PCOS Chat with Hillary Wright, MEd, RD, LDN

Hillary Wright: Hi everyone and welcome to our live chat on PCOS diet and lifestyle. If you have questions about any aspect of treatment — including meal plans, exercise, stress, fertility, support, etc – don’t hesitate to submit them now!

Hillary Wright: Before we begin, just a quick ditty on my background & experience. My name is Hillary Wright and I’m a registered and licensed dietician with a Masters degree in Health education from Boston University. I’m also the Director of Nutrition at Boston IVF/The Domar Center and author of The PCOS Diet Plan, a book that offers practical solutions that are critical to beat the disorder.

I have over 18 years experience counseling clients on diet and lifestyle change in relation to PCOS — and hope to do whatever I can to demystify this VERY confusing and difficult disease.

Now, let’s get started

Comment From Alicia: Hi, I have a question. What do I need to prepare myself before considering for pregnancy? For example, what will be the folic acid dosage I could start to take on?

• Hillary Wright: Hi Alicia — 400 micrograms of folic acid is the recommended intake to reduce your risk of neural tube defects.. up to 75%! I’d also recommend at least 200 milligrams of DHA from fish oil or algal oil supplements as this is critical for fetal brain and retinal development. It’s also important to get any underlying insulin resistance under control.

Comment From Allison: I am seeing a specialist for the first time after being diagnosed, what do I need to know walking in there?

• Hillary Wright: Hi Allison — I would first bring in with you copies of any preious blood test or other diagnostic tests, along with a list of questions you want to make sure you get to during the visit. . That way you can be sure to hit on what it is you want to make sure you cover in the visit.
• Giving them a thorough family and personal health history is important as well. I assume you’ve already chosen a specialist in PCOS so they should know what to ask, what tests to order, etc. If they say they don’t think you have classic PCOS, ask them what they think you should be paying attention to. Also — my book has a segment on preparing for a visit. That may help, too.

Comment From Amy:  Wondering if you think there may be a connection between PCOS and gluten intolerance. Have you noticed that women in your PCOS practice are sensitive to gluten?

• Hillary Wright: Hi Amy — I indeed have seen women with PCOS who also have celiac disease, but I don’t know that they are connected. But both PCOS and celiac are associated with infertility.
• Some women with PCOS may also have IBS – not uncommon for these to be found together – so sometimes what one may be feeling is a reaction to insoluble fiber in whole grains, etc from IBS.
• Anyone who suspects they might have celiac disease should be tested before putting themselves on a gluten free diet — as it’s possible to get a negative test if you’re already on the diet (and following it closely).
• This is an area of interest because there is a lot of talk about gluten intolerance because of the increased awareness of celiac. The short answer is that you can easily be tested for this by your primary care doctor.

Comment From Amy: What happens when you go into peri-menopause and then menopause? How does that change the way your PCOS should be treated?

• Hillary Wright: Hi Amy — Because getting older increases your risk for developing diabetes it’s important to keep doing what you can to control any underlying insulin resistance.
• Of course the issue of pregnancy isn’t still on the table, so long term chronic disease avoidance should be front and center.
• HDL cholestrol levels tend to rise with menopause, so making sure your diet is heart healthy is important – avoiding rtans and saturated fats, losing weight if necessary, exercising. These things also improve your quality of life by helping you retain muscle and bone mass.
• I would continue with vitamin D and fish oil and add Calcium if you’re not getting 1000 – 1200 mg of calcium from your diet.
• And it’s so important I’m going to say it again – EXERCISE! Daily if you can for at least 30 minutes. It will make a world of difference in how you feel in your body as time goes by. I’ve seen many women fitter than ever after menopause because they really start taking exercise seriously

Comment From Madhuri:  I ‘m 24 year old female and married, who is trying to conceive since a year, but was on and off birth control pills. Now we have stopped taking BC pills and trying seriously from 6 months without any problems. But i havent been pregnent yet. I’ve had have PCOS since I was 17 years old. I also had irregular periods but periods got regular after taking BC pills. We want a child as soon as possible due to family pressure on us. So what are the different treatment options for women like who wants a child as soon as possible?

• Hillary Wright: Hi Madhuri — BC pills just mask the underlying hormonal problems seen in PCOS.
• I know that in younger women it’s generally time to see a reproductive endocrinologist after a year of trying without success, but if you have PCOS maybe it’s appropriate to go sooner.
• Also — I’m not sure what you mean by off BC pills for 6 months without problems. If that means you’ve been getting your period regularly then maybe you should just have a conversation with you OB GYN to see what they say.
• And hang in there. Family pressures can be tough! I guess in the end it depends on how fast you want to get aggressive, The good news is you’re young!

Comment From Neelu: Hi I am on my second IUI right now. I have been diagnosed with PCOS ever since i started with my cycle. I am 30 and weigh 50 kgs, height 5.3 feet. I have also gone thru laparoscopy in past.I and my husband are working hard to maintain our diet. Please let me know what food items should one avoid if she has pcos? Some people say we should not eat rice/water melon. Is this true?

• Hillary Wright: Hi Neelu — In my book I outline a carbohydrate-distributed diet that focuses on eating mostly unrefined grains and whole fruits, and pairing them with lean proteins whenever possible to help mute your post-meal insulin response.
• The rice/watermelon theory comes from the previous emphasis on glycemic index — but we now focus on glycemic load.
• Glycemic load takes into account a reasonable sized portion because a smaller amount of these foods has a limited ability to raise blood glucose levels.
• 50 grams of carbs (for many of these high GI foods) is a large portion. You’d have to eat an awful lot of watermelon to get 50 grams of carb. With rice you can do that easier, so best to opt for brown rice and try to limit your portion to about 1/3-2/3 cup depending upon what other carbs you’ll eat at that meal.
• I outline this in a LOT of detail in the “implementing the diet” part of my book, including more on GI. Good luck!

Comment From Allison: And let me say that I am NOT trying to get pregnant…. and thats hard because no one will take me seriousaly.

• Hillary Wright: Hi Allison, I know — it can be really tough. But there is hope. If you ever need to talk with someone, myself and our Patient Liaison Rhonda Gannon are ALWAYS here to lend an ear and talk about your options.

Comment From Madhuri: Is it true all ladies suffering from PCOS are infertile and have very low chances of getting pregnant? Should I see a Infertility Specialist, as we’ve been trying since 6 months and no success yet??

• Hillary Wright: Hi Madhuri — Generally speaking, women with PCOS are considered pretty GOOD responders to fertility treatments.
• Overall — it isn’t a bad idea to try to have a baby younger if that’s an option — just so that the creeping affect of age doesn’t add to the hormonal problems.
• If it’s been 6 months and you’re over 30 — it’s not a bad idea to call a fertilty treatment practice and ask if given your PCOS you should come in sooner rather than later.
• But let me just say — women with PCOS can definitely have babies. Don’t ever let anyone tell you it’s not possible.

Comment From Guest: Just a quick one. What exactly is PCOS?

• Hillary Wright: PCOS is a hormonal disorder affecting up to 10% of all women, is the primary cause of infertility due to problems with ovulation, and increases your risk of developing type 2 diabetes and cardiovascular disease.

Poll Results:
Which PCOS symptom(s) are you most experiencing?

Depression: ( 0% )
Insulin resistance: ( 0% )
Weight gain/inability to lose weight: ( 100% )
Hair loss: ( 0% )
Hair growth: ( 0% )
Miscarriage: ( 0% )

• Hillary Wright: In addition, PCOS is very manageable with the same diet and lifestyle changes you should practice to stay healthy, with extra emphasis on managing the underlying cause, which we now know to be insulin resistance.
• Women with PCOS can be greatly helped by meeting with a registered dietitian family with treating PCOS.

Comment From Neelu: What is the main cause of pcos? Is it related to the diet that we intake? Do we have a cure based on diet control?

• Hillary Wright: PCOS is a hormonal condition that is genetic. It’s not caused by diet but can be exacerbated by weight gain and eating a diet high in refined carbohydrates. You can’t cure PCOS but you can definitely manage it with a carbohydrated distributed diet and exercise, and the things that you would do with diet and exercise to control your PCOS are good for you overall health in many ways.

Comment From Amy: Also wondering if you suspect women with PCOS generally may be low in seretonin …which may be one of the reasons women with PCOS often suffer from depression and crave carbohydrates.

• Hillary Wright: Hi Amy — I think there is a lot we don’t know about PCOS — and that could be possible. I think the carb cravings are mostly a reaction to uncontrolled insulin resistance, although it’s still unclear what else may be going on.
• Depression could be linked to troubles with fertility, body image problems, feelings of lack of control over health, or possibly some hormonal or other type of imbalance. Or any combination of the above.
• I know many women with PCOS who feel a whole lot less emotionally labile when they start following the carb-distributed diet outlined in my book. And therapy is always a good option when indicated. Sometimes it takes a village!

Comment From Alicia: Could strenuous exercise negatively affect pregnancy chance? Even after getting pregnant, could the person do some yoga excercise or pilates for the first trimester?

• Hillary Wright: Hi Alicia — MODERATE exercise is recommended when trying to get pregnant. So yes — yoga and Pilates would generally fall under that “moderate” level.

Comment From Neelu:  Can you suggest some specific food items (vegetables/fruits/cereals) that are of great help in controlling or managing pcos?

• Hillary Wright: Hi Neelu — LOTS of vegetables – though count the ones like potatoes, corn and peas as starches. Eat 2-3 fruits a day bit one at a time, Eat whole grain cereals with at least 5 grams of fiber and around 8 grams of sugar or less.

Hillary Wright:
Thanks everyone, it looks like we’re out of time for today. I’d like to wish you all a happy and SAFE holiday season!

If you have additional questions or to would like to schedule a PCOS consult with me, please call 781-434-6554 and ask to speak with Rhonda Gannon, our Patient Liaison.

Rhonda is a great resource for those looking to learn more about their treatment options and will get you going in the right direction. She’s just wonderful!