When hormones go wrong
The effects of polycystic ovary syndrome (PCOS) can be severe for a woman to cope with but good nutriton can help
There is no definite evidence to support one particular diet for PCOS, but it’s advisable to include lean protein at each meal to help lower the GI. Beans, peas, lentils are also very good choices
Polycystic ovary syndrome (PCOS) is a hormonal disorder which causes a woman’s body to produce too much of the male hormones androgens. As a result normal ovulation is disrupted and menstruation is irregular or it can stop completely. This makes it difficult to become pregnant.
Women with the condition have a number of small cysts on the ovaries. However it is usually the symptoms, rather than the presence of the cysts themselves, that are important in establishing a diagnosis. PCOS is a relatively common condition, affecting 6-10 per cent of women.
Typical symptoms of PCOS include:
- Irregular or absent menstruation
- Fertility problems
- Unwanted body or facial hair
- Thinning of hair or hair loss (alopecia)
- Oily skin, acne,
weight gain (especially around the abdomen)
- Poor glucose and insulin control
- High cholesterol and triglycerides
- High blood pressure
Not everyone with PCOS will have all symptoms. Some women have a few mild symptoms, while others have an assortment of more severe symptoms.
It appears that the weight gain that often accompanies the syndrome is thought to add to or aggravate metabolic and reproductive abnormalities. Characteristics of metabolic syndrome such as abdominal obesity, high blood pressure, insulin resistance and glucose intolerance are more common in women diagnosed with PCOS than from the general population.
The excessive production of male hormones, facial hair, acne and other symptoms may be a result of the irregularities in insulin production.
Normally when food is eaten and broken down into glucose, the hormone insulin, which is produced by the pancreas, regulates the amount of glucose in the bloodstream.
Insulin acts like a key. It opens the doors to the body’s cells (muscle cells, liver cells and fat cells) so that glucose can enter. With insulin resistance the keys won’t turn and unlock the cells. Higher than normal glucose levels build up in the blood.
This signals the pancreas to make more and more insulin, until finally the overburdened pancreas stops working. The high blood glucose (sugar) level can result in pre-diabetes and can be damaging to the heart and circulatory system.
Currently there is no definite evidence to support one particular diet for PCOS, but an emphasis on low glycaemic (GI) foods may be useful. However it is important not to rely on the GI alone when choosing foods.
For example, certain foods such as watermelon and carrot have a high GI but a serving contains so little carbohydrate that the overall effect on blood glucose is insignificant. The GI of a food is also influenced by what else is on your plate. Oils, vinegars and lemon juice can all lower the effects on blood glucose and insulin levels.
Overall it may be helpful to eat less high GI foods such as refined, processed carbohydrates and to choose low to medium GI foods such as oats and wholegrain or rye products instead.
- Aim for a weight loss of 5-10 per cent, at a rate of 1-2 pounds per week. The American Academy of Nutrition and Dietetics advises that this moderate weight loss can help normalise menstrual cycles, regulate blood sugar and increase a woman’s chances of conceiving a baby.
- Increase fibre by including more wholegrains, fruit, vegetables and pulses. Choose brown rice, oatmeal, barley, bulgur, quinoa, millet and spelt.
- Limit poor-quality refined carbohydrates (such as white sugar, white flour, white rice, white bread, biscuits, pastries, soft drinks and sweets).
- Include lean protein at each meal to help lower the GI. Beans, peas, lentils are good choices. Boiled eggs, small cans of tuna or salmon, shot-glass serving sizes of nuts and seeds, low fat yogurt or cheese (such as cottage cheese), nut butters and hummus make great snacks.
- Get enough omega 3 fatty acid. Eat at least two servings of oily fish such as salmon or tuna each week.
- Limit foods containing trans fats or partially hydrogenated fat on ingredient lists. Choose healthier fats such as olive oil, rapeseed oil or camelina oil.
- Watch your portion sizes. For weight loss aim to fill half your plate with vegetables or salad, a quarter with wholegrain carbohydrates and the remainder with lean protein.
- Include smaller more frequent meals and snacks to help keep blood glucose levels under control and avoid cravings building up.
- Include regular exercise. Aim for at least five days per week.
Long-term health problems associated with PCOS include heart disease and diabetes, particularly if a woman is overweight with a high blood pressure and a high blood cholesterol. Losing as little as 5-15 per cent of excess weight can help to improve insulin lev els and manage the condition. Testosterone levels are reduced by managing insulin levels. This in turn improves the chance of ovulation and fertility, and may help to reduce hair growth.
For symptoms such as irregular periods and fertility problems, medications are available. Speak to your GP if concerned.
The syndrome may run in families. But systematic reviews and meta-analysis confirm significant benefits of lifestyle (both exercise and dietary/weight loss ) interventions on various clinical outcomes in PCOS.
Paula Mee is lead dietitian at Medfit Proactive Healthcare and a member of the Irish Nutrition and Dietetic Institute. @paula_mee