• Calculate your caloric needs, whether it be to maintain or lose weight. Multiply your caloric needs by .4 (this will be a diet that is 40 percent carbohydrate) and then divide by 4 (carbohydrate has 4 calories per gram.
• If you are obese and insulin-resistant, then you may need less than 40 percent from carbohydrate. Check with your MD or nutritionist. For example: If the number of calories you need to lose one and one-half pounds a week is 1,425, then multiply that number by .4 and then divide by 4 (1,424 x .4 = 569, divided by 4 = 142 grams of carbohydrate per day).
• Count total grams of carbohydrate.not just grams of sugar. All carbohydrates eventually turn into sugar in the blood.
• To count "effective" grams of carbohydrate, subtract the grams of fiber in a food from the total carbohydrate content. For example, six whole-wheat crackers might have 15 grams of total carbohydrates and three grams of fiber. The effective grams of carbohydrate would be 12 grams. This is what you count when you are adding up your grams of carbohydrate.

Sample meal plan

The following is a sample meal plan for 1,400 calories, 35 percent carbohydrates.118 grams effective carbohydrates (e.c.)

Breakfast
  • One ounce oatmeal (14 gm e.c.)
  • ½ cup cottage cheese (3 gm e.c.)
  • ½ cup blueberries (8 gm e.c.)

Total: 220 calories/25 gm e.c.

Lunch
  • Grilled chicken, 4 ounces
  • 2 cups greens
  • 1 cup assorted vegetables (approximately 5 gm e.c.)
  • ½ cup kidney beans (14 gm e.c.)
  • 1 apple (18 gm e.c.)
  • 2 tsp olive oil
  • unlimited wine vinegar

Total: 490 calories/37 gm e.c.

Snack
  • 1 ounce low-fat mozzarella stick (1 gm e.c.)
  • 6 Finn Crisp crackers (22 gm e.c.)

Total: 180 calories/23 gm e.c.

Dinner
  • Poached salmon, 5 ounces
  • ½ cup spinach (4 gm e.c.)
  • salad (approximately 3 gm e.c.)
      - 1 cup greens
      - ½ cup assorted vegetables
  • 1 tsp olive oil, vinegar
  • ½ cup brown rice (20 gm e.c.)

Total:485 calories/27 gm e.c.

Snack
  • 1 ounce dry roasted soy nuts ( 9 gm e.c.)

Total: 134 calories/9 gm e.c.

Conclusion We know that weight loss is key in decreasing insulin resistance in obese women. It appears that a lower glycemic diet may play an important role in helping to control insulin levels as well as promoting weight loss. However this is an area that needs to be further researched.

Dr. Walter Futterweit is Clinical Professor of Medicine of the Division of Endocrinology of the Mount Sinai School of Medicine, New York, NY. He is also Chief of the Endocrine Clinic at the Mount Sinai Medical Center, and Attending in Medicine. He is board certified in Internal Medicine and Endocrinology and Metabolism. His main interest has been the study of polycystic ovary syndrome (PCOS) for the last 25 years, and has written extensively in this area and wrote the first textbook on the subject, "Polycystic Ovarian Disease", in 1984. His extensive practice which comprises mostly of patients with PCOS has allowed him the means to study insulin dynamics as well as recent genetic studies of the syndrome. As an international expert in the field of PCOS, he is invited to speak at many meetings, and still maintain his busy practice and teaching committments at the Mount Sinai Medical Center.

Dr. Futterweit also was past Chairman of the Membership Committee of the Endocrine Society, and also is a member of the ad hoc Task Force on Women's Health of the American Association of Clinical Endocrinologists (AACE). For the past several years he has been active in the Polycystic Ovary Association (PCOSA) where he serves as a member of the Medical Advisory Board and has been assigned to be Program Director for their Annual Meeting in San Diego, June 1-3 of 2000.

Martha McKittrick, RD, CDE is a registered dietitian and certified diabetes educator. She specializes in weight control, hyperlipidemia, polycystic ovarian syndrome, diabetes, and preventative nutrition. A staff dietitian at The New York Presbyterian Hospital for the past 17 years, she also counsels clients privately and is a consultant to physicians, corporations, and health clubs. She was the nutritionist for the 1998 NYC Marathon. She is also an exercise instructor and has been teaching exercise classes in NYC health clubs for the past 10 years.

Ms. McKittrick has appeared on numerous television, radio, and webcast programs. She lectures on a regular basis and has been interviewed and written for publications including Shape, Family Circle, Women's World, New York Newsday, and the Journal of The American Dietetic Association. For the past several years, Ms. McKittrick has been specializing in polycystic ovarian syndrome. She is on the medical advisory board for PCOSA and is on the editorial advisory board for PCOS Pavilion of OBGYN.NET. She lectured on diet and PCOS at the PCOSA conferences in San Diego in January, 2000 and New York City, September, 2000.