JCRM Insulin Resistance and PCOD diet (This diet is OK for anyone) The following dietary guidelines will take you through three stages: 1. Wean off phase 2 weeks 2. No Carb phase Minimum 4 weeks + Entire Weight Loss Period 3. Add back Carb phase For Life Approximately 3-5 years ago research indicated that PCOD is caused by Insulin Resistance in nearly all cases. Insulin in humans is released in response to the ingestion of carbohydrates and rising glucose (sugar) levels in the blood. Rapid rises or significant blood sugar elevations cause the release of pancreatic insulin in an attempt to reduce the blood sugar into the normal range. This happens in everyone. Elevation of insulin is the problem in this disease. Insulin excess causes many health problems. In the Ovary, anovulatory infertility, irregular periods, increases in male hormones causing facial hair, acne, scalp hair loss and male skin changes over time. In the Liver insulin, increases LDL (bad) cholesterol and decreases HDL (good) cholesterol. In Blood Vessels, insulin deposits fats and cholesterol causing high blood pressure, stroke and heart attack. In Peripheral Tissues, insulin deposits fat and prevents fat breakdown setting individuals up for constant lifelong weight gain. The fat distribution is primarily in the abdominal area, wrapping around to the back. If a person has this distribution, they most likely have insulin resistance. An extremely important point relates to what medicine has traditionally taught and what people believe about weight. It is said that if one loses weight, their diseases will get better (diabetes, high blood pressure, stroke and heart attack risk etc.). This is flawed thinking. The disease is high insulin, not obesity (obesity is the result of insulin resistance) and if not corrected, the disease rages on despite weight loss. Therefore, all our treatments are directed at lowering insulin levels. Weight loss then becomes a side effect of treatment not the primary goal. In people with insulin resistance, the ability of insulin to lower glucose is significantly reduced. The pancreas reacts by producing higher than normal insulin. Two to four hours later, because of the higher levels of insulin, the blood sugar is driven too low (reactive hypoglycemia). Often people are symptomatic at this point. Symptoms include intense hunger, cravings for carbohydrates, fatigue, nausea, sweating, headaches and mood changes. Often the blood sugar is dangerously low and these symptoms are warning signs from the body for eminent danger. The brain is programmed to send the person in search of food to fix the problem the quickest way possible. Over time people learn that ingesting simple carbohydrates is the quickest fix. Insulin levels spike again and the process starts over. This roller coaster ride into hypoglycemia can occur 5-6 times daily. Since all body systems are in alarm mode, a great deal of energy is expended trying to survive the crises and by the end of the day people are worn out. Hence, the fatigue that our patients report. The physiology described above led us to the conclusion three years ago that patients with these problems need to be on a low carbohydrate diet. Initially we tried existing diets such as the Southbeach Diet. These did not work for our patients. We began to make recommendations based on the responses we observed in our patients. What we now recommend represents three years of trial and error with our patients and is an ever improving process. All of our recommendations we have learned from our patients, not from textbooks or articles. In fact, there is very little meaningful
research in nutrition. Most of what is recommended is based on things passed down for hundreds of years. The primary goal of the first phase (wean off Carbs) is to have patients slowly wean off what we see as the 6 most dangerous carbohydrates. We don t necessarily want patients to exclude all carbohydrates during this stage. Sugar and flour are the most difficult to sort out. Sugar and flour are added to nearly all foods in the grocery store. Equivalents are starch, corn syrup, fructose corn syrup etc. This also takes a great deal of work and searching to evaluate individual foods. Don t buy foods with these additives. Expected weight loss = 3-5 pounds. In the second phase (no Carb), we have several goals. First, we want patients to realize that they won t die without carbohydrates. Conversely, patients feel better than normal, experiencing their best metabolic state in contrast to the worst several weeks earlier. It is important for patients to use this time as an educational period where they solidify knowledge about food components, ingredients etc. We would expect this to take several hours in the grocery store reading and making lists of foods that fit the no carbohydrate criteria. This will always serve as your base and many of the discoveries made will be useful for the long term. This knowledge provides a foundation or safe haven of no carbohydrates for patients to fall back on at any time in the future. Wt Loss = 10-12 lbs per month The third phase (add back Carb) is the long term healthy phase to be used indefinitely. If weight loss is needed, a patient can bounce back and forth between no carbohydrates and add back. This can be done week/month on vs off or from meal to meal. In this phase, we teach people how to add back complex carbohydrates in a small amount that will prevent the increases in insulin. Wt Loss = 4-6 lbs per month. Energy sources (food) fall into three categories: Carbohydrate (some type of sugar), Protein (come primarily from meats but some plants), and Fats (come from plants and meats). When evaluating a food, one should look at three areas on the packaging. First, the serving size, which for the average American diet is usually only 1/3 to 1/10 th of what is generally consumed at one sitting. Second, the square that contains Fat, Carb, and Protein content in grams per serving. If carbohydrates are present, it is important to figure out where they come from. Fiber can be subtracted from the total. If sugars are present, look to see if there is a sugar (any type) or starch in the ingredients. If so don t buy the product. Our goal is certainly to eliminate all added sugars. Some foods (e.g. tomatoes, milk products) contain natural sugars and are ultimately OK depending on the phase of the diet. Unfortunately in most categories, there are only one or two foods that meet these criteria. Lastly, the ingredients section should be evaluated for all foods even those such as meats that would be expected to be carbohydrate free. Do not buy any low fat or lite foods. When the fat comes out the carbohydrate (usually sugar) goes in. Also don t be fooled by sugar free or X grams of net carbs. In most cases, other additives such as high fructose corn syrup, polydextrose, maltodextrin etc etc have been substituted. These components are just as bad for you as sugar. Other resources include the theory section in the Southbeach Diet book. Not the diet itself but the introductory chapters explaining the insulin and glucose physiology. The glycemic index (GI) is a rating scale to compare various foods and components to glucose which is the worst sugar. Glucose is 100 and values under 50 are considered better. The GI scale was developed based on underlying measurements of blood sugar rise and not insulin rise. Insulin rise is the important factor and to date there are no tables looking at this parameter. Be careful not to take this table too literally. There are some foods that would rate as OK on the GI scale that we would say are not OK. For example, sucrose (sugar) is rated under 60. Based on this, our contention would be that the safe GI should be <40.
Wean off Carbohydrate Phase 1 (10 to 14 days) 1. Wean off 4 whites 1. All Sugar - all ose (fructose, maltose, sucrose etc) and hidden sugars (corn syrup, corn starch, fructose corn syrup molasses, brown sugar) 2. All White Flour Breads, pasta, pastries, chips, crackers, cornmeal, croutons, fried foods 3. All White / Red Potatoes fries etc 4. All White Rice 2..Vegetables to avoid: Carrots and Corn Notes: Sugar is in everything!! The above foods are considered the permanent hit list and should never be reintroduced into your diet. Spend several uninterrupted hours in the grocery store with pad and pencil and visit every section you normally frequent and read labels. The grocery is your classroom to learn this food approach. Read both the component square (calories, carb, protein and fat grams etc) and the ingredients list. Many foods are marketed as low carbohydrate but the carb component is sugar (or substitute) which is very toxic to your system. Do not spend money to buy foods where sugar has been added. We recommend that you figure out where you are with these foods at the beginning of the period and gradually wean off until you are at zero at the end of two weeks. It is advisable to get these foods completely out of your house. Likely this represents most of the foods currently in your house. Always read every label before you buy, even for things like packaged meats that you would expect to be no carb. The most important concept you can understand is the fact that everything on the hit list affects your body the same way as sugar. So instead of potatoes, for example, you could weigh out the same amount of sugar and eat that with the same metabolic effect. Your insulin rises based on a threshold phenomenon. This means if you cross the threshold, all your insulin is released. It takes very little simple carbohydrate to tip off insulin release. Maybe as little as a Hershey s kiss or 3-5 French Fries. So be careful of the nibbling syndrome. This would be nibbling from someone else s plate or eating the one hard candy or small chocolate with the thought that this small amount will not hurt you. IT WILL!! Consistency is the name of the game. In phase II when we re-introduce the cheating concept, we allow one cheat meal per week. A cheat episode represents either too much of a good (complex) carb or any amount of a bad carbohydrate. If you only cheat once per week, your metabolism is only disturbed (high insulin levels) for about 5 hours per week. If you nibble 1-2 times per day, you are out of balance 10 hours a day or 70 hours per week! CONSISTENCY. Caffeine is okay, only one diet soda, increase water intake to at least 64 oz day. Try to drink liquid beginning about 30 minutes before mealtime. Sugar alcohols are probably not healthy. Fake chocolate bars that are healthy are not possible. The glue that sticks bars together is always a simple carbohydrate. Splenda is OK in SMALL quantities. We want you to reduce the need for sweet.
Phase II: No Carb (weight loss phase) (No Carb, except those found in high protein foods and non-starchy vegetables i.e. nuts, meats) 3 Meals and Two Snacks per day. Snacks are extremely important! Pre conditioning Phase Recommendations plus: Foods to Avoid: Eliminate all Flour based foods (pasta, bread, chips crackers etc.) No starchy vegetables (beans, sweet potatoes, hard squash summer, acorn etc) No Dairy milk, yogurt, ice cream etc Hard cheese is okay as long as it has 2 gm carb or less per serving. No Juices fruit or other (never healthy) No Fruits limit tomatoes Acceptable Foods: Vegetables green leafy (lettuces, spinach etc) (oil & vinegar salad dressing) broccoli, Squash yellow and zucchini, cauliflower, asparagus, mushrooms, avocado, green beans, cabbage, cucumber, mustard Protein- meat (chicken, turkey, seafood, pork, beef etc), nuts, cheese (see above), tofu Oils Olive oil, butter, heavy whipping cream (the kind in a carton), mayonnaise, certain cream cheese. Don t be shy, cook with oils and butter for flavor and calories Snacks should ALWAYS BE no Carb: cheese, pork rinds, no sugar peanut butter, Celery is okay with peanut butter or cheese, boiled eggs, olives, meats, Nuts make the best snacks (peanuts and almonds are best) shoot for 150-200 cal for the snack Beverages 64 oz water per day, caffeine is okay Splenda is marginally better than sugar, use very sparingly Crystal light (limit), Diet sodas (limit to 1 per day), unsweet tea You may feel somewhat out of sorts for the first 5-7 days until your body adjusts to this overall change in metabolic state. The most important aspect is not to stretch the interval between meals; otherwise your blood sugar will drop just as it did before as a result of high insulin. This is not a starvation diet. Therefore, frequent snacking is important to suppress appetite at mealtime. Things to look for during this phase are increased energy, reduced cravings for carbs and better sleeping habits. Don t forget multivitamins and drinking a great deal of liquids. Breakfast is one of the hardest meals due to intense marketing and family history of high carb meals. There is no cereal that is safe for you to eat ever. Eggs and meat are OK. Bacon is OK. Egg and meat (+/- vegetable) casserole is a very easy breakfast answer. Contrary to popular belief, high cholesterol is not a function of the amount of cholesterol one eats, rather is the result of carbohydrate intake with resulting high insulin levels. Insulin causes the liver to produce cholesterol, thereby raising the blood cholesterol. This, relatively high fat/cholesterol diet will significantly reduce your cholesterol level. The message is eggs are OK! Still NO CHEATING unless you are on this phase > 4 weeks. Drink lots of water and take a multivitamin each day. Prenatals are a great multivitamin.
Phase III (Weight Maintenance & Pregnancy Phase): (add back complex carbs; limited cheat meals) 15-20 grams of carbs allowed per meal (Snacks-still and forever: absolutely no carb) Don t accumulate (i.e. 0 all day and 50gms at night) Changes from Phase II: (add back): Dairy whole milk (watch serving size; 14gms sugar in kiddie carton of milk) Starchy vegetables including sweet potatoes (1/2) okay Limited fruits (less ripe is better increase ripeness has more sugar) Apples, blueberries, raspberries, cantaloupe, honeydew melon, plums, grapefruit Grains: Brown rice (watch serving size; must be very small measure first few times) Old fashioned Quaker Oats or better steel cut oats, Oatmeal (watch serving size) 100% Whole Wheat Bread (no sugar) look for Nature s Own Sugar Free or Ezekial 100% Whole Wheat Pasta (again, watch serving size carefully) Red Wine is by far the lowest carbohydrate alcoholic beverage. Always mix complex carbs with protein and fats. Even consider eating some protein and fat before the carbohydrates. The most toxic thing restaurants do to us is to bring us a sugar containing drink and bread as a starter. This sends our insulin levels off the chart. Of course, the restaurant is never going to use sugar free bread, salad dressings or condiments. Tips: Frequent meals and snacks every 2-3 hours; Plan your outings and bring snacks. Have them in your car, at your office, home etc. They should be available. Don t wait until you are hungry eat. Lots of Water and Multivitamin every day. Drink 8oz of water 30 45 min before each meal. Metamucil if constipated Restaurants are great about substitutions. Don t be afraid to ask or pay a little more to be healthy! Even Hardees (fast food) has come out with a low carb food approach. To review, one cheat meal per week is allowed. A cheat meal is either too much good carb, or any bad carbs. The slightest amount of bad carb can bump up your insulin level, so consistency is key. We would much rather you cheat one time per week where you ate large amounts of sugar (at one sitting), than to cheat a little bit each day. Be steadfast in your conviction to this diet and you will reap great rewards. You may alternate between Phase II and Phase III. For example, Phase II for 4 weeks and Phase III for 6 weeks. The expected weight loss for 4 weeks of Phase II is 10-12 lbs. The expected monthly loss for Phase III is 6-8 lbs. Please let us know what you learn and what works for you. We have learned or inferred all of these recommendations from our patient s successes and failures.