Polycystic Ovarian Syndrome Nutritional Management

Author: Christian Maino Vieytes, B.S. Nutritional Sciences, University of Maryland, College Park, M.S. Candidate, Division of Nutritional Sciences, University of Illinois at Urbana-Champaign

What is Polycystic Ovarian Syndrome (PCOS)

PCOS is a complex condition that affects women of child-bearing age (ages 20-45, on average). The primary hallmarks of PCOS include:¹

• Higher levels of testosterone and other androgenic (i.e., predominantly male) hormones
• Irregular ovulation and menstruation
• A host of metabolic abnormalities (high blood cholesterol and triglycerides, insulin resistance)
• The presence of enlarged ovaries and/or recurring ovarian cysts
• Facial and abnormal hair growth (also called hirsutism)

Unfortunately, the origins of PCOS are somewhat difficult to pinpoint and the causes within each individual case of PCOS will vary. Nevertheless, it is generally accepted that PCOS results from the interplay of environmental, behavioral, and genetic factors.² The latter is evident, as many women that suffer from PCOS have close family members who have experienced the same. Of course, the scientific literature has contributed that overweight, obesity, and insulin resistance is associated with this condition and that women with PCOS do indeed have an elevated risk of developing Type II Diabetes.² Moreover, population-based studies have demonstrated that women with PCOS tend to consume greater quantities of fat, especially saturated fat, which may potentially explain why overweight and obesity are more prevalent among this affected demographic.³

The Good News

Given the strong environmental component, there are several lifestyle modifications that have been documented to improve the quality of life for those afflicted by PCOS. Weight loss is the primary intervention known to be associated with a lowering of testosterone.⁴ For a long time, it was commonplace to prescribe a low-carbohydrate diet for patients with PCOS, given that they tend to have hyperinsulinemia or high levels of insulin in the blood. However, a recent review of research studies published on the relationship between low-carbohydrate diets and PCOS symptoms found that the two primary modifications that appear to have an effect are caloric restriction and overall weight loss and not carbohydrates, specifically.⁵ Of course, the verdict is still out on carbohydrates although it is prudent to avoid refined forms of carbohydrates and simple sugars while consuming greater quantities of whole-grains and vegetables that are rich in fiber.⁶ That said, caloric restriction tends is largely an unfeasible, yet effective method for lowering weight. However, this is where we begin to see the awesome benefits of adding more fiber-rich foods to your plate.

Fiber

A more recent study highlighted the importance of increasing dietary fiber, for a number of reasons. With respect to PCOS, dietary fiber can improve blood sugar and subsequently insulin levels and is incredibly effective for weight management as well as for lowering blood cholesterol levels.^7,8 Fiber has no calories, yet has the ability to suppress appetite, as it is very filling.⁹ One interesting aspect for the inclusion of dietary fiber as part of a dietary regimen for managing PCOS is the effects that dietary fiber has on hormonal profiles. Studies have begun to pay more close attention to how dietary fiber can lower levels of sex hormones in the blood.¹⁰ This has been an area of tremendous interest for PCOS researchers given that the condition is characterized by abnormally high levels of testosterone.

Exercise

Addressing dietary intake alone can be an effective intervention for managing PCOS. Increasing daily exercise is another. Primarily, we see that by exercising more, women with PCOS can manage their metabolic and cardiovascular complications as well as body fat and weight status more effectively.^11,12 This is of high importance, given that PCOS predisposes women to further complications including cardiovascular events and type II diabetes.

The Take Home Message

PCOS is a condition that can have deleterious outcomes. Fortunately, we know that management through lifestyle modifications is plausible. Increasing consumption of healthier foods, which tend to have higher fiber content profiles and lowering consumption of refined carbohydrates and fatty foods are perhaps the most effective ways for managing PCOS. Incorporating daily exercise has also been shown to help, although the evidence is not as strong as that for diet alone. 

References

1. 1. Trikudanathan S. Polycystic ovarian syndrome. Med Clin North Am. 2015;99(1):221-235. doi:10.1016/j.mcna.2014.09.003
2. 2. Ollila MM, West S, Keinänen-Kiukaanniemi S, et al. Overweight and obese but not normal weight women with PCOS are at increased risk of Type 2 diabetes mellitus-a prospective, population-based cohort study. Hum Reprod Oxf Engl. 2017;32(2):423-431. doi:10.1093/humrep/dew329
3. 3. Lin AW, Lujan ME. Comparison of dietary intake and physical activity between women with and without polycystic ovary syndrome: a review. Adv Nutr Bethesda Md. 2014;5(5):486-496.
4. 4. Reinehr T, Kulle A, Rothermel J, et al. Longitudinal analyses of the steroid metabolome in obese PCOS girls with weight loss. Endocr Connect. 2017;6(4):213-224. doi:10.1530/EC-17-0051
5. 5. Frary JMC, Bjerre KP, Glintborg D, Ravn P. The effect of dietary carbohydrates in women with polycystic ovary syndrome: a systematic review. Minerva Endocrinol. 2016;41(1):57-69.
6. 6. Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R. Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes Metab Syndr. 2017;11 Suppl 1:S429-S432. doi:10.1016/j.dsx.2017.03.030
7. 7. Nybacka Å, Hellström PM, Hirschberg AL. Increased fibre and reduced trans fatty acid intake are primary predictors of metabolic improvement in overweight polycystic ovary syndrome-Substudy of randomized trial between diet, exercise and diet plus exercise for weight control. Clin Endocrinol (Oxf). 2017;87(6):680-688. doi:10.1111/cen.13427
8. 8. Smith CE, Tucker KL. Health benefits of cereal fibre: a review of clinical trials. Nutr Res Rev. 2011;24(1):118-131. doi:10.1017/S0954422411000023
9. 9. Howarth NC, Saltzman E, Roberts SB. Dietary fiber and weight regulation. Nutr Rev. 2001;59(5):129-139. doi:10.1111/j.1753-4887.2001.tb07001.x
10. 10. Katcher HI, Kunselman AR, Dmitrovic R, et al. Comparison of hormonal and metabolic markers after a high-fat, Western meal versus a low-fat, high-fiber meal in women with polycystic ovary syndrome. Fertil Steril. 2009;91(4):1175-1182. doi:10.1016/j.fertnstert.2008.01.035
11. 11. Benham JL, Yamamoto JM, Friedenreich CM, Rabi DM, Sigal RJ. Role of exercise training in polycystic ovary syndrome: a systematic review and meta-analysis. Clin Obes. 2018;8(4):275-284. doi:10.1111/cob.12258
12. 12. Kite C, Lahart IM, Afzal I, et al. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Syst Rev. 2019;8(1):51. doi:10.1186/s13643-019-0962-3