Laura Schoenfeld: That’s a really interesting question. I’m actually working on a guest post for Chris’s website on something called adrenal PCOS. That’s not a technical, medical term, but there is adrenal involvement with some PCOS patients. I would say somebody with the typical pattern of insulin resistance and being overweight would do better to be on a lower-carbohydrate diet. Now, when we talk carbohydrates and low- versus high-carbohydrate diets, we have to think about, what does “low carb” even mean? If you think about the typical American diet compared to the typical Paleo diet, even if somebody is eating a decent amount of carbs on a Paleo diet, they’re probably going to be eating a lot less carbs total than they might have been eating on their American diet. You’re cutting out things like grains and sugar and dairy where there’s going to be a lot of simple carbohydrates in those foods. There are going to be higher amounts of carbohydrates in those foods. It’s really hard to get the same amount of carbs from things like sweet potatoes, potatoes, bananas, apples—all the whole-food carbs that Paleo recommends, so the question would be for your patient, are they coming from a typical American diet that’s very high carb, probably high sugar, way more carbs than they need, depending on their exercise levels, and would switching to a carb-unrestricted Paleo diet actually be a decrease in carbs for them? I’d say for the majority of Americans it probably would be.
So the question is, do they need to be on a low-carb version of the Paleo reset? I would say it just really depends on where they’re coming from. If they’re already on a low-carb diet, maybe you need to go a little bit lower. I find that most women with PCOS don’t need to be very, very low carb to get the benefits of being on a lower-carb approach, so maybe they’re doing, like, 20 to 30 percent of their calories from carbs on a normal Paleo diet. You can try going lower, but especially if you’re worried about compliance and if it’s a major change from their original diet, I would say just go with the typical Paleo reset and see how it goes. Again, they’ll probably be eating a lot less carbs than they were before. And if after the 30 days they’re not seeing the improvements that they were hoping to see, then at that point you might reassess and say, OK, let’s try doing a lower-carb approach and removing sweet potatoes, and bananas, and you can have a little bit of fruit and non-starchy vegetables and then see how that goes.
Again, it kind of just depends on where the patient is coming from. If they come to you and they’re already on a very-low-carb Paleo diet and they have PCOS symptoms that have been exacerbated, which I’ve seen a lot in women—younger women, especially—then they may actually need more carbs to deal with their PCOS symptoms.
There’s going to be a lot of this no-one-size-fits-all answers in these question-and-response sessions that we’re going to have. Hopefully I’ll give you some things to think about as far as using clinical judgment with individual patients, but usually when it comes to these kinds of questions, there’s never going to be a straight answer yes or no.