The Low GI Guide to Living Well with PCOS

With Dr. Nadir R. Farid

With Kate Marsh

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The Only Book You Will Ever Need for Managing PCOS — Completely Revised and Updated

What exactly is PCOS? What are the signs and symptoms? How is the diagnosis confirmed? What causes it? And most importantly, what can you do about it? If you’ve been diagnosed with polycystic ovarian syndrome (PCOS) or suspect you have it, and you’re looking for a way to manage your condition, you’ve come to the right place.

In this newly revised edition of Living Well with PCOS, Dr. Jennie Brand-Miller and PCOS experts Drs. Nadir Farid and Kate Marsh address the root cause of PCOS — insulin resistance — and show you how eating a low-GI diet can help alleviate even your most troublesome symptoms, including weight gain, infertility, unsightly hair growth, irregular cycles, and fatigue. This all-new second edition features:

The latest up-to-date research on PCOS and its treatment
New quick-and-easy low-GI recipes
Low-GI kick-start menus — with vegetarian and gluten-free options
Easy-to-use tables of GI values
Tips for a more active lifestyle

Real-life stories from women who have used the GI to successfully combat PCOS

Praise for the New York Times bestselling The NEW Glucose Revolution Series

"The concept of the glycemic index has been distorted and bastardized by popular writers and diet gurus. Here, at last, is a book that explains what we know about the glycemic index and its importance in designing a diet for optimum health. Carbohydrates are not all bad. Read the good news about pasta and even—believe it or not—sugar!"

—Andrew Weil, M.D., University of Arizona College of Medicine, author of Spontaneous Healing and 8 Weeks to Optimum Health, on The Glucose Revolution

"The concept of glycemic index is key to understanding the effects of carbohydrate on human health. The Low GI Handbook, written by leading scientists, conveys this information clearly, thoroughly, and convincingly."

—Walter Willett, Professor of Epidemiology and Nutrition, Harvard School of Public Health

"Jennie Brand-Miller and her research colleagues have done pioneering work, showing how the glycemic index can help you lose weight and improve your health. They are leading scientific authorities, and I often rely on their important findings in our research studies to help people reduce weight, control diabetes, tackle triglycerides, and return to health."

—Neal Barnard, M.D., founder and president, Physicians for Responsible Medicine, and bestselling author

"Forget SugarBusters. Forget The Zone. If you want the real scoop on how carbohydrates and sugar affect your body, read this book by the world's leading researchers on the subject. It's the authoritative, last word on choosing foods to control your blood sugar."

—Jean Carper, bestselling author of Miracle Cures, Stop Aging Now! and Food: Your Miracle Medicine, on The Glucose Revolution

"Clear, accessible, and authoritative information about the glycemic index. An exciting, new approach to preventing obesity, diabetes, and heart disease—written by internationally recognized experts in the field."

—David Ludwig, M.D., Ph.D., director, Obesity Program, Children's Hospital, Boston, on The New Glucose Revolution

"Mounting evidence indicates that refined carbohydrates and high glycemic index foods are contributing to the escalating epidemics of obesity and type 2 diabetes worldwide. This dietary pattern also appears to increase the risk of heart disease and stroke. The skyrocketing proportion of calories from added sugars and refined carbohydrates in Westernized diets portends a future acceleration of these trends. The Glucose Revolution challenges traditional doctrines about optimal nutrition and the role of carbohydrates in health and disease. Brand-Miller and colleagues are to be congratulated for an eminently lucid and important book that explains the science behind the glycemic index and provides tools and strategies for modifying diet to incorporate this knowledge. I strongly recommend the book to both health professionals and the general public who could use this state-of-the-art information to improve health and well-being."

—JoAnn E. Manson, M.D., Dr.P.H., professor of medicine, Harvard Medical School and codirector of Women's Health, Division of Preventive Medicine, Brigham and Women's Hospital

"Here is at last a book explaining the importance of taking into consideration the glycemic index values of foods for overall health, athletic performance, and in reducing the risk of heart disease and diabetes. The book clearly explains that there are different kinds of carbohydrates that work in different ways and why a universal recommendation to increase the carbohydrate content of your diet is plainly simple and scientifically inaccurate. Everyone should put the glycemic index approach into practice."

—Artemis P. Simopoulos, M.D., senior author of The Omega Diet and The Healing Diet and president, The Center for Genetics, Nutrition and Health, Washington, D.C., on The Glucose Revolution

"The Glucose Revolution is nutrition science for the twenty-first century. Clearly written, it gives the scientific rationale for why all carbohydrates are not created equal. It is a practical guide for both professionals and patients. The food suggestions and recipes are exciting and tasty."

—Richard N. Podell, M.D., M.P.H., clinical professor, Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, and coauthor of The G-Index Diet: The Missing Link That Makes Permanent Weight Loss Possible

"The glycemic index is a useful tool which may have a broad spectrum of applications, from the maintenance of fuel supply during exercise to the control of blood glucose levels in diabetics. Low glycemic index foods may prove to have beneficial health effects for all of us in the long term. The Glucose Revolution is a user-friendly, easy-to-read overview of all that you need to know about the glycemic index. This book represents a balanced account of the importance of the glycemic index based on sound scientific evidence."

—James Hill, Ph.D., director, Center for Human Nutrition, University of Colorado Health Sciences Center

"The New Glucose Revolution summarizes much of the recent development of dietary glycemic index and load in a highly readable format. The authors are able researchers and respected leaders in the nutrition field. Much that is discussed in this book draws directly from their years of experimental and observational research. The focus on dietary intervention and prevention strategies in everyday eating is an especially laudable feature of this book. I recommend this book most highly as an indispensable source of good nutrition."

—Simin Liu, M.D., Sc.D., assistant professor, Department of Epidemiology, Harvard School of Public Health

"As a coach of elite amateur and professional athletes, I know how critical the glycemic index is to sports performance. The New Glucose Revolution provides the serious athlete with the basic tools necessary for getting the training table right."

—Joe Friel, coach, author, consultant

Other titles in the New Glucose Revolution Series

We have put together this handy guide to help you make the right choice for further reading or for more recipes.

The Low GI Handbook: The New Glucose Revolution Guide to the Long-term Health Benefits of Low GI Eating

COOKBOOKS

The Low GI Diet Cookbook: 100 Simple, Delicious Smart-Carb Recipes

The New Glucose Revolution Low GI Vegetarian Cookbook

The New Glucose Revolution Low GI Family Cookbook

SHOPPING AND EATING OUT

The New Glucose Revolution Shopper's Guide to GI Values 2010

DIABETES AND PREDIABETES

The New Glucose Revolution for Diabetes

The New Glucose Revolution Low GI Guide to Diabetes

What Makes My Blood Glucose Go Up ... and Down?: 101 Frequently Asked Questions about Your Blood Glucose Level

WEIGHT LOSS

The Low GI Diet Revolution: The Definitive Science-Based Weight Loss Plan

The New Glucose Revolution Low GI Guide to Losing Weight

HEART HEALTH

The New Glucose Revolution Low GI Guide to Your Heart and the Metabolic Syndrome

CELIAC DISEASE OR GLUTEN INTOLERANCE

The New Glucose Revolution Low GI Guide to Gluten-free Living

Introduction

Why we wrote this book

CHANCES ARE YOU'VE PICKED UP THIS BOOK because you, or your doctor, suspect that you have PCOS—the popular shorthand for polycystic ovarian syndrome—and you want to find out more about it.

No doubt you've got plenty of questions and want some simple, straightforward answers. What exactly is PCOS? What are the signs and symptoms? How is the diagnosis confirmed? What causes it? Why you? And most importantly, what can you do about it? These are the types of questions we often get asked as professionals working daily with women with PCOS.

We wrote this book to try and give you some answers, and to give you the practical tools you need to help improve the underlying cause of PCOS: insulin resistance—a condition in which the body resists the actions of the hormone insulin.

What's more, we'll show you how you can improve your insulin sensitivity, step by step, with a delicious low-GI diet that's so effective, you'll want to stick to it for life. Not only will you lose weight in the first few months, you'll eat till you're satisfied and you'll never feel hungry. And none of your favorite foods are excluded entirely. Once you've lost weight, we do what other diet books don't—we give you a long-term eating plan to ensure you keep that weight off for life. And we explain how the GI fits in with other health messages about different types of fat and protein, showing you how easy it is to expand your healthy eating choices.

Diet won't be the only thing you change, of course. Exercise and medication are also important tools, but without key dietary changes, you'll be doing it the hard way. So, congratulate yourself, you've picked the right book to start managing your PCOS. As you read on you'll discover lots of real-life stories showing exactly how exercise, healthy low-GI eating, and the right medication can balance hormones, reduce insulin resistance, help beat the symptoms of PCOS, and, best of all, enable you to take charge.

In this revised version of our book, we have incorporated all the latest findings with respect to managing PCOS through lifestyle changes. We have also provided more details on exercise for women with PCOS and have included a range of new menus and recipes, including vegetarian and gluten-free options.

What's so different about the low-GI diet?

The low-GI Diet is a lifelong eating plan, not a calorie-restrictive diet. It's a groundbreaking way of eating based on what is known as the glycemic index (GI), which is the scientifically proven way of describing how carbohydrates in individual foods affect blood glucose levels. What you need to understand about the GI is that:

• Foods containing carbohydrates that break down quickly during digestion, releasing glucose quickly into the bloodstream, have a high GI.

• Foods containing carbohydrates that break down slowly, releasing glucose into the bloodstream gradually, have a low GI.

Low-GI foods are our key to achieving weight loss and blood glucose control. In turn, these will lead to more effective management of your PCOS symptoms. If you make the change and base your diet around healthy low-GI foods you will achieve lower insulin levels, making it easier for your body to burn fat and less likely that fat will be stored. Eating plenty of healthy low-GI foods will also:

• help lower your blood fats

• make you feel "full" and thus reduce appetite

• reduce your risk of developing diabetes

• improve your overall health

These aren't claims. These are facts that have been confirmed in numerous worldwide scientific studies.

In The Low GI Guide to Living Well with PCOS we show you how easy it is to include more of the right sort of low-GI carbohydrates in your diet every day and in every meal; which common foods have a low GI; and how you can make the GI work for you throughout the day with:

• practical hints for changing your eating habits

• quick and easy, healthy, low-GI, low-calorie recipes, meal ideas, and snacks

You are not alone

If you have PCOS, you are not alone. PCOS is thought to affect between 5 and 10 percent of women in developed nations. At the root of PCOS is insulin resistance. In the next chapter, we explain exactly what insulin resistance is. We will show you that there's plenty you can do about it, starting with diet and exercise.

And remember: a diet that is good for a woman who has PCOS is a diet that's good for everybody, every day, every meal. The signs of PCOS range from subtle symptoms, such as faint facial hair, to a "full house" syndrome—lack of periods, infertility, heavy body-hair growth, obstinate body fat, diabetes, and cardiovascular disease.

The symptoms of PCOS can occur at any age. Insulin resistance rises naturally at puberty, so PCOS can be seen in girls as young as ten or twelve years old. What's more, it does not suddenly disappear when the ovaries retire at menopause. Management of insulin resistance should continue beyond menopause as a supplement to other healthenhancing lifestyle measures.

It's vital to diagnose and treat women and girls as early as possible in order to prevent their PCOS from progressing to the "full-house" syndrome. The outdated view that early signs are "clinically insignificant" and not worthy of proper management is simply not true. In fact, the sooner you (and your doctor) act, the better. As well as advice on medical management, diet and exercise, we also offer you tips on overcoming the stress and sleep problems that come hand in hand with PCOS. This is a total lifestyle plan for helping you manage your PCOS. It's your choice to adopt a program that ensures your present and future health. We have written this book to help you make that choice.

Insulin Resistance

Insulin resistance is at the root of PCOS. We now know that more than half the population is insulin resistant—men and women, young and old. Insulin resistance is a chameleon that shows itself in many ways, differing from one person to another and between men and women. At one extreme, an individual may have only mildly abnormal blood tests. At the other, she (or he) may have a severe condition such as diabetes that impacts negatively on health, quality of life, and life expectancy.

Knowledge is definitely power when it comes to your health. So, first up, we answer those pressing questions women ask about PCOS, its causes and medical management. In Chapter 2 we get down to detail on understanding the glycemic index, or GI for short, and the diet revolution we have been part of for over twenty years. A diet revolution that is now taking the whole world by storm. For the practical know-how to put it all into practice day by day, turn to Chapter 3 and check out the expert advice from a dietitian with more experience in managing PCOS than just about anyone else around. And finally we fill you up with delicious low-GI recipes specially devised by Alison Roberts and Tracy Rutherford, along with 16 new recipes for this new edition, that you will enjoy preparing time and again as you reap the benefits of healthy low-GI eating.

We believe understanding is very important if you are going to take charge and manage your PCOS, so we have included a glossary of technical terms at the back of the book as a quick reference. In the further reading section you will also find a list of organizations that will provide you with support and put you in contact with other women with PCOS, plus lots of Web sites and references you can follow up if you want to find out more.

"My experience so far has ensured a lifetime of lower GI eating for myself and my family."

—Fiona

"I am currently pregnant with my third child. I was diagnosed with PCOS in 1998. Although my specialist at the time specialized in PCOS for her doctorate, I had no understanding of the link between insulin and my condition. I went on to have two rather large sons—10 pounds at 37 weeks and 10 pounds, 2 ounces at 35 weeks (yes, that is right!)—and gained a lot of weight during pregnancy. My second son also had blood glucose issues after birth, although I have never tested positive for gestational diabetes. In my journey to try and fall pregnant a third time I finally read a book I had owned for four years but never read—The Low GI Guide to Living Well with PCOS. What an eye opener! I can't believe I had not got around to reading it before. As my husband was also trying to lose weight at the time, I took the opportunity to switch to a low-GI diet. I have since become pregnant again and, despite not being rigid in my diet, have only gained a 'normal' amount of weight and the baby is measuring average for dates at five months. My experience so far has ensured a lifetime of lower GI eating for myself and my family (at least while I have some control over what goes in their mouths!)."

Update: Fiona had baby number 3 in May—a very respectable 8 pounds, 7 ounces. "I know that is big for some but small for me! No blood glucose issues with the baby either," says Fiona.

Understanding PCOS

How can I tell if I have PCOS?

ONLY A DOCTOR CAN DIAGNOSE PCOS. But here's a list of the subtle symptoms of PCOS—not all of which need be present:

• delayed (or early) puberty

• irregular or no periods

• acne

• excess body or facial hair

• unexplained fatigue

• hypoglycemia (low blood glucose) after meals. The most common symptoms are light-headedness, sweating, sudden fatigue, and butterflies in the tummy

• excess weight around the waistline

• infertility

• mood swings

• hot flashes (heat intolerance and excess sweating) in young women

• sleep disorders, such as sleep apnea

• recurrent spontaneous miscarriages

• inappropriate lactation

• drop in blood pressure on standing up suddenly or with exercise

• acanthosis nigricans: rough, dark skin in the neck folds and armpits; a mark of severe insulin resistance from any cause

If you have one or more of these signs or symptoms, you should make an appointment with your doctor. They may refer you to an endocrinologist who specializes in PCOS.

A little history

Although polycystic ovaries were first described in France way back in 1844, it was two New York gynecologists, Irving F. Stein and Michael L. Leventhal, who diagnosed women with what we now consider to be severe PCOS and coined the term in 1935. The women that they described suffered from amenorrhea (no periods), severe hirsutism (unwanted hair), and polycystic ovaries (large ovaries with multiple cysts).

PCOS is more common than you'd expect

Up to 10 percent of women in industrialized countries have PCOS and the vast majority of them do not even suspect it. PCOS should be suspected in anyone with excess weight around the waist, excessive hair in the wrong places, acne, irregular periods, no periods, or problems getting pregnant. Young women who require insulin to control their diabetes are also at risk of developing PCOS.

Symptoms of PCOS usually first appear around menarche (the first period), but can occur anytime during a woman's reproductive life. Subtle symptoms such as hot flushes (long before menopause), otherwise unexplained weight gain, mood swings, hirsutism, and "hypoglycemia" (low blood glucose) after meals may be suggestive of PCOS. Despite its name, PCOS involves the whole body and not just the ovaries. This is why it is so important to identify girls who are at risk before they reach puberty. If PCOS can be treated early, there are lifelong health benefits.

The ovary is a sensitive beacon for insulin resistance and thus allows early recognition of a metabolic problem. Having PCOS increases the likelihood that further medical problems will develop over time. These include: type 2 diabetes, heart disease, hypertension, fatty liver, and cancer of the uterus. We also know that serious sleep disorders and depression are much more common in women with PCOS. Alarmingly, women with PCOS who do get pregnant stand a 40 percent chance of spontaneous miscarriage in the first three months of pregnancy. There is also an increased risk of gestational diabetes, multiple pregnancies, and in later pregnancy, preeclampsia (a serious complication of late pregnancy that requires immediate medical attention). When a thorough medical check was carried out after delivery, a high percentage of women with gestational diabetes were found to have PCOS. Although direct evidence is not available, some doctors even suspect that PCOS will also turn out to be a risk factor for Alzheimer's disease.

I have PCOS and know it is genetic. Is there any way I can prevent my baby girl from getting it?

This question is a difficult one to answer. There are no specific guidelines for preventing PCOS. We do know that it is genetic and therefore the best thing to do is to eat a healthy diet and be active as a family and hopefully she will adopt these good habits as she grows! Current research suggests that diets low in saturated fat and high in fiber are associated with a lower risk of diabetes as are diets with more whole grains and a lower GI. Since the underlying problem in both type 2 diabetes and PCOS (in most cases) is insulin resistance, these findings are also relevant to women with PCOS. We also know that exercising regularly protects against diabetes and improves insulin sensitivity. And of course, a combination of healthy eating and regular physical activity helps with weight management, which also helps with insulin sensitivity. Ensuring your daughter has a healthy rate of weight gain as she grows (not too much or too little) may also help in reducing her risks of health problems, including PCOS.

So, the best advice we can give right now is for you to encourage your daughter as she grows to eat a good variety of fruits, vegetables and whole grains, lean protein foods and dairy products (low fat varieties are not recommended for children under 2 years of age) or alternatives. Highly processed carbohydrate foods and those high in saturated fat and sugar with a poor nutritional value (e.g., cookies, pastries, chips, candy and soft drinks) are best kept for occasional treats rather than everyday choices. If you need some more specific advice, make an appointment to talk with a Registered Dietitian (RD) who has experience in PCOS to help you developing a healthy eating plan for her.

The Normal Female Cycle

To understand PCOS you need to understand the normal menstrual cycle.

The hypothalamus in the brain signals the pituitary gland to secrete FSH (follicle-stimulating hormone) and LH (luteinizing hormone). In the first half of the cycle, these pulses are infrequent and FSH is secreted preferentially, allowing a crop of follicles to grow inside the ovaries. This phase is therefore called the "follicular" phase. The follicles secrete estrogen and acquire receptors for LH. As estrogen levels rise, the hypothalamus pulses more and more frequently. Estrogen stimulates the growth of the breasts and of the lining of the uterus. Most of the follicles degenerate in the next few days and only one is mysteriously selected. This dominant follicle (the "egg") matures over the next few days, and just before ovulation—when the dominant follicle is expelled from the ovary—estrogen levels peak.

After ovulation, the dominant ruptured follicle becomes the corpus luteum. This little body secretes progesterone, the hormone that promotes the growth of blood vessels of the uterine lining in preparation of the implanting of a fertilized egg. This phase is called the luteal phase. If the egg is not fertilized, estrogen and progesterone levels fall, and the uterine lining is shed and menstruation occurs. At the time of puberty when girls have reached a critical muscle-to-fat ratio, the hypothalamus gives the GO signal for the start of menstruation. Excessive weight loss, exercise, or stress can negate that signal.

At the peak years of reproductive life most women have a regular 28-day cycle, plus or minus 2-3 days. The first day of the menstrual period is day 1. Ovulation usually occurs on day 14 to 15, but can occur anywhere from day 9 to 17 due to variability in the length of the follicular phase of the cycle. Around menarche and menopause, the cycles are irregular and often not associated with ovulation.

Given the fact that it afflicts up to 10 percent of women of reproductive age, PCOS should be considered a health hazard for all women. Indeed, one wonders if it should be called a disease at all—PCOS is more than just a personal problem, because it affects so many women. It needs to be seen as a public health issue that deserves community support.

Doctors have to suspect it to diagnose it

The sooner you have a definite diagnosis of PCOS the better. That's because intervention and treatment will be more effective if "the full house" of symptoms has not yet set in. This requires a high level of suspicion on the part of your doctor. Here are the test results that should alert your doctor:

• A blood test showing that key hormones are abnormally high or low: testosterone that is too high, sex hormone binding globulin (SHBG) that is too low, and high levels of luteinizing hormone (LH) while follicle stimulating hormone (FSH) levels are normal.

• An ultrasound examination showing "bulky" ovaries with cysts. In thin women, ultrasound through the abdominal wall will allow good views of the uterus and ovaries, but for those who are overweight, internal ultrasound examination is often necessary.

It's important to stress that the symptoms, blood test results, and ultrasound findings need to be interpreted by a medical practitioner with experience in PCOS. Some women do not show the "classic" signs at all.

Some doctors make a distinction between polycystic ovarian

Genre:

Today’s Dietician, May 2011
“A comprehensive guide to polycystic ovary syndrome (PCOS) dietary and lifestyle management.”

On Sale: Feb 1, 2011
Page Count: 266 pages
Publisher: Da Capo Lifelong Books
ISBN-13: 9780738213903

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Dr. Jennie Brand-Miller, MD

About the Author

Jennie Brand-Miller, PhD, is one of the world’s foremost authorities on the glycemic index.

Brand-Miller and Kaye Foster-Powell, BSc, MNutr & Diet, are coauthors of many books in the New York Times bestselling New Glucose Revolution series.

Stephen Colagiuri, MD, is Professor of Metabolic Health at the University of Sydney.

Alan Barclay, PhD, is the Head of Research at the Australian Diabetes Council and Chief Scientific Officer at the Glycemic Index Foundation.

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