In case you never thought about it, we celebrate our first birthday on the first anniversary of the day we were born. So today I celebrate the 69th anniversary of the day I was born which means I have already completed 69 years of life and I am entering my 70th year. To God be all the glory!
In my 69 years I have seen so much history unfold that today’s children will only read about in books. I remember going to segregated schools, movies and restaurants. I remember sitting in the back of city busses, not realizing that I HAD to sit back there. I remember watching President Kennedy’s funeral on a little black and white tv with my Grandmother. I remember participating in a civil rights march in downtown Memphis as a teenager and being tear gassed just for being there.
Other memories are more personal. I remember growing up in circumstances so poor that we did not even own a car – so I remember walking to Cummings elementary school and to St. Paul Baptist Church. I remember the pain of being ridiculed for being the “fat kid” in junior high school. I remember having my dreams of being a writer crushed by not getting a spot on my high school newspaper staff in spite of being a straight A student. I remember being made to feel as if I did not deserve my entrance into Washington University because affirmative action allowed me to “steal a spot” from a white student. I remember being the first college graduate in my family. I remember feeling out of place in a medical school class where only one other student was black and female! I could go on and on.
The fact that this chubby little black girl from South Memphis has been a been in private practice as a physician for nearly 40 years is nothing short of a miracle. Every time God closed a door, he opened another one! Proverbs 16:9 says “We can make our plans, but the Lord determines our steps.” Every morning I wake up grateful to God for ordering my steps and for getting to live another day of this remarkably blessed life. I cannot thank Him enough! As Jill Scott would say, I am “representing His glory, hope He’s proud of me.”#blessed #livinmylifelikeit’sGolden
“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 1:2 NLT
This month marks the fifth anniversary of the very first article I ever published in this blog. Where does the time go? I ended that first article with these words:
“I started this blog to share my current journey of seeking to find my way toward the healthiest me I can be, for the rest of my life. I desire that not only for myself but for those of you who choose to come along. I will seek to share healthy lifestyle tips not only about achieving a healthy weight but about all of the aspects of healthy living. In this blog I am not offering medical advice so much as offering information, encouragement and coaching to those of you are seeking to be healthy in body, mind and spirit. I am looking for partners in the struggle.”
So here we are 5 years later which is a good time to check in with you all and see what we have learned. A lot has happened in our lives both individually and collectively since 2018. My own life was marked with the illnesses and then loss of my mother, my husband and two very close friends just before and during the pandemic that threw all of our lives into a tailspin. It has been a time unlike any that I have known in my 68 years of life. And yet those of us who have survived this strangest of times are still left with the challenge of being the healthiest people we can be. For those of us who are believers, it is not only our desire but our responsibility! We are reminded in 1 Corinthians 6:19-20 that “our bodies are temples for the Holy Spirit” and that we are to “honor God with our bodies.”
During this 5 year journey that I have taken you on we have learned that getting healthy and staying healthy are two different things. Most of us have health issues because of a combination of factors such as genetics, a lack of resources and bad habits that we have developed in the name of “enjoying life.” Far too often we give in to that two year old inside of us who wants what she wants in the moment without regard to the long term consequences. All of us need to grow up and give these bodies the care that they need to function as they were intended to function. Just like we have developed unhealthy habits, we can also develop healthy ones.
Most of us, myself included, start each new year with good intentions to live a healthy life. We resolve to move more, sleep better and to stay away from unhealthy foods and alcohol. After achieving some success, we gradually return to the bad habits that got us unhealthy in the first place. The diet and fitness industries know this about us which is why every January we are bombarded with advertisements from weight loss plans, gyms and personal trainers. Year in and year out the story never seems to change.
5 years ago I decided to get off that roller coaster ride for good by educating myself as well as all of you about what it takes to obtain and then sustain a healthy lifestyle over the long haul. What follows are the some of the main take-aways from my journey so far that may help you in yours.
1. How we think determines what we do. In order to be successful at anything you must have a made up mind. I am not talking about a temporary resolution but a transformation in how you think about your life and how you want to live it. If we think that a healthy lifestyle is a temporary fix to a permanent problem, we are destined to fail. If your commitment is temporary, your good health will be temporary. Every action begins with a thought. However, just thinking about making lifestyle changes will not make you healthy. You have to put those thoughts into action.
2. It is important to set yourself up for success. Your decision making starts in the grocery store, the drive thru and when you are eating out. All of these are opportunities to make good choices. Just as we would not dream of purchasing a pack of cigarettes, we should have the same attitude toward calorie dense and sugar laden processed foods. Those products are intentionally designed to get us hooked on them like the drugs that they are. We all know what our trigger foods are (Peanut M and M’s for me) and the smartest strategy is to just stay away from them. If you know that you cannot, “eat just one,” do yourself a favor and leave those fake foods in the store! Trust me, there are delicious healthy alternatives among ‘real’ foods.
3. The tallest building is built one brick at a time. Making good choices over bad ones every single day will become a habit over time. For example, physical fitness is less about gym membership and more about intentionally moving our bodies in ways that make us feel good both physically and mentally. If you do not enjoy what you do it will not be sustainable. Find something that you are happy that you GET to do rather than something you HAVE to do. Personally, I have become addicted to brisk walking and Youtube dance workouts. I have said in a previous blog that exercise is not essential to weight loss but it is a great alternative to binge eating and makes us feel just as good, if not better. The possibilities are endless! We need to stop deceiving ourselves that we can sit on the couch binge watching Netflix night after night and be healthy. It is true that sitting is the new smoking and that movement really is medicine.
4. Emotional and mindless eating are not just buzzwords. They are major troublemakers in our lives. We develop the tendency to use foods to soothe us as babies so it is deeply engrained in all of us. We have become so disconnected from physical hunger that we do not even recognize it any more. Pausing to ask ourselves if we are really hungry before we eat goes a long way in reconnecting food with physical hunger rather than recreation. If the answer is NO, find something else to do!
5. Be honest with yourself and set realistic goals. You do not have to be a size two to be healthy, nor do you have to get back to what you weighed in college. Unrealistic goals can be a major source of disappointment that can derail the best of intentions. A weight loss of just 10% of your current weight can make a significant decrease in your risk for diabetes, hypertension, heart disease and strokes. Far more important numbers than the one on the scale are your blood pressure, blood sugar and the size of your waistline. Increased abdominal fat brought on by consuming too much sugar and simple starches is particularly dangerous to your overall health. Once you adopt a lifestyle that helps to improve those numbers, you are well on your way to improving your overall health and quality of life.
6. There is safety in numbers. Accountability and ongoing support are important to long term success. Once you develop your own healthy lifestyle, why not pay it forward by offering to help a friend or family member reach their own health goals. Instead of going to happy hour with girlfriends suggest a group walk or bike ride instead. Setting up regularly scheduled healthy group activities encourages you to stick to your resolve to be healthier, even when you do not feel like it! You do not have to hire a trainer or join a gym to become a healthier you but you do need to spend time with people who have similar goals and will hold you accountable to each other.
7. Holidays, anniversaries and birthdays are but single days. If you choose to allow yourself to deviate from your healthy lifestyle for a special occasion, get back on track the very next day! No one ever became unhealthy due to a single day of overindulgence. Do not fall into the popular trap of celebrating all month long! Give yourself some grace but not an excuse to return to your former bad habits!
8. Do not underestimate the importance of a good night’s sleep and of periods of relaxation. Our bodies were designed to need periods of rest and repair in order to perform at their best. Proper rest as well as periods of relaxation are important to reduce the stress than can be so hazardous to our physical, mental and emotional health. Remember that there is nothing selfish about self care!
9. As with every important thing our lives, we have to tap into the power source for the help we need. The Bible assures us that we can “do all things through Christ who gives us strength. (Philippians 4:13). Yet we do not submit the specifics of our wellness journey to the God who created our bodies. A patient recently told me that she would not ask God for help in forming healthy habits because she doesn’t believe in bothering God with small things! Because our body is the temple for the Holy Spirit, keeping a healthy body is not a small thing! We have a tendency to not pray about our unhealthy behaviors because we really do not want to give them up. “…ye have not because ye ask not.” (James 4:2).
10. “Dance with the one that brought you.” I am convinced that whatever you do to find your healthiest self will keep you at optimal health for as long as you continue to practice those habits for the rest of your life. What it takes to keep you healthy will be different for each one of us. It is not one size fits all and there are no quick fixes. Once you get it figured out, refuse to look back! To paraphrase scripture, we should be intent on “… forgetting what is behind and straining toward what is ahead,” (Philippians 3:13). What is ahead is a lifetime of good health’
Be Blessed, Yvonne Moore, MD “Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit” 3 John 1:2 (NLT)
If you have visited this blog site before, you likely know that I am the self proclaimed “Low Carb Queen.” A strong family history of diabetes and a personal diagnosis of pre-diabetes convinced me that for many of us sugar is the “root of all evil.” Before I knew any better, I was just like everyone else in my affinity for things sweet and starchy. I, like many of you, ate way too much bread, potatoes, rice and pasta and had a long standing love affair with Peanut M and M’s. I fell for the lie that becoming a runner would allow me to eat whatever I wanted only to find myself gaining weight and becoming more and more unhealthy. The memories of my struggles with childhood obesity and a lifetime of yo-yo dieting sent me in search of tools to help me not only improve my own health but to share what I have learned with you in this blog.
As I have completely reversed my pre-diabetes by cutting the simple sugars and processed starches out of my diet, I have adopted it as my forever lifestyle and have been sharing with my patients and friends how simple low carb eating can be. I have even completed classes that qualify me to teach the low carb way of eating within my medical practice. It is our collective indulgence in highly palatable processed sugary treats and other “junk foods” that has been a major player in the obesity epidemic. The inflammation that those foods cause has resulted in markedly increased rates of diabetes, heart disease, joint problems as well as certain cancers. All foods are not created equal in how they affect the body. Real self care is educating yourself about which foods you need to include and which to eliminate for your long term health. A generation ago, we came to grips with the dangers of smoking. We now know that the standard American diet, filled with refined sugars and other processed foods, is just as dangerous!
The most common objection I get from patients when I recommend the low carbohydrate way of eating is that it is too complicated and not sustainable over the long haul. My inability to convince my patients who struggle with obesity related diseases that they too can achieve improved health with SIMPLE dietary changes has become a real challenge for me. Many of my patients have tried internet keto diets, lost weight and quickly regained it when they returned to what they think of as normal eating. That is why I do not refer to low carb as a diet but rather a lifestyle. The term diet implies that what you are doing is a temporary effort you make to achieve a particular goal after which you plan to abandon that effort and go back to the way of eating that got you unhealthy in the first place. It is no wonder why diets don’t work over time and 90% of people who lose a significant amount of weight gain it all back within 2 years.
If you think you cannot stick to healthy dietary changes for the rest of your life, think of it this way. You have already proven that you can stick to healthy habits when you brush your teeth and shower daily. You would not dream of stopping those behaviors just because you got tired of doing them. Once you figure out the healthiest way of eating for you (it is different for everyone), you have within you what it takes to stick with it for the long haul. Food is medicine and the right foods can be stronger than any prescription to keep you healthy. This simple approach to eating has kept me off diabetes medication and has allowed me to maintain a 20 pound weight loss for over 4 years while continue to enjoy the experience of eating (did I mention how much I LOVE to eat?).
My simple maintenance strategy to keep my blood sugar and weight stable is to have in my head a list of the foods that I stopped eating in order to reverse my pre-diabetes. Those are the foods I no longer buy at the store or order in restaurants. They are simply no longer a part of my life. The interesting thing about giving up sugar is that once you stop eating it, you stop craving it. Your taste buds change so that some of the sugary things you used to love, now taste downright nasty! I choose to see that as God’s way of protecting me from things that are not good for me (He knows me so well!). The good news is that I feel better and have more energy than I did 20 years ago!
Bread, crackers, tortillas and pizza crust and pasta
Whole grains, rice and cereal
Deep fried foods
Fruits and fruit juices (except berries)
Beer and wine
I never feel deprived because I still have plenty of foods from which to choose including:
Meat, poultry, fish, seafood and eggs (increasing the intake of protein is very important as we get older)
Non-starchy vegetables like broccoli, cauliflower, Brussels sprouts, cucumbers, cabbage, kale and collard greens.
Limited amounts of cheese, raw nuts, and berries
Healthy fats like those contained in avocados and olives
Limited quantities of heavy cream, sour cream and butter
Sugar free condiments including all types of mustard, salsa, hot sauce and low carb salad dressings
Recently I took a mini vacation to spend some quality time with my adult children. I decided to take the opportunity to demonstrate just how sustainable low carb eating can be – even while traveling. My “ketocation” started with a road trip from Memphis to St. Louis with my son for a Cardinal game. Later that week I flew to Las Vegas to meet my daughter for a mother/daughter girls weekend. I took the pictures below of my meals during the trip. I ate as much as I wanted and thoroughly enjoyed my ketocation!
Starting at the top right and moving clockwise I had:
Grilled Chicken/ bacon salad at at Busch Stadium
Scrambled eggs with cheese with bacon in the Phoenix airport.
Naked Roasted wings and Grilled Salmon Salad at Hard Rock Cafe Las Vegas.
Scrambled eggs and cheese, chicken sausage and avocado at Primrose restaurant in the Park MGM hotel.
Bun-less cheeseburger with green beans and a side salad at Lambert’s Cafe in Sikeston, MO – Home of the “Throwed Rolls.”
Salami and cheese snack pack from the hotel gift shop (you can also get these at convenience stores when you are driving or make your own for road trips).
The point I am trying to make is that low carb eating can be an enjoyable lifestyle even on vacation! Fortunately, it has become easier and easier to find low carb friendly choices in restaurants. It is a good idea when eating out to look at the menu beforehand and to feel free to ask for substitutions. I have yet to have a waiter not try to accommodate my requests and some have even suggested alternatives that surprised me with how good they were. Who knew that chicken Alfredo sauce over steamed broccoli instead pasta could be so delicious???
Be Blessed, Yvonne Moore, MD “Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit” 3 John 1:2 (NLT)
When it comes to using food to help you lose weight and/or just be healthier, there can be a lot of confusion about what constitutes the healthiest eating plan. Patients have expressed to me how they are hesitant to try eating a healthy diet because there is so much conflicting information out there. When it comes to eating to promote your best health, we should not get the idea that one eating plan fits all. Take me, for example, a 68 year old prediabetic with a history of hypertension and childhood obesity. A LCHF (low carb healthy fat) lifestyle along with regular exercise is the approach that has made me healthier now than I was 20 years ago. Others whose medical profile or personal preferences are different might not find this approach either desirable or sustainable long term. That said, I believe there are some universal concepts that hold true no matter what WOE (way if eating) we choose. One of those concepts is that you must learn to love the foods that love you back!
Often when I try to advise patients on healthy eating they tell me that they cannot sustain a long term healthy eating plan because they “love” ice cream (or chips or cookies or cornbread, etc). My response to anyone who has struggled with their weight for this reason is typically, “what has ice cream ever done for you?” Having an unshakeable love for foods that are unhealthy for you is like being in a relationship with someone who is physicalIy abusing you. The victim keeps letting the abuser back into their life expecting it to be different this time but it rarely is! We can’t keep returning to eating sugary foods, french fries and other junk foods every day and expect them to make us healthy this time around. That is part of the reason why so many people who lose a significant amount of weight gain it back within 2 years! If you want something you’ve never had, you have to do something you’ve never done. Resolve that this time will be different!
I totally understand the passion we have for food because I LOVE to eat. That love led me to take up running in my late fifties with the notion that I would “run so I could eat whatever I wanted.” That turned out to be a big fat lie! Contrary to popular belief, you cannot “outrun” a bad diet. We need to acknowledge that we eat as much for enjoyment as we do for fuel. We just have to train ourselves to love the foods that not only taste good but reward us with positive changes in our health.
When you make a commitment to eating in a way that promotes good health, why not take the focus off the foods you should no longer eat and instead focus on learning to love those foods that you know are good for you? The disease-causing foods like sugar and sugary drinks, processed carbs (junk food) and deep fried foods pretty obviously have no place in your pursuit of good health. Regardless of which healthy eating plan you choose long term, you will be told to reduce or eliminate your intake of these foods. Instead of mourning the loss of the “bad” foods you shouldn’t eat, look at them as the poisons that they are and get excited about all the wonderful things you get to enjoy eating and still be healthy that are shown in the picture. Every bite you eat is either promoting good health or it is promoting disease. You can take control of your own health by making this simple shift in your mindset!
LEARN TO LOVE THE FOODS THAT LOVE YOU BACK!!!
Here is just a partial list of some of the wonderful things to eat that will promote wellness in your life. The closer any food can be to its natural state the better. Make it a habit to shop the perimeter of the grocery store to find the real food! I have included some of my personal favorites in this list but the list is not exhaustive by any means. Identify the good foods that you already like and eat more of those before venturing out to the foods you think you don’t like right now.
1. Green leafy vegetables, especially the dark leafy greens like spinach, mustard and collard greens and kale are encouraged in almost every diet I have ever seen (Lord knows I have tried them all). It is a good practice to eat a big salad topped with healthy proteins and fats every day as one of your meals.
2. Other non starchy vegetables that you should be eating on the regular include cabbage, cucumbers, broccoli, brussel sprouts, cauliflower and tomatoes. Learn to prepare these in ways that will tickle your palate and they will become your go to side dishes instead of the starches that gave you love handles but no love!
3. Foods containing protein and healthy fats like fatty fish (i.e. mackerel, lake trout, herring, sardines, albacore tuna and wild salmon) are excellent choices. Seafood, poultry, eggs, cheese and other dairy products and even meats can also be a part of a healthy diet depending on your medical history.
4. Raw Nuts and Seeds (i.e. almonds, pecans. walnuts, flaxseed, chia seeds, hemp) are also good choices in small quantities.
5. Berries – strawberries, blueberries and raspberries are preferred over the tropical fruits because their sugar content is so much lower.
6. Avocados. This stone fruit with a creamy texture is chock full of healthy monounsaturated fats, vitamins C, E, K and B6 as well as potassium and magnesium! This is the one healthy food that inspired me to write this post. I never even knew that I liked avocados until I found out how good they were for me. Now I eat them almost daily! A few years ago during a run-cation to New England, we were celebrating my birthday at a nice restaurant. I ordered the lobster cocktail thinking I would eat the fresh lobster and bypass the sugar laden cocktail sauce. Imagine my sheer delight when they put it in front of me and it was topped with guacamole!! I was tempted to ask them to put a candle on it so I could pretend it was my birthday “cake!” I was even surprised at myself for getting that excited over unexpected avocado!! I can honestly say that I love avocados in the same way that I used to love potato chips! Amazing! Here is a picture of that lobster cocktail and it was delicious!
All joking aside, I hope you get my point. If you eat a food that you thought you didn’t like and it contributes to your feeling great, you will soon learn to love it!! Give yourself the chance to fall in love with healthy foods and I promise they will love you back by making you a healthier you!
Yvonne Moore, MD
“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit”
Today’s blog post will be a bit of a departure from my previous entries and a little more personal. Today (March 30, 2022) is my 68th birthday!! I am incredibly grateful to God not only to see this birthday but to get here as a healthier me than I was when I was 50!
While others much younger than me are retiring, I am finding my career more rewarding than ever as I am able to use much of my life experience along with my medical knowledge to encourage my patients toward positive lifestyle changes that will make them healthier as they age. It has become something that I am quite passionate about.
In the year since my last birthday, God blessed me to finally complete my bucket list goal of completing half marathons in each of the 50 states as well as DC, Canada, Mexico and Puerto Rico. Since completing that goal last October, I have done 4 more half marathons in four different cities just for fun. In December I completed my 8th consecutive St. Jude Half Marathon, raising over $2800 for the children as a St. Jude hero. I was given the opportunity to encourage others toward active aging both on the local news and by being featured in an article in a local Health and Fitness magazine.
Based in part on the contents of this blog, I now serve as volunteer nutrition and lifestyle coach to a wonderful group of women in what we call the “Healthier You” support group started by my good friend Penne Allison. The group meets weekly via conference call. We have seen some amazing changes among our group members with not only weight loss but also improvements in fitness and in chronic diseases like diabetes and markers of cardiovascular disease.
Through my social media presence I have been able to encourage others spiritually by sharing daily devotional readings from the several that I read each morning. I use my Facebook group, No Gym-No Problem, to share YouTube workout videos that I enjoy as well as fitness challenges in the hope of inspiring others to get off the couch. I am amazed at the sheer number and variety of FREE workouts that are available on the internet!
I am sharing the way I have chosen to live this season of my life to make a point. I firmly believe that only God knows how long each of us will live but He has given us the free will to make choices that will enhance the quality of our lives. I was not active as a child and minimally active for most of my adult life. In an attempt to keep my weight down I would starve myself all day then reward myself with pizza or chocolate chip cookies and late night snacks. Being diagnosed with both hypertension and prediabetes finally convinced me to make the lifestyle changes I needed to make to get healthier. I was already 59 when I did my first half marathon and 64 when I finally made the permanent dietary changes that reversed my prediabetes and got me to a healthy weight without regaining it for the first time in my adult life. Now I like to think of myself as a living advertisement for active aging and good nutrition. I am out to prove that it is never too late to become your healthiest self!
For the last few weeks leading up to my birthday I have been doing a lot of reading and listening to podcasts during my walks about so called “successful aging.” You tend to read about that which is important to you personally. At 68, it has become increasingly important to me to understand this aging process so that I can make the most of whatever time I have left.
According to healthy aging expert Daniel Levitin, successful aging has nothing to do with status or financial security. He describes the three components of successful aging as as low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life. In other words, being able to do the things you want to do for as long as possible is the goal of successful aging.
How to accomplish successful aging involves the choices we make both before and after we earn that little red white and blue Medicare card. While there may be some disagreement about the best ways to age well, there are some tips on which most experts agree. Let’s explore some of these universal truths.
You must “eat as if your life depends on it.”Regardless of which way of eating you choose; vegan, plant based, paleo, low carb, Mediterranean or whatever, it is important to minimize your consumption of processed foods and foods high in refined sugar and simple starches. Processed foods are highly inflammatory and contribute to many of the diseases common in older people. A healthy diet as we age centers around simple whole foods and not processed fake foods. Every bite you eat is either feeding good health or feeding disease. Another important dietary consideration is that, contrary to popular belief, protein needs increase with age to combat the muscle loss (aka sarcopenia) that naturally comes with age. Make it a point to have some kind of protein at every meal.
You simply MUST keep moving. I am not saying you have to join a gym or train for a marathon but you do need to move your body with purpose every single day for at least 30 minutes. There is no magic formula but experts agree that you should vary your activities and get in some kind of cardio (walking, running, biking, dancing, swimming etc.), some resistance exercises to help combat muscle loss as well as movements that improve flexibility and balance. It is important to find activities you enjoy which makes it more likely that you will stick with them.
Reduce stress. This may be simple advice but likely the hardest thing to do. We often have no control over the aspects of our lives that cause us stress but we do have control over our responses. For me that involves daily quiet time with God to start each day. For others that might mean daily meditation, yoga or getting a massage. Also, the above mentioned physical activities are also great stress relievers.
Sleep Well. Most people think that our need for sleep declines with age when in actuality it becomes MORE important as we age. During sleep is when our bodies repair themselves and our batteries get recharged. The time honored advice of trying to sleep at least 8 hours a night becomes crucial as we get older.
Get outside daily if you can especially on sunny days. The sense of wellbeing that comes from getting fresh air and sunshine comes from the release of serotonin, the feel good hormone. The sun also boosts vitamin D which is important to bone health. The benefits of as little as a 15 minute walk outside in nature is priceless. Even if your mobility is limited, just being outside can boost your mood.
Keep your mind engaged by continuing to learn new things, visit new places and by staying connected with others. Become a lifelong learner. (I just found out that several universities offer free classes to high school graduates over 60). Join a book club. Try a new form of exercise, make some new recipes, learn a new language or get a new hobby. The possibilities are endless.
Remember to have FUN!!! If you are not going to enjoy your life in your 60’s and beyond – then when??
If you have lived your life up until now in unhealthy ways, make today the day you decide to change course. It is my prayer that you will take these tips seriously and apply them to your own life so that you too can live that “abundant life” and that you will finish strong.
Yvonne Moore, MD
“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 1:2 (NLT)
Most of us who have struggled with weight and health issues have heard of the ketogenic or “keto” diet. I have had several patients over the years ask me if I “believe in Keto” as if it were some disreputable underground movement. Opinions about this dietary strategy are all over the map. Countless articles on the internet tell you how good it is while others warn of its dangers. The truth likely lies somewhere in between those extremes. Hopefully this blog post will clear up some of the confusion.
The ketogenic diet was originally a therapeutic diet that has been used since the 1920’s by doctors to treat seizures in children who did not respond to any other therapies. Basically the diet consisted of a high percentage of fats with moderate protein and a very low amount of carbohydrates (20-50 TOTAL grams/day). This is not to be confused with the Atkins diet so popular in the 70’s which was a very high protein diet. The science behind the effectiveness of the keto diet is that in the absence of carbohydrates the liver uses fat to make an alternative source called ketones to fuel the body. Without a heavy load of carbohydrates, the fat storage hormone insulin is reduced and the body can now access its own fat stores to produce the energy it needs throughout the body, including the brain. The use of ketones instead of glucose by the brain is felt to be responsible for the reduction in seizures. Somewhere along the way the ketogenic diet has made its way into the mainstream because while it can be therapeutic for some specific diseases, it can also be can be used to promote weight loss because of the increased fat burning.
So how does a diet that restricts simple carbohydrates promote weight loss? At the risk of sounding like a broken record, it is all about how the types of foods we eat impact insulin levels. Simple carbohydrates like sugar, bread, rice, pasta and potatoes cause an increase in insulin levels in order to lower the blood sugar. Protein has a lesser effect on insulin levels and fats have no effect at all. You should recall from an earlier blog post that insulin is a fat storage hormone. The carbohydrates we eat must be immediately used as fuel or insulin will cause the body to store it as fat. Fat is our body’s natural back up fuel supply. The problem is that we rarely use up all the fuel we take in from processed carbohydrates and it stays with us in the form of increasing body fat. This is why a diet that is low in carbohydrates has been documented to result in significant weight loss, at least in the short term. The ketogenic diet takes the standard low carbohydrate diet to the next level by severely limiting starchy carbohydrates and encouraging that most of one’s daily intake come from fats and proteins.
(Photo credit: DietDoctor.com)
Proponents of the ultra low carbohydrate ketogenic diet tout these documented benefits:
1. Diminished hunger. One of the drawbacks to a high carbohydrate diet is the incessant hunger. An eating plan high in fats will help you stay satisfied because it is less likely to spike insulin levels to reduce your blood sugar and trigger hunger. This diminished hunger makes the ketogenic eating strategy much easier to stick to than a conventional low fat calorie restricted diet.
2. Improved cognition and mental clarity. This is thought to be due to the brain’s use of ketones instead if glucose for fuel.
3. Reduced cravings for unhealthy foods. The taste buds change over time and cravings for starchy foods diminish.
4. Improvements and reversal of prediabetes and diabetes. Again very low carbohydrate diets have been shown to improve insulin resistance. The more insulin resistant a person is the more beneficial it is to restrict the intake of simple carbohydrates.
5. Increased energy and improved athletic performance. Ordinarily the body’s supply of stored carbohydrates (glycogen) only lasts for a couple of hours of intense exercise. After a few weeks of a ketogenic diet, the body learns to use its much more plentiful fat for fuel leading to longer endurance without constantly having to re-fuel. Even the thinnest person has thousands of calories of energy stored in body fat. (Since I switched to this way of eating I do all of my morning workouts and have done numerous half marathons in the fasted state!)
6. A ketogenic diet can be a helpful adjuvant for the treatment of epilepsy and possibly other neurologic disorders. While first used for children with epilepsy, the diet is now being used in some adults to reduce the amount of medication required to decrease the number of seizures. Use of the diet is also now being studied to treat other neurological disorders as well as for the prevention of Alzheimer’s in persons with a strong family history of the disease.
Detractors of the ketogenic diet point to possible health risks:
1. Eating too much fat is bound to lead to high cholesterol and heart disease. There is much debate about whether consuming dietary fats increases the risk of cardiovascular disease. What we do know is that all fats are not created equal. Most experts agree that fats such as those found in processed convenience foods (trans fats) are artificially produced from hydrogenated vegetable oils are not good for anyone. On the other hand, naturally occuring monounsaturated fats like those in avocados, nuts and olives as well as the omega 3’s found in salmon and sardines are quite healthy and have been shown to actually decrease the risk of heart disease. The controversy lies with saturated fats from animal sources like meat, poultry, eggs and dairy products. You can find studies that support the deleterious effects of animal fats as well as many others that fail to show any link between the consumption of animal fats and heart disease. The good news is that there are enough good healthy fats available that you can achieve the benefits of a ketogenic diet without eating animal fats at all. In fact, we now know that it is not necessary to eat excessive amounts of fat to adhere to a ketogenic way if eating. The major key to success with keto is keeping the carbohydrate intake very low, not eating excessive amounts of fat. It is even possible to be vegetarian and/or vegan and still adhere to a ketogenic diet. The diet can be personalized to taste preferences and genetic profiles. A low carb lifestyle is NOT “one size fits all!”
2. The body, especially the brain needs carbohydrates to function normally. This is a medical myth. The brain is perfectly capable using ketones to fuel its daily function once a person becomes fat adapted.
3. The diet causes too many side effects. In the first few weeks on a ketogenic diet, some people can experience lethargy, dizziness, leg cramps, bad breath, constipation and decreased physical performance. We established in an earlier blog that simple carbohydrates can be addictive. The so-called “keto flu” that some experience when starting a low carbohydrate eating plan is in part due to withdrawing from dependency on carbohydrates. The dizziness and leg cramps are usually related to the electrolyte loss from the increased urination in the early stages and respond to magnesium and salt replacement. All of these symptoms go away as the body adjusts to the lower carbohydrate intake.
4. The diet is “dangerous.” There are some individuals who should not be on a ketogenic diet without medical supervision. This would include diabetics, hypertensive patients on medication, patients on medication for mood disorders and those with severely abnormal lipid profiles. Such supervision is necessary because the diet causes shifts in body chemistry which might affect medication dosages and side effects. Supervision is also needed with pregnant and lactating mothers and for children to assure that all nutritional needs are met.
Those of us who have switched to a low carbohydrate eating plan for health reasons and have reaped the benefits see it as a long term lifestyle and not a quick fix. The bottom line to successful weight loss and maintenance is finding an eating plan that you can adhere to over the long haul. The question for you to ask yourself before embarking on the severe carbohydrate restriction of the ketogenic diet is whether this is something you can live with indefinitely. Otherwise, keto becomes just like any other fad diet with initial success followed by rapid weight regain caused by returning to the eating patterns that caused you to gain weight in the first place.
““Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.”
This blog entry will discuss one of the most prevalent but misunderstood conditions in medicine – prediabetes. A diagnosis of prediabetes means that your blood sugar is elevated but not high enough yet to be diagnosed with type 2 diabetes. It is estimated that one in every 3 adults has prediabetes and that the vast majority of them, 84 percent by one estimate, do not know that they have it. Persons with prediabetes are at significantly increased risk of developing full blown type 2 diabetes, heart disease and stroke.
Over the years I have seen many patients in my practice who have been told that that their blood sugar is a “little high” or “borderline.” What they likely have is prediabetes. Prediabetes is not just diabetes lite, it is a serious health condition in itself. Normally the pancreas produces insulin which causes the cells in the body to take in sugar from the blood to be used as energy. Persons with prediabetes have become insulin resistant. This means that the cells in the body do not respond normally to insulin which causes the body to make more and more insulin trying to get the cells to respond. This chronically high level of insulin that does not work properly is at the core of the problem. While this excess insulin no longer works properly to lower blood sugar it is very efficient at storing body fat. This is why persons with prediabetes tend to hold on to belly fat and have trouble losing weight!
Before the blood glucose is high enough for a diagnosis of diabetes, a person may have prediabetes for years because there are no reliable symptoms. If a treatment plan is not instituted, up to 30 percent of them will progress to type 2 diabetes within 5 years. Complications of diabetes are numerous and include heart disease, kidney damage, nerve damage and impairment of vision. Fortunately, if a diagnosis of prediabetes is made early it can often be completely reversed such that the person might never develop diabetes.
Risk Factors for Prediabetes
It is important to know if you are at risk for prediabetes so that you can discuss being tested for it by your primary care provider. It should be noted that African Americans, Latino Americans and American Indians and Pacific Islanders are at greater risk for developing prediabetes. If you have any of the following risk factors, you should be tested for prediabetes.
1. Being overweight or obese
2. Being age 45 or older
3. Having a parent or sibling with type 2 diabetes
4. Exercising fewer than 3 times a week
5. Having a history of gestational diabetes or of delivering a baby over 9 pounds
6. Having a history of polycystic ovary syndrome
One simple test that does not requite an overnight fast is the hemoglobin A1C. This test tells what the blood glucose level has been averaging over the last 3 months. An A1C level below 5.7% is considered normal. An A1C level between 5.7% and 6.4% is considered prediabetes. An A1C level of 6.5% or higher on two separate tests indicates type 2 diabetes. Once a diagnosis of prediabetes is made, it is usually within your power to return your blood sugar and A1C values to normal with a few very simple lifestyle changes.
How to Reverse Prediabetes
1. Eat a healthy diet! Remember that it is the sugars, simple starches and processed “junk” foods that keep the insulin levels high and lead to fat storage. Work with a nutritionist to learn which foods are likely to spike blood glucose and insulin the most so that those foods can be avoided. The optimal carbohydrate intake will vary from person to person but should certainly be significantly lower when trying to reverse prediabetes.
2. Losing weight. If you are overweight, losing as little as 5-10 percent of your current weight can improve your blood sugar levels. The weight loss should come naturally as you implement the above mentioned diet lower in simple carbs and processed foods.
3. Exercise regularly to reduce insulin resistance, increase your energy level and improve your mental health. The goal is 30 to 60 minutes of moderate activity at least 5 days a week. Regular exercise is also a great stress reliever. Walking, jogging, dancing, biking, swimming, exercise classes or videos are just a few examples of moderate exercise.
4. Quit smoking. Smoking is a risk factor not only for heart disease and lung disease but for insulin resistance, prediabetes and type 2 diabetes. Smoking has no place in a healthy lifestyle.
5. Drink plenty of water as a healthy alternative to sugary sodas, juices and energy drinks. How much you should drink depends on your size, activity level and climate. The color of your urine will tell you if you are drinking enough water. If your urine is dark yellow rather than pale yellow, you are likely not drinking enough.
6. Limit or avoid alcoholic beverages. Not only is alcohol a source of empty calories but it lowers your inhibitions making you less likely to make healthy choices with your meals.
In some cases, prediabetes is so far advanced that the lifestyle changes we have discussed may not be enough. If you have made those changes and continue to have abnormally high blood glucoses, your primary care provider may suggest medications to lower your blood glucose as an adjunct to your lifestyle changes.
On a personal note, my own diagnosis of prediabetes in my early 60’s turned out to be a blessing in disguise for me. I had nearly every risk factor on the list. However, once I made the lifestyle change of markedly reducing my consumption of simple carbohydrates, my glucoses and A1C levels returned to and have remained normal without medication. It is my prayer that if you you have been diagnosed with prediabetes, you too will be able to make the changes that will reverse the condition.
“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 1:2 (NLT)
When I first started writing this blog 3 years ago, I was on a quest to finally solve the mystery of why I have been a yo-yo dieter for my entire adult life and how to get off that merry-go-round once and for all. I had also developed some medical issues that needed to be addressed. In the ensuing months I have learned a lot about myself and what it takes to get and stay healthy and I have tried to pass along some of what I have learned to you so that perhaps you might benefit not only from my successes but from my mistakes as well.
Because I am fighting personal battles with prediabetes and hypertension, the combination of 16:8 intermittent fasting and a low carb way of eating along with DAILY moderate exercise have gotten me healthier at 68 than I was at 40. My current lifestyle is what I call my “secret sauce” that has finally gotten me off the dieting merry-go-round. Regardless of what lifestyle choice gets us to our healthiest selves (it will be different for each of us) there is still one area of behavior that can derail all of our efforts to stay healthy. In a previous entry, I discussed emotional eating specifically but it turns out that it is only one of the many types of behaviors known as mindless eating. I am slowly coming to grips with the reality that I am now and have always have been a mindless eater.
I make this confession because it is an ongoing struggle for me and I know that it is a problem that many of us have without even knowing it. Recently I have been studying the concept of mindfulness as it applies to all areas of our lives. To be mindful is to be fully present and engaged in the moment without dwelling on the past or the future. Even the bible instructs us not to worry about tomorrow for it will take care of itself. Mindfulness is about focus and concentration without distractions. The opposite of mindfulness is mindlessness. We all have moments of mindlessness. Have you ever been reading a book or an article and had to go back and reread a section because you didn’t know what you just read? Your eyes may have been scanning the page but your mind was somewhere else. In a similar way, when we don’t give our eating our full attention in the moment, we are eating mindlessly and likely to eat beyond what we truly need to eat to stay healthy.
Here are just a few examples of mindless eating::
Eating anytime you are not “stomach growling'” hungry or continuing to eat beyond fullness
Standing at the refrigerator or pantry nibbling on whatever is there
Eating directly from a large container of food
Eating while watching tv, scrolling social media, reading, or working – this can lead to overeating
Eating popcorn at the movies or a hotdog at a sporting event out of habit – I call this recreational eating.
Eating because someone left treats in the break room at work
Eating because you are sad, angry, lonely, frustrated or tired or because you are happy or celebrating – also known as emotional eating
Eating in your car
Eating to satisfy a craving for a specific food even if you are not hungry
The list goes on and on!
When I realized I have done all of these for as long as I can remember, a lightbulb went off in my head. Growing up I was a “latchkey kid.” That means that from the age of 10 through high school, I was home alone between 4 and 11 pm every day. I was not allowed to have company so my friends were the television and food. I ate dinner alone in front of the tv every weekday!! No wonder I became an obese teenager. Studies have shown that eating in front of the tv, or distracted eating, impairs our ability to recognize when we are full and leads to chronic overeating! Even if you are eating healthy foods, the tendency is still to overeat!
There are multiple strategies you can try to help curb mindless eating. It is a learned behavior and with a little effort can be unlearned. Here are a few tips to get you started.
Think before you eat. Ask yourself if the reason you are about to eat is for any other reason than stomach growling physical hunger. If it is, find other ways to address those reasons without food. Remember that physical hunger is the God given mechanism to let us know when to eat, learn to listen to it. You don’t go to the restroom just because you happen to pass one if your bladder isn’t full so don’t pop a cookie into your mouth just because you see it.
Do not eat a meal or a snack unless you are sitting down with a plate or bowl instead of eating from packages. The mere inconvenience of having to put the food on a plate might deter unnecessary eating. Avoid eating in your car or standing up.
Serve yourself adequate but not large portions of foods that nourish your good health. Try to keep sugary treats and highly processed foods to a minimum and EAT REAL FOOD! If you are eating out, recognize that most restaurants serve portions that are larger than what one person should be eating at a meal. Either share your meal or ask for a carry out container at the start of the meal and put half of the meal in it for the next time you are truly hungry.
Give your food your full attention by eating without multitasking with the tv, a book, a computer or phone. If you must eat alone use mealtime as a quiet time for reflection and gratitude. Take the time to appreciate the taste, aroma and texture of your food. If you do not like eating in silence, try playing some low volume soft jazz or instrumental gospel music in the background. It can make mealtime a very relaxing experience and a great way to de-stress.
Eat slowly and stop when you are comfortably full. It takes a full 20 minutes for your brain to realize your stomach is full. Pause between bites and sip water to slow you down. If you eat too fast you are more likely to overeat.
If you can think of other tips, feel free to add them in the comments. In the interest of full disclosure, while I have been researching this blog I have spent the last two weeks using myself as a test case to try to break my lifelong habit of distracted eating. I have eaten all my food sitting down at a desk or table from or plate or bowl without watching tv, reading or looking at my phone. I have to admit that distracted eating has been one of the hardest habits I have ever tried to break! I challenge you to try it for a week. It really takes effort! It is said that it takes 21 days to develop a habit, so after another week I should have an additional reliable tool in my toolbox to help me become a healthier me.
Yvonne Moore, MD
“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit. 3 John 1:2 (NLT)
The health and fitness industry has been all abuzz in recent years about intermittent fasting (IF) or time restricted eating as if it is something new. Fasting simply means going for a period of time without eating. Many of the religions of the world have been using periods of fasting as a spiritual practice for centuries. There really is nothing new under the sun. All of us fast every day while we are sleeping. The only thing that makes today’s concept of fasting different is that research has now proven that extended periods of fasting can have a number of health benefits.
For the purpose of this blog entry, I will be giving you a basic introduction to the concept of time restricted eating of 24 hours or less without food based on the research as well as my personal experience. I will not be discussing the more extended fasting regimens that might go on for several days or even weeks. These extended fasts are best done under the supervision of a medical professional.
HOW INTERMITTENT FASTING PROMOTES GOOD HEALTH
Our bodies are always in either one state or the other, we are either in the fasted state or the fed state. During the fasted state our bodies are resting and repairing themselves. One of the most important aspects of the fasted state is the reduction in the hormone insulin which you will recall from previous blogs entries is known as the fat storage hormone. Any time you can lower your insulin levels for prolonged periods of time you are less likely to increase your body fat. In addition, fasting can reverse insulin resistance which has been linked to the development of obesity and Type 2 Diabetes. When the body no longer has food for fuel it turns to the glycogen stored in the liver. Once the glycogen stores are depleted, the body begins to burn its own fat. Hence, intermittent fasting has became a valuable tool for many of us both for weight loss and weight maintenance and for our attempts to achieve good overall health.
In addition to weight loss and the prevention of obesity and diabetes, intermittent fasting has been shown to have numerous other health benefits including improved mental focus, better digestion, decreased overall inflammation, better heart health and an improved immune system. Intermittent fasting also can play a major role in management of the symptoms of the perimenopause and menopause in women. As an aging woman, I have experienced those benefits myself and have begun recommending IF to patients.
TIME RESTRICTED EATING PLANS
1. Short fasts are fasts between 12 and 15 hours in a 24 hour period. For example, a 12:12 fast means that you fast for 12 hours each day. All of your meals are eaten within a 12 hour “window.” This usually means that you simply stop eating 3-4 hours before bedtime and have your first meal of the day 12 hours after whatever time you had dinner. If you are a nighttime snacker, this simple change in your eating habits will be a challenge at first but it is a great way to decrease your overall food intake. Close your kitchen by 8pm, stop eating for the night and you are well on your way to a fasting lifestyle. These short fasts are thought to be the easiest of the fasting approaches because most of the fasting is done while you are sleeping.
2. The most popular IF plan is 16:8 in which your eating window is only 8 hours per day. During your fasting window you are encouraged to drink water and 0 calorie beverages like black coffee and tea. With this plan you can usually get in two meals during the eating window. Some experts believe that unless you fast at least 16 hours you may be missing out on some of the health benefits of fasting. Some choose to stretch out their fasting window to 17 to 23 hours daily. These longer daily fasts are thought to be necessary to reap benefits of autophagy wherein the body begins to clean out the old, unwanted, and unneeded cellular material, as well as fixing and recycling damaged parts. Autophagy is thought to be important for being our healthiest selves as we grow older.
3. The 23:1 mode of daily fasting is also known as known as One Meal a Day or OMAD. You get to decide which single meal you choose to have but most OMAD users fast from dinner to dinner so they can have the evening meals with family and/or friends.
4. Eat Stop Eat is a strategy that has you refrain from eating for a full 24 hours once or twice a week and to eat normally on the non fasting days.
5. The 5:2 plan, also called the modified Alternate Daily Fast method, restricts calories to 500 on 2 non consecutive days of the week with normal eating on the other days. Many argue that this is technically not a fasting regimen but I include it here for the purpose of informing you of the option.
MYTHS ABOUT INTERMITTENT FASTING
1. Fasting starves the body and will zap your energy. The truth is that even lean individuals carry hundreds of calories in their livers in the form of glycogen and in their body fat. That is why we have stored fat in the first place, to use as a food source when food is not available. No one ever starved to death going a few extra hours without food. We have been told for years that we need to eat 5 times a day to keep our blood glucoses up. That is simply not true but is certainly what the food industry would like for you to believe. In the decades that we have followed this advice we have seen the rates of obesity and diabetes skyrocket. There must be a better way!
2. You will be ravenously hungry if you fast. A lot of the eating we do is out of habit because we have trained our bodies to eat at certain times. We can also train our bodies NOT to expect to eat by easing into the fasting lifestyle gradually. Most people have what I call head hunger at the expected mealtimes the first few days of a fasting lifestyle. That why it is a good idea to start a fast after a satisfying meal followed by overnight sleep then pushing your first meal of the day an hour later each week. Drinking water and zero calorie beverages are a big help in curbing hunger and cravings in the early weeks of a fasting lifestyle. Cutting back your consumption of sugar, simple starches and processed foods will also make you more successful at fasting. The body will learn to crave whatever you regularly feed it. If you continue to eat sugary treats, you will continue to crave sugary sweets.
3. Fasting will make it difficult to concentrate. Most people report that once their bodies adjust to a fasting lifestyle they actually have better mental acuity. It is not true that humans need food to be mentally sharp. Quite the opposite is true. Think of how sleepy you get after a big meal when the blood flow to the brain is compromised by digestion. Studies have shown that there is actually increased brain activity in mammals in the fasted state.
4. You can eat whatever you want during in your eating window. This is the most dangerous myth of all! Let us not forget that this is a healthy living blog. The key to a healthy lifestyle is not just when you eat, it is also WHAT you eat as well. You cannot use fasting as an excuse to pig out on junk food regardless of what you see on social media! Unless you nourish your body with leafy greens, protein, healthy fats and fiber, fasting alone will not help you reach your wellness goals.
WHY SHOULD YOU CONSIDER FASTING
According to Dr. Jason Fung, author of the Obesity Code and the Complete Guide to Fasting, there are several reasons to consider a fasting lifestyle.
1. Fasting is simple and convenient. Even if you eat just one less meal a day that is one less meal you have to plan and prepare and take the time to eat. Think of the time you will save.
2. Fasting is free. After all the money most of us have spent on diet programs, we finally have a strategy that doesn’t cost a penny. Not only that but you will be cutting your food budget by at least one third! In a sense you are being paid to lose weight and improve your health!
3. Intermittent fasting is flexible. It can be used with the dietary eating style of your choice. Because I am pre-diabetic, I use 16:8 daily IF in combination with a low carb/healthy fats eating style. Low carb eating is a great way to get rid of cravings and hunger and makes it easier to be a consistent faster. However, IF can also work wIth other healthy eating plans like vegetarian, vegan, plant based, whole 30, paleo, keto, etc. Once you find the eating plan that works with your health needs and goals, time restricted eating is a great adjunct to make that plan even more effective.
4. Intermittent fasting is great for maintenance of weight loss. Regardless of the method you use, 80-90% of persons who lose weight will regain it within 2 years. Intermittent fasting is a lifestyle that you can use forever in order to stay at a healthy weight.
On a personal note, I originally started IF 2 years ago searching for a way to maintain the weight loss I had attained by switching to a low carb way of eating. I was determined not to do what I had done so many times before when I regained the weight. Not only was I able to maintain the weight loss, I was able to do all my morning workouts in the fasted state without feeling hungry! I have even done several half marathons in the fasted state with no need for carbs before, during or after the races. In the past few weeks I have been experimenting with stretching my fasting window to up to 23 hours a couple of days a week and I am amazed at the amount of energy I have on those days. I can also report that my gimpy left knee hardly ever talks to me any more. I think she likes this fasting lifestyle!
As always, I do not claim to have all the answers to how to become a healthier you but it is my prayer that the information you find here will help you in your journey. I encourage you to share the blog with your friends and family and to contact me in the comments if you have questions.
Yvonne Moore, MD
“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 1:2 (NLT)
For this month’s entry I would like to pivot to writing about one of the specific disorders that patients have asked me to discuss. The goal here is not to give individual medical advice but to help you understand these disorders and how they might be impacting your overall health. Even if you personally are not dealing with a particular disorder, you likely have a wife, a daughter, a mother, a sister or a friend who might benefit from the information I will be sharing.
The first topic I would like to discuss is Polycystic Ovarian Syndrome (PCOS). I selected PCOS because I have found it to be a prevalent problem in my Gynecology practice as well as in the general population. While it often goes undiagnosed, it is the most common reproductive disorder in the world. PCOS is a condition whose primary signs are irregular menstrual cycles due to failure to ovulate (anovulation), male pattern hair growth (hirsutism) or balding and multiple small cysts on the ovaries. Not all women have all three signs but any two of the three make the diagnosis. The reason understanding PCOS is so important is that it is associated with a number of other medical problems including infertility, acne, obesity, type 2 diabetes, heart disease and hypertension.
The most common initial presentation of those with PCOS is irregular periods due to anovulation. Irregular cycles are very common in early adolescence so it is important to delay a diagnosis of PCOS until at least three years after the onset of menses unless the other two signs are present. In the normal menstrual cycle, only one follicle progresses from what is called a primordial follicle to a mature follicle which is released by the ovary (ovulation). In PCOS, multiple primordial follicles start the process but are unable to complete it due to an excess of the male hormone testosterone. These arrested follicles form tiny cysts that can be seen on USG. The failure of even a single egg to reach maturity in some or all cycles is the reason why so many women with PCOS may have difficulty becoming pregnant. Those enlarged ovaries have also been known to cause chronic pelvic pain.
The traditional treatment for the irregular cycles has been oral contraceptive pills (ocp’s) to suppress the ovaries and provide the patient with regular, although artificial periods. This works fine for the woman not desiring pregnancy but does not get to the root cause of the problem. Moreover, ocp’s and other hormones may not be acceptable to all women for a variety of reasons.
In the woman desiring pregnancy, the traditional treatment of PCOS has been with powerful ovulation induction drugs which work for a significant percentage of women and help them to become pregnant. However, some of these drugs are not well tolerated and have some potentially dangerous side effects. More recently doctors have added the diabetes drug metformin to treat anovulation to increase the likelihood of ovulation and pregnancy (more on why this strategy works later).
Male pattern hair growth and/or balding along with acne are visible manifestations of excess male hormones (androgens), primarily testosterone, produced by the ovaries in PCOS. Here again treatments with OCP’s and other drugs to block the effects of the androgens treat the symptoms but do not get to the root of the problem. Neither do electrolysis and other hair removal medications and procedures. These can successfully get rid of unwanted hair but do not inhibit regrowth.
Now that we can easily see very small cysts in the ovary on ultrasound we can use such studies to contribute to the diagnosis of PCOS. In spite of the name, having ovaries with multiple cysts does not necessarily mean that a woman has PCOS because they can be present in normal women and not all women with multicystic ovaries have PCOS. It is only when the cysts are accompanied by excess facial hair, thinning scalp hair and/or irregular menstrual cycles that the diagnosis is made.
PCOS and Insulin Resistance
No single cause has been identified for PCOS but we do know that there is a genetic predisposition, making it more likely to occur in daughters and sisters of women with the condition. PCOS is often linked with both obesity and Type 2 diabetes although neither condition is considered to be the direct cause of PCOS. Greater than 50 to 70 percent of women with PCOS are overweight or obese and there is a markedly increased risk for the development of diabetes in women who have PCOS. In fact it is recommended that women diagnosed with PCOS be screened for diabetes at diagnosis and every two years thereafter. Recent research has confirmed that the common denominator for these three conditions; obesity, diabetes and PCOS appears to be insulin resistance.
Insulin resistance is a condition in which the pancreas can produce insulin normally but the insulin does not function properly. Insulin is the hormone responsible for moving glucose out of the blood and into the cells where it can be used for energy. When the insulin does not do that effectively, the body responds by releasing more and more insulin leading to hyperinsulinemia (elevated blood insulin levels). High insulin levels signal the body to store fat rather than burn it, leading to weight gain and obesity and making it difficult to lose weight. When insulin resistance is at work, the excess fat is stored primarily in the midsection. This increased abdominal circumference is a risk factor for multiple metabolic diseases. High insulin levels are a precursor to prediabetes and diabetes because even though a lot of insulin is being produced, it is unable to perform its main function of lowering blood sugar. In addition, high blood insulin levels can trigger the increase in male hormones produced by the ovaries that cause the anovulation, hirsuitism and acne seen in PCOS.
This link between PCOS and insulin resistance explains why metformin, a drug used to treat diabetes, can be useful in the management infertility caused by PCOS. One of the mechanisms of action of the drug is to reduce insulin resistance which results in a decrease in testosterone and a higher likelihood of normal ovulation. Some infertility specialists now use metformin alone over traditional ovulation induction drugs as the first line treatment for anovulation in patients with PCOS.
In addition to the medications previously discussed, doctors are also recommending lifestyle changes that can result in significant improvement in symptoms of PCOS. These lifestyle choices are aimed at decreasing insulin levels and improving insulin resistance. Those efforts include weight loss when appropriate, increased physical activity and dietary changes.
Weight loss, whether it is achieved by lifestyle changes in diet and exercise, medications or bariatric surgery results in decreased insulin resistance. As little as a 15% reduction in weight can improve symptoms. The same can be said for regular physical exercise which increases muscle mass which improves insulin resistance even when not associated with weight loss.
Dietary strategies to improve PCOS focus on lowering insulin levels which indirectly lowers androgen secretion by the ovaries. This involves reducing or eliminating the consumption of sugar and simple carbohydrates (bread, potatoes, pasta, rice, etc.) and processed foods. These foods are known to spike glucose and insulin levels and increase insulin resistance. Such a low carbohydrate way of eating should focus on eating foods with a low glycemic index which means they are less likely to spike glucose and insulin levels. These would include complex carbohydrates like green and cruciferous vegetables as well as protein sources like meat, fish, poultry, and eggs and healthy fat like nuts avocado and olive oil. Dietary changes that improve insulin resistance should also focus not only on what to eat but when to eat as well. Another strategy to keep insulin levels low is to avoid snacking between meals and late night eating by practicing time restricted eating or intermittent fasting (see previous blog entry).
Because PCOS is associated with so many more dangerous health conditions, any woman who believes she might have it should see her healthcare professional for a diagnosis and close monitoring. The sooner the diagnosis is made and treatment and lifestyle changes are adopted, the more likely the woman with PCOS is to reverse her risk of conditions that might impair her long term health and quality of life.
Yvonne Moore, MD
“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 1:2 (NLT)