Nutrition Intervention for Polycystic Ovarian Syndrome
By Heather Wnorowski
Polycystic ovarian syndrome (PCOS) is an endocrinologic disorder that can appear in women of reproductive age. It is the leading cause of fertility and affects 6-10% of women of childbearing age. It was not described until 1935 by Stein and Leventhal. PCOS can also be referred to as Stein-Levanthal syndrome. It is referred to as a syndrome because it contains many symptoms. These symptoms include obesity, hirsutism, acne, infrequent or abnormal ovulation, amenorrhea, oligominorrhea, hyperandrongenism, an elevated utilizing hormone to follicle stimulating hormone ratio, chronic pelvic pain, insulin resistance, hyperinsulinemia, type II diabetes, dyslipidemia, and hypertension. These symptoms can get worse with weight gain. The onset of the disease can be as early as puberty, but usually begins in adolescence. The cause of PCOS is unknown. Some literature suggest it is genetic with autonomic dominant mode of transmission.
To diagnose PCOS some of the symptoms must be present and some test must be performed. The test may include glucose tolerant test (GTT), cholesterol levels (total chol, LDL, HDL, trig), testosterone levels, utilizing hormone, follicle stimulating hormone, and androstenedione levels. On occasion an ultrasound will be done. Women with PCOS have an increased risk for developing type II diabetes, high cholesterol and triglyceride levels, cardiovascular disease, endometrial cancer, and insulin resistance. Of these disease the most common is insulin resistance and type II diabetes.
About 35-50% of obese women with PCOS go on to develop impaired glucose tolerance or type II diabetes by the age of 30. Insulin resistance is when the cells don’t respond to insulin. The insulin builds up in the body, which is hyperinsulinemia, and causes ovarian cells to secrete androgens and decrease sex hormone binding hormone globulin (SHBG). The interacting of insulin and hormones lead to symptoms of PCOS. The International Council on Infertility Information Dissemination says “Insulin resistance that is common to PCOS may play a role in weight gain and the difficulty in losing any extra weight.” Studies have shown that the distribution of body fat is important with insulin sensitivity. They say the more fat stored the worse insulin resistance is and the hungrier you get. High levels of insulin can lead to carbohydrate cravings. Intense carbohydrate cravings and not feeling full are common in women with PCOS. Evidence shows that the western diet )increased fat and refined carbohydrates, and low fiber) can precede obesity and induce insulin resistance. Insulin sensitivity can be influenced by dietary modifications such as a low glycemic index diet. The glycemic index of a carbohydrate is a measure of its postprandial effect on blood glucose. The lower the glycemic index the less the carbohydrate affects postprandial glucose and insulin values. Martha Mckittric RD, CDE, Medical Advisory Board Member for PCOS Support Association usually prescribes a balanced diet with protein and heart healthy fats at every meal, but also recommends foods with a low glycemic index. She has found most women have less carbohydrate cravings on low glycemic diets. So she encourages whole grains and minimizes processed carbohydrates.
There are natural remedies to control insulin and blood sugar levels. Cinnamon (½-¾ teaspoon) with every meal can help keep insulin and blood sugar levels under control. It contains methyl hydroxy chaconne polymer (MHCP) which improves cellular glucose utilization and sensitivity of insulin receptors. Studies show that high fiber diets can decrease weight and increase insulin sensitivity. Fiber reduces insulin secretion by slowing the rate of nutrient absorption after a meal. Polyunsaturated fatty acids (omega-3 and omega-6) can keep cell membranes flexible. Flexible cell membranes have more insulin receptors which improve glucose metabolism. Chromium (200 mg) per day can improve insulin resistance symptoms. A study in the New England Journal of Medicine found that 1200 mg of D-chiro-inositol daily has many beneficial affects in the treatment of PCOS. D-chiro-inositol is part of a phosphoglycan that has been shown to mediate action of insulin. In patients with type II diabetes the level of D-chiro-inositol is decreased. Studies have suggested that women with PCOS may have insulin resistance and hyperinsulinemia due to a D-chiro-inositol deficiency.
The role of the dietitian is key in the treatment of PCOS. A balance of the food the patients eat is an important part of treating PCOS. One of the most important treatments for obese patients should be weight loss and exercise. A 5-10% weight loss has shown significant biochemical and clinical improvement. Studies have shown menstrual cycles and fertility have improved with weight loss. Also androgen production and hirsutism has decreased in weight loss.
PCOS is also associated with a high incidence of eating disorders including binge eating and fasting. Eighty percent of people with PCOS practice binge eating. The first step in weight loss treatment is to learn to be mindful. Katrin Kratina, MA, RD, LD developed a food journal to help identify hunger and satiety cues. The food journal also teaches about your nutrition needs and your eating habits. Brenda Bryan RD, LD/N a nutritionist for PCOS women at the Center for Applied Reproductive Sciences, uses the Food Pyramid and American Diabetes Guidelines of reducing calories by 250-300 per day from saturated fat and carbohydrates to counsel women with PCOS.
PCOS is treatable but not curable. It is generally treated by medications and changes in diet and exercise or a combination. Some of the medications used in treatment include; insulin sensitizers which reduce insulin resistance and many other symptoms and also aid in weight reduction, medication that induce ovulation, combination oral contraceptives (COC) which regulate menstrual cycles and control acne and hirsutism, Antiandrogenism and insulin regulating agents can control hyperandrogenism and aid in weight loss. Sometimes on special occasion surgical treatment is used.
There are many issues to still be explored in PCOS. The biggest challenge is making permanent changes focused on good nutrition. The patient should chose a dietitian with experience in type II diabetes and gestational diabetes because they will be knowledgeable in insulin resistance and special diets. The most successful counseling is education the patient on PCOS and insulin resistance and by allowing the patient to make self set goals in order to ensure long term success.
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