Polycystic Ovarian Syndrome: Nutritional Considerations
PCOS appears to be related to diet and lifestyle factors, particularly insofar as they influence body weight and insulin resistance. Although weight loss is an accepted treatment, even relatively lean women may develop PCOS, suggesting that diet may affect the outcome of this disorder even in the absence of weight change.
A diet that addresses cardiovascular risk factors is appropriate for women with PCOS. Roughly half of women with PCOS are obese,4 and losing as little as 5% to 10% of weight results in resumption of menses and decrease in blood androgen levels.4,5 The composition of the therapeutic diet is a matter of controversy. However, there are several reasons why a diet low in fat and high in fibrous carbohydrates is superior to other weight–loss treatments.
Such a diet helps reverse insulin resistance, which affects 50% to 70% of women with PCOS.4,6 This is particularly important because of insulin’s tendency to reduce sex hormone–binding globulin (SHBG) and increase free testosterone concentrations.7 Low–fat, high–fiber diets also reduce body weight and effectively address dyslipidemia (elevated triglycerides, low HDL), elevations of C–reactive protein and homocysteine, and oxidative stress.4 Low–fat, high–fiber diets reduce circulating androgens and increase SHBG.4,8
A diet that emphasizes whole grain intake, as opposed to refined carbohydrates, may improve metabolic defects in PCOS by providing fiber and inositol. Inositol has been repeatedly found in clinical trials to improve insulin action, decrease androgen levels, and improve ovulatory function in both lean and obese women with PCOS.9–11 The benefits of metformin in PCOS appear at least partly due to increasing inositol availability.12
What to Tell the Family
PCOS can often be effectively treated through weight loss, dietary changes, and medical therapies. Diets that are low in fat and high in fiber are likely to achieve the best results, particularly when coupled with exercise. Families of affected patients would do well to adopt a similar diet and increased exercise to facilitate the patient’s adherence and for their own health benefits.
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