Water fasting is a type of fast in which there is an absolute cessation of food consumption while consuming water only throughout the day. It can last for 24-72 hours at maximum and water fasting beyond this should require medical supervision. 

This type of fasting is believed to improve health and can help motivate a healthy diet and lifestyle changes. It has been shown through ancient to modern researches that this type of intervention can stimulate physiological effects that are potentially favorable to health. These include enhanced ketogenesis, modulated hormone activity, reduced inflammation and oxidative stress symptoms. Also includes lipolysis, autophagy, and improved physical and emotional well-being. 

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History of water fasting:

The origin of water fasting for health dates back the development of the present forms of animal life. The first records of human fasting for the remedy of disease go back to the ancient civilizations of Greece and the Middle East. ​The ancient Greeks were great believers in fasting.  

In the past, Socrates (philosophers) fasted for 10 days at a time to attain mental and physical efficiency. Many ancient people used water fasting as a source of treating many types of diseases.

For instance, the ancient Egyptians treated syphilis with fasting cures. And, the great Greek physician, Hippocrates, prescribed fasting during critical periods of disease. Asclepiades and Thessalus employed fasting; Celsus used it in the treatment of jaundice and epilepsy, and the Arab physician, Avicenna, prescribed fasting for three to five weeks at a time.

In Germany, Dr. Adolph Mayer asserted that “fasting is the most efficient means of correcting any disease,” and Dr. Moeller wrote that “fasting is the only natural evolutionary method whereby through a systemic cleansing you can restore yourself by degrees to physiologic normality.”

History thus shows considerable evidence of scientific and clinical work done to determine the effects of fasting. The therapeutic measure of water fasting is not a new idea and has been recognized and studied by brilliant minds for centuries.

What things to keep in mind while preparing for water fasting?

Before anyone wants to try their hands at water wasting, it’s a good idea to learn more about the dangers and risks associated with water fasting. This is more important for those people who are suffering from Diabetes, Kidney disease, Pregnant and/or breastfeeding, Eating disorders.

Here are steps you need to take to safely practice water fasting for weight loss or better overall health.

1. Prepare your body:

For water fasting, it is really important that you prepare your body well. Especially if you have never fasted before in your life. The best way to prepare is to start reducing your meal portion sizes, or you could try replacing a meal with water. You can keep doing this for a few days to see how well your body is adapting the water fast.

2. Stick to 24–72 hours only:

You should only stick to 24-72 hours of water fasting without any medical supervision. More than 72 hours can be dangerous to your health. 

3. Best to try it during your weekend or day off:

Water fasting is not for everyone as it may cause weakness and dizziness in some people. It is best to try water fasting on your weekend or day off especially if your job requires a lot of physical and mental effort. 

4. Resist eating a big meal just after your fasting:

It is normal that you will be famished by the end of your water fast and will feel the urge to consume a large meal. But you should resist the urge to do that just after your fast as it may cause some adverse effects such as bloating or other digestive problems. Instead of doing that, you can opt to break your fast with a light meal. And best to increase the portion size gradually throughout the day.

What can you eat while water fasting?

You can only drink water for the duration of the fast.

What you cannot eat while water fasting?

It is a fast during which all food and drink except water are restricted. That means no coffee, no tea, no alcohol, no zero-calorie sports drinks, or any other beverage. This also means no food.

What are the potential benefits of water fasting?

The list of health benefits of water fasting are as follows:

It may promote autophagy:

“Auto” means self and “phagy” means eat making it to “self-eating.” In other words, autophagy is the body’s way of cleaning out damaged cells in order to regenerate newer and healthier cells. For instance, it may prevent the accumulation of damaged parts of your cells which can be a risk factor for many cancers. 

May help lower blood pressure:

It has been shown that medically supervised water fast may help people with hypertension lower their blood pressure.

May improve insulin and leptin sensitivity:

Insulin and leptin are two important hormones that affect the body’s metabolism. Insulin helps the body to store nutrients while leptin helps the body to feel satiety. Many research shows that water fasting can make your body more sensitive to leptin and insulin. Greater the sensitivity, more effective your bodily hormones.

For example, being more insulin sensitive means your body is more efficient at reducing its blood sugar levels. Meanwhile, being more leptin sensitive could help your body process hunger signals more efficiently, and in turn, lower your risk of obesity.

Helps you in getting a healthier skin:

Water fasting improves hydration and elasticity which in turn will get you a healthier skin. It also activates metabolic pathways that protect your body from oxidative damage and aging.

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IBD stands for inflammatory bowel disease. It is the disease that signifies the ongoing inflammation of your digestive tract. This inflammation is usually chronic. Chronic refers to something that is going on for a long period of time.

And inflammation refers to the condition where due to an infection or an injury, the site of infection/injury gets red, swollen and sore.

Moreover, IBD has two major forms, Crohn’s disease and Ulcerative Colitis. These diseases are relatively rare but the prevalence is increasing and observed more in elderly.

Also learn about FODMAP diet and its benefits. FODMAP diet: Benefits, diet plan and food list

What are the risk factors of IBD?

• Age: it generally occurs often in the age of 15-30 and for some it may also get observed in adulthood.
• Sex: it affects both the genders equally.

It is observed that IBD is more prevalent in the urban as well as developed areas as compared to the rural.

What are the causes of IBD?

The cause of the IBD is not completely understood. But it involves the interaction of the gastrointestinal system with the immune system, genetic as well as environmental factors. Over time, it is seen that genes also play a role in the risk factor and cause of IBD.

If we talk about environmental factors, then we all are familiar with the micro-organisms living in our GI tract and the interaction of dietary components. Diet does play an important role when it comes to the IBD and its management.

Now, if we discuss the role of the immune system in the cause of this disease, there is a decreased immune defense against the increased antigen (foreign substance attacking the body). Furthermore, decreased immune response plays an important role in the causation of this disease. As there is an inflammatory response in this condition, there is damage to the body’s own cells and thereby increasing further inflammation. This causes the formation of ulcers in the intestines and also results in the malabsorption of the dietary components.

Let’s discuss Crohn’s disease and Ulcerative colitis (UC) in detail.

Crohn’s disease and UC share some common characteristics such as diarrhea, fever, weight loss, anemia, food intolerances, malnutrition, growth failure. And other characteristics which are not related to intestines such as liver related conditions, arthritis, and even skin-related conditions.

Moreover, malnutrition becomes a lifelong problem with patients with Crohn’s disease as compared to ulcerative colitis. Due to the malabsorption of nutrients in the body, malnutrition becomes an inescapable condition in these diseases. The body is not able to absorb sufficient nutrients. Which further leads to low immune response and increased inflammation. Thereby making it a vicious cycle or loop.

Now, you might wonder what is the difference between these two forms of IBD. Well, the difference is as follows:

Inflammatory bowel disease dietary management

Diet can be an environmental factor that triggers IBD and usually the triggers are not so uniform. You might see that one person may get triggered by a specific food item whereas another might get triggered by some ingredient or totally different food item. It is very important to observe the pattern of triggers and also to mark the food items you think you might have intolerance for.

But diet is also a remedy for IBD. You can manage your IBD forms with proper dietary modifications and recommendations. 

Persons with IBD are at increased risk of nutrition problems for a host of reasons related to the disease and its treatment. Thus, the primary goal is to restore and maintain the nutrition status of the individual. Foods, dietary and micronutrient supplements, and enteral as well as parenteral nutrition may be used to accomplish that mission. 

There is no single dietary regimen for reducing symptoms or decreasing the flares in IBD. Diet and specific nutrients play a supportive role in maintaining nutrition status, limiting symptom exacerbations, and supporting growth in pediatric patients. 

Energy:

Energy needs of patients with IBD are not greatly increased (unless weight gain is desired). Generally, when disease activity increases basal metabolic rate, physical activity is greatly curtailed and overall energy needs are not substantially changed. 

Protein:

Protein requirements may be increased, depending on the severity and stage of the disease and the restoration requirements. Inflammation and treatment with medications induce a negative nitrogen balance and cause a loss of lean muscle mass. So, to maintain positive nitrogen balance, 1.3 to 1.5 g/kg/day of protein is recommended.

Fats:

Omega-3 fatty acid supplements in Crohn’s disease significantly reduce disease activity. Use of omega-3 fatty acids or fish oil supplements appears to result in a significant medication-sparing effect, with reductions in disease activity. In cases in which fat malabsorption is likely, supplementation with foods made with medium-chain triglycerides may be useful in adding calories. And also serving as a vehicle for fat-soluble nutrients.

Carbohydrates:

Excessive intake of lactose, fructose, or sorbitol may contribute to abdominal cramping, gas, and diarrhea; and high fat intake may result in steatorrhea. However, the incidence of lactose intolerance is no greater in patients with IBD than in the general population. Patients with IBD who tolerate lactose should not restrict lactose-containing foods because they can be a valuable source of high-quality protein, calcium, and vitamin D. 

Minerals and vitamins:

Supplemental vitamins, especially folate, B6, and B12, may be needed. Also, minerals such as iron and trace elements to replace stores or for maintenance because of mal-digestion, malabsorption, drug-nutrient interactions, or inadequate intake. Diarrhea can aggravate losses of zinc, potassium, and selenium. Patients who receive medications may also need supplemental calcium and vitamin D. 

Dietary fiber:

Patients with strictures or partial bowel obstruction benefit from a reduction in dietary fiber or limited food particle size. In other words, follow a low residue diet to relieve abdominal pain and diarrhea.

Fluids and Electrolytes:

It is important to drink adequate amounts of fluid. Fluid requirements increase during or after episodes of diarrhea and with exercise. You should also make sure that you also replenish losses of electrolytes from diarrhea. Sodium, chloride and potassium as well can be replenished by drinking drinks, such as ORS.

Probiotics and prebiotics:

Probiotic foods and supplements have the ability to modify the gut microbiota and potentially modulate gut inflammatory response. Multi-strain probiotic supplements have been shown to be beneficial in maintaining disease remission in patients with UC. However, a different probiotic supplement at a lower dose did not significantly reduce symptoms. Specific probiotic supplements also appear to be useful for induction and extension of remissions in pediatric and adult UC. 

Moreover, regular intake of prebiotic foods such as oligosaccharides, fermentable fibers, and resistant starches can beneficially affect the gut microbiota. In addition, fermentation of prebiotics leads to increased production of short-chain fatty acids, creating a more acidic and less favorable environment for opportunistic bacteria. 

Role of Fermented cabbage juice in inflammatory bowel disease:

You might have heard about the role of fermented cabbage juice in the management of IBD. It helps to reduce inflammation. And also the other symptoms of gut disorder especially in the case of Crohn’s disease and ulcerative colitis. As there is chronic inflammation of the digestive tract in both of these forms of IBD, fermented cabbage juice helps to reduce that.

Moreover, many researches on fermented cabbage juice suggest that it helps to heal the gut. You might not be aware of, but cabbage is brimming with various micronutrients and it also possesses antioxidant properties. This property aids in the reduction of inflammation of the gut in IBD.

Role of Wheat-grass juice in inflammatory bowel disease:

Many studies suggest that wheatgrass juice can be used in the IBD management. Especially in the case of ulcers, it helps to reduce rectal bleeding and reduce the inflammation of large intestines. Studies also suggest that wheatgrass juice helps in ulcerative colitis recovery. 

You might be wondering why we are talking about taking juices in place of whole fruit or vegetables. Well, a low dietary fibre diet is recommended in the management of IBD. Whole fruits and vegetables are rich in dietary fibre and that can irritate the digestive system. And therefore, it is better to consume juices instead of whole fruits or vegetables. 

What is the role of a ketogenic diet in Crohn’s disease?

A ketogenic diet is basically a high-fat and low-carbohydrate diet which consists of about 80 % fat, 15 % protein and 5 % carbs. Generally, your body’s primary source of fuel is glucose which is made from the carbs that we eat. When you don’t eat enough carbs, your body goes into ketosis and starts to make ketones from fat, which are used as a secondary energy source. 

There is also emerging evidence that the underlying cause of IBD is a bacterial imbalance in the gut. Gut bacteria survive on sugar and carbohydrates, so by starving them, you can restore balance to your gut bacteria. By doing this, it will help you to reduce symptoms and will also improve your health.

Moreover, a ketogenic diet is low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). These FODMAPs are classically associated with irritable bowel syndrome but may also play a role in Crohn’s disease. And it’s possible that a reduction in FODMAPs is the real reason behind reduced Crohn’s symptoms.

What is the role of Paleo diet in Ulcerative colitis?

The paleo diet includes eating foods like meat, eggs, fruits, vegetables, and nuts. The paleo diet limits the amount of whole grains, dairy, refined sugar, and starchy vegetables that you generally eat. It encourages increasing the amount of healthy fats in your diet, including omega-3 fatty acids.

Following the paleo diet means avoiding foods such as cereals and whole grains, dairy products, legumes, processed foods, refined sugar, potatoes, refined vegetable oils and salt.

Moreover, these restricted foods items may include known common triggers of UC flare-ups.

• As starchy foods cause gas and increase the amount of stool you produce so eliminating these foods could relieve your symptoms.
• Avoiding dairy products can also help you manage symptoms. These symptoms include diarrhea, abdominal cramping, and gas as dairy intolerance is common among those with UC.
• Paleo diet helps you to get higher amounts of antioxidants in your diet from eating more fish and healthy fats. Omega-3 and other antioxidants encourage healing. They may have a protective effect on tissues, reducing inflammation and symptoms.
• The paleo diet allows you to get more B vitamins and other nutrients that you miss out on by keeping whole grains in your diet. People with UC often suffer from nutrient deficiencies because of rectal bleeding, chronic diarrhea, and poor appetite.
• The paleo diet doesn’t include beans and other legumes. These foods may aggravate your bowels and increase stool output and gas.
• Meat, fish, and poultry contain heme iron, which is more easily absorbed by the body than non-heme iron found in plants. People with UC have a high risk of iron deficiency anemia from chronic diarrhea and bloody stools. So, consuming meat, fish and poultry helps you to provide enough iron to correct your iron deficiency.

(Source: https://www.healthline.com/health/ulcerative-colitis-take-control/paleo-diet#paleo-diet-benefits )

What is the role of Intermittent fasting in inflammatory bowel disease?

Intermittent fasting is an umbrella term that describes many different fasting cycles. Rather than focusing on what foods are eaten, it focuses more on when foods are eaten. One theory behind the potential benefits of intermittent fasting is that it can lead to changes in your gut bacteria. It will help to create an anti-inflammatory environment in the intestines and will also restore the gut barrier.

However, it is important to know that achieving these benefits is less about the timing of eating, but rather an overall reduction in the amount of food being eaten. So, for those who are looking for a structured approach to eating, intermittent fasting may be a helpful way to limit excess food. Also, eating a wide variety of whole grains, fruits, and vegetables during periods of remission can help feed our gut microbiome and achieve similar results.

Source: https://www.ibdcentrebc.ca/2021/07/intermittent-fasting-on-ibd/ 

Foods to avoid: 

• Fatty, fried foods
• Spicy foods
• Meats
• Creamy sauces
• High-fiber foods including raw fruits and vegetables
• Nuts, seeds, and beans
• Caffeinated beverages
• Sweets including candy, soda, and juice
• Alcohol

Food to eat/enjoy:

• Applesauce
• Bananas
• Oatmeal
• Lean poultry or fish, plain
• Eggs
• Mashed potatoes
• Canned fruit
• Rice
• Noodles
• White bread
• Diluted juices
• Plain cereals
• Fermented products such as cabbage

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Let’s start by understanding what paleo diet is?

Paleo diet, or caveman diet is a type of diet that resembles to what the early men used to eat. It dates back to human-hunters era, that is many and many years ago, when there was no availability of processed foods. Early men used to hunt their food and then eat it without any processing.

Paleo diet supports the idea of consumption of unprocessed food such as fruits, vegetables, nuts, roots and meat. It excludes all dairy products, sugar, grains, legumes, processed oils, coffee, salt and alcohol. The rule is to not consume any food item that is processed. So, it generally involves very simple cooking methods, and consumption of fresh fruits and vegetables.

Now, you might ask, why paleo diet?

Well, the evidence suggests that back in stone-age era, when there was no such technology and no availability of processed food and food products. Human ancestors survived on a whole-food based diet combined with rigorous physical activity. And it has been assumed that the prevalence of lifestyle related disorder such as obesity or other non-communicable lifestyle related disease were quite low.

No one can actually tell that what exactly the diet of early men would have looked. Because the diet would surely would have been based on the availability of food at that time. But some suggests that it would have revolved around whole foods. Furthermore, some studies suggest that paleo diet may aid in significant amount of weight loss and may also aid in improving overall health of an individual.

Paleo diet: What to eat and what to avoid

Everyone might have their different definition of right paleo diet in their minds. Because, as mentioned earlier as well, the diet of the cavemen would have entirely dependent on the availability of the food. Therefore, some may say that the diet should be high in proteins as the human hunters might have hunted the animals and then consumed the meat. Whereas, some might suggest it to revolve around fruits, vegetables and nuts.

What to eat:

• Fruits
• Vegetables
• Nuts and oilseeds
• Lean meats
• Fish
• Eggs
• Healthy fats and oils

What to avoid:

• Grains, such as wheat, rice, oats
• Legumes such as beans, peanuts, lentils
• Dairy products
• Sugar, artificial sweeteners
• Processed foods, soft drinks
• Vegetable oils

The best way to follow this diet is to just avoid any processed product. If the food item is processed and made in a factory or industry, you must avoid it because that will not be paleo friendly.

Sticking to all the natural sources of foods is the key.

You might come across various versions of paleo diet, because over the course of years, this diet has changed and people from around the world incorporated various changes in the diet. Some people consume rice, or even grass-fed butter during this diet.

Drinks during paleo diet:

• Whenever you are thirsty, your go-to drink should be water. You can squeeze few drops of lemon in it to make the taste better.

• But to satiate your thirst, you can opt for teas and coffees in beverages, though not a part of paleo, but can be consumed in moderation. As we mentioned earlier, there are variations in the paleo diet.

Many people don’t follow a strict format of this diet, they try and include food items and keep increasing the list. So, you may think it as a template of the diet.

Before starting with the sample menu plan for the diet, let’s discuss what researches have to say about this diet.

Researches and Paleo diet

Many clinical trials are performed taking a combination of diets such as Paleo diet along with Mediterranean diet and various other diets. It has been found that paleo diet results in more weight loss, improved glucose tolerance, lower lipid profiles, and better blood pressure management. But to come to a conclusive answer and evidence, more research in this area needs to be done.

Also learn what FODMAP diet is by following this link!

Sample Paleo diet:

A day in paleo diet should look like:

Breakfast: Eggs and vegetables. Along with a fruit. OR Sautéed vegetables with a fruit.

Along with handful of nuts

Lunch: Chicken salad loaded with vegetables OR Boiled fish with vegetables. OR Sandwich in a lettuce leaf or chicken

Dinner: steamed chicken with vegetables OR steamed broccoli and mashed potatoes with loaded vegetables. Strawberries

Snacks: Carrots, handful of nuts, Hard-boiled eggs, a bowl of berries.

Also, to give you a clearer picture of condiments: you can surely use salt, pepper, garlic, parsley, turmeric, chili powder etc.

It’s always better to get a side of lots of vegetables along with your main dish. Be it fish curry, or grilled chicken or you can also make a salad with walnuts and apples and strawberries.

The only drawback of this diet is that it might be a bit expensive for few, and if vegetarian, you might go less on proteins, calcium and other few micronutrients. Though fruits and vegetables are rich sources of micronutrients, few macros might go missing from your diet.

The bottom line:

Paleo diet is a diet that resembles with the dietary patterns of early men or cavemen. It suggests to avoid the intake of processed food and food products and consume only whole foods. The list includes, fruits, vegetables, nuts, roots and meats and fishes. Researches suggest that you can lose more weight by using this diet. But when the goal is weight loss, make sure to keep calories in check. Because paleo diet often does not keep track of calories.

Avoiding the processed foods and consuming only the whole foods is the key of the diet. Though the diet is rich in fruits and vegetables and nuts, but it restricts the consumption of milk and milk products and legumes which are one the major sources of protein and calcium.

The paleo diet has changed during years and you can always substitute few modern paleo options such as rice and grass-fed butter and even gluten-free grains (i.e., grains expect wheat, rye and barley).

Happy dieting!

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What is FODMAP?

FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols.

FODMAPs are a group of sugars that are not completely digested or absorbed in your intestines. When these FODMAPs reach your small intestine, they move slowly, attracting water. When they pass into the large intestine, FODMAPs are fermented by gut bacteria, producing gas as a result. The extra gas and water cause the intestinal wall to stretch and expand. Because people with IBS have a highly sensitive gut, ‘stretching’ the intestinal wall causes exaggerated sensations of pain and discomfort.

FODMAPs are found naturally in many foods and food additives.

What is a low FODMAP diet?

A low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols diet is the diet which is low in foods containing oligosaccharides, disaccharides, monosaccharides and polyols. The principle behind the diet is to give the gut a chance to heal, especially if you have gastrointestinal problems like IBS. 

The treatment for people with IBS include avoiding high FODMAP foods and choosing low FODMAP foods as their daily staples. Also, it is important to monitor portion sizes because having a large amount of a low FODMAP food could turn it into a high FODMAP food.

Who should try this FODMAP diet?

Low FODMAP diets are for those people who suffer from digestive problems such as Irritable Bowel Syndrome (IBS). High FODMAP foods cause irritable bowel syndrome, but they also may aggravate IBS symptoms. That’s why a low FODMAP diet is often recommended for IBS treatment, Small intestinal bacterial overgrowth (SIBO) and also for functional GI disorders other than IBS.

How does the low FODMAP diet work?

Low FODMAP is a three-step elimination diet:

1. Restriction: Firstly, stop eating high FODMAPs foods for a minimum of 6-8 weeks.
2. Reintroduction: Once your stomach calms down, slowly reintroduce them one by one to see which ones are troublesome for you.
3. Personalization: Once you identify the foods that cause IBS or any other digestive symptoms, you can avoid or limit them while enjoying everything else in your diet worry-free.

What happens when a person with IBS eats FODMAPs?

FODMAPs are found in a wide range of foods, and most people eat high FODMAP foods everyday without issue. When a person with GI problems or IBS eat FODMAPs, they move slowly through the small intestine attracting water. When they reach the large intestine, gut bacteria use the FODMAPs as a fuel source to survive. The bacteria rapidly ferment FODMAPs, producing gas as a result. 

These events occur in all people i.e. people with and without IBS. The difference is that people with IBS can have problems with the speed at which contents move through the intestines or a highly sensitive gut wall as well. The extra water and gas in the intestines, causes the intestinal wall to stretch and expand and results in common IBS symptoms. These symptoms are pain, excessive wind, bloating, distension and altered bowel habit such as diarrhoea, constipation or both.

(Source- https://www.monashfodmap.com/about-fodmap-and-ibs/ )

What are the benefits of a low FODMAP diet?

A low FODMAP diet may help in improving the following symptoms:

• pain and discomfort
• bloating and distension
• Bowel habit such as diarrhea or constipation
• quality of life

You can see these benefits are usually within 2-6 weeks of following a low FODMAP diet.

In fact, the diet does not cure IBS symptoms, it just helps people to live more comfortably with their condition.

FODMAPs Guidelines:

• A diet low in FODMAPs may be an effective therapy in the management of GI symptoms in patients with IBS. 
• The low FODMAPs diet limits foods that contain lactose, fructose, fructo-oligosaccharides (fructans), galacto-oligosaccharides (galactans), and polyols or sugar alcohols (sorbitol, xylitol, mannitol, isomaltase, and maltitol). 
• A cutoff value for acceptable amounts of FODMAPs has not been well defined and is likely patient specific. Patients may tolerate small amounts, but symptoms can develop if they consume quantities that surpass their threshold. 
• Nutrition intervention begins with elimination of all high FODMAPs foods from the diet for a trial period of 6 to 8 weeks. 
• The challenge phase begins with a slow, controlled reintroduction of one FODMAPs diet category at a time to observe for symptoms and identify the most challenging foods. 
• Nutritional deficiencies that can arise with the low FODMAPs diet include folate, thiamin, and vitamin B6 (from limiting cereals and breads), as well as calcium and vitamin D (from avoidance of dairy). The goal is to eventually reduce or eliminate GI symptoms, by creating a diet that includes FODMAPs at the most tolerable intake level, and with use of alternative foods. 
• It does not present a cure but a dietary approach to improve symptoms and quality of life. 

(Source – Krause’s Food & the nutrition care process, 14th edition)

A sample FODMAP diet plan:

Table showing high FODMAPs and Low FODMAPs food sources:

To know more, have a look at the file below:

(Source- https://www.ibsdiets.org/fodmap-diet/fodmap-food-list/ )

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What are phytonutrients?

Let’s start this topic by a basic understanding of phytonutrients. Phytonutrients are naturally occurring chemicals or compounds that are present in plants. They are also known as phytochemicals. Or you can also understand them as the chemicals produced by plants.

They have different roles or functions such as protecting the plant from insects or from UV radiations. Phytonutrients are bioactive substances. Now, to make it easier, let me explain what are bioactive compounds. In simple words, bioactive compound is a compound that has an effect on living organism. These compounds are known to be essential compounds.

Phytonutrients have an excellent effect on health of human beings and they may provide health benefits in treatment/prevention of various diseases and in disease management. Moreover, it can be said that phytonutrients have a positive impact on human health.

Do you know that researches say, that phytonutrients being natural compounds have less side-effects as compared to various therapies and treatments such as radiations and chemo-therapy? Furthermore, the best part about them is that they are cost-effective and are easily available. If used widely, they can help in reducing health care cost. Which we all know is way higher in these times.

Let me introduce you to the various bioactive phytonutrients. Some of the important phytonutrients include, polyphenols (you must have heard about them), terpenoids, flavonoids, isoflavonoids, carotenoids (another common phytonutrient), phytoestrogens, phytosterols, omega-3 fatty acids and probiotics.  Now, let’s discuss about the characteristic values of these phytonutrients:

• They are anti-microbial, anti-oxidants, anti-inflammatory, anti-allergic
• Neuroprotective, hepatoprotective (preventing damage to the liver), hypolipidemic and hypotensive.
• They also aid in diabetes and osteoporosis management.

And this is not all, applications of phytonutrients are much wider.

Benefits/Efficacy of Phytonutrients

As mentioned above, we have seen that phytonutrients are loaded with ample amount of benefits corresponding to human health. Be it anti-oxidative properties or anti-carcinogenic or anti-inflammatory properties, they not only possess them, but are way rich in them.

So now, by seeing all these benefits, you might have a question, that What really is the efficacy of phytonutrients?

It is said by researchers that phytonutrients when consumed in diet have beneficial health benefits and promotes overall health. They protect against chronic degenerative diseases such as cancer, cardiovascular, neurodegenerative disease and diabetes, hypertension etc.

Let’s take examples of few phytonutrients to understand the benefits/efficacy:

• Carotenoids, tocopherols, lipoic acids and polyphenols have very strong anti-oxidative properties which helps to reduce the effect of free-radicals on your body.

• Phytoestrogens may help in hormone replacement therapy and are also good for cardiovascular health. These phytonutrients are also known to help in menopausal symptoms.

• Probiotics is another class of phytonutrients and generally constitutes the microorganisms from the following two classes: Lactobacillus and Bifidobacterium. They are used for controlling weight gain or obesity, improves insulin sensitivity and also increases satiety.

It can be said that phytonutrients pose an immense amount of benefits to the human health, but there are some factors that should be kept in mind before consuming them. Such as amount, interaction with the body, and their effects on individuals under certain medical conditions.

Different phytonutrients and their benefits

Polyphenols

• They are naturally occurring compounds majorly found in fruits, vegetables, cereals and even chocolates and legumes.
• Major sources include: cereals, legumes, nuts and oilseeds (flaxseeds, olive seeds), fruits and vegetables. Also found in tea, coffee, cocoa, beer and wine.
• Generally, fruits include 200-300 mg of polyphenols per 100g. Dietary intake of polyphenols may be about 1g per day.

Therapeutic property:

• These are generally available as fortified nutraceuticals and their health benefits include:

• Influential anti-oxidative, anti-inflammatory, antidiabetic, anti-viral, anti-allergic, anti-aging and DNA protective properties.

Resveratrol

It is a natural compound make by plants when they are under stress and under the attack of pathogens. Most commonly found in grapes and peanuts. They are found in grape skins and little in the grape flesh. Do you know that they are present in red wine in good amounts?

Therapeutic property:

• It is considered to be good for cardiovascular health and also possess neuroprotective effects.
• You will be amazed to know that resveratrol has two forms under UV radiations. It goes under isomerization and produced “trans” and “cis” form. Trans form has much more beneficial effects as compared to cis form.
• The most important property of resveratrol is that is has anti-carcinogenic and anti-tumor properties. And that is really great for cancer treatment and prevention.

Flavonoids

Flavonoids are said to be polyphenolic compounds and they are majorly present in legumes, fruits and vegetables, tea, olive oil, walnuts, peanuts and even in spices. Green leafy vegetables, onion, apple and berries are one of the richest sources of flavonoids.

Therapeutic property

• These has been an extensive research on flavonoids. And they have anti-bacterial, anti-viral and anti-oxidative properties. That means they have a protective effect on free radicals.
• They also act against allergies, inflammation, microbes, and tumors.
• Do you know they have a protective effect on inflammatory disease, such as cardiovascular disease and cancer?

Carotenoids

• Carotenoids are one of the major groups of phytochemicals. Majorly found in red, yellow and orange fruits and vegetables, this class possess amazing health benefits.
• Do you know a fun fact: that there are around 700 phytochemicals of carotenoids present and out of these 700, only about 24 are commonly available for the human consumption!
• You must have heard about different carotenoids such as α-carotene, β-carotene, lycopene (present in tomatoes), and lutein.

Therapeutic properties

• They have anti-cancerous properties. And they are also found to be protective against cardiovascular diseases.
• Eye health protection is also one of the properties of carotenoids.
• They also have anti-oxidant properties that reduces the risk generated by free-radicals.

Phytoestrogens

Phytoestrogen are naturally occurring non-steroidal compounds produced by plants. They mimic estrogens in human body. These are present in natural dietary products such as soybeans, wheat, barley and corn.

Therapeutic properties

• Phytoestrogens have similar structure to the estrogens and possess both, estrogenic and anti-estrogenic properties. They also provide protection against bone loss and heart disease.
• You must be aware of menopausal symptoms, and high rates of fractures associated with post menopause. Phytoestrogens protects bone loss.
• They also have anti-cancerous properties and promotes heart health.

Glucosinolates

For this phytonutrient, cruciferous vegetables are the richest source. Furthermore, Glucosinolates are present in the crucifers in very good concentrations. Such as, cabbage, broccoli, cauliflower, kale. Not only these vegetables are rich in this phytonutrient, but also are rich in various vitamins and minerals.

Therapeutic properties

• They are activators of liver’s detoxifying enzymes. Therefore, aiding in detoxification of the body.
• Also have a protective effect on carcinogenesis and from free radicals. They not only helps in digestion but also improves overall digestive health.

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What is pre-diabetes?

Pre-diabetes is defined as the higher blood glucose levels than normal range but not high enough to be diagnosed as diabetes. That is why it is also called as the Borderline diabetes. 

It occurs in those people who already have some insulin resistance or whose pancreatic beta cells do not produce enough insulin to keep blood glucose in the normal range. 

It does not show any clear symptoms for years, so there is a high chance that it often goes undetected until serious health problems shows up. 

Want to know about PCOS? Check out this article. A comprehensive guide- PCOS and Dietary Habits

What is the prevalence of prediabetes?

In the United States, it is estimated that 84 million adults in the USA have prediabetes in 2015 and that’s about 1 out of 3 adults. 

According to a study published in the Indian Journal of Medical Research in 2018, the estimated prevalence of prediabetes in India is 14%. And this data only includes just those people who have been tested. (Source-How should one tackle prediabetes in India?)

According to a survey by National Health of India and National Center of Biotechnology Information, 70.5% of pre-diabetes cases were found in 25–44 age.

While 40% and 51.4% of diabetes cases were found in 25–44 and 45–60 aged individuals, respectively. Pre-diabetes is more prevalent in middle age (25–44 age group) and diabetes in 45–60 age group.

The prevalence of prediabetes is growing worldwide, and authorities have estimated that more than 470 million people will have prediabetes by 2030 (Sethuram K et al.).

What are the stages of diabetes?

Figure: Stages of diabetes

Stage 1: Insulin resistance

Insulin is a hormone which is produced by the beta-pancreatic cells that helps glucose to enter in your muscle, fat, and liver, and use it for energy. 

The insulin resistance occurs when cells in your muscles, fat, and liver do not respond well to insulin.  And because of that, blood glucose cannot be used for energy. In turn, your pancreatic cells make more insulin to help glucose enter your cells. 

If your body becomes insulin resistant, this is what happens:

• Rise in blood glucose (blood sugar) after you eat. 
• Then beta-pancreatic cells produces insulin, but it does not enter the cells and the glucose isn’t introduced to the cells efficiently. 
• Now, glucose stays in your blood because your cells aren’t burning the glucose for energy.
• Over time, continuous high blood sugar levels damage your cells. It may lead to nerve damage, blood vessel and organ damage, cardiovascular disease and more.

Figure: Insulin Resistance cycle

(Image source: Insulin Resistance: Causes, Symptoms, Prevention – This silent condition increases your risk of diabetes, heart attacks, and more)

If this insulin resistance occurs for a long time, it may develop into prediabetes. 

Stage 2: Pre-diabetes

Pre-diabetes is also called borderline diabetes. Because it is at the verge of becoming diabetes mellitus but can be reversed if right measures are taken beforehand.

The most important thing about prediabetes is that it is reversible. You can prevent or delay prediabetes from developing into diabetes with a change in your lifestyle.

It is a serious condition and if not treated, then it can develop into diabetes.

Figure: Pre-diabetes cycle

(Image Source- The Stages of Diabetes: A Guide)

Stage 3: Diabetes

Diabetes is a group of disorders, characterized by high blood glucose concentrations resulting in insulin secretion, insulin action or both. In other words, hyperglycemia develops gradually due to a progressive loss of beta-cell insulin secretion with insulin resistance. 

Stage 4: Post diabetes:

If your blood sugar levels are too high for a long time, then it can lead to serious health problems including heart, nerve, kidney, eye damage and more.

It affects the microvascular and macrovascular of your bodies.

Microvascular diseases due to diabetes:

Diabetes is an important risk factor for Microvascular diseases affecting small blood vessels: retinopathy, nephropathy and neuropathy.

Diabetic retinopathy:

Diabetic retinopathy is the diabetic eye disease which includes all disorders of the retina caused by diabetes. It is the leading cause of blindness in people with diabetes and silent complication with no initial symptoms.

But when symptoms occur, treatment is more complicated and often impossible.

Diabetic nephropathy/Diabetic kidney disease:

Diabetic nephropathy is a condition caused by damage to the filtering system of the kidneys.

In severe cases, it can lead to kidney failure. The long standing diabetic nephropathy can lead to Chronic kidney disease (CKD).

Figure: This cycle shows how Chronic Renal Failure occurs due to diabetes.

(Source: http://www.idf.org/diabetes-education-modules)

Diabetic neuropathy: 

Diabetic neuropathy is a group of nerve disorders caused by diabetes. It causes numbness and sometimes pain and weakness in the hands, arms, feet and legs. Longer the duration of diabetes, the greater the risk.

American Dietetic Association recommendations for screening of diabetic neuropathy:

1. All patients should be assess for diabetic peripheral neuropathy starting at diagnosis of diabetes at least annually thereafter.
2. Assessment for distal symmetric polyneuropathy should include a careful history and assessment of either temperature or pinprick sensation (small fiber function) and vibration sensation using a 128-Hz tuning fork (for large-fiber function)
3. All patients should have annual 10-g monofilament testing to identify feet at risk for ulceration and amputation
4. Symptoms and signs of autonomic neuropathy should be assess in patients with microvascular complications.

Macrovascular diseases due to diabetes:

Diabetes is an important risk factor for Macrovascular diseases affecting large blood vessels: Cardiovascular disease (CVD), Cerebrovascular disease, Peripheral vascular disease (PVD).

Cardiovascular diseases (CVD):

CVD complications are one of the most common causes of morbidity and mortality in people with diabetes.

Coronary Artery Disease, stroke and Peripheral Vascular Disease are increased by 2 to 4-fold in people with diabetes.

Symptoms include chest pain, chest tightness, chest pressure and chest discomfort (angina), shortness of breath. It also include pain, numbness, weakness or coldness in your legs or arms if the narrow blood vessels are present.

Cerebrovascular diseases: 

Cerebrovascular diseases can occur due to sudden narrowing or occlusion of brain blood vessels.

Symptoms include sudden weakness or numbness of face, arm, leg on one side of the body, sudden confusion, sudden dizziness, loss of balance, visual impairment and sudden severe headache.

Peripheral vascular disease (PVD): 

PVD is defined as the reduced blood supply due to occlusion/narrowing of peripheral blood vessels. It is a risk factor for diabetic foot amputations. 

Symptoms include pain on doing any activity, calf pain, numbness in hands and feet.

Other complications due to diabetes:

Liver diseases/liver failure:

Liver is a multi-functional organ. One of the liver’s many jobs is regulating blood sugar, but fat in the liver makes that organ less responsive to insulin. In turn, leaves too much glucose in the blood, which can lead to type diabetes.

Diabetes raises your odds of having a more severe form of Non-Alcoholic Fatty Liver Disease, also known as nonalcoholic steatohepatitis (NASH). Fatty liver disease itself usually causes no symptoms. But it raises the risk of developing liver inflammation or scarring (cirrhosis).

It’s also linked to an high risk of liver cancer, heart disease and kidney disease.

Last stage: Death due to diabetes

In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2019, diabetes was the direct cause of 1.5 million deaths and 48% of all deaths due to diabetes occurred before the age of 70 years. Both types of diabetes can also lead to other long-term complications, like kidney disease, that may result in premature death. Problems like vision loss, nerve damage and infections that may lead to amputations can increase the likelihood of injuries and accidents.

Between 2000 and 2016, there was a 5% increase in premature mortality rates (i.e. before the age of 70) from diabetes.

(Source-https://www.who.int/news-room/fact-sheets/detail/diabetes ).

Who is more likely to develop insulin resistance or prediabetes?

People who have genetic or lifestyle risk factors are more likely to develop insulin resistance or prediabetes. These risk factors include

• overweight or obesity
• Old age-usually 45 years or older
• Genetic factor- a parent, brother, or sister with diabetes
• physical inactivity/sedentary lifestyle
• health conditions such as hypertension and abnormal cholesterol levels, heart disease or stroke
• a history of gestational diabetes
• a history of heart disease or stroke
• polycystic ovary syndrome, also called PCOS

People who have metabolic syndrome—a combination of high blood pressure, abnormal cholesterol levels, and large waist size—are more likely to have prediabetes.

How can you diagnose pre-diabetes?

To test for prediabetes, these 2 tests are the most important:

• Fasting plasma glucose test, which tests your blood after you have fasted for eight hours.
• HbA1C or glycated hemoglobin test, which provides your average blood glucose level over the past two to three months.

You would be diagnosed with prediabetes if:

• Your fasting plasma glucose test is 100 to 125 mg/dL (normal is <100; diabetes is 126 or higher).
• Your HbA1c test is 5.7% to 6.4% mg/dL (normal is < 5.7%); diabetes is 6.5% higher.

Figure: Pre-diabetes diagnostic test and criteria

(Image source: Recommended Tests for Identifying Prediabetes | NIDDK)

Is there a test for insulin resistance/Pre-diabetes?

There is a HOMA-IR test that determines if there is insulin resistance or not.

HOMA-IR stands for Homeostatic Model Assessment of Insulin Resistance or Pre-diabetes. It is an index which determines if a patient has insulin resistance. The blood tests like HbA1C or fasting sugar (glucose) levels may be normal, but if the insulin levels are high, this means that your body may be struggling to maintain normal blood sugar levels. This may be the precursor to diabetes. 

Your results from the HOMA-IR test are displayed against a reference scale or range that determines the level of your insulin resistance. 

Low HOMA-IR implies that you are sensitive to insulin. On the other hand, higher levels indicate insulin resistance and higher chances of you developing diabetes.

Interpretations of HOMA-IR lab test:

• Optimal insulin-sensitivity- less than 1.0
• Early insulin resistance- above 1.9
• Significant insulin resistance- above 2.9

Labs from where you can get your HOMA-IR test done:

TATA 1 mg: HOMA IR C – PEPTIDE MODEL : Purpose & Normal Range of Results | 1mg 

Apollo 24×7: Homa IR Test – Price, Procedure, Preparation, Range – Apollo 24|7

Lal path lab: homa-ir ; insulin resistance index 

How can you treat or reverse insulin resistance and prediabetes?

It is possible to reverse the insulin resistance or prediabetes if diagnosed early. You can achieve it through lifestyle changes such as diet and exercise.

In other words, taking small steps, such as eating healthier foods and moving more to lose weight, can help reverse insulin resistance. Also, prevent or delay type 2 diabetes in people with prediabetes.

Don’t rely on dieting or exercise alone: In one University of New Mexico School of Medicine study, published in the International Journal of Obesity, overweight people who lost 10% of their weight through diet plus exercise saw insulin sensitivity improve by an impressive 80%. Those who lost the same amount of weight through diet alone got a 38% increase. 

Dietary guidelines to improve glycemic control:

• Firstly, a moderate calorie restriction of about 500-750 calories from usual daily intake and an increase in physical activity by 30 minutes/day may lead to improved insulin sensitivity.
• Avoid whole milk and prefer skimmed milk for tea, coffee, curd, paneer, etc.
• Choose lean sources of protein such as fish, skinless chicken, low-fat cottage cheese, turkey or ground turkey breast, etc. Protein helps to stabilize blood sugar.
• Prefer whole grain cereals like millets, oats, quinoa, barley, long grain basmati rice and whole pulses.
• Avoid refined carbohydrates like sugar, juices, jams, jellies, candies, honey, jaggery and chocolates.
• Also, increase your fiber Intake. Fruits and vegetables are a good source of fibre such as pears, apples, dried figs, berries, green leafy and seasonal vegetables.
• Limit roots and tubers like potato, arbi, sweet potato, and beetroot.
• Sago, arrowroot and refined flour preparations like white bread, biscuits, sago poha, noodles and pasta should be avoided.
• Also, reduce the intake or eliminate fried and creamed foods.
• Emphasize on eating healthy and omega-3 rich sources such as fish, nuts and oilseeds.
• Read the nutrition label carefully. Products that are “sugar-free”, “fat-free” or high fibre do not necessarily have a reduced number of calories or carbohydrates also. 
• Drink plenty of water as it may help in controlling blood glucose levels, and it’s also a healthy substitute for sodas and fruit juices.
• Portion control can keep with your carbohydrate control. Practice mindful eating for your portion control.

The most important thing to consider when choosing foods to incorporate into diet is to aim for balance, variety, and moderation. Your goal should be to adopt an eating pattern that is sustainable and that you can stick with long-term, while still incorporating foods you enjoy.

Physical activity and exercise:

Clinical guidelines from the American Diabetes Association suggest exercising for at least 30 minutes a day, five days a week. If you have a strong family history of type 2 diabetes, it might be best to take it up a notch to 45 to 60 minutes a day.

Furthermore, losing as little as 5 to 10 percent of body fat can improve your blood sugar level and help reverse prediabetes.

Stop smoking:

Everyone knows that smoking increases the risk for heart disease and lung cancer. But smoking is also a risk factor for insulin resistance, prediabetes, and type 2 diabetes. So, quitting smoking is the best idea to reverse insulin resistance and prediabetes.

Get proper sleep everyday:

In a study presented at the 2015 meeting of the Obesity Society, researchers found that just one night of sleep deprivation boosted insulin resistance as much as eating high-fat foods for six months. So, get at least 8 hours of sleep for a better insulin production and usage by your cells.

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What is PCOS?

PCOS stands for Polycystic Ovarian Syndrome which is a form of hormonal imbalance that affects 1/10 women of reproductive age, in India, today. The syndrome leads to overproduction of male hormones in women, resulting in multiple surfaced/under-surfaced symptoms.

Studies suggest that up to 70 percent of women with PCOS hadn’t been diagnosed. Underdiagnoses results in delay in seeking help therefore worsening the situation. Physically, PCOS affects a woman’s ovaries, resulting in disturbed production of estrogen and progesterone. The syndrome leads to other physical and mental effects on the overall wellbeing of the sufferer.

There are three main characteristics of PCOS:

• First one is the formation of cysts in the ovaries
• Second one is high level production of male hormones
• And the third one is irregular periods or absence of periods for longer periods.

Between 5% and 10% of women of reproductive age can have PCOS. Furthermore, mostly women find out that they have PCOS in their 20s and 30s, when they have problems getting pregnant. But everyone should know that PCOS can happen at any age after puberty.

What is the prevalence of PCOS in India?

The exact prevalence of PCOS is not known as the syndrome is not defined precisely. Prevalence of PCOS is highly variable ranging from 2.2% to 26% globally. In few Asian countries, prevalence figures are ranging from 2% to 7.5% in China and 6.3% in Srilanka. 

There are few studies conducted in India. Studies done in South India and Maharashtra, prevalence of PCOS were reported as 9.13% and 22.5% respectively.

[Source-https://www.nhp.gov.in/disease/endocrinal/ovaries/polycystic-ovary-syndrome-pcos]

Moreover, one in every 10 women in India has polycystic ovary syndrome (PCOS), among women of reproductive age, according to a study by PCOS Society. And out of every 10 women diagnosed with PCOS, six are teenage girls.

What is the difference between PCOD and PCOS?

• PCOD stands for polycystic ovarian disease and PCOS stands for polycystic ovarian syndrome. 
• PCOS is a metabolic disorder which is a serious condition and PCOD is not considered a disease entirely.
• PCOD can be controlled with proper diet and also exercise routine. Whereas PCOS needs treatment by consulting doctors as it is a metabolic disorder (disruption in chemical processes of your body).

What are the symptoms of PCOS?

The symptoms of PCOS may include:

• Skipped periods, irregular periods, or very light periods
• Large ovaries or cysts in ovaries
• Excess body hair including the chest, stomach, and back
• Weight gain – obesity or overweight
• Acne or oily skin
• Male-pattern baldness or thinning hair/loss of scalp hair
• Infertility 
• Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts

What is the exact cause of PCOS?

The cause of PCOS is not perfectly clear. It is clear that genetic and environmental factors contribute to the development of PCOS. But do not know exactly what causes PCOS.

• Excess insulin production in your body: Insulin is the hormone produced in the pancreas that allows cells to use sugar. If your cells become resistant to the action of insulin, then your blood sugar levels can rise. In turn, your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation.
• Low-grade inflammation in your body: This term is describes white blood cells’ production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens. And it can also lead to heart and blood vessel problems.
• Heredity: Research suggests that certain genes might be linked to PCOS.
• Excess androgen production in the body: The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne.

(Source – https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439 )

Who is at risk of developing PCOS?

• Women of all races and ethnicities are at risk of PCOS. 
• Your risk of PCOS may be higher if you have obesity or if you have a relative with PCOS. 
• You may also be more likely to have it if you have insulin resistance.

How to detect that you have PCOS?

There’s no specific single test for PCOS but a physical exam, ultrasound, and blood tests can help in the diagnosis of PCOS. 

The diagnosis begins with a thorough history and physical examination also. The main focus is on menstrual history, any fluctuations in the weight and their impact on PCOS symptoms, and also other PCOS-related symptoms.

A diagnosis of PCOS can be made if you have been ruled out of other rare causes of the same symptoms. And you meet at least 2 of the following 3 criteria:

• If you have irregular periods or no periods – this indicates that your ovaries do not regularly release eggs. In other words, ovulation occurs irregularly.
• If your blood tests show that you have high levels of such as androgen (or sometimes just the signs of excess male hormones, even if the blood test is normal).
• Also, your ultrasound scans show that you have polycystic ovaries.

Collections of 12 or more “cysts” on your ovaries that may be larger than normal also indicates PCOS. But women who don’t have PCOS may also have cysts, but fewer than 12 don’t meet the criteria for a diagnosis.

Diagnosis of polycystic ovary syndrome.

(CT = computed tomography; DHEA-S = dehydroepiandrosterone sulfate; FSH = follicle-stimulating hormone; LH = luteinizing hormone; MRI = magnetic resonance imaging; OGTT = oral glucose tolerance test; PCOS = polycystic ovary syndrome; TSH = thyroid-stimulating hormone.) (Source-https://www.aafp.org/afp/2016/0715/p106.html )

How to detect PCOS in adolescents?

Generally, it is difficult to diagnose PCOS in adolescent women. Especially, at an early stage during their first few years of menstrual cycle. In the beginning, menstrual cycles of adolescent women can be irregular for reasons that are unrelated to PCOS. Because in the first year, periods are often irregular, and in their second year periods, they normally settle into a regular pattern.

In adolescent women having PCOS, periods are either very close together (fewer than 21 days) or far apart (more than 45 days). And also if this irregularity continues after three years, this suggests PCOS might be the cause.

How to read these lab reports yourself at home?

Lab results are often shown as a set of numbers known as a reference range. A reference range may also be called normal values which are based on the normal test results of a large group of healthy people. 

Your lab results may also include one of these terms:

• Negative or normal, which means the disease or substance being tested was not found.
• Positive or abnormal, which means the disease or substance was found.
• Inconclusive or uncertain, which means there wasn’t enough information in the results to diagnose or rule out a disease.

These are the reference range values for some of the tests that are conducted for the PCOS. These values might differ based on the type of method used in the laboratory.

Testosterone:

• Most testosterone values in PCOS will be ≤150 ng/dL (≤5.2 nmol/L).
• Testosterone values of ≥200 ng/dL (≥6.9 nmol/L) warrant consideration of an ovarian or adrenal tumor.

Dehydroepiandrosterone-sulfate (DHEA-S)

• DHEA-S values may be normal or slightly elevated in PCOS.
• Values ≥800 µg/dL (21.7 µmol/L) warrant consideration of an adrenal tumor.

17-hydroxyprogesterone

• A morning, fasting, unstimulated level of <200 ng/dL in the follicular phase reliably excludes late-onset 21-hydroxylase deficiency.
• Further evaluation of levels ≥200 ng/dL involves adrenocorticotropic hormone (ACTH)-stimulation with an intravenous 250 µg dose and a 30 minutes value (stimulated values ≥1,000 ng/dL confirm the diagnosis).
• Also, Oral contraceptives and glucocorticoids can affect values.

Luteinizing hormone/follicle stimulating hormone (LS/FSH) ratio

• A ratio ≥2.0 is suggestive of PCOS but is not highly sensitive or specific.
• Gonadotropin levels are affected by oral contraceptives.

(Source- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069067/)

What are the health complications that developed due to PCOS? 

Yes, studies have found links between PCOS and other health problems, including:

• Diabetes:  One of the most common complications of PCOS is diabetes. According to researchers, more than half of women with PCOS will have diabetes or prediabetes before the age of 40.
• High blood pressure: Another complication is high blood pressure or hypertension. Women with PCOS are at greater risk of having high blood pressure compared with women of the same age without PCOS. 
• High cholesterol: Women with PCOS often have higher levels of LDL cholesterol also known as bad cholesterol. And low levels of HDL (good) cholesterol which raises risk for heart diseases.
• Sleep apnea: A sleep disorder in an disorder in which breathing repeatedly stops and starts. Many women with PCOS are overweight or obesity, which can cause sleep apnea which raises the risk of heart disease and also diabetes.
• Depression and anxiety: Depression and anxiety are common among women with PCOS.
• Endometrial cancer: Anovulation, obesity, insulin resistance, and diabetes increase the risk of developing cancer of the endometrium.

What can you do to manage your PCOS?

PCOS can wreak havoc on your hormones and still doesn’t have a known cause and even permanent cure. Researchers suggest that the first line of treatment for PCOS is lifestyle changes, healthy diet and physical activity. This can also help women modify their focus and remove obstacles that may be in their way on the path towards wellness.

Lifestyle changes:

You can live with your PCOS without any complications if you change your lifestyle. There are certain things that I meant by a change in your lifestyle.

• For instance, weight loss if overweight or obese through a calorie deficit diet combined with moderate exercise activities. A modest reduction in your weight, per say, losing 5-10 percent of your body weight may improve your condition. 
• Also, if you are taking any medications for your PCOS then losing weight may increase the effectiveness of medications.
• Regular sleep for about 7-8 hours is also essential for the management of PCOS. Sleep is important to our hormone health. If you’re not getting enough sleep, your body can’t repair itself. And also a good night’s sleep is essential for the physical and mental well-being of women.

Healthy diet: 

What you eat plays an important role in the management of PCOS. The most important focus of diet is weight management. This helps in the regulation of hormone levels, which in turn helps to improve symptoms of PCOS.

 When you combine a healthy diet with exercise, it is more effective than following only one thing alone in achieving a healthy weight. In the long term, a healthy diet aims not only to prevent weight gain. But also reduces the risk of related health conditions such as type 2 diabetes and cardiovascular disease.

1. Watch out for types of carbs you are eating:

Eat low glycemic index foods like whole grains, pulses and a variety of vegetables. Every day add them to your meals, to make sure that your body gets proper nutrition. These types of foods are also rich in fibre which makes them digest slowly and causes less glucose spikes in your body. 

Some of the examples for low glycemic foods are whole grains and millets like wheat, oats, quinoa, jowar, bajra, ragi. Pulses and legumes like bengal gram dal (Chana dal), beans, rajma, peas. And vegetables like broccoli, cabbage, mustard leaves, etc are great to balance your hormones. 

2. Reduce intake of milk and dairy products:

Milk and milk products are not completely prohibited for women with PCOS. You can consume milk and its products but in a limited amount. Excess consumption of dairy which is a carbohydrate can lead to an increase in blood glucose level. According to several reports, milk, nonfat in particular, can contribute to increased androgen and insulin levels.

You don’t need to completely eliminate dairy. You can consume a few servings per week unless you are a lactose intolerant.

3. Choose your fruits wisely:

There are certain fruits that are very high in natural sugar. If you are already insulin-resistant, then you need to watch out for what type of fruit you are consuming. 

4. Include lean protein in your diet:

Eating meat low in fat will aid in weight loss and keep you feeling full longer.

Food sources: Salmon, tuna, shrimp, skinless chicken and turkey breast, beans, pulses, legumes, and tofu

5. Increase your intake of omega-3 fatty acid:

Fish oil is a rich source of omega-3 fatty acid. It is also associated with a long list of health benefits. There is some research indicating that omega-3 supplements can decrease androgen levels in women with PCOS.

Food sources: Cooking oil such as Olive oil, sunflower oil, safflower oil. And Nuts and oilseeds such as walnuts, almonds, chia seeds, flaxseeds, and sunflower seeds.

6. Choose food high in Vitamins and Minerals:

Various studies show that  consuming foods high in Vitamin D, Vitamin B, and Magnesium will greatly aid in improving insulin resistance, and decrease the severity of symptoms associated with PCOS.

Vitamin D food sources: salmon fish, eggs, mushrooms and fortified products

Vitamin B food sources: eggs, meat such as chicken, tuna, mackerel, and salmon,  and dark green vegetables, such as spinach and kale.

Magnesium food sources: Avocados, nuts and oilseeds, pulses, whole grains, banana

7. Do not skip meals:

Skipping meals can crash your blood sugar levels, leading to food cravings and overindulgence. Keeping a routine will allow your blood sugar levels to stabilize. Also, stable blood sugar aids in the proper androgen production in your body. 

Best food for PCOS:

Physical activity and PCOS:

Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity may help in improving insulin resistance. And also help you keep your weight under control. The best type of exercise is one that you’ll do regularly i.e. Aerobic exercise such as brisk walking, biking, swimming, and jogging. 

The regular physical activity will help you to reduce androgens levels in your body. It will also improve insulin resistance, regulate menstrual cycles, improve fertility, improve self-esteem, reduce anxiety and depression. You can also see these improvements in your body even when weight loss doesn’t occur.

There are some of the exercise links for you which can help you in weight loss.

What foods to eat and what food to avoid in PCOS?

Counselling points:

1. Firstly, eat regular meals including a variety of food groups.
2. Also, include plenty of vegetables and salad (at least 5-6 servings every day). 
3. Include a good amount of protein and a low to moderate amount of carbohydrate in each meal.
4. Opt for unrefined and unprocessed carbohydrates, such as whole grain cereals, legumes and fruit, rather than refined carbohydrates. (For example, white bread, white rice, soft drinks, lollipop, biscuits)
5. Replace saturated fats with unsaturated fats such as olive oil, sunflower oil, safflower oil, mustard oil, palm oil, and soybean oil. Also, nuts and oilseeds such as walnuts, almonds, pumpkin seeds, sunflower seeds, sesame seeds, etc.

What is seed cycle and its role in PCOS?

Seed cycle is a naturopathic remedy which claims to balance hormones, boosts fertility, and ease symptoms of menopause. It has become a trend nowadays. This seed cycle involves eating flaxseeds, pumpkin seeds, sesame seeds, and sunflower seeds.

These seeds are taken in 2 phases.

First Phase: It instructs women to eat 1 tablespoon of freshly ground flax and pumpkin seeds. You have to take them everyday for the first 13–14 days of their menstrual cycle, which is known as the follicular phase.

Second Phase: During the second half of their cycle, which is known as the luteal phase, seed cyclers eat 1 tablespoon each of ground sunflower and sesame seeds per day until the first day of their next period when their cycle starts again.

Phase 1 is believed to support the estrogen-dominant follicular phase when the ovaries increase estrogen levels in the body. On the other hand, Phase 2 is believed to support the increase of progesterone in the luteal phase.

But there are no scientific proven reason behind these seed cycle.

What is the effect of Oral contraceptives pills (OCPs) in PCOS?

Oral contraceptive pills are estrogen and progesterone containing hormonal birth control pills that acts on a person’s monthly cycle.

Albeit considered the first-line therapy for PCOS, the data regarding the effects of this mode of treatment on metabolism of carbohydrates, lipids, insulin, coagulation, and inflammation profile in women with PCOS is conflicting.

In PCOS, oral contraceptives are used to improve clinical symptoms of overproduction of androgen. And also help in regulating the menstrual cycles. It protects the endometrium against effects of unopposed estrogen action. This happens because estrogen content in the OCP increases Sex Hormone Binding Globulin levels, thus decreasing the free circulating androgens. The progesterone in OCPs suppresses the secretion of Luteinizing Hormone and decreases androgen production. (Source- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6094524/)

OCPs may also reduce adrenal production of androgens.

Furthermore, use of OCPs in PCOS women should be individualized after risk stratification and not used if any contraindications exist.

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