PCOS Management with Nutrition

Topics covered in the article include:

• Understanding PCOS: prevalence and characteristics
• Appreciating the added difficulties those with PCOS may face
• Learning how simple diet and lifestyle modifications can greatly improve PCOS symptoms and well-being
• Implementing the specific, practical tips that help manage PCOS
• Discovering which supplements you should consider if you have PCOS

PCOS

To understand PCOS firstly we shall have to understand what is endocrine gland and what is endocrinopathy.

Endocrine gland is an organ that makes hormones that are released directly into the blood and travel to tissues and organs all over the body. Endocrine glands help control many body functions, including growth and development, metabolism, and fertility. Some examples of endocrine glands are the pituitary, thyroid, and adrenal glands.

Endocrinopathy is a disease of an endocrine gland. The term endocrinopathy is commonly used as a medical term for a hormone problem. Common endocrinopathies include hyperthyroidism and hypothyroidism.

Polycystic ovary syndrome (PCOS) is the most prevalent endocrinopathy in women, yet there is much debate over the optimal approach to nutrition for its treatment.

PCOS is characterized by hyperandrogenism, oligo/anovulation and polycystic ovaries. The etiology is thought to be closely linked to insulin resistance, and the concomitant hyperinsulinemia, therefore strategies aiming to increase insulin sensitivity are of great importance. Similarly, women with PCOS generally have increased markers of risk for cardiovascular disease (CVD); therefore, strategies that improve blood lipid profiles and inflammation are also important. These strategies include weight loss, low glycemic index/load diets and alterations of the fatty acid composition of the diet. The evidence presented here suggests current guidelines and practice are at times based on equivocal evidence that could even be detrimental to health; such as a reduction in saturated and an increase in polyunsaturated fats. Interventions should focus on lowering the glycemic index/load of the diet whilst increasing the protein content at the same time as promoting lasting weight loss.

There is a paucity of research and more research may help further elucidate the effects of certain dietary composition manipulations, independent of weight loss.

Characteristics of PCOS

It’s important to note that not all women with PCOS will have the same set of symptoms. The diagnosis of PCOS is typically made based on the presence of a combination of symptoms, and healthcare professionals may use various criteria to make a diagnosis. These criteria include reproductive, metabolic and psychological symptoms.

• Irregular Menstrual Periods: PCOS often causes irregular or absent menstrual periods. Women with PCOS may have fewer than eight periods in a year, or they may experience heavy, prolonged periods.
• Hyperandrogenism: Increased levels of androgens (male hormones) such as testosterone are commonly seen in PCOS. This can lead to symptoms such as excess facial and body hair (hirsutism), acne, and male-pattern baldness.
• Ovarian Cysts: While the term “polycystic” suggests the presence of multiple cysts on the ovaries, not all women with PCOS have visible cysts. These are actually small, fluid-filled sacs in the ovaries that can cause the ovaries to enlarge.
• Insulin Resistance: Many women with PCOS have insulin resistance, which means their body’s cells do not respond properly to insulin. Insulin is a hormone that regulates blood sugar levels, and insulin resistance can lead to higher levels of insulin in the blood.
• Weight Gain: PCOS is associated with weight gain and difficulty losing weight. Insulin resistance and hormonal imbalances can contribute to weight gain, particularly around the abdomen.
• Skin Changes: PCOS can cause skin changes, including oily skin, acne, and darkening of certain areas of the skin, such as the neck, groin, and under the breasts. These changes are related to hormonal imbalances.
• Fertility Issues: Women with PCOS may have difficulty getting pregnant due to irregular ovulation or lack of ovulation. PCOS is one of the leading causes of female infertility.
• Mood Disorders: Some women with PCOS may experience mood swings, depression, and anxiety. The hormonal imbalances and the impact on self-esteem due to physical symptoms can contribute to these mood disorders.

Added Difficulties that Those with PCOS May Face

In addition to the physical symptoms and challenges associated with PCOS, individuals with PCOS may face several other difficulties, including:

• Infertility: PCOS is a common cause of infertility in women. Irregular ovulation or lack of ovulation can make it challenging to conceive naturally. Fertility treatments such as medication to induce ovulation or assisted reproductive technologies (e.g., in vitro fertilization) may be necessary to improve the chances of pregnancy.
• Metabolic Complications: PCOS is often associated with insulin resistance, which can lead to an increased risk of developing type 2 diabetes. Insulin resistance can also contribute to weight gain and make it more difficult to lose weight, further increasing the risk of metabolic complications such as high blood pressure and high cholesterol levels.
• Gestational Diabetes: Pregnant women with PCOS have a higher risk of developing gestational diabetes, a form of diabetes that occurs during pregnancy. Gestational diabetes can increase the risk of complications for both the mother and the baby.
• Increased Risk of Endometrial Cancer: Women with PCOS may have a higher risk of developing endometrial (uterine) cancer. This is due to hormonal imbalances, specifically the elevated levels of estrogen and insufficient progesterone, which can cause the lining of the uterus to thicken and potentially lead to cancerous changes over time.
• Emotional and Psychological Impact: PCOS can have a significant impact on a person’s emotional well-being. The physical symptoms, such as excess hair growth and acne, can lead to body image issues and decreased self-esteem. The challenges of dealing with infertility, hormonal imbalances, and the chronic nature of the condition can also contribute to increased levels of stress, anxiety, and depression.
• Disrupted Menstrual Cycle: PCOS can cause irregular or absent menstrual periods, which can be emotionally distressing and may require medical intervention to regulate the menstrual cycle. This can also make it difficult to predict and manage fertility, further adding to the challenges for women with PCOS.

Managing PCOS with Nutrition

Nutrition management plays a crucial role in managing PCOS symptoms and promoting overall health. Here are some dietary recommendations that may be helpful for individuals with PCOS:

• Balanced and Whole Foods: Focus on consuming a balanced diet that includes a variety of whole foods. Incorporate fruits, vegetables, whole grains, lean proteins, and healthy fats into your meals. This can provide essential nutrients while keeping blood sugar levels stable.
• Complex Carbohydrates: Opt for complex carbohydrates, such as whole grains (oats, brown rice, quinoa), legumes, and vegetables, rather than refined carbohydrates (white bread, sugary cereals, pastries). Complex carbohydrates have a lower impact on blood sugar levels and can help manage insulin resistance.
• Adequate Protein: Include adequate protein in your meals to promote satiety and stabilize blood sugar levels. Good sources of protein include lean meats, poultry, fish, eggs, dairy products, legumes, and plant-based proteins like tofu and tempeh.
• Healthy Fats: Include healthy fats in your diet, such as avocados, nuts, seeds, olive oil, and fatty fish like salmon. These fats can help reduce inflammation and promote hormonal balance.
• Fiber-Rich Foods: Increase your intake of fiber-rich foods like fruits, vegetables, whole grains, legumes, and nuts. Fiber aids in digestion, helps maintain stable blood sugar levels, and promotes a feeling of fullness.
• Limit Added Sugars: Minimize your consumption of sugary foods and beverages, as they can cause blood sugar spikes and worsen insulin resistance. Choose whole fruits instead of fruit juices and opt for natural sweeteners like stevia or honey in moderation.
• Manage Portion Sizes: Pay attention to portion sizes to avoid overeating and support weight management. Use smaller plates and practice mindful eating by listening to your body’s hunger and fullness cues.
• Regular Meals and Snacks: Aim for regular meals and snacks throughout the day to maintain stable blood sugar levels. Avoid skipping meals, as it can lead to overeating and blood sugar fluctuations.
• Hydration: Stay hydrated by drinking an adequate amount of water throughout the day. Water helps support overall health and can aid in weight management.
• Limit Processed Foods: Minimize your intake of processed and packaged foods, as they are often high in added sugars, unhealthy fats, and preservatives. Instead, opt for whole, unprocessed foods as much as possible.

It’s important to note that every individual is unique, and dietary needs may vary. It’s recommended to consult with a registered dietitian or healthcare professional who specializes in PCOS to receive personalized guidance and create an individualized nutrition plan that suits your specific needs and goals.

CHO Vs Fat

There are currently no RULES we can follow and CHO vs Fat is equivocal. Protein is either neutral or good.

We have research results on this. The study found following results while studying differences between a low carbohydrate (LC) and low fat (LF) diet in overweight/obese individuals.

Both groups followed 6 month diet of either:

• Low fat (57% CHO:21% FAT)
• Low carb (22% CHO:53% FAT)

Results:

• Weight loss was evident in all groups
• No significant effects for weight loss by diet group or IR (Insulin-Resistance) status
• No significant interaction between diet assignment and IR-IS status detected

Vit D, Omega 3, Carnitine, Inositol Supplementation

Following are some results based on studies:

Omega-3 Supplementation

• Insulin resistance reduced with EPA+DHA
• Cross-sectional data on modulation of hormones & lipids
  • Interventions improve androgenic profiles in PCOS
• Decreased liver fat in PCOS
  • Significant compared to placebo. Reduction in systolic & diastolic BP
• Serum adiponectin levels, insulin resistance & lipid profile
  • Improved with 1.2g EPA+DHA/day vs placebo
• Differential effects of LC-PUFAs vs. essential n-3 PUFAs
  • Distinct metabolic and endocrine effects in PCOS

Vitamin D Supplementation & PCOS

• Improved menstrual frequency
  • 50000IU vitamin D3 per week for 12 weeks or a placebo
  • These individuals were Vit D insufficient
• Wehr et al. (2011)
  • (25(OH)D) levels showed significant negative correlation with IR and positive correlation with insulin sensitivity
• Selimoglu et al. (2010)
  • Single dose of 300,000IU vitamin D3 orally
  • 2 subjects still had levels <20ng/ml
  • (HOMA)-IR significantly decreased
  • Decreases in glucose and insulin levels were found but did not reach significance

Carnitine Supplementation RCT

• 60 Overweight women with PCOS
• 250 mg carnitine
• 12 weeks
• Results
  • Reduction in weight (-2.7 vs +0.1kg, P < 0·001)
  • Waist circumference (-2.0 vs -0.3cm, P < 0·001)
  • Hip circumference (-2.5 vs -0.3cm, P < 0·001)
  • Reduction in fasting plasma glucose, serum insulin levels, homoeostasis model of assessment-insulin resistance, DHEA-S

Probiotics in PCOS

• Emerging benefits:
  • Reduction in weight
  • Decrease in fasting plasma glucose
  • Serum insulin concentration
  • HOMA-IR and HOMA-β
  • Triglycerides
  • Quantitative insulin sensitivity check index (QUICKI
• No benefits found in Karimi et al, (2018) using synbiotics
• Improved serum T, SHBG, mFG scores, hs-CRP, TAC

Inositol Supplementation RCT’s

• Significant reductions in insulin levels/improvements in insulin sensitivity
• Improved ovarian function, menstrual cyclicity, amenorrhoea & oligomenorrheoa
• Significant reductions in free testosterone
• Significant weight loss
• Other health markers
  • Improved blood lipid profile (cholesterol and triglycerides); blood pressure

Conclusion

• Don’t stress on macros…
• Where possible, do all you can to promote weight loss
• When BMI is ‘normal’ considering moving it to lower end of ‘normal’
• Resistance Training or HIIT where possible to improve IS and ‘burn’ glucose
• Consistency is incredibly difficult but is of paramount importance
• Take inositol… probably.

Please contact me Abhinav Malhotra to learn what I and my team AbhiFit can do for you through personal training and nutrition services. We train kids, teens, adults, elders, athletes and models in Dubai and online across the UAE and around the world. We help our clients achieve their fat loss, weight loss, muscle gain, strength gain, rehab, figure / physique transformation & healthy living goals.

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