Top positive review
This is the book to read for PCOS in 2020
Reviewed in the United States on April 14, 2020
I've read most of the other books from reputable sources that are published on PCOS. The content of this book didn't add to my knowledge base in any way, but that's only because I already read Fung's other books as well as his posts on PCOS. If I had to pick one book to give to someone with PCOS in 2020, this would be it, because it covers the most recent and up-to-date content available (for the most part) in an easy to understand format.
I had a few gripes with it: for example, in one portion she implies that obesity causes PCOS, or at least that it is more likely than PCOS causing obesity. This is not accurate, many women become obese and do not acquire the symptoms of PCOS. Nor is it genetic; no genes have been identified for PCOS that unilaterally lead to the condition despite much effort to find them. There is good evidence that the predilection for hyperandrogenism and polycystic ovaries stemming from hyperinsulinemia is caused by exposure in utero to high levels of amh. So: the symptoms of PCOS are the result of being a second generation hyperinsulinemic. Of course, she goes on to later discuss that insulin is the root of evil here, which is of course true, but the implication that each woman with PCOS caused her own symptoms is not. Nonetheless it is of course each woman's responsibility to reduce her levels of insulin if she wishes to improve her condition long-term. This point is relevant because I feel the author is pushing a personal bias on the reader that fat PCOS women are somehow less worthy than thin PCOS women because they utilized their excess insulin to store fat. Many thin women with excess insulin have different, and sometimes worse problems such as epilepsy. Whichever pathway the excess insulin takes, it's the excess insulin that's the problem and needs to be removed. The fat is simply a side-effect of that insulin that some women experience.
Second gripe: a passing mention about a woman with PCOS concerned because she is higher risk for cancer with PCOS, and then mentioning that women in her family were at risk of breast cancer. PCOS women are at increased risk of endometrial cancer due to lack of regular menstruation. The increased risk of breast cancer is minimal, especially as with many PCOS women, they are unable to have children, which consequently _reduces_ the risk of breast cancer. This should have been left out or corrected as it is misleading.
Third gripe: the section on letrozole mentions that it has higher risks of birth defects. This is pretty unilaterally disproved. Although one very small study showed a slight bump, much larger studies have shown this is not the case. In fact, letrozole clears from your system well before it would be a problem for developing fetuses, which is one of the many reasons it is more effective for PCOS women, because it reduces the problem with thinned endometrial lining that clomid causes, because clomid is around longer. Letrozole also tends to cause significantly less side-effects for most women over clomid and can be used many more times than clomid, which is useful if male factor is at all a concern, which it frequently is these days. While low carb diets are clearly a better long-term solution than letrozole (or clomid), depending on the age of the woman and the amount of time she has already spent trying to improve her health, letrozole may be a good option to induce ovulation.
A final point: the diet. Yes, it's straight strict keto. This diet is known to crush hyperinsulinemia in both thin and obese PCOS women and has an excellent track record of encouraging health for pregnancy. I've been on it for a year without success in pregnancy, but I did lose a significant amount of weight and I do ovulate on schedule with the addition of letrozole. (I'm old and have no time to wait.) Something to keep in mind is that infertility is not always just the woman's problem. Men also need to be regularly evaluated to ensure their sperm is healthy and populous. This is obvious, but...after a year of doing keto and finding out that our sperm analysis a year ago was not that great *now*, to be honest I am sick of the diet. Eggs, chicken, beef, and non-starchy veggies are good and healthy but despite what some would have you believe, it *is* restrictive and it does in fact get old. A year later and I've decided that none of the pasta subs on the market are worth ingesting. You can use one kind of bread, but even that is questionable due to modified wheat starch. Mostly these days I try to make regular meals and consume a minimal amount of the carbohydrate where it is a critical part of the dish. I do not eat rice or other "filler" carbs that aren't required for dishes, but sub those items out with roasted veggies or salads.
Yes, this is the book I would give to another PCOS woman who wanted to get pregnant. No, there was nothing new in it for me, which was a bummer. To be honest I would love to see some really well-executed studies on Keto and PCOS that cover exactly what happens to our dysregulated hormone levels as insulin levels reduce. While SHBG is a huge part of the process in removing excess testosterone from the blood stream, due to the efficacy of aromatase inhibitors in inducing ovulation, at least in some women, it's clear that the primary problem is the excess estrogen that is being converted to testosterone, and not as much the lack of SHBG from liver damage due to hyperinsulinemia. This may be two sides of the same coin as we know that estrone from excess body fat has the potential to also cause hormonal dysregulation, but I haven't seen any work that covers both SHBG on one hand and estrone from body fat together. Scientists tend to pretend that only one or the other is happening, depending on whether they believe the carbohydrate-insulin hypothesis. Well, anyway, it's a good book. I'm still waiting on a great book.