Polycystic Ovary Syndrome Nutrition Game Plan

The PCOS Treatment Blueprint

Step-By-Step Strategies to Reverse PCOS Symptoms and Improve Your Overall Health, Appearance, and Fertility

By Mike Andora

Table of Contents

Introduction 2

How Does PCOS Affect Your Loved One’s Weight? 6

How to Fix Your Eating Patterns? 12

Where Do I Start? 17

It’s Okay to Have Carbohydrates If You Follow These Rules 20

Diet, Insulin Resistance and PCOS. A Complicated Relationship 23

Vitamin D is a Rare Commodity That You Need to Get Your Hands On 27

Micronutrients Equal Big Results! 30

Iodine a Miracle Treatment? 36

Trust Your Gut 38

What Foods Are the Best at Reducing Inflammation? 42

Why is Fiber So Important in Regulating Blood Sugar? 46

What Foods to Avoid? 49

The Profound Effects of Eating Breakfast 53

30 Day Meal Plan and a World of Possibilities 55

Conclusion 81

References 87

Disclaimer 90

Introduction

What if I told you that 4.5 out of the 6 million American women that are suffering from an ailment, either don’t know they have it or were misdiagnosed (1)? What if I told you this ailment caused symptoms such as: infertility, acne, weight gain, hair loss, irregular periods, depression, anxiety, and trouble sleeping (1)? No, this is not some rare tropical disease that is being transmitted by mosquitos. The ailment is called Polycystic Ovary Syndrome (PCOS) and on top of the terrifying symptoms, physicians believe the root cause of this disease can vary dramatically. Even more alarming is that even though 94% of physicians agree that they should be required to assess patient’s nutrition habits, only 14% of physicians are adequately trained in nutrition (2). At this point, you may be asking, “How do I know if someone has this terrible disease and if the majority of physicians rely on medication alone, what is the likelihood that they will live a fulfilled life? Have no worries, I have done the heavy lifting for you by researching and distilling a vast amount of scientifically proven journal articles, discussing ways to treat people with PCOS that you care most about. I have an undergraduate degree in Clinical Lab Science and I have been working in the medical device industry as a scientist for the past 7 years. I have seen the industry change with technology, offering individuals a more thorough course of therapy. I’ve witnessed the increase of recommendations for preventative measures made by physicians to patients. The majority of the time, the preventative measures were tied directly to diet. My journey with nutrition has been similar, in that it has evolved with research and will continue to evolve with the knowledge I gain. We live in a time where more knowledge is at our fingertips than any other time in history. I have spent countless hours, days, and months researching peer reviewed scientific articles that meet certain criteria to be used as valid resources in this book. The guide to combat PCOS that is laid out in this comprehensive book will have a compounding effect on reversing this terrible disease. Your better tomorrow starts by taking the action outline in this book today. Grab a notepad, make some mental notes, and begin planning a future where you feel better than ever showing off your new look, new health, and optimistic outlook on sustained health with the information in this book. Congratulations on taking the first step to reversing PCOS symptoms. Now, let’s get to work.

Before we get into a game plan to counter this disease, we need to understand the genesis of the disease, the symptoms, how it is diagnosed, and its impact on the individual. Women with PCOS produce excess male sex hormones known as androgens. The condition of having these high levels of male hormones is called hyperandrogenism. Too much of these hormones circulating in a women’s body leads to excessive body hair growth, acne, and male pattern baldness (3). Hyperandrogenism and abnormal levels of other sex hormones prevent normal release of egg cells from the ovaries (ovulation) and regular menstrual periods, leading to difficulty conceiving a child or a complete inability to conceive (infertility). For those who achieve pregnancy, there is an increased risk of complications and pregnancy loss. Due to irregular and infrequent menstruation and hormone abnormalities, affected women have an increased risk of endometrial cancer (cancer of the uterine lining). In PCOS, multiple cysts in each ovary can be seen with medical imaging. These cysts are small, immature ovarian follicles. Normally, ovarian follicles contain egg cells, which are released during ovulation. In PCOS, abnormal hormone levels prevent follicles from growing and maturing to release egg cells. Instead, these immature follicles accumulate in the ovaries. Affected women can have 12 or more of these follicles. The number of these follicles usually decreases with age.

Upon entering the examination room, your doctor will ask you about your menstrual-cycle history and if you have tried to get pregnant but couldn’t. PCOS has a genetic component and often runs in families, so she or he will also ask whether your mother, sisters or other close female relatives have had PCOS or PCOS-like symptoms (4). Your healthcare practitioner will look for signs of high levels of androgens through blood testing as well as visual signs such as excess hair growth and acne on your body. You may also receive a pelvic exam to check your ovaries. An ultrasound may also be warranted to receive more insight into your ovary health (4). The main indicators of PCOS are: atypical menstrual periods, increase androgen levels, and polycystic ovaries. Other factors that physicians will consider is weight gain and trouble sleeping. It is important to note that although there is no agreed upon international criteria for diagnosing PCOS, physicians are finding common ground when deeming someone as officially having PCOS. Many of the factors used to determine whether or not someone has PCOS stem from the root cause of poor diet.

You are about to gain insight into a tailored PCOS management plan. You may recall discussing that only 14% of physicians are formally trained in nutrition, and it turns out that most management plans center around reducing the symptoms through nutrition. You’re about to gain access to information that 86% of physicians don’t know. This guide will help you understand which foods you must avoid at all costs, how the timing of your meals throughout the day can help you with reducing symptoms, what types of fats and carbohydrates you should be targeting, as well as the beneficial impacts of probiotics and fiber. Keep in mind that a holistic approach of incorporating new meals, exercise and building a positive support team around you will help you stick with your new healthy lifestyle. You are also about to receive practical tips such as: the supplements that pay the biggest dividends for fighting PCOS symptoms, how to look for multivitamins that contain these key vitamins and minerals so that you’re not breaking the bank, as well as a complete 30 day meal guide with simple, tasty, and healthy meals that you can add to your daily routine to drastically improve the quality of life for you or other loved ones.

How Does PCOS Affect Your Loved One’s Weight?

Just in the past few years many countries have seen increases in obesity in both children and adults. There are countless contributing factors to obesity and to go through them all would be draining, but one thing we do know is that this has hit people’s pockets. In the journal article Polycystic Ovary Syndrome and Weight Management, the author indicates, “Leaders and country officials are starting to implement policies to mitigate and reduce the obesity of their constituents because of the financial impact it has on society” (5). This discouraging trend towards citizens living with chronic disease caused by their unhealthy weight and racking up unaffordable health costs, is a wakeup call to be proactive with planning your diet plan of attack, rather than retroactively, obediently, swallowing the medication physicians prescribe to keep your body functioning and hoping and praying that it will be enough to return your health. The fact that governments are paying closer attention to this issue, should be an epiphany to their constituents that they need to start taking control of their health but focusing on proper nutrition. What is the relationship between obesity and Polycystic Ovary Syndrome you may ask?

Polycystic ovary syndrome is a condition that has a strong relationship with obesity. It is believed that women with PCOS are affected by both insulin resistance, with additional obesity issues that stem from the insulin resistance. In simpler terms, just as your retirement fund has been compounding (increasing on the previously increased amount); PCOS and insulin resistance act in the same way, showing compounding negative effects on health. Alvarez-Blasco and his scientists reported an increased prevalence of PCOS in overweight and obese women (28.3%) in Spain, a significant increase from a previously described prevalence of 4–8% in a number of studies. A comprehensive Nordic study reported a greater number of clinical features of PCOS with individuals with an increased BMI (5). A noteworthy scientific journal article notes, “In women, obesity manifests with a range of reproductive conditions, including but not limited to: subfertility, PCOS and pregnancy complications, gestational diabetes, which usually precede typical obesity-related metabolic ailments. Obese women with reproductive complications such as PCOS, are identified as high-risk for further progression to metabolic complications, including: diabetes, muscle degeneration, and cardiovascular disease. This paints a daunting picture of what neglecting to take action against PCOS could lead to. Clinicians have the opportunity to identify female patients that are at a higher risk of obesity related complications early in life, by recognizing women with reproductive insulin-resistant conditions” (5). Okay, by now you get it. Not only does obesity make women more susceptible to acquiring PCOS, but once they have it, their obesity makes it more difficult to manage this terrible disease. The majority of women with PCOS display a high amount of low-density triglycerides (LDL), which is the bad cholesterol. More studies are suggesting that these unwanted high levels of fats can influence the way our bodies respond to sugar. Fat cells can produce hormones that play key roles in maintaining health, but too much body fat can throw this normal hormone production out of whack. Later in this book, we will also get into studies that suggest poor diets can also influence hormone production, the types of bacteria that normally reside in our gastrointestinal tract, and how these two things can lead to systemic edema (painful inflammation throughout your entire body). It’s important to keep in mind that poor diet can lead to a number of issues that may be interconnected, so eliminating one ailment may lead to removing another issue that was dependent on that original issue’s abnormality. Figure #1 below will help you understand what leads to PCOS, and the interconnectivity of symptoms that I mentioned.

Poor Diet, Genetics, and Environmental Factors such as Stress

Diagnostic Characterisitics of PCOS

Atypical follicle maturation

Figure 1: PCOS Flow Chart

Thyroid gland hormone production issues

High levels of blood sugar

Figure #1 shows that if the diet can be corrected, this interrupt the pathway to various symptoms, ultimately leading to the body returning to normal insulin production, hormone production, and menstruation in your body. The domino effect of a poor diet leads to the pathogenesis of PCOS. You can see how blood sugar can affect hormone production, which then in turn causes issues with the ovaries. It is pertinent that the root cause that is poor diet be addressed, since this leads to worsening insulin sensitivity which then has a cascade effect to many of the other symptoms associated with PCOS. Obese women with PCOS can have a compounding effect on both blood sugar levels, and systemic inflammation which in turn makes life pretty miserable by triggering other issues, but what can they do about their poor eating habits? Ever cheat on that no carbohydrate diet and take a spin class that was a little too intense for you? Yah, we’ve all been there. Strangely enough, it turns out that having a nutrition plan and an exercise program leads to a lower dropout rate when compared to just doing one or the other. Don’t believe me? Just listen to the results of this study, “Exercise or combined integrated approaches to weight loss lead to lower drop-out rates. A group using a combined diet and exercise intervention had a dropout rate of 40.6% versus a group using diet alone, where the dropout rate jumped to 53% in women with PCOS (5). A great starting point may be to start a journal that lists some of your goals and how you plan to get there by making incremental progress over time. See an example journal entry below:

Goal: Lose 15-25 pounds in 6 months

Week 1: Eat a salad before dinner every night and go for a walk around the block two nights per week

Week 2: Continue eating the salad before dinner and incorporate a portion of steamed vegetables to a meal every night. Go for a walk around the block three nights per week.

Week 3: Continue the salad and steamed vegetables and have one ounce of nuts between lunch and dinner every afternoon. Go for a walk around the block five nights per week.

Notice that you didn’t focus on cutting out any foods? The guide above was actually a rough interpretation of a course that was derived from an expensive nutrition program, so use this valuable information to your advantage. The journaling will help transform your mindset to prioritize healthy eating and visualize your success. I highly recommend engaging in low impact exercise programs such as but not limited to: water aerobics, swimming, walking, stationary biking, or elliptical machines. Low impact exercises will not only mitigate injuries that can keep you from burning calories for an extended period of time, but it can also provide a sustainable program that you can carry with you for decades. Don’t you want to be that attractive person in their 60’s that actually look like they’re in their mid-40’s? There has been growing interest in a workout routine heavily studied by professors at the University of Maine. The exercise program is called HIIT, which stands for High Intensity Interval Training. The studies showed that short workouts (30 seconds or less) that elicited a heart rate of 120 beats/minute or more, with equal rest periods before engaging in another exercise that increased their heart rate for a duration of 10-15 minutes caused participants to burn more calories while resting throughout the day (20). When our bodies burn sugar in our bloodstream from high heart rates (think sprinters or powerlifters), this is called anaerobic respiration. When our bodies burn fat stores from a slightly elevated heart rate (think marathon runners or cross-country skiers), this is called aerobic respiration. Aerobic respiration utilizes the Krebs Cycle which you may recall from General Biology courses. The Krebs Cycle takes place in the mitochondria of cells. The process consumes oxygen and produces carbon dioxide and water as waste products. It converts fats into ATP (adenosine triphosphate which is what are bodies use for energy) by the oxidation of acetyl-CoA which is derived from these said fats. The study by researchers at the University of Maine were interested in seeing what the effects of a workout routine of 30 second exercises, requiring an elevated heart rate (anaerobic respiration) over a 10-15 minute cycle of these exercises. The researchers then measured their oxygen intake throughout the day. Oxygen intake is important because this correlates with the amount of fat we burn. Even though the exercises themselves elicited blood glucose as the energy source, long after the workouts, the participants were taking in increased levels of oxygen and burning fat while going about their everyday activities (20). It is important to note that this workout routine takes a high demand on the body and if you’re currently suffering from joint discomfort, a low impact exercise routine will be more suitable for you. High Intensity Interval Training isn’t for everyone but can pay large dividends with fat loss. If you do plan to attempt a HIIT regimen a good place to start is with an exercise to rest ratio of 1 to 2. This means exercising for 30 seconds, resting for 1 minute repeatedly until 5 different exercises are completed in 3 cycles. The entire 3 cycles (each with 5 different exercises should take about 20 minutes). As this becomes easier for you, try to reduce the rest time by 10-15 seconds until your exercise to rest ratio is 1 to 1. An even more simplified approach can be applied to lightly jogging for the same duration of time outlined above before returning to your walk. The point of this is to find a sustainable approach that will have high compliance and will be sustainable as you age.

High fiber plant-based foods play a positive role in maintaining healthy blood sugar levels for your workouts that we will discuss in more detail later. Incorporating these foods will eventually crowd out some of the less healthy foods that you’re currently eating (without you even knowing it!). One study discovered that women with PCOS took in higher amounts of high glycemic index (GI) foods (e.g., white bread and fried potatoes) compared with women without PCOS. The study also showed that lean women with PCOS consumed a lower amount of calories than women of the same weight without PCOS. The study indicates that women who are the same weight may trigger PCOS, not by the number of calories they consume, but by the types of foods they are consuming. This suggests that women with PCOS may need to follow more stringent dietary restrictions in order to maintain a suitable weight. Two different studies compared separate groups of women that took in the same calories with the only difference being that one group had their calories coming from 15% fewer carbohydrates and 15% more protein. The group of women taking in the same calories with a larger percentage coming from protein and a lesser percentage from carbohydrates showed reductions in weight, fasting insulin, and reproductive hormones while also seeing a greater reduction in postprandial (after a meal) glucose, and sustained reduction in free androgen index in weight loss (5). It’s important to emphasize that these advantages were coming from a group that did not cut out carbohydrates completely, in fact, this group was still getting roughly 40% of their calories from carbohydrates, but the marginal decrease from having your daily caloric intake made up of 55% carbohydrates to 40% carbohydrates can have dramatically positive implications to your health. If you were thinking that the science was going to suggest that you cut out carbs completely, then you would be wrong. The types of carbohydrates are what’s important and we will discuss examples of what types of carbohydrates need to be on your radar and which need to avoided at all costs. Flip the odds on the PCOS casino and proactively create an exercise and nutrition plan that will give you a high level of confidence of combating PCOS and maintaining your new healthy lifestyle.

How to Fix Your Eating Patterns?

Everyone has that neighbor that lost 10 pounds by using a meal program that assigned points to food. People have proven you can do this by having a single portion of a food low in nutrition density (cookies, brownies, pizza, etc.) as long as the total caloric intake is less than what you’re burning throughout the day. More recent studies are showing that a lack of essential B vitamins and minerals can wreak havoc on your nerve signaling and overall health. It is more ideal to restrict calories while also consuming nutrient dense food. If you’re unsure of how nutrient dense a food is, try looking up the Aggregate Nutrition Density Index or ANDI for short. The index will provide higher scores to food that have an abundance of vitamins and minerals that are essential for cellular function such as: kale, bok choy, or collard green (which scored a perfect 1000 by the way). Some foods that scored low on the index are cheese and soda.

Most diets have mechanisms to limit your caloric intake, but is there a way to tailor the frequency of meals to suppress some of your PCOS symptoms or even reverse them? A study in the American Journal of Epidemiology found that increasing the number of eating episodes is inversely associated with obesity (6). Yes, having four or more meals of at least 50 calories throughout your day can actually help you maintain a healthy weight. How can this be? The study tracked the meals and weight of women over a nine-month period. Clear correlations were found with a higher rate of obesity and the women who skipped breakfast and ate more frequently away from home. Subjects in the study reporting four or more eating episodes per day experienced a 33 percent lower risk of becoming overweight. Breakfasts eaten away from home had more than 105 calories, 7 % more fat, 2.8 % more saturated fat, and 2.2 less grams of fiber per 1,000 calories than breakfasts eaten at home. We will discuss breakfast in more detail along with easy, healthy, meal ideas that will pay dividends throughout the entirety of your day. We will balance convenience with nutrition, as well as flavor for fail free meals that will spark new recipe ideas for you to hold onto for the rest of your life.

Perhaps you already knew this, but what are you supposed to make out of this new intermittent fasting fad? Is it even healthy? Maybe you overheard a young couple talking about intermittent fasting while you were picking up your coffee, or maybe a celebrity on your favorite podcast was discussing the window of time they allow themselves to eat in. Intermittent fasting is generally practiced by abiding by a 10 to 12 hour window of eating each day. Most surveys have shown that the majority of people perceive eating within 12 hour time windows each day, but recent studies that asked a group to take a picture of each food they eat and upload it to an app that timestamps the image has shown that the majority of the population actually eats in a 14-15 hour time frame each day. Sounds familiar? Yes, even though coffee is calorie free it elicits a metabolic response, so if you start the day with a cup of coffee or tea, start the clock. A typical American will have a meal or coffee at 7am and have their last meal between 9 and 10 pm. That’s 14-15 hours! It’s essential to cut this window by 2-3 hours and we will discuss hacks to achieve just this. Intermittent fasting is not solely based on testimonials, there has been quite a bit of research into the benefits. In a renowned journal, it is stated, “A regular night sleep can be defined as a fasting period, and individuals show favorable insulin and glucose levels after this normal fasting period” (7). Intermittent fasting has been shown to have significant benefits for insulin resistance and has been shown to lead to an impressive reduction in blood sugar levels (6). Fasting blood sugar is the concentration of sugar in your bloodstream after at least 8 hours of not eating. Studies on intermittent fasting in humans has shown that fasting blood sugar can been reduced by 3-6%, while fasting insulin can be reduced by 20-31% (7). A study in diabetic rats also showed that intermittent fasting protected against kidney damage, one of the most severe complications of diabetes (7). What this implies, is that intermittent fasting (slightly expanding the window of not eating beyond sleep) may be highly protective for women with PCOS who are at risk of developing type 2 diabetes. If you value your vital organs and metabolism, intermittent fasting is something that needs to be on your mind for consideration.

Reduce late night snacking. Our bodies have evolved and are designed to use the calories that we take in fairly quickly after consuming them. That’s why you have heard stories about marathon runner’s carb-loading before an event or see the athletes on the sideline eating a banana for sugars and potassium to maintain their energy and prevent cramping. Late at night you will not be participating in any of these strenuous challenges, you will most likely be watching the news, feeding your cat or winding down for bed; don’t handicap yourself by consuming a large number of calories right before bed.

How do I use this information to create an actionable plan for someone with PCOS? Glad you asked. It’s important to limit eating out, binge eating, and eating outside of a 12-hour window. Spending hours at the DMV, doctor’s office, or running countless errands to prepare for a family member’s birthday party throw a wrench into your eating schedule. Obviously, life complicates abiding by these rules but there are some simple tricks to help you take control of your eating patterns.

Bring snacks from home to work. Something as simple as a bag of cashews and blueberries provide healthy fats and antioxidants which will benefit you more than anything out of the vending machines or pastries in the lobby. The snacks from home also can satiate hunger to prevent binge eating later in the day. The next thing to do is to become more mindful of your cravings. Are you hungry because you’re stressed? There are evolutional explanations to why we feel the need to eat that entire pie since after the holiday season, you may not see this particular type of pie until next year. Humans experience the fear of missing out with high calorie foods because during our hunter gather days, if food was present, we needed to take advantage in order to assure our survival (who knows what the success rate of hunting and gathering was back then?). Really take the time to understand why you feel the need to eat, ask yourself what you’ve already eaten, and try and control you breathing. My favorite technique is a type of meditation where you replay your day in your head, watch it unfold like a movie, and be indifferent to interactions that would normally elicit a response. Another great way to calm yourself is to have a cup of herbal decaffeinated tea after lunch. I can’t tell you how many times I ate my soup and sandwich, and because of a hot cup of herbal tea my desire to indulge on donuts or bagels that a coworker brought in completely dissipated.

Intermittent fasting can be difficult, but the most popular technique is to either delay your first meal of the day to right before work, or to have it during your first break. If I have a bowl of oatmeal right before starting work at 8am, I’m still able to have dinner and post meal snack until 7:45pm before shutting down nibbling on treats for the day. This is great but what types of foods should I be focusing on? We will go in depth about what types of fats, proteins, carbohydrates, vitamins, probiotics and micronutrients that will offer the greatest dividends with managing PCOS.

An average day may look something like this:

7:45am – Have a bowl of mixed nuts, oats, and berries with almond milk.

10:30am – Walk past those pastries in the break room and open that Tupperware of apple slices with peanut or almond butter on the side to dip in.

12:45pm – A brown rice bowl with beans, flavored with garlic olive oil, a bit of lime juice and finely chopped cilantro.

2:30pm – A cup of full fat Greek yogurt with your favorite berry mixed in.

5:45pm – A salmon fillet with grilled zucchini.

7:15pm – A low calorie protein shake or a piece of leftover salmon

Pay less attention to the specific foods listed above and focus more on the timing. The plan was developed for a typical 8 am – 5 pm work day, but if yours varies, simply adjust the times to fit your schedule. Remember that certain foods may have been studied individually to determine whether they are good or bad for humans but it is more important to understand how the foods cause the human body to react within the context of your eating pattern. The eating pattern of when you eat, as well as what else you’re eating, all are contributing factors to how the food of interest will affect you. Surprisingly, independent of what people ate prior to an intermittent fasting period, individuals have seen positive results with reducing key indicators of disease in their serum. You will find that you wake up more alert and because of this timing you will look forward to and enjoy that first meal more than you ever had. I’ll let you in on a little secret that will help with making that first meal convenient for you so that you won’t have to disrupt your morning routine by having to make breakfast. A small mason jar can be loaded with oats, nuts, berries and almond or another alternative milk the night before and left in your refrigerator. In the morning simply grab it as you head out the door and enjoy your tasty treat to give you energy for the day ahead.

Where Do I Start?

The approach of diet therapy in PCOS patients must be to reach a specific goal. An example of this can be to improve insulin resistance, metabolic and reproductive functions through an optimized diet plan. Numerous studies have clearly defined that special attention must be paid to the reduction of saturated and trans fatty acids, as well as possible deficiencies such as vitamin D, chromium and omega-3 (8). I’m about to take you through some different diet approaches but it is important to understand that the ketogenic diet is not appropriate for pregnancy or breast feeding since this is a time when fat stores are crucial to both the mother and baby’s well-being. The ketogenic diet is also not advised for individuals with kidney damage. People with diabetes, epilepsy, and gallbladder issues require a physician’s supervision to monitor the use of this diet. It is more important to take away the types of fats you need to be targeting such as fats high in omega-3’s.

Scientist are overwhelmingly warning against the consumption of trans-fats. What are trans fats you ask? Trans fats are unsaturated fats that occurs in small amounts in meat and milk. These fats can be found in vegetable margarines, vegetable oils, and fried fast foods. In a comparison study over 78,000 women, Harvard researchers discovered that trans-fat consumption was associated with a higher risk of cardiovascular disease. Another study of 823 women by the Harvard Medical School showed that consuming trans-fat was linked to increased systemic inflammation (9). Please bear in mind that women with PCOS have a higher risk of both types of diabetes, heart disease, as well as systemic inflammation. When you add it all up, it’s clear that you must avoid trans-fats at all costs.

What is the perfect range of grams of protein to have in a diet? If you eat too little protein, your body will rob muscle tissue in order to use their proteins to repackage the amino acids they contain for enzymes used for normal body function. If you were to intake too much protein, the body sends the excess to the liver where a conversion process produces a toxic chemical (ammonia), which then causes urea as the byproduct. In order to excrete ammonia without damaging the kidneys, individuals need to intake a large amount of water to dilute this toxin. These toxins can be mitigated through the incorporation of healthy foods such as leafy greens that we will give more detail about later. You may have also heard that soy products can cause you to produce more estrogen which can cause issues; is this true? The short answer is no, this is a misconception. It’s a little more complicated than that in regards to PCOS. Soy contains “isoflavones” which are different than estrogen. For one thing isoflavones have a 400-1000 times weaker physiological response when compared to estrogen. The reason that Isoflavones don’t elicit the same response as estrogen is due to their poor ability to bind to either of the two estrogen receptors. Studies in the UK have shown that premenopausal women given 60 grams of soy (containing 45mg of isoflavones) daily for one month showed significant reductions in luteinizing hormone. The lower surge of luteinizing hormone makes ovulation not occur. Many PCOS women do not have surges of luteinizing hormone, so it is neither advisable to include or exclude soy products in a diet for PCOS women (9). If you’re vegetarian and currently consume soy products, you have nothing to worry about, you can continue enjoying your miso, tofu and mocha. Many studies agree that 46 grams of protein is a healthy target for women with PCOS which can be accomplished utilizing many different types of diets.

What about the popular Paleo Diet, can this help my PCOS symptoms? The paleo diet is a based on the types of foods presumed to have been eaten by early humans, consisting solely of meat, fish, vegetables, and fruit, and excluding dairy or grain products and processed food. When the Paleo Diet is compared to the modern American diet, individuals receive 2-3 times more fiber, 4 times more omega-3 fats, 60-70% less saturated fats, 2-3 times higher protein intake, and 4-5 times lower sodium intake when compared to the normal American diet (9). I can’t emphasize this enough; women with PCOS are at a much higher risk of both diabetes and cardiovascular disease so it is imperative to focus on eating regimens such as the Paleo Diet plan to reduce the risk of PCOS related ailments. Increasing protein and reducing sodium and saturated trans fats can help patients manage their symptoms. Everything that we discuss from now on will be dedicated to mitigating or reversing some of the symptoms and risks inherited with PCOS. Now that you have this information, how can you balance fats and proteins into your diet? Well, the main takeaways are to avoid trans-fats, focus on including more fish, nuts, vegetation (yes, vegetables have protein too), and reduce the amount of high/medium glycemic foods for a sustainable diet plan. A typical day may look something like this:

Breakfast: 2 scrambled eggs with half an avocado sliced on top

Lunch: 1 cup of long grain brown rice, 6 oz salmon filet and steamed broccoli

Dinner: Thai curry (full fat coconut milk) with chicken thighs or garbanzo beans (vegetarian/vegan friendly)

It is worth noting that plant-based protein shakes and nuts are great snack options. In some cases, these shakes contain probiotics, whose benefits we will discuss in more detail later in this book. Nuts are an excellent source of vitamin E, arginine, healthy fats, magnesium, potassium, and fiber which are all powerful ammunition for attacking PCOS. The arginine in nuts stimulates nitric oxide, which is a potent vasodilator (expansion of blood vessels). Even though nuts are high in fats they actually have been shown to reduce LDL (bad cholesterol) by 8-12% in human feeding trials since they contribute to HDL (good cholesterol) (9). I know that I sound like a broken record, but the evidence is overwhelming for people who eat one ounce of nuts each day, showing dramatic reductions in the risk for diabetes and heart disease (both major concerns for women with PCOS). To recap what we have learned up until this point, we want to eat as much as 6 meals in no greater than a 12-hour window each day. We also want to target foods high in omega-3 fats while still being able to consume carbohydrates that are low on the glycemic index. Now that you have a grasp on the proteins and fats you need to include in your diet, let’s circle back to carbohydrates and the almighty glycemic index.

It’s Okay to Have Carbohydrates If You Follow These Rules

Carbohydrates are delicious. I mean who doesn’t love Italian food, but eating regimens don’t mean anything if you can’t continue using them long-term. Compliance to diets long-term is precisely why you shouldn’t cut out carbohydrates completely. Whenever you cut out a certain food, they begin to glitter, like going on a carb free diet and walking past the box of bagels that your coworker brought into the office. Sound familiar? A lot of evidence points to incorporating a modest amount of low glycemic foods to go along with the proteins and fats we discussed in the previous section. The compliance rate of people maintaining most diets for longer than a 6-month period is less than 50%. A recent study has shown a hybrid to the ketogenic diet that allows a more liberal amount of low glycemic carbohydrates (brown rice, agave nectar, etc.) and has shown to have a compliance rate near 90% (9). Yes, you read that correctly. Only a 5% reduction in weight can improve problems such as insulin resistance, high levels of androgens, and reproductive issues in PCOS women (9). That’s why a game plan with the end goal of weight loss is your number one priority.

So how do you lose weight? At a very high level, you have to burn more calories than you take in, but this can be accomplished in many different ways, some healthy, some not so healthy. Losing weight is just part of what you should be targeting, of the weight you lost it is preferred that a large percentage be fat. You also don’t want to sacrifice nerve and hormone functionality for dropping a couple pounds. There are ways to balance the intake of foods that provide you the greatest benefit, while also being responsible about your total calorie intake. There are many different diets out their (Zone, Mediterranean, Adkins, etc.) and all of them depend on calorie restriction or portion control as being the key to their success. It is important to note that weight loss can be accomplished with a varying percentage of your total daily calories coming from carbohydrates but one study in particular sheds light on the value of reducing carbohydrates. In a 10-week study at the University of Illinois, 24 overweight women were divided into two dietary groups. Each group ate the same number of calories and the same amount of fat. However (pay attention this is important), one group ate twice as much protein as the other group. The two groups lost approximately the same amount of weight, but the high-protein (low carb) group lost 13.9 pounds of body fat versus 8.4 pounds for the low-protein group (9). This study is significant because targeting body fat is of interest to PCOS women. Reducing body fat can lead to returning insulin levels, reducing systemic inflammation, as well as returning ovulation back to normal. Now it’s great that there are many diets to lose weight, and obviously, reducing the amount of carbohydrates someone eats (depending on their baseline diet) can be important, but how does one do that? Can it even be done if you are a vegetarian or a vegan? Let’s explore.

Don’t get me wrong, reducing carbohydrates is not easy and takes a lot of strong-willed individuals to accomplish this, but here are some tips for making this a reality.

Vegetables: Many vegetables are low in carbs, but high in fiber. These desired vegetables include: tomatoes, onions, cauliflower, eggplant, bell peppers, broccoli and Brussels sprouts.

Fruits: Strawberries, blueberries, as well as other types of berries can be eaten on a low-carb diet. Depending on the amount carbs you decide is suitable for your lifestyle, other fruits may be acceptable as well.

Fatty Fruits: Olives and avocados are packed with micronutrients to aid your health. These fruits are also low in carbs but high in beneficial fat.

Seeds and Nuts: Nuts and seeds are low in carbs, but high in fiber, protein and healthy fats. This includes almonds, walnuts, macadamia nuts, peanuts and pumpkin seeds.

Soy: Tofu and tempeh are high in protein and fat, but low in carbs. This makes them acceptable on a low-carb vegetarian/vegan diet.

Legumes: Legumes that are low in carbohydrates are green beans, and chickpeas.

Healthy fats: Foods that are high in omega-3 fats or medium chain triglycerides include: extra virgin olive oil, avocado oil and coconut oil.

Chia seeds: The majority of carbs in chia seeds are fiber, so nearly all of the usable calories in them come from protein and fat.

Dark chocolate: Dark chocolate with a high (70-85%+) cocoa content (also referred to as curvature in the culinary world), then it will be low in carbs but high in fat and antioxidants.

Yes, that’s right. You don’t need to exclusively eat meat and high curvature chocolate. In fact, the fiber in many of the foods listed can help regulate blood sugar levels. I want to emphasize that reduce doesn’t mean cut out completely. If you’re going to have carbohydrates, you want to look for foods with a low glycemic index (GI). You may be wondering how a low glycemic food is defined? If a food is 55 or less it is considered low glycemic; high GI if 70 or more; and mid-range GI if 56 to 69. If you’re a baker, you would be surprised with the creations you can make using almond flour and coconut flour. Sure, you’re on a restricted calorie plan but that doesn’t mean you can’t have homemade macaroons or pancakes which check in with a glycemic index of 46. Egg based fettuccine pasta checks in at a GI 32 and if you’re craving pizza, look into cauliflower crust pizza (it’s surprisingly delicious). Everyone is different and it’s important to reflect on your energy expenditure throughout the day and plan your carbohydrate consumption accordingly. Many studies suggest loading in the morning and tapering off throughout the day to account for your physical activity subsiding. You should have a clear picture of how to reduce carbohydrates but also understanding that allowing yourself to have pancakes and pasta (as long as it’s controlled and tailored to your day) can keep your eating parameters sustainable. A mindful approach may be to choose 2 days of the week to include some of these low carbohydrate food options into a meal. I find that for social purposes, leaving a day on the weekend open will help you choose foods for dinner parties or brunches with friends that will not leave you feeling like the person limiting everyone else to your food preferences. The key takeaway here is that you need to reduce the amount of carbohydrates in a typical meal throughout your day and not cut them out completely. Portion control is one tactic; however, I find that changing the types of carbohydrates while maintaining the same portion size as your used to can be just as beneficial and more sustainable. Let’s dive in deeper to how exactly you’re eating decisions affect insulin resistance and women with PCOS.

Diet, Insulin Resistance and PCOS. A Complicated Relationship

Insulin resistance is a terrible condition in which cells fail to respond normally to the hormone insulin. To prevent hyperglycemia and noticeable organ damage over time, the body produces insulin when glucose starts to be released into the bloodstream, primarily from the digestion of carbohydrates in the diet. Under normal conditions of insulin reactivity, this insulin response triggers glucose being taken into body cells, to be used for energy, and inhibits the body from using fat. Genetics, diet and exercise play a role in the pathogenesis of PCOS, and physicians usually prescribe anti-inflammatories and insulin sensitizers to reduce the symptoms. For examples, the genetics of South Asian women make them more susceptible to PCOS since they have a higher standing insulin levels, as well as lower insulin sensitivity (10). You have probably gathered that insulin levels are a point of emphasis with controlling PCOS symptoms. Both fasting insulin levels and insulin responses to meals correlate to body fat. In other words, the fatter you are, the more insulin you will have in circulation post meals. Since we can’t change our genetics it’s important to understand how our diet enhances or suppresses PCOS symptoms. Even more disheartening is that commonly prescribed drugs have poor efficacy when treating insulin resistance with PCOS women since the metabolic pathways aren’t well understood. Metformin does not decrease insulin resistance in PCOS. This finding suggests that the cellular pathways to insulin resistance in PCOS is different from other common insulin-resistant states, such as non-insulin dependent diabetes mellitus and obesity (10). In a study published in a scientific journal, twenty‐four obese women with polycystic ovary syndrome were scheduled for treatment for 6–7 months with a 1000 calorie, low fat diet. Nineteen of the 24 had menstrual improvements, 12 became clinically fertile and 19 had a significant decrease in hair growth. The data from the weight loss of these individuals indicates that moderate weight loss during long‐term calorie restriction is associated with clinical improvement which is related to the reduction in insulin concentrations. The improvement in menstrual function and fertility may therefore be consequent upon an increase in insulin sensitivity which affects ovarian function (11). This shows that weight loss can have a trickle-down effect to metabolic pathways that lead to complications from PCOS. Weight management and insulin resistance are your primary focus when deciding how you’re going to reverse this disease.

Ever wonder what the cells that make fat in your body are called? Those are adipocytes and they have been of increasing interest to scientists because of their role in inflammation pathways. These inflammation pathways are robustly associated with many different diseases, including (yes you guessed it) PCOS. Your normal flora of gut bacteria also plays a prolific role in systemic inflammation that we have dedicated a chapter to later in this book. There have been small studies showing that high fat diets can actually increase insulin sensitivity but more trials are needed to have a high level of confidence. One thing that many scientists agree on, is that of the fats in your diet, having a larger ratio of omega-3 (fish oil, flax seeds, chia seeds, etc.) compared to omega-6 (vegetable oils) can reduce inflammation and possibly decrease insulin resistance. In the article Inflammation and Lipid Signaling in the Etiology of Insulin Resistance the author notes that striking progress has been made in the last few years in de-convoluting the complex relationships between lipid metabolism and inflammation that contribute to metabolic disease. In particular, new molecular mechanisms accounting for pro-inflammatory effects of saturated free fatty acids and anti-inflammatory effects of omega-3 fatty acids have been discovered. In addition, the production of ceramide in response to inflammatory signaling in skeletal muscle and macrophages (innate immune cells) is emerging as an important mechanism contributing to insulin resistance. This shows that the composition of fat in your diet can play a major role in the prevalence and severity of symptoms caused by inflammation. It is crucial that foods high in omega-3 free fatty acids are incorporated into a diet for PCOS women, in order to reduce or even prevent inflammation that causes joint pain or acne.

The elephant in the room that we haven’t gone into much detail with is exercise. In an acclaimed scientific article, studies were done on groups of PCOS women; were one group of women that were solely on a diet regimen, one group was solely exercising while eating normally, and one more group was taking a weight loss drug called Orlistat, as well as combinations of therapies. The results were that Orlistat administration, combined with diet, for 24 weeks, resulted in significant weight loss and improvement of insulin resistance in obese women, with or without PCOS. There appears to be a trend during the first 12-week period for greater improvement of metabolic and hormonal parameters in women with PCOS (12). It’s important to consult with a physician for prescriptions, but according to this study Orlistat along with diet and exercise can have a compounding effect on hormonal patterns, which are the root cause of PCOS. How might you start an exercise program? Do you need to go out and sign up for marathons? An incremental approach can provide better compliance and reduce the risk of injury. A simple after dinner stroll around your neighborhood twice a week is a good place to start. Increase it by one day each week, and once you’re at the 5-7 days a week level, try and up the pace of each stroll. Before you know it, you will be jogging through parks. It is also worth noting that beets are powerful vasodilators that can reduce blood pressure as well inflammation. Athletes are starting to use beets as a natural pre-workout supplement. The increase in blood vessel diameter that vasodilators provide gives athletes the advantage of being able to deliver more oxygen enriched blood to muscle tissue to sustain their demanding workouts. This is a small part of a larger idea that your nutrition needs a strong support network of tactics such as supplements, people encouraging you, and exercise. Combine these tactics with the eating guidelines we discussed earlier and PCOS symptoms will be reduced by getting your hormones to act normally.

To summarize the abundance of information you received from this chapter in your steep learning curve, exercise is not to be overlooked, since studies show that it can have a compounding effect with medication and diet. Weight loss is key but the types of fats you eat play a major role with the severity of symptoms in PCOS women due to their association with insulin resistance and inflammatory pathways. Choose the fats you eat wisely. What can we add to your growing plan of attack on PCOS? Gradually start exercising, no matter how modest the workout (hey, we all have to start somewhere). Next, concentrate on adding omega-3 rich fats into your diet and reduce the amount of vegetable oils you consume. Ever wonder how the omega-3 craze started? Scientist noticed that Japan had much lower rates of cardiovascular disease, and close attention was paid to their diet. It turns out that the Japanese consume lower amounts of both omega-3 and omega-6 fats at a one to one ratio. In comparison, Americans eat much larger amounts of fats with the majority of them being omega-6 fats from vegetable oils. Not enough information has been seen with consuming both omega-3 and omega-6 fats at high levels to reduce cardiovascular disease, but scientists unanimously believe consuming them at a one to one ratio is preferred. Invest in flax and/or chia seeds and toss them into your oatmeal or cereal to increase your omega-3 fat intake. Cod Liver Oil is a supplement that has vast amounts of omega-3’s and will benefit your HDL, as well as vasodilation to allow blood to move throughout your body with less resistance A.K.A. blood pressure. We have taken a look at things on a very macro level, which is a good start, but we need to dive deeper to understand what role micronutrients and specifically vitamin D can play with PCOS.

Vitamin D is a Rare Commodity That You Need to Get Your Hands On

If you’re an indoor person, have intolerance or allergies to milk products, or adhere to a vegetarian or vegan diet, you may be at risk for vitamin D deficiency. Known as the sunshine vitamin, vitamin D is produced by the body in response to skin being exposed to sunlight as well as being prevalent in some foods. Vitamin D occurs naturally in the following foods: fish, fish liver oils, egg yolks, and in fortified dairy and grain products. Academic research suggests that vitamin D could play a role in the prevention and treatment of a number of different conditions, including both types of diabetes, high blood pressure (also known as hypertension), glucose intolerance, and multiple sclerosis (9). Anyone can be deficient in Vitamin D, regardless of whether you’re an omnivore, vegetarian, or vegan, however, the amount of cases of Vitamin D deficiency is weighted towards individuals that do not eat meat. Yes, if you’re a vegetarian or vegan you can find Vitamin D in mushrooms but it is recommended that you coordinate a supplement plan with a physician to ensure you’re getting this important vitamin. What is so valuable about the role Vitamin D plays in your body?

Vitamin D deficiency is common and linked with metabolic risk factors in patients with polycystic ovary syndrome. It has been demonstrated in multiple studies that Vitamin D levels can predict the severity of insulin resistance even though the mechanisms are not fully understood. This is a key finding because this one compound in your body plays a role in the pathogenesis (how the disease is created). Vitamin D also plays a hand in nerve signaling and hormone functionality. Both can contribute to many abnormalities in your body. One hormone of interest in women with PCOS is Anti-Mullerian Hormone (AMH). AMH plays a critical role in pathways that maintaining ovarian reserve and modifying follicle sensitivity to Follicle Sensitivity Hormone (FSH) activation. Studies suggest that vitamin D has the ability to interact with the pathway for AMH production in test tube experiments. What does this hormone normally do and why are high levels so bad? AMH normally prevents the premature development of a follicle, however, when the levels of AMH are too high, the processes is stopped and leads to the release of an immature egg during ovulation. At the present moment, while test tube studies suggest vitamin D has the potential to modify AMH production, clinical study findings are conflicting. More studies are needed to determine the exact role Vitamin D is playing with the hormone pathway, so let’s focus on the benefits of Vitamin D therapy that have been proven without a hair of doubt.

Vitamin D plays a role in increasing the intestinal cellular absorption of calcium, magnesium, and phosphate, and multiple other biological effects. If you know someone suffering from PCOS and are wondering what the most important supplement to be taking is…Vitamin D is it! In a popular clinical journal, the author suggests, “Many of the symptoms associated with PCOS can be reduced through calcium and vitamin D supplementation (13)”. How was the study conducted you ask? A large group of women suffering from PCOS were divided into two groups. Group 1 was given 1500 mg of Metformin (a powerful fat blocking drug for weight management) per day, while Group 2 was put on a regimen of 1000 mg Calcium per day and 100000 IU Vitamin D per month. After monitoring these women for 6 months the scientist found that BMI decreased significantly in Group 2. More favorable results were gained in regulating menstrual abnormalities, follicle maturation, and infertility in Group 2 compared with Group 1 (13). Isn’t it fascinating that one vitamin and one mineral can have such a profound effect compared to a pharmaceutical weight loss drug? By adding this Vitamin D through a combination of supplements, mushrooms, and meats, you can increase the odds of your menstruation returning back to normal, decrease the opportunity for ovarian cysts to form, and improve the odds of becoming pregnant.

Now that we’ve established the importance of calcium and Vitamin D with weight management, and menstrual abnormalities among other things, we need to devise a plan for assuring ourselves that we have enough Vitamin D in our diets. If you’re a carnivore, then many red meats and liver are good sources of this magical vitamin. If you’re vegetarian or vegan it gets a little tricky. Maitake, Chanterelle, and Morel mushrooms are good sources of Vitamin D. I can’t emphasize seeking a supplement plan that includes Vitamin D enough, especially if you’re vegetarian or vegan. How could I forget to mention that when sunlight hits your skin cells a reaction is triggered in your body to synthesize Vitamin D. Step out of the office on your lunch break, take your morning cup of coffee that you have on the weekends outside and treat your body to free Vitamin D from the sun. Once those wavelengths of light hit your skin an amazing process unbeknownst to you occurs. Cutaneous 7-dehydrocholesterol that is in your skin is converted to a precursor to Vitamin D and through a few more chemical reactions that I won’t bore you with, you have Vitamin D! You may be wondering how much is too much sun. After all, the sunlight can cause melanoma, right? Just 10-15 minutes of sunlight exposure to your arms, legs, abdomen, or back to untreated skin. If you still plan to be exposed to the sunlight after this, you need to follow up with a 30+ SPF sunscreen. This small amount of sun exposure can play a huge role in mitigating the severity of symptoms caused by PCOS.

Micronutrients Equal Big Results!

It’s no secret that people are overfed and undernourished. Weights of each age group have been trending up while multiple sources show the average person being deficient in crucial vitamins and minerals used in everyday cellular function. We’ve already touched on calorie restriction, types of carbohydrates, fats, and the importance of vitamin D. We’ve discussed your holistic support system as well as some macronutrients and how they should be used. Now let’s focus on what micronutrients can reduce PCOS symptoms and even help reverse the disease.

Plant compounds such as anthocyanins and bioflavonoids reduce inflammation and can trigger the body to produce anti-inflammatory compounds such as adiponectin. Apidonectin is produced in fat tissue. Studies have shown that normally this hormone circulates throughout the body in high levels, but in obese individuals the levels of adiponectin are reduced (23). Not only was adiponectin hormone reduced but more recent studies are discovering that this hormone also plays a critical role in insulin resistance. You may recall that insulin resistance is one of the diagnostics to PCOS and can lead to a plethora of other symptoms. When we discuss reducing calorie intake, the foods that you haven’t cut out become that much more important. It’s easy to have a piece of pizza or a cookie, and as long as you’re under the amount of calories you’re burning for the day, you can call it a day, but think about all of the enzymes, amino acids and vitamins you’re missing out on that keep your body running properly. Plant based foods are the best source of countless micronutrients that play a critical role in the body. When fruits and vegetables are combined with a diet high in omega-3 fats such as the Mediterranean Diet, studies show that plant compounds contribute to fat loss (9).

Nutrition can affect the biological pathways associated with reproduction in women. Notable published studies give evidence that the use of micronutrients beneficially affects fertility, creation of an embryo, and that the prevention of disease. Micronutrients may be useful in preventing several adverse pregnancy outcomes (9). These beneficial effects of the multiple micronutrients can be obtained not only through food in your diet, but also the presence of multiple vitamins and minerals and antioxidants such as Vitamins C and E, N-acetylcysteine in supplements. Multiple micronutrient supplementation is a cost-effective remedy that is well tolerated with no adverse effects. This shows that women should be more aware of the benefits of lifestyle changes and a healthy diet, which are essential not only during pregnancy but also pre-conceptually. Many pharmaceutical drugs only mask symptoms and do not address the root cause, which is poor diet and the absorption of essential nutrients. Women susceptible to micronutrient deficiencies or women that currently have these deficiencies should be supplementing micronutrients to optimize their reproductive health.

Angiogenesis is a medical term that means the creation of vascular tissue. When women are trying to become pregnant, a single type of protein (Matrix metalloproteinases) that is expressed during the early stages of pregnancy is responsible for priming the endometrium (mucous membrane that lines the uterus) for implantation. In the embryonic development, angiogenesis is rampant because the vascularization of your baby is beginning to take place. Many studies show that although there are genetic and environmental factors that can cause the inhibition of this important protein, micronutrients such as B vitamins (specifically Folic Acid) can play an influential role in the expression of this protein. If you know someone who is trying to become pregnant, it is a must to assure that they are getting micronutrients from both their diet and supplements. If the person has PCOS the importance of these compounds exponentially goes up.

Increased anti-Mullerian hormone (AMH) circulating in blood has been observed in PCOS women compared to healthy women. This begs the question, is there anything women with PCOS can be taking to reduce this hormone that seems to be causing issues in PCOS women. The answer is “yes”. Co-Q10, catechin, and selenium when taken together for a period of no less than 3 months have been shown to reduce AMH in women (22). Co-Q10 is found in many foods, so you won’t have to break the bank trying to find a quality capsule to take. Co-Q10 can be found in: grass-fed beef, free range chicken, cage free eggs, trout, herring, cauliflower, broccoli, strawberries, oranges, and pistachio nuts. Selenium is commonly found in multivitamins, and there are quite a bit of foods where this element occurs naturally. Just one ounce of brazil nuts carries 990% of your daily selenium requirements. Selenium can also be found in tuna, shellfish, pork, chicken, and tofu (for you vegetarians and vegans out there). Catechin is a powerful antioxidant that can be found at high concentrations in fruits such as: green tea, apples, apricots, cherries, peaches and berries. If you enjoy red wine and dark chocolate, I have good news for you, these items contain significant amounts of catechin too.

D-chiro-inositol (DCI) and myo-inositol (MI), are two compounds that are abundant in brain tissue. Recent studies in Europe have shown a supplement regimen with inositols (DCI & MI) can improve insulin receptor activity, and unlike prescribed insulin sensitizer drugs, these supplements don’t carry the side effects of diarrhea or nausea (21). Wondering how these scientists decided to conduct studies on these two compounds? Initially a clear correlation was found with the levels of these two compounds in a woman’s body and the viability of their oocyctes (egg cells). These compounds are not normally in multi vitamins so you will have to invest in D-chiro-inositol (DCI) and myo-inositol (MI) capsules, and this investment along with improved diet can instantly improve the health of all women (not just those affected by PCOS).

How do you work in more micronutrients to guarantee that you’re receiving enough of these vital nutrients? If you have a blender at home, an easy way is to throw a handful of greens into a morning smoothie. Not only will this give you a spectrum of micronutrients that has its flavor masked by fruits and other ingredients, but it also mitigates hiccups in your diet that may happen later in the day. What do I mean by hiccups? On the days that you’re busy buying birthday presents, taking the kids to basketball games, or grocery shopping, it’s easy to miss out on your daily serving of vegetables and indulge in a convenient sugary snack. The calories from the green smoothie will provide you with cruciferous (green leafy) vegetables that are exploding with micronutrients as well as a high fiber content that can reduce the rate at which sugar is absorbed by the bloodstream. Mushrooms are also a good source of a lot of micronutrients, so try replacing that flank steak with a Portobello mushroom or throw in some oyster mushrooms to a pasta dish. I’m willing to bet that you will be surprised at the meaty texture and buttery flavor. Of course, supplements can also help mitigate any possible deficiencies in micronutrients but what should you be looking for in a supplement?

All vitamins are not created equal. Yes, it is true that some nutrients in the supplements only have 10% of their total content absorbed by the body. It’s easy to focus on the 90% loss and say vitamins are not worth it, but that 10% should not be dismissed. The modest amount of essential nutrients absorbed may be the difference in the manifestation of a particular symptom or not. Choosing a multivitamin is not an easy task but here are some tips for comparison shopping that will help you get the biggest bang for your buck:

Supplements that provide more than 100% of the daily value for any vitamin or mineral are unnecessary. Your body won’t be able to use the excess vitamins and mineral to your benefit.

Try and choose a supplement with no more than 3,500 International Units (IUs) of retinol or vitamin A. Too much of this vitamin have been associated with birth defects in some studies.

Women who are postmenopausal should choose multivitamins with 50% or less of the DV for iron. Iron can be utilized by bacteria and complications with processing it can lead to liver issues like jaundice.

It is rare to find 100% of the DV for calcium or magnesium in a multivitamin, so don’t waste your time trying to find one that does(Adding these would make the pills very large). You need to zero in on foods that provide this either naturally or through fortification.

Look for the USP (United States Pharmacopeia) symbol, a mark of a quality product. This regulated agency assures quality, while some foreign brands are not under this scrutiny and may pose the risk of being an inadequate product.

Additives, such as herbs, are unnecessary and just drive up the price of the supplement so you should avoid supplements with these unnecessary ingredients.

Some supplements are marketed towards men or women. These supplements tend to be pricier. You can usually find a similar formula in an alternative or generic brand (9).

There is something to be said about being solely reliant on multivitamins and supplements. The ideal way to receive critical nutrients to help individuals manage PCOS is through real food since you will absorb a larger percentage of the micronutrients. Your body absorbs nutrients more readily and mainly in plant-based foods, and certain synergistic enzymes can help the absorption of foods. If you’re interested in searching the web for a method to increase the absorption of foods, you’re probably already eating; you may want to type “Phytic Acid” into your web browser. This is an active enzyme in many grains and legumes that inhibits the microvilli (intestinal cells that mediate the absorption of nutrients) from up taking nutrients present in the foods you’re eating (16). So, is there a way to stop this from happening? Glad you asked. Sprouting foods such as brown rice, seeds or lentils neutralize this enzyme and allow you to uptake more nutrients in these foods. There are various tutorial articles and videos you can watch but all you need is a mason jar and some type of filter (cheese cloth or plastic grate). Simply fill the jar about a third of the way full with the food item you intend to sprout, fill the jar with water so the level is past the top of the food item, let it sit overnight, then drain it and keep in inverted (45 degree angle is optimal) in a cereal bowl and rinse at least twice a day. The sprouting should be complete in 2-3 days before you start benefiting from their transformation. You will notice a tail forming that looks like the miniature stem of a plant, this means the sprouting process has started and the food is ready to eat. A favorite of mine is broccoli seeds, that sprout very rapidly. The only issue is that the yield from these sprouted broccoli seeds is too much to eat in one go so I would recommend placing the excess in a plastic bag with a paper towel and freezing them. It adds a small amount of spice that is almost undetectable in salads and smoothies. Broccoli sprouts are extremely high in a chemical called sulforaphane. Sulforaphane has been shown to have beneficial effects in aiding the burning of fat and reducing the risk of cancer (9). Not only is the food that’s yielded from this method healthy but it’s a fun craft to take on that is also a pleasant conversation starter for family, friends and co-workers to engage others in your nutrition goals. I have found that my family is more interested in trying the sprouted food and co-workers are more likely to try it for themselves. This support team around you acts as a type of cocoon that encourages your healthy eating habits.

Question: It’s now time for a quiz to see what you have learned. Okay, fine, I’ll give you the answers. What are foods that you can target to assure you receiving micronutrients that have been scientifically proven to aid the reversal of PCOS symptoms?

Answer: Leafy greens, legumes, mushrooms, meats (beef, pork, chicken, fish, & shellfish), tofu, raw fruits, red wine and dark chocolate.

Question: What are some components listed in multivitamins that are important for individuals with PCOS?

Answer: B-vitamins (especially Folic Acid), D-vitamins, anthocyanins, and bioflavonoids.

Question: What is a compound found in the brain that is not commonly found in multivitamins, but when taken as a supplement can aid PCOS women with insulin sensitivity?

Answer: Inositols (D-chiro-inositol (DCI) and myo-inositol (MI).

Iodine a Miracle Treatment?

Is it true? Can there be something not marketed by a large pharmaceutical company that can play a critical role in helping infertile women or women that have experienced miscarriages? Believe it or not the ovaries contain the highest concentration of iodine in the body after the thyroid gland. Iodine deficiency is a hidden epidemic and women are more than twice as likely than men to be affected. Stress is a key environmental factor in throwing thyroid hormone production out of whack. Women’s menstrual pattern is influenced by thyroid hormones. These hormones have both a direct and indirect action on ovaries via its impact on sex hormones secretion and coagulation factor. The thyroid dysfunction not only affects the ovulation by interacting with ovarian function but also affect the lipid metabolism and fertility of a women. It’s only effect on the menstrual pattern and interfere with fetal implantation which can be prevented by early recognition and treatment with thyroid hormone. PCOS is one of the most common endocrine disorders in women within the reproductive age group. Treating thyroid dysfunction can reverse menstrual abnormalities and thus fertility in cases of polycystic ovaries. The pathway for androgen production is the pituitary gland in the middle of the brain sends a hormone signal to the thyroid gland (located in the neck), which then sends hormone signals to the adrenal glands (located above each kidney), which in turn produces androgens. The main endocrine derangement responsible for the clinical manifestation are hyperandrogenism (high levels of androgen hormones) and abnormal response to glucose (14). Iodine plays a critical role in breaking down fats and carbohydrates in the body. The benefits of iodine are not limited to women with PCOS, it has been shown to prevent hair loss, regenerate skin and can reduce free radicals in circulation that have been known to cause different types of cancer.

A study from the University of Karashi, Japan monitored women with PCOS of different age groups in three different countries. One group was prescribed a common weight loss drug, the other remained on their normal diet, and one group was asked to take iodine orally twice per day. The results show that the group taking iodine orally twice per day reversed their irregular menstruation, reduced ovarian volume and increase key factors in assessing fertility (14). This shows that iodine can have a profound effect on the reduction of symptoms as well as increasing the probability of becoming pregnant for women with PCOS. There have also been studies showing the iodine can either halt the progression of tumors or even cause death to cancer cells (14). It is also important to understand that PCOS women cannot solely rely on medication to keep their symptoms at bay. A holistic approach of medication, exercise, mindfulness, and nutrition is needed to attack these ailments from all angels.

How can someone with PCOS work in foods high in iodine? Seaweed such as nori, kombu, and wakame are great low calories snacks that are packed with iodine. Not a seaweed fan? That’s okay, you can also get solid doses of iodine in cod and sea salt. Simply choosing to purchase iodized versus unionized sea salt, or cooking a cod fillet with sliced lemon and olive oil for dinner every now and then can increase your iodine levels and ultimately help your menstruation, fertility, or both. Maybe there is something behind the cod liver oil your grandma swears by for health. Supplement therapy can also help, so look to see if your multivitamins include this element. That will save you time and cash by not having to go out and buy a separate capsule or liquid to take.

Trust Your Gut

What if I told you something that could not be seen with the naked eye was contributing to your PCOS symptoms? Something microscopic, something that usually gets associated with poor hygiene and infections. I’m talking about bacteria. Specifically, commensal bacteria, which means bacteria living in close association with another species, while also benefiting that species. You may have seen commercials for probiotic supplements? Mainly Lactobacillus species that live in your intestines (normal flora), can improve immune function, protect against pathogenic bacteria, and improve the digestion and absorption of nutrients (19). Ever wonder what happens if you have a poor flora of beneficial bacteria in your gut?

In a 2012 journal article, scientists hypothesize that disturbances in a women’s normal flora through poor diet can increase gut mucosal permeability. This increased gut permeability can lead to a toxin known as lipopolysaccharide that is derived from gram negative bacteria in your intestines passing into your bloodstream and having a systemic effect (19). The lipopolysaccharide is a part of gram-negative bacteria’s cell wall. Once harmful gram-negative bacteria adhere to the lining of your intestine they shed pieces of their cell wall which acts as a toxin. The systemic immune response from these lipopolysaccharides from their cell walls can lead to disturbances with insulin receptor function which causes an increase in serum insulin levels, which can then increase ovaries production of androgens, which in turn causes complications with normal follicle development (19). The scientists paint a clear picture that the possibility of your gut bacterial health can influence three major components of PCOS: disturbances in menstruation, hyperandrogenism, and development of ovarian cysts. What if I never bought a probiotic before, is their way to get it in my diet? How do I get the most bang for my buck?

A co-worker of mine told me that in the Indian culture, it is a widely accepted belief that if you take care of the center of your body, then the rest of your body will follow. I’m not entirely sure if she meant that I need to do more crunches, or if I should pay attention to my gut health, but I’m leaning towards the latter. If you don’t currently eat fermented foods, and you have PCOS, now is a good time to start. Sauerkraut, kim-chi, yogurt, and kombucha are great ways to cultivate these beneficial bacteria in your body. Not a fan of these foods? No worries, you can also take supplements that contain microbes to help you mitigate systemic immune responses from gut toxins. Here is a list of tips for choosing your next probiotic supplement:

Tip #

Avoid unnecessary ingredients such as: artificial colors, corn, gluten, dairy, and soy. These ingredients offer no benefit to you.

Make sure that the expiration date is from the date of manufacturing and NOT bottling. The manufacturers may delay from the time of manufacturing to the time of bottling to save costs and the microbes may be less effective because of this.

Look for the amount of bacterial strains. A general rule of thumb is that the more strains offered, the better.

“CFU” is a term that will come up a lot during your research. This stands for colony forming units, which is the number of bacteria being delivered from the capsule. The advertisements for high amounts (5-90 billion CFUs/mL) offer a low margin of benefits compared to 5-10 billion CFUs/mL, so don’t pay extra for a larger dose of bacteria when a smaller amount will offer you the same benefits.

Delivery systems described on bottles that protect the microbes from stomach acid are preferred and are worth a few extra bucks when choosing the right supplement.

What strains of bacteria should you be looking for and what benefits do they offer? Two species that are common and have been studied extensively for their immune function, digestive health, and weight loss properties are Bifidobacteria and Lactobacillus. Here is a list of the top 10 strains of bacteria and how they benefit you:

Streptococcus thermophilus has been shown to prevent nitrates naturally occurring in foods like spinach and celery from being converted into harmful nitrites which at increased levels can contribute to anemia and cancer (19).

Bacillus laterosporus has been shown to out compete harmful yeast strains such as candida (19).

Pediococcus acidilactici plays a role in preventing foods from essentially rotting in your gut (19).

Bifidobacterium brevi is essential for colon health especially if you’re taking antibiotics. Antibiotics target the good beneficial bacteria along with the harmful ones. In some cases, a bacterium that is normal to the human gut flora (Clostridium difficile) can over grow after antibiotic therapy. Why is this an issue? When C. difficile disseminates to parts of the intestine that it normally doesn’t inhabit, the changes in environment cause it to release toxins that can lead to a “C. diff infection”. C. diff infections can cause an issue known as pseudomembranous colitis (a scab like membrane formed on the lining of your colon). You can only imagine how painful this is (19).

Bifidobacterium infantis is known for producing an acid that plays a role in preventing harmful bacteria from adhering to your intestinal lining and producing toxins (19).

Bifidobacterium bifidum has been shown to play a role in immune and allergy response and plays a role in reversing skin ailments such as eczema (19).

Bifidobacterium lactis neutralizes gliadin, a wheat protein associated with wheat sensitivity in some individuals (19).

Lactobacillus acidophilus, you guessed it, helps process lactose sugar from dairy products (19).

Lactobacillus brevis has been shown to reverse both oral and colon issues (19).

Lactobacillus bulgaricus produces a bioproduct that has antimicrobial effects that are specific to harmful bacteria (19).

Now that you have an idea of how to assure your gut flora health, let’s look at some practical ways of incorporating habits to reduce the risk of systemic immune responses caused by poor commensal bacteria health. Adding kim-chi to dishes that need extra spice and tang is an easy way to add probiotics into your diet. Personally, I add kim-chi to soups and rice dishes to balance out the buttery flavors with the spice of kim-chi. Kombucha is a polarizing drink, but if you’re a wine drinker; the difference is minimal (effervescence and a slight sour taste). The flavors of kombucha vary widely, but I find the flavors that incorporate small amounts of juice such as mango and guava as being the best introductory flavors. If these are items that are not currently in your diet and because of the demand to minimize dairy intake (yogurt) a supplement taken once to three times daily will offer the same benefits. Remember that maintain commensal bacteria can prevent pathogenic bacteria from adhering to the lining of your intestine, will break down undigested food, and will synthesize vitamins for you to absorb.

What Foods Are the Best at Reducing Inflammation?

“There’s a good reason to believe foods associated with the Mediterranean Diet reduce inflammation, but they are most effective if you make them part of your daily lifestyle, not just something you eat occasionally,” says a world renowned doctor who is also a spokesperson for the Academy of Nutrition and Dietetics. Research shows that many foods associated with the Mediterranean diet (fish, olive oil, fruits, vegetables, and whole grains) reduce inflammation. Although much of this research has been done in test tubes, some studies have found a connection between eating these foods and an improvement in inflammation symptoms. PCOS can lead to the activation of countless pathways that lead to edema, producing acne, stomach bloating, and systemic pain. Reducing caloric intake puts more of a demand on increasing the quality of food that has replaced the legacy foods that were high in trans fats, processed carbohydrates, and offered little nutrient density.

By now you realize that the lifestyle choices one makes when faced with the daunting task of taking on PCOS is cumulative. It’s also important to give you a heuristic when doing your own research when it comes to inflammation in humans caused by food. In many studies only a specific food is being eaten by individuals, which may or may not cause inflammation, however, it is more important to understand the effects of the food in relation to the context of eating patterns and other foods in your daily diet. An example would be the effects of red meat on its own have been shown to cause gastrointestinal inflammation, but other studies show that when the red meat is eaten with leafy greens the effects of this ailment or obsoleted (9). Understand that the overall diet you formulate will impact the pros and cons of each food you eat individually. Along with exercise, managing stress, eating frequency, and calorie intake we need to consider which foods specifically in your new diet can help reduce some of the symptoms caused by PCOS. If I retained anything from my college Immunology lecture, it was that most symptoms manifest themselves in the form of edema (inflammation). Most physicians are trained to prescribe medication that masks certain symptoms but doesn’t necessarily treat the root cause. Eastern medical practices are advanced for proactive/preventative therapies to diseases while Western medicine is more retroactive. In America a higher percentage of us don’t start taking steps to reduce or prevent disease until after we’re diagnosed. In many instances our diet decisions are the root cause of some of our health complications but it’s important to realize that foods can be used as drugs (after all they have chemical compounds that in some cases are derived to create medication). Let’s dive into which foods specifically have the most powerful anti-inflammation properties so that we can proactively stop this disease either before it begins or before it becomes unmanageable.

Many studies link the omega-3 fatty acids in fish and fish oil to reduced inflammation in the body, and reduced morning stiffness and pain in the joints. Fatty fish, such as salmon, albacore tuna, herring, lake trout, sardines, and mackerel, are highest in omega-3s. Research has found that a compound in extra-virgin olive oil called oleocanthal also helps reduce inflammation. A good rule of thumb is the stronger-tasting the oil, the more oleocanthal it contains. To add olive oil to your diet without piling on extra calories, try using it in place of other fats, such as butter or margarine. Many fruits and vegetables are packed with antioxidants and phytochemicals, compounds found in many plants. Like omega-3 fatty acids, these compounds may help decrease enzymes that cause inflammation in the body. Some fruits and vegetables that are especially potent include tart cherries, apples, citrus fruits, red and yellow onions, shallots, ginger, potatoes, and strawberries. Whole grains also contain compounds that help lower inflammation. Research shows that many Americans don’t get enough whole grains in their diet. Look for breads, crackers, and cereals that list whole grains or whole wheat as the first ingredient. Other good choices include brown rice and oatmeal (4). A good replacement for mayonnaise is avocados. I mash up 2 avocados per can of garbanzo beans and add chopped celery to make a chicken salad type spread. It is delicious, easy to make and will up your omega-3 intake.

Special attention is warranted for turmeric. The spice turmeric is linked to Neurotrophic Factor which has been linked to improved brain function, tumor suppression, antimicrobial effects, as well as anti-inflammatory responses (especially in individuals with arthritis) (9). It has also seen beneficial results as an all-natural topical remedy for acne which is one of the symptoms of PCOS.

Do it Yourself Turmeric Facial Mask:

Ingredients:

Turmeric powder, Greek yogurt and a spoon full of honey.

Directions:

Simply add a half cup of full fat Greek yogurt into a bowl, add 1 teaspoon of turmeric powder and drizzle a spoon full of honey on top. Mix the three ingredients with a whisky thoroughly. Apply to your face and leave on for 15 minutes. Rinse with warm water and enjoy your newly clear, awakened face.

I even have made turmeric tea by taking 1-part almond milk, 1-part water, adding a tablespoon of turmeric, heating the mixture and then adding honey or agave nectar to sweeten. Not only do you have testimony from me, but the active ingredient in turmeric (curcumin) has been proven to increase the rate of in which wounds heal. Adding a little bit to oatmeal, tea, or dinner meals will decrease inflammation experienced due to PCOS. Did you enjoy those tips and want to get more inside information that you can apply to your typical day?

In order to give you insight, as well as provide a personal testimony to the anti-inflammatory foods that I have incorporated into my own diet, here are some easy ways to get more of these foods into your body. Slice strawberries the night before, so that in the morning you can toss a handful of nuts and oats into a bowl for a quick and easy breakfast that will help mitigate some of the terrible symptoms. If you’re not a fish- eating person, you may want to put in some effort. Sardines or cans of smoked herring are loaded with beneficial omega-3 fatty acids that are a convenient after workout or in between meal snack. These canned foods also travel well. It’s great to keep in your bag for work, backpack at school, or even on flights for a convenient health packed snack that will cause you to fulfill your hunger. A decaffeinated ginger tea will work wonders with alleviating stomach issues after meals as well as calm you so that you’re less likely to overeat. Don’t hesitate to take the extra 20 seconds before a meal to add the spices or foods discussed to alleviate excruciating pain caused by inflammation. A diet using the Mediterranean guidelines is a good start to re-prioritizing the foods you consume. Omega-3 rich foods, turmeric, and plant-based foods offer a tremendous amount of upside for managing your pain levels and allowing you to add to your plan of attack.

A simple way to keep your hunger satisfied, as well as assure the intake of these powerful anti-inflammatory compounds is by reducing your meal size and having the following snacks in between meals:

Coconut oil

Nuts mixed with tart cherries

Adding canned sardines or herring to a salad, rice bowl, or even just having it on its own

Keeping turmeric and ginger powder with you at all times to sprinkle into your coffee or tea for that natural anti-inflammatory boost.

Why is Fiber So Important in Regulating Blood Sugar?

Fiber itself is a carbohydrate. If someone where to draw a sugar molecule on paper, fiber is just a long chain of sugar molecules that cannot be broken down by our bodies. Ever wonder how cows get so big off eating grass which is high in fiber? They contain microbes that co-evolved with them to break down these long molecules into single sugar molecules. In the past 10 years, people have started to be more mindful of their consumption of pasteurized fruit juices. This is because when compared to the raw fruit or vegetable, juices have a drastically lower fiber content and are usually pasteurized which denatures many beneficial enzymes, and these factors causes spikes in blood sugar. In fact, fiber content is a key factor in determining a foods glycemic index. Maintaining blood sugar levels is not the only benefit to a diet high in fiber.

In a study from the University of California Davis, scientist observed that women given a diet high in fiber boosted the feeling of fullness (4). That high fiber cereal may help you not feel the need to indulge in a high calorie snack later in the day, which aligns with PCOS women’s goal of responsible calorie restriction. Fiber also promotes a healthy flora of gut bacteria. Commensal bacteria in humans play a role in preventing gastrointestinal issues by blocking pathogenic bacteria displaying certain virulence factors like a fimbria, (it looks like a finger under a microscope, no really!) which mediates the adherence of pathogenic bacteria to your intestinal lining and causes damage. These microscopic bacteria also break down undigested food, and synthesize vitamins and beneficial short chain fatty acids (4). No problem, I’ll just have a bran muffin every now and then to get my fiber for the day. Wrong! Many foods such as pastries marketed through their packaging to be high in fiber also have added sugar like juice concentrates and in many cases use multiple sweeteners. The use of multiple sweeteners is a common trick used by food manufacturers since the FDA mandates that the list of ingredients on food labels correspond to the abundance of that ingredient in the final product. In simpler terms the more of a certain ingredient in your granola bar, the further up the ingredient list it should be. Food manufacturers have found a way to not have sugar high on the list by using a little bit of many different sweeteners (cane sugar, honey, syrups, etc.). Adding seeds to oatmeal and salads is a great way to add fiber, as well as psyllium husk. Psyli-what? Psyllium husk is harvested from the Plantago ovata plant which is common in India. It’s what is used in Metamucil, but if you want to reduce the cost, you can oftentimes find this in health food grocery stores for cheaper. These grocery stores keep them in bulk bins and you scoop out as much or as little as you like. I have to warn you, that you may want to incrementally increase the amount you mix into liquid since once hydrated the husk forms a gel like substance which is not an enjoyable texture to swallow. A similar concoction can be created with placing a couple spoons full of chia seeds in a glass of water overnight. After your intermittent fasting overnight, you will awake to a thirst quenching, fiber, B-vitamin and omega-3 filled beverage that will make you feel like you just had a cup of coffee.

If you know that you will be indulging in a piece of cake or something else that is sweet, you can mitigate the negative effects of the sugar by first drinking a glass of psyllium husk or a high fiber smoothie. Circling back to maintaining healthy bacteria flora in your intestines. A fascinating study in the International Journal of Preventative Medicine shows, 36 women varying in ages 15-40 were divided into a placebo group, and a group taking probiotic supplements. Blood test were taken over a period of 8 weeks and although they couldn’t detect differences in pancreatic cell functionality, the group given probiotics over the 8-week period showed lower standing serum insulin levels (15). This proves that not only are you mitigating the timing for glucose being released into your bloodstream by increasing your fiber intake, but you can also combine the fiber with probiotics to work synergistically in correcting insulin irregularities. Let me alleviate some of your concerns about the perception of eating foods that take live sawdust. The benefits of a morning smoothie with leafy greens can provide you with a high dose of fiber along with flavors of citrus, banana, berries, or other ingredients that will mask the flavor.

Here is your game plan. Buy psyllium husk, chia seeds, flax seeds, fermented foods (such as Kim-Chi, kombucha, sauerkraut and/or probiotic capsules. In the morning add chia seeds or flax seeds or better yet both to your oatmeal. Before lunch gulp down a glass of a small scoop of psyllium husk mixed with your preferred beverage or carry a green smoothie mix with you for convenience. If you’re unsure of where that snack a co-worker brought in lands on the Glycemic Index, make sure you’re pairing it with something high in fiber. Not only is fiber essential in healthy diets but it can mitigate poor diets. Looking to add a spicy vinaigrette to your salad or kick up the spice level on your soup? Sauerkraut or Kim-Chi are great options that have beneficial microbes that will protect your intestines from bad bacteria along with synthesize beneficial vitamins to suppress your PCOS symptoms that pack a large punch of flavor. We’ve gone over tactics to cut your insulin levels by the foods you eat, but you also need to provide a support system to enhance the effects and probiotics are a great partner in crime. Before dinner take a probiotic capsule and the fiber and beneficial bacteria that you have added will have a compounding effect by working synergistically to combat spikes in blood sugar as well as normalize your insulin production that was mentioned in the studies we touched on.

What Foods to Avoid?

It is important to focus on incorporating whole foods, and unprocessed carbohydrates along with the other nutrition tips from previous sections. Eventually these foods will crowd out the foods that negatively affect PCOS, that also may be currently in your diet. It’s crucial that you are aware of the foods that can wreak havoc on your body. Recently I was listening to a podcast where a producer of a documentary promoting veganism was debating a nutritionist, who was promoting a diet that was mainly plant based that also incorporated meat. Both the individual promoting veganism and the individual promoting the allowance of meat in diets agreed that trans fats were hazardous to humans. Rarely do vegans and meat eaters find common ground, but experts in each field are telling you to avoid trans fats and we should listen. Foods high in trans fats such as fried foods, vegetable oil-based spreads, shortening and dairy fat (16). Great alternatives to these foods are using olive oil or seed oil-based spreads like hummus, supplementing coconut oil which is high in medium chain lipids that contribute to HDL (the good cholesterol), as well as trying almond milk with your cereal or coffee.

By now, the link between PCOS and blood sugar issues should be apparent. It is crucial that foods that can overwhelm your bloodstream with a spike in sugar should be avoided at all costs. The top high glycemic foods that cause an over release of insulin are: cereal (puffed and flaked), sweeteners, syrups, bread (especially white), white potatoes, carrots, corn, peas, and chips. In place of sweeteners and syrups, try using agave nectar for sweetening up oatmeal and low glycemic foods. Nuts and seeds are great low glycemic foods, muesli is a Swiss breakfast cereal that incorporates nuts and seeds with rolled oats for a filling meal to start your day that will sustain your energy. In place of white potatoes and white bread, try sweet potatoes that are medium glycemic, as well as breads that use almond flour or pureed cauliflower that can be made into pizza crust.

You may be wondering if there are any easy low glycemic meals that you can make that can serve both as a meal prep dish for the week, as well as enjoyed by the rest of the family. Here are my top low glycemic meal ideas:

Ingredients for the Best Vegetarian Chile in the World:

1 Tablespoon Olive Oil

I medium Onion

2 Bay Leaves

1 tablespoon cumin

2 tablespoons oregano

1 tablespoon salt

2 celery stalks

2 bell peppers (any color you desire)

1 jalapeno

1 can each kidney, garbanzo, and black beans

3 cloves of garlic

¼ cup chili powder

3 (28 oz) can crushed tomatoes

2 (4 oz) cans of green chiles

(optional) vegetarian burger crumbles

Steps:

Heat the olive oil in a large pot over medium heat. Stir in the onion, and season with bay leaves, cumin, oregano, and salt. Cook and stir until onion is tender, then mix in the celery, green bell peppers, jalapeno peppers, garlic, and green chile peppers. When vegetables are heated through, mix in the vegetarian burger crumbles. Reduce heat to low, cover pot, and simmer 5 minutes.

Mix the tomatoes into the pot. Season chili with chili powder and pepper. Stir in the kidney beans, garbanzo beans, and black beans. Bring to a boil, reduce heat to low, and simmer 45 minutes. Stir in the corn, and continue cooking 5 minutes before serving (17, n.d.).

What will this help you avoid?

This will help you avoid trans fats in many of those savory dishes that use vegetable oil, butter, and fried foods. This may also reduce the craving for barbeque sauce, which is usually high in sugar.

Ingredients for Quinoa and Flavor Friends:

1 teaspoon olive oil

1 onion

3 cloves garlic

¾ cups quinoa

1 ½ cups vegetable broth

1 teaspoon ground cumin

½ teaspoon cayenne pepper

2 cans black beans

½ cup of fresh cilantro

Steps:

Heat oil in a saucepan over medium heat; cook and stir onion and garlic until lightly browned, about 10 minutes.

Mix quinoa into onion mixture and cover with vegetable broth; season with cumin, cayenne pepper, salt, and pepper. Bring the mixture to a boil. Cover, reduce heat, and simmer until quinoa is tender and broth is absorbed, about 20 minutes.

Stir frozen corn into the saucepan, and continue to simmer until heated through, about 5 minutes; mix in the black beans and cilantro (18, n.d.).

What this will help you avoid?

The cravings for bread, white rice, and potatoes will disappear after having this hearty, fiber, and protein packed meal. Surprisingly it is not bland, due to the garlic, cumin, pepper, onion and cilantro. You will not feel the need for a wheat tortilla burrito or 500 calories plus rice bowl anymore.

These meals are a good source of protein and fiber without the trans fats and high glycemic characteristics that you want to avoid. Did these meals give you any inspiration to alter existing recipes that you have to make them healthier? Salsa is another great way to avoid condiments that generally have added sugars. Salsa is low in calories and packs a big punch of flavor that will add to the taste profiles of savory dishes. When you focus on cutting out foods, it will heighten the desire to get your hands on them since they’re forbidden fruit that is taboo. A healthier mindset is to focus on incorporating nuts, seeds, and legumes that will provide healthy fats instead of trans fats, as well as provide fiber to help regulate your blood sugar levels. Eliminating puffed and flaked cereal, potato chips, as well as the other foods mentioned that are filled with trans fats or simple sugars will put you in a position to start reversing the symptoms of PCOS.

The Profound Effects of Eating Breakfast

Changing eating habits are incredibly difficult. One of the simplest things we can do to ensure that we’re on our way to better health is eating breakfast. Let me expand on this simple thing that you’re probably already doing. Not only should you be eating breakfast but you should be eating breakfast made from home with specific types of ingredients. Let’s start by understanding the benefits that breakfast can have long after eating it. A breakfast with 20 grams of protein and with at least 5 grams of fiber per serving can lead to reduced snacking, and lower calorie meals afterwards because of their satiety effect (9). Why not make revising your diet easier by starting your day off with a tasty, high protein, high fiber breakfast to set you up for controlled calorie intake throughout the rest of your day? Starting your day off with something that will set you up for maintain your energy while also reducing your overall calorie intake is powerful because the health benefits of weight loss in overweight and obese women with this syndrome is well established. Weight reduction leads to improve insulin sensitivity and lipid profile; it reduces hyperandrogenism and regulates menstrual cycle (16).

Now let’s explore what types of foods we need to be targeting that will provide the best combination of feeling satisfied, provide sustainable energy, and reduce meal sizes later in the day. A diet lower in sugars and higher in complex carbohydrates decreases the postprandial excursion in serum glucose and the excess of insulin secretion in response to dietary load. Low glycemic index carbohydrates are preferable, such as peaches, old-fashioned oatmeal, bran cereals, lentils, sweet potatoes and milk, but also foods with high fiber content and low glycemic index; they promote an increased level of satiety, help to control appetite, decrease hunger and are useful in body weight control (16). We touched on some of these foods earlier but here are some great ideas for meals that fall within the PCOS nutrition scope that you’re working on:

Quick Nuts and Berry Paleo Cereal:

Throw a handful of your favorite nut (mine is cashews) with a handful of your favorite berries (black berries are my choice), with a splash of almond milk. It is optional to add a spoon full of rolled oats as your complex carbohydrate and/or a tablespoon of ground cinnamon that studies have proven to help reduce the pace in which sugar makes its way into the bloodstream.

California Omelet

Add two eggs to a pan with ghee or olive oil and cook to your preference (I like mine scrambled but a little runny in the middle). Next, slice a half of an avocado and lay on top. One dollop of salsa and you’ll have a meal rich in amino acids and healthy fats that your body will thank you for.

I challenge you to add vegetables and nuts to the next breakfast you make. On top of that, I challenge you to keep it up for 100 days. Accomplish this and healthy eating will start becoming the default, second nature, whatever other synonym you have in your vocabulary. To recap, start off your day by eating breakfast made at home since fast food chain’s breakfast items have vastly lower protein content, trans fats and increased carbohydrate percentages. Seeds, nuts and vegetables are great sources of fiber along with their vitamins and minerals that will reduce your hunger for lunch and dinner. The recipes above show that you don’t have to sacrifice flavor, and by flavor, I mean sweet, salty, sour, bitter, and savory. You’re a creative person, think about what adding a spice like cinnamon or cumin would do that meal instead of adding sugar, or what would the addition of salsa or avocado or better yet, both, due to the flavor of your meal. A new world of possibilities is now yours to harness that will allow you to manage your weight, which will reduce your PCOS symptoms and ultimately lead to a more fulfilled life. Let me give you some more ideas for a monthly eating plan.

30 Day Meal Plan and a World of Possibilities

It’s all coming together. Your family and co-workers are noticing your drive to improve the quality of your meals, to make your food work for you, and to feel and look better. You took notes from each chapter and have compiled grocery lists and began researching supplements online. You mapped a nightly walking route around your neighborhood. You may be wondering what an average day should look like? How can I change up snacks to keep my new diet feeling fresh rather than the same day after day? Before we get into your 30-day strategy for defeating PCOS, let’s set some ground rules.

Rule #

Do your best to eat within a 12-hour window. Delay your first meal until right before you start work, which will buy you time later in the day to satisfy your hunger before bed.

Vitamin-D as well as Iodine have been shown to play huge dividends in returning your body to normalcy with menstruation and hormone balance. Rather than buying these supplements separately, look for a multivitamin that include both of these supernatural compounds.

A probiotic regimen as a capsule and/or the use of fermented foods in your diet can reduce inflammation and lower the risk of gastrointestinal illnesses.

Multiply the effects of the meal plan below by starting to ramp up physical activity in a sustainable exercise program (like a mile walk).

*Note: The snacks listed in the meal plan can be used as an after-dinner snack along with green smoothies, or powdered protein shakes with the caveat that you’re still eating within the 12-hour window.

Inspirational Quote of the Day:

“Everyday may not be good, but there is always something good in everyday”

Inspirational Quote of the Day:

“You’re prettiest when you’re happy”

Inspirational Quote of the Day:

“Be who you are and say what you feel”

Inspirational Quote of the Day:

“No one is in charge of your happiness except you”

Inspirational Quote of the Day:

“A healthy life means a happy life; a happy life means a healthy life”

Inspirational Quote of the Day:

“Spending today complaining about yesterday, won’t make your tomorrow any better”

Inspirational Quote of the Day:

“The secret of getting ahead is getting

started”

Inspirational Quote of the Day:

“No rest is worth anything except the rest that is earned”

Inspirational Quote of the Day:

“Limitations live only in our minds”

Inspirational Quote of the Day:

“Purity, Patience, and perseverance are the three essentials”

Inspirational Quote of the Day:

“Don’t let a bad day make you feel like you have a bad life”

Inspirational Quote of the Day:

“Every accomplishment starts with the decision to try”

Inspirational Quote of the Day:

“Be strong when you are weak, brave when you are scared and humble when you are victorious”

Inspirational Quote of the Day:

“Success is focusing the full power of who you are”

Inspirational Quote of the Day:

“A journey of a thousand miles beings with a single step”

Inspirational Quote of the Day:

“The only person you should be better than is the person you were yesterday”

Inspirational Quote of the Day:

“The secret of success is learning how to use pain and pleasure instead of having pain and pleasure use you”

Inspirational Quote of the Day:

“Everyday is a second chance”

Inspirational Quote of the Day:

“Everyday, do something that will inch you closer to a better tomorrow”

Inspirational Quote of the Day:

“Life is like riding a bicycle. To keep your balance, you need to keep moving”

Inspirational Quote of the Day:

“Never regret anything because at one time, it was exactly what you wanted”

Inspirational Quote of the Day:

“Falling short doesn’t always mean you are weak”

Inspirational Quote of the Day:

“Above all else guard your heart”

Inspirational Quote of the Day:

“When life changes, change yourself to be stronger”

Inspirational Quote of the Day:

“The most difficult phase of life is not when no one understands you, it is when you don’t understand yourself”

Inspirational Quote of the Day:

“Success is not the key to happiness”

Inspirational Quote of the Day:

“Pay no attention to those that talk behind your back, it only means that you’re two weeks ahead of them”

Inspirational Quote of the Day:

“We learn something from everyone who passes through our lives”

Inspirational Quote of the Day:

“Optimism is a happiness magnet”

Inspirational Quote of the Day:

“Anyone who has made anything of importance was disciplined”

Conclusion

Congratulations! I now deem you adequately educated on nutritional treatments for PCOS. A subject that 86% of physicians are not formally trained on. Just for peace of mind, let’s review what you’ve learned.

You now understand the role that weight gain and poor diet can play on insulin levels, androgen hormone production, and menstruation cycles which in turn leads to the development of PCOS and subsequently the symptoms associated with it. To combat this, you will target a calorie restricted diet eaten in a 12-hour window each day. You’re going to look for foods that have high levels of omega-3 fats such as chia seeds, extra virgin olive oil, coconut oil, and fish oils. You can breathe easier knowing that cutting out carbohydrates completely is not necessary since it is beneficial for thyroid gland health and compliance with long term eating regimens. However, the types of carbohydrates that you eat are crucial. You will be targeting complex, low glycemic carbohydrates that will release monomer sugars into your bloodstream slowly, so that your insulin release will be steady. Remember that reducing your weight by just 5% and reducing your total carbohydrate intake by only 15% can reduce PCOS symptoms. You will also try and consume the bulk of these low glycemic carbohydrates early in the day and slowly taper off to coincide with your physical output. You should also be mindful of ways to mitigate falling short with certain vitamins and minerals that are crucial to managing your PCOS.

Supplements are also important to assure that you’re receiving specific vitamins and minerals that are vital to mitigating the terrible symptoms of PCOS. Do you remember what these vital compounds are? You got it. Vitamin D, Iodine, and probiotics are the holy trinity. Don’t break the bank buying a bunch of different capsules. Do your due diligence and see if a multivitamin contains at least two of three components to save yourself money that you will eventually need for new clothes after you drop a few pounds. Try some foods you may have not tried before or are not very familiar with, such as: Kombucha, Kim-Chi, or kefir to please your gut with beneficial microbes. Remember taking the time to add small things to dishes such as cinnamon, turmeric, or fermented vegetables can play a huge role in reducing inflammation. Probiotics along with sprouted foods such as lentils, rice, and groats will reduce systemic inflammation and get you back to feeling pain free. If you’re looking to add flavor to these new dishes that you’re creating using plant-based foods, try salsa. Authentic salsa is 10-15 calories per serving which gives you a high ratio of flavor to calories. Don’t feel restricted with adding salsa to eggs, rice bowls, or dinner entrees. Now that you altered when you eat, the amount you eat and what you eat, you can tweak existing recipes and use this to spread the word about your new eating goals. The socialization will make others aware and even participate in your plan to provide a strong support network around you that will help you accomplish your goal of beating PCOS. Recruit your family, co-workers and friends to go on an adventure trying a new food or drink. There’s nothing better than starting a conversation around a fermented tea like Kombucha to get people to appreciate your quests towards a new healthy lifestyle. The pain alleviation will play a role in you sticking with your meal plan and ultimately building on your healthy eating foundation. Don’t underestimate the power of superfoods such as pumpkin seeds, blueberries, avocados and dark chocolate. Fill your body with foods that will work for you, not foods that will make you have to work off. You’re going to do your best to add plant-based foods since they offer anthocyanins and bioflavonoids which are anti-inflammatory compounds that will help relieve add to your arsenal for alleviating PCOS symptoms.

The common symptoms of: irregular menstrual periods, increase androgen levels, and polycystic ovaries upon the review of the ultrasound results shouldn’t paralyze you now that you have gained a vast number of concepts to apply to your daily routine that will reduce, reverse, or even halt these ailments. You have the confidence to plan your new sustainable eating patterns that will help you navigate your way back to health. Since you have read this book you now understand how to combat these issues by upgrading your nutrition to go along with the recommendations your physician has given you. Remember that you now have insight to nutritional information that 86% of physicians were never formally trained on.

Circling back to blood sugar since this is public enemy number one when planning a nutrition plan for PCOS; fiber will help lower the glycemic index of foods. You know that flipping your poor eating habits and reversing insulin sensitivity is your primary goal in reversing PCOS symptoms. Targeting foods that are higher in fiber, leafy greens, nuts, seeds, and legumes will help decrease the rate that sugar from the sweetened latte you had on a cheat day gets released into your bloodstream. If these foods are too difficult for you to incorporate, try mixing a couple spoons full of psyllium husk in a glass of water to fill your body with a high dose of beneficial fiber. Probiotics and Vitamin-D will partner with your new diet to help combat high blood sugar and ultimately leave you feeling better and less in pain. Combine your uptick in fiber, probiotics, vitamin D with low glycemic carbohydrates and more plant based foods and not only are you actively fighting PCOS but you have reprogrammed your mind to formulate a nutrition plan that you can carry with you even after you get past this terrible disease. A regimen of a fiber supplement like psyllium husk mixed in your favorite beverage can lessen your serum glucose levels, as well as support a healthy gut bacterial biome.

The foods you will avoid at all costs are the ones containing: trans-fats, refined and high glycemic carbohydrates. This means staying away from fried foods, spreads made with vegetable oils, baked goods with vegetable shortening, high amounts of dairy fats, white bread, white potatoes, and other processed carbohydrates. If you had a busy week and couldn’t abide by all these rules, do your best to eat a breakfast with at least 20 grams of total protein and 5 grams of fiber per serving to give yourself sustained energy and to satiate your hunger so that you’re less likely to over eat later in the day. On top of that, make sure you’re eating breakfast made at home as opposed to a fast food chain, since you will get less trans fats, carbohydrates, more fiber and protein. Do your due diligence and meal prep with some of the meal ideas shown in previous chapters. Make eating healthy convenient and tailored to your needs. Your daily demands should not be an excuse for poor eating. After all, isn’t the excuse of not having enough time to prepare healthy meals a part of the reason that you’re remedying eating habits to begin with? You should be able have meals that check all the boxes on your new PCOS nutrition checklist handy and if not, there is always easy do it yourself trail mixes, coconut oils and canned fish that travel well to keep up with your busy day. Try the 30-Day Meal Plan and even if you don’t end up using some of the recipes, you may resonate with a few ingredients that will spark new meal ideas that are still within the PCOS nutrition parameter that we outlined.

A holistic approach to combating this terrible syndrome is what you’re after. Gradually start an exercise program, just a casual walk around the neighborhood or morning swim can go a long-ways, since it will cause you to burn more calories and increase the benchmark of total calories that you will target being below with your meal consumption. Taking deep breaths to understand the source of hunger cravings (often times they’re triggered from stress). You can also incorporate an after-meal routine of hot herbal tea, soft music on your headphones, and a walk outside to dismiss some of the triggers for overeating such as anxiety. Taking the time to think critically about your physiological “needs” versus “wants” will help you understand what your body requires versus what food is just a coping mechanism for other emotions in your life. There is also something to be said about the effects of being open with others about your nutrition goals. The easiest way to accomplish this is by showing family, friend and co-worker’s things you have picked up from this book that they may not be familiar with. Sprouting grains is a fun new craft that can work as an ice breaker for discussing your new knowledge about neutralizing phytic acid and how this will allow your body to absorb more of the nutrients that are already in the foods you eat that would normally pass through you. A great do it yourself project at home is sprouting foods in a sprouting jar. The project will open your imagination by creating new dishes with these optimized sprouted grains that will help keep things interesting. After all, you don’t want to be eating the same boring foods every day. The conversations about new foods and dishes will help you build a support team that will make you feel like you have superhuman powers that no one else possesses since you’re adding superfoods into your diet. The development of a supplement plan so that all of these tools can work synergistically in dissipating your PCOS. As determined as you are and with lots of planning you may still some up short on the daily requirements of certain nutrients that play key roles in insulin levels, menstruation and follicle development, so mitigate this scenario by taking multivitamins. Fermented foods such as sauerkraut, kim-chi, and kombucha will make your gut happy. Scientists hypothesize that probiotic health can reduce systemic immune responses that are caused by poor diet and deviations in gut flora health. Picture your average day before reading this book, the support team around you, your physical activity, supplements, and diet; then picture your family and friends encouraging you to keep up the homemade breakfasts, healthy snacks, nightly walks, intermittent fasting and nutritious snacks. It may sound like a lot to juggle now but soon this will become apart of your normal daily routine and you will be passed PCOS and continuing to proactively eliminate the chances of being chained to another horrific syndrome. You are the real super heroes that live amongst us and inspire others to follow your lead.

We have zeroed in on the root cause of a poor diet leading to blood sugar issues that trigger a domino effect of associated ailments. These blood sugar issues wreak havoc on your hormones, which then cause issues with menstruation and follicle development (see figure #1). Using meal suggestions, as well as the ground rules from the previous chapter, you are on your way to successfully obsoleting this crippling disease. Now, you’re fully prepared to take this game plan and attack the root cause, then sit back and watch all of the issues and symptoms slowly dissipate like the steam rising from your morning cup of green tea. A personal journal will also help in showing you the progress you’re making and sticking with this plan. A journal is also great for reflection to see how far you’ve come or recall weeks that you felt benefited you the most or a framework that you would like to tweak in order to optimize your health plan. Three months from now, I’m excited to see the new you and how far you’ve come. Relationships and projects require a coordinated approach and maintenance, treating PCOS with nutrition is no different. You have tackled obstacles in your life before and succeeded and reversing PCOS will be no different. I hope this book has resonated with you and that you carry some of these tools forward in your quest for a better more fulfilled life.

Living in fear of painful systemic inflammation, hair loss, diabetes, cardiovascular disease and not being able to get pregnant is no way to live. You will need to ask the question; how do I define myself? In the many memoirs that I have read throughout the years, often times the subjects make choices based on how they identify themselves. Do you define yourself by your career, your role in the family, your side projects, or friendships? Now ask yourself what you would you like your quality of life to be? Has PCOS affected the way you or someone you know defines themselves. Take this knowledge and help this person recapture what makes them feel most alive. The gift of health should have a new importance to you and the distilled information in this book from countless peer reviewed scientific papers should give you a clear picture of how to achieve this. Choose to be the best you and use this new found knowledge to your advantage. I look forward to seeing the best version of you.

References

1. A Patients Guide to PCOS: Understanding--and Reversing--Polycystic Ovary Syndrome by Futterweit M.D., Walter.

2. What Do Resident Physicians Know about Nutrition? An Evaluation of Attitudes, Self-Perceived Proficiency and Knowledge Marion L. Vetter , MD, RD,Sharon J. Herring , MD,Minisha Sood , MD,Nirav R. Shah , MD, MPH &Adina L. Kalet , MD, MPH.

3. Jones MR, Goodarzi MO. Genetic determinants of polycystic ovary syndrome: progress and future directions. Fertil Steril. 2016 Jul;106(1):25-32. doi: 10.1016/j.fertnstert.2016.04.040. Epub 2016 May 11.

4. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome.” M Gibson-Helm et al. The Journal of Clinical Endocrinology & Metabolism, 2016; jc.2016-2963 .

5. Moran, L. J., Lombard, C. B., Lim, S., Noakes, M., & Teede, H. J. (2010). Polycystic Ovary Syndrome and Weight Management. Women’s Health, 271–283.

6. Association between Eating Patterns and Obesity in a Free-living US Adult Population Yunsheng Ma, Elizabeth R. Bertone, Edward J. Stanek, III, George W. Reed, James R. Hebert, Nancy L. Cohen, Philip A. Merriam, Ira S. Ockene American Journal of Epidemiology, Volume 158, Issue 1, 1 July 2003, Pages 85–92.

7. Metabolic Effects of Intermittent Fasting Annual Review of Nutrition Vol. 37:371-393 (Volume publication date August 2017) Ruth E. Patterson1,2 and Dorothy D. Sears.

8. Diabetes & Metabolic Syndrome: Clinical Research & Reviews Volume 11, Supplement 1, November 2017, Pages S429-S432 .

9. The Insulin Resistance Diet for PCOS: A 4-Week Meal Plan and Cookbook to Lose Weight, Boost Fertility, and Fight Inflammation by Tara Spencer and Koslo RDN PhD, Jennifer .

10. Can metformin reduce insulin resistance in polycystic ovary syndrome?* Özer Açbay, M.D. † , Sadi Gündoğdu, M.D. .

11. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome Deborah S. Kiddy Diana Hamilton‐Fairley Anne Bush Frances Short Vtctor Anyaoku Michael J. Reed Stephen Franks .

12. Obesity, weight loss, and the polycystic ovary syndrome: effect of treatment with diet and orlistat for 24 weeks on insulin resistance and androgen levels Author links open overlay panelDimitriosPanidisM.D., Ph.D.aDimitriosFarmakiotisM.D.aDavidRoussoM.D.aAnargyrosKourtisM.D.aIliasKatsikisM.D.aGerassimosKrassasM.D.b .

13. Complementary Therapies in Clinical Practice Volume 18, Issue 2, May 2012, Pages 85-88 .

14. The Miracle of Iodine Complex in Treatment of Cases of Polycystic Ovarian Disease Induce by Subclinical Hypothyroidism Razia Iftikhar.

15. Effects of Probiotic Supplementation on Pancreatic β-cell Function and C-reactive Protein in Women with Polycystic Ovary Syndrome: A Randomized Double-blind Placebo-controlled Clinical Trial Tanaz Shoaei, Motahar Heidari-Beni, Hatav Ghasemi Tehrani,1 Awat feizi,2 Ahmad Esmaillzadeh, and Gholamreza Askari

16. Looking at the Link between Diet and PCOS Onset and Management Giusy Porcaro1*, Piero Filati2 and Vittorio Unfer3 .

17. https://www.allrecipes.com/recipe/72508/the-best-vegetarian-chili-in-the-world/?internalSource=staff%20pick&referringId=15587&referringContentType=Recipe%20Hub.

18. https://www.allrecipes.com/recipe/49552/quinoa-and-black-beans/?internalSource=staff%20pick&referringId=15587&referringContentType=Recipe%20Hub&clickId=cardslot%201.

19. Dysbiosis of Gut Microbiota (DOGMA) – A novel theory for the development of Polycystic Ovarian Syndrome Author links open overlay panelKeltonTremellenabKarmaPearceb .

20. Foster C, Farland CV, Guidotti F, et al. The Effects of High Intensity Interval Training vs Steady State Training on Aerobic and Anaerobic Capacity. J Sports Sci Med. 2015;14(4):747–755. Published 2015 Nov 24.

21. The Combined therapy with myo-inositol and D-Chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone M. NORDIO, E. PROIETTI .

22. The impact of a standardized micronutrient supplementation on PCOS-typical parameters: a randomized controlled trial .

23. Adiponectin: action, regulation and association to insulin sensitivity. Lihn AS1, Pedersen SB, Richelsen B.

Disclaimer

Thе іnfоrmаtіоn соntаіnеd іn this book аnd іtѕ соmроnеntѕ, іѕ mеаnt tо ѕеrvе аѕ a соmрrеhеnѕіvе соllесtіоn оf ѕtrаtеgіеѕ thаt thе аuthоr оf thіѕ bооk hаѕ dоnе rеѕеаrсh аbоut. Summаrіеѕ, ѕtrаtеgіеѕ, tірѕ аnd trісkѕ аrе оnlу rесоmmеndаtіоnѕ bу thе аuthоr, аnd rеаdіng thіѕ bооk wіll nоt guаrаntее thаt оnе’ѕ rеѕultѕ wіll еxасtlу mіrrоr thе аuthоr’ѕ rеѕultѕ.

Thе аuthоr оf thіѕ bооk hаѕ mаdе аll rеаѕоnаblе еffоrtѕ tо рrоvіdе сurrеnt аnd ассurаtе іnfоrmаtіоn fоr thе rеаdеrѕ оf thіѕ bооk. Thе аuthоr аnd іtѕ аѕѕосіаtеѕ wіll nоt bе hеld lіаblе fоr аnу unіntеntіоnаl еrrоrѕ оr оmіѕѕіоnѕ thаt mау bе fоund.

Thе mаtеrіаl іn thе bооk mау іnсludе іnfоrmаtіоn bу thіrd раrtіеѕ. Thіrd раrtу mаtеrіаlѕ соmрrіѕе оf орiniоnѕ еxрrеѕѕеd bу thеіr оwnеrѕ. Aѕ ѕuсh, thе аuthоr оf thіѕ bооk dоеѕ nоt аѕѕumе rеѕроnѕіbіlіtу оr lіаbіlіtу fоr аnу thіrd раrtу mаtеrіаl оr оріnіоnѕ.

Thе рublісаtіоn оf thіrd раrtу mаtеrіаl dоеѕ nоt соnѕtіtutе thе аuthоr’ѕ guаrаntее оf аnу іnfоrmаtіоn, рrоduсtѕ, ѕеrvісеѕ, оr оріnіоnѕ соntаіnеd wіthіn thіrd раrtу mаtеrіаl. Uѕе оf thіrd раrtу mаtеrіаl dоеѕ nоt guаrаntее thаt уоur rеѕultѕ wіll mіrrоr оur rеѕultѕ. Publісаtіоn оf ѕuсh thіrd раrtу mаtеrіаl іѕ ѕіmрlу a rесоmmеndаtіоn аnd еxрrеѕѕіоn оf thе аuthоr’ѕ оwn оріnіоn оf thаt mаtеrіаl.

Whеthеr bесаuѕе оf thе рrоgrеѕѕiоn оf thе Intеrnеt, оr thе unfоrеѕееn сhаngеѕ іn соmраnу роlісу аnd еdіtоrіаl ѕubmіѕѕіоn guіdеlіnеѕ, whаt іѕ ѕtаtеd аѕ fасt аt thе tіmе оf thіѕ wrіtіng mау bесоmе оutdаtеd оr іnаррlісаblе lаtеr.

Thіѕ book іѕ соруrіght ©2019 bу Mike Andora wіth аll rіghtѕ rеѕеrvеd. It іѕ іllеgаl tо rеdіѕtrіbutе, сору, оr сrеаtе dеrіvаtіvе wоrkѕ frоm thіѕ bооk whоlе оr іn раrtѕ. Nо раrtѕ оf thіѕ rероrt mау bе rерrоduсеd оr rеtrаnѕmіttеd іn аnу fоrmѕ whаtѕоеvеr wіthоut thе wrіttеn еxрrеѕѕеd аnd ѕіgnеd реrmіѕѕіоn frоm thе аuthоr.