How is PCOS (polycystic ovary syndrome) diagnosed?

How is PCOS diagnosed?

Many women who suspect they have PCOS feel they don’t need to worry about it until they are ready to start having children. Truth is, the sooner you understand the type of PCOS you have and how best to manage your symptoms the easier things will be for you when you are trying to fall pregnant. Managing your symptoms is also important for reducing your risk of other conditions linked to PCOS.

If you have any symptoms of PCOS it is important that you get an official diagnosis, as this will help you manage your symptoms going forward.

As a reminder not everyone will have all the symptoms, the most common symptoms of PCOS include: hirsutism (excessive hair growth), acne, difficulty losing weight or unexplained weight gain, irregular or absent periods (typically menstrual cycles that are shorter than 21 days and longer than 35 days) and alopecia (hair loss).

The most widely accepted diagnostic criteria are the 2003 Rotterdam criteria, it states that women need to have two of the following three:

  1. Hyperandrogenism (increased androgens):

This includes hirsutism (excessive hair growth appearing in a male pattern e.g. around the chin) and acne. It can be diagnosed on clinical appearance or through testing serum androgen levels or both.

  1. Ovulatory Dysfunction:

This is typically defined as a menstrual cycle that is shorter than 21 days or longer than 35 days. It is important to note that regular periods every 21-35 days do not indicate normal ovulation in women with hyperandrogenism (increased androgen levels). Around 15-20% of women with hyperandrogenism and regular periods suffer with ovulatory dysfunction.

  1. Polycystic ovaries:

This is currently defined as 12 or more follicles (2 to 9mm in diameter) in either ovary, ovarian volume greater that 10ml in either ovary, or both.

As part of your diagnosis it is important that your GP rules out any of the following: late-onset congenital adrenal hyperplasia, Cushing’s syndrome, or an androgen-secreting tumour. It is also recommended that the following tests are carried to assist in diagnosis:

  • Total testosterone
  • Prolactin
  • Luteinizing Hormone and follicle stimulating hormone (LH & FSH)
  • Sex hormone-binding globulin
  • Thyroid stimulating hormone

Getting an official diagnosis is not always easy, unfortunately not all GP’s are up to date with the latest research around PCOS. If your GP does not see the need to test the above, then I encourage you to see another GP who is slightly more up to date on PCOS.

 

 

References:
Azziz R, Carmina E, Chen Z, et al. (2016) Polycystic ovary syndrome. Nature Reviews Disease Primers;2.
Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). (2004) Human Reproduction; 19:41–7.

What is PCOS (Polycystic ovary syndrome)?

What is Polycystic ovary syndrome (PCOS)?

PCOS is the most common endocrine condition affecting women of a reproductive age (15 – 49 years, WHO). The reports vary but it is said to affect between 5-20% of women in that age group worldwide; that’s between 1 in 6 and 1 in 20 women.

Although the name suggests the presences of cysts on the ovaries, this is in fact not the cause, but rather one of the potential symptoms of the condition. These ‘cysts’ are not in fact true cysts, rather follicles that have not matured into ovulation.

The cause of PCOS and the hormonal imbalances associated with this condition are still largely unknown. It is thought to be a genetic condition that is triggered or exacerbated by environmental conditions. The hormonal imbalances seen in PCOS are thought to be responsible for the severity and type of symptoms.

What are the symptoms of PCOS?

It’s important to remember that PCOS shows up differently for everyone. Some women may experience all the symptoms listed below, and others only a few. Because PCOS seems to be impacted by our environment as you go through different stages in your life, some symptoms may vary in severity.

Some of the more common symptoms of PCOS include:
– Acne
– Irregular periods
– Excess facial and body hair
– Insulin resistance
– Anxiety and depression
– Infertility
– Weight gain and difficulty losing weight
– Alopecia (hair loss)

What else do we know about PCOS?

Other conditions associated with PCOS are:

Insulin resistance
It is thought that 65-80% of women with PCOS have insulin resistance. This is one of the reasons women with PCOS struggle to lose weight. Elevated insulin levels also stimulate the ovaries to produce excess testosterone which causes excess hair growth, acne, and irregular periods. Women with PCOS are also more susceptible to developing diabetes because of this insulin resistance.

Cardiovascular disease
Evidence suggests that elevated androgens, insulin resistance and low sex hormone-binding globulins result in increased risk factors for cardiovascular disease, particularly high blood pressure, elevated LDL cholesterol, decreased HDL cholesterol.

Infertility
Caused due to anovulation. It is important to note that women with PCOS have successful pregnancies all the time, it often just takes a little longer due to irregular ovulation.
Psychological disorders
PCOS has been linked to increased rates of anxiety and depression, although the cause has not yet been confirmed. It is thought to be closely linked to other PCOS symptoms including acne, hirsutism, infertility and difficulty losing weight.

Pregnancy complications
Gestational diabetes, pregnancy-induced hypertension and pre-eclampsia and premature births are more common in women with PCOS. This is thought to be caused by hyperandrogenism, insulin resistance and metabolic abnormalities.

Currently there is no cure for PCOS, and although all the above sounds very doom and gloom it is important to remember that PCOS is manageable through lifestyle changes. The good news is that most symptoms can be controlled through a healthy diet, supplements, exercise, adequate sleep and stress management. This will also help reduce your risk of developing other conditions and risks associated with PCOS.

If you think you may suffer with PCOS it is important to ask your GP for a diagnosis to rule out other conditions and start managing your symptoms straight away. For more information on how PCOS is diagnosed and what to ask you GP for, read my blog post on diagnosing PCOS.

 

 

 

 

 

 

References:

1. Azziz R, Carmina E, Chen Z, et al. (2016) Polycystic ovary syndrome. Nature Reviews Disease Primers;2.
2. International PCOS Network (2018) International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018. [Free Full-text]
3. Marshall, J. C., & Dunaif, A. (2012). Should all women with PCOS be treated for insulin resistance? Fertility and sterility, 97(1), 18–22. doi: 10.1016/j.fertnstert.2011.11.036
4. McCartney, C. R., & Marshall, J. C. (2016). CLINICAL PRACTICE. Polycystic Ovary Syndrome. The New England journal of medicine, 375(1), 54–64. doi:10.1056/NEJMcp1514916
5. National Institute for Health and Care Excellence. (2018). Polycystic ovary syndrome. Retrieved from https://cks.nice.org.uk/polycystic-ovary-syndrome
6. RCOG (2014) Long-term Consequences of Polycystic Ovary Syndrome. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk
7. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). (2004) Human Reproduction; 19:41–7.
8. Spritzer PM, Marchesan LB, Santos BR, et al. (2019) Prevalence and characteristics of polycystic ovary syndrome in Brazilian women: protocol for a nation-wide case control study. British Medical Journal Open;9: e029191. doi:10.1136/ bmjopen-2019-029191
9. Yu, H.F., Chen, H.S., Rao, D.P. et al. (2016) Association between polycystic ovary syndrome and the risk of pregnancy complications: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) (51), e4863.

Is dark chocolate good for you?

“If you’re craving chocolate you should have dark chocolate because it’s healthier than milk chocolate”. I’m sure most of you have heard this statement before and wondered what the difference is and if it’s even true.

Let’s take a look at the differences and why dark chocolate is promoted as the ‘super hero’ of the chocolate world.

What’s the difference?

Calorie for calorie, there isn’t much of a difference at all, in fact dark chocolate is slightly higher in calories containing 580 calories per 100g and milk chocolate containing 534 calories per 100g.

An important question then follows, where do those calories come from and why is dark chocolate higher?

I’ve put it in to a table for you, so you can clearly compare the two:

Milk Chocolate (per 100g) 70% Dark Chocolate (Per 100g)
Energy 524kcal 580kcal
Fat 30g 42g
Saturates 18g 25g
Carbohydrates 57g 36g
Sugar 56g 29g
Fibre 2.1g 10g
Protein 7.3g 9.1g
Salt 0.24g 0.08g

 

You’ll quickly see that the biggest differences are in the fat and the sugar content, dark chocolate contains 7g more saturated fat and 27g less sugar than milk chocolate and because fat is more calorie dense than sugar this is what drives the total number of calories up. In addition to this, dark chocolate is also slightly higher in protein and in fibre.

The difference in the two comes from the quantity of original cocoa found in the chocolate, the quality of the other ingredients and the additives.

A standard bar of milk chocolate contains 10-20% original cocoa, whereas a bar of dark chocolate contains anywhere between 30-80% original cocoa, the higher the cocoa concentration the more bitter the chocolate.

Looking at the ingredients list is always a good way to understand the difference;

Milk chocolate bar Dark chocolate bar
Milk**, Sugar, Cocoa Butter, Cocoa Mass, Vegetable Fats (Palm, Shea), Emulsifiers (E442, E476), Flavourings, **The equivalent of 426 ml of Fresh Liquid Milk in every 227 g of Milk Chocolate, Milk Solids 20 % minimum, actual 23 %, Cocoa Solids 20 % minimum, Contains Vegetable Fats in addition to Cocoa Butter Cocoa Mass, Sugar, Cocoa Butter, Natural Bourbon Vanilla Bean, Cocoa Solids: 70% min

As you can see there are very few ingredients that go in to dark chocolate. And although sugar is listed as the second ingredient in each of them the quantities vary greatly, as mentioned in the first table.

Lower quality versions of dark chocolates may contain added butter fat, artificial flavours or colours and vegetable oils so always check the ingredients list.

Milk chocolate contains milk, sugar and fats to make a creamier, sweeter and less bitter variation of its darker counterpart.

Although dark chocolate has a higher amount of fat, nutrients should not be looked at in isolation, it also has higher amounts of protein and fibre, less sugar and other additives. Dark chocolate is also usually consumed in smaller quantities than milk chocolate due to its rich flavour.

Why then is dark chocolate said to be so much better?

The ‘health benefits’ of cocoa come from the flavanols which are naturally occurring in the cocoa plant. These flavanols are anti-oxidants and studies have shown they decrease our risk of heart disease, lower blood pressure, improve glucose metabolism and provide cognitive benefits. As dark chocolate has a higher percentage of cocoa it generally contains a higher amount of flavanols which means gram for gram it offers more health benefits than milk chocolate and you’d need to eat a lot more milk chocolate to gain the same benefits.

But before you think of using this as an excuse to add dark chocolate to every meal of the day to improve your health there’s something you should know. Most of the studies looking at the benefits of these flavanols contained doses of between 100-800mg, the average bar of 70% dark chocolate contains approximately 100mg, therefore to reap the benefits you would need to consume 100g (that’s 1 bar) of 70% dark chocolate a day. When you look at the impact that the fat and sugar content may have on your health it’s clear that this wouldn’t be a wise move.

However, having a few squares of dark chocolate alongside a healthy balanced diet that included other good sources of flavanols such as apples, pears, grapes, tea and red wine (no more than one glass) may be beneficial to your health.

Because dark chocolate has a slightly richer and bitter taste it’s less likely that you’ll over indulge. Milk chocolate on the other hand just tastes like more and before you know it you’re left trying to hide the evidence of an empty wrapper, choosing dark chocolate is a handy tactic to help control your portions.

Should you avoid milk chocolate completely?

Firstly, if you can do this I’m not sure if you’re an alien or a superhuman but I need to meet you! Secondly, no! If you put yourself on a milk chocolate ban you are likely to be left feeling sad, deprived and haunted by images of galaxy bars floating around your head. Practice moderation, if you allow yourself a bar of chocolate (maybe not the whole slab) every now and then, alongside a healthy balanced diet that’s ok!

If you are making a conscious effort to be healthier and know you struggle to cut down on your chocolate intake, then try having a few squares of dark chocolate (70% or more) as a tactic to help you eat smaller quantities.

And let’s be honest not all chocolate bars are created equal, when that craving for a Twix or a Kit-Kat strikes no amount of dark chocolate is going to help. So, eat the darn Twix, just not too often.

What about flavoured dark chocolates?

This is hugely dependant on the brand. Some flavoured dark chocolates contain roughly 20g more sugar per 100g compared to their plain bar and only contain around 40-50% cocoa. Other brands use oils to flavour the chocolate which has little/no impact on the sugar or cocoa content – so choose your brand wisely and ALWAYS read the label!

Its true then, dark chocolate does have more health benefits in comparison to its milk chocolate counter parts but like anything if consumed in excess it’s not going improve your health and it shouldn’t be used as your only attempt to improve your health. Eating milk chocolate is not BAD and it’s not going to have a negative impact on your health unless you consume it in excess.

Eat your fruits and vegetables, be active, and nibble on some chocolate when the craving strikes – it’s all part of living a healthy, happy and balanced life!

How does caffeine keep you awake, and can you have too much?

Caffeine Coffee image

Caffeine is a natural ingredient found in coffee beans, tea leaves, cocoa beans and over 50 other plants. Coffee, tea and fizzy drinks are the most common sources of caffeine in our diet, however it can also be found in some medications like cough syrups. Caffeine is a stimulant, when consumed it causes a feeling of alertness which is why so many of us reach for a coffee first thing in the morning and late afternoon to help wake us up and get over that 3pm slump.

But how does caffeine exert its ‘awakening’ effect on us? In order to understand this, we need to understand why we feel tired in the first place. This process is begun by a compound called adenosine, which is naturally released by our bodies throughout the day.

During the course of the day our muscles and brain are actively working. As they do so they trigger the release of adenosine. Once adenosine is released it binds to receptors in our brain, and this binding action promotes muscle relaxation and sleepiness. As the day goes on more adenosine is released, binding to more of these receptors and making us feel progressively more tired.

By the time bedtime rolls around we feel very tired and sleepy due to a whole day’s worth of adenosine binding to those receptors in our brain, telling us we need to sleep. Whilst we’re sleeping our bodies recover from this fatigue by metabolising (getting rid of) adenosine and we wake up feeling refreshed, unless of course you didn’t get enough sleep (less than 6-8 hours), in which case not all the adenosine was metabolised leaving you feeling a little sleepy and feeling the need for a big steaming cup of coffee.

So what effect does caffeine have in this process?

Once caffeine enters our blood stream it heads towards the receptors that adenosine normally binds to and blocks the way, this stops the receptors connecting to those receptors preventing the feeling of sleepiness and influences the release of dopamine, serotonin and adrenalin which all play a role in causing you to feel more alert and awake.

As your body metabolises the caffeine – this could take anything from 3-10 hours – those receptors become vacant again and the adenosine heads straight for them which is why you start to feel sleepy again. However, if you’ve consumed caffeine too close to bed time it takes a while for this sleepy feeling to return which may negatively impact your sleep.

Can you have too much caffeine?

Yes, you can, but too much will be varying amounts of caffeine for different people. Some are more sensitive to caffeine whilst others may have built a tolerance to caffeine after drinking it for long periods of time.

Current guidelines state that adults should consume no more than 400mg per day. During pregnancy, caffeine clearance from the mother’s blood slows down. Therefore pregnant and breastfeeding women should aim for no more than 200mg/day. Excessive intake in pregnant women may result in growth restriction, low birth weight babies or premature labour.

Here are a couple of common drinks and the amount of caffeine they contain per cup:

Tea – 10-50mg

Green tea – 30-50mg

Energy drink – 40-250mg

Single shot espresso – 75-85mg

Instant coffee – 60-100mg

Filter coffee (Short/small) – 157mg

Can of coke – 32-42mg

How do you know if you’d had too much caffeine?

A normal effect of caffeine is to feel slightly more awake and alert, however, if you are particularly sensitive to caffeine or have had too much you might experience side effects such as an upset stomach, headaches, anxiousness, fast heart rate, insomnia or nausea.

If you are currently consuming a large amount of caffeine and wish to cut down, it’s advisable to do so slowly as drastically reducing your caffeine intake can cause withdrawal symptoms such as headaches and drowsiness.  Here are a few tips to help you gradually cut back:

  1. Replace every second cup of coffee with a decaffeinated version;
  2. Swap your coffee for tea, this way you’re still getting some caffeine but not as much;
  3. Reduce the size of your coffee, if you usually order a tall/large simply scaling back to a short/small will half your caffeine intake;
  4. If fizzy drinks like coke are a source of caffeine for you then try cutting back on the amount you have.

If you feel as though you have become tolerant to the effects of caffeine it can help to eliminate caffeine intake for a month to reduce your tolerance.

Caffeine can be part of a healthy balanced lifestyle and has been linked to health benefits such as reduced risk of diabetes, Alzheimer’s and liver cancer as well as improved physical strength and endurance. However, it should not be used in place of sleep, exercise or a healthy diet – using it as an occasional pick-me-up or simply enjoying a few cups of tea is definitely allowed!

Is Breakfast really the most important meal of the day?

We’ve all been told that breakfast is the most important meal of the day, eat breakfast like a king, lunch like a prince and dinner like a pauper. But is there any truth behind this?

Unfortunately, there are very few studies which look at the overall impact on your health when it comes to skipping breakfast, most are focused on the impact it has on your weight.

The latest study on this topic, published in the British Medical Journal, found that individuals who ate breakfast ended up weighing 0.44kg more and eating an extra 260 calories per day when compared to breakfast skippers. They found no evidence that eating breakfast resulted in weight loss or that skipping breakfast resulted in weight gain. So according to this study it’s totally okay to skip breakfast, however the authors themselves admitted that the quality of the study was low, that the findings should be interpreted with caution and that skipping breakfast should not be used as a technique to lose weight.

Will skipping breakfast cause you to gain weight?

This will depend on your total calorie intake for the day. The reason this statement has been made in the past is that some studies showed that individuals who skipped breakfast were more likely to snack more throughout the day and tended to have a higher BMI. There are many things that could be at play here. Did those who skipped breakfast feel they were entitled to snack more during the day because of their early calorie deficit? Did the individuals with a higher BMI have a high BMI to start with and used skipping breakfast as a way to help them lose weight?

If skipping breakfast means that you end up reaching for a high energy snack mid-morning and being ravenously hungry, or eating larger portions than usual at lunch time then yes, skipping breakfast may result in weight gain. If you’re able to carry on as normal without needing to fill up on high energy snacks and large portions then skipping breakfast should not result in weight gain.

Will skipping breakfast help you lose weight?

Studies have shown that individuals who eat breakfast tend to have a lower BMI, snack less throughout the day and have more energy. Starting your day with a healthy breakfast often sets you in good stead to continue choosing healthy options throughout the day; it helps you maintain your energy levels so you’re not tempted to reach for a sugary pick me up.

By skipping breakfast you will create a calorie deficit in your total daily intake which should result in weight loss, however this is not a strategy I would recommend. Breakfast is a great opportunity to provide your body with some key nutrients like fibre, protein, calcium and other essential micronutrients. By skipping this meal it becomes slightly more difficult to consume the recommended daily intake of these key nutrients and not consuming sufficient amounts of these nutrients will have a negative impact on your overall health, so even if you do end up losing weight you might not feel that great.

Instead of skipping breakfast, have a look at what you are currently eating for breakfast and ask yourself if you are making healthy choices. Could you make some changes to ensure your breakfast is packed with all those good nutrients?

Will eating breakfast boost your metabolism?

Many believe that having breakfast is essential for an efficient metabolism; however there are currently no studies to support this. In fact, studies have shown that skipping breakfast had no impact on metabolic rate. Your metabolic rate is not impacted by the frequency of your meals but rather by your total caloric intake – once you start consuming fewer calories than your body needs for maintenance it compensates by slowing down your metabolic rate.

What if you’re not hungry in the morning?

I hear this one a lot, and whilst I do believe it’s ok to skip breakfast – as long as this isn’t your strategy to lose weight and you’re not depriving your body of the nutrients it needs – I also believe that not being hungry in the morning could be a result of one of two things, or a combination of the two.

Firstly, you’ve trained your body to not be hungry in the morning. If for the last however many years you’ve not had breakfast then you’re likely to no longer feel hungry every morning as you’ve conditioned your body to not expect it. Whilst this isn’t necessarily a bad thing, it’s important you look at the impact this has on the rest of your day – are you reaching for snacks or having larger portions when hunger does finally strike? If the answer is yes, then it might be worth trying to re-introduce a morning meal.

Secondly, you’re eating large portions or snacking on energy dense foods the night before. By doing this it’s likely that you’re not giving your body the chance to adequately digest your evening meal/snack in time for your morning meal, which results in you not being hungry. Try having smaller portions in the evenings or cutting out that late night snack and see if that has an impact on your morning hunger levels.

There is no right or wrong, healthy eating is not a one size fits all approach. The important thing is that you do what works for you, and if you’re not sure then play around with a few of the things I’ve suggested and see if they make a difference to you.

Be Healthy, Be Happy, Be you!

Can your diet help save the planet?

Did you know it’s forecast that by 2050 there will be 10 billion humans inhabiting the planet, that’s an increase of 2.5 billion from today.

That’s a lot of pressure we’re putting on the planet to provide for us all, not to mention the carbon footprints that will be created by all of these billions of beings.

It’s not all doom and gloom, by making changes to the way we live and reducing our carbon footprint it will be possible for us all to live healthily and happily ever after. One of the ways in which we can help is by taking on board some of the recommendations published in the EAT-Lancet Planetary Health Diet.

The planetary health diet was created by 37 scientists in an attempt to define sustainable food systems that will minimise damage to our planet; it informs the changes we need to make to the way we eat. What’s more by making these changes, not only will the planet as a whole benefit but our individual health too.

So what does this diet entail?

Firstly let me begin by saying that I am not a vegetarian or a vegan; I love red meat and fish but I’m also a huge fan of plant based meals and I am making a concerted effort to eat more plant based foods every day. Secondly, the information below is a guide – I’m not saying you need to completely overhaul your diet immediately, I’m simply giving you the information for you to use as you see fit.

A week on the planetary health diet would look like this:

  • 1 portion, 98g of red meat (beef, lamb and pork) per week
  • 1-2 portions, 203g of chicken per week
  • 1-2 portions, 196g of fish per week
  • 2 eggs per week
  • 250ml of dairy per day
  • Nuts, lentils and beans should make up the rest of your protein intake
  • Plenty of fruits and vegetables every day
  • Wholegrain carbohydrates for fibre and energy

What else should you take in to consideration alongside this planet friendly diet?

Choose locally grown seasonal fruits and vegetables, if a food is not sourced locally it needs to travel 100s of miles, be sprayed, stored in refrigerators and artificially ripened in hot houses – all of these things create a huge carbon footprint, so always check what’s in season and find a local farmers’ market for your weekly veg shop.

Reduce food waste; food waste has a huge impact on the environment so taking steps to reduce the amount of food you waste will have a positive impact on the environment. Try not to over-purchase when doing your grocery shop and plan ahead to make sure you don’t have ‘just in case’ ingredients in your fridge that you won’t end up using. Always use leftovers or freeze them for quick mid-week meals and support grocers that sell wonky veg.

If looking at the diet recommendations above feels a little overwhelming and a huge leap from what’s usually on your plate then don’t worry, you don’t need to make these changes overnight and you don’t need to follow the recommendations precisely. The important thing is that you start making small changes where you can – every little bit makes a difference.

I started by turning every second day in to a plant based day and swapping out some of my dairy for dairy alternatives like fortified soy milk and yoghurt. I’ve loved my plant based days so much that they’re becoming more of a norm, and it’s resulted in me being a lot more creative and adventurous in the kitchen!

See what changes you can start making; you never know where they may take you.