PHYSIOLOGY OF POLYCYSTIC OVARY SYNDROME: ITS CLINICAL AND NUTRITIONAL INTERVENTIONS

POULAMI DASGUPTA

MSc.FOOD AND

NUTRITION

PREVIOUS

PCOD vs. PCOS

WHAT IS PCOD?

•This disease exists where there is an imbalance of

hormones which cause cysts to develop

•There is a gathering of developing or mature eggs, which are

inside the ovary, but for some reason, cannot be released

•This cycle continues every month and finally results in quite a few

health issues for women

•A number of incidents can trigger a shift in the normal flow of

hormones such as stress, poor diets, and including too much or not

enough insulin

•The symptoms involve irregular periods, hair loss, temporary

infertility, or fat collection in the abdominal area

•The simplest treatment is hormone medication

WHAT IS PCOS?

Also known as STEIN-LEVENTHAL SYNDROME (in the

name of U.S.gynaecologist I.F.Stein and Obstetrician

M.L.Leventhal) (Taber’s Medical Dictionary,20th Edition)

Hormone inconsistencies results in no release of ovum

The ovaries starts to produce high levels of testosterones,

causing the hormones to cause imbalance

Increase in weight, irregular cycles, loss of hair, difficulty

conceiving, and skin irritation

Of the two diseases, PCOS is the most serious, although both

conditions can be treated with pills and intravenous medication

COMPARISON

Both conditions are contributors of unstable hormones,

irregular cycles, loss of hair, weight gain, and some form of

infertility. However, these symptoms will not show up in

women until they are well into their twenties

Excessive ovarian stimulation caused by the progressively rising insulin and insulin like growth factor - I (IGF-I) levels during puberty induces a PCOS in predisposed girls

(Nobel's and Devailly Fertil Steril 1992)

5-alfa reductase activity is stimulated by iGF-I. This intensifies the hirsute response in hyper androgenic patients

(Speroff 1993)

CAUSES

•The cause of PCOS is unknown, although some

evidence suggests that patients have a functional

abnormality of CYTOCHROME P450 C17 which

is the rate-limiting enzyme in androgen biosynthesis

•CYTOCHROME P450C17 is active in the

adrenals and ovaries, and excess activity of this

enzyme could explain the increased androgen

production

DEFINITE

Type 2 diabetes

Dyslipidemia (Hypercholesterolemia with diminished HDL2 and increased LDL)

Endometrial cancer

POSSIBLE

Hypertension Cardiovascular disease Gestational diabetes mellitus Pregnancy-induced hypertension Ovarian cancer

UNLIKELY

Breast cancer

TESTS FOR DETECTING PCOS

•An enlarged clitoris (very rare finding) and enlarged

ovaries

•Diabetes, high blood pressure, and high cholesterol are

common findings, as are weight gain and obesity

•Increased Weight & BMI, and abdominal circumference are

helpful in determining risk factors

Levels of different hormones that may be tested

include:

•Estrogen levels

•FSH levels

•LH levels

•Male hormone (testosterone) levels

•17-ketosteroids

Other blood tests that may be done include:

•Fasting glucose and other tests for glucose

intolerance and insulin resistance

•Lipid levels

•Pregnancy test (serum HCG)

•Prolactin levels

•Thyroid function tests

Other tests may include:

•Vaginal ultrasound to look at the ovaries

•Pelvic laparoscopy to look more closely at, and

possibly biopsy the ovaries

SYMPTOMS

CHANGES IN THE MENSTRUAL CYCLE

•Absent periods, usually with a history of having one or more normal

menstrual periods during puberty (secondary amenorrhea)

•Irregular menstrual periods, which may be more or less frequent, and

may range from very light to very heavy

•Development of male sex characteristics (Virilization)

•Decreased breast size

•Deepening of the voice

•Enlargement of the clitoris

•Increased body hair on the chest, abdomen, and face, as well as

around the nipples (called hirsute)

•Thinning of the hair on the head, called male-pattern baldness

OTHER SKIN CHANGES

•Acne that gets worse

•Dark or thick skin markings and creases around the armpits, groin,

neck, and breasts due to insulin sensitivity

ACNE

VULGARIS AND

HIRUTISM

ANXIETY, MOOD DISORDERS IN ALL WOMEN WITH

PCOS

•Low self-esteem, poor body image, and fears about future health

problems, including infertility, and perceived lack of effective

treatment, all of which may make them anxious (Dr. Dokras et.al.

November 29 , online report in Fertility and Sterility)

•Two of three studies reported a higher prevalence of social phobia

in women with PCOS and

•one of two studies reported a higher prevalence of obsessive

compulsive disorder (OCD)

However studies say more research is needed to clearly define the

prevalence of anxiety disorders in adolescents with PCOS

ENDOCRINE ABNORMALITIES

GONADOTROPINS

Elevated mean serum concentrations of LH

ANDROGENS

Elevated Serum concentrations of testosterone and androstenedioneESTROGENS

Serum concentrations of estradiol (both total and free) lie within the normal

ranges for the early follicular and mid-follicular phases of the cycle

PROLACTIN AND GROWTH HORMONE

Less common hyperprolactinemia and impaired secretion of growth hormone.

The prevalence has been reported to be between 5 and 30 percent

METABOLIC ABNORMALITIES

Characterized by extreme insulin resistance associated with ovarian

hyperandrogenism.

INSULIN

RESISTANCE

TREATMENT

•Losing weight (which can be difficult) has been shown to help with diabetes, high blood pressure, and high cholesterol. Even a weight loss of 5% of total body weight has been shown to help with the imbalance of hormones and also with infertility

Medications used to treat the abnormal hormones and menstrual cycles of polycystic ovary syndrome include:

•Birth control pills or progesterone pills, to help make menstrual cycles more regular

METFORMIN : can improve the symptoms of PCOS

and sometimes will cause the menstrual cycles to

normalize

•also makes cells more sensitive to insulin, and may

help make ovulation and menstrual cycles more

regular, prevent type 2 diabetes, and add to weight loss

when a diet is followed

•Use of LH-releasing hormone (LHRH) analogs

•Anti-androgen medications, unwanted hair removal

using laser-non laser light sources, treatment with

MYO (L-Myo-Inositol-1-Phosphate), PELVIC

LAPAROSCOPY to treat anovulation and infertility

are some of the treatments for PCOS

NUTRITIONAL

INTERVENTIONS

IN PCOS:

MACRONUTRIENTS,

MICRONUTRIENTS

AND

HERBS

DIET•Patients with polycystic ovarian syndrome (PCOS) who have

impaired glucose tolerance should have a comprehensive

program of diet and exercise to reduce their risk of developing

diabetes mellitus

•In addition, obese women with PCOS can benefit from a low-

calorie diet for weight reduction

•A diet patterned after the type 2 diabetes diets have been

recommended for PCOS patients

•Increased fiber; decreased refined carbohydrates (LOW GI

FOODS), Tran’s fats, and saturated fats; increased omega-3 and

omega-9 fatty acids

•However, others have shown that in obese patients with PCOS,

weight loss improves menstrual regularity; the type of diet used

did not matter

•Omega-3 fatty acid supplementation has been

shown to reduce liver fat content and other

cardiovascular risk factors in women with

PCOS, including those with hepatic steatosis,

although these effects have not yet been proven

to translate into a reduction in cardio metabolic

events

•Women with abnormal lipid profile need to be

counseled on ways to manage the dyslipidemia.

Such measures include eating a diet low in

cholesterol and saturated fats and increasing

physical activity

MULTIVITAMIN AND MINERAL

VITAMIN D

Evidence suggests that vitamin D deficiency may contribute to

the development of the metabolic syndrome, and one study

found insufficient levels of 25-hydroxyvitamin D (< 30 ng/ml)

in almost three quarters of PCOS patients, with lower levels in

those with the metabolic syndrome than in those without (17.3

vs. 25.8 ng/ml, respectively)

B VITAMINS

•Vitamins B2, B3, B5 and B6 are particularly useful for controlling

weight

•Vitamin B2 helps to turn fat, sugar and protein into energy

•B3 is a component of the glucose tolerance factor (GTF), which is

released every time blood sugar rises, and vitamin B3 helps to keep

the levels in balance

•B6 is also important for maintaining hormone balance and, together

with B2 and B3, is necessary for normal thyroid hormone production

• So any deficiencies in these vitamins can affect thyroid function

and consequently affect the metabolism

CHROMIUM/CHROMIUM PICOLINATE

•It helps to encourage the formation of glucose tolerance factor (GTF) which is a

substance released by the liver and required to make insulin more efficient

•A deficiency of chromium can lead to insulin resistance, which is a key problem

in the case of PCOS; too much insulin can be circulating but it is unable to

control one’s blood sugar (glucose) levels

•Chromium is the most widely researched mineral used in the treatment of

overweight

•It helps to control cravings and reduces hunger, also helps to control fat and

cholesterol in the blood

•One study showed that people who took chromium over a ten-week period lost

an average of 1.9kg (4.2lb) of fat while those on a placebo (sugar tablet) lost only

0.2kg (0.4lb)

Warning:

A diabetic and on medication, one should speak to their doctor before taking

chromium

ZINC

•Important mineral for appetite control and a deficiency can cause a loss of taste and

smell, creating a need for stronger-tasting foods, including those that are saltier, sugary

and/or spicier (in other words, often more fattening!)

•Also necessary for the correct action of many hormones, including insulin

•Also functions together with vitamins A and E in the manufacture of thyroid hormone

MAGNESIUM

Magnesium levels have been found to be low in people with diabetes and there is a

strong link between magnesium deficiency and insulin resistance. It is, therefore, an

important mineral to include magnesium if suffering from PCOS

CO-ENZYME Q10

This vitamin-like substance, is important for energy production and normal

carbohydrate metabolism .

One study showed that people on a low-fat diet doubled their weight loss when they

supplemented with Co-Q10 as compared to those who did not take it. Co-Q10 has also

been proved useful in controlling blood sugar levels

HERBS : SAW PALMETTO

Saw palmetto works by inhibiting 5 alpha reductase, a

key enzyme in the breakdown of testosterone into

dihydrotestosterone (DHT) and hence can keep

androgen levels low

STINGING NETTLE

There is some evidence that Stinging nettle can help

reduce the conversion of testosterone into

dihydrotestosterone, a more potent form of the

hormone

GARCINIA CAMBOGIA

Garcinia cambogia is a small tropical fruit called the 'Malabar tamarind’

It contains HCA (hydroxy-citric acid) which enables carbohydrates to be turned into usable energy instead of being deposited as fat

The HCA in this fruit seems to curb appetite, reduce food intake and inhibit the formation of fat and cholesterol

It seems to be particularly helpful when teamed with chromium

AGNUS CASTUS (VITEX/CHASTETREE

BERRY)

This is one of the most important herbs for PCOS because it helps to stimulate and normalize the function of the pituitary gland, which

controls the release of LH (luteinizing hormone)

REFERENCES

1)www.nutritionandmetabolism.com

2)www.nutritionj.com

3)Introduction to Human Nutrition 2nd Edition Ed. Gibney,Lanham

New,Vorster

4)Gropper,Smith,Groff Advanced Nutrition and Human Metabolism 5th

Edition

5)International Journal of Obesity (2004) 28, 1026–1032.

doi:10.1038/sj.ijo.0802661 Published online 25 May 2004

6)Daya S: Luteal support: progestogens for pregnancy protection.

Maturitas 2009, 65 Suppl 1:S29-S34.

7)Alpert PT, Shaikh U: The effects of vitamin D deficiency and insufficiency on

the endocrine and paracrine systems.Biol Res Nurs 2007, 9(2):117-129.