Evidence-Based Nutrition Strategies For PCOS With Hillary Wright

Welcome to Episode 8 of Season 6 of The PCOS Revolution Podcast:

Evidence-Based Nutrition Strategies For PCOS With Hillary Wright

Nutrition is a key factor in fertility and getting pregnant with PCOS. There are many cases where individuals have benefited from focusing on diet. On today’s episode we explore fertility and PCOS as well as diet and weight loss.

This week on PCOS Revolution Podcast, I am joined by Hillary Wright. Hillary has over 30 years’ experience as a nutrition educator, writer and consultant. She is also a registered dietician with a bachelor’s degree in nutrition and dietetics from the University of Massachusetts at Amherst and a master’s degree from Boston University in health education. Additionally, Hillary is the author of two books.

In this episode, Hillary and I discuss everything from how Hillary got started in the world of fertility and PCOS to nutrition related to pregnancy, recommended diet and various findings from Hillary. Hillary shares her diet recommendations and how adding healthful foods to your diet regardless of weight can be beneficial.

Episode Spotlights:

  • How Hillary began working with fertility and PCOS ([1:22])
  • Nutrition and trying to get pregnant with PCOS ([5:05])
  • What’s going on behind the scenes? ([9:55])
  • Cases where someone has benefited from starting with diet ([12:02])
  • Choosing reasonable 3-5% weight loss goals ([14:21])
  • Findings regarding screening ([17:30])
  • Does diet help reduce risk when pregnant? ([21:34])
  • Recommended plant-based diet ([24:02])
  • Whole grains and fertility outcomes ([27:47])
  • Adding healthful foods to your diet ([29:55])
  • Interpreting the science ([34:00])

READ the entire transcript here:

Read Full Transcript

Farrar Duro [0:03]
Hello everybody and welcome back to the PCOS Revolution podcast, today I have Hillary Wright, who’s a registered dietician with over 30 years of experience as a nutrition educator, writer and consultant. Hilary holds a bachelor’s degree in nutrition and dietetic from the University of Massachusetts at Amherst and a master’s degree in health education from Boston University. Hillary’s the director of nutrition counseling for the Domar Center for Mind Body Health at Boston IVF inWaltham, Massachusetts, one of the largest fertility treatment practices in the United States, and is author of two books, the PCOS Diet Plan, a natural approach to health for women with polycystic ovarian syndrome, and the Pre-diabetes Diet Plan, How to Reverse Pre-diabetes Through Healthy Eating and Exercise. She also works part time as a senior nutritionist at the Dana Farber Cancer Institute in Boston, Massachusetts, and is a founding member of the nutrition technology company “Good Measures”. Welcome, Hillary, so great to have you!

Hillary Wright [1:15]
Thanks for having me!

Hillary Wright [1:17]
Tell us a little bit about how you began working with fertility and also with PCOS, and how you became interested in the nutritional aspect of it.

Hillary Wright [1:26]
Sure. I do sometimes get the question, do I have PCOS? And the answer to that question is no, though there is a strong history of diabetes in my family. We know that PCOS, type two diabetes and many other problems fall under this umbrella of insulin resistance, so I live in that world from that perspective. But when I was trying to conceive my second child, this was back in the mid 1990s, I experienced secondary infertility, I can see my first child, and within like two or three months, I’m trying to conceive, and then it just wasn’t happening with the second one. I eventually sought the assistance of a reproductive endocrinologist who was in the medical practice that I worked in at the time, which was a large group medical practice called Harvard Vanguard Medical Associates in Boston. Fortunately, for my situation, I had some minor hormonal tweaking and had a miscarriage, then had my second child, and ended up having a surprise third child, because I made some assumptions about my fertility that apparently weren’t correct. Basically, that put me in a position of, even though I don’t have PCOS, I’ve experienced the testing and the rigorous, emotional journey of fertility, infertility treatment. After I had my third child, when I came back from maternity leave in February of 2000, this reproductive endocrinologist who I developed a relationship with because not only was she my doctor, we worked in the same building, she contacted me and she said, I want you to start seeing my women with PCOS. And I said, okay, I’ve always been one of those people that says, Yes, first and then figures it out.

Hillary Wright [3:13]
I had never heard of this condition. I had no idea what it required for diet and lifestyle management. Natalie Schultz shared some information with me. I went to the task of trying to learn about PCOS, to inform myself about the physiology, because then I knew I’d be able to tie into diet and lifestyle strategies that made the most sense. At that point, I read a book by an amazing physician named Samuel Thatcher, he wrote a book called “PCOS: The Hidden Epidemic” which is kind of the textbook on PCOS. I looked online, that was sort of the early days of being able to find people online and I found Malcolm McKittrick, who was a registered dietitian in New York City, who had written some things about PCOS online, and we sort of networked. I ended up in this world due to my relationship with this reproductive endocrinologist. But then, having experienced what it took to manage these patients in that clinical practice, I eventually opened a private practice that was absorbed by Boston IVF, because they were specifically looking for nutritionists with experience in PCOS. This was in 2006, which, again, we all know that people aren’t talking about this problem as much as they should, but back then it was much worse. This really painful experience of dealing with infertility actually brought this incredible professional experience into my life, which is very rewarding, because what could be better than helping people have children and develop families?

Farrar Duro [4:51]
I always say we have the best job.

Hillary Wright [4:54]
Pretty amazing.

Farrar Duro [4:56]
I wonder if you could share something with our listeners that they perhaps didn’t know about nutrition and trying to get pregnant with PCOS that you’ve seen in your office and your experience.

Hillary Wright [5:11]
The thing about PCOS is, in a perfect world, women would learn about the condition and get the education around diet and lifestyle strategies early on, because it’s really a process of learning how to manage the insulin resistance, largely, that underlies PCOS so the primary management for that is diet and lifestyle strategies. One of the things that people also are unaware of is that to be in an insulin-resistant state is a pro-inflammatory state, and that’s not good for egg quality either. So fortunately, the same strategies, eating a plant-based diet, getting some physical activity, trying to manage your stress, all of the things that are good for all of the cells in our bodies are also good for reproductive cells. Frequently, we all focus on managing the insulin resistance, because that’s the number one factor that we really need to try to control to optimize people’s fertility. But the trickle down effect to other aspects of health, I think is also important to appreciatea, and that is egg quality as well.

Farrar Duro [6:15]
How does that work? When we work with inflammation, bout how long would you think it would take if somebody is just starting out? Let’s say they’re thinking about getting pregnant, but they want to do some preconception care. Would you say three to six months, or maybe a year, or depends on the level of inflammation?

Hillary Wright [6:36]
I think, ideally, 6 to 12 months would be a really great headstart, because we all know that diet and lifestyle strategies take time to roll in. I’m not a big fan of over restrictive approaches, I’m not a big fan of sudden changes. Particularly, when someone’s plan is to try to conceive, one thing I feel like I see, unfortunately too often, is a woman decides to focus on this because she wants to conceive and at that point becomes very vulnerable to a lot of over restrictive diet plans. And from my perspective, as a nutritionist and as a health care provider, we’re in the position of trying to tell your body, this is a good place to be pregnant, this body is well nourished, this body is not under too much stress, this body moves around, this body gets a reasonable amount of sleep. Those aren’t things that kind of turn on and off like a light switch. I would say at least three months. I love when I get teenagers and women in their early 20s in my office, because I think, Oh my goodness, it’s so much easier to teach a young dog new tricks, so they get a good Running Start at having an understanding of the importance of managing the insulin resistance that underlies this condition, way ahead of the time, when it becomes urgent.

Farrar Duro [7:58]
I think that’s where we see this as practitioners working with fertility patients that were like, I wish that they were told this earlier, because like we just spoke about, we had a 19 year old who was just told in my office, well, you have PCOS, but just take birth control, and then worry about it when you’re ready to get pregnant. And she’s like, “No, I don’t want to do that, I want to figure out why my body is experiencing all these cystic ovaries and fibroids, I don’t want to just cover it up anymore.” She’s 19, so she’s really taking action on changing up her diet and trying to get to the bottom of it. But I think that slapping a band aid over it isn’t going to help in these future generations. I don’t know what’s going to happen with the fertility rate, if we keep doing that. So it’s really frustrating.

Hillary Wright [8:42]
I’ve been Massachusetts, which has the oldest first time mothers in America, I’m regularly seeing women between 35, 40 and older trying to conceive. First of all, I’m somewhat shocked when women in that age tell me that they were diagnosed as a teenager, I’m like, “Well, if that was the case, that you would have a very insightful practitioner, because frequently, it’s just overlooked, particularly, 20 years ago or more.” I totally agree with you, it’s such a band aid approach to just slap somebody on birth control pills, or to say, some women don’t feel great about birth control pills or the other, they’re not sexually active, they don’t want to be on them. I’ve seen women, they’re not even getting like Provenge or something every few months to make sure they have a period, because your menstrual periods are a harbinger of your overall health. To not have a period is a red flag and it’s not healthy for your body to not shed the lining of your uterus. While it makes sense to put people on birth control pills and force that to happen, it completely represents a missed opportunity to get into the diet and lifestyle strategies that are going to be not just good to PCOS, but every aspect of your health.

Farrar Duro [10:03]
Right, definitely. “Scientific American” had an article about that last month, a whole issue devoted to reproductive health. If you guys haven’t read that issue, it was really amazing, it was the future of IVF. Also, the future of, and why we need a period? Why do we have it in the first place? It was really a good issue. They talked about that, it is important and it’s really not there just for decorative purposes, it does serve certain purposes. If we look at trying to force the body to not have a cycle, we’re not really sure about the long term effects of that and we have to be careful.

Hillary Wright [10:41]
It doesn’t make sense to me, because it’s not normal to not have a period. When a clinician, particularly a young girl, who should have pretty regular periods, says, well, maybe it’s this, maybe it’s that maybe you’re stressed, we’ll just put you on birth control pills. What’s going on behind the curtain?

Farrar Duro [11:00]
Yeah, definitely.

Hillary Wright [11:02]
Do we want to catch up?

Farrar Duro [11:04]
Yes, and that’s a good discussion to have, if you have a practitioner who’s just preferring to just see you for about five minutes, write you a prescription, and then be on your way, which is what I experienced a while back, it’s just until I finally started researching what the other alternatives were. I think, if you have that, it just takes a little trial and error to find somebody. Maybe you want to start with a nutritionist and start with kind of looking into a little bit more research until you get to the point where you find the providers that are willing to sit down with you and say, Okay, here’s some options, let’s try these first. Can you tell me a little bit more about some of the cases that you’ve seen as a nutritionist working with IVF patients? Maybe a specific case you can think of, where they’ve actually benefited from just starting with the nutritional side of it, treating that first.

Hillary Wright [12:01]
I actually have a really good example of that, right now, a patient that I’m currently meeting with, again, who I first met with prior to the birth of her first child. We worked together for a few months, she had lost about 30 pounds at that time, and her BMI (body mass index) had gone from 32, to 28. After that, a very reasonable amount of weight loss, she was able to conceive her second child. Anyone who’s had babies knows pregnancy presents a challenge at trying to eat healthfully and try to manage weight gain, then you have a baby and a more complicated life. It’s not unusual for women to retain some of the weight gain through pregnancy, more possibly even gain more after their child was born. I actually hadn’t seen her for a couple of years, she had a daughter, she was healthy, she didn’t have gestational diabetes, or any other complications. Then, at this post phase, she regained the weight that she had lost before. She came back to my office, and she said, I need to reboot, we did this before, I want to have another child. We actually sat down and did the math.

Hillary Wright [12:40]
Currently at your weight, this is what your body mass index is, let’s look and see what your BMI and your weight was when you conceived your daughter. It really it was the difference, she hadn’t actually regained all of her weight. It was really an opportunity to say, listen, even if you lose 20 pounds and get your BMI down where it was when you conceived your daughter that is a pretty good indicator of where your body felt like is a good place to be pregnant. I think it’s really important to emphasize that a weight that improves your fertility lowers your risk of diabetes and other complications related to PCOS, maybe just a little south of where you are, maybe nowhere close to where you feel like you want to be. I’m not a big fan of very distant, large waking goals. Because first of all, it’s not needed to get healthier. I prefer when people sets, reasonable 3% to 5% weight loss goals, work on that, achieve some success, pat yourself on the back, realize that it’s doable, and then people can move the goalposts. Women with PCOS are so ashamed about their weight, they go into doctors offices, and the weight issue often just sucks all the energy out of the room, they’re often not believed that they’re trying because weight loss can be more difficult. And again, that also is a good opportunity to mention that not all women with PCOS are overweight, but the overweight women tend to be more symptomatic and struggle with fertility problems more.

Hillary Wright [13:31]
There’s a lean PCOS too, that we don’t talk about a lot. We do see that, it’s like 30, or 40% ofwom en with PCOS have that lean type. And they just are the ones that are overlooked a lot of times like, oh, you’re fine, I think they’re the most ignored.

Hillary Wright [13:40]
I actually read a study that had several hundred women in it, and the foundation of the study was to ask women if they would be okay being screened for PCOS as part of a pre employment physical. They weren’t specifically going after women with PCOS, they were trying to get a sense of how much it may actually occur in the population. They actually found that the percentage of women with PCOS symptoms and the lean group was actually quite high. It’s just that when you have PCOS, and you’re overweight, you tend to be more symptomatic, therefore, you tend to be more likely to go to the doctor and experience fertility problems, and then maybe end up in a research study. One of the reasons why I think it’s really hard to nail down statistics on what percentage of women with PCOS are overweight or obese is because the excess weight makes them more symptomatic. So they know they grab more attention. But I have many lean women with PCOS, who are a metric, do not get their period, have elevated insulin levels, facial hair and acne. They’re often update attention that they have the same approach through birth control pills, regulate things giving people the illusion that everything’s fine.

Hillary Wright [14:19]
Right? And it’s like, what about missed opportunity? A little bit of something I researched, I read about testing for glucose, when you test for fasting glucose, that I was really shocked about this. When we just test for fasting glucose, how much pre diabetes we miss if you’re not doing a GT. All the time I see when I go, well, I already got screened, and my doctor said everything’s normal. All I see on there is a fasting glucose. I don’t see this testing done, and I usually just see it with pregnant women. How often should somebody, and this is saying that women with PCOS should have this done at least every two years, but this is a newer study, I think it came out last year, and I don’t think we talked about a lot, and it’s not a fun test to do but I know that it’s important. We actually asked our patients to get this done, because I don’t want to miss that. When we look at the rate of diabetes in this country, it’s pretty scary, and with women with PCOS, it’s like one and two after you reach for age 40. We want to make sure that we don’t miss that. So, what have you found as far as screening goes?

Hillary Wright [14:53]
You’re absolutely right, there is a decent amount of evidence to suggest that the glucose abnormalities that occurred with PCOS may be more significant in the postprandial phase that the fasting phase. That means the fasting glucose may be okay, but if you want to capture what went on in the two hours or the three hours after woman consumes carbohydrates, you may get a different picture. There was actually a pretty large study done that looked at this glucose screening, and when with PCOS, and found that any one of the three common tests, so were fasting glucose, hemoglobin A1C, which is, kind of a reflection of an average of your glucose level for a period of two or three months, or an oral glucose tolerance test, any of those would show if somebody had diabetes, so it already progressed on to that phase, but the A1C and the fasting glucose, this is a lot of women with pre-diabetes. Pre-diabetes is is significantly reversible, if the attention is paid to it early on. So the androgen access society makes recommendations for glucose screening, and they suggest all women with PCOS to have an oral glucose, 1 hour oral glucose tolerance test every two years, and more often, if it shows any abnormalities.

Farrar Duro [15:39]
Okay, so that’s important.

Hillary Wright [15:40]
Earlier intervention is always better.

Hillary Wright [15:42]
Yeah. And if your insurance doesn’t cover it, it’s not an expensive test to get. I think that there’s so much you could discuss with your primary doctor.

Hillary Wright [15:49]
When my PCOS patients get pregnant, I always tell them, ask your OB to have an oral glucose tolerance test, early, like right away, know what your glucose tolerance is, in the first trimester, because if they do the typical way to 26 to 28 weeks, these women may already be a full blown gestational diabetic or had been possibly for months, because the placenta secretes hormones that makes the mother more insulin resistant, that’s by design, because nature is trying to preserve some circulating glucose for the babies growth. But that becomes more significant in the third trimester when the placenta is bigger, and the baby’s calorie demands are higher. Diabetes screening is really designed to unearth those women that as a result of the pregnancy hormones, are just occasionally diabetic, but that in the typical population doesn’t occur to 26 to 28 weeks. I’m thrilled that I had a patient my office just the other day, who was now 15 weeks pregnant, and one of the first things her ob did without her having to ask, because I always tell them, ask them to do it. It’s not a big deal. To your point, it’s not an expensive test. She said her doctor, you know, didn’t make a big deal out of it. She said, You know what, with PCOS diagnosis, we just want to know where your blood sugar is, early in this pregnancy, I’m just going to order it and it was fine, it was normal. She will have it repeated at 26 to 28 weeks, but she has a peace of mind knowing. If you enter a pregnancy and you’re already insulin resistant, why wait until too far into the pregnancy and see if the pregnancy hormones on top of your pre existing state are causing unhealthy elevations and your glucose levels?

Farrar Duro [16:46]
That really makes a lot of sense. You recommend also women who conceive continue to see a nutritionist during pregnancy as well to avoid a gestational diabetes? Or is there a way to because we know women with PCOS are a little bit more risk of that. Have you seen if you’re working with diet beforehand is that setting them up for a lower risk when they are pregnant?

Farrar Duro [21:33]
I’ve seen mixed evidence on gestational diabetes prevention. But honestly, just thinking about the physiology, and just what it takes to have a healthy pregnancy that’s lower in all kinds of complications, it makes perfect sense to me that going into a pregnancy already eating and already being active in such a way that’s consistent with managing the underlying insulin resistance, has to have some impact on what’s going on during that pregnancy, because insulin resistance is involved in not just gestational diabetes, but also preeclampsia, pregnancy’s hypertension.

Hillary Wright [22:12]
With my women with PCOS, when they get pregnant, I tell them, right out of the gate, it doesn’t change, anything that we’re doing, we’re still going to try to follow this kind of more moderate carbohydrate and balanced diet, we’re going to try to kind of pare your carbohydrates with proteins. What a lot of women don’t understand, and this is not just one with PCOS is that your increased calorie and protein means for pregnancy actually don’t go up until the second trimester. Most women, including one with PCOS, have heard pregnancy requires an extra 300 calories a day. Well, that’s actually for anybody who starts a pregnancy that the BMI below 25, and most of my women will be starting a pregnancy with a BMI that’s higher than that. With a BMI below 20, between 18.5 and 24.99 it’s no additional calories inthe first trimester, 350 a day in the second, 450 a day in the third.

Hillary Wright [23:14]
However, that’s with an expectation of 25 to 35 pounds of weight gain. If a woman starts a pregnancy with a BMI over 30, some physicians will tell them, You don’t need to gain any weight, I follow the official guidelines and say 11 to 20 pounds is the recommendation, perfectly fine to aim for the low end of that, you do not need to start eating more calories and more protein, you find that you’re pregnant, you just want to continue on with your healthy diet and lifestyle habits designed to manage insulin resistance. And then we’ll kind of eat the calories to the left, I might say 200 extra calories in second trimester, see what happens with their weight. maybe 300 instead of 450 in the third. If physicians want to make the recommendation that we don’t need you to gain any weight, then I leave that between them and their doctor. I’m most interested in, are you eating adequately to make a healthy baby and to maintain a healthy you through your pregnancy?

Farrar Duro [24:11]
And it’s more veggies and protein base would you say like in particular diet plan to recommend?

Hillary Wright [24:18]
It’s a plant based diet. It’s basically what I outlined in my book, a balanced plate approach where about 25% of it is on the plate of some sort of protein, about 25% some sort of a quality carbohydrate. And we do need some carbohydrates, they are fuel for the human body, over restricting them can cause ketosis which we don’t believe to be good for pregnancy, and it can raise cravings for carbohydrates if your central nervous system feels too deprived. If we kind of follow this fairly simple visual, like these infographics of things like a balanced plate, that is again 25% protein 25% whole grain like quinoa, brown rice, sweet potato, those legumes, and then half, mostly non starchy vegetables and some whole fruits. The science tends to fall into place, I try to make diet and lifestyle recommendations feel doable. Women with PCOS are assaulted with all kinds of complex messages about nutrition. During pregnancy, there’s no do-overs when it comes to making a healthy baby, it’s not a time to experiment with a restricted diet, but rather to say, what are the basics of nutrition to fuel my body and fuel the growth of a healthy baby?

Farrar Duro [25:37]
Yeah, I wonder about women who are following the keto diet and are pregnant, that’s something that is very popular out there to do this diet. I see that a lot. But, I really caution people to try not to do things that are overly restrictive. And definitely I’m afraid sometimes that these diet plans don’t give enough variety.

Hillary Wright [26:00]
Again, there’s no do overs, it’s not an experiment and assume that it’s fine. All I know was prior to much of my early career, I took care of women with gestational diabetes. We were always told that they needed to dip their urine with these sticks to make sure they work in ketosis, because we didn’t think it was great for babies developing brains, it just makes sense to me that a dietary pattern that restricts too many healthful foods, even prior to conception. I haven’t read anything to convince me that it’s a good idea to over-restrict. I recently put together a deep dive in the fertility nutrition world.

Hillary Wright [26:41]
This is independent of the PCOS. I was looking at research studies that looked at dietary patterns prior to conception and live birth outcomes, these studies were looking at things like looking at women going through IVF, looking at their successes rates and having them fill out validated food frequency questionnaires and lifestyle questionnaires for the year prior to conception. And, as you would expect, they were we’re finding that alcohol and smoking wasn’t a good idea, eating too much red meat wasn’t correlating well with outcomes, but eating fish eating fruit. Fruit always gets demonized, eating whole fruit, I can cite that study and another study that specifically looked at group and pregnancy outcome and women going through IVF and found that eating fruit, statistically correlated with better outcomes and eating a lot of fast food statistically correlated with poor outcomes.

Hillary Wright [27:41]
There’s another study that I came across that specifically looked at whole grains and fertility outcomes, and actually found that eating whole grains correlated with better outcomes. What I thought was really interesting, because they tried to look at different phases of the conception like blastocyst formation, endometrial thickness, and one other thing, I can’t think of what it is, but they are the data. Data is not perfect either, but they thought it was possibly a specific benefit endometrial thickness to including whole grains in your diet. The thing is, a lot of the grains people are eating are not whole grains, are carbs are the devil, and they’re all getting thrown in the same bucket. But if you look at, again, that balanced plate approach where we’re allocating a quarter of the plate, to some sort of a carbohydrate, as close to nature as possible, there is such a thing as too little, just as there is such a thing as too much.

Hillary Wright [28:42]
I would say to my patients, we know that eating a lot of carbohydrate is not a great idea for probably most women with PCOS because their insulin resistance. The problem is a lot of the research often goes from there to like way low. It’s like, why don’t we focus on the middle ground here? Why don’t we focus on a place where we’re not throwing the baby out with the bathwater by saying, be selective about the carbohydrates that you consume, try to eat proactively before you’re starved so that when you do eat, and you know, maybe hungry, not starving, we have a better ability to stay in the driver’s seat when it comes to making food choices. Proactive eating regularly throughout the day, respecting our hunger, instead of viewing it as this thing we’re supposed to willpower, ourself against. It’s never going to happen, it never favored human survival to resist food. The problem I have with diets, which often have some over restrictive capacity or nature to them is, they rely on people just being able to suck it up and in here, and I’m interested in, let’s just getting you adding some healthful foods to your diet, because I believe just adding healthful foods, regardless of what the scale says, people start to appreciate how their body responds to that, which becomes a strong motivator. I’d much rather help people add healthful foods to their diet in the hopes that it nudges out some of the less desirable stuff, then to give people lists of things that says, Don’t eat this and don’t eat that and you can’t.

Farrar Duro [30:14]
I agree totally. Yeah, and beat yourself up for not following things perfectly. All that just doesn’t work. We usually say we’ll just start with a Mediterranean plan, and try to eat the rainbow and adding in more things instead of subtracting like you’re saying. And just as you eating, as you eat healthier, you actually crave healthier foods.

Hillary Wright [30:42]
Actually a recent study that just came out at Mass General here in Boston, called “The Earth Study” and there’s many aspects to this study. What they were doing is so many women have gone through their fertility world, they’re familiar with the fertility diet, saw the fertility diet. It’s written by Walter Willett and Jorge Schapiro from Harvard School of Public Health, and the school of nutrition. Basically, it advocates for a plant based diet, that’s where the recommendation that many women eventually find that including as little as one serving of full fat dairy.

Hillary Wright [31:20]
Basically, it’s a healthy plant based diet that includes regular physical activity, that book came out in 2006, I think. They were interested in comparing different dietary patterns, including their own, “The Fruit Of Fertility Diet”, but also what they call this a “pro fertility plan”, which was kind of the fertility diet with some additional things added on. The different types of dietary patterns they were looking for in these women that were going through fertility treatment, and I can’t remember the exact number of women, but it was a lot was a Mediterranean diet. This other one called the healthy eating index, 2010, it’s just another one that came as part of a research study. Then there was the fertility diet information that’s in that book, and then their pro fertility diet was basically the fertility diet with some add ons, those add ons were trying to make sure you’re getting at least 852 micrograms of folic acid, correlated with better outcomes. So anybody who’s taking a preconception multivitamin, oftentimes, they have 800, or 1000mg of folic acid, and I think it was 15.7 milligrams of B12 micrograms, that would advocate for a multi or preconception that it would be 12 content, or, you know, taking a B12 supplement. They also had them eat organic, and they looked at sea food, I think soil in theory. And what they found was the most consistent true directory of improvement outcome was basically to the Mediterranean diet, they didn’t really say much about the healthy eating index thing.

Hillary Wright [33:09]
These things are not perfect science there, they don’t show up to cause and effect. But basically, the dietary pattern that seemed to do the best was a plant based diet, like the Mediterranean diet, making sure that you get enough folic acid enough B12, that you include seafood, which is important, that’s anti inflammatory, contains omega threes, including BHA, and they did find some benefit for eating organic, but I always point out, that was one study. It doesn’t mean that all people have to eat organic, it just means if it’s one of those things that the correlation was small, but it’s one of those things that people choose to pay attention to it. I would just say you should eat fruits and vegetables, no matter what. But I will often refer them to the Dirty Dozen from the Environmental Working Group and say, if you wanted to cover your base and say, Look at the Dirty Dozen, strawberries are on there, you have so much money to spend on organics, a finite amount for most people, if at all, maybe you spend it on the strawberries and not on the avocados.

Hillary Wright [34:18]
What I liked about it was it really demonstrated what we believe to be the case that it’s dietary patterns that matter, and that if people want to be able to cover some of their bases with this organic. I’ve had a conversation with Dr. Shapiro about this, and they all say it’s not enough evidence to say all women trying to conceive should eat organic, but for people that decide they want to capitalize by spending some money on certain fruits and vegetables organic that they can do that. I see way too many women blaming themselves for things when the fertility journey doesn’t turn out. I would say if it’s going to drive you crazy that you didn’t organic strawberries, if things don’t turn out, then do that, but don’t feel like you have to eat entirely organic.

Farrar Duro [35:06]
So true. This is so good, and I think that every woman out there who has PCOS should have your book The PCOS Diet Plan. Definitely, if you don’t have that book already, please check out Hillary’s book, because I think it’s really helpful, it makes it easy to implement, it shows you exact proportions and all kinds of things to do. We’re going to link that in our show notes as well. I really appreciate you bringing your knowledge to our audience, because there’s always a lot of confusion around diets and what to have, when, and all the information out there. Our job is to actually help you guys by bringing new evidence based information on PCOS and giving you the amount of studies that are out there. We’ll try to link to the ones that we mentioned before, but to have that conversation with the providers that you are seeing, or also, the people around you and your family, perhaps, and letting them know this is important. I need to eat like this, and I need you guys to help me because it’s a group effort a lot of times. Thank you so much for all this information, and I really hope we’ll have you back again, maybe to talk about pregnancy. Because there’s a lot there to say.

Hillary Wright [36:26]
I try! Women with PCOS are subject to a lot of information. I feel like my role is trying to interpret the science that is complicated into terms people can understand. Because otherwise, if you’re not really knowledgeable with the condition, it’s much harder to recognize something that might be misinformation.

Farrar Duro [36:50]
Definitely, I really appreciate it. And again, thank you for coming on Hillary and thank you everybody for listening. Please feel free to leave comments on our Facebook page, and we look forward to having you back again. Thank you.

Hillary Wright [37:05]
It was fun. Thank you!

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Disclaimer: The information in this podcast is intended for general audience only and is not intended to diagnose, treat or replace professional medical advice.

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