Effective strategies for dealing with PCOS

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age.  PCOS was first recognized in 1935 and is associated with small cysts on the ovaries leading to hormonal imbalances.  Women with PCOS can also have insulin resistance increasing the risk for diabetes in addition to developing high blood cholesterol. 

PCOS may affect as many as 5 million women in the United States and can occur in girls as young as 11 years old.  The cause is unknown but seems to run in families as women with a mother or sister with PCOS are more likely to develop it also.  The main issue is a hormonal imbalance where the ovaries are making more androgens (male hormones such as testosterone) than what normally a woman makes.  The high androgen levels can lead to various symptoms in women:

·      Weight gain

·      Acne

·      Excessive hair growth

·      Menstrual irregularities – infrequent, and/or absent

·      Infertility – PCOS is the most common cause of infertility in women

·      Cysts on the ovaries

·      Male-pattern baldness or thinning hair

·      Skin tags – excess flaps of skin in the armpits or neck area

·      Pelvic pain

·      Anxiety or depression

·      Sleep apnea

·      Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
Why diet and exercise can help manage PCOS

Currently there has been no optimal diet composition identified for PCOS yet - but diet and lifestyle modifications are considered to be one of the first lines of defense in treating PCOS.  Therefore certain dietary modifications along with exercise can be used to help make a significant difference in women with this condition.  Here are some changes to try:

·      Weight Loss – Women with PCOS have a higher rate of being overweight, obese and having abdominal obesity making weight loss a top priority to achieve. The excess weight, particularly central obesity, makes infertility problems worse and increases risk for diabetes.  A weight loss of just 5% to 10% can improve PCOS.  This means if a woman weighs 210 lbs, a weight loss of 10.5 lbs can help bring improvements in lab results and menstrual cycles, helping to increase the chance of fertility.

·      Consume low-glycemic foods – The glycemic index (GI) measures how a food containing carbohydrates raises blood glucose.  Foods with a high GI raise blood glucose more quickly while medium and low GI foods don’t affect blood glucose as much.  Since women with PCOS have a four times greater risk of developing type 2 diabetes, they are advised to eat foods with a low to medium GI.  High GI foods to avoid include white bread, white rice and potatoes. Medium GI foods include sweet corn, bananas, raisins, and multigrain bread.  Low GI foods are the best to choose from - green vegetables, most fruits, raw carrots, kidney beans, chickpeas, lentils and bran breakfast cereals.  

Low GI foods also have more fiber, help increase satiety and reduce hunger.  High GI foods can increase androgen production and stimulate appetite causing weight gain. 

·      Dietary fat – The advice on fats is to avoid saturated and trans fats while using more omega-3 rich foods and keeping total fat consumed under 35% of total calories.

A high intake of saturated and trans fats can increase the risk of diabetes and metabolic syndrome. Some studies have shown trans fats to also increase infertility. Saturated and trans fats can be found in foods such as red meat, poultry with the skin on, butter, doughnuts, cookies, pies, cakes, and shortening. 

Omega-3 fats play an important role in helping PCOS.  They’ve been found to reduce LDL cholesterol, decrease insulin resistance and androgens in women with PCOS.  Foods containing omega-3 fats include walnuts, almonds, flaxseed, and fish like salmon, mackerel and tuna.

·      Dairy food – Even though dairy foods are an excellent source of calcium, (women need 1,000 mg a day) research has shown dairy foods may affect fertility and acne.  Consuming 3 or more servings of milk may increase acne in some women - the acne was surprisingly increased more by drinking skim milk and not by whole milk.  At this time there is no formal advice on dairy but to limit dairy intake to two servings or less per day to reduce acne, androgens, and increased insulin.  Other nondairy foods to choose from containing good sources of calcium include cow’s milk alternatives (e.g., almond, hemp, rice, coconut), kale, broccoli, bok choy, fish like salmon and seeds such as chia, sesame and flax.

·      Exercise – Regardless of a woman’s weight status, physical activity is an important component of treating PCOS particularly in terms of bringing about weight loss or maintaining a normal body weight.  It’s known that exercise can improve insulin sensitivity along with improving cholesterol levels.  Fertility can also be positively influenced by regular exercise as it helps in regulating menstrual cycles and ovulation rates.  Regular exercise also improves body mass index, waist circumference, and helps reduce androgen levels. 

Take home message   

While there is no cure for PCOS, it can be greatly improved by making dietary changes and increasing exercise to help manage the symptoms.  If you are not certain if you have PCOS, check with your physician to see if you should get tested.  The sooner you know, the sooner you can start treating it, avoiding complications and leading a healthier life.