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Polycycstic Ovary Syndrome (PCOS)
Improving symptoms through diet
Polycystic ovarian syndrome (PCOS) is a disorder affecting between 6 and 8% of women in the United States, involving over production of the male hormone androgen. Although specific causes are unknown, there appears to be a combination of environmental, genetic, and metabolic factors that affect PCOS including:
Changes in insulin secretion/ action
The over synthesis of androgen
Increased body weight/ excess fat storage
Energy inbalance (high caloric intake)
Changes in secretion (and action) of hormones that stimulate either the testes or the ovaries
In most cases, insulin resistance is the most presumed cause, affecting 50-70% of women with PCOS.
Insulin is a hormone produced in the pancreas that regulates the amount of sugar circulating in your blood. Its function can be compared to that of a key, opening up our cells so that sugar can enter and be used/stored for energy. In the absence of insulin, energy cannot be obtained from carbohydrates and blood sugar levels rise, as is common in type II diabetes mellitus. Insulin resistance occurs when the insulin is unable to unlock the cells and allow sugars to enter. The body may be overproducing insulin in this case, yet sugars are not able to be harvested for energy and instead build up in the bloodstream.
The overproduction of insulin leads to an overstimulation of ovarian cells, causing, in turn, an overproduction of androgen (which, if you recall, is one of the primary causes of PCOS).
The onset of PCOS typically occurs during puberty, though it can also manifest at any point during an adult woman’s life. Diagnosis is difficult, as symptoms are also characteristic of many other pathologies and presentation of symptoms vary amongst women. PCOS is therefore a diagnosis of exclusion, meaning all other potential pathologies are first eliminated and then 2 of the 3 symptoms must then be met:
Including delays of over 35 days, the complete absence of a period, bleeding irregularities, or anovulation [the absence of ovulation because the body doesn’t release an oocyte (a cell that turns into an embryo)]
Signs that androgen are produced in excess amounts
Including elevated levels of testosterone, acne, male-patterned baldness, and hirsutism (the growth of unwanted hair, such as a moustache)
Ovarian cysts alone are not diagnostic of PCOS. 12 or more must be present and enlarged
Without treatment, PCOS can increase risk of cardiovascular disease, non-alcoholic fatty liver disease, sleep apnoea, depression, anxiety, and infertility.
Enhancing insulin sensitivity is of primary importance in the treatment of PCOS, as insulin is able to reduce testosterone levels and SHBG, a protein that binds to estrogen and androgen.
Because fat accumulation impairs insulin sensitivity, weight loss and exercise are first-line treatments for PCOS. Between 35% and 75% of women with PCOS are obese, but even in the absence of obesity, excess fat accumulation is common (specifically around the stomach). Even a 5-10% reduction in body weight has been demonstrated to decrease androgen levels and re-establish regular periods.
Other factors that impair insulin sensitivity include high cholesterol, inflammation, oxidative stress, elevated levels of androgen in the blood stream, and high levels of homocysteine, an amino acid present in meat.
Glycotoxins, or advanced glycation end products (AGEs), are strong contributors to inflammation. Women with PCOS tend to have almost twice the amount of circulating AGE levels in their blood, compared to undiagnosed individuals. Within just 2 hours of eating a single meal, high in AGE concentration (though common to a standard American diet), significant oxidative stress and inflammation is visible. And while some AGEs are formed within the body, the modern diet is, without a doubt, the primary source of these pro-inflammatory compounds. Whereas plant-based foods contain very few AGEs, uncooked animal products contain dangerously high amounts.
A food’s cooking process additionally impacts AGE formation. Cooking at low temperatures, using acidic ingredients such as lemon juice or vinegar, employing shorter cooking times, and cooking in a moist environment appear to produce the fewest amount of AGEs, where high cooking temperatures, such as deep frying, appear to generate the most. Tantalaki et al. (2014) demonstrated that by switching to a low-fat, whole foods, plant-based (LFWFPB) diet, symptoms of PCOS improve within just two months. This may be due to the reduction of AGEs and the high levels of antioxidants that are supplied by whole grains, fruits, and vegetables.
Plant foods are also high in a substance known as inositol hexaphosphate which decreases androgen levels, enhances insulin’s function, and improves ovary function. A whole foods, plant-based diet is also able to effectively reduce cholesterol levels, thereby increasing insulin sensitivity.
Insulin desensitivity is also associated with genetic alterations to proinflammatory cytokines which increase inflammation in order to regulate infection, inflammation or an immune response.
Women with PCOS and decreased insulin sensitivity are also more likely to be deficient in the trace mineral chromium. Studies have demonstrated that chromium supplements improve insulin sensitivity and chances of ovulation, while reducing hirsutism. Chromium can also be found in a wide variety of foods including broccoli, grapes, whole grains, garlic, potatoes, basil, oranges, red wine, apples, bananas, and green beans. By consuming a variety of unrefined plant foods, a sufficient amount of chromium should be easily attained, as the recommended daily allowance is only 25 μg/day.
Oral contraceptives also appear to ameliorate symptoms including period irregularities, acne, and unwanted hair growth. The pharmaceutical drug Metformin is also able to reduce insulin production, increase glucose sensitivity in bodily tissues, enhance weight loss, and prevent pregnancy complications. However, as is typical with many pharmaceutical interventions, side effects such as nausea, diarrhoea and stomach cramps are commonly reported. Additionally, evidence that metformin enhances fertility is limited.
1. Diamanti‐Kandarakis, E., Piperi, C., Kalofoutis, A. and Creatsas, G. (2005). Increased levels of serum advanced glycation end‐products in women with polycystic ovary syndrome. Clinical endocrinology, 62(1), 37-43.
2. Stirban, A., Negrean, M., Götting, C., Uribarri, J., Gawlowski, T., Stratmann, B., Kleesiek, K., Koschinsky, T., Vlassara, H. and Tschoepe, D. (2008). Dietary advanced glycation endproducts and oxidative stress. Annals of the New York Academy of Sciences, 1126(1), 276-279.
3. Uribarri, J., Woodruff, S., Goodman, S., Cai, W., Chen, X., Pyzik, R., Yong, A., Striker, G.E. and Vlassara, H. (2010). Advanced glycation end products in foods and a practical guide to their reduction in the diet. Journal of the American Dietetic Association, 110(6), 911-916.
4. Tantalaki, E., Piperi, C., Livadas, S., Kollias, A., Adamopoulos, C., Koulouri, A., Christakou, C. and Diamanti-Kandarakis, E. (2014). Impact of dietary modification of advanced glycation end products (AGEs) on the hormonal and metabolic profile of women with polycystic ovary syndrome (PCOS). Hormones (Athens), 13(1), 65-73.