Polycystic Ovarian Syndrome (PCOS)

PCOS is an endocrine disorder that occurs in 9-18% of reproductive aged women and has a strong familial genetic link. Of this population, 95% of these women are obese. PCOS is a chronic condition characterized by elevated levels of androgen hormones (ie, mainly testosterone) from the ovaries and is closely associated with insulin resistance. The overproduction of these androgens in women is associated with hirsutism (excessive hair growth on the face and body), acne skin problems, alopecia (male pattern baldness), and irregular or absent menses. Insulin resistance (IR) occurs in approximately 50%-70% of women with PCOS. Insulin resistance causes weight gain in the abdominal area leading to increase in visceral stores. Studies have shown that high visceral fat stores are linked to an increased risk in developing cardiovascular disease (CVD) and diabetes. According to one estimate, up to 50% of women with PCOS develop Type 2 Diabetes by the age of 40. Hyperinsulinemia is associated with weight gain which leads to insulin resistance which results in further weight gain. This vicious cycle of weight gain is why so many patients with PCOS struggle with not only weight loss but maintaining a healthy weight as well.

In addition to metabolic complications, there is also a close relationship with binge eating/over restricting behaviors due to changes in glucose levels leading to insulin changes. These eating behaviors also contribute to depression and anxiety issues due to unstable weight control. In summary, all women with PCOS would benefit from CoreLife services because the medical staff and registered dietitians can monitor their diet and lifestyle to help improve health outcomes.  

Hyperinsulinemia is the greatest predictor of hormone imbalances related to PCOS and the first line of intervention is diet and lifestyle changes. Hyperinsulinemia causes the body to store fat in the abdominal area increasing the waist circumference. In addition, the higher insulin levels also leads to higher testosterone levels which consequently interferes with ovulation and menstrual cycles. IR can lead to cause hypoglycemic events which leads to an increase in carbohydrate cravings. An increase in waist circumference is also a risk factor for developing CVD. Dyslipidemia is the most common metabolic abnormalities that impacts HDL levels, total cholesterol and triglycerides. Due to the nature of these risk factors, women with PCOS are also at higher risk for developing Cardiovascular Disease (CVD). Post menopausal women with PCOS are also at higher risk for CVD due to the hormonal changes having a worsening effect on lipids as they age. At CoreLife, all patients with PCOS have access to a Registered Dietitian to help develop a diet and exercise plan that could reduce their risk of furthering metabolic processes. In creating a diet plan, it is important to consider preventing hypoglycemic and hyperglycemic events, so the recommended pattern is to ensure that complex carbs are paired with lean proteins at main entree times. In addition, every CoreLife location has a gym with personal trainers to aid with new lifestyle changes.

Studies have shown that overweight/obese women with PCOS who lose ~5-10% total weight experience improvement in metabolic parameters such as IR, dyslipidemia and fasting glucose. Although diet and lifestyle changes are the first line of treatment for addressing PCOS, specific diet recommendations have not yet been established due to the lack of research. Several studies have shown that not only is calorie restriction  effective in weight loss but also following the DASH diet (Dietary Approaches to Stop Hypertension) and increasing intake of animal based proteins show benefits to weight  and metabolic profile.  A higher protein diet is shown to have positive effects on appetite because it contributes to improved meal satisfaction. In addition, consuming a higher percentage of calories from protein will help reduce episodes of hypoglycemia, therefore leading to better appetite control during and after meals. At CoreLife, calorie needs are calculated based on a patients basal metabolic rate plus activity factor less 500 kcals to determine individual needs. The standard dietary patterns of macronutrients  are calculated and distributed: 30% protein, 30% fat, 40% carbohydrates. At 30% protein, this does represent to be a higher protein intake with low fat and lower carbohydrate needs.

We recommend all of our patients at CoreLife track their daily intake. In studies, daily food journaling has shown that those who track consistently lose 25% more weight than non trackers. Tracking is easy and adds a level of accountability to help the patient stay on track while adapting to a healthier diet and lifestyle. 

Many of our patients have never participated in regular fitness routines and therefore are just getting started with lifestyle changes. A weight loss change of 5-10% has a positive impact on some metabolic parameters and therefore the need to increase physical activity is an important component to overall health outcomes. All patients are encouraged to participate in regular activity by utilizing CoreLife gym and trainers to help achieve their goals. At the CoreLife locations, gyms are available for clients to use and can  work with a certified personal trainer to develop individualized fitness plans.  

Resources

Puurunen J, Piltonen T, Morin-Papunen L, et al. Unfavorable hormonal, metabolic, and inflammatory alterations persist after menopause in women with PCOS. J Clin Endocrinol Metab. 2011;96(6):1827-1834.

Krentz AJ, von Mühlen D, Barrett-Connor E. Searching for polycystic ovary syndrome in postmenopausal women: evidence of a dose-effect association with prevalent cardiovascular disease. Menopause. 2007;14(2):284-292.

Sharma ST, Nestler JE. Prevention of diabetes and cardiovascular disease in women with PCOS:treatment with insulin sensitizers. Best PractcRes Clin Endocinil Metab. 2006;20 (2);245-260

DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrone using the homeostasis model assessment. Fertil Steril. 2005;83(5):1454-1460

Moran LJ, Pasquali R, Teede HJ, Hoeger KM, Norman RJ. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society. Fertil Steril. 2009;92(6):1966-1982.