Nutrition Intervention for Polycystic Ovarian Syndrome

• Nutrition Intervention for Polycystic Ovarian Syndrome  

By Heather Wnorowski 

Polycystic ovarian syndrome (PCOS) is an endocrinologic disorder that can appear in women of reproductive age. It is the leading cause of fertility and affects 6-10% of women of childbearing age. It was not described until 1935 by Stein and Leventhal. PCOS can also be referred to as Stein-Levanthal syndrome. It is referred to as a syndrome because it contains many symptoms. These symptoms include obesity, hirsutism, acne, infrequent or abnormal ovulation, amenorrhea, oligominorrhea, hyperandrongenism, an elevated utilizing hormone to follicle stimulating hormone ratio, chronic pelvic pain, insulin resistance, hyperinsulinemia, type II diabetes, dyslipidemia, and hypertension. These symptoms can get worse with weight gain. The onset of the disease can be as early as puberty, but usually begins in adolescence. The cause of PCOS is unknown. Some literature suggest it is genetic with autonomic dominant mode of transmission. 

To diagnose PCOS some of the symptoms must be present and some test must be performed. The test may include glucose tolerant test (GTT), cholesterol levels (total chol, LDL, HDL, trig), testosterone levels, utilizing hormone, follicle stimulating hormone, and androstenedione levels. On occasion an ultrasound will be done. Women with PCOS have an increased risk for developing type II diabetes, high cholesterol and triglyceride levels, cardiovascular disease, endometrial cancer, and insulin resistance. Of these disease the most common is insulin resistance and type II diabetes. 

About 35-50% of obese women with PCOS go on to develop impaired glucose tolerance or type II diabetes by the age of 30. Insulin resistance is when the cells don’t respond to insulin. The insulin builds up in the body, which is hyperinsulinemia, and causes ovarian cells to secrete androgens and decrease sex hormone binding hormone globulin (SHBG). The interacting of insulin and hormones lead to symptoms of PCOS. The International Council on Infertility Information Dissemination says “Insulin resistance that is common to PCOS may play a role in weight gain and the difficulty in losing any extra weight.” Studies have shown that the distribution of body fat is important with insulin sensitivity. They say the more fat stored the worse insulin resistance is and the hungrier you get. High levels of insulin can lead to carbohydrate cravings. Intense carbohydrate cravings and not feeling full are common in women with PCOS. Evidence shows that the western diet )increased fat and refined carbohydrates, and low fiber) can precede obesity and induce insulin resistance. Insulin sensitivity can be influenced by dietary modifications such as a low glycemic index diet. The glycemic index of a carbohydrate is a measure of its postprandial effect on blood glucose. The lower the glycemic index the less the carbohydrate affects postprandial glucose and insulin values. Martha Mckittric RD, CDE, Medical Advisory Board Member for PCOS Support Association usually prescribes a balanced diet with protein and heart healthy fats at every meal, but also recommends foods with a low glycemic index. She has found most women have less carbohydrate cravings on low glycemic diets. So she encourages whole grains and minimizes processed carbohydrates. 

There are natural remedies to control insulin and blood sugar levels. Cinnamon (½-¾ teaspoon) with every meal can help keep insulin and blood sugar levels under control. It contains methyl hydroxy chaconne polymer (MHCP) which improves cellular glucose utilization and sensitivity of insulin receptors. Studies show that high fiber diets can decrease weight and increase insulin sensitivity. Fiber reduces insulin secretion by slowing the rate of nutrient absorption after a meal. Polyunsaturated fatty acids (omega-3 and omega-6) can keep cell membranes flexible. Flexible cell membranes have more insulin receptors which improve glucose metabolism. Chromium (200 mg) per day can improve insulin resistance symptoms. A study in the New England Journal of Medicine found that 1200 mg of D-chiro-inositol daily has many beneficial affects in the treatment of PCOS. D-chiro-inositol is part of a phosphoglycan that has been shown to mediate action of insulin. In patients with type II diabetes the level of D-chiro-inositol is decreased. Studies have suggested that women with PCOS may have insulin resistance and hyperinsulinemia due to a D-chiro-inositol deficiency. 

The role of the dietitian is key in the treatment of PCOS. A balance of the food the patients eat is an important part of treating PCOS. One of the most important treatments for obese patients should be weight loss and exercise. A 5-10% weight loss has shown significant biochemical and clinical improvement. Studies have shown menstrual cycles and fertility have improved with weight loss. Also androgen production and hirsutism has decreased in weight loss. 

PCOS is also associated with a high incidence of eating disorders including binge eating and fasting. Eighty percent of people with PCOS practice binge eating. The first step in weight loss treatment is to learn to be mindful. Katrin Kratina, MA, RD, LD developed a food journal to help identify hunger and satiety cues. The food journal also teaches about your nutrition needs and your eating habits. Brenda Bryan RD, LD/N a nutritionist for PCOS women at the Center for Applied Reproductive Sciences, uses the Food Pyramid and American Diabetes Guidelines of reducing calories by 250-300 per day from saturated fat and carbohydrates to counsel women with PCOS. 

PCOS is treatable but not curable. It is generally treated by medications and changes in diet and exercise or a combination. Some of the medications used in treatment include; insulin sensitizers which reduce insulin resistance and many other symptoms and also aid in weight reduction, medication that induce ovulation, combination oral contraceptives (COC) which regulate menstrual cycles and control acne and hirsutism, Antiandrogenism and insulin regulating agents can control hyperandrogenism and aid in weight loss. Sometimes on special occasion surgical treatment is used. 

There are many issues to still be explored in PCOS. The biggest challenge is making permanent changes focused on good nutrition. The patient should chose a dietitian with experience in type II diabetes and gestational diabetes because they will be knowledgeable in insulin resistance and special diets. The most successful counseling is education the patient on PCOS and insulin resistance and by allowing the patient to make self set goals in order to ensure long term success. 

I Want Triplets!

Or quadruplets! Doesn't matter which, I just want to have a lot of babies at once.

Before we got married Dh always said he wanted twins. It's good that he's completely relaxed about the idea of having multiples. Twins run in both our families you see, and we both want to have a large family with at least 4 kids. The probabilities of us having twins is up there. So I'm hoping his prayers will be answered in that regard, if I get pregnant naturally. I want to take it a step further though. I would like to have multiples. Lots of 'em!

Actually what I really want is to have a lot of kids at once and be done with it rather than waiting for four years between each child because of PCOS. Only a sufferer can understand the psychological torture of waiting, stalking your periods, sleuthing every change that occurs in your body and having different people poking around your lady bits every now and then.

I also don't plan on doing any family planning, or child spacing or any of that crap. Can't afford to, again not with PCOS snapping at my heels. I don't care if I get preggy again while one baby is still attached to my nipples. My mum got preggy with me while my brother was just 5 months, and we both turned out okay. The little suckers will have to deal with it. Ha!

Most ovulation inducing drugs often put a warning there that your risk of multiple births are higher. Bring it on, I say. Who wants one, when you can have three at once! I realize for this to happen we'll need help with fertility treatment. Again I pray that I can get pregnant on my own without needing to. But if we ever have to, I really hope we get three, or four for the price of one.

Yeah, the risks also get higher as you carry more babies. I know that. That's why I'm working out like a mad woman. By the time I'm done with my body, it'll be fit enough to carry ten babies!

PS. I'm not preggy. Bummer. The struggle continues!

Fertile Friends

My best friend just told me she's preggy. I suspect another friend is also preggy, but feeling weird about telling me. Whenever someone I know gets preggy I genuinely feel happy for them and at the same time I get a pang of sadness on the upper left side of my chest. I know these feelings are irrational. Because other people's ability to conceive is independent of mine. There is no logical correlation between their fertility and mine, but even then I still feel sad. Sad that my own longing for a baby has not yet been fulfilled.

Lately I've found myself drifting away from friends with children and they from me. Envy has nothing to do with it, rather it seems we have less and less in common as their kids are growing up. They are all full time mums whose daily lives are consumed by their children. And whenever I call them up that's all they seem to talk about. Which is weird for both of us. And whenever we get together I'm always sidelined when they get into their 'motherhood caucus'. These days we've found fewer reasons to call each other up. 

At the beginning of my fertility journey I promised myself not to dwell on things I cannot control or make a pathetic mess of myself because I can't yet have children. I vowed to stay focused, zero in on what is within my control and grasp tightly.

For instance, I cannot control my erratic hormones, but I can control my weight which helps to keep them in check. And I cannot control when I will become pregnant, but I can keep healthy, take my medications and prepare my body for when that time comes thus reducing the probabilities of having a miscarriage. I may not have total control over what my body does, but I do have 100% control over my attitude. Only my attitude can determine whether I'll be miserable or happy with myself should it turn out that I can't have any children (Yes, I've thought of that too). I should be thankful for the things that are going well for me as opposed to the thing I don't have. And I am! I have come a long way since being diagnosed in March. 

I am thankful that my body is responding to weight loss

I am thankful that my periods are regular and predictable

I am thankful that I no longer have any outwardly symptom of PCOS

It's all good really and everyday brings me closer to that elusive double line. I should get a grip. Stay focused, for whatever has been written for me is what will come to pass. 

"To Allah belongs the kingdom of the heavens and the earth. He creates what He wills. He bestows females (offspring) upon whom He wills, and bestows male (offspring) upon whom He wills. Or He bestows both males and females, and He renders barren whom He wills. Verily He is the All-Knower and is Able to do all things" - Quran, 42: 49-50

Happy & Hoping

I'm quite happy with my life, thank you. I don't know what I want to change in the next 21 days. Except maybe my nefarious tendency to procrastinate. I feel so overwhelmed sometimes I don't know where to begin so I end up doing nothing and putting off the little I could have achieved. *sigh*


The only thing in my life so far that I've been able to sustain is my baby-driven-weight-loss. 14.5kg down 9.2kg more to go. And that's because of the life-changing pay-off in the end. Plus I want to keep healthy, so my PCOS doesn't 'do me in' for the rest of my life.


Speaking of babies, I've never had any double lines on any ttc test I've ever taken, until three days ago. My opk came back with two lines. I know I wasn't crazy, because I used two different tests from two separate manufacturers with different sensitivities. The second line was fainter than the control line. Although according to the test instructions if you get a fainter line than the control, there has not been an LH spike. At this point I'm also having some doubts because my calculated ovulation date falls on the 4th of June. 


I repeated the same test the following day, also with the two different strips and they came back negative. I'm not exactly sure if I ovulated, but it is more probable that, scientifically speaking, if two separate tests came back positive, I did. We did bd the following day, with the help of some egg whites (slippery bastard!).


So that's that for now. Even if I don't get preggy this month I'm still VERY HAPPY that I am ovulating and all my efforts at weight loss are paying off. As long as I'm ovulating getting a bfp is only a matter of time. Dh will be travelling for about 2 months. As soon as he gets back, we'll start bd'ing again. And hope something happens within 6 months so I don't have to see the specialist again. 

The Rewards Of Self Love

Had this inspiring article forwarded to me from Ovarian-cysts-pcos.com which I am subscribed to. Thought I'd share it. The original article can be found here.

Enjoy!

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An important rule of success in life is to learn to love and appreciate yourself.

You are worthy of all the world’s riches, whether financial, physical, emotional or spiritual.

To be able to have anything in life, you must first believe that you are worthy of it. If you do not believe you are worthy of living the good life, you will unconsciously sabotage yourself and your efforts.

It's well known that we strive to prove ourselves right. As Richard Bach said, "Argue for your limitations and they will be yours."

Have you decided you don't deserve what you really want in life? Maybe that was the message that your parents gave you or maybe you just picked up that belief from your environment.

But here's a question: How is this belief serving you or your family? What will this belief cost you in time and lost opportunities for fun and enjoyment? Is this belief really worth hanging on to?

Do things daily that improve your self-esteem. An excellent way to improve your life is to expose yourself to information every day that reminds you of how worthy you are of having whatever you are willing to create for yourself.

The power of your mind is the instrument of your success or failure, and happiness or unhappiness in life.

Don’t associate with others who dwell on the negative. Stay away from negative newspaper, magazine, television, and radio information that drags you down and makes you focus on what is not working.

Get out of old ruts of thinking, acting, and behaving. A rut is a living death.

For the next 21 days create a new routine for yourself. Do things differently. Simply changing your habits will give you the opportunity to enjoy new things. Allow yourself to see new opportunities and you will recreate the spark in your life that makes life fun again.

It's sad that most people go through life unconsciously. They get up at the same time every the morning, eat the same breakfast, drive the same route to work, eat lunch with the same people, talk about the same worn, tired subjects and then go home and do the same thing night after night.

These are the same people who say life is no longer fun. They complain there is nothing to do and that life is boring. Their relationships are dying on the vine from lack of stimulation.

Today is the first day of the rest of your life, so do something different!

Try changing your routine -- experiment by wearing different outfits, trying new foods, going out to eat in a new place, shopping in a different part of town. Invite a neighbor over whom you’ve not really gotten to know before. Go to a museum or the library and read books on subjects that you've never read before. Try a new haircut.

Just do something different every day for next 21 days and discover how much more alive you have become!

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I think I'll give myself a 21 day challenge, starting now! Lets see how this goes...