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.

 Diet for PCOS [ Polycystic ovarian syndrome ]

  What is PCOS or polycystic ovarian syndrome?

    Polycystic ovary syndrome (PCOS) is a common hormonal disorder occurring in 6-15% of women of reproductive age group. It is a hormonal disorder in which the ovaries produce excess amount of androgens, the male sex hormones[ normally found in small amounts in women]. It is  called a syndrome as PCOS includes a group of symptoms which consistently occur together, and are characterized by a set of associated symptoms such as acne, growth of excessive body hair, loss of scalp hair, menstrual irregularities etc. 

    The name polycystic ovary syndrome describes the numerous small cysts (fluid-filled sacs) that form in the ovaries with associated symptoms of hormonal imbalances such as acne, body hair, thinning of scalp hair, weight gain, obesity etc.  However, some women with this disorder do not have cysts in ovaries while other symptoms of PCOS are present.

    Another important but curious fact is that, some women without PCOS also do develop multiple cysts in ovaries that resemble PCOS. That means PCOS is not simply a disease characterized by multiple small ovarian cysts but a condition that involves the whole body. 

      A woman having PCOS may fail to have regular monthly ovulation. When ovulation doesn’t happen, the ovaries start developing multiple small cysts. These cysts make  male sex hormones called androgens.

Women with PCOS often have high levels of androgens which may affect menstrual cycle and whole body.

    The first stage of PCOS is insulin resistance. This is a state in which the body can't use insulin for proper glucose metabolism.  Increasing insulin levels in the body may cause higher androgen level.

Obesity from inactive sedentary life style and over eating can also increase insulin levels and exacerbate or worsen PCOS symptoms.

The exact cause of PCOS is unknown , although genes and environmental factors have some role .PCOS often runs in families.

Impact of PCOS on your health 

PCOS is a syndrome affecting multiple systems of your body apart from forming numerous small cysts in the ovaries. Its major health impacts are insulin resistance, other hormonal imbalances, metabolic syndrome with obesity, high blood pressure [hyper tension], dyslipidemia or bad cholesterol in high amounts.

Each of these risk factors associated with PCOS have serious health effects on heart and blood vessels, fertility, skin and mind over the time.

The women with PCOS may develop type 2diabetes, high blood pressure, heart attacks and stroke gradually if left untreated.

PCOS make pregnant women predisposed to gestational diabetes (with high risk to the pregnancy and the baby]

Gestational diabetes may progress to type 2 diabetes later in life. It also enhances the probability for type 2 diabetes in children.

Hyperandrogenism or elevated levels of male hormones in PCOS women may cause hirsutism or excessive growth of body hairs. While abnormal androgen secretion causes alopecia or hair loss from scalp .That means, PCOS cause hair thinning on scalp progressing to severe hair loss in women. Dietary modification has great role in managing hair loss associated with PCOS.

Obesity and infertility are observed in 70-80% of women with PCOS which also emphasize the importance of dietary management in PCOS affected women.

Women with this clinical condition or syndrome may be having insulin resistance .That means their bodies can produce insulin but cannot use it properly to manage glucose levels, eventually enhancing their risk for type 2 diabetes. Dietary modification is essential along with medication to tackle insulin resistance associated rise in glucose levels in blood.

Polycystic ovary syndrome is also linked to depression and anxiety although the exact mechanism is poorly understood.

 PCOS may cause difficulty in breathing during sleep [sleep apnea] mostly in obese women.

 PCOS affects skin causing acne, comedones and acanthosis nigricans [ Dark velvety growth on various parts of skin due to insulin resistance]. All these are cosmetic problems which may reduce the confidence of women. Obesity predisposes to acanthosis nigricans  and dietary plans are crucial in women diagnosed with PCOS.

PCOS may also lead to high blood pressure, problems with the heart and blood vessels and risk for cardiovascular diseases is increased in women having PCOS .

 The hormonal irregularities associated with PCOS may cause uterine cancer, endometrial hyperplasia and endometrial cancer.

Symptoms & signs of PCOS

It is a clinical condition or syndrome with abnormally high male sex hormones and other associated hormonal imbalances with absent ovulation which are manifested as :

·       Acne, oily skin ,comedones

·       Excessive body hair growth

·       weight gain, especially around the belly [ central obesity]

·       irregular periods, heavy bleeding or skipped periods.

·       discomfort in the pelvic area

·       difficulty getting pregnant, infertility 

Why is diet plan very important in PCOS management ?

PCOS  is associated with severe impacts on health as discussed above. The goal of dietary intervention is to prevent PCOS or to  manage these health effects.

The dietary goal for PCOS women is:

o   weight loss and prevention of obesity

o   improved insulin metabolism to prevent type 2 diabetes.

o   To  ensure regular menstruation

o   Prevent infertility

o   Reduce androgen and its detrimental effects on ovaries, scalp and body hair.

o   Manage or prevent hair loss.

o   Lower blood cholesterol levels, blood pressure and cardiovascular problems.

Diet planning- What to include in the diet of PCOS women?

·       Choosing more low-glycemic carbohydrates. That is, 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.

·       Include 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 help PCOS also. It includes natural, unprocessed foods, high-fiber foods; fatty fish, including salmon, tuna, sardines, and mackerel; healthy fats, such as olive oil, as well as avocados and coconuts and nuts.

The Mediterranean diet is 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

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. Altogether , 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 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, sodium, and sweets. Following of 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 nutrients like 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.

Research has indicated that the heart-healthy monounsaturated fats (MUFAs) and polyunsaturated fats (PUFAs) found in nuts can improve insulin, androgens, and cholesterol levels in women with PCOS.  A 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 supports 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 dietary interventions 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.

In 2019, Barrea and his colleagues conducted a cross sectional/case control study in Italy (2). They 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 paves the way for insulin resistance and excessive androgen production in PCOS. Diet has a very important role in the symptoms and laboratory findings of PCOS.

DASH & Mediterranean diet have crucial 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 inducers of PCOS, by causing intestinal flora imbalance and triggering chronic inflammation, insulin resistance, and production of androgen. Consumption of DASH diet for 8 wk 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 gut bacteria have been associated with clinical manifestations of PCOS . Unhealthy gut microbiota or intestinal microbes can cause insulin resistance, which is closely linked to the occurrence of PCOS. The use of microbiota-targeted agents in the treatment of PCOS is under discussion [3].

References

1.    https://pubmed.ncbi.nlm.nih.gov/32629978/
2.    https://pubmed.ncbi.nlm.nih.gov/31547562/
3.    https://pubmed.ncbi.nlm.nih.gov/32552864/
4.    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8643565/
5.    https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
6.    https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0034-1376990
7.    https://www.cochranelibrary.com/central/doi/10.1002/central/CN-01098545/related-content