PCOS, i.e. PolyCystic Ovarian Syndrome – key information – part II

In one of the previous articles, I shortly described the basic aspects of PCOS. I focused most on etiology, diagnostics and symptoms of this disease. In this article I will pay attention to the matters concerning the treatment of PCOS, especially with nutrition.

You should definitely read:

PCOS, i.e. PolyCystic Ovarian Syndrome – key information – part I

Here is Part I of this article

Treatment of PCOS in clinical practice

The procedures in case of women with PCOS are aimed at alleviating the symptoms of this ailment and preventing from its long-term negative effects. Therefore, the treatment should depend on the disease course and it should be personalized. As I mentioned earlier, in the previous part of the article about PCOS, this illness includes many disorders, which cause:

  • infertility,

  • insulin resistance,

  • obesity,

  • hirsutism.

Treatment includes procedures, which are supposed to exclude or ease the anomalies listed above. Apart from pharmacology and nutrition, changing lifestyle is very important.

Undertaken pharmacological actions

Pharmacological procedures include using the following:

  • metformin – a hypoglycemic medicine used in diabetes, but it occurs that it also works well in treating PCOS, as much as there is usually insulin resistance with this ailment. Scientific research point out that using metformin may additionally help patients lower the level of androgens, it supports losing excess amount of body mass and may foster bringing back the ovulation,

  • clomifene – it is a medicine used in treating infertility, which has positive influence on ovulation, it works well with metformin in this matter,

  • cyproterone – hormonal product, based on the progesterone derivative, it shows anti-androgene, gestagenic and anti-gonadotropic activity, it's excellent for treating hirsutism thanks to its properties. Additionally, this medicine may also lower the risk of occurrence of the endometrium cancer, which is a risk for women diagnosed with PCOS,

  • rosiglitazone – like metformine, it is used in treating diabetes, but it may be also good at supporting the treatment of PCOS by lowering the negative effects of insulin resistance.

These are, of couse, just some examples of pharmaceutical products used in treatment of PCOS. Therapy sometimes demands including other medicines. It should be underlined that, especially in reference to the treatment of obesity and insulin resistance, nutrition may be of large importance.

Diet in PCOS

With the help of proper nutritional procedures, the aim is to lower excessive body mass and to improve the insulin sensitivity. Diet is crucial in this matter. Unfortunately, there aren't any unified nutritional standards in case of PCOS. It's connected with the fact, that the disease course may differ (accompanied by insulin resistance and obesity, or not). Generally speaking, many dietitians and doctors agree that each diet, which reduces excess amount of body fat efficiently, may be used therapeutically in the treatment of PCOS. On the other hand, the attitude towards nutrition in PCOS should not be treated so superficially. It's good to optimize the nutritional procedures and take care of making the diet rich in non-energetic nutrients.

Key nutritional assumptions in PCOS in case of insulin resistance and obesity

Although obesity and insulin resistance do not always accompany PCOS, these disorders are very common. What's more, if obesity is diagnosed, insulin resistance is more than certain to occur, too. Therefore, the key goal is to lower body mass and improve insulin sensitivity. So, diet in the treatment of PCOS should have the following features:

  • calorific deficiency on the level of about 15-30% of total metabolism, (if it's essential to cause the reduction of body fat, whereas, the higher level of BF, the higher level of deficiency is allowed),

  • low glycemic load of food products (there is evidence in a form of scientific studies, which show, that basing meals on low-glycemic food products may help the patients improve insulin sensitivity and body mass reduction, as well as support the process of regulating the menstrual cycle),

  • lower intake of carbohydrates (low-carb diet may lead to fast improvement in the functioning of insulin-glucose economy, as well as foster efficient loss of excessive body mass, it is not commonly advised in case of PCOS, but there is a lot of research, which shows that it's excellent, however, there is no agreement about the optimal amount of carbohydrates. In many experiments, the ketogenic diet was a success, but there is evidence that also slight decrease of the amount of carbs – to the level of about 40% of the daily energy supply- may be advantageous),

  • increased intake of proteins (there is evidence pointing out that higher intake of proteins in diet may be positive in relation to... the influence on the mood, which is a very interesting effect, even surprising),

  • higher intake of monounsaturated fatty acids (there are reasons to believe that diet rich in monounsaturated fatty acids influences positively the course of PCOS by fostering faster loss of body mass),

  • higher intake of omega 3 fatty acids (in case of omega 3 fatty acids, there were randomized clinical experiments, in which it was observed that higher intake of these acids may foster normalization of the levels of andogens in blood),

  • limiting the intake of dairy products and starch (these assumptions are not that well based in literature, but in one of the studies it was observed, that limiting the supply of starch and dairy products was advantageous for women with PCOS, what can be explained with high insulinogenic properties of such products).

Interesting literature

It's worth mentioning that a group of Australian scientists, led by Dr Moran from the University of Adelaide, created a very interesting work on dietary recommendations in the treatment of PCOS. It's called: “Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines.” You can read it here: http://www.researchgate.net/publication/235658633_Dietary_Composition_in_the_Treatment_of_Polycystic_Ovary_Syndrome_A_Systematic_Review_to_Inform_Evidence-Based_Guidelines

You can also find a lot of interesting information in the following works connected with the topic of PCOS:

http://www.ncbi.nlm.nih.gov/pubmed/23444983

http://www.ncbi.nlm.nih.gov/pubmed/16359551

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211969/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085920/

Other dietary guidelines

In the common studies concerning nutritional procedures in case of treating PCOS, you can often find dietary guidelines, which are supposed to cause various advantages. The following may be mentioned here:

  • elimination of gluten,

  • elimination of products rich in omega 6 fatty acids,

  • excluding technologically processed food products,

  • including fermented products,

  • including herbal infusions,

  • excluding legumes,

  • basing the diet on ecological products,

  • many others.

You should remember, that majority of the guidelines mentioned above have no support in scientific literature (apart from herbal infusions – mint tea has interesting properties, but I will write more on that in the next part of the article). However, simple logic is for some of the mentioned products. Let's take under consideration the fact, that there is less pollution in ecological products (e.g. That kind of pollution, which influences hormonal economy), so, basing diet on them is justified. In case of other recommendations, you should stay reserved.

What to eat with appropriate body mass and good insulin sensitivity?

It sometimes happens that in case of PCOS there is neither obesity, or insulin resistance. In such cases there's no need of implementing negative calorific balance and limiting the presence of carbohydrates in diet, however, it's good to pay attention to the glycemic load of food products, intake of omega 3 fatty acids, supply of dairy products. It's also important to make the diet balanced.

Summary

Both, properly adjusted medicines and diet modifications are key factors in the treatment of PCOS. Thanks to the proper connection of nutrition and pharmacology, you can improve significantly the quality of life of women suffering from the mentioned ailment. However, you should remember, that, in case of diet, it's important to take under consideration the individual possibilities of realizing the created guidelines. It's important to provide high availability of full spectrum of nutrients. Apart from pharmaceutical and dietary procedures, supplements are also important – it will be described in the next part of this article.

PCOS, i.e. PolyCystic Ovarian Syndrome – key information – part I