What is Poly Cystic Ovarian Syndrome (or PCOS)?

Poly Cystic Ovarian Syndrome or PCOS, is one of the most common hormonal issues affecting women in childbearing age which is characterized by imbalance of women’s sex hormones; The term “Polycystic” means to have multiple cysts in the ovaries. the main symptoms of PCOS are:

• Cysts in the ovaries, although the presence of cysts are not necessary for diagnosis
• High levels of Androgens (male hormones) which may be manifested by acne, male pattern baldness, and hirsutism (growing hair on face and body)
• Irregular or skipped periods
• 4-weight gain
• Insulin resistance: when cells in muscles, fat, and liver don’t respond well to insulin and can’t easily take up glucose from your blood. As a result, your pancreas makes more insulin to help glucose enter cells.

Additionally, higher levels of insulin can imbalance the sex hormones and this, in turn, may worsen the symptoms like acne, excess hair growth on face and body, and other high-androgen related symptoms. Meta-analyses of cross-sectional studies have shown that women diagnosed with PCOS have more feelings of depression and anxiety compared to healthy controls.

Although, there is no known cure yet, and the cause is unknown, life style changes and proper diet are effective. In this article, we will go through some of dietary recommendations for controlling PCOS.

The Healthy eating pattern and regular physical activity can help in controlling weight and insulin resistance. As noted earlier, Insulin resistance is common in patients diagnosed with PCOS; which can lead to higher insulin levels in the blood for compensation. Insulin increase the testosterone levels (the male hormone). A low glycemic Index (GI) can help for controlling insulin resistance.

Let’s talk about “Glycemic Index”. Glycemic index is ranking system for carbohydrate containing foods based on their effect on increasing blood sugar or “Glycemic Response”. Foods with higher GI levels will increase the blood sugar faster and higher compared to foods with lower GI level. Foods have been categorized in 3 groups based on their GI:

Low (55 or less), like: spelt/sourdough/heavy mixed bread, barley, mung beans, pulses, quinoa, sweet potato, parboiled rice, apple, berries, grapefruit, mango, etc.

Medium (56-69), like: pumpernickel/pita/chapatti bread, brown/basmati rice, beets, corn, red potato, grapes, pineapples, etc.

High (70 or more) like: whole wheat/white bread, corn flakes, pretzels, rice cake, watermelon, etc.

The Glycemic Index of foods is established through testing the effects of different foods in comparison to a portion of specific foods (like white bread or glucose). Swapping high GI foods with lower-GI foods has been shown to improve insulin response in women with PCOS, when combined with loosing weight. Here is an example, you can substitute:

• Sticky rice with quinoa or parboiled rice or you can mix your rice with quinoa or some pulses
• Regular potato with sweet potato
• White/whole wheat bread with spelt/ sourdough bread

The prevalence of vitamin D deficiency in women with PCOS is about 67-85 per cent, with serum concentrations of 25(OH)D <20 ng/ml. Vitamin D deficiency may worsen the symptoms of PCOS like Insulin resistance, menstrual cycle regularity, hyperandrogenism, overweight and obesity elevated risk of cardiovascular diseases. Vitamin D supplementation could be considered if you’re deficient or if not getting enough vitamin D from food or sunlight.

Physical activity is another key component in lifestyle changes for management of PCOS. In overweight women, the symptoms and overall risk of developing long-term health problems from PCOS can be improved by losing extra weight. Additionally, research shows that physical activity is associated with lower depression in women with PCOS.

In conclusion, following a well-balanced diet which promotes healthy body weight and reduce insulin resistance, in conjunction with regular physical activity can help in controlling PCOS symptoms.

References:

1. Mario FM1,2, Graff SK1, Spritzer PM. Habitual physical activity is associated with improved anthropometric and androgenic profile in PCOS: a cross-sectional study. J Endocrinol Invest. 2017 Apr;40(4):377-384
2. Ming-Wei Lin1 and Meng-Hsing Wu. The role of vitamin D in polycystic ovary syndrome. Indian J Med Res. 2015 Sep; 142(3): 238–240.
3. C E Wright, J V Zborowski, E O Talbott, K McHugh-Pemu & A Youk. Dietary intake, physical activity, and obesity in women with polycystic ovary syndrome. International Journal of Obesity volume 28, pages 1026–1032 (2004).
4. Lauren K Banting, Melanie Gibson-Helm, Remco Polman, Helena J Teede and Nigel K Stepto. Physical activity and mental health in women with Polycystic Ovary Syndrome. BMC Women’s Health201414:51.
5. “Glycemic Index” handout , Diabetes of Canada, 2013.