PCOS Review Newsletter #8

Natural Health Ideas for Polycystic Ovary Syndrome
A free monthly newsletter for women with ovarian cysts or PCOS.

Issue #008 May 27, 2003 Bill Slater, Research Associate


TABLE OF CONTENTS

1) Is There a "Best Diet" for Reducing PCOS Symptoms?

2) Low Carb (Atkins) Diet - What Do the Studies Say?

3) Latest Study Says Low Carb Diet Works

4) Low Carb Diet Induces Fat Weight Loss

5) Food Statistics Now a Mouse Click Away


1) IS THERE A "BEST DIET" FOR REDUCING PCOS SYMPTOMS?

"Diet" is one of the more controversial or confusing issues in figuring out how to deal with PCOS. Some say the Atkins diet is the way to go. Others say the Zone diet is best, or a "low glycemic" diet is superior. Some still recommend that you follow the Food Pyramid developed by the U.S. Dept. of Agriculture, which is a high-carbohydrate diet.

Many are confused about whether eating fat makes you fatter or causes you to lose fat. Some carbohydrates (starches and sugars) are "good", while others are "bad". You may have heard that you should eat more protein, but you also may have heard that too much protein can hurt your kidneys, or that saturated fat in animal protein will give you heart disease.

So what are you supposed to do?

Your best strategy is to educate yourself, and then make your own decisions. To help you get started, we'll share our knowledge with you in our newsletters and on our website.

The first thing you should know is that there is no "one size fits all" diet for women who have polycystic ovarian syndrome. Even though women with PCOS have a lot in common genetically, each of you has a unique set of genes and a unique biochemistry. Therefore the Atkins diet, or any other "diet" may work for your friend but not for you. So don't despair. Explore different healthy modifications to your diet until you start getting the results you want.


2) LOW CARB (ATKINS) DIET - WHAT DO THE STUDIES SAY?

The Atkins low carb diet is arguably the most popular diet in American history -- and perhaps the most controversial. Millions of people are on the Atkins diet, or have been. Have they lost weight? And has the weight stayed off? Does the Atkins diet really work?

Well, researchers at the University of Cincinnati undertook to find out by looking for all the published studies on the low carb diet.(3) As reported in the April 9, 2003 issue of the Journal of the American Medical Association, they found 2,609 potentially relevant articles and selected the most relevant 107 articles, which reported on 3,269 patients.

After carefully analyzing the 107 studies, the researchers found that "there is insufficient evidence to make recommendations for or against the use of low-carbohydrate diets." The studies indicated that the weight loss appeared to be attributable to reduced calories and length of time on the diet, but not to reduced carbohydrate content. Unfortunately, only five of the studies evaluated the diet for more than 90 days, so the long-term effect of the low carb diet is unknown.


3) LATEST STUDY SAYS LOW CARB DIET WORKS - NO ADVERSE EFFECTS AFTER SIX MONTHS

But more recently, in the April 2003 issue of the Journal of Clinical Endocrinology & Metabolism, another group of researchers at the University of Cincinnati published a study suggesting that a low carb diet is definitely beneficial.(4)

In this clinical trial, 53 overweight but otherwise healthy women were put on either one of two diets for 6 months: (1) an unrestricted calorie, very low carbohydrate diet; or (2) a calorie-restricted, moderately low-fat diet (30% of the calories as fat).

Women on the very low carb diet lost more than twice as much fat weight, and total weight, than the low-fat group, even though their calorie load was similar.

There were no adverse effects from either diet during the six months. Blood pressure, blood fats, fasting glucose, and insulin in both groups improved during the study, and there were no differences between the two groups at three or six months. Some women had trouble staying on their diet toward the end of the trial.

The authors warned that these results should not be extrapolated to people with cardiovascular risk factors. They also said longer studies are needed. The authors of the study concluded: "Based on these data, a very low carbohydrate diet is more effective than a low fat diet for short-term weight loss and, over 6 months, is not associated with deleterious effects on important cardiovascular risk factors in healthy women".

OUR COMMENT: We think the basic Atkins approach appears to be valid. In other words, for many women with PCOS, a very low-carbohydrate diet, for a limited time, may be beneficial in kick-starting the weight loss process. However, we definitely do not endorse the idea of eating NO carbohydrates. We've seen people do crazy things like have 5 sausages and coffee laced with heavy cream for their breakfast. This is not a healthy low carb diet and will only get you into trouble later on. We do suggest you eat carbohydrates such as fresh vegetables and fresh fruit. Minimize grain consumption, especially wheat products. Good protein sources would be fish, poultry, eggs, and very lean meat. We'll have a lot more to say about a healthy PCOS diet in future newsletters.


4) LOW CARB DIET INDUCES FAT WEIGHT LOSS

Some women with PCOS are blessed with not having a weight problem. But many of you struggle with being overweight. It seems that in spite of everything you do, you can't lose weight.

The reason you have so much trouble is that women with PCOS have "thrifty genes", which means that you are programmed to hold onto the calories you consume. This is not to say that it will be impossible for you to lose weight. It's just that you have to work harder than other people at losing weight.

But what do we mean when we say "losing weight"? Basically, when you lose weight, you can only lose three things: fat, water, or lean body mass. Lean body mass is mostly muscle. What you need to do is lose FAT, not muscle.

Water weight will fluctuate, so we're not concerned about that, except to say that the rapid success in some weight-loss diets is due to loss of water weight, which is simply regained later on.

The low carb diet may play an important role in losing fat weight, which is the type of weight you want to lose. To illustrate this point, we'll discuss a study just released by the Department of Food Sciences and Human Nutrition at the University of Illinois.(1)(2)

The study examined the efficacy of two different weight loss diets. Twenty-four overweight women 45-56 years old were assigned to one of the diets for ten weeks. Each diet had the same amount of total calories, a modest 1,700 calories per day. The amount of fat was the same in each diet. However, in one of the diets, some protein was substituted for carbohydrate. Women on the higher protein diet were called the Protein Group. Women eating the diet higher in carbohydrates was called the CHO Group.

The Protein and CHO groups each had an average weight loss of 16 pounds over the ten weeks. That's a very respectable amount of weight loss for ten weeks. You might think that so long as you limit your calories, it doesn't matter whether you eat carbohydrate or protein -- the effect is the same. While the modest calorie restriction probably helped these women lose weight, there was a very important distinction between the two groups.

The Protein Group lost nearly twice as much FAT weight as the CHO Group! Let's see why this is so significant.

There are two main components of your body: (1) fat, and (2) non-fatty tissues, which includes bone and muscle. From here on, we'll focus in on fat and muscles.

If you're overweight, you know that you're carrying too much fat. In other words, most of your excess weight is fat, not bone and muscle. So let's be clear about one thing: it's fat weight you need to lose, not muscle or water weight.

You don't want to lose weight if the weight you lose is muscle. Here's why.

You probably know that you have to burn fat in order to lose weight. But have you considered WHERE the fat is burned? Fat can only be burned in muscle cells. So the more muscle cells you have, and the more active they are, the more fat you can burn.

On the other hand, when you don't consume enough protein, your body takes protein from your muscles and uses it to keep the rest of your body going. So you lose weight and are pleased with the short-term results. But the problem is that you've also reduced your CAPACITY to burn fat, so the weight loss is only temporary. As your capacity to burn fat diminishes, your fat stores will increase.

With the wrong kind of weight-loss diet, you can lose muscle and water, but actually gain fat. What's tricky is that you may actually have lost some total body weight. How can this be?

Here's the reason for this apparent contradiction: (1) muscle is heavier than fat; and (2) water is heavier than fat (that's why fat floats in water).

So you could be losing weight and actually be getting fatter at the same time. Here's an example. Suppose you went on a very restricted calorie diet and you lose 5 lbs. of water and 3 lbs. of muscle, but gain 2 lb. of fat. You would have a net loss of 6 pounds. However, you actually got fatter, and you REDUCED your capacity to burn fat in the future.

In contrast, suppose you consumed a moderately restricted calorie diet with adequate high-quality protein, and you exercised every day. You might lose 2 lbs. of water, add 3 lbs. of muscle, and lose 1 lb. of fat. In this case, you didn't lose a single pound of body weight. However, you got rid of 1 pound of fat, and you significantly INCREASED your capacity to burn more fat in the future by adding 3 lbs. of muscle.

This is why it can be misleading to focus only on losing total body weight.

Now…back to our discussion of the study.

Although the women in each group lost about the same amount of total weight, the Protein group lost 66% more FAT than the CHO group. And that's not all!

The Protein group also fared better than the CHO group in these areas: 1. More stable blood sugar between meals. 2. Low insulin levels after eating a meal. 3. Lower triglycerides (a blood fat associated with insulin problems). 4. Reduced hunger.

OUR COMMENT: Even if you don't change the total calories in your present diet, you're likely to fare better with weight loss and PCOS if you replace some of your starchy carbohydrate with protein. Minimize grain-based carbohydrates, especially products containing wheat. You should maintain (or increase) fresh vegetable and fresh fruit carbohydrates. Good protein sources would be fish, poultry, eggs, and very lean meat.

We also recommend that you maintain or increase your amount of exercise. In an earlier newsletter, we told you about a study where women who did intense aerobic exercise for 30 minutes five times a week had an improvement in insulin sensitivity, whereas the women who exercised less had no change in insulin sensitivity. Diet and exercise are crucial for reducing insulin resistance, which is a primary cause of polycystic ovary syndrome.

5) FOOD STATISTICS NOW A MOUSE CLICK AWAY

Are you wondering just how many calories are in that pizza? You can now find out from a database published by the U.S. Department of Agriculture that lists information about more than 6,000 food products. All you have to do is download the database from the USDA's website onto your computer. Or you can get it on a CD. This saves you the trouble of going onto the Internet every time you want to look up a food. The database is free.

It contains information on up to 117 different nutrients, including calorie and carbohydrate contents as well as vitamins, minerals and fats. The foods are listed in 22 convenient categories and can be researched by brand name or generic name. The program describes what an actual portion looks like and allows you to modify the portion so that you can get the exact nutrient content for that portion.

To get your copy of the USDA food database, go to:

www.nal.usda.gov/fnic/foodcomp

(Note: This link is not always working. If it doesn't work for you, try again later).


REFERENCES

(1) Layman, DK et al, A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women, J Nutr, 2003, 133(2):411-7

(2) Layman, DK et al, Increased dietary protein modifies glucose and insulin homeostasis in adult women during weight loss, J Nutr, 2003, 133(2):405-10

(3) Bravata, DM et al, Efficacy and safety of low-carbohydrate diets, JAMA, 2003, 289:1837-1850

(4) Brehm, BJ et al, A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in health women, J Clin Endocrinol Metab, 2003, 88:1617-1623


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