September is Polycystic Ovary Syndrome (PCOS) Awareness Month. I wanted to highlight PCOS since it is the most common endocrine disorder and there is a ton of misinformation and stigma that exists around this disorder. I have so much information to share that this will be part one of the series on PCOS.
What is Polycystic Ovary Syndrome known as PCOS?
PCOS affects 1 out of 10 women, with 10-15% globally estimated to have PCOS. 1 It is not a new medical condition but is slowly starting to get more recognition. Scientists first recognized PCOS in 1935. There have been documented cases of medical records dating back to ancient times with women presenting symptoms similar to PCOS. 2
PCOS is known to be a condition of androgen excess and problem with ovulation. Typically, if you have PCOS, you have an increased production of testosterone and other androgens (male hormones) which are naturally present in only small amounts in females. These hormonal abnormalities cause many metabolic and reproductive disruptions. It is also an inflammatory condition but with lifestyle changes, you can help to lower inflammation.
Genetics plays a role, with research finding that women with PCOS are 50% more likely to have a mother, sister, or aunt with PCOS. Having a first-degree relative with type 2 diabetes also increases the risk.
Insulin resistance is very common with PCOS. In 30% of people who are tested, insulin resistance is not detected. Women of this phenotype tend to be lean and non-ovulatory but not always. 2
Insulin helps glucose which is our body’s main source of fuel get from our bloodstream into our cells to be used for energy. Think of a lock and key analogy. Insulin acts as a key which unlocks the cell doors to allow glucose to enter. When we eat food with carbs, such as a banana, it gets broken down into glucose particles and enters the bloodstream. Insulin gets stimulated by the pancreas, which opens the cell door and allows the cell to open and get into the cell to be used as energy.
Insulin resistance (having high insulin levels) happens when the cell doors don’t open to insulin (key) trying to open the cell door (body is resistant) or there is not enough insulin and glucose builds up in the bloodstream. Extra insulin is produced to increase chances of getting more glucose into your cells and you end up with a buildup of insulin and glucose in the bloodstream.
Insulin is a growth hormone, excess of it promotes weight gain. A vicious cycle can occur where the larger a person is, the more insulin resistance you are, so more weight is gained. There are factors in those with PCOS that it is harder to lose weight.
Common symptoms of PCOS
Absent or infrequent menstrual cycles, infertility due to lack of ovulation, excessive hair hair growth on the face, increased abdominal weight, and hair loss (alopecia), Acne especially acne on the jawline, cheeks, chin and upper neck.
Nutrition Myths for PCOS
Weight loss is often what is recommended by the medical community especially if you are in a bigger body. In the short term, weight loss does seem to temporarily relieve some symptoms, in the long run, purposeful weight loss does more damage.
Women with PCOS have a high risk of developing an eating disorder, and dieting is a common trigger for eating disorders with bulimia and binge eating disorder being common.3 Low blood sugar caused by high levels of insulin and low glucose caused by insulin resistance both lead to intense carbohydrate cravings. Dieting contributes to this, especially the low carb diets commonly recommended for PCOS.
PCOS is not caused by weight gain or being at higher weight so weight loss is not the cure. There are many women with PCOS who are thin so what advice would they be given?
Let’s say weight loss did make a difference; only 3-5% of people are able to keep weight off over 2 years. 4
Avoiding gluten or going dairy-free is often recommended but there is no evidence based studies confirming the effectiveness of a gluten free or dairy free diet for those with PCOS. Unless you have a food allergy to dairy, have found your acne increases with drinking milk, or have celiac disease or a gluten sensitivity, no need to avoid these foods.
I will discuss non-diet suggestions that can be used to help manage PCOS as well as a few supplement highlights. Stay tuned!
1 PCOS Awareness Month 2020 https://pcoschallenge.org/pcos-awareness-month/
2 The PCOS Workbook: Your Guide To Complete Physical And Emotional Health by Stephanie Mattei and Angela Grassi
3 Increased Odds of Disordered Eating in Polycystic Ovary Syndrome: a Systematic Review and Meta-Analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918293/