Diet and PCOS

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Barbara Nesbitt: “Hi, I’m Barbara Nesbitt, and I’m in San Diego at the PCOS Conference. I’m with Martha McKittrick who is on our Editorial Advisory Board for OBGYN.net PCOS Pavilion. You’re a registered dietitian in the state of New York?”

Martha McKittrick, RD: “Yes, I am.”

Barbara Nesbitt: “And you work with PCOS patients as well as other patients with diet and exercise?”

Martha McKittrick, RD: “Yes.”

Barbara Nesbitt: “I’m going to let Martha say a few words here. I guess a couple of things we could talk about are how do you get patients? Are they referrals from physicians who have patients with PCOS and/or do women just seek you out on their own, and then what do you do with them after they do?”

Martha McKittrick, RD: “Most of my referrals come from physicians, and I also get a fair amount of referrals lately from being listed on the web. Surprisingly, I get a lot of women who come into my office who need to lose weight, and when I probe a little bit I find out they have PCOS, which is interesting. I’ve been working with women with PCOS for about two years. I’ve been working in the area of nutrition for about sixteen years, mainly specializing in weight control and eating disorders, and I’m also an exercise instructor so I educate them as to what kinds of exercise they should be doing. My approach is really an individualized type of approach, I don’t believe there is one set diet for every person whether you have PCOS or not. I will contact the physician and find out a little bit about their insulin levels or their medical history and then I’ll get a diet history and find out how they are currently eating. I’ll also find out a little bit about what their problem areas are and if there are certain areas maybe it’s emotional eating or they have a really busy schedule, they kind of eat on the run, or they don’t cook and they order in. Then I take all that into account and I’ll help them by planning a diet for them. I’ll figure out approximately how many calories they need to lose weight, if they need to lose weight, and then I’ll figure out how much carbohydrate they should have. I usually recommend starting out at about 40% carbohydrate in their diet and I’ll educate them as to what kind of carbohydrates are better, focusing more on the complex unrefined which have higher fiber content than simple carbohydrates which is sweet stuff or the “white carbs” as I call it which are refined carbohydrates. I find most people eat too many white carbs, and those are the easy carbs - stuff like pretzels, bagels, or muffins.”

Barbara Nesbitt: “Anything with flour or sugar.”

Martha McKittrick, RD: “Anything with white flour or sugar and again those are the easy things to do so I’ll educate them as to what the better carbs are, and then I’ll talk about combining a little protein and fat with the carbohydrate.”

Barbara Nesbitt: “A better carb would be an orange?”

Martha McKittrick, RD: “A better carb would be a fruit, especially the higher fiber fruits, vegetables, whole grains like whole grain bread, brown rice, and bran cereal.”

Barbara Nesbitt: “Get that seven grain bread.”

Martha McKittrick, RD: “Right.”

Barbara Nesbitt: “Not to name any, but the white bread in the little plastic bags we’ll say. I’m through with diets, I’m sorry, I’ve been on everyone they ever had but a lot of my friends, not PCOS patients, but just people I know are on that high protein diet - that one scares me. You lose weight quick but that’s an awful lot of fat and an awful lot of protein.”

Martha McKittrick, RD: “Right, now when you say high protein, I’m assuming you mean high protein - high fat.”

Barbara Nesbitt: “The one they’re on is high protein - high fat, very few vegetables, very few fruits, just eat a pile of corn beef or something.”

Martha McKittrick, RD: “That’s not my first recommendation, but if somebody wants to do it for two or three weeks to lose weight quickly, of course, most of its water weight but whatever gets the person motivated. So if you come into me and say you need to get some weight off quickly, that’s fine but then you need to ease into a healthier diet where you’re having a couple servings of fruit, lots of vegetables, and you don’t totally omit all starches – have at least two servings of starch – but no, I think those diets long-term are not healthy.”

Barbara Nesbitt: “They’re not teaching anyone how to eat.”

Martha McKittrick, RD: “No they’re not, and chances are you will regain all the weight because like you said - you’re not changing behavior.”

Barbara Nesbitt: “Now another thing from being at this Conference these last few days, heart disease or cardiovascular disease is a big problem for these women. Now how could eating all that fat and all that protein do any good for you?”

Martha McKittrick, RD: “It’s terrible, studies have shown that saturated fat which you mainly get in animal products, whole milk, dairy, chicken skin, fatty red meat, as well as transfatty acids or hydrogenated fats which you get in stick margarine, fried foods, and a lot of processed foods, those kinds of fats will raise your LDL bad cholesterol - studies definitely show that.”

Barbara Nesbitt: “I know these people are suppose to drink half and half, heavy cream, or God knows what but they can’t have skim milk.”

Martha McKittrick, RD: “It’s terrible.”

Barbara Nesbitt: “It scares me. I’ve also learned that carbs are a big thing with these people, but do you take a patient that is obese - grossly overweight - and do you then tell them a life long plan of how they should eat?”

Martha McKittrick, RD: “I’ll always tailor it to the way they’re currently eating. I never give them a radical plan because they won’t follow it life long. It has to be tailored and realistic, and I kind of make small changes. I’ll ease them into things and see how far we can go making it realistic. I do a lot of work with behavior modification, you know you cannot hand somebody a diet and say do it - you have to work. I usually have my patients keep food records, and we talk about if you fell off the wagon - why, what could you have done differently? Again, just making small steps.”

Barbara Nesbitt: “I’m certainly not underweight, but I see a lot of obese people drink diet Coke and use saccharin or whatever they call it now in their coffee. Obviously in their head, and these are friends of mine, they think they are really making a big effort here to lose weight but at the same time they are having apple pie with coffee with the saccharin. Don’t people have to learn that sometimes a piece of apple pie won’t kill you but lets forget all those diet Cokes and all that stuff that’s not good for you?”

Martha McKittrick, RD: “Yes, that’s good to say but if someone’s going to drink a regular Coke or a diet Coke and they hate water and seltzer, I guess I would rather see them have a diet Coke versus a regular Coke. Of course, I’d rather see them have water but if they hate water, they’re not going to have it, and then I would say diet Coke. I try and set goals, let’s say they’re drinking six diet Cokes a day; I might suggest they cut it down to two or three. I’m not going to say you can never have it. You know the apple pie you mentioned, I’ll probably say allow yourself one treat a week or one rich dessert a week.”

Barbara Nesbitt: “Yes, I mean it’s a long life, you have to be able to eat something pleasant once in a while. I’m not running around, don’t get me wrong, I’m not the diet Coke nazi. My kids do this, they’re full grown and they’re thin but I have some relatives that are not thin and they think that they’re really cutting down on calories. That’s not where you’re cutting down calories, cutting down on what you’re actually sitting and eating.”

Martha McKittrick, RD: “I think maybe subconsciously what’s going on in their heads is they think having a diet soda is not like having a piece of cake. I don’t know but like I said before, I’d rather see them have diet versus regular but I would much rather see them have water.”

Barbara Nesbitt: “So are you like Dr. Say-vin, a couple of the physicians talked about it earlier, regarding fast food restaurants, just close them all down and we probably would all live longer? Does diet Coke go with prepared fast food, it’s just a quick fix, and quick to get?”

Martha McKittrick, RD: “Prepared fast food is loaded with fat and calories, yes.” 

Barbara Nesbitt: “So you eat that and then you drink a diet Coke with it.”

Martha McKittrick, RD: “You’re against diet sodas.”

Barbara Nesbitt: “I am; I really am. You know why I am, I’m against it because it’s a mindset that a person thinks - I can eat a cheeseburger as long as I’m having a diet Coke.”

Martha McKittrick, RD: “You’re right, I totally agree.”

Barbara Nesbitt: “And I’m not a nazi.”

Martha McKittrick, RD: “So what would you have?”

Barbara Nesbitt: “I’d have a real Coke and get a little fix with some sugar.”

Martha McKittrick, RD: “But these women especially should not be having a regular Coke, that’s twelve teaspoons of sugar. It’s going to shoot their blood sugar up.”

Barbara Nesbitt: “No, they shouldn’t.”

Martha McKittrick, RD: “They should be drinking water.”

Barbara Nesbitt: “Water, I just drank a whole thing of it, I’ll be floating.”

Martha McKittrick, RD: “I love water but if you hate water, you’re not going to have it. I would encourage them to have water but if they’re not going to have it, what’s their other choice?” 

Barbara Nesbitt: “I am a diet nazi, I’ve just decided I am. I personally think that anyone who is grossly obese and has a health problem, I guess, they should just sit down and say either I’m going to do something about this or I’m just going to stay like this and enjoy being like this. Now what do you do with a person that comes in that you just cannot get on the track. Do you give up?”

Martha McKittrick, RD: “I might suggest that they come back to me at a different time. First of all if they’re going to pay my fee and they’re going to come to my office, they have to be somewhat motivated.”

Barbara Nesbitt: “And they’re home cheating.”

Martha McKittrick, RD: “If I see no results, two things could be going on. There could be something going on metabolically, and it’s not their fault. I don’t assume everybody’s lying. Something could be going on metabolically or they could just not be ready to do this. They could be in the process of losing their job, having marital problems, they’re stress eating, or maybe it’s a personality conflict. But I would say take a break, think about it, when there’s a better time in your life come back and see me but it could be two things going on.”

Barbara Nesbitt: “I’m going to tell you something, I know you all hate to hear this, I was a life long smoker and I’ve had some health problems. I’m healthy as a horse but I did have breast cancer and even during all that I could not quit smoking. I had the best doctors in the world say, “Barbara, why can’t you just throw those things away?” I couldn’t throw them away because something wasn’t making it and it was me. Now I quit in January, and I haven’t had a cigarette since and everybody now looks at me like if you can quit so easily why didn’t you quit sooner. I wasn’t ready. Are you saying that these women are not ready so they have to make that decision?”

Martha McKittrick, RD: “You have to be ready because obviously there’s going to be some deprivation there; you have to be ready.”

Barbara Nesbitt: “I’d still like a cigarette once in a while, and I’m sure they would like what we would call a nice meal.”

Martha McKittrick, RD: “You could have a nice meal once in a while but you have to be ready to make small changes every single day.”

Barbara Nesbitt: “So if I was to come to you and I was grossly obese and you were to help me with this PCOS problem of this weight gain, I would have to be committed.”

Martha McKittrick, RD: “Yes, you have to be committed, absolutely.”

Barbara Nesbitt: “I would want to.”

Martha McKittrick, RD: “I think a lot of these women are, I can’t say everybody, but a lot of them are committed because it’s more than just a vanity issue. There’s a lot of potential complications down the line, maybe they’re trying to get pregnant so it’s not just - I want to fit into my size 12 dress, there’s other serious health issues.”

Barbara Nesbitt: “I have a relative that’s grossly overweight and she has said and it’s true, the way people look at you, the way people treat you like you’re not as smart as anybody else, people look at you like they’re disgusted with you, and you’re still just you but that look that you have is what they see. I lost hair and I know what people do, they look at you and there’s another look in their eyes. They don’t look at me like that anymore now that I have a head of hair but that’s how fat people have to live.”

Martha McKittrick, RD: “Absolutely.”

Barbara Nesbitt: “So I think it’s a wonderful thing you’re doing, and I really would give any woman that is grossly overweight five A’s for having the courage to tackle it with diet.”

Martha McKittrick, RD: “Absolutely.”

Barbara Nesbitt: “So I really appreciate what you do because you really care.”

Martha McKittrick, RD: “I do, I enjoy helping people. I see a real big connection with diet, by changing the kind of diet you’re eating or changing the kinds of foods that you’re eating, we can see results, and women feel better. Maybe they don’t lose weight, and I don’t just mean morbidly obese people, I work with people who actually are at a good weight already but by eating a little bit less of refined carbohydrates and having better meal planning, they will say - I have less cravings, I have better energy, and I feel better. So that’s really…” 

Barbara Nesbitt: “The insulin level, everything else is all working better.”

Martha McKittrick, RD: “I have a couple of patients who baffle and frustrate me, and I don’t know what to do with them but I think most people I do see feel better and they can lose some weight if they need to.”

Barbara Nesbitt: “Thank you very much, and I’m glad you’re on our Board.”

Martha McKittrick, RD: “Thank you.”