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. PCOS often runs in families.PCOS eventually lead to many serious health problems including high cholesterol ,diabetes, heart attack etc.

This is a syndrome involving a group of hormones in women and is characterized by lack of ovulation, irregular menstruation, hair loss from scalp, excessive body hair growth, acne & comedones on face with or without obesity. PCOS may leads to infertility in women.

 What is the cause of PCOS?

It is believed that genes play a key role in the occurrence of PCOS. However, environmental factors such as sedentary life style, lack of physical activity, over eating, obesity also have contributory role in the development of PCOS in women.

 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.

   In women having PCOS, the ovaries produce unusually high levels of male sex hormones called androgens. Due to the elevated levels of androgens, egg [ovum] is not released from ovaries in every menstrual cycle. Ovulation does not happen. Thus, irregular ovulation causes development of small, fluid-filled sacs on the surface of ovaries.

   The excessive androgen production may also cause an imbalance in the levels of other reproductive hormones also. High androgen levels may also cause acne and excess body hair growth in women.

Obesity is seen in PCOS women and it may lead to insulin resistance and hormonal imbalance. Many studies have shown that both lean and obese women with PCOS have insulin resistance. 

Cardiovascular  impact of polycystic ovarian syndrome

   PCOS  has detrimental impact on cardiovascular system also. Most of the PCOS women may have elevated triglycerides, LDL and decreased HDL cholesterol 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.

 The management of PCOS needs a combined approach of medicines, exercise and diet to tackle obesity, hormonal imbalances and other associated risks to the health of heart, brain and fertility.

    It is very important to achieve optimum weight reducing fat in obese women with PCOS to avoid complications.

                            SIAHMSR                                                 

Diet and moderate intensity exercises are very much important in managing PCOS and preventing its complications.

The most preferred dietary pattern for PCOS is:

·       Choosing more healthy, low-glycemic carbohydrates.

In this diet you are not eliminating carbohydrates but choosing healthy carbs such as 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. Low glycaemic foods of these kinds help in weight loss also. 

·       Consume anti-inflammatory foods

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

      There are various types of diets to reduce the insulin resistance associated with PCOS and obesity.

Diets focus also on preventing the cardiovascular complications such as high blood pressure, cholesterol, heart attack, diabetes and infertility.

The most important diets prescribed for PCOS are mostly  Mediterranean diet and DASH diet.

The Mediterranean diet for PCOS

  Mediterranean diet includes healthy foods which include natural, unprocessed and high-fiber foods;

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

It is recommended in this diet that you consume more fatty fish, including salmon, tuna, sardines, and mackerel;

Also healthy fats, such as olive oil, avocados and coconuts and nuts are highly recommended.

These foods are rich in Omega-3 fatty acids. In this diet fish, such as salmon, tuna etc.containing omega fatty acids are also included.

Olive oil is used in Mediterranean diet as a main ingredient in salads etc. instead of butter or margarine etc.

Olive oil is a good source of essential fatty acids and also have 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.

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 excessive intake is restricted.

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.

    These dietary changes not only lead to weight loss, reduced insulin resistance, lower incidence of type 2 diabetes and reduction in androgen levels, 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 one of the best nutritious and safe diets which also helps weight loss and preventing diabetes and heart disease.

It recommends fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, cholesterol, refined grains, and  some 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 reducing 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).

 The plant foods provide a good source of fiber, as well as magnesium and potassium to lower blood pressure.

Studies show that the healthy fatty acids 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 it may help PCOS associated problems also, as an adjuvant to lose weight, reduce insulin resistance and prevent stroke and heart attack risks.

Evidences supporting Mediterranean &DASH diets

   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).

·       Reduction of beverage and sodium intake is recommended in DASH diet which may increase glucose regulation, reduce insulin resistance, and improve abdominal fat deposition  related to PCOS.

In 2019 study[2]  conducted in Italy examined the significance of Mediterranean diet  in PCOS. The study could find the role of individual foods and nutrients of the Mediterranean diet are helpful to reduce the inflammatory sate , insulin resistance and excessive androgen production in PCOS.

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

High-sugar foods are considered as one of the triggers of PCOS, as they can cause intestinal flora imbalance and triggering chronic inflammation, insulin resistance, and  high androgen production. Studies  has shown that following DASH diet for 8 week produced 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 in the body. That means it has positive effect on PCOS related effects and triggers.

    Furthermore, 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].

In short, PCOS is a hormonal disorder affecting multiple organ systems of your body. The role of diet is indispensable in managing PCOS and its complications. The two diets described above can be followed by every women even by those who do not have PCOS but wants to lose weight  or reduce cholesterol, high blood pressure etc. Obesity is often associated with insulin resistance and poses risk for cancer also. Therefore any health and fitness enthusiast can follow these two diets as part of healthy living as well as for preventing and managing PCOS.

Physical exercise also have equal role in managing PCOS. Hence, keep yourself active always with moderate intensity exercises and dietary modifications.

Summary  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.  PCOS in women has impact on cardiovascular system also. Most of the PCOS women may have elevated triglycerides, LDL and decreased HDL cholesterol 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. The management of PCOS needs a combined approach of medicines, exercise and diet to tackle obesity, hormonal imbalances and other associated risks to the health of heart, brain and fertility. The most important diets prescribed for PCOS are mostly  Mediterranean diet and DASH diet. In 2019 study[2]  conducted in Italy examined the significance of Mediterranean diet  in PCOS. The study could find the role of individual foods and nutrients of the Mediterranean diet are helpful to reduce the inflammatory sate , insulin resistance and excessive androgen production in PCOS. DASH &  mediterranean diets have crucial role in reducing insulin resistance, sex hormonal imbalances, glucose levels and weight gain associated with PCOS. written by dr sanjana vb[ copyright]

 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
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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.