Improving PCOS with Dietary

Compositions
Ezgi ErteminPearson
11/19/2014

What is PCOS ?
Polycystic Ovary Syndrome is a
multifactorial endocrine disorder in women
diagnosed by two of the following three
criteria:
hyperandrogenism
chronic anovulation
polycystic ovaries.

Whats going on in a PCOS patients

body?

Insulin resistance
Hyperinsulinemia
High cortisol levels
High testosterone

Polycystic ovary/ Healthy ovary

https://www.youtube.com/watch?v=caeNL4nprnQ

Complications associated with PCOS;

Reproductive: menstrual dysfunction,
infertility, hyperandrogenism, and increased
pregnancy complications
Metabolic: insulin resistance and increased
risk factors for, and risk of, type 2 diabetes
mellitus and cardiovascular disease
Psychological: worsened anxiety, depression,
and quality of life

Facts about PCOS

Around 60% of PCOS patients are obese
Insulin resistance may be present regardless of
BMI, although obesity tends to enhance insulin
resistance
PCOS appears to have a genetic component

Facts about PCOS

PCOS affects 5 % to 10% of women of
reproductive age.
The risk of heart attack is 4 to 7 times higher
in women with PCOS than women of the same
age without PCOS.
Women with PCOS are also at risk for
endometrial cancer.

Soulcysters.com
Ive been able to stabilize my fasting glucose
level, but am borderline hypoglycemic during
activity and must eat often. My OBGYN doesnt
want to start me on any medication unless I
am ready to conceive, and I want to work on
things with natural remedies, but I am so
stressed out and emotionally and mentally
exhausted from failing at everything. I have
been considering metformin through my
regular doc if nothing else will work for me, but
am indecisive on taking it.

Current treatments
Oral contraceptives
Clomid & Fertility shots
Antiandrogens
Metformin : Increases insulin sensitivity by translocating
GLUT4
Alternative therapies
Weight loss

Current nutritional management

Primary goal: Increase insulin sensitivity
Whole grains
Lean sources of protein
Fruit and vegetables high in protein
Sufficient fiber intake
Nonfat dairy products
Low-GI carbohydrates
Adequate Vitamin D

PICO
In reproductive-aged women with
Polycystic Ovary Syndrome do
dietary compositions improve
complications more effectively
than taking Metformin?

An Isocaloric Low Gylcemic Index Diet Improves Insulin Sensitivity in

Women with Polycystic Ovary Syndrome
Barr S, Reeves S, Sharp K, Jeanes YM, 2013
Model

Methods

Findings

Prospective non-randomized
clinical study

Subjects visited research center

weeks 0,12, 18,24 and 36

12 week habitual diet control

phase , 12 week low-GI
intervention, 12 week follow up

Anthropometric and biochemical

measurements were taken
-Participants met with a registered
dietitian at week 12 ( control week)
- Low- GI recipe book, Low- GI
diet info book provided
-Anthropometrics measured at 6th
week

Measures of insulin sensitivity and

non-esterified fatty acid improved
after intervention ( P=0.03 and p+
0.01 respectively )

Subjects:- 21 premenopausal women with

PCOS,
Age: mean 32.1
Avg. BMI: >25

There were no changes to

measures of glycemia, other lipids,
weight,or waist circumference
Saturated fatty acid intake
decreased

Small increases to insulin sensitivity is achievable through dietary modification in

the short term.

Comparison of hormonal and metabolic markers after a high-fat, Western

meal versus a low-fat, high-fiber meal in women with polycystic ovary
syndrome
Katcher et al, 2009
Model
-Randomized

crossover design

-Subjects:-

15 women with
PCOS
Age: 19 to 40 years
BMI ranging from19.9 to
53.5
7 subjects were normal
weight
3 subjects were over
weight
5 subjects were obese.

Methods
Baseline blood sample collected
from the subjects: testosterone,
SHBG, DHEA-S, cortisol, glucose,
insulin
Subjects were served either
HIFAT meal ( 62% fat, 24%
carbohydrate, 1 g fiber)
Or an isocaloric HIFIB meal
( 6% fat, 81 % carbohydrate, 27 g
fiber)
Subjects consumed each meal
in 15 min.
After each meal a blood sample
was taken at 30 min. and then
every hour for six hours

Findings
27 % reduction in testosterone
levels within 2 hours after eating a
HIFAT and HIFIB meal
However T levels were reduced
for 2 hours longer after the HIFAT
meal
Similar circulating T levels over
the 6 hours
No significant differences in
DHEA-S, cortisol.
insulin itself is not responsible
for the postprandial decline in T
levels.

Eating small, frequent meals throughout the day could be a means of reducing
testosterone levels in women with PCOS

 Metformin versus lifestyle changes in treating women with polycystic

ovary syndrome
Curi et al., 2012

Model

Prospective, randomized
clinical trial
Six-month duration
Subjects:- 40 women with
PCOS, 27 women completed
( N=27)
Age: 18 to 34 years
Avg. BMI: >25

Methods
Metformin group
850 mg metformin capsule ,
orally twice a day for six
months
Life style changes group
Individualized nutritious diet
(carbohydrate 50%, fat 30%, and
protein 20 %) given by a dietitian

Caloric intake reduced by 500

kcal
Exercise training consisted of 30
minute walk and 10 min self-weight
resistance exercises

Findings
BMI deceased both in metformin
( p=0.041) and life style changes
groups ( p=0.004) after six months
of treatment.
Menstrual pattern improved in both
groups.
Testosterone showed a significant
reduction in the metformin group
( p=0.002)
Waist circumference reduced in life
style changes group ( p<0.001)

Both metformin and life style therapy and life style changes improved the
menstrual pattern after 6 months of treatment.

Conclusion

Given the association of obesity and

insulin resistance with PCOS, weight
management is recommended as firstline management for women with PCOS.

Conclusion
It is best achieved
through
multidisciplinary
lifestyle
management
comprising dietary,
exercise, and
behavioral
treatment.

Limitations
Small sample sizes,
occurrence of dropouts during
longer studies
Variability in biochemical
outcomes
Cofounder factor : no
control for a single nutrient
Larger randomized trials
that include a long term follow
up are warranted in this area

Strengths
Included most accurate data
Genetic variability
No significant cofounders
study designs targeted
unknown areas

Application to Practice
No need to change current application
and treatment plans at this point.
Emphasizing importance of lifestyle
changes
Targeting insulin resistance problem in
young women

Questions?

References
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high-fiber meal in women with polycystic ovary syndrome. Fertil Steril. 2009;91(4): 1175-1182. Doi:10.1016/j.fertnstert.2008.01.035
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polycystic ovary syndrome. Gynecological Endocrinology. 2012; 28 (3); 182-185. doi:10.3109/09513590.2011.583957
3- Barr S, Reeves S, Sharp K, Jeanes YM. An Isocaloric Low Glycemic Index Diet Improve Insulin Sensitivity in Women with Polycystic Ovary Syndrome.
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