PCOS Diet: It's About Managing Insulin Resistance

With Hillary Wright, MEd, RDN

Everyone wants an easy solution to whatever ails them. And if there’s a diet that can make a difference, all the better. For anyone struggling with polycystic ovary syndrome, you might consider The PCOS Diet Plan.1

EndocrineWeb spoke with the author, Hillary Wright, MEd, RDN, during the American Dietetic Association 78th  Scientific Sessions in Orlando, Florida, to understand what is behind the PCOS Diet Plan, and how this approach has been helping women who have polycystic ovary syndrome (PCOS).                       

Ms. Wright is director of nutrition counseling at the Domar Center for Mind/Body Health at Boston IVF, and a dietitian/nutritionist at Dana Farber Cancer Institute in Boston, Massachusetts. She first published The PCOS Diet Plan: A natural approach to health for women with polycystic ovary syndrome in 2010, and it was updated and reissued in 2017 to reflect the latest evidence-based research since she is all about informing the growing number of women with polycystic ovary syndrome about how to help themselves.2-5

Polycystic ovary syndrome can be improve with this lifestyle approach to managing PCOS. Hillary Wright, MEd, RDN, developed this lifestyle approach to PCOS to help women improve their fertility, reduce weight gain and lessen the risk of diabetes.

What Prompted You to Write a Diet Book for PCOS?

“While the book title has the word diet in it, my approach is much more focused on the lifestyle aspect of managing PCOS, which of course includes food choices and physical activity as key components necessary to address the insulin resistance that is a driving force for many of the complications faced by women with polycystic ovary syndrome (PCOS),” says Ms. Wright.

“Creating the PCOS  lifestyle plan came after more than 30 years of experience in working with women to help them better manage the problems associated with the polycystic ovary syndrome. The goal was to share strategies that helped my patients to better manage their insulin resistance,” she says because the women who adopted the concepts in the PCOS diet were able to get pregnant, control their weight, and reduce the risk of developing diabetes.

“It's also about knowledge," Ms. Wright said, "its only been since the 1990s that the connection between insulin resistance and PCOS was made. And the role of insulin resistance, leading to weight gain, has slowly been recognized through research as a driver of  polycystic ovary syndrome.

Understanding this link is very important since PCOS is a complex disease that may also lead to type 2 diabetes and nonalcoholic fatty liver disease (NAFLD), as well as complications of conception and pregnancy,” she explains.

Not only does Hillary address the struggle that women face in coming to terms with this multifaceted condition that involves metabolic, hypothalamic, pituitary, ovary, and adrenal interactions, she even acknowledges the debate that continues to ensue regarding the use of the term “PCOS,” which reflects the first noted symptom associated with this condition—ovarian cysts.

However, she points out that one of the strongest arguments for changing the name is because it is wrong to link a single symptom to every woman who is diagnosed with polycystic ovary syndrome but who may or may not develop ovarian cysts but will be diagnosed with PCOS just the same.

“Rather,” she says “it is in the best interest of women who have PCOS to focus on the much greater effect that insulin resistance has in producing the unwanted, hard-to-manage symptoms so relief can be gained, and a sense of balance can be restored.”

What is the Basis for the PCOS Diet Plan?

“I realized that I had been counseling women PCOS for more than 20 years. Many had been trying to conceive or seeking help to reduce the health consequences common in diabetes. When I connect the dots, I realized that the common factor in managing their condition actually was insulin resistance,” Ms. Wright recalls.

“What I’ve come to realize is that PCOS is a collision between blood glucose regulation and reproductive hormones,” she says, “so helping women to understand what this means, how insulin resistance interacts with their hormones, allows us to take the focus away from weight, and gets them focused on strategies to improve their insulin resistance.”

From the beginning, Ms. Wright calls out the common themes experienced by women with polycystic ovary syndrome: confusion, frustration, and motivation, to demystify the condition so you can approach your health from a position of understanding and knowledge. Feeling overwhelmed and stressed out are emotions that limit your ability to improve your health.

So whether you are facing issues like acne that you didn’t even experience as a teenager, uncontrollable weight gain, or an inability to get pregnant, by gaining insight into the reasons behind this complex medical condition, you will be in a better position to reduce your risk of developing diabetes, and when ready, to improve your changes of conceiving.

The Best Way to Manage PCOS: A Holistic Lifestyle Approach 

We can all do with a little less stress in our day. Just by gaining some control over your choices, and by recognizing that all it takes is making a few reasonable adjustments to your eating approach and level of movement can make a huge difference in how your face your health each day.

Less about diet per se, Ms. Wright introduces you to way to approach your life that addresses eating, exercise, and other lifestyle factors that target insulin resistance and its adverse effects on reproductive hormones so that you can begin to feel better. Drawing on her skills as a dietitian and relying on scientifically based principals, she recommends that women with PCOS  “adopt realistic lifestyle patterns that fit each person’s daily life, rather than trying to do something that won’t help and can’t last.”

“You will discover a rhythm of eating that suits your body, and meets your needs, and you will gain an understanding about the underlying causes of your symptoms and what you can do so you can feel good most every day,” she says.

Ms. Wright not only explains the reasons behind the problematic weight gain, glucose intolerance, and difficulty conceiving that commonly arises in women who have PCOS, she presents practical strategies to address the problems so you can be in charge of your health. 

Choosing Carbohydrates is About the Two Qs

Ms. Wright believes that the best and really the only effective way to deal with weight gain is to address insulin resistance, which is also influenced by physical activity. These two factors are targeted in the dietary therapy that is presented in The PCOS Diet Plan.

Focus on the Quality & Quantity of Your Carbs

 “When it comes to diet, I focus on helping people to develop a better understanding of carbohydrates. I do this by talking about the two Qs: quality and quantity. That and the importance of pairing carbohydrates with proteins and heart-healthy fats,” Ms. Wright says.

She has found that women with PCOS benefit from a slightly lower intake of carbohydrates—not low, but lower—because of the challenge that arises due to insulin resistance. 

Making quality choices when eating carbs will lessen the glucose load. The key to quality carbs is about choosing whole grains; it’s essential to boost dietary fiber to achieve good glucose regulation. 

Relying on the science of a balanced meal, Ms. Wright guides her clients to fill the plate with no more than ¼ of it with whole grains such as brown rice, whole grain pasta, quinoa, or multigrain bread. Essentially, the meal is built around vegetables, some fruit, some lean protein, and a bit of added heart-healthy fats such as olive or nut oils.

Eat When Your Body Needs Fuel: Earlier in the Day

Another focus of the PCOS Diet Plan is the recommendation that women spread their food intake throughout the day but avoiding overeating at night, which has become the American way. "Instead I encourage women with PCOS to focus on eating the bulk of their calories earlier in the day, and matching the calorie intake with the activity level and energy needs so less is eaten as the day winds down.”

Ms. Wright also encourages her clients to use a luncheon plate to help manage the amount of food eaten at a meal. She also stresses that physical activity cannot be underestimated because increasing exercise helps the body to use insulin better, essentially lowering circulating glucose, so insulin resistance is optimized and so is body weight.

Make Room in Life for Self-Care

As sad is it as may seem, we need to be reminded to do something as simple as ...Breath. If you’ve ever taken an exercise or yoga class at a gym or the Y, your instructor will invariably remind you to breathe. Just taking a few deep breathes in, and slowing letting the breath out, can do a world of good in helping you to relax, de-stress, and plan your next step.

You won't eat well if you don't plan. So it's very important to schedule time to grocery shop, set aside time to prepare meals, and set aside time to get in a walk or a yoga class, most days of the week.

“It will go a long way when you realize that taking these steps and adjusting your lifestyle even a little will trickle down to have a positive effect on other aspects of your life,” she says, “this is so critical in many, many ways because of the broad reach that insulin resistance has in affecting every organ and cell in the body.” 

Maybe the best news is that you should expect the PCOS diet to be an all or nothing endeavor. “I advocate an 80/20 approach. I don’t believe in highly restrictive diets; rather, what matters is whether you can achieve sustainable lifestyle practices that you can incorporate going forward, Ms. Wright says.

"In effect, rather I’m more interested in helping you get it right about 80% of the time, and I’m less interested in what you do during the other 20%,” as this reduces stress, and allows for the occasional splurge and unavoidable situations. 

The reason that Hillary Wright has found the 80/20 rule to be so effective is that a whole life approach can set you up to be the master of the your PCOS, yet her approach goes much further. “These eating patterns and getting daily activity will improve your chances for a healthy pregnancy (if that’s a goal) and to reduce your risk of heart disease and high blood pressure, which are also common complications of both diabetes and PCOS.  

After all, no diet is perfect and nobody is perfect either, she says.

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