Spotlight - PCOS


Spotlight - PCOS


Polycystic Ovary Syndrome - obviously a female condition affecting the ovaries but it can have a huge negative impact on quality of life and ability to conceive.  


This syndrome is medically diagnosed by having 2 of the following 3 symptoms:- 1) multiple cysts on the ovaries, 2) loss or disturbance of menstruation & 3) hyperandrogenism.  Although it is called “Polycystic Ovaries” it is actually possible to have cysts on the ovaries and NOT have PCOS (if neither one of the other conditions are met).


There is a greater prevalence of PCOS in Overweight women (Alvarez-Blasco et al 2006).



This syndrome has characteristics which can be Reproductive, Metabolic or Psychological in nature.  Let’s look at each of these a bit closer.


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Reproductive Characteristics

Menstrual dysfunction or missing periods are common.  Hyperandrogenism (elevated testosterone levels) can lead to possible infertility, increased pregnancy complications and symptoms such as acne or excess body (facial) hair. 


Metabolic Characteristics

Many PCOS sufferers are also insulin resistant - although not all sufferers are (Kauffman et al. 2002).  Having IR leads to increased blood glucose and hyperinsulinemia, which in turn can increase a certain enzyme leading to a worsened androgenic profile in susceptible PCOS sufferers.  This IR leads to an increased risk of Cardiovascular Disease (CVD) and Type 2 Diabetes (T2D).


Psychological Characteristics

Anxiety, depression and negative impacts on quality of life can all feature strongly within PCOS sufferers.


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What’s the Recommended Treatment?

There is limited research into PCOS treatment but reducing insulin resistance should be a key goal.  If the sufferer is overweight then losing weight would help with IR.  If the sufferer is not overweight, then BMI may still need to be reduced slightly to increase insulin sensitivity and gain the associated benefits.  (Dunaif et al. 1992).


Additionally reducing stress is key.


Exercise should include resistance training and possible HIIT (High Intensity Interval Training).  This will help with Insulin Sensitivity and burning glucose.


But what about the type of diet needed?

Many think that it’s necessary to cut out all carbs in order to treat PCOS, but in fact a study by Moran et al. (2013), showed that weight loss itself improved the presentation of PCOS regardless of dietary composition.  Adherence may be more the key in terms of success with the weight loss diet.  A study by Cornier et al. (2005), showed that PCOS sufferers who were also IR had more success at losing weight on a lower carb and higher fat diet (LCHF) - but this could just be due to better adherence to the diet and therefore personal preference.  However, the science is unsure as to whether this is down to higher circulating insulin levels (Pittas et al. 2005).


One thing that is recommended is a higher protein intake.  PCOS females typically show metabolic inflexibility and less than expected fat oxidation at night due to hyperinsulinemia.  In fact their protein oxidation at night is higher.  This could have implications for muscle loss and so therefore a high protein diet could be beneficial.  Another suggestion is to reduce starchy carbs and dairy products and increase vegetables and especially the intake of fruit (Whigham et al. 2014).  


Moran et al (2013) suggests a low-GI (Glycaemic index) - or low GL - diet, high in Mono Unsaturated Fatty Acids (such as Olive Oil, Nuts, Avocado, Olives) which could induce better weight loss, improve menstrual regularity, improve mental health issues, improve IR.


Supplementation

Supplementation research specifically for PCOS is limited but the recognised recommendations include:-


Vitamin D - linked to Insulin Sensitivity and risk of T2D - check your existing levels first and supplement accordingly.

Fish Oils (EPA/DHA) - can decrease liver fat in PCOS women (Cussons et al 2009) - minimum of 1.2g EPA/DHA per day.

L-carnitine - 250mg/day - could help with weight reduction in PCOS women (Samimi et al 2016)

Probiotics - to possibly help with gut health.

Inositol - 2g/day.  Helps with symptoms such as menstrual dysfunction, hyperinsulinemia and hyperandrogenism. 


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To Summarise - if you have PCOS here are some things to try:-


 - Reduce stress levels - try meditation / yoga for example.

 - Lose weight.  Try a low GI/GL diet, with higher protein, higher ‘healthy fats’ and more fruit.  Consider fasting protocols.

 - Resistance training and HIIT training. (avoid the long slow cardio for ‘fat burning’!)

 - Supplements to try; Vitamin D, Fish Oils, L-Carnitine, Probiotics, Inositol.