Find YOUR “Best PCOS Diet” [Podcast] - PCOS Diva

Find YOUR “Best PCOS Diet” [Podcast]

PCOS Podcast No. 112 YOUR Best PCOS Diet“Do your own research. Don’t get overwhelmed, don’t feel like you have to take 20 supplements, and you have to follow all these rigid plans. Just take it a step at a time, set some goals for yourself. It needs to be the big picture, not just nutrition, but also exercise, sleep, stress management, and emotional health.” – Martha McKittrick

There are a lot of people out there willing to tell you the best diet for PCOS. Many of them are well meaning, telling the story of what worked for them. As a result, there is a lot of confusion. Should we all eat Keto or vegan? Try intermittent fasting, low carb, no carb? The truth is this: There Is No Best PCOS Diet. It is entirely individual. Registered Dietician Martha McKittrick explains why that is true and the steps you can take to find the diet that works for you. Listen in (or read the transcript) as we discuss:

  • 4 things just as (or more) important than diet
  • The diet that will help you find a diet
  • Role of the gut microbiome & why it may dictate your diet
  • Tips and tricks to figure out what works best for you
  • Exercise that we all need to do

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Mentioned in this podcast:

From Martha McKittrick:

Food Sensitivity Testing- Your Next Step in Healing PCOS? [Podcast] (Dr. Margrit Mikulis)

Managing PCOS, Dating, & Relationships [Podcast] (Dr. Gretchen Kubacky)

Full Transcript:

Amy:                     I am thrilled to welcome back one of my most popular PCOS Diva Podcast guests, and that’s registered dietician, Martha McKittrick. Just so that you know, she has done two other episodes, episodes 63 on Practical Tips to Tame PCOS Inflammation, and episode 84 on the Pros and Cons of the Ketogenic Diet. Welcome, Martha. I’m so excited to be talking about today’s topic, which is why there is no “best diet” for PCOS.

Martha M:          Thanks, Amy. I’m so excited to be back. I always love coming on your podcast, and I’m so happy that this is the subject that we’re going to be talking about, because it’s kind of my mantra.

Amy:                     I know. I think that there is a lot of confusion, especially among social media with all of these Facebook groups out and about, and people expressing a lot of success with whatever diet that they’re choosing, and then it kind of sends us down this path of okay we’re going to try the Keto diet, or the Vegan diet, or Intermittent Fasting, because it worked for another woman with PCOS, it must work for me.

Martha M:          Exactly. I think social media is a blessing and a curse. I think it’s great because we can do our own research, and you can advocate for yourself, or learn about PCOS, but where it can be I think kind of a curse is that if you’re on Instagram, or Facebook groups, like you said, there are maybe women who have had success with certain types of programs, and they’re attracting followers, but it’s kind of like they’re saying this is how you have to do it.

There’re all kinds of articles if you Google “diet and PCOS” you’re going to find all kinds of stuff out there, and it’s kind of like this is the diet you have to follow, and it’s just so confusing for women. When I read this stuff, it drives me nuts, but I can’t even imagine if you have PCOS how you must feel when you’re reading all this stuff.

Amy:                     We’re going to sort of demystify and talk about really the one best diet, and before we dive into the content for today’s podcast, I just want to give those who don’t know about your work a little bit more information about you. You’re a registered dietician, a certified diabetes educator, and well coach. You’re a certified health and wellness coach, and you’ve been specializing in PCOS for over 15 years.

You’ve lectured across the country to medical professionals and women with PCOS. You’ve been published in many medical journals, and you wrote two chapters in a book about PCOS, it was one of the first books that I read about PCOS, which was, A Patient’s Guide to PCOS, by Doctor Walter Futterweit. You’re also on the Health Advisory Board for PCOS Challenge. I know I see you at a lot of PCOS Challenge events. You’re just really immersed in this PCOS world, and so I think that you’re really one of my go to guides for nutrition for women with PCOS. I’m glad you’re here today sort of talking about really what’s the one best approach.

I just want to call out your Instagram page. You have a great Instagram page, and you had a really good meme about why there is no one best diet, and I was talking about sort of the one best approach, but one best diet, so I thought that was really informative, and I was hoping that you can kind of talk a little bit more about what was on that meme, and what do we have to consider when we’re looking at the best way of eating for us.

Martha M:          Yeah. I don’t have PCOS, but I’m super passionate about it, and I just find it’s very interesting, and I think kind of helping to treat women, diet and lifestyle play a huge role in it, and that’s why I say lifestyle, because it’s not just diet, and I think a lot of women kind of get caught up on just follow this kind of diet, or that kind of diet, and forget about getting enough sleep, and exercise, and stress management, and emotional health. That to me is sometimes even more important than the actual diet part.

To answer your question, I kind of believe there’s no one size fits all approach when it comes to nutrition for PCOS, or diet for PCOS. There’s so many reasons why, and when you read some of these things on social media it might say, “You have to go Keto,” or the opposite, “Go plant based,” and, “This is what you need to do if you have PCOS,” but we can’t say there’s a one size fits all approach for women with PCOS, and there’s a couple different reasons, and some of them are really sneaky, but really interesting.

I think the more basic reasons is everybody has different metabolisms. Some women can eat 1800 calories and others need to eat a lot less to lose weight, and I know not everybody counts calories, and I don’t recommend everybody counts calories, but we have very different varying caloric needs, so if you’re trying to follow this kind of one diet plan that somebody’s selling it may not work for you, because if you eat too few calories it’s not good, but on the other hand if you eat too many you’re not going to lose. We’re very individualized there. We have different activity levels.

If you’re very, very active, you may not do well on a very low carb diet, because you need carbs for energy, and that can actually backfire, and you can make your symptoms worse. There’re different degrees of insulin resistance. Some women are not as insulin resistant as others. In my experience, I found the more insulin resistant you are, you might need to be a little stricter with your carb intake. Again, it depends on the woman. Every single woman with PCOS does not have to be on a really low carb diet.

Amy:                     Yeah. I wanted to just interject my personal experience. I tend to be more on that sort of thin phenotype of PCOS. I never really had insulin resistance come up on my blood work, but I know I do have a degree of insulin resistance. For me, I cannot go without any grains, because it makes me feel very shaky, I don’t feel grounded, so I have to have some type of grain like rice, or oats in my diet to just sort of make me feel stable, where in my experience, a lot of women who are more insulin resistant tend to feel better without as much grain.

Martha M:          Exactly. They have done studies where lean PCOS women tend to have increased rates of hypoglycemia, which is exactly what you just said. If you don’t have enough grains, or if you go to long without eating, you can get these really shaky bad feelings, so you’re right. That’s why there’s no one size fits all approach for carb intake, for sure.

Another one is, and this is where, oh, medical conditions, for example, somebody might have high cholesterol, so they might need to be a little more careful with the kinds of fats that they’re eating. If you have other medical conditions and you take that into account, because you know Keto may not be the best diet for you, if you have high cholesterol, or genetically high cholesterol, especially, so you need to keep that in mind.

Amy:                     Yeah. Something else I was wondering if you’re seeing this, that women that are on the ketogenic diet that may have sort of fatty liver issues that it tends to kind of aggravate fatty liver, that’s what I’m seeing in some-

Martha M:          That makes me a little bit nervous. I mean, I’m really open minded about different kinds of plans, that’s why if somebody comes to me, and they have their heart set on Keto, I’ll work with them and say, “Well, maybe it’s not the best, but, hey, let’s do it this way, let’s make it be healthy,” but my concern is if you have fatty liver, and a huge percentage of women with PCOS and type II diabetes have fatty liver, and eating large amounts of fat is not good for fatty liver. I haven’t seen any studies that show it worsens it, but I certainly would think that it would. Yeah. That’s certainly an issue.

Other things where I think it kind of gets interesting is when it comes to food intolerances or food sensitivities. The thing about this is it’s kind of hard to diagnose it in a test, and you read a lot of things on the internet that says, don’t have dairy, and don’t have gluten, and I don’t think there are any studies that really show if you have PCOS you should not have gluten, but if you cut it out, and you feel better, you might have a gluten sensitivity.

That’s a huge, I think, part when you are picking a diet that fits best for you, would be the food sensitivities. Common food sensitivities could be to diary, it could be to gluten, there are other foods, too, but those are two common ones. How do you know if you have a food sensitivity? The best way would be to cut it out. Cut it out of your diet for at least a couple weeks, even two to four weeks, and then you could reintroduce it, one food at a time, and just see, do your symptoms come back?

If they do, then you know that you might have a food sensitivity to that particular food, but I don’t think automatically every woman with PCOS needs to cut out gluten. I know that’s on a lot of the social media accounts is that you have to go gluten free if you have PCOS. I really believe it depends on the woman. I have lots of women who say, “Hey, when I have gluten I don’t feel well, I might have some stomach issues, or I have achiness, or PCOS symptoms get worse, but when I cut it out, I feel better,” then you know what that’s great, don’t have it.

Amy:                     I know for me it’s not so much stomach bloating, it’s the mood when I have it, I get very kind of depressed and irritable to the point where my husband can sometimes tell if it’s slipped back into my diet.

Martha M:          Wow.

Amy:                     I think it’s inflaming my gut and brain, that’s my theory.

Martha M:          Yeah. I would say that gluten can cause inflammation in people who are sensitive to it, and it’s because all different symptoms, like you said, it’s irritability, it’s mood. Some people say joint pain, or fatigue, brain fog, migraine, so there’s a lot of symptoms that could come from having gluten, if you’re sensitive to it. I think women with PCOS tend to already have a low-grade inflammation, and if you’re eating a food that you’re sensitive to it can make your inflammation worse. That’s why when you cut that food out, you feel better. It certainly works doing a trial of cutting certain foods out.

Amy:                     Right. I think all of those symptoms that you mentioned are good kind of benchmarks for you to pay attention to with any food.

Martha M:          Exactly. Then, the dairy one it’s the same kind of thing. Dairy, could cause a couple different things. I’m not anti-dairy with PCOS. I mean, I certainly don’t recommend you start drinking glasses of milk, and eating ice cream, but I find if you have a plain Greek yogurt, or a little maybe shaved Parmesan on a salad, I’m okay with that, but you have to pay attention to how your body feels. A couple different things could occur with dairy. One of them is lactose intolerance.

It’s believed about 70% of the population has a lactose intolerance to a certain degree, and that means you’re missing an enzyme that helps you break down the milk, sugar lactose, so when you eat something with lactose, like yogurt or milk you would get gas, or bloating, or diarrhea. You would have a gastrointestinal symptom, so that’s lactose intolerance. If that’s your issue, sometimes if you have something like hard cheese, you wouldn’t get the issue as much, it occurs more with milk and yogurt. In that case, just don’t have it, or if you really love yogurt, you could buy a lactose free yogurt kind of thing. That’s lactose intolerant.

Another thing that could happen, and that’s due to the sugar in the milk, there’s also protein in milk, some people actually have allergies to the protein in milk, so if you eat dairy, and you have reactions like itchy throat, or hives that could be actually due to the allergy, and then you get tested from your doctor, and they can tell you if you have an allergy to milk, or any other food.

The last thing is a sensitivity. You may have a sensitivity to dairy, and the way you would test that is you cut the food out, and you see if you feel better. They have done studies with acne and dairy, and if you have acne and PCOS, you may want to do a trial of cutting out dairy, or eating it very minimally and see if your acne gets better. That’s kind of how I feel about dairy.

I don’t think women with PCOS should be having a lot of dairy just due to the hormones in the milk, but I’m not totally anti-dairy. I think it also depends on the kind of dairy that you’re having. Like, if you have a Greek yogurt, or something that’s fermented, that can actually help with good bacteria in your gut, which is a really good thing, so I would say if you are going to have dairy I’d rather see you have something fermented, like kefir, or yogurt, or real milk.

Amy:                     I often say to think about cheese, like you had mentioned just a little Parmesan on a salad, or an entrée to think of cheese as like a garnish. I know so many are I think addicted to cheese, and think of cheese as really your protein in a meal, and I just don’t think that, that’s the right approach to looking at dairy.

Martha M:          I agree. Also, think about cheese, like what does it often go along with? Pizza, lasagna, maybe on pasta, so like you said, if you have a little cheese in salad that’s different than having something where there’s a lot of cheese in your main meal, so that depends.

Amy:                     The food sensitivities, I just wanted to call attention to the podcast I did with Dr. Margrit Mikulis, and we’ll put that in the show notes, but she talks about food sensitivity testing. My husband and I did the test that she talks about on the show, and my husband found out that he’s highly allergic to cinnamon, and we never really put two and two together until we got those test results, and now he can really tell when he’s had cinnamon, it makes him feel really kind of logy for the rest of the day.

Martha M:          Yeah.

Amy:                     He can kind of feel it in his mouth, too, his mouth gets kind of raw, but you’d never think cinnamon would be something that you’d be allergic to, so I think that there’s a lot of different foods you could have sensitivity to.

Martha M:          Exactly. That’s so interesting. Wow. I’m going to have to listen to that podcast. Then, the next thing is we’re going back to the food intolerance, there is a condition called, IBS, which can affect up to 20% of the population. It’s so common. That’s one of the areas that I specialize in my practice, and some studies say that it might even be more common in women with PCOS, that’s because of the ultra-gut microbiome, but in any case, it’s very popular, it’s very common in general.

What that means is when you consume certain sugars and fibers, they ferment in the intestines and they can cause diarrhea, gas, bloating, constipation, pain, and it’s from really healthy foods, too. Foods like asparagus, or blackberries, or hummus, or garlic, or onions, apples, and these are foods that I generally encourage my patients to eat, but if you have IBS, or an undiagnosed IBS and you’re eating a lot of these healthy foods, it might be causing you a lot of bloating and an uncomfortable feeling.

The good news about that is if you go on it’s called a Low-FODMAP diet, that can actually help you with your symptoms, because you’re cutting down on these fermentable carbohydrates. You don’t go on this diet long-term, you go on for like two to four weeks, so you cut these fermentable carbohydrates out, and then very systematically you will add the food groups back in, so you can identify which food group causes you the problem.

Is it the oligosaccharides, which is onions, and garlic, and beans, or is it the polyols, or is the fructose, which has a lot of fruit, so it doesn’t mean you have to be on this diet long-term, but the people I’ve worked with that have gone on this diet some of them just said it’s changed their life, because they were always uncomfortable with these GI conditions, and their stomach was always really bloated, and now they’ve figured out they can have onions, and garlic, or foods in the oligosaccharide groups. That, to me, is really interesting.

I find a lot of women who think they’re sensitive to gluten, when you cut out foods that have gluten usually it’s like pasta, and bread, and that kind of stuff, those foods also have oligosaccharides in it, so you might actually be having a problem with the oligosaccharides versus the actual gluten, but you feel better, because you’ve cut these foods out, so it’s worth looking into that if you have a lot of those symptoms of the gas, the bloating, the diarrhea, or the constipation.

Amy:                     Do you have more resources about FODMAPs on your site?

Martha M:          I do, but a really good resource would be Monash University. There’s a Monash app, and they’re the ones that kind of were the Low-FODMAP originated, and they have really some great information on it, so that’s a good one. There’s another dietician, her name is Patsy Catsos, it’s C-A-T-S-O-S, and another dietician is Kate Scarlata, and these are dieticians who specialize in IBS, and they have fantastic blogs, and free downloads.

Amy:                     Great. Great resources. Thank you.

Martha M:          Yeah. Now, is where it gets really interesting. We’ve talked about metabolism, oh, food preferences, I forgot to talk about that. That’s real important, because if you love meat, and your doctor said, go on a vegan or plant based diet, that’s probably not going to work for you, or if you feel like you really need some chicken, or fish at your meals, a plant based diet may not work for you.

Amy:                     I’ll just share a little story, and I don’t know how you feel about kind of that blood type diet, but I do think that there’s something to being an O blood type, and needed animal protein. My sister has tried her best to be a vegan. You go to her house, she’s got all of these vegan cookbooks, and she kind of jokes around that she’s a vegan, but a couple times a month she needs to go have a prime rib, because she just craves meat so bad, and that’s what her body’s telling her it needs. I don’t know, I’ve seen that in a lot of my clients, too, that the O’s seem to need to have animal protein.

Martha M:          Yeah. I think you just have to listen to your body.

Amy:                     Yeah.

Martha M:          If you feel like just having beans or grains, and vegetables, if it doesn’t hold you long enough, then you really need to have the meat, fish, or chicken in there. You have to pay attention to your body. Then, obviously if you’re a plant based, Keto or a very low carb diet is not going to work for you, because there’s nothing left for you to eat. You have to take that into account, because we’re looking at an eating plan for life, this is not something you do for a couple weeks, and then you go back to whatever, it needs to be something you can stick to. You need to keep your food preferences in mind.

The areas I find really interesting would be genet genes. This is I think where everything is really heading in the direction is personalized nutrition, where you can have your genes tested and they’ll be able to tell you what kinds of diets work better for you, or how your body responds to certain nutrients. I know, Amy, we were just talking before the podcast about 23 and Me, and you said you had yours done, and I had mine done, it doesn’t give you that much information, yet, I think it said I was a slow caffeine metabolizer, and a saturated fat, I’m not going to gain weight, or something like that.

Amy:                     Yeah. I think they just put out a new marker for type II diabetes, too.

Martha M:          Yes.

Amy:                     Yeah.

Martha M:          Yes. I think, it said I have an average risk of type II diabetes, it doesn’t really tell us much, so I think this is an area that maybe in the next five or 10 years it’s going to explode, and we might get a lot more information on it. Right now, it’s interesting, but it’s not that helpful yet, but that’s where I think it’s going is personalized nutrition. But the area that I’m super interested in is the gut microbiome. This to me, really helps explain why there’s no one size fits all diet approach for people. It’s because we all have about five pounds of bacteria living in our gut, and they metabolize food differently.

Here’s an example, they did this really interesting study at the Weizmann Institute of Science, where they had about a 1,000 people, and they happened to wear glucose, continues glucose monitors, they tested their blood sugar, their genes, they looked at their medical history, and they did samples of their gut microbiome. Basically, what they found is that people respond very, very differently to different kinds of carbohydrate. For example, if somebody had jellybeans, or if somebody had a banana, or somebody had whole wheat bread, you would expect the whole wheat bread would have a slower rise of blood sugar, but in some people it did, but in other people when they had the jelly beans there was a slower rise of blood sugar.

Amy:                     That’s so interesting.

Martha M:          Yes. Fascinating to me. They were able to bring it all down to the gut microbiome. The kind of bacteria you have in your gut will determine how you respond to food. How can we say to everybody, “Oh, you shouldn’t have something high glycemic, or you shouldn’t have this, or you have to follow this diet,” we don’t know what your gut microbiome is, so that’s just another reason why I think we can’t do this one size fits all approach. The thing is right now we don’t have enough information yet.

Again, I bet 10 years down the line you can give a sample, a stool sample, we’ll check your gut microbiome, and we’ll say, “Okay, you shouldn’t have dairy, or you should eat this way,” and we’ll know a lot more, you do better on a fat diet, or a higher carb diet, but we don’t know that yet, but that’s where it’s headed, but the point is, is that we can’t say everybody responds to food the same way.

I just had a client who did this, because I kept encouraging her, “Do it, I want to see the results.” She has diabetes, and she tests her blood sugar, and I had been encouraging her, “Don’t have white carbs, and eat this healthy kind of fruit,” or whatever, and when she had this done by a company called, Day Two, they said that she could eat these foods that I was really saying she shouldn’t eat, because it really wouldn’t raise her blood sugar, and that she should limit another healthy food like an apple or something. She now has tested her blood sugar, and she’s seeing what they’re saying is actually true, and this, again, is based on her gut microbiome.

Amy:                     Tell us more about that test, I’m kind of interested.

Martha M:          It’s called, if you go onto the website called Day Two, you will see there’s like a kit you can order. It started out in Israel, but now it’s actually in the US, and I think they’re partnering, it might be with the Mayo Clinic, but you’ll get an app, and they’ll based on your genes and your gut microbiome they’ll be able to kind of predict when you eat blueberries, it will raise your sugar X amount, but if you combine it with nuts, like walnuts, now it only raises your sugar this much.

They show you how to combine foods. But what was fascinating to me is just the different types of fruit, as a certified diabetes educator, I do a lot of work with counting grams of carbohydrate, but 15 grams of carbohydrate from an apple might respond differently in your body than 15 grams of carbohydrate from blueberries, kind of thing. I thought that was really interesting.

Amy:                     All right. Now, that we have a better understanding why one size doesn’t fit all, what are some tips and tricks on how to figure out what works best for us individually?

Martha M:          I don’t think anybody would dispute certain dietary recommendations when it comes to PCOS. You want to follow an anti-inflammatory diet, and a diet that’s good for insulin resistance, and a diet that’s good for the gut microbiome. The good news is all three of those have certain things in common. You want to eat plenty of vegetables. Choose organic when possible. They’re anti-inflammatory. They don’t affect blood sugar.

They’re very good for the gut microbiome, because you want to really be feeding your good bacteria lots of food to keep them alive. Make vegetables a huge part of your diet. You want to limit or avoid added sugars. Obviously, sweetened drinks, or candy, or that kind of stuff, even like the healthy sugars, like maple syrup, and honey, and agave, use those in moderation, because a lot of sugar will worsen inflammation, and can make higher levels of insulin, and not be good for the gut microbiome.

I kind of like to say, make your plate maybe like a quarter of protein at meals, so the protein could be fish, I’m especially a fan of fatty fish, poultry, or lean meats, or you could count beans as a protein, or nuts and seeds, if you’re plant based. Then, you would want to fill half your plate with vegetables, and then you could do a quarter of your plate with a healthy grain like brown rice, or quinoa, bulgur, barley, and then some fat, you’ll want to put some healthy fats in there like olive oil, avocado, you could do even coconut oil. Then, you want to put some anti-inflammatory spices in there like different kinds of turmeric, or pepper.

Then, the teas, I’m a huge fan of green tea, and spearmint tea, it might help lower androgens, so that should be like the basis, kind of the basis of your plate, and then I would suggest that you keep a food record, or a food journal, I should say, where you record what you eat, the time you eat, and then see how you feel. If you currently enjoy consuming dairy products, just make a note, that you had a yogurt, and then you would know that you felt bloated later, or if you felt foggy, or if you feel like your acne is kind of getting worse. Keep a note of how your body feels, physically, and mentally.

Then, you can kind of start to narrow down if certain foods may be bothering you. Then, you could cut it out, see if you feel better, and then add a certain food in. I kind of like the Mediterranean style of eating, because it’s not a low-fat diet. I’m a fan of eating fat, but it comes from healthy fats, like nuts, and seeds, and all that. Fatty fish, lots of vegetables, some fruit, and some whole grains.

Amy:                     That’s really my approach, too, is you were describing your dinner plate, that sounds a lot like my PCOS Diva dinner plate.

Martha M:          Yeah.

Amy:                     Yeah. It just sounds nutrition advice I think, and then just tailoring it to the way that food makes you feel.

Martha M:          If you want to give really low carb a try, go ahead, I’m certainly on board with that. I’m bored with experimenting, see what feels better for your body. If you want to try some intermittent fasting, try it, maybe in a 12 hour fast, but I think the point is if you’re following a plan, and it’s not making you feel good, or it’s causing you more stress, then it’s not the plan for you.

I tried Keto, for example, to see what it felt like, and I don’t have PCOS, but it stressed me out, because I was trying to think of what should I eat, and did I eat enough fat, and it didn’t feel right for me, and I like a little bit of fruit. See what works for your body. There’s so many different kinds of plans, and if you see somebody on Instagram and they have 20,000 followers, and they’re saying, “Don’t eat this, and don’t eat that,” don’t feel like that’s what you have to do, you have to find what works for you.

Amy:                     Yeah. You mentioned earlier in the podcast that it’s a lifestyle, and it needs to be sustainable. I think we really need to stress that this isn’t a diet that you’re going to go on, and off. It needs to be something that you can follow over a course of a lifetime a lot.

Martha M:          A 100%. It needs to be healthy, because there are increased health risks with PCOS, diabetes, and heart disease. If you want to go on a very, very low carb, or even Keto diet, and you like it, then that’s fine, but just make sure you’re taking in enough vegetables, and fiber, things that you need to be anti-inflammatory and for the gut microbiome. You need to keep health in mind, as well.

Amy:                     Let me ask you, what are some of your go-to sites, like websites, or resources for finding easy recipes that you can kind of prepare during the week to sort of stay on track with this healthy way of eating?

Martha M:          There’s so much on Instagram. I basically will Google things. I might just Google a salmon dish. On my website, I do have free PCOS meal plans where they have a lot of recipes that you could just do a trial of like a week or so, but I get a lot of my meal plans, or I shouldn’t say, my recipes online, I might even look on Instagram, I might look at salmon recipes, there’s not one site that comes to mind that I think is great for meal planning or meal prep.

Amy:                     Yeah. I kind of find that, too, and especially with cookbooks, like I tend to buy cookbooks, but then I only really only use a couple recipes out of each one.

Martha M:          I know. They look pretty in your kitchen, but they take up space, and you don’t like all the recipes. That’s why I think you can’t go wrong with social media. Here is where social media is great. You can find any healthy recipes online.

Amy:                     Yeah. I love Pinterest, as well.

Martha M:          Yes. Pinterest is great.

Amy:                     You had mentioned earlier how it isn’t managing PCOS, and it’s not just about what you’re eating. Tell us a little bit more about the lifestyle factors and maybe some tips that you give your clients beyond food.

Martha M:          I kind of like to think of managing PCOS as like a pyramid, and this is how I changed in the past 15 years, since I started working with PCOS, I used to always zero in on a diet, cut back on carbs, and eat a lot of vegetables. I don’t really do that anymore, but sometimes when someone comes to my office for a session I might spend the entire session talking about sleep and stress management, because you can be on the best diet in the world, but if you aren’t getting adequate sleep, or dealing with stress, or being active, it’s not going to be the ultimate treatment, so it really has to be kind of like I said a pyramid.

Are you getting enough sleep? I might even say that could even be number one, because if you don’t get enough sleep, how do you feel the next day? You’re hungrier, you have more carbohydrate cravings. Studies have shown inadequate sleep increases the risk of heart disease, diabetes, of you gaining weight, so to me sleep is huge.

Amy:                     Yeah.

Martha M:          Yeah. [crosstalk 00:36:09].

The next thing is dealing with stress. I think our lives are so crazy and you don’t take time for yourself, and there’s just so much stress, like what can you do in your life to take care of yourself, and help to get your stress levels down? Because when stress is heightened, your symptoms with PCOS will get worse.

Amy:                     Yeah. I think it’s all interconnected. You can’t out exercise a bad diet, or vice versa.

Martha M:          No. Exactly. Emotional health. I love Gretchen Kubacky’s book, I hope I’m saying her name right, The PCOS Mood Cure.

Amy:                     Yes. She was on the podcast, so listen to her podcast session, if you’re interested, it’s a great one.

Martha M:          Love it. Right. That’s huge. These are areas I think have been neglected for so many years. How often do you go to your doctor, when you have PCOS, and they talk about sleep, and stress management, and emotional health? Nobody talks about that. There’s where you have to really do your own research, and advocate for yourself. Then, there’s exercise. I want to mention something here about exercise is that I had a client come to me recently, and she wanted to train for a half marathon, and she felt good, she was running, but she was afraid, because she was reading on the internet that you shouldn’t run, that you should just do Pilates, or yoga, or whatever.

I just want to say is that if you’re running, and you feel good, and you get a runners high of it, and it’s not having ill effects on your body, then it’s fine. I just read something today where women were being kind of discouraged from doing really any kind of cardio, and it should all be very calm and soothing kind of exercise, and that’s fine. I think there’s a huge role of having yoga and Pilates in an exercise program, and weight training, but if you want to do some high intensity interval training, or some cardio, and you feel good, then do it.

Amy:                     Yeah. I absolutely agree with that. I think that everybody, again, it’s down to the individual. As we get older, if things change, too, I know that my adrenals can’t manage the high intensity kind of like the single exertion exercise, you know, training for marathons. I can’t do that anymore, but I could do it in my 20s.

Martha M:          Yeah.

Amy:                     Things change, too, as you age, and that’s something to consider.

Martha M:          A 100%. I used to go out and bike 100 miles at a pop, and now it’s like I would be, it would kill me for a week. You have to listen to your body. But I do think weight training, there should definitely be some kind of weight training, or strength training component to your exercise program. It’s important to keep the muscles there, because that’s how you dispose of the glucose, helps to lower insulin levels.

Martha M:          I’m a huge fan of yoga for a lot of reasons. You want a well-balanced kind of exercise program. Being active, not sitting a lot. Sometimes you might go to the gym three times a week, but then you’re sitting 16 hours a day, and that’s not good for insulin resistance. You kind of want to get up and move. It’s a whole kind of a balanced approach.

Amy:                     Yeah. As you were talking, I was kind of thinking you know you really need to do your own research. There are so many great online social media assets people talking about PCOS, so you do get a lot of different information, maybe some of it is misinformation, but you really at the end of the day you have to kind of do your own research. Find the evidence-based studies. Really do your own digging to sort of figure out what’s going to work for you.

Martha M:          In terms of the studies, that’s really interesting, because the study, there aren’t really great studies out there, and even if there are, I mean, some of the studies are done on five women, like-

Amy:                     Right.

Martha M:          You might have a headline, oh, you shouldn’t eat this, studies show you shouldn’t have this, but then when you actually look at the study it was done on five women. Look for evidence based when you can, but take it with a grain of salt. If somebody’s telling you that you should not do this, if you have PCOS, take that with a grain of salt, it probably worked for that person, it might work for you, but it doesn’t mean you have to do that.

Amy:                     Any other words of wisdom you want to impart on us before we have to close up our podcast?

Martha M:          Yeah. I would just say that the good news is I think we’ve come a long way when it comes to research and PCOS, and making it be out there in the open as compared to when I first got into this in the year 2000, people hardly ever talked about PCOS, and when we did all we talked about was insulin resistance, we didn’t talk about any of these other areas, like inflammation, and gut health. I think there’s a lot of information out there.

Amy, like you said, do your own research, don’t get overwhelmed, don’t feel like you have to take 20 supplements, and you have to follow all these rigid plans, just kind of take it a step at a time, set some goals for yourself, and it needs to be the big picture, not just nutrition, but like we talked about the exercise, the sleep, the stress management, the emotional health, and take steps slowly.

Amy:                     Excellent advice. Make it work for you.

Martha M:          Yeah.

Amy:                     Martha, thank you so much for coming back on the podcast, and talking to us today. Again, if you enjoyed this podcast, please check out Martha’s other two episodes, 63 and 84, you’ll learn a lot. Thank you so much for joining us, Martha.

Martha M:          Thanks so much, Amy. I love being on your show. Thank you so much for inviting me.

Amy:                     Thank you everyone else for listening. I look forward to being with you again soon. Bye-bye.

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