Polycystic Ovarian Syndrome (PCOS) is considered to be the leading cause of female infertility, with nearly five million women in the United States diagnosed. It is the most common endocrine disorder in women of reproductive age. Polycystic ovarian syndrome, or PCOS, is a condition in which a woman's levels of the sex hormones oestrogen and progesterone are out of balance. This leads to the growth of ovarian cysts, which are benign masses on the ovaries.
Women diagnosed with PCOS typically fall into two categories; insulin resistant and non-insulin resistant. This can be diluted down to five further stages, but we will talk about the main two categories.
Insulin-Resistant PCOS is also referred to as Type 1 PCOS and it is what is most often associated with the classic symptoms of PCOS. These include weight gain, ovulatory interruptions, facial hair, hair loss and acne.
Non-Insulin Resistant PCOS
There are some women who meet the diagnostic criteria for PCOS, but who don’t present with insulin resistance. This is what is referred to as Type 2 or Non-Insulin Resistant PCOS. There can be a variety of causes for this type of PCOS, including Vitamin D or Iodine deficiency, hormone-disrupting toxins, thyroid disease, and adrenal stress. For women experiencing Non-Insulin Resistant PCOS, blood sugar lowering drugs will have no effect on the condition, and neither will reducing weight or going on the pill.
Symptoms can include:
Excessive hair growth on the face, chest, stomach and back, irregular or absent periods, acne and oily skin, ovarian cysts, excessive weight carried around the stomach, pelvic pain, skin tags, sleep apnea.
In order to meet the diagnostic criteria, a patient must present with at least two of the following three issues:
1. Increased testosterone
2. Abnormal ovulatory patterns
3. Polycystic ovaries
It remains unclear as to why women may develop PCOS, but it could be a mixture of dietary, lifestyle, environmental and genetic factors. PCOS can run in families where there is often a history of type 2 diabetes. Lifestyle factors include unhealthy eating (i.e. high intake of fats, processed foods and refined sugars) and lack of physical activity.
Diagnosis of PCOS includes obtaining a thorough medical history, an ultrasound and a blood test that measures hormone levels in the blood. Management of PCOS involves a number of factors with lifestyle and dietary changes at the core. The medication that may be prescribed by a doctor is metformin (glucophage) which, supposedly, helps increase insulin sensitivity. It works by reducing the amount of glucose produced by the liver and increasing the ability of body cells to absorb glucose. Nutrients like chromium, zinc, alpha lipoic acid and arginine have all been shown to have a very positive effect, especially alpha lipoic acid.
Currently, there is no scientific evidence to support one particular diet for PCOS. Evidence-based recommendations suggest that women with PCOS should focus on balance and moderation. This also includes low-GI carbohydrates, which help maintain blood sugar control. The key lifestyle changes to embark on are the following:
- Weight loss of 5-10% in three months if overweight.
- Decreased intake of enriched/ white carbohydrates (focus more on complex carbohydrates). Complex carbohydrates take longer than enriched/ white carbohydrates to digest and absorb. These carbohydrates are known as low-GI carbohydrates. Choose brown rice, whole wheat breads and pasta, oats, barley, etc. Look for the word “whole” as the first ingredient on the Nutrition Facts Label.
- Increased fibre intake including fruits, vegetables, and beans. Fruits, vegetables, beans, legumes, whole grains, fish, lean meats, nuts, and seeds should be eaten daily. Incorporate starchy vegetables such as sweet potatoes and corn. Be wary of high sugar fruit however. Stick to low-GI fruits
- Decreased fat intake, particularly saturated and trans fat. This does not include your healthy omegas. Small, more frequent meals (every three to four hours) to help control blood glucose levels.
- High activity levels – ideally, four to five times per week of moderate to vigorous activity for one hour.
- Eat fish three times a week. Fish such as tuna, salmon, herring, sardines, and trout can improve heart health.
- Bake, grill, broil, boil, steam foods instead of frying them.
If you do suspect that you may have PCOS, please see your health care provider.