Project PCOS: When did you first become interested in PCOS and treating its symptoms?
Kate Marsh: My interest in PCOS is thanks to endocrinologist Dr Warren Kidson who is one of the top specialists treating women with PCOS in Sydney. I had been working closely with him seeing his patients with diabetes for a few years when he started seeing women with PCOS and referring them to me for dietary advice. I quickly learnt about this condition and its implications, and realised the difference I could make by helping women with PCOS to make lifestyle changes – they now make up the largest proportion of the clients I see each week. Through my interest in the area I also found that there is little research into the dietary management of PCOS despite the fact that it can make such a difference, so I am now completing my PhD under the supervision of Professor Jennie Brand-Miller at the University of Sydney, researching low GI diets in women with PCOS. We have also written a book called The New Glucose Revolution Guide to Managing PCOS (in the US) or The Low GI Guide to Managing PCOS (in the UK and Australia & New Zealand).
Project PCOS: Why are lifestyle changes so important to controlling PCOS?
Kate Marsh: We now know that insulin resistance is the underlying problem for the majority of women with PCOS and that improving this insulin resistance can significantly improve the symptoms of PCOS, assist with weight management and help to reduce the long term risks of type 2 diabetes and cardiovascular disease. The good news is that lifestyle changes including diet and exercise can go a long way towards improving insulin resistance, thereby reducing symptoms of PCOS. In fact research has shown that lifestyle modifications including diet, exercise and weight loss are particularly beneficial in women with PCOS, with a reduction in weight of as little as 5-10% having been shown to reduce insulin levels, improve menstrual function, reduce testosterone (male hormone) levels, improve symptoms of hirsutism and acne, restore ovulation and increase fertility. While some women will also need medication, exercising regularly and eating well are the first step towards managing PCOS.
Project PCOS: How can a low GI help influence lifestyle changes?
Kate Marsh: GI, or glycemic index is a measure of how quickly or slowly the carbohydrate from food is digested and absorbed into the bloodstream. High GI foods are those in which the carbs break down quickly during digestion, releasing glucose quickly into the bloodstream while low GI foods are those in which the carbs break down slowly, releasing glucose into the bloodstream gradually. Because insulin is produced in response to glucose in the blood, high GI foods can lead to high insulin levels which can worsen symptoms of PCOS. Conversely, low GI carbs are the best choice for women with PCOS.
Low GI foods are beneficial if you have PCOS because:
- they are more filling and satisfying, which helps to control hunger and assists with weight loss
- they result in lower levels of insulin circulating in the bloodstream, which means fat is less easily stored by the body and is more easily burnt
- lower insulin levels also mean that less male hormones are produced, which can improve many of the symptoms of PCOS
- they help to reduce the risk of diabetes and heart disease and improve blood fat levels.
I find that most women with PCOS feel much better eating a low GI diet – they have better energy levels, feel fuller and no longer experience fluctuations in blood sugar levels. And for most people, changing to a low GI diet isn’t difficult – it is largely just about swapping one food for another and eating less processed foods.
Project PCOS: Why should PCOS management be a full body approach?
Kate Marsh: Many things impact on insulin resistance and your health in general, including the food you eat, how much activity you get in your day, stress and whether you get enough sleep and rest. Focusing on only 1 or 2 of these things is unlikely to lead to long term success. The women who I have seen who have been successful in the long term (eg they have lost weight and kept it off, improved their symptoms or achieved a healthy pregnancy) are the ones who have focused on all aspects of their lifestyle. This may also mean taking medication or having other medical treatments, but getting your lifestyle right first will mean that you achieve optimal results from these interventions.
Project PCOS: How can lifestyle changes transition into long-term success?
Kate Marsh: To be successful in the long term, the key is to start with small achievable changes and to keep building on these over time until you reach your goal (whether that is losing weight, falling pregnant, improving your PCOS symptoms or reducing your diabetes risk). If you can make gradual changes that become new habits rather than trying the latest ‘quick fix’ you are much more likely to succeed in the long term. And if you are trying to lose weight it is important not to make this the whole focus of your efforts, but to also think about all the other benefits that lifestyle changes can bring. I commonly find that women with PCOS feel so much better after modifying their diet and increasing activity levels that this itself provides the motivation to keep going. The most important thing you can do to achieve long term success is to have a realistic goal and to develop a plan to get there.
Project PCOS: What is the mission of The PCOS Health and Nutrition Center?
Kate Marsh: I established the PCOS Health & Nutrition Centre with the aim of bringing together like-minded health and fitness professionals with an interest and expertise in PCOS to work together to provide a more holistic approach to caring for the women we see with this condition. After many years of seeing women with PCOS, it became clear to me that managing this condition is a whole lifestyle approach, not just diet. This means eating well, regular exercise, managing stress, getting adequate sleep and rest. Our centre aims to help women with PCOS to make these lifestyle changes, providing the information and support they need to help them in doing this.
Project PCOS: What type of consultations and programs are available through the center?
Kate Marsh: We offer individual consultations with an Accredited Practicing Dietitian, Accredited Exercise Physiologist and Clinical Psychologist (although our psychologist is currently on maternity leave!). We also have a birth consultant available to provide independent expert advice on planning a pregnancy, pregnancy and birth options and childbirth education. For those who are unable to attend our clinic due to time or distance, we also offer email dietary consultations. The centre runs group education sessions and group personal training as well as pilates classes and we have a close association with a Laser Hair removal clinic. Our website has an online bookshop and you can also subscribe to our free e-newsletter. The centre is still in the early stages and we hope to add more services over time, depending on interest.
Project PCOS: You have a new CD PCOS Made Easy, which Dr. Fraser collaborated on with you. Can you tell us what patients can expect from the CD?
Kate Marsh: The program has two audio CD’s, one covering healthy eating with PCOS and the other focusing on exercise for women with PCOS. They explain why eating well and being active are important if you have PCOS and give you lots of practical information and ideas for improving your eating habits and building more activity into your day. You can listen to them in the car, while you are exercising, or at home and many of the women we see have commented that they are a great motivational tool! Also included in the pack is a data CD containing handouts on all the topics discussed in the audio CDs – you can print these out as a reminder or if you want more information. We will be donating $5 from the sale of each CD to Project PCOS (for US sales) and POSSA (for sales in Australia).
Project PCOS: What tips can you offer to someone who wants to change their life with PCOS?
Kate Marsh: Sometimes getting started with making lifestyle changes can seem overwhelming and it can be hard to know where to start. The key is not to try to change everything overnight – set some realistic goals and make small achievable changes. Make sure you have a good understanding of PCOS and the benefits of making lifestyle changes, as well as the steps you need to take. And get support and help where you need it – this may be seeing a dietitian, psychologist, exercise physiologist, personal trainer or a good doctor who works with women with PCOS. The support of family, friends and partners is also important so make sure you enlist their help!
Project PCOS: Any words of inspiration you would like to share with our readers?
Kate Marsh: These are 2 of my favourite quotes:
- “You can be anything you want to be, do anything you set out to accomplish, if you hold to that desire with singleness of purpose” - Abraham Lincoln.
- “A journey of a thousand miles begins with a single step” - Lao-Tzu
Read Kate's full biography and visit her website.
