Polycystic Ovaries Syndrome (PCOS) is a hormonal condition that occurs in 5-10% of women between late adolescence and menopause. It is one of the most common hormonal related problems in women during their reproductive years. Not only is PCOS a leading cause of infertility it can also be a risk factor for other health problems.
The diagnostic criteria of PCOS has been a topic of debate. Merely the presence of polycystic ovaries ( enlarged ovaries with small cysts on the outer edges) does not qualify for the condition to be called a syndrome. In November 2015, the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE), and Androgen Excess and PCOS Society (AES) released new guidelines in the evaluation and treatment of PCOS and it was mentioned that the diagnostic criteria for PCOS should include two of the following three conditions:
Chronic anovulation ( chronic absence of ovulation), hyperandrogenism (excess of male hormones which can be clinical/biologic), and polycystic ovaries.
Signs and symptoms
The major features of PCOS include menstrual dysfunction, anovulation, and signs of hyperandrogenism. Other signs and symptoms of PCOS may include the following:
Metabolic syndrome ( a cluster of conditions such as high blood sugar, abnormal lipid levels, high blood pressure, obesity)
Obstructive sleep apnea
Most PCOS patients are overweight or obese ( except a small percentage who are not markedly overweight). One of the most common metabolic abnormality associated with PCOS is insulin resistance. In this condition the cells fail to react to insulin which leads to abnormal glucose metabolism and high blood sugar. To compensate this condition, the body produces more insulin, thereby increasing the insulin levels in the blood and causing a condition called hyperinsulinemia. This then further leads to Type 2 diabetes. The mechanisms by which insulin resistance leads to PCOS and Type 2 diabetes are different. The details of which I shall not discuss in this article. PCOS has also been related to Type 1 diabetes. Insulin resistance has also been related to dyslipidemia ( abnormal lipid levels) and risk of cardiovascular disease.
A lot of research still needs to be done on PCOS. Research to gain a clearer understanding of the mechanisms linking each condition is required. Nevertheless, there are enough studies which have shown that even a moderate weight loss of about 5-10% helps in restoring functions of the ovaries which leads to normal hormone production. This then results in improvement in symptoms of PCOS.
Since PCOS is related to so many metabolic abnormalities, many studies have shown that apart from the required drug therapy, diet and lifestyle changes is the first line treatment.
Diet for PCOS
PCOS diet is very individualistic. Since the symptoms will vary from woman to woman. But there are a few basic guidelines
1. Foods with low GI (Glycemic index ): These are foods which release the sugar slowly to the blood stream, therefore there is a steady rise in blood sugar and insulin, as opposed to high GI foods which are broken down and absorbed quickly by the body leading to a rapid rise in blood sugar levels.
Image courtesy of (Grains: rakratchada torsap; fruits and vegetables: Suat Eman; Almonds: phasinphoto) at freedigitalphotos.net
List of low GI foods
Whole wheat ( chapati, bread)
Whole wheat pasta
Buckwheat ( kuttu )
Kidney beans (Rajmah)
Black eyed kidney beans ( Rongi/ Lobia)
Almost all vegetables except beetroot which is a medium GI, potatoes, pumpkin and parsnips which are high GI.
Cherries, Plums, Grapefruit, Peaches, Apples, Pears, Dried Apricots, Grapes, Coconut, Coconut Milk, Kiwi Fruit, Oranges, Strawberries, Prunes,
Nuts and seeds such as walnuts, peanuts, almonds, chia seeds, ground flaxseeds.
2. Less than 30 % of the daily calories should be from fat: This should comprise of mostly unsaturated fats and only a very low amount of saturated fat (<10%). So how does one translate this to normal day to day life. The basic idea is to cook the food in very less oil. Stir fry vegetables and let them steam cook. If you are in the habit of adding a bit of ghee ( clarified butter) to your chapatis, it's completely ok since ghee is one of the good fats, but reduce the amount and the number of times you have it in a week. The amount and restrictions will also depend upon the metabolic conditions of the individual.
3. Dairy: The effect of dairy on PCOS has some conflicting views. Studies have shown that regular consumption of dairy increases insulin production. It is also believed to increase androgen production (except cheese). At the same time whole milk and whole milk products have been related to increased fertility. There are very few studies relating dairy to PCOS. So the effect of dairy will probably vary from person to person. Therefore an individual with PCOS can avoid dairy for a certain period of time and observe if there are any changes in the way they feel. As for the calcium, there are other sources such as broccoli, okra ( bhindi), kidney beans, chickpeas, sweet potato, to name a few which are easily available in our country . Also since cheese is said to have a lesser effect on insulin production, one can try having cheese in moderation. Apart from this, one should take a good calcium supplement and a multivitamin, which is recommended by their physician.
4. For non vegetarians, organic good quality chicken and fish are the best options.
Foods to avoid: White rice, White bread, Maida, White pasta, Bagel, Potatoes, Refined sugar, Processed packaged foods, Red meat. A person with PCOS has a very fragile system. Therefore as much as possible have organic products. Keep yourself as much chemical free as possible.
In smaller cities the availability of organic products might be a bit difficult. But all is not lost. There are a lot of products that you can find online.
Living with PCOS is not easy but a few changes in your diet and some form of regular exercise of about 30 mins will help you deal with it.