What is Polycystic Ovary Syndrome?
Polycystic Ovary Syndrome (PCOS) is the most common endocrine and metabolic disorder in women of reproductive age, affecting 1 in 10. The cause is unknown, but it is believed to be a combination of genetic, environmental and lifestyle factors. Some of the symptoms of PCOS include – irregular menstrual cycles, acne, infertility, alopecia, increased facial and body hair, fatigue, skin conditions, mood swings.
Insulin resistance and PCOS
A major endocrine problem that occurs is insulin resistance. Approximately 80% of women with PCOS suffer from this. Insulin resistance means a higher tendency to gain weight, a higher risk of developing diabetes and hyperlipidemia, an increased risk of cardiovascular disease and metabolic syndrome, as well as increased androgen levels. Insulin resistance is also associated with cravings for sweets, hunger, weight gain, fat storage especially in the abdominal area, and infertility. Another factor that exacerbates all of the above is the low-grade, chronic inflammation caused by PCOS.
How can I improve PCOS symptoms?
One way to improve the above symptoms is to reduce insulin resistance and this can be achieved with lifestyle modifications. An initial goal is a 5-10% weight loss, which can provide clinical improvements and is considered successful if it occurs within 6 months. The MONASH University (2018) guidelines for PCOS advise a 30% caloric deficit to achieve weight loss, along with a combination of a Mediterranean diet.
The Mediterranean diet has been shown to reduce inflammation, as it incorporates whole grains, vegetables, legumes, nuts, seeds, fish, fruits, and moderate consumption of poultry and red meat. It can also provide a low glycaemic index diet, which helps reduce insulin resistance and can keep blood glucose levels more stable. The glycaemic index is a ranking system that shows how quickly blood glucose levels rise after consuming different carbohydrates. A low glycaemic index diet means eating foods that help blood glucose levels rise slowly. This can help reduce some of the symptoms mentioned above.
Some tips for lowering the glycaemic index are:
1. Switch from white bread to multigrain/rye/sourdough
2. Choose to cook pasta al-dente for a lower glycaemic index
3. Try basmati or brown rice
4. Try bulgur wheat, quinoa, couscous, buckwheat as part of your diet
5. Cook potatoes with their skins on or try sweet potatoes, which are rich in fibre
6. Choose high-fibre cereals, such as oats, muesli or granola with no added sugar, whole grain products with low sugar content
The Importance of Meal patterns
Recent studies have also shown that the pattern of meals during the day is very important. Women with PCOS often report cravings, possibly due to fluctuations in blood sugar, and for this reason it is recommended that they have a regular meal pattern, ideally 3 meals during the day, with snacks in between. In addition, research has shown that eating larger meals earlier in the day, as opposed to eating them later, can reduce blood glucose spikes, provide improvements in insulin sensitivity in the morning, and provide better metabolism of fats from our diet. This is linked to our biological clock, called the circadian rhythm.
Micronutrients and PCOS
There is also evidence that women with PCOS have a high rate of deficiencies in certain micronutrients, such as vitamin D, magnesium, zinc, chromium. Deficiencies in all of the above are linked to insulin resistance, inflammation, hyperlipidemia, and more. It is also very important to consider whether the diet is adequate in omega-3 fatty acids, folic acid, and iron for those who experience infertility, hair loss, and other conditions. Inositol supplementation has also been shown to help with cravings, improve insulin levels, reduce acne, and regulate menstruation.
Some additional dietary tips that may also help are nuts, specifically almonds and walnuts, which help reduce bad cholesterol, Ceylon cinnamon, which can help with insulin resistance and regulate menstruation, peppermint tea, which reduces testosterone, and probiotics, as people with PCOS tend to have reduced biodiversity in the gut microbiome.
Exercise and PCOS
When it comes to exercise, guidelines always recommend exercise interventions alongside dietary modifications. Exercise can reduce insulin resistance, improve cardiometabolic markers, and have a positive impact on psychological health.
