Guidelines for Women with PCOS During COVID-19

The World Health Organisation (WHO) has declared the coronavirus disease 2019 (COVID-19) a pandemic. Presentations of COVID-19 have ranged from asymptomatic/mild symptoms to severe illness and mortality.

Common symptoms have included fever, cough, and shortness of breath. Other symptoms, such as malaise and respiratory distress, have also been described. Symptoms may develop 2 days to 2 weeks following the exposure to the virus. [1]

PCOS is also linked with chronic low-grade inflammation which can be further linked with other aspects of PCOS as insulin resistance, cardiovascular disease, etc. Inflammation directly stimulates excess androgen production, worsening PCOS condition if more abdominal adiposity.

Evidence has suggested that PCOD associated low grade inflammation also results in elevated White blood count, endothelial dysfunction and increased oxidative stress WBC has lead role in immunity of body and might back virus, and hence the inflammation needs to be controlled for better immunity.[2]

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Keeping this in view, Truweight has formulated guidelines which can help women with PCOS during COVID- 19 Pandemic.

Nutrition And Gut Health

Evidence based dietary guidelines demonstrate positive effects on PCOS outcomes like weight loss and reduced insulin sensitivity when a diet includes low glycemic index foods, high fibre, high protein and healthy fats.

• Whole grains like Brown rice, Oats, Whole wheat, Quinoa, Barley, millets like Ragi, Jowar, Bajra, etc. are nutrient dense and good sources of complex carbohydrates which should be included in diet.
• Including vegetables like cauliflower, cabbage, broccoli, bell peppers, etc will give the body an adequate supply of fiber and micro-nutrients. Ensure having salads in each meal to make it a more fiber rich diet. 
• You can enjoy all the seasonal fruits (1-2 servings/day) like Oranges, Sweet lime, Muskmelon, Watermelon, Mangoes (1/2 half) that are dense in essential micronutrients Vitamin C, B-complex vitamins, etc. You can simply squeeze lemon (for Vitamin C) over a salad, soup, dal or snack.
• Lentils like kidney beans, chickpeas, soybeans etc also give complex carbohydrates along with benefits of fiber and protein. Lean meats like egg whites, chicken and fish can also be added to improve protein content in the diet. Non vegetarian food portions should be confined to 70 grams of serving/twice a week. 
• Dietary omega-3 (n-3) fatty acids from nuts and seeds, cold pressed oils (oil intake – 2 to 3 tsp/day) have effects on anti-inflammatory and immune-modulating; decreasing insulin levels in the body.
• Hormones and fat-soluble vitamins need healthy fats for optimal production and absorption. You can take 1 tbsp of seeds combination throughout the day, it can be spread on a smoothie, salad, soups, etc. Handful nuts like Almonds, Walnuts, Pistachios, etc can be consumed during mid mealtime. 
• Regular intake of Vitamin E is crucial for maintaining the immune system via the activity of T cells – the white blood cells that provide protection from viruses e.g. flu. Food sources include Nuts like Almonds, peanuts, hazelnuts etc, Greens like spinach, broccoli. 
• Vitamin A, and they have an antioxidant effect to help strengthen the immune system against infection. Include orange coloured foods in your diet that are rich in Vitamin A. Foods like carrots, pumpkin, sweet potatoes, etc are one of those.
• Zinc promotes healing, protein synthesis, growth of immune cells. Food groups that can supplement your body with Zinc are pumpkin seeds, beans, chickpeas, almonds, cashews, and products fortified with zinc. 

Growing evidence has implicated the intestinal immune system as an important contributor to metabolic disease. Looking after the health of the gut and maintaining a right balance of microorganisms in the digestive tract is vital for proper absorption of nutrients, physical and mental health, and immunity. [3]

• Prebiotic, probiotics, essential amino acids should be consumed to degrade anti-nutrients like phytates, etc. 
• Including preparations of Brown/White Rice based fermented foods like Idli, Dosa that are soaked overnight in water; can promote growth of good bacteria in the gut.
• Seasonal pickles (less oil) can also be consumed which acts both prebiotic and probiotic. Since pickles contain oil, therefore we advise you to stick to the portion size (0.5-1 tsp a day). 
• Consuming the rice water from the fermented Rice too has health benefits, it works as a prebiotic and reflects antimicrobial and antioxidant properties. This should be consumed early in the morning empty stomach for better gut health and immunity. 
• You can add prebiotics like fiber rich foods – salads, sautéed or stir-fried vegetables, resistant starches like small green banana, oats, barley, white beans, lentils and cooked and cooled rice; which produces short chain fatty acids (butyrate) in the intestine.
• Butyrate, SCFA helps growth of good bacteria in the gut. It also boosts the immune response in the body, reduces inflammation and improves nutrient absorption. 
• Including herbs and spices like Cinnamon, ginger, garlic, turmeric, fennel seeds while cooking will improve immunity as well as these herbs are good in correcting hormonal imbalances. 
• Include anti-inflammatory foods like Olive oil (2-3 teaspoons in salad dressings), Green vegetables (75 – 100 gm), Turmeric or Cinnamon (pinch in warm water/hot milk) to reduce inflammation, one of the symptoms of PCOS. 
• Hydration is important to calm the hormonal imbalances in PCOD. Also, it improves the metabolic rate of the body. Drinking 2-3 litres water per day is essential. Water is a natural detoxifier. 
• Avoiding processed and junk foods like breads, pasta, noodles, etc since they spike sugar levels in the body therefore making PCOS management difficult. 
• Avoid alcohol and smoking as it affects hormonal imbalances and raises the oestrogen levels in the body. Apart from hormonal changes, it suppresses immunity. 

Take back your Immunity with our Immune Booster Diet plan

 Supplements

• Vitamin D plays an important role promoting a healthy immune system. Scientific research suggests that supplements of Vitamin D in the form of granules or chewable tablets like Tayo60k, D-rise, ShelCal D, etc improves Vitamin D levels in the body that in turn protects the body against respiratory infections. 
• Best source to absorb Vitamin D would be getting oneself exposed to sunlight preferably from 7 AM to 10 AM. 
• Adding a probiotic supplement like Velgut, Darolac everyday for a month has shown to have improved immunity and is associated with changes to the gut microbiota. The gut immune system may represent a novel therapeutic target for systemic inflammation in insulin resistance. 
• Supplements like chromium, inositol (APCOD/ NORMOZ), folic acid, iron, and Vitamin B12 should be taken based on lab reports for deficiency and better results. This should be under consultation of Nutrition coach or Gynaecologist. 

Exercise

PCOS is more about living a healthy lifestyle to improve your hormonal imbalance. A healthy lifestyle which includes healthy dietary intakes, regular exercise and regular sleep. 

• Being active everyday, will give you a healthy body-physically and mentally. Studies have shown doing 30 mins of Aerobic activity not only helps in weight loss but can improve PCOS symptoms like reducing Body Mass Index, controlling Insulin resistance and regulating menstrual cycles. 

• Few Yoga asanas like Suryanamaskar, Bhujangasana, Dhanurasana, Bhramari Pranayam, Kapalbhati, etc helps to reduce cortisol levels therefore improving mental health. You can begin your day by doing basic 5-10 Suryanamaskar, everyday to improve flexibility. 
• It is advisable to do 30-90 minutes of moderate exercise a day 5 times a week as simple as Spot jogging, skipping, lunges, planks, etc. If you have a lawn or veranda attached to your house; or a lobby or premises in your housing society, then you might want to do a 30minute brisk walk. 

Stress and Sleep

Studies demonstrate, increased stress can adversely affect PCOS conditions and exacerbate the symptoms related.

Having PCOS might have a drastic effect over your body during COVID-19. It also can be linked with depression, anxiety, and increased risk of Cardiovascular disease and Diabetes. [4]

• Connecting with your distant friends and family relatives, over a voice or video call can keep you engaged & can help you reduce your stress and anxiety. It can be called as distant socialising. 
• You can also start with a hobby which got lost because of your busy hectic lifestyle. This will help you increase your happy hormone Serotonin and reduce cortisol. 
• You involve yourself in group activities with family members in the house, as simple as playing indoor games, cooking and cleaning together, kitchen gardening, etc. 

• Sleep is considered an important modulator of the immune response. Thus, a lack of sleep can weaken immunity, increasing organism susceptibility to infection. You must aim to get a good 7- 8 hrs of undisturbed sleep at night. 
• Meditation for 20-30 mins or deep breathing exercises like Pranayam either early in the morning post waking up or before going to bed can help control Stress and also induce good sleep.

General Guidelines

• Use Mask when you are going out to buy essentials or if you are coughing, or sneezing. Ensure the Mask is washed thoroughly after each use. 
• Wash Hands Frequently and thoroughly for 20 seconds OR clean your hands with an alcohol-based hand rub or wash them with soap and water. 
• Social Distancing – Maintain at least 1 metre (3 feet) distance between yourself and anyone who is coughing or sneezing. 
• Avoid touching eyes, nose and mouth. This will ensure the virus does not enter your body. 

 Diet Plan

Time	Plan 1	Plan 2	Plan 3	Plan 4
Waking Up	Apple Cider Vinegar 1tsp + Lukewarm Water or Soaked White Rice Water	Apple Cider Vinegar 1tsp + Lukewarm Water or Soaked White Rice Water	Apple Cider Vinegar 1tsp + Lukewarm Water or Soaked White Rice Water	Apple Cider Vinegar 1tsp + Lukewarm Water or Soaked White Rice Water
Breakfast	Red Rice Poha / Veg Sandwich +1	Oats upma/Dosa – 2 + 2 tsp Flaxseed chutney	Millet Idli / Millet Dosa – 2 + 1 cup Sambar	Akki Roti 2 with 2 tsp Garlic chutney
Mid Morning	Lemon Water or Chia Seeds + Almonds 2-3 Or Fruit	Buttermilk Or Sattu water + Almonds 2-3 Or fruit	Lemon water Or Chia seeds + Almonds 2-3 Or fruit	Buttermilk Or Isab gol (1tsp) + Almonds 2-3 or fruit
Lunch	Dal 1 Bowl Brown Rice 1 Bowl / ½ Bowl White Rice Veg Curry 1 Bowl. Buttermilk (200ml)	Veg salad Veg Pulao 1 Bowl Tomato Raita – 1 bowl Turmeric & Mango pickle	Sambhar 1 Bowl Brown Rice/ Red Rice 1 Bowl Onion Raita / Curd 1 Bowl	Veg Dal 1 Bowl Brown/ Red Rice 1 Bowl Kosambari 1 Bowl Buttermilk (200 ml)
Mid Evening	Herbal tea + Khakhra	Herbal tea + Roasted Chana	Herbal tea + Dry bhel	Herbal tea + Roasted Makhana
Dinner	Veg Soup 1 Bowl + Vegetable dal chilla 2 no. +green chutney 2-3 tsp	Millet Roti 1 no + Sprouts curry 1 bowl + Onion salad	Sauteed veggies 1 Bowl + Upma 1 Bowl	Veg soup 1 Bowl + Veg Daliya 1 Bowl
Bedtime	1 cup cinnamon / turmeric water	1cup cinnamon / turmeric water	1 cup cinnamon / turmeric water	1 cup cinnamon / turmeric water

Disclaimer: Truweight does not claim to cure any diseases. Results may vary. Diet supervision is not a substitute for medical treatment. You can prefer food/recipes as per local availability. 

Recipes

1. Turmeric Root & Mango Ginger Pickle in Lemon Juice

Ingredients 

• 150 gms Fresh Mango Ginger 
• 150 gms Fresh Turmeric Root 
• 1/3 Cup Lemon Juice (~5 Large Lemons) 
• 4-5 Green Chillies (optional) 
• 1/2 tsp Salt 

Method: 

• Using a few drops of oil, grease your palms. This prevents the turmeric root from staining your palms. 
• Peel and chop the turmeric and mango ginger into thin slices. You can also julienne them. Cut the green chillies into 1/2′′ pieces. 
• Add the mango ginger slices, turmeric root slices, green chillies, lemon juice and salt to a clean, dry, airtight glass bottle. Use a spoon and mix well. Close the bottle and let the pickle rest for 2 days.

2. Kambu Ragi Koozh / Ambali (fermented, vegan, gluten-free)

Ingredients: 

• Whole kambu or Bajra – 1 cup 
• Ragi flour – 1.5 cups 
• Water for cooking – 4.5 – 5 cups 
• Salt to taste
• Chopped onion (Optional)

Method: 

• Soak the whole kambu or bajra for an hour. Rinse and let it air- dry for a couple of hours. 
• Then use a mixer and grind to a coarse rava/broken grain consistency. Add water to the broken kambu. 
• Add the ragi flour and mix well. Set aside till it ferments. Overnight does the trick. 
• Boil the water, add salt and add the fermented grain mixture to it. Keep some more water aside. 
• In case the porridge becomes too thick, add water as required. Allow it to cook till it thickens and flour gels together. Set aside till it cools completely. 
• Koozh can be eaten in a couple of ways. Thick koozh can be eaten as one would eat paddy/millet rice. Serve it with sambar and poriyal or however it is you eat your rice.
• Alternatively, once the koozh has completely cooled down, it can be diluted with water so a more flowing porridge and chopped raw onion can be added to it. This is pretty much a complete food in itself. 

Conclusion

Nearly 10% of women have this common reproductive and endocrinology disorder, PCOS, today. Women with PCOS during COVID-19 pandemic can get their health in trouble if not maintained a healthy lifestyle.

Today, while the world is at home fearing the virus, do not neglect the impact of it on your health without even coming in contact with it. That is, as said, maintaining a healthy food habit, exercising more often and keeping your mind engaged is as important as staying home.[5]

‘You get it when you put it’. That is, if only you put an effort towards getting better, you get an efficient result. Having PCOS and COVID-19 is such a time where you have to get alerted towards how healthy you are living.

There is no way that someone else is going to make that happen until you do it yourself. Share this blog with people you care about and have PCOS. If not you someone else will surely require these guidelines. Also contact us for any queries regarding the guidelines.

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