Managing Life with PCOS
An Interview with Dr. Shabnam Das Kar, Co-founder of Metabolic Dietary Solutions (MDS) Program
One in five women worldwide has Polycystic Ovary Syndrome (PCOS). They struggle with weight gain, acne, facial hair, and trying to get pregnant. PCOS not only affects one’s physical health but also one’s mental well-being due to body image issues.
In this interview with Dr. Shabnam Das Kar MD, we will discuss how to deal with the condition using modulation and strategies to maintain a healthy lifestyle. Dr. Kar is the Director of Medical Education at Better Medical Centre, Canada, and co-founder of the Metabolic Dietary Solutions (MDS) Program.
Dr. Kar, let’s start with the basics. What is PCOS? What causes PCOS? How does it affect a patient’s life?
PCOS is a hormonal abnormality present in women. It can be found in women from adolescence onwards. The manifestation varies with age.
When you have PCOS, the hormone insulin does not function as well as it should, resulting in insulin resistance. If you are a young woman, teen, or adolescent then you will have to deal with acne. Those between the ages of twenty and forty may suffer from irregular cycles, undergo heavy bleeding with large blood clots, difficulty getting pregnant, and/or weight gain.
All forms of manifestation of PCOS have the potential to cause mental health issues like depression and anxiety, which makes the conventional treatment for long-term remission a huge challenge. That is why we advise multi-modality lifestyle-based treatment rather than only pills. We help mitigate the symptoms in our patients and improve their state of life.
What is lean-PCOS?
Women of certain ethnicities with PCOS suffer from obesity while others may not present the same symptoms. Though these women are not overweight, they gain fat in the wrong places, such as around organs. So, if a doctor checks their weight, it may not be high enough to indicate high BMI — one of the reasons for misdiagnosis. These women have what is called “lean-PCOS”.
How does PCOS affect transgender men and women?
I do not take care of transgender patients in my practice because I am not trained in that specialized field. However, insulin resistance would be similar in them. Hence, the nutritional medicine strategies of food, movement, sleep, etc. would apply to them as well.
If someone suspects that they have PCOS, what type of doctor should they go to?
The answer depends on the patient’s country of residence. In Canada, patients first see their family doctor whereas in India they visit their gynecologist. The challenge with family doctors is if the patient is not obese or does not have a pronounced case of hirsutism, they may fail to make the diagnosis for a long time. I would recommend that patients see a specialist if possible or ask their family doctor to rule out PCOS.
As there are so many diverse symptoms — such as acne, irregular ovulation, and infertility — how are patients typically treated?
The line of treatment depends on the person’s initial complaint and age. In young patients, it will be either tackling issues with weight, acne, or irregular cycles whereas someone trying to get pregnant will need infertility treatment and so on.
Regularization of cycles using birth control pills is a typical treatment, but these pills should not be prescribed to women with hypertension.
The alternative to birth control pills is to use the hormone progesterone which can be taken in the form of a pill.
Does increased exercise lead to weight loss in PCOS patients?
Weight loss helps most of the symptoms of PCOS. Exercise helps in improved mood and sleep. The other problem that gets tackled with exercise is the “Sitting Disease” — the adverse metabolic consequences of sitting continuously — which has been exacerbated by the pandemic.
This lifestyle impacts our metabolic rate and worsens insulin resistance. My recommendation for PCOS patients is a low-calorie, low-fat diet and exercise to maintain weight loss.
Is it fair to say that though medication is necessary, women should explore other means to deal with PCOS? What kind of solutions would you recommend?
There is no single treatment for PCOS. I believe in multi-modality treatment. That is one of the reasons why I moved from being an OB/GYN and trained to be a Functional Medicine Consultant. I would not want to give the same treatment to adolescents as I would to women in their twenties or thirties.
Lifestyle management is always a preferable strategy for managing PCOS.
A patient must strive to lose weight because the male hormones are then reduced in the body and cycles become regularized. Even a loss of five to ten percent will yield significant results.
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One solution for weight loss for PCOS patients is eating low-carb food. Weight loss is not only dependent on food but what you eat and when. Are you eating carbs first or fats and protein first? Are you eating late at night? Those are the habits that need to change.
It boils down to metabolism. In my MDS Program, I teach my patients the concept and method of Time Restricted Eating (also known as intermittent fasting), which means eating in shortened intervals of time. Many patient groups have used this method and have been successful in their quest of reducing and maintaining their weight.
How do we tackle hirsutism?
Hair in unwanted places compounds the mental health challenges of the patient.
The good thing is: it’s treatable. One can go to a dermatologist and discuss a host of different options, such as laser therapy.
We have talked about adolescents and young women trying to get pregnant. Let’s talk about menopausal women. What should those people expect if they have PCOS?
Estrogen, progesterone, and testosterone are the major hormones that change during menopause; both estrogen and progesterone are deficient, but testosterone levels may rise. This becomes an obstacle in maintaining body weight and triggers hirsutism. One of the other effects is thinning or loss of hair and the incidence of hypertension (high blood pressure).
These women also may face significant mental health challenges. Women with PCOS have more instances of depression, anxiety and mood issues, which increase with age if left untreated or unaddressed.
It is clear that PCOS is all about hormones, so how does it affect mental health? What are signs to watch out for?
A lot of the mental health challenges are related to the underlying disease condition. It’s not only because patients are struggling with obesity, or dealing with infertility but also because hormonal imbalances, use of birth control pills, and chronic inflammation all affect our brain.
Mental health is complicated. If you want to watch out for signs, answer this two standard recommended questions:
1. Have you recently felt a concerning lack of interest or pleasure in usually enjoyable activities?
2. Have you been feeling down, depressed, or hopeless in the last month?
If you answered “yes” to either then you need to see a doctor for further evaluation.
What do you consider the biggest challenges of living with PCOS, and how would you recommend tackling them?
I think the biggest challenges are not recognizing mental health issues, being overweight, and infertility. The challenges depend on the patient’s age and stage of life, but all actively contribute to their stress levels.
My recommendation is to build stress resilience and work on problem-solving abilities. Analyse and pinpoint what is causing the stress. Find someone who is knowledgeable in this field and follow their advice.
There are also options like guided meditation and mindfulness practices. Try out different apps such as Headspace. See what works for you. It will build enough mental resilience to work through problems and get on top of every situation.
And finally, would you recommend that a woman should discuss her condition of PCOS with her significant other?
I am not qualified to talk about that but my opinion is that women should be open about it. It is worthwhile to have this conversation with their partner ahead of time and be transparent.
I write about small businesses, health, productivity, and life as I see it on Medium, LinkedIn, and my website.
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