General advice/info from PCOS symposium : PCOS

I recently watched most of the presentations from day 1 and day 2 of the recent PCOS Challenge symposium and thought I would provide a general summary of the advice given. Hopefully this is OK to do! Btw you can still buy tickets and watch recordings of each presentation for yourself, there are also several Q&A sessions and panels that I didn’t watch all of, so I highly recommend checking it out if you can. I think the recordings are available for 30 days from the day of the symposium – so day 2 recordings of the symposium are available until ~19th October. Day 1 of the symposium covered fertility stuff that may also interest you but IMO a lot of the takeaways was similar to the lifestyle stuff on day 2. I didn’t watch any of day 3 which I think was largely around adolescent health. (fyi – you need to buy a separate $40 ticket for each day that you are interested in. For most people, that would probably be day 2). There was also a lot of explanation about the various aspects of PCOS, how cycles and the endocrine/reproductive systems work and what is happening when PCOS is involved etc, I won’t go into any of that here but will answer any questions as best as I can.

Note that the advice and information given was very general, and may not apply to your specific situation. I took notes but also relying on memory for some of this so it may not all be 100% accurate.

Diagnosis

The Rotterdam criteria is generally the most accepted criteria for diagnosing PCOS.

Weight

The fat shaming or “just lose weight” approach that many doctors take is not helpful and you should avoid these doctors. While losing weight can help with PCOS, it is better to make it about optimizing for health rather than focusing on the number on the scale. (I was less focused on the weight aspect so I hope I’ve managed to convey the general attitude about weight reasonably well – apologies if I haven’t).

Diet

Most speakers did not advocate for any one particular diet. Instead, think about what you can add to your diet, rather than restrict, and keep it sustainable for the long term! General guidelines for what/how you should eat:

  • aim for half of your meal to be fruits and veges, a quarter protein and a quarter low GI carbs, and a small amount of healthy fats. Get plenty of fiber – 25g per day!

  • there is no particular reason to avoid dairy, gluten or soy, unless you do feel better without them (caveat: one doctor on day 1 did say that their studies showed that dairy can worsen things but did not elaborate further)

  • aim for unprocessed foods as much as possible – plant based whole foods is best! (note this doesn’t specifically exclude meat/animal products)

  • increase anti-inflammatory foods – green tea, nuts/seeds, veges/fruits, omega 3, flaxseed, fermented foods containing live active cultures (pre/probiotics), e.g. kombucha, kimchi, pickles, yoghurt, fermented soy

  • decrease inflammatory foods – sugary drinks/foods, refined carbs, processed meat, fried/charred foods, excess omega 6

  • timing of your meals – try to eat around the same time each day; eat fewer, larger meals; limit snacking; have dinner and next day breakfast 13+ hours apart (intermittent fasting)

  • eat more of your calories earlier in the day. Studies show that eating half of your daily calories at breakfast led to lower androgen/insulin levels

  • edit to add: another recommendation was if you have a glucose monitor, using that to see what spikes your blood sugar so you know what foods to personally avoid – since something that spikes one person might not spike another. Also can use it to see the effects of foods you eat in combination e.g. carbs with a protein, carbs with a fat etc.

Exercise

The bottom line: any exercise you can do is good! It lowers androgens and increases insulin sensitivity. There is no “bad” exercise for PCOS however doing too much may be detrimental.

  • Aim for a minimum of 120 minutes of vigorous exercise per week

  • Try not to do more than 60 minutes in any one day (this is where it may get detrimental), but if you’re an athlete doing more than this then you may need help to optimize your recovery

  • If you had to pick only one type of exercise, strength training is meant to be the best as it increases your lean muscle mass and this is great for PCOS because it makes your body so much better at using energy and regulating everything. Do upper body push, upper body pull, core, and leg exercises, increasing progressively.

  • But anything that you can do and keep up is great

  • Try to do something light on your rest days like a walk or a short, light yoga session

  • Yoga is also good for PCOS and there are a few studies that show this

  • HIIT was also discussed and said to be great exercise too. Recommendation was max 20 mins at a time, with alternating short periods of high intensity and low intensity exercise, e.g. 30 seconds high intensity then 30 seconds low intensity.

Meds

There was some discussion of metformin (including vs inositol), but spiro and BC were generally only mentioned in passing. Metformin may be helpful but not necessarily for everyone, and inositol may be as good as metformin but without the side effects (personal note: I don’t think inositol is entirely without side effects). BC has its place but too many doctors throw BC at patients and say “come back when you want to get pregnant”.

Supplements

Supplements were discussed in various presentations. I will just give a list of some of the supplements discussed – inositol, berberine, NAC, melatonin, vitamin D, omega 3, zinc, CoQ10, probiotics, white peony, licorice, EGCG(?), saw palmetto, spearmint, pygeum bark. Obviously it’s not recommended to take all of these, just some supplements that might be recommended/beneficial depending on your specific situation.

  • For inositol, 40:1 myo/d-chiro inositol is best

  • Make sure you take any supplements correctly (with a meal, at specific time etc)

  • Check for fillers in supplements

  • make sure that they have been certified by one of two organisations (for those US based) – since supplements are unregulated

Other lifestyle factors

  • stay hydrated!

  • manage stress and emotional/mental health. Therapy, meditation etc. From memory, the insights timer app was recommended for meditation but anything you find and use to get started is good. The PCOS psychologist talked about various issues you might face, including depression, anxiety, anger/irritability, eating problems, relationship/sexual problems etc.

  • ensure adequate sleep. Try to have a consistent routine with sleeping and eating to try and get your body to fall into a natural circadian rhythm. If you keep waking up feeling unrefreshed after 8 hours sleep, consider looking into sleep apnea.

Blood tests

There was a talk on blood tests for PCOS. In summary, reference ranges are set by labs using the distribution of samples from within the population. This means that your results can be “normal” (falls within the range found in 95% of the “normal” population) but can still be too low/high. Examples given – the range for testosterone may be approximately 14-76 (depending on the lab), but anything over 45 would be indicative of PCOS. Similarly with DHEA-S – the range would be approximately 44-425 but in PCOS you would often see values over 200.

Be a detective in figuring out what works for you, make a plan, and make one or two small changes at a time, to help build better habits that stick for the long term – it’s a marathon, not a sprint!

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