What is PCOS?
Do you find yourself putting on weight very quickly and are unable to loose weight quickly? Do you have irregular menstrual periods?
These could be signs of PCOS.
PCOS refers to polycystic ovary syndrome which is a complex hormonal condition.
When diagnosing PCOS doctors use the Rotterdam criteria. A patient must fulfil 2 out of the 3 criteria factors below:
- Polycystic ovaries on ultrasound
- Anovulation (absence of periods or irregularity and reduced fertility)
- Increase in the male hormone production (signs include excess facial hair, acne and/or scalp hair loss)
Insulin resistance in women with PCOS
50-80% of women with PCOS have what is known as insulin resistance. Insulin is a hormone released by the pancreas which effects the production of androgens (‘male’ hormones). If the body’s cells are not responding to insulin more insulin gets secreted. This increases the production of the male hormones. Insulin resistance is commonly associated with people who have abdominal obesity as the weight around the abdomen makes it hard for the insulin to work as efficiently. However, in the case of patients with PCOS the insulin resistance can occur independent of obesity.
Why are we concerned about high insulin levels?
Insulin is essentially a fat storage organ. In the case of insulin resistance, the cells are resistant to the action of insulin. This means the glucose remains in the blood instead of being taken up by the body’s cells. The excess carbohydrates are converted to fat and stored in the liver. Since the cells are starved of the glucose, patients tend to feel more hungry and tired. In addition, as more fat is getting stored this means less of the of the fat is being burned. Insulin resistance is also associated with inflammation in the body and this is what causes the progression of insulin resistance to diabetes.
Some common medications used include:
- Oral contraceptive pills which regulate the menstrual cycle and improve acne and hirsutism. The two components of the OCP are oestrogen and progestin which work in combination to reduce the levels of androgens. The acne and hirsutism are multi-factorial. They are usually related to the skin glands and hair follicles responding to the different levels of androgens.
- Insulin sensitisers, such as metformin, increase the sensitivity of the insulin.
Nutritional management of PCOS
Where to seek nutrition information from
It is important to seek evidence based on nutrition advice from an accredited practising dietitian. It has been found through surveys that only a very small percentage of patients with PCOS consult with an accredited dietitian. Many patients seek information from books and the internet. A number of people take herbal supplements which may not be useful, particularly if there’s no evidence supporting the use of the supplement in the management of PCOS.
How does diet influence insulin resistance?
As mentioned before, insulin resistance is the underlying cause of PCOS. Insulin is secreted in response to eating carbohydrates. Examples of carbohydrates include bread, rice, pasta, fruit and dairy. Carbohydrates are broken down into glucose. So basically, when we eat carbohydrate-containing food the pancreas secretes insulin which focuses on clearing the glucose from the bloodstream and giving it to different cells in the body to use as energy.
So, should women with PCOS stop eating carbohydrates?
It is important to note that not all carbohydrates cause a spike in the blood glucose level. There are some that are released slowly in the blood and hence, give a steady glucose profile. In addition, the quantity of carbohydrates consumed also affects the blood sugar level. Evidence suggests that consuming moderate carbohydrate amounts (150-225g of carbohydrates a day) can be more sustainable than following low carbohydrate approaches (less than 130g). Essentially, lower carbohydrate amounts reduce the stress on the insulin hormone.
What about inflammation?
Since insulin resistance is associated with inflammation, you should include monosaturated fats in your diet such as avocado, nuts and other omega-3 fats like oily fish, walnuts and soy linseed bread as these help reduce inflammation in the body.
Do you have to be on a low carbohydrate diet?
The most important goal in PCOS is weight loss. It is important to choose a diet that not only helps with weight loss but one that is also sustainable and can help you maintain the weight loss. A study was done to compare the results of different weight loss diets including low fat and low protein, low fat and high protein, high fat and moderate carbohydrate and high fat and low carbohydrate diets. At 12 months, it was found that all diets yield similar results. Bottom line is that one should choose an approach they can comply with. There is no ‘one size fits all’ approach.
What about exercise?
The skeletal muscle is responsible for taking up 75% of the glucose. In the case of insulin resistance, the skeletal muscle is resistant to the insulin and hence is not able to take up glucose effectively. Instead, the excess glucose gets deposited as fat on the muscle which further reduces the sensitivity of the skeletal muscle to the insulin. In order to decrease insulin resistance, we want to increase the oxidation of fats in the skeletal muscle which can effectively take place through increasing exercise levels. It is found that a combination of aerobic and resistance activity is more effective in improving the sensitivity of the insulin than doing either activity separately. The starting point would be 150 minutes per week of regular, moderate intensity exercise.
Contact us for results focused nutritional advice
This article was written by our dietitian and nutritionist Juhi Bhambhaney. If you have any questions regarding health and nutrition, make an appointment with one of our dietitians. We‘ll provide you with a simple and effective routine targeted to your concerns. Contact us today.