Episode #84: Sweet Science: Glycemic Index and PCOS Dietary Strategies

PCOS is caused and worsened or improved by a combination of our genetics and how they play with our environment and so in today’s episode, we are going to dive into some research that discusses and dives into the intricacies of how our environment in regards to nutrition directly impacts our genetics of PCOS and how they play together to worsen or if we work with the nutrition to support and benefit our PCOS, how our nutrition and what we eat and what we consume can actually help us reverse our PCOS and balance our PCOS hormones. So with that, let’s go ahead and dive in.

You’re listening to the PCOS repair podcast where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally, with a little medical help sprinkled in. Hi, I’m Ashlene Korcek, and with many years of medical and personal experience with polycystic ovarian syndrome, it is my joy to watch women reverse their PCOS as they learn to nourish their body in a whole new way. With the power of our beliefs, our mindset, and our environment, and the understanding of our genetics, we can heal at the root cause.

Welcome back to the PCOS Repair podcast, where I’m really excited to be starting a series of research review. We’ll do these about once a month and I’m going to pick an article and we’re going to dive into what is some of the latest research on PCOS. All of these will be articles from the last couple of years, nothing from back over about five years ago because we know so much more now, and so much of the information out there on the web is outdated. Even so much of the information that you’ll get from your doctor in your doctor’s office is outdated because they learned this back in medical school and residency and when it comes to how we can support PCOS through lifestyle one, it is considered in literature, without a doubt, the best way to approach PCOS. So environmental changes our lifestyle adjustments. That is considered the gold standard, the best way to address PCOS and when you go to your doctor’s office, they may not be up to date on how to adjust your lifestyle. In fact, it’s not really their field of expertise to know that. So they may be able to help you with diagnosis, they can help you if you need medications or fertility treatment but when it comes to the lifestyle adjustments, let’s dive into some of the most recent research and find out what is being discovered and correlated in regards to PCOS and our lifestyle and environment.

The research article that we are going to be looking at today is called a glycemic index and glycemic load estimates in the dietary approach of polycystic ovarian syndrome and it’s by Mata and Pashu and several other researchers and you can find, I will put the link to this article, so you can actually read the article for yourself if you want to in the show notes below. Now, really important, this was not a specific study. This is a review of all the literature and so I love reviews because they kind of pull a bunch of different studies together to show us what’s going on overall in nutrition as compared to just looking at one thing. Now, the nice thing is when you go to the research article, if you like digging into this kind of thing, if you go to the research article, there will be references, and then you can follow the rabbit hole through all the different references that you want to and read more on specific things throughout the article. So with that, let’s go ahead and dive into the article itself.

So, first of all, like I said, this is a review of literature, so not a specific study that was conducted. I do want to point out that when it comes to nutrition, we have some significant limitations when it comes to research. So anytime we’re researching something, we need to have a length of time that’s reasonable in order to do an experiment, and we need to have subjects that are reasonable, and then we need to kind of take away all the variables. So when you think about the subject for PCOS, we could try to replicate this in rats or other animals. However, when it comes to all of the symptoms of PCOS, that isn’t very practical but when you look at the time frame and the restrictions that it would put on somebody to say, look, you have to eat this way. We don’t know if it’s the best way or not, but you have to eat this way for like 30 years. It’s very difficult to see where that would take us. So when we think about how insulin resistance to diabetes occurs, someone who is 20 and diagnosed with PCOS would essentially, to give us good data, have to eat a certain way until they were at least postmenopausal, to see how it affected their fertility throughout their fertile years and so this is not a reasonable study, basically, is what I’m getting at here and so, because it’s very difficult to create a reasonable study in nutrition, we are left with understanding, to the best of our ability, the pathophysiology, meaning the disease process of PCOS or any disorder for that matter, and then extrapolating to that nutrition that we have become aware of but again, you have to remember that this type of limitations on how we can study research kind of goes across the board, across the disease board. It’s not like if you were studying for hypertension that you could really create even a better study, it’s the same problems. How long are you going to make somebody do something? What you can do with something like cholesterol or diabetes or hypertension is someone who has this disorder. You could change their diet to various things for a couple of months, maybe a year, maybe two to three years but again, it’s very difficult to have a human subject follow a rigorous diet strictly enough, without any cheat meals and things like that in order to get good data.

So the information on nutrition, we have to realize is cloudy. So anyone who tells you blanket statements, this is how a nutrition works, tread lightly. While we have a lot of information about nutrition, we do have to also recognize the gaps of how 100% ironclad this information is. Okay, so I want to just kind of throw that out there as we talk about nutrition, because I think it’s very important, especially when we get into research, to realize that a research finding is not 100% fact. It’s research, it’s learning, it’s like cutting edge stuff, it’s not like the law of gravity, where we understand it, we have a formula, and it’s replicable every time. So it’s not that specific, it’s not that dependable. Okay, so basically what they’re looking at is they’re focusing on things like the fact that PCOS, the genetics, seem to be worsened and drawn out when it comes to things that create inflammation, things that worsen our insulin and glycemic control, and how that affects our hormones.

So, first of all, let’s just remind ourselves that polycystic ovarian syndrome, or PCOS, is like a puzzle with numerous pieces. According to the Rotterdam criteria for PCOS, it is defined by either biochemical hyper androgenism, which is going to be like lab values that show high androgens, or an indication of ovulation disturbances. Polycystic ovarian morphology on ultrasound, meaning that you may see cysts on the ovaries, not like one cyst, but that polycystic appearance on ovaries and you’re going to have, like, a picture that’s a collection of symptoms. So when we deal with a syndrome, it’s not this black and white. You have this, you don’t have this, et cetera. When we have a syndrome, it’s kind of like this mood that medicine presents with. So when you show up and you have a history and you have some clinical findings on labs or imaging, we kind of get this vibe that you have PCOS. That’s kind of how a syndrome is diagnosed, it’s not as black and white, it’s more of a picture that is similar to other pictures of PCOS, but it’s not what makes it so different from person to person. So we may see things like hirsutism, alopecia, acne, menstrual irregularities. We may see things like mood disturbances, fluctuations in weight, or difficulty managing weight, acne, all sorts of the regular symptoms.

So let’s dive into the key factors that are influencing these symptoms. So, when it comes to PCOS, these symptoms arise or reverse from a dance between the genetics and the environmental factors. So excess weight, particularly abdominal fat, so not like necessarily all over the body, but people who have a tendency towards that midsection of gaining weight or holding their weight in the midsection has been studied as a risk factor for all sorts of things, but in particularly, inflammation, a more oxidative stress in the body, and insulin resistance. So this is where the combination of heart problems and long term risk of type two diabetes are risk factors for women that have PCOS but typically, in the early years when you’re diagnosed, such as in your, you’re not going to necessarily have progressed to those things yet. That may be something that’s more likely to show up in your 50s, whereas in relatives that did not have PCOS, maybe didn’t show up until their 60s or 70s.

So this is where we see it speeds up, but we’re not going to see heart disease or even diabetes or insulin resistance in necessarily someone who’s 20. So we have to kind of remember the timeline of when we talk about the risk factors and the underlying disorders of when those are likely to show up.

So, with nutrition, which is a fundamental part of our daily lives, it plays a significant role in that pathophysiology, that disease process of PCOS. In particular, we think of carbohydrates. Okay, these are often a very misunderstood and mistaken about macronutrient. They come from so many different forms, and so many of them are so nutritious for you, like all your vegetables and even your fruits and so this is where I particularly like this study because it’s focusing on, well, what is the glycemic load and what is the glycemic index of these foods. So just really quick, let’s go through what is a glycemic index versus the glycemic load? Okay. A glycemic index is how much on a spectrum a certain food single ingredient is spiking your blood sugar. As in, if you eat an apple, to what degree is it going to spike your blood sugar? Glycemic load, on the other hand, is looking at the full combination of what you ate. So it’s a little bit more of a calculation between overall grams of carbohydrates and looking at the amount that you ate, and it’s looking at kind of the actual impact. So when you think of index, you’re thinking more of on a spectrum how much is this compared to that going to spike your insulin? You’d almost think of it like, if you lined up all the foods in order, there would be the ones that would be higher, ones that would be lower, and you would just like if they were numbered, you would put them in a numeric order, whereas load is giving you more of a value of the actual impact based on the ingredients and the amount that you ate in a certain setting. So you can imagine that if you ate one bite of apple, it’s not going to spike your insulin nearly as much as if you ate three apples, because that’s a lot more blood sugar that’s hitting your system and glycemic low doesn’t fully take this into account but just for actual lifestyle considerations, if you ate three apples really fast, like in a juice, and just gulped it down and drank it really fast, you would spike your sugar that much higher because the volume plus the velocity of how fast it entered your system.

So let’s get into the nitty gritty of those dietary choices, especially concerning GI, glycemic index and GL, glycemic load, and how they affect the pathophysiology and the symptoms of PCOS. So, our body’s glucose and insulin balance is a very delicate dance. So high carbohydrate diets, especially rich in processed carbs and sugars, may lead to rapid spikes in blood sugar levels, triggering an insulin resistance. Now, remember, they will trigger insulin release long before you have resistance. This is the most misunderstood thing when it comes to insulin, blood sugar and PCOS, women in their are often not insulin resistant and so when we look at the test for insulin resistance, their doctor is telling them, PCOS is linked to insulin resistance. You should take metformin or you should watch your diet and then they test them for insulin resistance and the patient asks, well, do I have insulin resistance? No, you don’t and so the patient leaves very confused. Well, I don’t have insulin resistant type PCOS. Those are two very different things. Every person, the most fit and healthy person, when they eat something, releases insulin. Now, someone who is less metabolically healthy is going to release a very different amount of insulin, and their body composition is going to be more prone to not using their blood sugar and insulin wisely and so it’s less of a well tuned machine. In that situation, they are pushing themselves towards overworking the pancreas, overworking the insulin machine, and ultimately developing insulin resistance, and then type two diabetes. The person who has really good metabolic health, on the other hand, is handling the foods that they’re eating. Hopefully, the reason they’re probably in metabolic health is they’re choosing their nutrients wisely and balancing out delicious treats and so forth with really healthy amounts of protein and other nutrients. So it’s finding that balance and when we see that our metabolic health is functioning well, our body is like a well tuned machine. When our metabolic health leaves something to be desired, it’s just struggling. All the mechanisms are struggling, leading to higher androgen production, such as a PCOS.

So, sorry, I got off on a tangent there, because that’s such an important thing to recognize that just because you aren’t insulin resistant today doesn’t mean that your body is not affected by insulin with every single item that you choose to eat. Okay. So when we think about trying to improve the glycemic index, glycemic load, several things become really helpful. Dietary fiber is our ally, protein is our ally, making sure that we are focusing on lots of vegetables and then carbohydrates when we get into the ones that are higher in carbohydrates, using some legumes and whole grains when possible, instead of refined grains. The less amount of processing and packaging, the better. The more we package things, the more we process things, we have found that these tend to be more disruptive to our metabolic health, as well as more disruptive to our endocrine system. By following these guidelines, we can reduce our blood sugar spikes and the tendency towards insulin resistance, or just high insulin circulating our system and this allows us to decrease both the insulin effect as well as inflammation.

So when it comes to chronic inflammation, persistent levels of low grade inflammation is what we’re looking at here. So we’re not talking about you hurt your knee and your knee is inflamed. We’re talking about your body living in a state of low grade inflammation and this is oftentimes linked to our food and it can be a reaction that every time we eat certain foods, our post-prandial inflammation reaction, this is going to be the post-prandial means post eating and this can be due by our caloric content, such as types of carbohydrates that we are consuming, the lipids, so the fats that we are consuming, these all come into play and also the body composition that we currently have comes into play. So when our body composition has extra fat involved in it, we’re not necessarily insulin resistant yet. However, that extra fat tissue is fanning the flame of whatever we just ate. So if we ate something that spiked our insulin high and we do not have extra body fat, our body can get away with it a little bit better than if we do have extra body fat.

When we do, what happens is we already have extra body tissue, that body fat is already prone to an insulin resistant state, and so it works against us in that meal where we ate extra fat. Now, I have experienced this firsthand, where I have a zone of sweet spot where when my body composition is in a certain zone, and you’ve heard me talk about this before on the podcast, I can get away with a lot more, I can eat pizza, I don’t have to be as careful now. I’m always watching how much protein I’m eating. I’m always making sure I’m eating vegetables, and I’m always making sure I’m drinking enough water. That said, what else is going into my diet becomes a little bit less rigid because my body handles it better, now for longevity and all of that, it’s still important and so I do focus on it, but it’s so much easier, which is so unfair, because when we’re struggling, that’s when we need it to be easy to kind of get over that hump, right? But when we are outside of that sweet zone, and everyone has a different zone of sweet spot, when we’re outside of that zone, it is so much harder. Our body is working against us, basically. So we just need to be a little stricter, that’s the healing phase of the PCOS healing journey, where we’re really diving in, being as strict as we can, and then we can move into the lifestyle phase once we’ve reached our goal and gotten to that sweet spot, and our body just works with us so much better. So it’s not fair. We can stay hung up on the fact that it’s not fair, or my recommendation is be mad about it for a little bit, accept it, and then work with it, because it’s just a fact and this has to do with those inflammation biomarkers that our body is dealing with.

Okay, so then when it comes to PCOS, we also want to talk about oxidative stress biomarkers. This is where prooxidants or antioxidants come into play. So, antioxidants, you hear a lot about things that help our body detox, the oxidative stress, basically and then there’s the things that cause the oxidative stress. So items that are processed have additives. This is where the whole clean eating and non inflammatory foods kind of come in and it’s not 100% across the board, like eat this, don’t eat that but the more that we eat organic, the more that we eat fresh foods, the less amount of tampering with the foods that we have, especially outside the home. So anything that’s being canned or processed or frozen is potentially having more things done to it than if you had done that in your own home and we don’t know the process that this food went through, but the more things that happen to it, the more likely it is to have prooxidants in it and cause the body things that are going to be inflammatory, in other words.

Okay, so how does this affect our androgen levels? So let’s explore the realm of androgen levels. These are our sex hormones and how nutrition can sway their delicate balance. Because when it comes to androgens, the teeniest, tiniest shift in amount that we have in our bodies has a tremendous effect and that’s where normal ranges are kind of laughable, because when we look at normal ranges, we’re looking at what is normal for the population but if you ranged inside those normal ranges, your body would be like chaos. So your range should stay very stable. Aside from like, in women we should be having cycles, so we should be having changes throughout the month but if you were to measure the changes at each point in your cycle, there should be very minimal adjusting between those ranges each month. Okay, so our body should be fairly stable. When it comes to our hormones, any little up or down has quite a huge effect. So if your testosterone goes just slightly up, it’s amazing how much that will affect your symptoms and you’re looking at the labs going, well, it’s pretty close to where it was before. That very slight change has a huge difference, or a huge ramification, is what I’m trying to say.

Okay, so how does glycemic index and glycemic load fit into this picture? So, basically, a low glycemic index has been shown to reduce total testosterone in overweight women with PCOS and the reason is because when we have sugar, it spikes insulin, which spikes our androgens, which is going to be primarily our testosterone, so that goes up. Now, there’s a whole nother side of this and so you can actually have too low of testosterone, too and it can be still linked to the whole insulin thing, but that gets a little bit more complicated. So what I like to kind of just say is that you can have either high or low testosterone. But I think the key takeaway here is that your androgens, your testosterone is directly correlated to your metabolic hormones. So if your metabolic hormones are off, which we can help improve by our glycemic index, by watching the glycemic index of the foods that we’re eating, we can make a tremendous difference by the dietary foods that we are choosing and how we’re setting up our diet.

So when you’ve seen your doctor, you have probably had some degree of conversation about weight management. Now, of course, there are the outliers, the unicorns, the few women who some people would say are lucky but I’ve worked with women who have thin type PCOS, and they have some serious struggles and in some ways, as much as it can be very difficult to lose weight with PCOS, women with thin type PCOS don’t have that as a tool in their toolkit and so that, in a lot of ways, makes their journey a little bit more complicated but for most women with PCOS, they end up having a conversation with their physicians about weight management and how their excess weight is making their PCOS worse but no one talks a whole lot about what to do about it or what they should do and so in this article, it talks about, again, how refined carbohydrates, sugar intake, in specifically looking at things like glycemic index and glycemic load, are linked to that higher body mass index or that excess weight and so as we lower our glycemic index and how we eat, we can reduce our body weight, improving several factors of our body composition.

Now, this is really important because we did not talk about calorie restriction. We talked about just the glycemic load. I just want to kind of throw that out there, we’re not going to get into all of that today, but I do want to throw that out there because I think that’s so important to realize, it’s not so much about counting calories, it’s about improving that metabolic health. So how do you get started with a low glycemic index, how do you meal plan for this? What are some practical ways to get started? These are things that we have talked about many times throughout the podcast. The research article does go through some of it, but I encourage you to go and listen to some of the other episodes on topics like the PCOS pantry, and I will link to these in the show notes.

The other two things that I really want to leave you with as far as tools for you to get started with glycemic index and the nutrition to help support your PCOS is there’s an episode and I will link to it in the show notes about a tool called a continuous glucose monitor. This is going to be a huge tool to get you started in understanding what foods are actually doing to your body. So you know how we talked about someone who has really great metabolic health, they can get away with more, and someone whose metabolic health is needing some love and care, they may not be able to get away with as much but how do you know where you fit into that? Because again, you may be in your biomarkers, all of your labs look really good. Glucose looks great, so how do you know? So something called a CGM, a continuous glucose monitor, can let you see in real time how food is affecting your body and sure, there’s a lot of things that kind of can affect the CGM, it’s not a perfect measurement, it’s not considered as standardized for treating as a laboratory test, but we don’t need it to be precise. What we’re looking for is these trends of if I eat a certain meal, do I get a small expected healthy spike in blood sugar and a slow curve down decrease over time, or do I get an abrupt high spike and then a sudden drop? Those are things that we’re looking for, and then we can look at, well, what did I just eat? How it affected my blood sugar, and then from that start to make better and better choices on our diet. So I am going to link to both CGM. If you buy through the link, you’ll get a discount, I forget the exact amount, but you’ll get a discount when you buy through the link. Also, if you email my team at [email protected] I will send you a little mini recording that goes over and it’s a video so you can see screenshots and some educational things on how to interpret your CGM results and all of that’s completely free, I will give that to you if you get started with the CGM.

So with that, there’s going to be several resources for you to accompany this episode because we’re really getting into the science in this episode and so a lot of resources are needed.

And with that, if you have any questions, you know where to find me, I’m over on Instagram. You can send me a DM and ask any of your questions @nourishedtohealthy and I would particularly like to know what you found most insightful about today’s episode. In other words, what one action step takeaway are you going to take from this episode and get started with today? And maybe this will be your action step. Another resource that I’m going to include in the show notes is, and you can grab the link below at the episode page. If you just go to that page, all the links will be there for you is a download of a glycemic index list. I find it just super helpful to be able to glance through and see which food items, vegetables, fruits, grains, milks, et cetera are high or low on the glycemic index and so you can just get a really quick visual of, oh, I eat a lot of that and that one’s good. Ooh, I eat a lot of that one and that one’s pretty high in glycemic index. It just gives you a really quick glimpse into where you may want to lean in and where you may want to be a little more conservative on what you’re putting in your mouth each day. So with that, I hope you enjoyed this research episode and until next time, bye for now.