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Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) effects 5-10% of the women of reproductive age and is the leading cause of infertility. Women with undiagnosed PCOS typically seek out medical treatment due to concerns about missing menstrual cycles or an inability to become pregnant. Primarily related to lack of ovulation, PCOS is a syndrome with a host of clinical symptoms including irregular menstrual cycles, ovaries with many cysts, excess abdominal fat, insulin resistance (leading to type 2 diabetes),
overweight or obesity, abnormal facial and body hair, acne, high testosterone levels, infertility, low HDL cholesterol ("good cholesterol") levels, and high triglycerides. Remember that having one or a few of these symptoms does not necessarily indicate PCOS diagnosis.
While the cause of PCOS remains inconclusive, the leading theory suggests that insulin resistance is
likely the cause for this syndrome. Other evidence notes that PCOS can be caused by hormone-secreting tumors in the ovaries or adrenal glands. These increased hormones, called androgens, result in “hirsutism,” or excess hair growth on the face, and the high insulin levels generate high triglyceride and low HDL cholesterol levels.
PCOS has a genetic component and tends to run in families where females have a history of infertility, menstrual problems, type 2 diabetes, central obesity, and hirsutism. While obesity does not cause PCOS, it tends to exacerbate the reproductive and metabolic problems associated with it, and women with PCOS are at an increased risk of gestational and type 2 diabetes, miscarriages, hypertension, and cardiovascular disease.
The primary goal of PCOS treatment is to promote the action of insulin in order to reduce blood sugar
levels. This is where nutrition plays a huge role. Western medicine will prescribe insulin-sensitizing drugs such as metformin and suggest birth control pills to manage hormonal imbalances. However, weight loss and exercise can greatly improve insulin sensitivity, the blood cholesterol, and insulin levels, and lower fasting glucose and testosterone levels in women. In fact, just a 5-10% loss of initial body weight has been shown to alleviate several PCOS symptoms.
Dietary recommendations for women with PCOS are similar to healthy weight loss and include eating consistent meals of: lean protein, whole grains, fruits and vegetables, fiber, whole milk dairy products, and low glycemic index carbohydrates. Maintaining healthy vitamin D and folic acid levels are also important. Exercise of at least 30 minutes per day is recommended to supplement diet modifications to promote healthy weight loss.
A recent study compared a normal healthy diet with a low glycemic index diet for women with PCOS. Initial results suggested that a low glycemic index diet was more effective in the management of PCOS symptoms than a conventional healthy diet alone (1). For more information on glycemic index, look at this Academy of Nutrition and Dietetics article.
In another recent case study, a woman diagnosed with PCOS consulted an integrative medical therapy clinic. After a combined treatment of diet, acupuncture, Chinese herbs, functional medicine, and supplements, many of her PCOS symptoms were gone and she was able to become pregnant and give birth to a healthy baby boy. While it is difficult to pinpoint which modality was most effective in her treatment, the article cites, “…counseling the patient on her diet was a first logical step. Clinically, this author sees less of a tangible outcome in this patient population when patients do not follow a low-carbohydrate diet” (3). There is currently no significant clinical evidence that following a low-carb, ketogenic, or fad diet is beneficial in someone with PCOS.
The treatment for Polycystic Ovary Syndrome demonstrates another opportunity for the use of food
as medicine. A nutrient-dense diet along with regular exercise is key to improving symptoms associated with this condition. It is best to seek out a registered dietitian who can recommend personalized diet modifications that focus on a plan that optimizes your overall health status.
Samantha Mogil, Nutrition Intern