PCOS: A Personal Management Guide (Part 3)

Supplements

The world of supplements and ‘wellness’ is frankly overwhelming. When it comes to PCOS, the type of PCOS and your specific symptoms will dictate which supplements may be helpful for you. As I have insulin-resistant PCOS, I can only speak from my experience but if you have lean PCOS or pill-induced PCOS, for example, you may need to explore other or additional options.

Conventional medicine generally dictates the use of a hormonal pill to induce bleeds (which are not real periods, and effectively suppress your natural hormonal system), or the even generic advice of ‘just lose weight.’ People with PCOS will know that losing weight is definitely easier said than done, and that the pill (I was prescribed a combined pill), just didn’t fix the underlying issue - as someone who has developed an innate sense of what my body wants and needs, I stopped taking the pill and decided to tackle my PCOS my way.

Supplements should not be your first port of call. They are generally useful as an additional helping aid, but they are not there to replace the work you need to be doing with your diet and exercise. I would suggest giving yourself at least 3 months of having made diet and exercise changes, before starting supplements. It will give you a good baseline to start from, and to really understand the effects of any supplements you do take.

The supplements that I take are:

• Inositol

• Berberine

• Zinc

• Vitamin D3

• Mushroom complex

• Omega 3, 6, 7 and 9 complex

• Vitamin B complex

• DIM

• Saw palmetto

I have deliberately not included information regarding dosage or frequency beccause this is generally very personal and what works for me, may not work for you. I would encourage you to research as deeply as possible before making any decisions, and to speak with PCOS focused doctors / practitioners. In the world of social media, I have found people like Dr Jolene Brighten and Shahzeen Baig (@the.pcos.nutritionist on Instagram) to be knowledgable and helpful.

Additional lifestyle changes I have made are:

• drinking two cups of spearmint tea per day (it has to be specifically spearmint - not regular mint tea or peppermint)

• consuming one teaspoon of soaked fenugreek seeds per day (add the seeds to a glass with water for at least 5 hours or so until the seeds have plumped up. I drain the water and swallow the seeds instead of chewing).

• taking one teaspoon of black seed oil - this is an old home health hack I have been doing for years but I do notice the effect when I stop so it’s part of my daily routine to have this too)

• yoga / meditation - one chronic issue which makes PCOS symptoms exponentially worse is the effect of stress on the body. Increased stress has a physiological impact on hormones - specifically cortisol. Keeping this well-managed is key to acheiving maximum impact from all the other changes you may wish to make

• waking / sleeping cycle. To regulate cortisol levels, go to sleep and wake up at the same time each day. Aim to be up and having eaten breakfast by 9am at the latest.

• get 15-20 mins of sunlight before 9am to help regulate cortisol levels
  
  

Disclaimer: I am not a health professional of any description. The content of this article is based purely on my personal experience and research. Whilst this may be helpful as an overall guide, it is not intended to replace any medical advice. Please speak to your doctor before making any changes.

PCOS: A Personal Management Guide (Part 2)

How to start managing PCOS: Diet and Exercise

Before you start thinking about taking medications for PCOS, it’s worth noting that the greatest overall impact to your health and the greatest benefits will come from ensuring you are eating a PCOS friendly diet and exercising in the right way. Whilst this can sound overwhelming, it is actually fairly straightforward if you understand which macronutrients you are getting from your food. Depending on your current diet this may mean a significant lifestyle change, or small strategic changes. What I have found has worked for me is:

• ensuring every meal has a good source of protein, complex carbohydrates and healthy fat - understanding macronutrients of food will make this so much easier in practice.

• if you are a beginner, I would suggest making a list of foods that fit these three groups with a strong focus on whole foods (i.e. unprocessed foods), as far as possible.

• eating meals at the same time every day

• eating breakfast every single day

• having my last meal of the day at least 90 mins - 2 hours before I sleep (giving my digestive system time to digest food)

• focusing on my daily protein intake - whilst 45g-65g is enough for most women, some women with PCOS can need up to 100g of protein per day. Protein will help to keep your blood sugar stable so it is absolutely key.

• aim for 25g of fibre per day

• keep it simple! Food does not have to be complicated to be PCOS friendly

• understanding which foods and drink can directly support PCOS and help to regulate hormones

• pay attention to how your body feels after eating food - see if you notice any patterns. For example, I found that whilst I am not allergic to gluten, I do have a sensitivity to it which causes serious bloating. I don’t however, have an issue with dairy, which some people with PCOS can experience.

• I do not calorie count or restrict myself from food that I want to eat - however, if your PCOS has led to weight gain (typically around the abdomen), you may wish to eat in a slight calorie deficit. Please be careful that this is only a slight deficit (no more than 200 calories reduced per day) as PCOS tends to react very strongly to extreme dieting and it never sticks.

How to think about food

Food is fuel and you need to eat properly to manage PCOS. My routine includes waking up at 8am, breakfast (around 9am), lunch (around 1 pm), one snack (around 5.30-6pm) and dinner (around 7-7.30pm). This does change on some days and I might eat an extra snack for example - or the portion of my meal might be bigger or smaller than it was the day before. Keeping it flexible and eating intuitively has helped.

A typical food day for me would be:

• Breakfast - 2 eggs, either hard boiled or fried (using a cooking spray or minimal oil); a slice of toast or half a bagel with avocado and hemp seeds; a protein shake (frozen banana, milk, chia seeds, a mix of flax, sunflower and pumpkin seeds, and maca powder. Protein powder of choice - mine is usually one scoop from Form Nutrition here in the UK).

• Lunch - varies. It might be a sandwich, a stew and rice, a bowl of some sort. The focus is always on ensuring there is some sort of good protein (hummus, beans, chicken, fish or tofu are my go-to’s); complex carbs (rice, sweet potato, gluten free pasts/noodles, bread etc); and healthy fat (avocado, olive oil, nuts/seeds etc). My plate typically consists of the main meal on one half, with the other half made up of vegetables (either salad or cooked vegetables).

• Snack - varies. If I have something left over from lunch (a few bites worth), then I’ll finish this. Or have some milk and fruit, or cheese and fruit or nuts. Some days I will just eat a chocolate bar and crisps (which definitely isn’t the best option but it’s also one moment in an overall day of eating well and keeping an overall focus on health instead of nitpicking every bite, is important).

• Dinner - usually some kind of stew or curry with gluten free flatbread, rice, or pasta. Vegetables/salad in addition.

Most importantly, at NO point with PCOS, should you be extreme dieting or drastically reducing calorie intake. Experience (and the science, as far as I am aware) tells me that this will only create a stress response, and as soon as your cortisol levels are out of sync, any excess weight will only get worse.

In general, my opinion is that the focus should always be on overall health, diet and movement. I have generally tried not to focus on excess weight alone (which I definitely have some of), because exclusively looking at weight/weight loss is not going to give you the long term results you will need if you want to properly manage PCOS.

Exercise

I keep exercise simple. The one big change I made was moving from the conventional wisdom of significantly increasing cardio exercise to a gentler, steadier focus of strength training at a slower pace. Basically, I would recommend avoiding running any marathons. Exercise is very personal however, and you need to find what works for you.

My own routine tends to involve some kind of strength training 3-4 times per week because lifting weights helps with blood sugar control. It doesn’t need to be an excessively long session - 45 mins of focused work is good. Instead of running or any ‘stressful’ cardio, I just focus on walking and acheiving a general step count of 5000-7000 per day. Consistency will pay off and I enjoy walking but hate running so I avoid it.

I also have a weak core so a couple of pilates classes each week are also helpful.

In summary - focus on your macros (get enough protein, healthy fat and compex carbohydrates). Do not restrict calories - a moderate deficit will be helpful if you are also trying to lose some excess weight but do not starve yourself - you need to eat enough food. Eat strategically (meal times / snack times). Move your body - walk and lift weights. Do not try to do excessive cardio - gentle cardio and increased strength training is a better option.

Part 3 will focus on supplements and lifestyle changes

Disclaimer: I am not a health professional of any description. The content of this article is based purely on my personal experience and research. Whilst this may be helpful as an overall guide, it is not intended to replace any medical advice. Please speak to your doctor before making any changes.

PCOS: A Personal Management Guide (Part 1)

Living with PCOS

What is PCOS?

Living with PCOS can be a minefield and many people living with it can struggle to know where to start. The first thing to understand is that PCOS which stands for polycystic ovary syndrome, is a hormonal condition. It typically means your reproductive hormones specifically are out of kilter - and yes, women do have natural testosterone too. There are different types of PCOS (i.e. with different key symptoms which can range from amenorrhea (absent periods / no menstruation), hirsutism (hair growth where there shouldn’t be hair growth as well as coarse, dark hair), acne, androgenic alopecia (male pattern baldness / hair loss) - not to mention issues with fatigue, insomnia, night sweats, anxiety and a whole host of other effects from PCOS which you may not have connected the dots to.

My PCOS

I have the most common type of PCOS which is insulin resistant PCOS. What this means is that my body doesn’t regulate insulate properly (if I’m not careful), and could lead to pre-diabetes. The knock on effect is that I have higher levels of testosterone (twice as high as the ‘normal’ range for the average woman) - this in turn, means that my symptoms have generally centred around amenorrhea, hirsutism and androgenic alopecia. The good news however, is that over time, and with some trial and error, I have worked out how to manage my symptoms (for the most part), and this has helped to bring my testosterone levels into the normal range, regulated my insulin levels, and reversed the signs of hirsutism. However, if there is one piece of advice I can give you, it is that PCOS is a lifelong condition and not something that can be fixed immediately - once you have figured out how to manage your PCOS, you will need to do so for the rest of your life.

Blood tests / deficiencies

A good starting point is a full panel of blood tests. You need to know what exactly your hormones are doing - my blood tests revealed that my testosterone levels were twice as high as they should be as well as a chronic Vitamin D3 deficiency. Thankfully my thyroid tests came back normal (symptoms of thyroid dysfunction can cross over with PCOS symptoms - you may have one condition but it is mistaken for the other, or you may have both conditions). Your test results will give you a baseline to start from - some deficiencies can be helpfully supported through diet and lifestyle changes, others may require supplementation. Between this and your symptoms, you should be able to identify the type of PCOS you have.

Types of PCOS

It is possible for your PCOS type to change - don’t be surprised if it seems as though you are moving between the different types listed below - these are an approximate guide and most people with PCOS will typically recognise themselves as having different symptoms at different times. There is no hard-and-fast rule with ‘types’ of PCOS.

• Insulin-resistant PCOS: The most common type of PCOS, characterized by insulin resistance

• Inflammatory PCOS: A type of PCOS characterized by low-grade inflammation

• Hidden-cause PCOS: A type of PCOS where the underlying cause is not immediately apparent

• Pill-induced PCOS: A type of PCOS that develops after stopping birth control pills

• Non-hyperandrogenic PCOS: Also known as type D, this type of PCOS is characterized by ovulation problems and ovarian cysts, but normal androgen levels

• Ovulatory PCOS: Also known as type C, this type of PCOS is characterized by increased androgen levels and ovarian cysts

• Non-PCO PCOS: Also known as type B, this type of PCOS is characterized by high androgen levels and ovulation problems

• Full-blown PCOS: Also known as type A, this type of PCOS is characterized by high androgen levels, ovulation problems, and ovarian cysts

• Lean PCOS: A type of PCOS that primarily affects women who are underweight or of normal weight

In summary - get a full panel of blood tests with specific focus on hormones and thyroid function as well as general health. Your doctor might suggest having two or more tests a few weeks apart to aim for different points in your cycle and see how your hormones are changing throughout the month.

Part 2 will cover how to manage PCOS with diet and exercise

Part 3 will cover supplements and lifestyle changes which may be helpful

Disclaimer: I am not a health professional of any description. The content of this article is based purely on my personal experience and research. Whilst this may be helpful as an overall guide, it is not intended to replace any medical advice. Please speak to your doctor before making any changes.

A Gut Feeling

Gut-friendly grub seems to be on everyone's mind; the importance of gut health has made it into the mainstream from the peripheral territory of Actimel in the yoghurt aisle.

If I'm entirely honest, I only really started paying attention to information about gut health after I saw an episode of the BBC docu-series called 'Doctor in the House.'

In the show, one of the people featured was a child whose weight gain couldn't be explained any other way, so the doctor decided to investigate his gut health. It turns out that this boy's gut had far fewer microbes than it should have had, but interestingly, it only takes a minor incident to cause this to happen e.g.taking a course of antibiotics. 

The solution was surprisingly simple; to eat as wide a range of fruit and vegetables as possible. After recommending a solution of eating as wide a variety of vegetables and fruits as possible, we return to find that this particular child has in fact, lost a solid amount of weight. 

The gut is home to the most dense concentration of microbes in your body, and these play a critical role in everything from digestion to immunity to weight management. The biggest single factor which impacts the gut and how well it, and these microbes, function, is diet. The foods we consume are absolutely critical. 

Here's a handy-dandy infographic from the BBC to explain.

Foods to Support the Gut

Fermented foods are one of the best choices when it comes to promoting the growth of healthy bacteria and eliminate the bad kind. This includes foods like sauerkraut, kefir, pickles, and kimchi. Yogurt is also one of your top choices because it contains millions of the healthy bacteria that your gut needs. Foods rich in fiber are also important because it helps promote healthy digestion throughout your intestines. Fruits, vegetables and whole grains are the best, and healthiest, source of fiber.

You might also want to take a probiotic supplement to boost your body’s store of good bacteria. At the same time, limit artificial sweeteners and unneeded antibiotics, both of which can skew your gut’s balance of good vs. bad bacteria, leading to issues in your intestines and with your general health. 

Benefits of Gut Foods

As mentioned above, these gut foods help promote health in a variety of ways. When you choose the right foods, you help build a healthy immune system, which as you know, helps keep you healthy. This means your body is better able to respond to viruses and infections that can make you sick. In addition, having a healthy gut just makes you feel better in general. 

Another perk to balancing your gut biome is that you can control your weight. People with specific digestive problems, such as irritable bowel syndrome or inflammatory bowel disease may experience an alleviation of symptoms by following a healthy gut diet. 

Additionally, a healthy gut has been shown in certain research studies to help support good heart health and may also prevent the risk of developing diabetes or high blood sugar. Some studies show that a healthy gut biome can also help reduce the symptoms and incidence of depression and other brain disorders. 

Diseases Caused by Poor Gut Health

Having a healthy gut can help treat or prevent certain health conditions. It makes sense to assume then, that poor gut health can lead to or exacerbate health problems. Research has linked an unhealthy gut biome to cancer, obesity, bowel disorders, autism, heart disease, autoimmune conditions, skin infections, Parkinson’s disease, and asthma. More research is needed, but the results of these studies show promise in finding ways to prevent and treat a wide range of health issues. 

So, the foods you eat play a huge role in your overall health, something you’ve likely known for a long time, but not fully understood the relevance of. In addition to eating the right foods, you can also support your gut health by controlling stress, getting plenty of physical activity and sleeping enough at night.

These simple steps could have you feeling great in no time at all. 

It's Time to Eradicate Polio in Pakistan.

Some of you may know that I'm British Pakistani. I was born and raised in the UK where I have lived my entire life but I hold Pakistan very, very close to my heart. The stories of my mother's childhood, climbing mango trees with mischievous cousins, my dad standing up to his college Principal in the 1980's, the turmoil of political change from democracy to dictatorship and back again; all of these things coupled with my own visits and time spent in the country have strengthened the natural fondness I felt for this far-away nation. 

Perhaps because of all these things, I've spent a lot of my time thinking about what Pakistan needs in order to grow and develop as a nation, and how it can ensure the country is fit for purpose for its population of c.200 million people in the future.

Pakistan is a young country both in age and demographics. The majority of the country's population is young, under the age of 30. But it is a country that faces significant challenges, the majority of which are unfortunately state-enabled, if not a direct result of. One of its key issues is healthcare, or rather the lack of affordable, high quality healthcare as well as accessibility to healthcare provision. Healthcare and medicine as a whole is a huge topic and with a population the size of Pakistan's, there is never going to be an immediate fix.

However, the one area that has persistently seen setbacks but is possibly also the one area that could realistically be solved in my lifetime, is the eradication of many major diseases; chief among these, is polio. Pakistan and neighbouring Afghanistan are the last two countries in the world with significant instances of polio across the population. Every other country around the world has managed to either fully eradicate the disease, or seriously limited its instances so that it is no longer statistically significant. 

Pakistan's journey to eradicate polio has been the centre of attention globally both from other states but also charities and NGO's including organisations like the Bill and Melinda Gates Foundation which has focused a significant amount of resources and attention globally, to eradicating polio and you can bet that Pakistan is very much on their radar. 

If you speak to people in Pakistan who have children with polio, there are a couple of things you're likely to hear. Firstly, that the presence of polio is an American conspiracy, secondly, that the vaccine doesn't work, or perhaps most troubling of all, that it's God's will. All of these objections can be managed with appropriate education and learning in order to teach people the reality of how vaccines work, but also how (as a Muslim majority country), it is not God's will for you to allow your children to become sick.

The conspiracy theory one is more difficult however - Pakistanis have not forgotten that American intelligence agencies used the ruse of a health clinic providing vaccinations to children during the hunt for Osama bin Laden. Unfortunately, getting the population past this is a colossal task; the distrust and skepticism caused by that sole incident has had severe repercussions and sadly, in some parts of Pakistan, the fear remains that such clinics are all fake and that parents making use of them may be inadvertently be subjecting their children to something much worse. 

In other areas, and I'm thinking particularly of broader healthcare coverage, certain areas in Pakistan are making great strides, not least of all in Khyber Pakhtunkhwa, where the PTI led administration has made affordable healthcare a reality for many poor Pakistanis thanks to insurance coverage. Tackling polio needn't therefore be a showstopper, yet it seems that this disease, and specifically this disease, is tied up with so many negative connotations in large swathes of the country that addressing this may take longer than is advisable. 

The children don't have long. Once polio sets in, it sets in. I can only hope that the government of Pakistan begins to take a far more proactive approach than it has in the past to address this. A generation of children cannot be allowed to suffer as a result of ignorance or misguided notions, however instilled they may be.