How to manage PCOS

By Juliana Kassianos, Transformational Coach, Yoga Teacher and Founder of The School of Fertility

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WHAT IS PCOS?

Polycystic Ovary Syndrome (PCOS) is a condition that affects hormone levels in women and is characterised by cysts on the ovaries. Women with PCOS tend to have high levels of androgens (male hormones) and insulin resistance.

HOW TO LOWER ANDROGEN LEVELS

In Greek, the word ‘andro’ means male human being. Androgens stimulate or control the development and maintenance of male characteristics. The most well-known androgen is testosterone. In women, it is produced by the ovaries and adrenal glands and is a precursor of oestrogen. Women with PCOS have high levels of androgens and may show symptoms such as acne, hair loss, deepening of the voice and menstrual problems.

INOSITOL

This is part of the vitamin B family and has nine forms. It helps with the transfer of energy and nutrients across cells. Myo-inositol (MI) is found in follicular fluid. In a study with patients undergoing IVF, MI appeared to play a role in follicular maturity and provide a marker of good quality oocytes. In overweight women with PCOS, MI has been found to improve the number of good quality oocytes, clinical pregnancies, and delivery rates. MI and D-chiro inositol (DCI) have been shown to improve insulin resistance, improve ovarian function, and reduce androgen levels in women with PCOS.

The body produces inositol from glucose. Food sources of inositol include grains like buckwheat and oats, lima beans, grapefruit, carob, bananas, nuts and seeds. Fresh vegetables and fruit have been shown to contain more MI than frozen or canned.

OMEGA-3 FATTY ACIDS

One study found Omega-3 supplementation could reduce serum concentrations of testosterone in overweight and obese PCOS patients and make their menstrual cycle more regular. Omega-3 also has an anti-inflammatory response. A good source is oily fish such as:

  • Salmon

  • Mackerel (not King Mackerel)

  • Anchovies

  • Sardines

  • Herring

If you take a fish oil supplement, make sure it’s mercury free and doesn’t contain vitamin A.

LICORICE

Licorice has a phytoestrogen effect and has been found to reduce testosterone levels in women. Note however, liquorice is not recommended in pregnancy, so if you do choose to include it in your diet, only have it in moderation and stop once you find out you’re pregnant.

INSULIN RESISTANCE

Insulin resistance is when cells fail to respond to insulin, which results in blood glucose levels rising above normal levels. This can cause the ovaries to make excess androgen hormones, which are converted into oestrogen, increasing the level of this hormone above normal levels, affecting ovulation.

RESTRICT SUGAR/INCREASE PROTEIN

Restrict your sugar intake as it can cause greater fluctuations in blood glucose and can increase inflammation, which can be a huge source of chemical stress in the body. Try to have protein with every meal as it will help to stabilise your blood sugar. E.g. eggs, nuts and beans

LOW STARCH/LOW-DAIRY

Dairy can increase inflammation, which can be a huge source of chemical stress in the body. One study showed an eight-week low-starch/low-dairy diet resulted in weight loss, improved insulin sensitivity and reduced testosterone in women with PCOS.

CALORIE INTAKE

Calorie intake should ideally be distributed between several meals per day, with little intake from snacks and drinks.

HIGH FIBRE DIET

A diet high in fibre is recommended. Although the body can’t digest it, it helps to control blood sugar and slow down carbohydrate metabolism. E.g. oatmeal, banana and beans.

LOW FAT DIET

A diet low in saturated fats is recommended, with fats restricted to less than or equal to 30% of total calories.

LOW GLYCAEMIC INDEX (GI) DIET

A low GI diet helps to improve symptoms of PCOS. GI ranks carbohydrate-containing food from 0-100 based on how quickly and how much they raise your blood sugar levels after eating.

High GI food are digested and absorbed quickly causing blood sugar levels to spike and then crash, sapping you of energy. This crash comes about from a large surge in the hormone insulin, which converts sugar from the carbohydrates you eat into energy.

Low GI food are digested and absorbed slowly, causing a gradual rise in blood sugar and insulin levels, fuelling your body with sustained energy.

High GI= 70-100. E.g. Baked sweet potato, watermelon and white bread

Medium GI= 56-69. E.g. Beetroot, pineapple and couscous

Low GI= 0-55. E.g. Boiled sweet potato, broccoli and sourdough bread

Some foods may have a high GI value, but as they contain low carbohydrate, they have little impact on your blood sugar levels. This is where it is useful to calculate the Glycaemic Load (GL), as it takes into account the amount of carbohydrate the food contains with how quickly it raises your blood sugar levels. Work out GI and GL values of your food at www.glycemicindex.com

REFERENCES

  • The inositols and polycystic ovary syndrome. Bharti Kalra et al. Indian J Endocrinol Metab. 2016 Sep-Oct; 20(5): 720–724. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5040057/

  • Endocrine and clinical effects of myo-inositol administration in polycystic ovary syndrome. A randomized study. Artini PG et al. Gynecol Endocrinol. 2013 Apr;29(4):375- 9. doi: 10.3109/09513590.2012.743020. Epub 2013 Jan 22. https://www.ncbi.nlm.nih.gov/ pubmed/23336594/

  • Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Costantino D et al. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):105-10. https://www.ncbi.nlm.nih.gov/pubmed/19499845

  • Follicular fluid and serum concentrations of myo-inositol in patients undergoing IVF: relationship with oocyte quality. Chiu TT et al. Hum Reprod. 2002 Jun;17(6):1591-6. https://www.ncbi.nlm.nih.gov/pubmed/12042283

  • Myo-inositol content of common foods: development of a high-myo-inositol diet. Clements RS Jr and Darnell B. Am J Clin Nutr. 1980 Sep;33(9):1954-67. https://www.ncbi. nlm.nih.gov/pubmed/7416064

  • The effect of omega-3 supplementation on androgen profile and menstrual status in women with polycystic ovary syndrome: A randomized clinical trial. Azadeh Nadjarzadeh et al. Iran J Reprod Med. 2013 Aug; 11(8): 665–672. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3941370/

  • An Update on Plant Derived Anti-Androgens. Paul Grant and Shamin Ramasamy. Int J Endocrinol Metab. 2012 Spring; 10(2): 497–502. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3693613/

  • Licorice reduces serum testosterone in healthy women. Armanini D et al. Steroids. 2004 Oct-Nov;69(11-12):763-6. https://www.ncbi.nlm.nih.gov/pubmed/15579328/

  • Relation of nutrients and hormones in polycystic ovary syndrome. Kasim-Karakas SE et al. Am J Clin Nutr. 2007 Mar;85(3):688-94. https://www.ncbi.nlm.nih.gov/pubmed/17344488

  • Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co- Morbidities Linked to Polycystic Ovary Syndrome (PCOS). Jennifer L. Phy et al. J Obes Weight Loss er. 2015 Apr; 5(2): 259. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4516387/

  • Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management. Farshchi H et al. J Obstet Gynaecol. 2007 Nov;27(8):762-73. https://www. ncbi.nlm.nih.gov/pubmed/18097891

  • The optimal diet for women with polycystic ovary syndrome? Marsh K and Brand-Miller J. Br J Nutr. 2005 Aug;94(2):154-65. https://www.ncbi.nlm.nih.gov/pubmed/16115348

  • Diet and nutrition in polycystic ovary syndrome (PCOS): pointers for nutritional management. Farshchi H et al. J Obstet Gynaecol. 2007 Nov;27(8):762-73. https://www. ncbi.nlm.nih.gov/pubmed/18097891

  • Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Marsh KA et al. Am J Clin Nutr. 2010 Jul;92(1):83-92. doi: 10.3945/ajcn.2010.29261. Epub 2010 May 19. https://www.ncbi.nlm.nih.gov/pubmed/20484445


Juliana Kassianos