spironolactone’ or cyproterone acetate.
For fertility problems
Lifestyle changes are the best way to address fertility problems, but if some help is needed, you may be prescribed a drug called ‘clomid’ (clomiphine citrate), often with chorionic gonadotrphin (a reproductive hormone). The two together help the follicles in the ovary to develop properly and for ovulation to occur. If you don’t ovulate, no egg is released to be fertilised by the sperm.
For weight loss
If you are finding it tough to lose weight, despite having tried to do so on numerous occasions, and/or your current weight is endangering your health, your doctor may put you on one of the three anti-obesity drugs that are on the market. You need to be carefully monitored while you are on such medication, as these drugs are not without some side effects.
Supplements and herbals
When you read up about PCOS, or surf the Web on the subject, you find that a whole plethora of herbal remedies and supplements are recommended for PCOS. Go to Chapter 11 for more information about supplements and herbals.
Be wary of the advice you find. Supplements and herbal remedies can be harmful, especially if you decide to take them without the backing of a professional medically qualified practitioner. Before you take any herbal or supplement, consult your doctor.
Supplements
The following list explains what supplements you can safely take, unless advised otherwise by a doctor or dietician:
Calcium and vitamin D: Take these supplements if you don’t include much milk or dairy products (or their alternatives such as fortified soya products) in your diet.
Iron supplements: Iron supplements may be necessary if you have heavy periods and have been found to be anaemic.
A multivitamin and mineral supplement: If you know your diet has been unbalanced for a while, you may need multivitamin and mineral supplements. Only take a supplement that provides up to the recommended intake of the nutrients and choose one that includes chromium.
Folic acid: If you are planning on getting pregnant, you want to make sure that you get enough folic acid. The dose advised is 400 micrograms per day.
Herbals
As far as herbals go, the really strong contender as being truly effective in PCOS is Agnus Castus. Other herbals may have an effect but so far, the evidence supporting them is still weak.
Agnus Castus is available as a dried berry extract in tablet, capsule, or liquid form. The active ingredients are compounds similar in structure to sex hormones that act on the pituitary gland in the brain to affect ovarian hormonal production, helping to normalise menstruation patterns.
Alternative therapies
Natural remedies should only be tried if you follow the advice of an experienced qualified practitioner with an interest in women’s health including fertility. At present, no clinical trials have been completed on alternative therapies in this area. However, you can try some treatments that may help you to relax and which should be relatively safe, including massage and reflexology. Chapter 11 discusses the alternative therapies – both good and bad.
Chapter 2
Knowing You Have PCOS
In This Chapter
Checking out the physical symptoms of PCOS
Thinking about the psychological effects of PCOS
Finding out if you are at risk
Dealing with the symptoms
If you have PCOS, you have the most common hormonal and reproductive problem affecting women of child-bearing age. In recent years it has become apparent that PCOS is much more common than was previously realised.
In the past, only women with the most severe symptoms were acknowledged to have the condition that is now known as Polycystic Ovary Syndrome. (Previously the condition was known as Polycystic Ovarian Disease or Stein-Leventhal syndrome, after the two doctors who discovered it in the 1930s.) Nowadays, with much more advanced diagnostic tools being available such as ultrasound, doctors are better at recognising the condition, even if the symptoms are only mild.
This chapter spells out how you can recognise if you have PCOS by exploring the physical, emotional, and hidden symptoms of PCOS. It also looks at how you or your doctor can spot PCOS and touches on how to cope with PCOS through your life stages.
Overweight and under the Weather: Symptoms of PCOS
PCOS is associated with multiple cysts on the ovaries (sometimes described as a ‘string of pearls’). These cysts are immature follicles, the egg-containing structures in the ovary, one of which should grow monthly to release an egg (ovulate). The cysts themselves are harmless, but PCOS is also accompanied by a host of other symptoms which are caused by certain hormones being out of balance, and this inhibits the normal growth of the egg-containing follicles. (In fact the word syndrome means a group of symptoms.) The following sections outline both the obvious and not-so-obvious symptoms of PCOS.
You and your PCOS are unique. You can get quite a few symptoms with PCOS, but the combination of particular symptoms probably varies from someone else’s symptom profile. Some symptoms are more common than others; namely weight gain (especially around the middle), skin problems, hairiness, and a tendency towards diabetes and infertility.
Around 20–30 per cent of women have polycystic ovaries, but not all go on to develop symptoms. Once symptoms do develop, that marks the change from simply having symptom-free polycystic ovaries to polycystic ovary syndrome. The incidence of actual PCOS is probably around 5–10 per cent of women in the developed world, although it is on the up which experts claim is due to the increasing number of overweight and obese people in the population.
Physical symptoms
Several symptoms manifest themselves physically in PCOS. Because many of them affect the way you look, they can have a large impact on your psychological health too. The situation isn’t all doom and gloom though – these symptoms start to lessen as you take on the advice in this book.
Period disruption
In PCOS, your period may be:
Absent altogether – known medically as amenorrhoea.
Irregular – known medically as oligomenorrhoea.
Heavy – known medically as menorrhagia.
Lasting for a long time.
As a PCOS sufferer you are more likely to have higher than normal levels of androgens sloshing around your body. Androgens are male hormones – the best known being testosterone – which all women produce in their ovaries. The abnormal level of these male hormones, along with other hormonal disruption, is responsible for the period problems you may be experiencing. However, you may be one of the lucky ones because about 1 in 5 women with PCOS have perfectly normal menstrual cycles.
Weight gain
You have a 50 per cent chance of being overweight with PCOS (but that also means you have a 50 per cent chance of not being overweight!). Insulin resistance and the increased levels of male hormones that occur in PCOS are believed to be the main causes of weight gain, which occurs particularly around the middle. If you observe any male friends (or maybe your partner!) who are getting a bit chubby, you often find that this is where they first put on weight. In males, weight gain around the middle is sometimes referred to as a beer belly.
The elevated levels of glucose in your blood stream, which occur, for example, after you eat a carbohydrate-containing meal, trigger the pancreas to release insulin which allows the cells in the body (such as muscle cells) to absorb the glucose. If you are insulin resistant (a common condition in PCOS), excessive amounts of free-floating glucose remain in the blood stream because it can’t properly enter the cells. This excess amount is eventually sent to the liver and converted there to excess body fat.
Different hair growth patterns
A change in hair growth usually manifests as excessive hair growth on parts of the body that ought not to be hairy on a woman. (The term for this pattern of hair growth is hirsutism.) You may find that you develop hairiness on your face, chest, stomach, and back.
Unfortunately, as well as gaining more hair in places where you don’t want it, with PCOS you are more likely to lose it on your head, a condition known as alopecia. Don’t worry: You aren’t going to go completely bald! What tends to happen with PCOS is that you get a gradual overall thinning of the hair, or thinning at the corners above the temple. As thinning continues the hair may go see-through so that it looks like a fine, fuzzy halo when light shines on it.
If you do suffer from alopecia, it’s rarely severe and can be controlled by bringing down your male hormone levels by following the diet and exercise advice in this book (in the short-term your GP may also prescribe medication to do this). Remember that losing around 100 hairs a day is normal. Keep this in mind before you convince yourself you have alopecia.
Fatigue/exhaustion
You may find that you need more sleep than you used to and perhaps also crave a nap in the middle of the day. Even so you may still feel tired a lot of the time and have a real job waking up in the morning. This kind of tiredness is commonly associated with PCOS.
Lack of good quality sleep also means you’re more prone to tiredness and exhaustion. Although some women with PCOS do go on to develop chronic fatigue, dealing with symptoms early can help avoid this happening.
The hormonal fluctuations underlying PCOS can mean that you experience difficulties in getting a full night’s restful sleep. Worry and frustration associated with having PCOS may also be contributing to any rough nights you’re experiencing.
