“Nutritional counselling is important along with dermatological advice.”

Dr Lakshmi K (PhD, food science and nutrition), Head-Holistic Nutritionist, URlife, shares her views with SHRIYAL SETHUMADHAVAN on how a balanced diet and regular exercise can help in reducing the risk of PCOS in the long run.

Tell us about your experience with consulting patients conditioned to PCOS.

PCOD is a lifestyle disease while PCOS is an endocrine related disease. PCOD can be reversable in most cases. PCOD is a hormonal condition that affects approximately 5-10 per cent of women in their childbearing ages (12 to 45 years). It affects around 9 to 22 per cent of Indian women. Recent statistics states that one out of five women has this condition. There is hormonal (estrogen progesterone and insulin) imbalance – symptoms, including the absence of ovulation cycle, irregular menstruation, difficulty conceiving, weight gain, acne and hirsutism, if left untreated, can lead to further health complications, like diabetes obesity, heart diseases, and high cholesterol.

How do you view the increasing risk of PCOS among women in the present day?

Cases of Polycystic Ovary Syndrome, commonly called PCOS, have especially seen a sharp rise since the lockdown began.

Causes: Enforced sedentary lifestyle, irregular sleep patterns, not following circadian rhythm, ignoring irregular menstrual cycles, binge watching shows, weight gain due to sedentary lifestyle, non-nutritious food, and lack of exercise. Stress is a contributing factor.

How is increasing levels of stress playing a role in increasing the risk of PCOS?

Several studies have shown a strong correlation between stress and PCOS. Obesity leads to increased cortisol levels and decreased serotonin levels. Irregular periods and hirsutism are associated with increased stress levels in PCOD. It has been suggested that women with PCOS have a lower self-esteem, a more negative self-image, and higher levels of depression and psychological distress owing to the physical appearance characteristics of hyperandrogenism, including obesity, hirsutism, cystic acne, seborrhea and hair loss. A study conducted in Tehran of 81 women suffering from PCOS, eight (9.9 per cent) did not have any stress, 32 (39.5 per cent) had stress levels, 29 (35.8 per cent) had high, and 12 (14.8 per cent) had extremely high levels of stress that needed immediate intervention.

Why does maintaining a balanced diet become important here? Any specific diet that you recommend your patients to follow?

The basic guidelines for a PCOS diet are to focus on whole grains, rainbow-coloured fruits and vegetables, and plantbased proteins while limiting sugar, processed food and fried food. Based on Your BMI, you may need to adjust your intake of specific macronutrients (fat, protein, carbohydrates) or add supplements. This general list can be used as a starting point, however, the healthcare provider or dietician may suggest including or avoiding certain food as part of the specific PCOS diet plan.

What can be considered:

• High-fibre fruits and vegetables (apples, plums, broccoli, cauliflower)

• Leafy greens

• Beetroot, carrot and no other root vegetables

• Red berries and grapes

• Beans, legumes, lentils

• Whole-grain rotis, or multigrain bread, pasta

• Brown rice, quinoa, Millets

• Oats, ragi, jowar barley

• Flax, chia, and sunflower seeds

• Paneer

• Lean chicken and chicken breast

• Fatty fish (salmon, tuna)

• Veggie burgers

• Eggs, egg whites

• Low-fat curd and Greek yogurt

• Non-dairy milk alternatives (almond, oat)

• Avocado

• Hummus

• Coconut and coconut oil

• Nuts and nut butters

• Olive oil, flax seed oil

• Fresh herbs and spices (turmeric, cinnamon, ginger)

• Dark chocolate (in moderation)

• Green tea

Not good, and one must avoid

• Bread, baked goods, crackers, pasta, and cereals made from refined white flour

• Starchy vegetables (white potatoes, corn, peas)

• White rice

• Sugar

• Red meat

• Full-fat dairy

• Processed meat (lunch meat, hot dogs, sausage, bacon)

• Fried food, fast food

• Potato chips, microwave popcorn, salted pretzels

• Dried fruit

• Packaged snack foods

• Frozen meals and snacks

• Artificial sweeteners

• Instant noodles, packaged pasta/soup mix

• Instant soup cubes, noodles

• Commercial salad dressing, marinades, seasonings

• Candy

• Ice cream, pudding, custard

• Pastries, cake, cookies, pies

• Soft drinks

• Sugary fruit juice

• Energy drinks

• * Gluten and wheat

• ** Soy products (tofu, soy milk)

• One can try with reducing or eliminating gluten, wheat, and/or soy from your diet. For some people with PCOS, these food groups worsen their symptoms, but others have no problem with them.

*phytoestrogens from plant-based proteins like soy have a complicated relationship with hormonal conditions. Research in rats and humans has been mixed.

Making the right choice

Fruits and vegetables: Fresh produce is versatile and nutrition-packed. Choose fruits and veggies that are full of fibre, like crucifers (eg: broccoli), leafy greens, apples, and plums. Red berries and grapes also have anti-inflammatory properties that make them particularly well-suited for a PCOS diet.

Dairy: The PCOS diet generally recommends avoiding full-fat dairy. Small portions of low-fat, low-lactose dairy products like cottage cheese or Greek yogurt are usually fine. Consider also trying dairy-free and low sugar alternatives like almond, rice, or coconut milk.

Grains: Whole-grain or multigrain bread, pasta, and cereals are approved on a PCOS diet. Avoid heavily processed food made with refined white flour. Choose brown rice instead of white, make overnight oats topped with fresh fruit.

Protein: A mix of proteins on a PCOS diet can be considered such as lentis, beans, paneer, egg whites, fish and chicken breast. Avoid red meat such as mutton and beef.

Desserts: Sugar can increase inflammation, so it is best to try to limit sweets. While a small serving of dark chocolate in moderation, one can use dates or til ladoos to satisfy craving for sugar.

Beverages: One may choose to avoid caffeinated beverages like coffee and black tea if they worsen your symptoms. Alcohol can cause racking up calories quickly, so it is best to avoid it or consume it only occasionally. Avoid highsugar beverages like soda, sweetened fruit juice, and energy drinks. Water is the healthiest choice for staying hydrated, and other options like coconut water and green tea are also approved on a PCOS diet.

How about regular exercise and its role in reducing the risk of PCOS in the long run? Is this something you strongly recommend along with maintaining a diet, and why?

Exercise should not be a punishment for what you ate but it has to be a part of your daily routine like brushing your teeth or showering. Exercise improves insulin sensitivity, glucose metabolism and helps build muscle that helps in metabolising glucose better.

Exercise for at least 150 min per week or 1 hour a day is essential for PCOS. You don’t have the right to eat unless you exercise is what I tell my patients like brushing before eating.

Why is it important for a dermatologist to make their patient aware of how a balanced diet and regular exercise can help in reducing the risk of PCOS in the long run. Do you work along with dermatologists to ensure the same?

Dermatologists have to make the patients aware that it is important about what goes inside the body since it eventually shows up on the skin and hair. Nutritional counselling is important along with dermatological advice. I would highly advice the dermatologists to encourage the importance of good nutrition for their patients.

Any Quick Tips on the basics for managing PCOS?

• Practice good nutrition – at an early age. This could include fruits and vegetables at three to four servings atleast. Consider whole grains, and no processed food.

• Ensure hydration: Good water intake is necessary.

• Exercise: 150 min per week

• Yoga and meditation to lay off stress

• Sleep: Six to eight hours of night time rest to reset the body