PCOS stands for Polycystic Ovarian Syndrome, but the weird thing is that usually the person does not have even one cyst on their ovaries. PCOS is really more of a collection of symptoms, which originally was thought to only occur with cysts on the ovaries, hence the name.

PCOS is actually really common, affecting around 4% of all women. (1) PCOS can severely impact the quality of a person’s life, and it can increase the risk of infertility. Luckily, most of the time the symptoms are easy enough to catch, and there are some good natural treatment options that have proven success.

What are the symptoms of PCOS?

PCOS Symptoms
PCOS Symptoms

While the exact features can differ from person to person, the usual symptoms of PCOS are the following:

  • Insulin resistance
  • Unwanted excess body or facial hair
  • Too much testosterone or androgens
  • Altered ovarian function causing skipped, missed, delayed, or light or heavy periods
  • Excess body fat, especially around the waist (not always but common)
  • Increased risk factors for cardiovascular disease
  • Oily skin and prone to acne
  • Depression and low mood, and sometimes anxiety (14)
  • Loss of hair
  • Increased risk of hormonal cancers, such as breast and endometrial cancer (5)

What Causes PCOS?

What we do know is that insulin resistance is intimately tied to PCOS. (2) This may also help explain the obesity link, as obesity greatly increases the risk for insulin resistance.

This insulin resistance also likely contributes to the increased levels of androgens, including testosterone, that characterize the syndrome.

These high levels of androgens can: (3)

  • Interfere with the signals for ovulation
  • Cause the follicles in the ovaries to enlarge, forming cysts
  • Contribute to the excess body and facial hair growth, as well as the oily skin and acne

So now you can see that the cysts are really an “effect”, not the “cause” of the symptoms. Since PCOS is very likely on a spectrum – with some people having the full-blown syndrome and some barely being classified as having PCOS – we can understand that although some medical doctors still use the number of cysts as part of the diagnosis, the cysts do not really have to be there to benefit from treating this collection of symptoms.

Besides insulin resistance and high levels of androgens as causes, you can also be at an increased risk if there are people in your family that have PCOS, as there are genetic links. (4)

Diet for PCOS

The ideal diet for someone with PCOS would be similar to the ideal diet for someone with insulin resistance or Type 2 Diabetes, as insulin resistance is such a prominent feature.

Dietary changes can be simple, but can have a large influence. It has been shown that simply achieving a 5% drop in bodyweight, if overweight, can lead to a large decrease in insulin resistance, outside of other dietary changes. (5)

Setting up a diet in a way that will help reduce insulin resistance and thus help with PCOS symptoms include: (5, 9)

  • Limited refined sugars such as table sugar, soda, candy, and even fruit juices
    Unrefined sugars coming from whole, unaltered fruits are okay and encouraged (6)
  • Limiting animal fats (including butter), trans fats, fried foods, and refined vegetable oils (soybean, corn, palm, etc.)
    Extra virgin olive oil (from a trusted brand) and *unrefined* coconut oil are great oils to use instead (7)
  • Limiting refined carbohydrates like pasta, white bread, white rice, etc.
    – Whole grain foods like oats, quinoa, beans and lentils, and all-bran cereals are much better options
  • Choosing stevia over Splenda (i.e. sucralose) (8)
  • Eating generous amounts of vegetables and tubers like sweet potatoes
  • Making sure you are eating enough high quality protein

Effect of Exercise on PCOS

Exercise has been shown to play a big role in helping to reduce the symptoms of PCOS, including decreasing insulin resistance, waist circumference, and overall fitness levels. (10)

Moreover, one study found that aerobic exercise improved the morphology of their ovaries even without changes in weight or fat loss. (11)

The women in this study completed 16 weeks of individualized aerobic exercise training 5 times per week under supervision on a treadmill for about 30-60 min per day.

The women with PCOS started the study with larger ovaries and more follicles than the control group who did not have PCOS (despite having a similar body composition).

After the 16 weeks, the PCOS group became more insulin sensitive, had a small drop in testosterone levels, and had less ovarian follicles, though still higher than the control group. They did not lose any weight, likely due to eating more to make up for the exercise, and weight loss would have likely made the results stronger according to previous research.

Personally, a combination of slow aerobic training, higher intensity interval training, and resistance training would likely be best in my opinion. Resistance training is very beneficial for insulin resistance. This is because while endurance training makes the existing muscles more likely to suck up glucose, resistance training increases the overall muscle mass to suck up more glucose from the bloodstream. (12, 13)

Supplementation for PCOS

There has actually been a large amount of research done into the effects of various supplements on the symptoms of PCOS.

In the next article in this series, I will be reviewing the evidence of one particularly important supplement to ease PCOS symptoms. Stay tuned!

Please post any questions or comments below!

References

  1. Guzick DS. Polycystic ovary syndrome. Obstet Gynecol. 2004 Jan;103(1):181-93. Review. Apr;103(4):799. PubMed PMID: 14704263.
  2. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechaxnism and implications for pathogenesis. Endocr Rev. 1997 Dec;18(6):774-800. Review. PubMed PMID: 9408743.
  3. https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes
  4. Unluturk U, Harmanci A, Kocaefe C, Yildiz BO. The Genetic Basis of the Polycystic Ovary Syndrome: A Literature Review Including Discussion of PPAR-gamma. PPAR Res. 2007;2007:49109. doi:10.1155/2007/49109
  5. Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R. Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes Metab Syndr. 2017 Nov;11 Suppl 1:S429-S432. doi: 10.1016/j.dsx.2017.03.030. Epub 2017 Apr 5. Review. PubMed PMID: 28416368.
  6. Sharma SP, Chung HJ, Kim HJ, Hong ST. Paradoxical Effects of Fruit on Obesity. Nutrients. 2016;8(10):633. Published 2016 Oct 14. doi:10.3390/nu8100633
  7. Khaw KT, Sharp SJ, Finikarides L, et al. Randomised trial of coconut oil, olive oil or butter on blood lipids and other cardiovascular risk factors in healthy men and women. BMJ Open. 2018;8(3):e020167. Published 2018 Mar 6. doi:10.1136/bmjopen-2017-020167
  8. Romo-Romo A, Aguilar-Salinas CA, Brito-Córdova GX, Gómez-Díaz RA, Almeda-Valdes P. Sucralose decreases insulin sensitivity in healthy subjects: a randomized controlled trial. Am J Clin Nutr. 2018 Sep 1;108(3):485-491. doi: 10.1093/ajcn/nqy152. PubMed PMID: 30535090.
  9. Moran LJ, Ko H, Misso M, Marsh K, Noakes M, Talbot M, Frearson M, Thondan M, Stepto N, Teede HJ. Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines. J Acad Nutr Diet. 2013 Apr;113(4):520-45. doi: 10.1016/j.jand.2012.11.018. Epub 2013 Feb 16. Review. PubMed PMID: 23420000.
  10. 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. Published 2019 Feb 12. doi:10.1186/s13643-019-0962-3
  11. Redman LM, Elkind-Hirsch K, Ravussin E. Aerobic exercise in women with polycystic ovary syndrome improves ovarian morphology independent of changes in body composition. Fertil Steril. 2011;95(8):2696–2699. doi:10.1016/j.fertnstert.2011.01.137
  12. Poehlman ET, Dvorak RV, DeNino WF, Brochu M, Ades PA. Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial. J Clin Endocrinol Metab. 2000 Jul;85(7):2463-8. PubMed PMID: 10902794.
  13. Shaibi GQ, Cruz ML, Ball GD, Weigensberg MJ, Salem GJ, Crespo NC, Goran MI. Effects of resistance training on insulin sensitivity in overweight Latino adolescent males. Med Sci Sports Exerc. 2006 Jul;38(7):1208-15. PubMed PMID: 16826016.
  14. Chaudhari AP, Mazumdar K, Mehta PD. Anxiety, Depression, and Quality of Life in Women with Polycystic Ovarian Syndrome. Indian J Psychol Med. 2018;40(3):239–246. doi:10.4103/IJPSYM.IJPSYM_561_17

			

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