Ask Angela is your chance to ask Angela Grassi, a nutritionist specializing in PCOS, questions about food, eating and exercise. You can submit your questions through the “PCOS Questions” link here, on any of the Facebook PCOS sites, or send an e-mail to the PCOS Today editors. Here are a few of Angela’s most recent answers.
__________________________________________________________________________________________
A great many searches about soy and PCOS have popped up on PCOS Today recently, so Angela is chiming in this month about the connections between the use of soy in your diet and its affects on all-things PCOS.
Should women with PCOS avoid soy milk?
One of the most controversial topics regarding nutrition and PCOS is soy. Both the soy industry and the FDA say that soy is safe. In fact, there is a food claim approved by the FDA stating that “diets low in saturated fat and cholesterol that include 25 grams of soy protein a day may reduce the risk of heart disease.” Soy foods include soy milk and cheese, tofu, tempeh, miso, soy sauce, and edamame. Another form of soy, soy protein isolate is often added to energy bars. Proposed benefits of soy include improved cholesterol, decreased risk of cancer, and improved menopausal symptoms among others. Some claims against soy say that soy is detrimental to the health of humans as it may cause cancer, nutrient deficiencies, osteoporosis, thyroid problems, reproductive difficulties, and Alzheimer’s Disease.
It is important when making a bold claim such as “women with PCOS should not eat soy” to evaluate the evidence first. As a nutrition expert, it is my job to provide reliable and objective nutrition information. I can’t just rely on one or two studies to base my recommendations on. I have to look at the whole picture. There are some studies available that do show adverse effects of soy. Most of this evidence, however, is based on animal studies and involves a much higher amount of soy than most humans typically consume.
Some studies associate soy intake with hypothyroidism, a condition that many women with PCOS have. Soy foods contain isoflavones called genistein and diadzien (also found in some other foods such as some whole grains and legumes). Generally these isoflavones only cause problems in areas where iodine intake is low (iodine is an important mineral for thyroid function). Individuals who do consume a healthy diet and have an adequate iodine intake (milk and fish are rich in iodine), probably won’t be affected by a moderate amount of soy products in their diet. Those individuals who do eat a poor diet or consume a low calorie diet and are deficient in iodine may experience thyroid disturbances from eating soy.
A lot of talk in internet chat rooms implies that women with PCOS should avoid soy because it mimics estrogen in the body, making PCOS worse. Currently, there are very few studies done on PCOS and soy intake and the ones that are available show favorable results for PCOS in improving cholesterol and even ovulation. Keep in mind soy is not estrogen and does not act the same. The power of soy is extremely weak when compared with estrogen.
Many women with PCOS have elevated cholesterol levels. This is dangerous as it can lead to cardiovascular disease. Limiting the consumption of saturated fat (often found in animal products) is one way of reducing cholesterol. A moderate intake of soy can then be used as a substitute for products containing saturated fat (tofu used in stir fry instead of beef).
Bottom line: more studies need to be conducted on soy consumption as it applies to humans, and with PCOS in particular. Women with PCOS who consume few calories or eat a poor diet may want to avoid or limit soy products. Otherwise, a moderate intake of soy (once a day or several times a week) can be part of a healthy diet for women with PCOS.
_______________________________________________________________________________________
What would be the best nutritional supplements to take if you have PCOS and at what doses? -Veronica
Hi Veronica! Thank you for your important question. According to the National Institutes of Health (NIH) Office of Dietary Supplements, consumers spent $20.3 billion on dietary supplements in 2004. The trend is driven by several factors including increased availability of supplements, desire for control of one’s own destiny, perception of increased safety, and disillusionment with traditional medicine. Many women with PCOS who have been misdiagnosed or have not seen improvement in their symptoms are frustrated with their medical care and it is not surprising, therefore, for them to turn to alternative treatments in hopes of getting better results.
As with all supplements there are numerous concerns, one of which is supplement-medication interactions. This is particularly important considering that most individuals do not reveal to their physicians that they are taking a dietary or herbal supplement. Many supplements and drugs utilize the same metabolic pathway in the liver, increasing the chances for an interaction which could alter the effect of the supplement or medication in the body resulting in serious side effects, even death. Currently the FDA does not regulate the production of supplements nearly as close as they need to be.
That being said, there are several nutritional supplements I recommend my patients take to help improve their PCOS symptoms. The following are some of the supplements that have been shown to be the most promising in treating PCOS with the least side effects. It is important to inform your doctor or health professional if you take these or any other nutritional supplements.
Vitamin D . It has been speculated that the majority of individuals in the U.S. are deficient in Vitamin D. Vitamin D receptors have now been identified in almost every tissue and cell in the human body and the Vitamin has been found to be involved in follicle egg maturation and development. Vitamin D also plays a key role in glucose regulation, notably in decreasing insulin resistance. Low levels of vitamin D have been negatively correlated with the incidence of type 1 and 2 diabetes. Few foods contain Vitamin D other than milk fortified with Vitamin D, eggs, liver, cereals with vitamin D added, and fatty fish. Skin exposure to the sun provides as much as 80 to 90% of the body’s vitamin D. However, overweight individuals have a greater chance of lacking vitamin D because it is a fat-soluble vitamin and may not be as bioavailable in high amounts of fat tissue. I recommend my patients take 1,000 IU of Vitamin D daily and have your doctor check your Vitamin D blood levels to see if you are deficient.
Cinnamon . Recent research indicates that cinnamon may help you better regulate your insulin levels and even lower your cholesterol. Careful monitoring of blood sugar levels is important to prevent hypoglycemia, which a lot of women with PCOS tend to experience as a result of elevated insulin levels. While side effects are very minimal, there is no need to exceed more than 2 teaspoons (6 grams) per day to get results. Cinnamon contains no calories nor does it have any carbohydrates in it, makin git a great spice to use in foods. Cinnamon can be sprinkled on cereal, coffee drinks, peanut butter sandwiches, oatmeal, cottage cheese, yogurt, and other foods. It can also be taken in a capsule form, sold as cinnamon cassia extract to meet therapeutic dosages of 3-6 grams daily or 1 to 2 teaspoons per day.
Fish Oils . Dietary guidelines recommended that we consume fish 2 times per week to reap the many benefits of the omega-3 fatty acids found in fish. Some of these benefits include treating depression and working as an anti-inflammatory. Women with PCOS may particularly be interested in consuming more fish or taking fish oil supplements for it uses in treating acne, high cholesterol and high blood pressure, high triglycerides, reducing food cravings, preventing hair loss, regulating hormone levels, and improving infertility and insulin resistance. About
1-3 grams daily is recommened. If you have elevated triglycerides, talk to your doctor about a prescription for Lovaza (Reliant Pharmaceuticals), which provides 1 gram of fish oil in a single capsule.
Magnesium . Magnesium supplementation may be beneficial to women with PCOS due to its ability to reduce insulin, glucose, cholesterol, blood pressure, and overall risk of metabolic syndrome. It has been suggested that women with PCOS have lower magnesium levels. Magnesium is found in certain types of fish, whole grains, some fruits, nuts, seeds, legumes, and soy products. Approximately 600 mg daily is needed to see results.
Angela Grassi, MS, RD, LDN, is the author of The Dietitian’s Guide to Polycystic Ovary Syndrome . She provides individual nutrition counseling by phone or in person to individuals with PCOS or eating disorders. For more information or to sign up for her FREE PCOS Nutrition Tips visit www.PCOSnutrition.com .
_________________________________________________________________________________________________________
Earlier Questions:
“Can you tell me some long-term diet strategies I can adopt to improve my insulin resistance, high cholesterol, and high triglycerides?” -Helena Eriksson (Sweden)
Helena , I am glad you are looking at making long-term changes to your eating. While improvements to your eating and exercise habits can significantly decrease your cholesterol and triglyceride (blood storage form of fat) levels in as little as 3 months, long-term changes are typically needed to bring down insulin levels. Lasting changes are also necessary to maintain health and weight and prevent the onset of chronic conditions usually associated with PCOS like high blood pressure, heart disease, and diabetes.
The best diet to improve your insulin, high cholesterol and high triglycerides is one that is rich in whole grains, legumes, fruits, and vegetables and limited in refined carbohydrates. These high fiber foods have important vitamins and minerals like magnesium and chromium which have been proven to improve insulin and cholesterol and fight cancer. Refined carbohydrates, on the other hand, tend to worsen insulin levels. In addition, eating a diet that limits saturated fats (butter, mayo, sour cream) but includes unsaturated fats (olive oil, nuts, fish) will bring down your cholesterol and triglyceride levels and can greatly improve your health for the long-run. Consuming foods or multivitamins with phytosterols (added in some milk and butter spreads) and/or taking a fish oil supplement daily has also been shown to reduce cholesterol and triglyceride levels. Engaging in physical activity regularly is essential to reduce insulin, cholesterol, and triglyceride levels, for weight management, and overall health.
What’s up with thin cyters? I feel like an anomaly! Skinny PCOS girls have troubles with the symptoms of PCOS too so the solution can’t be to lose weight, even if that helps women. What can I do?” -Ashleigh Motz Griffen (Midland / Odessa, TX)
You are not alone. In fact, many thin women with PCOS have difficulty getting diagnosed because weight is one of the main factors doctors look for when diagnosing PCOS. You can be thin and suffer from the symptoms of polycystic ovaries, amenorrhea, annovulation, excess hair growth, hair loss, and excess androgens. Chances are you probably do have some insulin resistance too. Although the cause is still unknown, it has been recently demonstrated that both thin and overweight women with PCOS have insulin resistance. Thin women with PCOS just don’t have it to the degree that overweight women do. Because of this, thin women can benefit from taking metformin or other insulin-sensitizers. Metformin can improve insulin sensitivity, prevent weight gain and miscarriage, and help regulate menstrual cycles. Of course, this is only one piece of the treatment. Changes to diet and exercise are equally important if not more so than medication. Even if you are thin, you are still at risk for developing diabetes and heart disease. A healthy diet is one that includes whole grains, fruits, vegetables, legumes, lean proteins, and unsaturated fats.