Artificial Sweeteners and PCOS

Sugar or artificial sweeteners for PCOS?
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A lot of people ask which is worse PCOS – sugar or artificial sweeteners? Like a lot of topics in nutrition, it can complicated. Since insulin resistance is thought to be the root cause of PCOS, using artificial sweeteners sounds like a good idea for managing PCOS. These sweeteners don’t have any (or many) calories. This should keep insulin levels lower. But do artificial sweeteners improve our health? Let’s first take a look at sugar. 

What we know about sugar

  1. Sugar or sweeteners with calories such as honey, high fructose corn syrup, agave, maple syrup, brown sugar, or cane sugar will cause blood sugar to go up quickly. This causes the pancreas to produce insulin so that the sugar can get into the cells. Excess insulin drives a lot of PCOS symptoms. Having sugar as part of a meals with protein and fiber can help prevent blood sugar and insulin from spiking. Check out this blog on Nutrition Basics: Macronutrients for more information.
  1. We know that a lot of people consume a lot of sugar, especially in drinks such as soda, juices, iced tea, lemonade, and prepared coffees. There’s also a lot of added sugar in cereal, yogurt, and bars.
  1. Sugar is found in so many products because it makes food taste good and we humans like it. It is a cheap food additive, especially as high fructose corn syrup. Sometimes people may be taking in more sugar than they realize.
  1. Eating too much sugar can contribute to higher weight, higher cholesterol, fatty liver, and cardiovascular disease. Most people know that having too much sugar is not good for our health. This is why people are interested in trying an alternative like artificial sweeteners.

What are artificial sweeteners? 

The artificial or non-nutritive sweeteners which are “generally regarded as safe” (GRAS) according to the FDA include saccharin, aspartame, acesulfame potassium (Ace-K), sucralose, neotame, and advatame. Steviol glycosides (Stevia) and Luo hun guo fruit extract (monk fruit) are approved as food “additives”, but not as “sweeteners”. The products are sweeter than sugar without calories. Some people like that Stevia is marketed as a more “natural” product. It is still processed and more research needs to be done on it to see if it is a better choice than the other products. Here is a link for more information about the history and safety of these non-nutritive sweeteners from the FDA.

What we don’t know about non-nutritive (artificial) sweeteners

While the artificial sweeteners are regarded as safe for people to consume, there are still a lot of questions about how these products affect us long term.

  1. How do they affect the gut microbiota? Gut microbiome research is very new and is thought to have a large effect on our health including how we metabolize foods. Some research indicates that some artificial sweeteners can negatively impact the gut microbiome. This may affect weight and insulin resistance. If we have a more “unhealthy” make up of bacteria in our intestines, we may gain more weight or have blood sugar go up quicker than if we had more “good” bacteria in our gut.
  1. Do they increase our cravings for sweets? When are used to everything we eat or drink tasting sweet, it may cause us to want more sweets. There is also a theory that since artificial sweeteners are sweeter than sugar but have no calories, we are more likely to seek out extra calories to compensate later in the day. 
  1. Do artificial sweeteners affect blood sugar, insulin or metabolism? Research is not conclusive about how artificial sweeteners impact weight or insulin resistance, but it’s possible that these products are contributing to some of the very conditions that people are trying to avoid by using them. This could be due to how these sweeteners are affecting insulin receptors or hormones that affect fullness.
  1. If something is labeled “sugar free”, will you eat more of it? In my experience, people tend to eat a larger quantity of foods (or drinks) if they are labeled “sugar free”. It could be that foods sweetened with artificial sweeteners aren’t as satisfying as the “real” version so people need more of the sweet food to satisfy a craving. Or it could be that psychologically people feel like can overeat these products and they won’t impact their health. The problem is that these cookies, cakes, ice creams, and candies made with artificial sweeteners (usually) still do have carbohydrates in them and will raise blood sugar and insulin, especially if eaten in large quantities. 

So which is better, sugar or artificial sweeteners? Overall, I think it’s best to have small amounts of “real” sweeteners, preferably as part of a meal.

My Recommendations

  1. Try to get used to less sweet drinks. If you are used to sweet beverages (artificial or regular sugar), start by diluting them with water or seltzer. Or try water with lemon, berries, cucumbers. There are a lot of flavor seltzers out now you may like.
  1. If you want to sweeten coffee, plain yogurt, or oatmeal, try using a little of the “real” sugar (could be honey, maple syrup, or brown sugar too). 1 teaspoon of sugar is only 5 grams of carbohydrates which is not enough to impact blood sugar.  
  1. If you want something sweet, go for what you really want. Enjoy it. If you allow yourself to eat what you really want without guilt, you will probably find you need less of it. Avoiding sugar completely is not necessary and trying to completely avoid it may cause you to binge on it. 

Bottom line: I don’t recommend that people with PCOS frequently use artificial sweeteners. More research needs to be done on artificial sweeteners and their effects on metabolism. I suggest reserving the sweet tastes for foods you really enjoy and try to cut back on some of the incidental sweets (sugar or artificial) you may be taking in. Check out this review article from December of 2018 in the Journal of Endocrinology and Metabolism for a review of recent research on how non-nutritive sweeteners affect metabolism.

Are you interested in learning more about nutrition and how it affects PCOS? Click PCOS Nutrition to contact me about nutrition counseling!

10 Tips for Managing PCOS Hunger

We all are born with natural hunger/fullness feelings
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One of the symptoms of having insulin resistance and excess insulin production for people with PCOS is often intense hunger! This can be because insulin is a storage hormone and having more insulin in your blood triggers your body to crave more food to store. Also, a huge side effect of restricting your calories and/or your carbohydrate intake is strong, biological hunger. Since so many people with PCOS have tried a lot of diets, this kind of hunger is really common.

Here are 10 tips to help manage both the hunger that comes from dieting and restricting food AND the hunger that happens as a result of excess insulin production in PCOS. If you have questions about carbohydrates, protein, and fat, check out this link to my blog on Nutrition Basics: Macronutrients.

1. Plan to Eat 3 Times per Day 

If you fuel your body at regular intervals around the same time each day, you can get into a pattern of eating when you are just starting to get hungry and stop before you are uncomfortably full. You body can learn to expect meals and snacks at certain times and you may find you get hungry around those times. Most importantly, eating frequently (without skipping meals) prevents you from becoming too hungry at later meals. Getting too hungry can lead to overeating or binge eating. See my blog Start with Eating Three Time a Day.

2. Have Protein with Carbohydrates

Carbohydrates are broken down to glucose which all of our cells use for energy and are digested relatively quickly. Protein helps our body with growth and repair and digests more slowly than carbohydrates. People feel most satisfied with meals and snacks when they combine carbohydrates with protein because you get the quick energy from the carbohydrates and feeling of fullness that protein provides.

3. Plan for Snacks

Most people feel best when they eat something every 3-5 hours they are awake. Having snacks can be a way to make sure that you don’t get too hungry before a meal. When you get too hungry, it can lead to overeating or binging. Snacks are most effective when you plan for them, so try packing them for when you are out of the house and keep healthy snack options available for when you are at home.  

4. Increase your Fiber Intake

Fiber is found in plants and provides bulk to foods. This bulk can take up a lot of space in our stomach and provide feelings of fullness. Our bodies break down fiber but we do not absorb it. This can help keep your bowel movements regular, bind to fat and cholesterol which can reduce blood cholesterol levels, and promote the health of “good” gut bacteria. Good sources include fruits, vegetables, beans, seeds, and whole grains. 

5. Decrease Refined Carbohydrates

Refined carbohydrates are foods or drinks made primarily from white flour or sugar without much fiber, healthy fat, or protein. These foods digest very quickly which can cause blood sugar to spike and then drop quickly. This “drop” can lead to rebound hunger soon after you eat since the increase in blood sugar causes your body to produce a lot of insulin. When you eat or drink something that is high in refined carbohydrates, you can try having a small portion, have it as part of a meal with protein, and/or go for a walk after eating to help bring blood sugar down. 

6. Add Heart Healthy Fats to Meals and Snacks

Adding unsaturated fats such as avocado, olive oil, nuts, nut butter, seeds, or fish to meals and snacks can contribute to feelings of fullness and satisfaction. Unsaturated fats will not spike blood sugar or insulin the same way that carbohydrates alone can. Swapping these unsaturated fats for saturated or trans fats (like butter, fried foods, processed meats, or cheese) can help improve your cholesterol numbers too. 

7. Drink Plenty of Low Sugar Fluids

When we are not properly hydrated, our body can sometimes mistake hunger for thirst. Aim to drink around 64 ounces of water, tea, coffee, milk/non-dairy milk, or sparkling water each day. If you drink non-dairy milk, choose ones with the least amount of sugar (unsweetened is best). You don’t need to drink more than 24 ounces of any milk per day. Limiting caffeine to the morning can help make sure you get enough sleep. The best way to tell if you are hydrated is if your urine is a pale yellow color. 

8. Eat Slowly and Mindfully

Our brains take around 20 minutes to register fullness after we eat. Sometimes if we eat too quickly, we end up eating past the point of being comfortably full. This can sometimes happen if we let ourselves get too hungry. We also tend to eat more food if we are distracted by phones, computers, or TV. Eating slowly and without distractions is the best way to pay attention to our natural hunger and fullness cues and to tell if you have eaten the right amount of food you need at that time.   

9. Get Enough Sleep

Getting at least 7 hours of sleep at night can help reduce feelings of hunger and cravings the next day. Our bodies will often crave more food when we are tired as a way to “wake up” or  get that burst of energy that (especially refined carbs) foods can provide. 

10. Work on Stress Management and Emotional Eating

While all people eat for emotional reasons at times, if you find that you are leaning on food to manage stress or difficult feelings often, you may want to work on other strategies for managing stress. Look for other activities you can do that can provide the same feelings of calm and wellbeing that eating does. This can be talking to a friend or family member, reading, watching TV, going for a walk, taking a bath, or writing in a journal. If you need help with managing emotions and stress, consider meeting with a therapist for more support.

If you would like more help dealing with PCOS hunger or other PCOS related symptoms, click here to contact me about nutrition counseling.

The Best Diet for PCOS

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Because everyone’s situation with PCOS is different, there is not one perfect way of eating that is right for everyone. However, your PCOS symptoms can and will improve with changes to your lifestyle, including how you eat. 

As I’ve mentioned before, the majority of people with PCOS have insulin resistance. It is this insulin resistance that causes ovaries to make more androgens and can lead to weight gain. Doing what you can to reduce insulin resistance can help improve your PCOS symptoms, which is why I’m saying that eating a diet to lower insulin resistance is the best diet for PCOS. Here are some strategies: 

  1. Eat carbohydrates with protein. It’s even better to add fiber and healthy fat! Simple carbs on their own raise blood sugar really quickly. Protein, fiber, and healthy fat don’t raise blood sugar as much and will slow down how quickly the sugar from the carbs hits your bloodstream. When blood sugar spikes, your body makes more insulin which can lead to weight gain and cause your ovaries to make more androgens. Check out this blog post for a review of carbs, protein, and fat: Nutrition Basics: Macronutrients
  2. Add more non-starchy veggies to each meal. Non-starchy veggies are low in calories and carbohydrates so your blood sugar will not be affected much by them. They are also high in fiber, vitamins, and minerals. Some tips – buy convenience vegetables. Frozen veggies are just as good as fresh and just need to be microwaved, which is the best way to preserve vitamins since it’s a fast cooking method. Also consider buying pre-washed and chopped veggies or salads that you can throw on your plate, in a salad, on a sandwich, or in a wrap.
  3. This may sound redundant, but add foods that are high in fiber to your meals and snacks. This includes veggies, but also fruit, beans, and whole grains. High fiber foods digest slower and are more filling, which is helpful if you find that you are hungry a lot.
  4. Choose unsaturated fats instead of saturated fats most of the time. Eating foods high in saturated fat can cause an increase in insulin resistance, even shortly after eating a fatty meal. Unsaturated fats can actually help improve insulin resistance.
  5. Limit sugary drinks. This includes juice, drinks with honey, and sugary coffee drinks. Liquid sugar makes our blood sugar spike the fastest since our body does not have to break down the food to be absorbed. The sugar hits your blood quickly. My suggestion is to save your sugar for desserts instead of drinks.
  6. And the final tip of the day – work in those treat foods. That’s right. Don’t aim to eat a perfect diet all of the time because you are very likely going to feel deprived if you never eat sweets or chips again. You are much better off allowing yourself to eat these foods when you really want them so that you won’t feel the need to eat a lot of them all at once when you “fall off” your diet plan.

Changing what you eat is not the only way to improve insulin resistance. Stay tuned for more ways to improve insulin resistance with other lifestyle changes.

Click on PCOS nutrition counseling to learn more about working with me for individual nutrition counseling!

What in the hell is PCOS why did it happen to me?

Hello friends! Thank you for reading my first blog. Since I’m working with clients who have PCOS, I thought I would start by describing what it is exactly.

Polycystic ovary syndrome (PCOS) is an endocrine disorder which affects around 10% of women. It is often just thought of as something that affects women of reproductive age, but it does impact women even past menopause. Women with PCOS have some combination of high levels of androgens (male hormones) and insulin resistance which results in different symptoms for each person.

Two of the following symptoms need to be present in order to be diagnosed with PCOS:

  • inconsistent and/or lack of ovulation (oligo/anovulation)
  • increased male sex hormones (hyperandrogenism)
  • presence of “string of pearls” cysts on ovaries (polycystic ovaries)

Just because you don’t have cysts on your ovaries, doesn’t mean you don’t have PCOS!

Excessive male hormones can cause hair growth on face and body (hirsutism), male patterned hair loss, and acne. Insulin resistance cause weight gain, abdominal weight gain, difficulty losing weight, carbohydrate cravings, hypoglycemia, and darkening of some parts of your skin (especially around the neck).   

Women who are diagnosed with PCOS are not usually surprised (see symptoms), but it often takes a long time to get diagnosed. It’s really common for teenagers with irregular periods to go on birth control to “fix it” without a proper diagnosis. Years can go but and they only get a diagnosis when they are trying to get pregnant. Other women have regular cycles and then gain weight out of nowhere. Most women I’ve met with PCOS always knew something was a bit off for them. The actual diagnosis is so helpful in order to takes steps to improve these symptoms and overall health.

Why did it happen to you (and me)? Genetics. It tends to run in families (but not always). Some research suggests exposure to elevated testosterone in the womb and can trigger it. The truth is that a lot more research needs to be done on this disorder because it’s not really well understood. Bottom line – it’s not your fault.