Polycystic Ovary Syndrome (PCOS) is a common condition that affects how a woman's ovaries work. Healthier food choices and regular exercise can improve the symptoms of PCOS.

It is currently estimated that PCOS affects between 15-20% of women who are still within their reproductive years. In South Africa, up to 40% of female infertility can be attributed to PCOS.

The diagnoses of PCOS includes any two or more of the following:

1. The presence of a number of fluid-filled sacs (follicles) that surround the eggs in the ovaries (despite the name 'polycystic ovaries', these follicles are not cysts).
2. Eggs are not regularly released from the ovaries during ovulation
3. A higher level of male hormones than normal, or male hormones that are more active than normal.

The symptoms of PCOS are:

• Irregular or absent periods
• Excessive hair on the face, chest or stomach
• Thinning of hair or male-pattern baldness
• Acne
• Difficulty in maintaining a healthy body weight
• Abnormal insulin regulation
• Fertility problems (difficulty getting pregnant)
• Later in life, PCOS can increase the risk of type-2 diabetes and high cholesterol

Apart from having an impact on the likelihoods of conceiving, PCOS increases the risks of miscarrying. This is because of the influence of hormones, which are produced by the ovaries which help to sustain early pregnancy.

There is also an increased risk of the following:

• Pregnancy induced hypertension (PIH)
• Developing Gestational Diabetes
• Premature delivery of the baby and the associated risks of this occurring

If you have polycystic ovaries, your major nutritional goal is to keep a healthy weight or lose weight if you are overweight or obese. Weight loss improves hormonal profiles and pregnancy rates in obese women, and it helps to regulate menstrual cycles and increases fertility rates. In obese women with PCOS, it also lowers hairiness and the risk of diabetes. You can achieve great effects on your fertility and metabolism by losing 5 to 10% of your body weight. The best way to lose weight is to do so slowly, by lowering the number of kilojoules (calories) you eat in a day, and increasing the use of energy by exercising regularly. A healthy weight loss of ½ - 1 kg per week is recommended and is sustainable in the long term.

The quality of your diet also matters. Studies show that there is a low level of inflammation present in women with PCOS and it is therefore important to look at your entire diet and include foods that are anti-inflammatory.

A lot of woman are carb-phobic and often avoid carbs - including vegetables and fruits, at all cost. This leads to a high consumption of protein and fats, and not enough healthy plant-based foods. Eating large portions of proteins can also increase insulin levels, just like certain carbohydrates can do. When you have PCOS, you don't need to avoid all carbohydrates. It is well known that refined and sugary carbohydrates increase insulin levels. But if you are eating moderate portions of healthier-, and especially lower glycaemic index and -load carbohydrates along with enough fibre, fats and proteins in your diet, glucose spikes and elevated insulin levels are prevented.
Certain wholegrains, legumes, fruit, vegetables as well as fatty fish like salmon and sardines, olive oil, nuts and seeds are anti-inflammatory foods. Inflammatory foods include foods like red meats, processed meats, sugar and foods with a high content of saturated fat and trans fats. So, loading up on a lot of animal proteins can increase your levels of inflammation.

Unnecessary restriction of carbohydrates can also lead to a depressed mood due to low serotonin levels as well as an increased risk for eating disorders because you are focusing so much on excluding foods that most people would normally consume.

Over-restriction of carbohydrates can also lead to low energy levels, and chances that you will be working out, is slim. Exercise forms a very important part of the treatment of PCOS and especially improving insulin sensitivity.

Excluding carbohydrates can also have a negative effect on your gut microbiome and reduce the levels of good bacteria in your digestive tract.

My top 10 tips for improving PCOS symptoms are:

1. Get enough good quality sleep
2. Eat regularly to avoid blood glucose dips and over-eating or binging
3. Balance is key - include suitable portions of wholegrain and low GI carbohydrates, and adequate amounts of proteins and fats, based on your personal nutritional requirements
4. Prevent weight gain and keep your weight, visceral fat and body fat at a healthy level
5. For weight loss, know how many calories you need to consume daily to achieve your weight loss goal
6. Avoid refined sugars and processed carbohydrates
7. Include fruit and vegetables daily
8. Limit saturated- and trans fats
9. Don't smoke
10. Exercise regularly

For personalized advice to treat PCOS, contact the practice to book your appointment.

Sources:
Riccardi G & Rivellse A. Dietary treatment of the Metabolic Syndrome - the optimal diet. British Journal of Nutrition. 2000; 83(suppl 1): s143-s148.
Hoeger K. Role of lifestyle modification in the management of polycystic ovarian syndrome. Best Practice & Research Clinical Endocrinology & Metabolism. 2006; 20(2): 293-310.
Richard S. Legro Silva A. Arslanian David A. et al. Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 12, 1 December 2013; 12(98): 4565-4592. https://doi.org/10.1210/jc.2013-2350
Foods that fight inflammation. (2017, October 16). http://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation
Moran LJ1, Ko H, Misso M, Marsh K et al. Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines. Hum Reprod Update. 2013 Sep-Oct;19(5):432.

Keywords:
Polycystic ovary syndrome, insulin resistance, reproductive health, infertility diet, low GI diet