The Food Medic - S9 E3: How food and movement can help manage Polycystic Ovary Syndrome with Claire Pettitt

Episode Date: January 23, 2023

This episode explores the role of nutrition and lifestyle in managing PCOS (Polycystic Ovary Syndrome). Dr Hazel is joined by Dr Claire Pettitt, a dietitian working in both private practice and in academia, with a special interest in women’s health nutrition - especially PCOS and fertility. Find her on Instagram @Cp_nutritionrd In this episode: What is PCOS and how is it diagnosed? Different types of PCOS Insulin resistance and its role in PCOS Weight management and PCOS Low-carb diets and PCOS The most effective dietary strategies for PCOS Key supplements for PCOS Enjoyed this episode? Please do rate & review this podcast. And why not send it to someone you think will love it too? Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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exclusions and terms apply. Instacart, groceries that over-deliver. Hello and welcome back to the Food Meta Podcast. I'm your host, Dr. Hazel. I am so excited about today's episode because this topic was so highly requested and our guest today has so much experience in this particular field. Today we are taking a deep dive into PCOS or polycystic ovary syndrome. As someone who received a diagnosis of PCOS a few years ago, I know how confusing and how conflicting information about nutrition and lifestyle can be when it comes to this condition. So I wanted to record this episode to help give you some clarity. If you want to know more about this topic, we do have a special webinar all about PCOS, which you can find on our website,

and I'll pop the link in the show notes too. So today's guest is Dr. Claire Petit, a UK and Singapore registered dietitian working in both private practice and in academia. Claire Petit, a UK and Singapore registered dietitian working in both private practice and in academia. Claire has years of experience working across many areas of dietetics, including in the NHS, in research and in private practice, and she's a special interest in women's health, including nutrition, especially PCOS and fertility. It's a brand new year and naturally many of us are setting goals and resolutions for 2023 and one of my resolutions is to be more consistent with my bedtime routine so that I can set myself up for better sleep and recovery overall. One tool I'll be using to help me with this is my Whoop. Many of you will know I'm a huge fan of Whoop already,

and I've recently joined their scientific advisory board. But if you haven't heard of Whoop before, let me quickly explain. Whoop isn't just another fitness tracker. Whoop is constantly measuring important metrics and vital signs like resting heart rate, heart rate variability, activity levels and sleep performance. The WHOOP algorithms then process all of these inputs to provide you with personalized recommendations and coaching feedback to help you accomplish your goals, whatever they might be. So if you're setting some goals, whether it's preparing for your first half marathon or like me trying to get more sleep,

WHOOP are here to help each and every member in their community set and smash their goals and resolutions for 2023. If you're interested in improving your health and overall performance you can go to join.whoop.com slash thefoodmedic to get started. Claire thank you for coming on the podcast today. Thanks for having me. I'm so excited to be here. Yeah, I'm excited to chat to you about everything to do with nutrition and PCOS. But first of all, I want to learn more about you and just talk about your journey and how you got to where you are today in terms of your expertise. Yeah, sure. Well, I'm also very excited to talk about PCOS

because it's my favourite topic. So I'm a dietician. How did I start off my career? I actually started doing biology. I started doing biology as my first degree and realised that I loved food, I loved health, and then I ended up into dietetics. And I worked in the NHS for a long time

and that's probably where I kind of experienced lots and lots of different areas clinically so things like gastro and Stroke weight management all those sorts of things But I had my first at the time Weight management clinic and so many of the people in that clinic had PCOS. So that was where I first started seeing them. And I really, really just was so interested in it, I actually have PCOS myself. So for me, I'd already had my own personal experience and my own journey. But like dealing with other people and supporting them with it was was just really

rewarding. So it was only a small part of my role. And then, you know, as things do in the NHS, you kind of rotate and change and do other jobs. And I ended up getting frustrated with the NHS and the systems in the NHS and decided to go on and do some research. So I left the NHS and moved into research. And most of my research was in weight management. I ran a few clinical trials looking at the different effects of different diets and how they impact appetite and changes in your body composition when you lose weight and through all of that kind of research and learning about weight science I kind of came to the conclusion that there is no real one good way to lose weight

and actually maybe weight loss is not the answer but anyway alongside my research I also kept up with my private practice which I had started back when I was in the NHS so I left the clinical side in the NHS but carried on with some of it in terms of private practice so I had research and private practice finished my PhD and then decided to just focus on private practice. And the majority of what I do now is actually women's health. So my favourite area is PCOS management, but that kind of took me into fertility and other women's health issues. So endometriosis and even things like menopause.

So, yeah, that's my journey so far. Lovely. I love that. And your PhD sounds so interesting as well. Let's just go back to basics and chat about what PCOS actually is and how's it diagnosed? Yeah okay so PCOS stands for polycystic ovary syndrome so it is a syndrome which means a collection of symptoms um it is a really really common condition you see in people with ovaries so traditionally it was thought to be a reproductive condition because the um the main kind of symptom of it is irregular periods the most obvious one um but actually the more we learn about it the more we know that it's far more than just a reproductive problem actually there's a lot of metabolic issues, psychological issues. So it's a really complex condition.

So in order to diagnose it, you need to have two out of three different criteria. The first one is the irregular periods, which I mentioned already. And then the second one is having high levels of androgens. So those are male type hormones. And you either can have clinical symptoms or clinical signs of those high levels or test it biochemically and have a blood test done. So it's the regular periods, high androgens. And then the third one is having what we call cysts on your ovaries. So PCO, which is polycystic ovary morphology rather than syndrome

and those are not actually cysts so traditionally when we when they first discovered this condition they would scan the ovaries and they found what looked like cyst but the more we learn about it we realize that actually they're not cysts and they're actually immature follicles so in a normal menstrual cycle you would um the follicles would develop and mature and grow and then you would ovulate but with um pcos that doesn't happen so these kind of immature follicles collect on the ovaries so you have lots and lots of them um on the ovaries that's where you get these polycystic ovary kind of um picture so those are the three different criteria and you need two out of three of them. So irregular periods, high androgens and cysts on the ovaries. Yeah and when I was in medical school and we first learned about PCOS I mean we briefly skimmed over it as part of

Ops and Gynae and endocrinology but it was you know they kind of really paint this picture of like what a typical pcos patient looks like and really hammers that home so like even when you're doing assessments it will always be a woman who is very overweight who has like male pattern hair growth so a beard and balding and is insulin resistant and can't get pregnant. And it's just very typical presentation. And so I also have a diagnosis of PCOS. And for a very long time, I couldn't get a diagnosis because my GP wouldn't move beyond just doing the initial blood tests.

After a while, I was then referred to a gynecologist had my scan and was given the diagnosis and for me it was a really interesting experience being the patient and really learning about PCOS because because I had a personal investment then I really dived into it a lot more I was going through my master's in nutrition as well so I was learning about it from that side of thing yeah I came to realize that PCOS can have lots of different um presentations and it can affect women of all shapes and sizes and you know we don't all experience the same symptoms um so I'd love to chat to you about kind of the different phenotypes whether you think it's necessary that we diagnose it

in that way, does that change how we manage it Yeah, I think that's a really good point and listening to you talk about your experience, I feel like it's such a common experience, women really struggle to get diagnosis and I feel like that's across the board with women's health conditions actually which is such a shame

but hopefully it's changing slowly but anyway um that yes aside from the kind of three criteria which is the rostam criteria that we mentioned already you can also have these kind of phenotypes of pcos and it's essentially the combination of those symptoms so you could have all three of them you could have the irregular periods the high androgens and the cysts on the ovaries and that's what we call like the classic um pcos where actually it's easier to diagnose because they are all all the symptoms are there um then the other combinations will be the different other different types so you might have irregular periods and cysts on the ovaries you might have irregular periods and um high androgen

levels or you might have high androgen levels and cysts on the ovaries but might have irregular periods and high androgen levels or you might have high androgen levels and cysts on the ovaries but without the third one basically yeah now I think it's really useful to understand the phenotype which helps you to then think about how you're going to manage that person in front of you because as you said like everybody presents differently it is a syndrome it isn't just you know tick one box there you go you've got your diagnosis and everyone you treat the same there's no cure it's just managing the symptoms and understanding what is the root cause of those symptoms so I think it is helpful to understand which type of PCOS you have I don't think it's always helpful to label it in that way but I think understanding your biochemistry and

understanding your symptoms and understanding how PCOS presents itself for you is really important. And I don't think that patients really get that much information about that. And like, you know, if they go see their doctor and they get a diagnosis, they have 10 minutes with them. It's not enough to really understand the condition and understand what it means in terms of their long-term health risks and and how they can then manage those typically like as you said there's that typical picture of PCOS and people who get that diagnosis are then told okay off you go go away lose weight that will help um here's a pill which will help manage your periods and come back to me when you struggle to have kids and then we'll help you with your fertility issues. Yeah, that last sentence that you just said there is such a universal statement that was also used on me.

And I hear it from so many other women in that, like at the time of my diagnosis, I had a very senior gynecologist say to me, well, you're lean enough so you don't need to lose weight, but just cut down on your carbs not once did he ask me about my diet and come back to me when you want to have kids and I just found that so unhelpful because I had knowledge that his comment about my diet was very throwaway and it didn't cause me to think about it too much

but I thought if I was someone who was maybe very new to this condition had no previous knowledge and was really trusting the senior doctor I might go away and fear carbohydrates and feel like that was what was causing it and therefore I needed to strip that from my diet. And just kind of going away with no tangible tools or support or, you know, where can I read more? And that just really infuriates me. 100% agree with you. And I feel like so many of my clients come to me and they almost conflicted when they hear what I have to say. Because they're like, oh, my doctor's told me the complete opposite oh what do I do sometimes there's relief they're like oh thank god I don't have to do that

anymore like they end up in this chronic dieting cycle because they're like oh well it must be my fault because I've gained weight or because I'm eating the wrong things and as you said that like sentence around fertility it's so unhelpful because if you're at a stage where you're not ready for kids then actually all it does is cause you anxiety about what the future has 100 because you feel like it's out of your control and it is going to go wrong and like i feel like for a lot of women that just is like this shadow over them for the rest of their life and and well until they're ready to try yeah um so you're 100% right it's it's so unhelpful such a an unhelpful way of of treating PCOS and supporting women it's not supporting them at all no I think it can be really triggering for women. It seems to be that is the universal advice that's given

is weight loss and cutting carbohydrates. And I think we should like really pull that apart because one of the reasons why that's recommended is because one of the drivers of PCOS and a lot of women with PCOS is insulin resistance. Can we talk about that first? Kind of what is insulin resistance and how is it related to PCOS? Yeah, absolutely. So up to 80% of women with PCOS have insulin resistance. So it is a real important factor in terms of managing the condition and keeping under control so insulin is a hormone

and when you um your body produces insulin in the pancreas in response to carbohydrates or you know sugar in the blood so once you have a um a meal and you digest everything and the the glucose or the sugar enters the blood then your body will start to produce insulin insulin's role is to help transport that that sugar that energy into your muscles into your organs so that you can use it and your body can function so it's a bit like a gatekeeper right when we have insulin resistance our body doesn't seem to recognize the insulin that we're producing and it doesn't seem to be able to use it so we tend to then produce more of it so you get this state of high insulin levels in the body which is not helpful because high insulin

levels are linked to lots and lots of other issues so when we have high levels of insulin it can actually increase the production of those hormones that we talked about earlier things like testosterone so that's one of the other driving factors of PCOS so high insulin levels and high testosterone levels and unfortunately it's a little bit of a vicious cycle because they are linked high insulin drives the production of testosterone and testosterone drives the production of insulin so it's a little bit of a catch-22 so managing insulin resistance is key high insulin levels also tends to lead to things like cravings. So we often see in women with PCOS that they tend to crave either sugary or carbohydrate type foods. And especially when you get like peaks and troughs in your insulin levels.

And that often happens with insulin resistance. It drives appetite because your body is not getting the energy into the cells. And so even though you're eating and you're not your body is not getting the the energy into the cells and so even though you're eating and you're producing insulin you it's not transporting the the energy into the cells efficiently so then your body's like hold on a second i'm really i really need food so you just have these intense cravings and like increase in appetite so and that's part part pcos as well we see that often um in women with pcos it's one of the things that they would often tell me about oh i get these really strong cravings for sweet foods or you know i just really want a bag of crisps or something like that

um so high insulin levels is linked to high testosterone levels it's linked to cravings appetite it also drives weight gain so um all these things that we've already talked about that we see in people with pcos can be related back to insulin and high insulin levels yeah that's why it's really important that we kind of teach people about it and they understand why it's important to control it so we would really be focusing on just maintaining blood sugar levels and keeping them under control and not having peaks and troughs in blood sugars and insulin production yeah and i mean you just highlighted that 80 percent of women with pcos have insulin resistance but um and i can tell you from my experience of my diagnosis

that was not something that a blood test that was done and there's a couple of ways we can look at kind of blood sugar and insulin levels and things like that and and I know that that's probably the case for many many people in the UK and I'm sure it's across the board where they'll just do the kind of baseline sex hormones and not look into these other factors which carry such a huge risk profile if it's undiagnosed in certain people. I guess for health professionals listening, what tests would you like to see in a woman with PCOS when you're trying to manage the condition? Yeah, it's a great question. And I do think with diagnosing PCOS, there isn't enough consensus on what you should measure because I probably couldn't even find two of my clients that come to me with the same blood test results like it's so

variable what's important also to mention is it is a diagnosis a differential diagnosis so you need to exclude other conditions so to get your PCOS diagnosis they should have excluded other things and done blood tests to do that yeah so things like you prolactin and cortisol to look for maybe tumors or other conditions that would lead to those changed levels of those hormones so that is important but then when we think about actual pcos diagnosis like because insulin resistance is important it would be great yeah if they looked at least um fasting insulin and and blood glucose if you look at the guidelines the recommendation is to actually monitor and do oral glucose tolerance test every year i think i think it's around 50 of women with pcos develop diabetes diabetes or prediabetes before they're 40.

So it is really important to monitor and to understand where they are at with their metabolic health. In an ideal world, it would be great to know their insulin resistance. But that's something that you would test in research more so than clinical practice. So things like home IR. But just having an eye on what's going on with them in terms of glucose and insulin would be great when it comes to the androgen levels again there's no there's no universal kind of consensus on what you should measure but commonly um you see testosterone free testosterone shpg sometimes some of the other androgens are measured as well um what's key with the

testosterone levels is not total testosterone but actually the amount of testosterone that's free in their blood so testosterone tends to bind to something called shpg or sex hormone binding globulin and when it's bound it doesn't have't have those negative effects in terms of the symptoms of high androgen levels, which is, as you said, things like excess facial hair or balding and those sorts of symptoms, acne even. So when it's bound to SHBG, it doesn't have the same effect. So it's the free testosterone that's much more important. So you can either measure free testosterone or you can look at something called free androgen index, which is more like a ratio.

Also would be great to have those levels, but it's not it's not commonly seen. And in addition to that, another driving factor of PCOS is inflammation. And we see that many women with PCOS have like low grade inflammation. So not like you would see in an infection where you know your inflammatory markers go up through this through the roof but just this slightly high just outside of range you know maybe things like crp or some of the other inflammatory markers just tends to be floating just slightly high and inflammation has an impact on so many different pathways you know it will worsen insulin resistance it will

increase androgens you know it will impact reproductive function so like it's important to keep that under control as well so having some insight into whether there is some inflammation going on is also helpful and and in addition once you've got pcos you have increased risk of diabetes cardiovascular disease so it's important to keep an eye on things like your lipid profiles and um things like that i would also i would also want in an ideal world to know things like vitamin d levels because um we see that women with pcs tend to be vitamin d deficient yeah we don't really understand the complete mechanism behind it and the more we learn about vitamin d

then the more we realize it's involved in pretty much every every part of the body um but yeah i often try and get my patients to check their vitamin d levels as well yeah i feel like that's something really helpful that everyone should be doing anyway i mean absolutely and i would say most of the time that they they should supplement with vitamin d anyway especially now in the winter but it's useful to know what their baseline level is so yeah yeah 100 percent um and i really want to kind of go into nutrition and supplements next but before we go on to that um let's just briefly talk about weight loss because it's often recommended to lose five to ten percent of body weight in order to improve PCOS symptoms but like we just said um that's not always the best advice

for every person with PCOS what what do we know from the evidence do you think that weight loss is essential for women with PCOS do you think think there are more or less effective strategies when it comes to losing weight with women in PCOS? Yeah, I love this question. So given my background in terms of my most my research was in weight loss, like the more I understood about weight loss strategies, the more I realized that intentional weight loss is a very, very personal thing. And it's a very, almost like a black hole. Once you start down there, it's very difficult to get out. And I feel like for many women with PCOS, if they focus on weight, they lose sight of everything else. And it's very easy to get stuck in this weight loss cycle and forget about nutritional quality.

Weight loss, yes, there is evidence. There's definitely evidence that 5-10% weight loss can improve things like insulin resistance and testosterone levels. But there's no long-term studies in PCOS that really have great results in terms of the lasting weight loss and then the beneficial effects on your PCOS status. And I would say that also applies to weight loss in general, you know, outside of PCOS. There isn't the long-term evidence to support it. And we know that with people with PCOS, they have higher risk of psychological issues. So mood disorders, depression, anxiety and increased risk of eating disorders. They're much more likely if you tell a woman, hey, look, go away, lose weight and it will help you.

They're going to focus on that and they're going to think that that's the only objective. Yeah. But as we've just spoken about you know managing insulin resistance and keeping control of your testosterone levels and your androgen levels and inflammation like there's so much more that you can do weight loss might happen but it doesn't necessarily cause a beneficial change in all those other factors so to me weight loss is a very simplistic way of looking at it yeah and if you look at the different phenotypes and like for example the lean pcos where you as an example you know you said you weren't overweight so actually your gp said no you don't need to lose weight so what did you need to do cut carbs well we can debate that in a minute. But actually, you can have PCOS without being overweight.

So weight isn't necessarily the only driving factor. And in fact, I would say it's not really a driving factor. It is a consequence of high insulin levels and high testosterone levels. But it's dealing with those that will help you see the change in weight rather than focusing on the weight itself. Weight is not behavior you know you need to focus on your your lifestyle and your health behaviors are you eating well what's your nutritional quality like are you exercising all those sorts of things that will actually have an impact on whether or not your weight can change and and

actually i would say your weight's slightly irrelevant and and if you're doing all those positive health behaviours, then you should see a change in your PCOS symptoms. And actually, that's what's much more important. Yeah, I think that's really empowering that focusing on the health behaviours, independent of weight loss, you can still improve your symptoms. And looking at the research around weight loss and PCOS like there is some evidence to say that it can improve symptoms and whether that's just a reflection of the lifestyle changes

that have been taken to cause the weight loss is another question but I think like you mentioned there's this higher risk of disordered eating than women with PCOS. And they also find it harder to lose weight. So it's a very challenging situation to be in. And it can be really, it can feel very stressful if someone says you need to do this in order to be, in order to have babies in the future. And I really dislike that message. I'm going to interrupt you for a second. Yeah. Just because I wanted to mention

like the types of eating disorders that are much more common is actually binge eating and if you think about that in relation to things like carb cravings, you know, if you're starving yourself most of the day because you think you need to lose weight

and then you get to a certain point and your body's telling you, eat something, come on, I'm hungry, eat something, then you almost I'm hungry, eat something, then you're almost bound to end up in that binge restrict cycle. And we do see it's actually much more common to have binge eating and bulimia with PCOS rather than something like anorexia in terms of the types of eating disorders. Yeah, which is not going to contribute in any way, in a positive way.

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nutrition is like the biggest thing when it comes to PCOS and there's a lot of information out there now there's lots of PCOS diets and things like that and I think one of the common things is largely centered around going low carb or going high fat and let's talk about that what's the evidence around low carb diets and PCOS? This is a really common thing to discuss with PCOS, people with pcos because it is what they're told right they're told cut carbs lose weight um and that will solve your problems if we look at the evidence the evidence is not conclusive because the evidence is variable if you look at how you define low carb diets most of the time studies don't actually have low carb diets that they're testing

the percentage of carbohydrates can vary from 20 percent energy from carbs up to about 45 percent energy from carbs 45 percent energy because it's not low carb yeah you know and so some of these studies are claiming they're low carb and then you see beneficial effects when they're not so actually and there's not even that huge number of studies. So actually, the takeaway should be, OK, maybe carbohydrate is important in some way, but we do not have to be restrictive. A moderate amount of carbohydrates is OK. There's some evidence around high carbohydrate diets having a negative impact. But going that low and following a really restrictive diet is is not helpful first of all because of the impact on in terms of like dieting behaviors and risk of eating disorders but also

carbohydrates are really good for us you know they have such good nutrient profiles especially when it comes to reproductive health the profile of b vitamins fiber for gut health it's actually really really important food group to have in our diet and including lots of whole grains is important for reproductive function so sticking to a low carbohydrate diet is is not actually that beneficial mental health wise diet wise overall health wise gut health wise you know it, you know, it's not a good idea. I think instead of focusing on low carb, it should be the type of carbs. And actually thinking about including whole grains and high fiber carbs, because those are the kinds of foods that will help manage blood sugars and keep your blood sugar stable.

The higher fiber content, the longer it takes for your body to digest the carbohydrate and then for it to be absorbed into your blood sugars stable the higher fiber content the longer it takes for your body to digest the carbohydrate and then for it to be absorbed into your bloodstream so you won't have a big spike in your blood sugars and then a subsequent spike in insulin um it will be much more gentle rise and it'll give your body a bit more time to recognize and for that insulin to start working so So actually type of carbohydrates are much more important than the cutting it out completely. Yeah, I completely agree with you there. And what are some other nutritional strategies

when it comes to managing PCOS that are evidence-based? I mean, I think we can probably add a few on to a few effective strategies for insulin resistance, including protein and healthy fats and things like that. Exactly. Yeah. So when we think about blood sugar control and insulin resistance, we're just trying to keep the blood sugar stable and not get those peaks and troughs. So adding protein, I tend to try and get my clients to think about it almost like a puzzle and making sure that your meal snack always contains lots of different elements and you start putting them in puzzle pieces together. So a carbohydrate source, which is ideally whole grain high fiber and when you add to that protein again it reduces the um speed at which you're digesting your food and so the the um all the nutrients will enter your

bloodstream much much more slowly so that will have a good positive impact on blood sugar control um protein has lots of other benefits as well in terms of appetite regulation you know keeping after under control it helps in terms of body composition too if you're getting adequate protein when we think about weight loss and and the typical focus is just the number on the scale right but actually body composition is much more important for people with PCOS because you're um because it's a metabolic condition what you're trying to do is keep all those hormones in in balance and if you have much more muscle tissue it is um uh going to positively impact your insulin levels um and insulin resistance as well so forget about weight loss focus on your

body composition and trying to i mean we talk about exercise later but you know that's actually another important part of it is is the balance of body tissues so fat muscle and actually having enough protein in your diet helps you to maintain your your muscle mass getting protein with every meal every snack helps maintain that blood sugar levels and also gives you a good amount of protein overall yeah so adding protein and also adding good fats fats another one where people are like ah you know it helped me either to lose weight or improve my health but fat's really really important for reproductive function yeah you know and as a woman we need enough fat you know enough fat intake for our cycles to be regular for our bodies to work properly yeah so adding good fats is also really important and that can also be beneficial in terms of the inflammation side of things.

So adding omega-3 fats, your oily fish, monounsaturated fats, avocados and nuts and olive oil, all those sorts of things. So we shouldn't be afraid of any of the nutrients, right? And don't cut carbs, don't cut fats. We need all of them for our bodies to be healthy and especially when it comes to women's health. That's so important i love that message and i guess the takeaway from from that then when it comes to nutrition and pcos is it's not a single diet and it's not about cutting certain foods out it's about looking at the dietary pattern yeah including a balance of all of the food groups and just opting for those

i guess the higher quality carbohydrates where possible and making sure you're including protein and healthy fats at mealtimes as well. Yeah. And if you think about the overall picture of that, it's very much in line with something like a Mediterranean style diet, right? Lots and lots of high fiber carbohydrates, nuts and seeds, they've got good fats, they've got fiber, they've got fiber they've got protein um plant-based um proteins as well balancing that with you know good quality animal-based proteins um oily fish olive oil um loads of fruits and veggies you know so it's it is a kind of mediterranean style way of eating yeah which has so many health benefits so yeah we should all be following a diet like that anyway um and then supplements is another thing that is quite topical with pcs

um and i mean you can just type into google and there'll be like various different supplements on the market and i was actually having a look at them for a different project recently. And some of them include like nutrients that, to my knowledge, I cannot find any research to back up the evidence for their benefit in PCOS. So I just think that industry is so unregulated that and I don't think people are aware of that. Because if you are buying a supplement and it says, you know, for PCOS, you're going to think that's gone through a clinical trial and there's some evidence for it yeah but what are kind of the top line supplements that you think show good promise in PCOS? I 100% agree with you in that it's a bit of a kind of cowboy kind of zone you know there's so many opportunistic practitioners out there or salesmen who will just prey on people's insecurities and desires to improve their health. And we see this with PCOS especially, but also with fertility.

There's another area working a lot. And it's just such a shame that people will waste a lot of money on supplements and products that are not helping them in any way. And there's a risk. You know, if they're not regulated, then how way and there's a risk you know if they're if they're not regulated then how do you know they actually contain what they say they contain even if it did have evidence behind it you know some some of these products are not um just not worth the money yeah when it comes to supplements that probably are worth it so i would i would say it's actually really important to personalize supplementation with

pcos so it depends on your presentation of pcos and what's going on with you So I would say it's actually really important to personalize supplementation with PCOS. So it depends on your presentation of PCOS and what's going on with you. I already mentioned vitamin D. Now, I'd say that's probably a really important one because so many women with PCOS are deficient in vitamin D. So, yes, you can take a supplement and the standard, know 10 micrograms which is recommended across the across the board but often if you're deficient you might need more than that so i do think it's really important to test levels and supplement to your levels um another one is omega-3 so and we've mentioned already about inflammation and the importance of omega-3 fats and in terms of

healthy Mediterranean style diet and their impact on very potent anti-inflammatories I would say I'm very much a food first type person if you if you manage to get your oily fish in twice a week then there's probably no need for an omega-3 supplement but if you don't then it's a good option to to have as a backup yeah um. So vitamin D, omega-3. Another really popular one at the moment is inositol, which is a bit like a vitamin B type substance. It helps to improve. It's a signaling messenger.

So it helps to improve insulin resistance. You can find it naturally in food products. So things like grains and nuts and fruits and veg and things like that. But there's more and more evidence showing that it helps to support women with PCOS in improving insulin resistance, but also ovulation. It's definitely something I get asked about a lot. And I would say that the evidence is improving in terms of the quantity and the quality to say it could be a good option for people to try. It's not an across-the-board recommendation

because I do think it needs to be tailored to the person, depending what else is going on with them and what their symptoms are. So if they are struggling with insulin resistance, it could be a good option. And if they have issues of irregular periods it might help yeah yeah i think that one is um comes up quite a lot but there are so many different types on the market and is there like a particular one that you recommend or yeah so again i think because the evidence is still quite new um it would be helpful if we had more studies but overall the picture tends to be that um the the so there's different

forms of inositol so there's um myo-inositol and d-chironositol and what we think is that it's best to take supplement that most represents how it is in the body and in the body we have a 40 to 1 ratio of myo to d-chironositol so that's what we recommend overall it's sometimes difficult to find supplements that do state their ratios and have that ratio it's not impossible there are some out there um often the supplements might just say inositol um or myo-inositol because the the amount of myonositol is that much higher than the d-chiro you know you could get away with just taking a myo-inositol but i would say if you can if it's accessible for you to choose one which is 40 to 1 myo to d-chiro then go for that one yeah yeah i've actually um seen more and more they've put

that kind of on the bottles or have advertised it and i even questions like it asked on social media i feel like a lot more people with pcs are interested in this are reading more about it and so i'm glad that we covered that off and I guess the final thing I want to cover off is the benefits of exercise. I'm a huge advocate for this. And I think there are so many benefits for exercise in general, but for women with PCOS in particular, both cardio and resistance training. So let's let's talk about that. Yeah, I mean, it's part of the guidelines. So there's some international guidelines around PCOS management, and they definitely encourage exercise as part of your lifestyle modifications so it's

150 minutes of moderate intensity exercise or I think it's 75 if it's vigorous intensity exercise it's also not that helpful because like people have different interests and some people will love going for a run. Some people will hate going for runs. You have to do exercise that you enjoy, right? So I would say if you look at the quality of the evidence in terms of exercise, it's a little bit of a similar picture, actually, in that there's evidence to say HIIT exercise is really great for PCOS. And there's evidence to say that actually moderate intensity exercise is okay for PCOS.

What's exciting is that there's lots of evidence coming out around other forms. So things like yoga, for example, even has some evidence in terms of improving PCOS picture. So I would say it's definitely important to exercise. Resistance training can be helpful because as we talked about, body composition is important in PCOS. So if you can include a little bit of of everything

that would be great but it's also important not to go extreme so you know some cardio some resistance and some of that more gentle form of exercise that actually you know for things like yoga it's it helps to improve pcos picture but it also helps things like anxiety and gut health so you want to be doing things that are giving you overall improvements in health as well as just focusing on pcos um so when it comes to exercise my advice is always like to to find something that you actually enjoy doing yeah because you're only going to do it if you enjoy it and and actually that's what's most important being generally active as well like try i mean we're so so many of us fall um down with the everyday lifestyle of getting up getting your coffee going to your

home office which is like 10 steps away and then sitting on your butt all day actually being generally active is so important so if people are struggling to get exercise in even just starting off with with general movement and going for a walk at lunchtime instead of eating at your desk or you know something simple it doesn't have to be crazy goals of like trying to run a marathon yeah yeah that's it um i love that message in that like whatever way you can move and all forms of movement count um and try to break up sitting time i think that's really i mean that's the advice i'd give to anyone anyway and the the recommendations are the same as it would be for general population um i love that and i think like you mentioned when it comes to resistance training um we had danny lennon on the podcast before and we were talking about the benefits of

resistance training and insulin resistance and glucose regulation and he said you know muscles are like a sponge for glucose and i say that all the time when i'm speaking to people because it's a really good way of thinking about it it really helps your body use the glucose better and so if you are in a situation where your your body doesn't handle glucose as well you can almost improve that by lifting weights or doing some form of strength training that could be yoga yeah absolutely and from a personal side of things for me exercise is super important for managing my PCOS. I notice the difference and not only for my PCOS, but my mental health. Yeah. Like and even if it is lifting weights or doing yoga or like even just going for a walk and listen to a podcast.

Yes. You know, anything that moves your body. Like it's actually for me essential. Yeah. Yeah. I completely agree um I feel like that's a really great positive note to finish on but I do have three questions for you that I didn't share with you that we ask every podcast guest and these questions were decided by listeners of the podcast so you can blame them if they're too challenging but the first one is what is one thing that you've changed your mind about maybe related to like the field that you're in gosh that's a great question um I mean I think it's clear from our conversation that

I changed my mind about weight loss I thought you might pick that one having done research in weight loss and then now my my clinical practice is totally not in the pursuit of weight loss right um I always focus on health with people rather than weight and I think for some people that can be so empowering especially when it comes to PCOS because the the focus is elsewhere and you can see the relief in people's faces and in their actions in their body even when you say do you know what let's just let's just put weight loss on the back burner and let's focus on something else for a minute and it's such a change for people with PCOS especially yeah and so empowering. That's a really great one. The next one is hopefully a little bit easier.

What's a non-negotiable in your day? Coffee. Agree, agree with that one. And finally, what would be your death row meal? Ooh, do you know what? A really good mango. Really? I love mangoes.

I'm so shocked. I thought you might say like A really good mango. Really? I love mangoes. I'm so shocked. I thought you might be like a mango sorbet. You don't need anything with a mango if it's amazing. We get boxes of Indian mangoes when they're in season and they're just delicious. You don't need anything else with it. Oh, I love that. I do love a mango. Amazing. Well, I'm sure there will be lots of requests to hear more from you and find out more about kind of the work that you do. And maybe people want to get in touch with you. Where is the best place to kind of direct people? Yes. So you can find me on Instagram, although I have not been that active recently because I also took on a new role and I do some teaching and lecturing.

So I've been quite busy with that. But my goal for next year is to be a bit more active on Instagram so you can find me there my profile is at cp underscore nutrition rd but yes I'm happy to answer more questions if people have any amazing well thank you so much for your time today it's been so nice having you in the studio thank you so much for having me I've loved our conversation and it was um so great to meet in person yeah finally I hope you found that episode helpful perhaps send it to someone you know might enjoy it too quick request from me before you go to please leave a review and a rating hopefully five stars that's all for me see you again next time