Weighty Matters

Photography by: Mark Viker
Weighty Matters
The best diet
For obese women battling PCOS, shedding excess pounds is an important first step. According to Futterweit, losing as little as 5 percent to 7 percent of body weight can help women resume more normal menstrual patterns, even if they have long histories of infertility. In one small, London-based study, 40 percent of obese women with PCOS who lost more than 5 percent of their body weight by restricting calories got pregnant. Weight loss can also improve symptoms by reducing insulin resistance and male-hormone levels. "The women I see are motivated to change their diets because they know it can help decrease their symptoms," says Martha McKittrick, R.D., a New York City-based dietitian who specializes in PCOS. "And once they feel better, they're encouraged to keep following the plan because they're empowered by the results."

High protein, low-carbohydrate diets are most often recommended by nutritionists who treat PCOS patients. "If a woman is highly insulin resistant, I may cut her total carbohydrate intake from the standard recommendation of 55 percent of total calories to 30 percent," says McKittrick. Most experts also favor foods that are low on the glycemic index, which measures how quickly a particular food raises blood sugar levels. These include fresh fruits such as grapefruit, plums, and apples; fresh vegetables such as asparagus, broccoli, tomatoes, and spinach; legumes; and whole-grain breads, pasta, and cereals. Eating frequent small meals, rather than two or three large ones, also helps keep blood sugar steady. For protein, nutritionists generally recommend lean meats, fish and shellfish, poultry without skin, low-fat cottage cheese, egg whites, skim milk, and low-fat, sugar-free yogurt.

Coyle, now 26, was referred to McKittrick after clinical testing revealed she had insulin resistance, high testosterone levels, and cysts on her ovaries. McKittrick prescribed a reduced-calorie, lean-protein, low-carb diet and a strict exercise regimen. After a year and a half, Coyle lost 40 pounds--and her fears of a childless future. "Even if I have to take fertility drugs to get pregnant someday, I feel so much healthier and more confident because my periods are completely regular," she says.

Engaging in regular exercise can help improve insulin resistance and reduce its related risk factors--even if you don't lose weight--by improving the uptake of sugar from the bloodstream into the body's cells. Experts recommend aerobic exercise like running or brisk walking for up to 30 minutes, 5 times per week. "The key is to increase your level of activity from whatever it is currently," says McKittrick.

The fat factor
Healthy fats, including nut oils and olive oils, may also play a special role in a PCOS diet. Monika Woolsey, R.D., a dietitian in Phoenix, surveyed 183 women with PCOS and found that the group's rates of inflammatory disorders such as irritable bowel syndrome, food allergies, and eczema were higher than those among the general population.

"It makes sense for women with PCOS to try an anti-inflammatory diet," says Woolsey, who describes the diet as "aggressively Mediterranean." It includes plenty of fish and produce, a daily dose of nuts, meats in moderation, and a focus on olive oil for cooking.

The diet also includes a healthy balance of omega-6 to omega-3 fatty acids. A typical American diet is high in omega-6 fatty acids (found in processed foods made with vegetable oils such as corn, safflower, sunflower, and soybean oils), and low in omega-3s (found in foods like canola oil, flaxseed, and fatty fish). "The proper balance may be critical for reducing food cravings that can lead to weight gain," says Woolsey, who often finds that when women with PCOS balance this ratio in their diets, their cravings for carbohydrates disappear. The reason, Woolsey explains, is that a poor omega-6 to omega-3 ratio results in overstimulated brain cells, which draw more sugar from the bloodstream; it is this depletion of sugar that causes carbohydrate cravings.

One way to balance the ratio is to increase omega-3 intake with supplements. Woolsey describes a patient who suffered from intense carbohydrate cravings. "I started her on four-gram supplements of fish oils daily, and when I saw her again 10 days later she told me about a chocolate cake she had baked but kept forgetting to eat." Another way is to eliminate as many sources of omega-6 fats from your diet as possible. "Get rid of almost everything that contains vegetable oils--foods like salad dressings, dips, margarines, crackers, and cookies--unless they're made with canola or olive oil," Woolsey recommends.

The alternative
Nutritional supplements such as chromium picolinate and magnesium, which are often associated with treatment of insulin resistance, have yet to prove effective against PCOS in clinical studies. And you won't find a plethora of scientific information on the outcomes of herbal treatments given to women with PCOS. But that doesn't stop practitioners from using alternative approaches--and achieving success. One registered dietitian and licensed acupuncturist uses Traditional Chinese Medicine (TCM) to treat the syndrome. "PCOS is a Western diagnosis. I have to translate it into a TCM diagnosis in order to provide the appropriate treatment," says Karen Siegel, M.P.H., R.D., of the Acupuncture and Nutrition Wellness Clinic in Houston. A TCM diagnosis might include damp phlegm accumulation, which translates to ovarian cysts, or kidney yang deficiency, which indicates irregular periods, fatigue, or a cold feeling. "I'll give an herbal treatment that regulates the kidney yang and resolves damp phlegm," says Siegel. Her prescription might include a combination of 10 different Chinese herbs, including dong quai root, morinda root, eucommia bark, and Chinese licorice root. "This is not something you can find at your local drugstore," says Siegel. "You must go to an herbalist or a licensed acupuncturist." Regular acupuncture sessions are part of Siegel's treatment as well. "Acupuncture helps to clear the damp and can alleviate painful periods," says Siegel.