Written by Dr. Sanjana V.B Bhms,dbrm,cdn
Founder & medical director of siahmsr wellness.in
all rights reserved with siahmsr digital healthcare[siahmsr wellness]
Reviewed by SIAHMSR medical team.

    Polycystic ovarian syndrome [PCOS] is a common problem affecting women of reproductive age and it characterized by lack of ovulation, irregular menstruation, hair loss from scalp, excessive body hair growth, acne & comedones on face with or without obesity. Sometimes ,PCOS may leads to infertility also. 

 Genetic factors as well as environmental factors play crucial role in the development of this hormonal disorder.

Risk factors such as sedentary life style, lack of physical activity, over eating, obesity lead to PCOS in susceptible women.

   PCOS is associated with a group of hormonal imbalances stemming from insulin resistance. Obesity and insulin resistance is closely connected with Polycystic ovarian syndrome.

Insulin resistance is a condition in which body produces insulin but it does not take up glucose from blood and not used by cells and tissues . So blood glucose level as well as insulin level remains high. 

 High insulin level is the prime cause which forces your ovaries to produce and release male hormones excessively. 

 Although  PCOS is associated with obesity it  appears in lean women also. Many studies have shown that both lean and obese women with PCOS have insulin resistance.

   Insulin resistance is the most important issue in PCOS which leads to excessive androgen or male hormone production and other symptoms and signs of PCOS.

What is the cause of insulin resistance in PCOS? 

The exact cause of insulin resistance is thought to be genetic. The insulin resistance in at least 50% of PCOS women appears to be related to excessive serine phosphorylation of the insulin receptor.

Is PCOS associated with serious complications ?

   Most of the PCOS women may have elevated triglycerides, LDL and decreased HDL in addition to insulin resistance. Increased level of bad [LDL] cholesterol and elevated triglycerides enhances the risk for heart attack and stroke in women having PCOS.

  Dark or thick skin patches appear on the back of neck, in the armpits, and under the breasts in women with insulin resistance and PCOS. This is called acanthosis nigricans [Read more].

 

How can you manage PCOS with Diet & physical exercise?

   Physical exercise is recommended as a life time routine to be followed by PCOS women. Nutritious as well as weight loss promoting foods are suggested for women with PCOS as the disease can cause many obesity related and hormones related complications which may enhance the risk for heart problems, infertility, stroke and cancers. 

  Moderate physical activity to strength trainings are recommended for women having PCOS depending on the complexity of the problem.

Dietary modifications such as inclusion of Mediterranean and DASH diets are very effective in prevention as well as management of PCOS.

 

Diet planning 

·  Choosing more low-glycemic carbohydrates.

Not eliminating carbohydrates; but choose whole grains, fibers etc. which do not cause a sudden spike in blood sugar level.

Fiber also helps digestion as well as help to reduce bad LDL cholesterol, which is another impact of PCOS. It can also help weight loss and obesity management.

·  Include anti-inflammatory foods, such as berries, fatty fish, leafy greens, and extra virgin olive oil, which may reduce inflammation-related symptoms

 

The Mediterranean diet for PCOS

    Mediterranean diet includes healthy foods which can help PCOS also.

It includes natural, unprocessed foods, high-fiber foods; 

Consume more fatty fish, including salmon, tuna, sardines, and mackerel; Also healthy fats, such as olive oil, as well as avocados and coconuts and nuts. These foods are rich in Omega-3 fatty acids containing fish, such as salmon, tuna etc.

Olive oil is used in Mediterranean diet instead of butter or margarine which is also a good source of essential fatty acids and also having anti-inflammatory properties.

Beans and other protein-rich legumes are part of this diet.

Non-starchy vegetables such as leafy greens (spinach, kale, escarole, endive, lettuce, etc.), tomatoes, mushrooms, peppers, broccoli, cauliflower, snow peas, celery and fennel are used which provide all the essential vitamins and minerals for the body. These are effective antioxidants also; capable of preventing obesity, insulin resistance, cardiovascular disease risks associated with PCOS.

The carbohydrates are got from whole grains, such as brown rice, barley, sorghum and others. Breads and pastas made with whole grains can help people with PCOS avoid spikes in blood sugar.

 

Mediterranean diet limits or restricts the following:

Fried foods and oily snacks [cakes, cookies, candy and pies]

Saturated fats such as butter, margarine etc.

Red meat in excessive amount, but allowed one serving a month  although not mandatorily for all.

Sugary beverages or soft drinks.

Alcoholic beverages

Refined flour, white bread, rolls, white rice.

  All these restrictions in Mediterranean diet help in preventing and managing obesity, insulin resistance and cardiovascular risk associated with it. In a nutshell, Mediterranean diet is recommended for women with PCOS.

 In addition to dietary changes promoting physical activity also is recommended in PCOS management.

 These changes not only lead to weight loss, reduced insulin resistance, lower incidence of type 2 diabetes and reduced hyperandrogenism, but also enhance women's fertility as menstruation is restored.

 

DASH DIET FOR  WOMEN WITH PCOS

 DASH Diet stands for Dietary Approaches to Stop Hypertension (DASH) diet. It is nutritious, safe, and effective for weight loss and preventing diabetes and heart disease also.

It is rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, cholesterol, refined grains, and sweets.

 A study shows that following the DASH eating pattern for 8 weeks in overweight and obese women with PCOS resulted in the improvement of insulin resistance, serum hs-CRP levels, and abdominal fat accumulation [6]. 

  Fruits and vegetables contain nutrients such as potassium, calcium, magnesium, and fiber that are important for fighting high blood pressure. These nutrients can also help improve insulin and glucose levels related to PCOS.

  DASH diet recommends keeping sodium intake under 1500 milligrams, the maximum amount of sodium the American Heart Association recommends for people with high blood pressure.

The DASH diet is a plant-based diet that emphasizes including 4 to 5 servings a week of a variety of nuts, seeds, and legumes (lentils). These foods provide a good source of fiber, as well as magnesium and potassium to lower blood pressure. 

Studies show that the monounsaturated fats (MUFAs) and polyunsaturated fats (PUFAs) found in nuts can improve insulin, androgens, and cholesterol levels in women with PCOS.

The diet being packed with fiber, omega-3 fatty acids, protein, and essential vitamins and minerals help PCOS associated problems also, as an adjuvant to lose weight, reduce insulin resistance and prevent stroke and heart attack risks.

  

Research studies support Mediterranean &DASH diets for managing PCOS.

In 2020, a study [1] concluded that the Mediterranean and DASH diets improved the appearance of the ovaries. These diets were shown to reduce insulin resistance, hyperandrogenism or excess male hormone production and obesity, also causing satiety and weight loss in women.

These diets appear to improve ovarian steroid hormone production and affect ovarian development by regulating follicle stimulation hormone (FSH).

Reduced beverage and sodium intake is recommended at DASH, which increases glucose regulation, reduces insulin resistance, and improves abdominal fat deposition of PCOS.

In 2019 study [2] conducted in Italy examined whether the Mediterranean diet was related to PCOS; found the therapeutic role of individual foods and nutrients of the Mediterranean diet helping to reduce the inflammatory condition that causes insulin resistance and excessive androgen production in PCOS. Diet has a very important role in the symptoms and laboratory findings of PCOS.

DASH & Mediterranean diets have crucial role in reducing insulin resistance, sex hormonal imbalances, glucose levels and weight gain associated with PCOS.

High-sugar or glucose foods may be one of the triggers of PCOS, by causing intestinal flora imbalance and triggering chronic inflammation, insulin resistance, and production of androgen.

Consumption of DASH diet for 8 week led to a significant reduction in serum insulin, triglycerides and very-low-density lipoprotein cholesterol and a significant increase in total antioxidant capacity [TAC] and glutathione GSH levels.

    Moreover, studies show that changes in the relative abundances of specific types of unhealthy gut microbiota or intestinal microbes can cause insulin resistance, which is closely linked to the occurrence of PCOS. The use of gut microbiota-targeted agents in the treatment of PCOS is still under discussion, not implemented [3].

 

Summary

  Moderate physical activity to strength trainings are recommended for women having PCOS depending on the complexity of the problem. Dietary modifications such as inclusion of Mediterranean and DASH diets are very effective in prevention as well as management of PCOS.

Studies show that the monounsaturated fats (MUFAs) and polyunsaturated fats (PUFAs) found in nuts can improve insulin, androgens, and cholesterol levels in women with PCOS.

The diet being packed with fiber, omega-3 fatty acids, protein, and essential vitamins and minerals help PCOS associated problems also, as an adjuvant to lose weight, reduce insulin resistance and prevent stroke and heart attack risks

 References

1.  https://pubmed.ncbi.nlm.nih.gov/7671850/   
2.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387116/
3.  https://academic.oup.com/jcem/article/91/10/3878/2656479 
4.https://www.sciencedirect.com/science/article/abs/pii/S1083318821000280      
5.  https://radiopaedia.org/articles/polycystic-ovaries  
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409808/#:~:text=According%20to%20the%20Rotterdam%20consensus,in%20at%20least%20one%20ovary) .   
7.  https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos  
8.  https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
9.    https://pubmed.ncbi.nlm.nih.gov/32629978/
10.    https://pubmed.ncbi.nlm.nih.gov/31547562
11.    https://pubmed.ncbi.nlm.nih.gov/32552864/
12.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8643565/
13.    https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
14.    https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0034-1376990
15.https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01098545/related-content
16. https://pubmed.ncbi.nlm.nih.gov/9408743/
17. https://pubmed.ncbi.nlm.nih.gov/9408743/
18.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6181615/#:~:text=The%20major%20reason%20PCOS%20increases,may%20lead%20to%20endometrial%20cancer