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Improving PCOS... diet + lifestyle changes

Ovulatory dysfunction is the most common cause of female infertility. The most common type ovulatory dysfunction is polycystic ovarian syndrome, PCOS, which is said to impact around 5% of women.

Other causes of irregular or absent ovulation are:

  • Too high or too low body weight
  • High stress levels including with excessive exercise which is seen by the body as a form of stress (not a stress release as some would argue)
  • Under eating
  • Premature Ovarian Failure or when estrogen levels produced by the ovaries drop before the age of 40
  • Ovulation can slow or cease in women over 35 as ovarian reserve diminishes
  • Thyroid dysfunction
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The symptoms of PCOS are varied and they include things like:

  • Easy weight gain, and/or obesity
  • Difficulty getting and staying pregnant
  • Acne
  • PMS
  • Polycystic ovaries
  • Depression or anxiety
  • Sexual dysfunction
  • High levels of androgens and low ovarian estrogen
  • Male pattern hair growth and balding
  • High levels of insulin/insulin resistance
  • Irregular or absent ovulation and menstruation
  • Heavy periods
  • Skin tags or darkening skin areas, particularly on nape of neck
  • Sleep apnea
  • Gray-white breast discharge
  • Pelvic pain
  • Painful boil-like abscesses in the groin (hidradenitis suppurativa)
  • Cardiovascular issues and Type 2 diabetes

Because symptoms vary so much between women, treatment is very individual. Lifestyle changes are normally the first line of defense for women with PCOS, targeting prevention of weight gain and promoting weight loss (where required) with significant health benefits.

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Often diet and lifestyle changes can be enough to kick start ovulation again, especially in cases where body weight is high or low, or exercise is excessive. If you are overweight, losing 10% of your current weight may be enough to get you ovulating again. When you are living with PCOS, losing weight can be a lot easier said than done. And yeah, diet and lifestyle changes can (sometimes) take longer to have an impact on hormonal imbalances. That’s why people, like me, end up turning to medications to help speed up the process[1].

However, the PCOS Australian Alliance recommend pharmacological ovulation only be attempted after diet and lifestyle changes have been made, and in the case of obesity, only after appropriate weight loss has been achieved[2].

Metformin and Clomid are the most common medications given to women to promote ovulation. But even if you need to go down this route, making diet and lifestyle changes can improve the success of both drugs.

According to one study, women with PCOS taking Metformin who also reduced their weight through diet, were more likely to lose a greater amount of weight, and lower their androgens and insulin resistance[3]. Which means the chances of conceiving would improve.  

Another study of people with metabolic syndrome (high blood sugar levels, blood pressure, weight) looked at two groups – one adopted a low GI diet, the other were prescribed Metformin. Results showed that both groups had the same positive changes in measurements. This goes to show that medication should not always be the first point of call as diet changes can greatly improve health markers[4].

Key lifestyle changes that should be the first line of defence are:
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1. Managing weight

Insulin is released into the blood stream after eating to help bring blood sugar into balance. If you have PCOS, insulin resistance is often a common symptom, meaning that the body isn’t able to process the higher insulin levels, so they build-up in your body. This can cause cravings and contribute to weight gain. Some studies show that in overweight or obese women with PCOS, the main concern is losing weight, regardless of the composition of the diet[5]. If you need to lose weight, you may want to choose the lower energy snacks like this Roast Carrot Dip. The Preconception Program provides a host of low and higher energy snacks for you to choose from. Always listen to your body.

2. PCOS Diet to manage blood sugar.

The main principles are:

Low GI - You can manage insulin spikes through a low GI (glycemic index) diet. This means choosing foods that are absorbed more slowly, limiting the glycemic load on the body. Swap out high GI foods with low GI options. For example, swap white potato with sweet potato, long grain rice with basmati rice and corn flakes with oats or millet flakes. You can also reduce the overall GI rating of a meal by pairing foods high in fat and protein with higher GI foods, so think of adding nuts when you eat higher GI fruits such as apples and pears, or your chocolate treat.  

High fibre – eating fibre with every meal will help slow the body’s absorption of sugars which reduces the insulin spike. Fibre can also help balance estrogen and androgens.

Small frequent meals – eating smaller meals at regular intervals reduces the blood sugar load and is helpful at manages cravings.

Gluten and dairy can cause systematic inflammation, which can aggravate many PCOS symptoms, so if you’re suffering from PCOS and you’re trying to conceive, it’s best to remove or limit these.

3. Exercise

Is a great way to improve moods, manage insulin sensitivity and boost metabolism. All of which can help with maintaining a healthy weight.

4. Stress management

Exercise has been shown to have an impressive impact on your outlook and positive mind frame, but adding a meditation practice to your day can supercharge your stress management.

5. Supplements

Supplements and hormone balancing herbs shouldn’t really be self-prescribed. It’s best to talk to your fertility specialist or natural health care provider for your specific requirements. The ones to look out for include:

  • Vitex (though not recommended if you have high LH levels as Vitex can exacerbate this).
  • Vitamin D – low levels of Vitamin D are common in women with insulin sensitivity.
  • Magnesium – deficiency is common in women with PCOS and we need it for most hormone reactions.
  • B Group vitamins – are essential if you’re trying to make a baby and women on Metformin or oral contraception (both used to manage PCOS) are more likely to be deficient.
  • Chromium – enhances insulin and healthy glucose metabolism (can cause blood sugar to drop so avoid if you’re on diabetes medication and always check with your doctor first).
  • N – Acetylcysteine and Myo-Inositol – have both been shown to improve insulin resistance, with evidence that myo-inositols can induce ovulation, improve IVF and pregnancy outcomes[6],[7],[8].   
  • Cinnamon – can balance blood sugar and is used traditionally for heavy menstrual bleeds, and to ‘warm’ the uterus and improve menstrual irregularities and circulation.

Traditional Chinese Medicine (TCM) treats PCOS slightly differently depending on whether you fall into the ‘thin, wiry, restless and yin deficient women with high testosterone’ camp, or the ‘overweight, yang deficient, damp women’ camp. There are lots of recommendations for each type which include:

  • Yin Deficient (cooling) – get plenty of rest and downtime, meditate, don’t be in a rush, add more oily fish to your diet and avoid coffee and alcohol.
  • Yang Deficient (warming) – rest is important again, limit cold food and drink, avoid swimming when menstruating and too much exposure to cold. Your feet are on the same meridian line as your uterus, so make sure your feet are always warm to ensure warm blood flow to your baby-making machine.  

 

 

 

[1] Futterweit, Walter, A Patient’s Guide to PCOS- Understanding-and Reversing-Polycystic Ovarian Syndrome, New York, Henry Holt, 2006, xvii.

[2] CREPCOS, Evidence based guideline for the assessment and management of polycystic ovarian syndrome, 2011.

[3] AL-Nozha O, Habib F, Mojaddidi M, El-Bab M. Body weight reduction and metformin: Roles in polycystic ovary syndrome. Pathophysiology [serial online]. April 1, 2013;20:131-137. Available from: ScienceDirect, Ipswich, MA. Accessed December 8, 2015.

[4] Rajabi S, Mazloom Z, Zamani A, Tabatabaee HR. Effect of Low Glycemic Index Diet Versus Metformin on Metabolic Syndrome. International Journal of Endocrinology and Metabolism. 2015;13(4):e23091. doi:10.5812/ijem.23091.

[5] Rajabi S, Mazloom Z, Zamani A, Tabatabaee HR. Effect of Low Glycemic Index Diet Versus Metformin on Metabolic Syndrome. International Journal of Endocrinology and Metabolism. 2015;13(4):e23091. doi:10.5812/ijem.23091.

[6] N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome. Volume 77, Issue 6, June 2002, Pages 1128–1135

[7] Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007 Dec;23(12):700-3. Epub 2007 Oct 10.

[8] Myo-inositol: ovarian stimulation and IVF outcomes Volume 98, Issue 3, Supplement, September 2012, Pages S74–S75