Guest post by Dr. Brooke Kalanick
PCOS nutrition advice often falls into two camps: eat a diet rich in whole grains or simply, go low carb. While women do need to be mindful of carbs, as they trigger the hormone insulin which is one key hormone issue (insulin resistance) for PCOS, it’s certainly more complicated than good carb (whole grain) vs. bad carb (bread, pasta, candy, etc.) OR merely low carb vs. high carb.
First, let go of the idea that some carbs are “good” (i.e. whole grains) and other are “bad” and instead think of carbs as fibrous or as starch/sugar.
Fiber carbs (vegetables): any greens, cucumber, asparagus, celery, broccoli, cauliflower, etc.
Starch/sugar carbs (all grains): all grain based products (breads, cereals, pastas, etc.), all legumes (kidney beans, soy, etc.) and all root veggies (beets, sweet potato, turnip, etc.).
As far as fruits go, again it comes back to fiber.
Highest fiber fruits: apple, pear and berries
Lowest fiber fruits (aka: highest sugar): melons, grapes, tropical fruits and banana
Other fruits are somewhere in the middle.
This doesn’t mean starch/sugar carbs have no fiber; it means its starch or sugar load outweighs its fiber content when it comes to insulin and blood sugar response. It’s this hormone reaction we’re trying to manage when it comes to carb sources for PCOS and insulin resistance. And because insulin resistance – the decreased ability for your body to respond to insulin’s message to shuttle glucose, vitamins, etc. out of the blood stream for use and storage – varies from woman to woman with PCOS, and even from tissue to tissue (i.e. liver, muscle, fat) within that same woman, how many carbs, what type and even when to eat them needs to be customized. Luckily, you can do that through a bit of detective work.
You must understand your Unique Carb Tolerance (UCT) to best manage insulin and your PCOS. With it, you can suss out your own ideal diet for optimal health, great energy, managing your PCOS symptoms (cycle irregularities, fertility, clear skin, etc.) and maintaining or losing body fat.
- This goes beyond good carb/low carb templates which fall so short for women with PCOS for several reasons: Other hormones are often involved (i.e. cortisol, thyroid)
- Certain foods cause more inflammation and trouble for some of us (i.e. gluten or dairy)
- Food combining (i.e. too much fat with too many carbs) are harder for some of us to metabolize.
Learning to let your symptoms guide you to find the amount, type and frequency of carbs that work for you is the best nutrition strategy for PCOS that I’ve found.
Now back to you and your detective work. Did you know insulin is talking to you all day? It is a key hormone in the symptoms or signals you experience such as appetite, craving, energy and sleep (ACES). The other hormone involved it cortisol. And yes, there are many other hormones involved these ACES symptoms, but insulin and cortisol are largely within our control and adjustable in real time. (More on this here.)
The symptoms having to do with insulin resistance happen mostly after meals whereas the symptoms of struggling to have cortisol keep your blood sugar regulated between meals happens just then: between meals. So, if your ACE symptoms are off between meals, think adrenals and dysregulation in the HPA (the brain-adrenal axis) and symptoms after meals are related to insulin resistance and a stressing of your blood sugar lowering mechanism, commonly an issue with PCOS. And it’s not uncommon to experience both trouble between and after meals (insulin and cortisol issues).
Here is what you’re looking for:
After eating: fatigue, sleepiness, craving for sugar/starch (cravings not typically relieved by eating those things), increased appetite (just want a little something more….) or craving stimulants like a cup of coffee. These are all signs you overshot your UCT either with the amount or type of carb you choose.
If you’re getting symptoms between meals such as fatigue, forgetfulness, irritability, sugar cravings, lightheadedness, headache etc., this is likely more difficulty keeping your blood sugar up vs. insulin resistance. However, these two are closely linked, and insulin issues can be part of reactive hypoglycemia (blood sugar rollercoaster). More on that here.
Ready to experiment?
Be scientific. Use the same meal and only change the carb source. Pick one starch or sugary fruit and eat it with the same combo of protein, fiber and fat. Here’s an example:
Mixed green salad dressed w/olive oil & vinegar, 4oz chicken breast ½ cup or 6 bites of sweet potato
Watch for symptoms above immediately after eating or 2 hours after eating.
If right after eating you get symptoms of sleepiness, craving for coffee/stimulants, cravings for more starches or sweets, try cutting the amount of sweet potato back at next meal of mixed greens salad and chicken.
If you get symptoms 1-2 hours after eating of cravings, ravenous hunger, irritability, lightheadedness, cranky, etc. then at the next meal, up protein slightly, up fiber slightly (i.e. bit more chicken and bit more greens), but do not adjust carbs yet. If this doesn’t relieve the issue, add a touch healthier fat (olive oil or avocado to the meal we’re using as an example, or a few nuts). If none of these work, then up the sweet potato by 2 bites.
Continue this experimental eating for different types of carbs and different amounts. This may seem tedious, but most women find they get in tune with these symptoms within a couple of days and can then infer how they will feel for multiple foods based on one food reaction. For example, I can tolerate about 2 bites of gluten free grain whether it is quinoa or brown rice. I can tolerate a fair amount more of legumes, but sweet potato – although I love it – seems to make me crave more sweet potatoes no matter if I have 1 bite or 10. So not a good carb for me, right?
And note that many women with PCOS have food intolerances when it comes to dairy, gluten or grains in general. This means if you get sleepy or craving sugar/starch after eating these foods, it can be related to either an exaggerated insulin response OR inflammation from that particular food. I actually coach women with PCOS to think of dairy as a carb, although it has plenty of protein, the insulin response can be increased to dairy, and it tends to cause more inflammation when you have insulin resistance.
You will notice that if you’re trying to do this for more processed foods like breads and sugars, then your symptoms will be more severe – the reason these foods made the “bad carb” list in the first place. But you’ll also notice that you’ve got some unique tendencies, and while some nutrition expert may say legumes are the best carb out there, you may not do so great with them.
Get yourself a journal or notebook and make some notes – you’re literally learning your chemistry and seeing what makes it work better or worse. Writing it down in real time – although a pain in the rear – is far more accurate and effective than trying to recall if you were cranky because of your lunch or your boss an hour after you ate.
Struggling to get a clear message from your symptoms alone? Here’s where you pull out the glucose meter and during this experiment you’ll take your blood sugar…a lot. But don’t’ worry it’s not forever.
Get a reading fasting as well as just before eating, 1 hour after the start of eating (to see the peak doesn’t go over 200) and 2 hours after eating (to see if you get back down below 100). Then use the same experiment above to make adjustments and get the blood sugars within range.
Here’s to learning what works for you.
A licensed Naturopathic Doctor (ND), Dr. Brooke attended Seattle, Washington’s Bastyr University, where she earned a Doctorate in Naturopathic Medicine and Masters in Acupuncture and Chinese Herbal Medicine.
Dr. Brooke takes a balanced approach to health, using both conventional and alternative therapies. Metabolic nutrition, fat loss resistance, and fitness remain her area of focus and in her Manhattan clinic she primarily treats women with Hashimoto’s Hypothyroidism and PCOS – as well as other female hormone imbalances.
With these women she works to reset their hormones, their heads, and their habits, so they can finally feel at home in their bodies. Learn more about Dr. Brooke on her website, and connect with her on Facebook and Twitter.