Polycystic ovarian syndrome (PCOS) is a metabolic and endocrine condition affecting women of reproductive age group worldwide. While there is no confirmed criterion stating the root cause of developing PCOS, there are certain factors that may collectively or individually contribute towards a positive diagnosis of PCOS.
Common Causes for PCOS
- Genetic/Heredity
- Insulin resistance (IR)
- Hypothyroidism
- Poor gut microbiota
- Unmanageable chronic stress
- Overweight & obesity
- High androgen activity
PCOS affects women in more than one way and can impact their health and wellbeing through:
- Reproductive abnormalities
- Abnormal menstrual cycle
- Increase in ovary size and/or cysts
- Anxiety
- Depression
- Hirsutism
- Low libido
- Skin pigmentation in neck, armpits, thighs
- Increasing the risk of type II diabetes
- Increasing the risk of dyslipidemia
- Increasing the risk of hypertension
- Increasing the risk of heart disease
Several bilateral relationships are also being explored between PCOD & Non-Alcoholic Fatty Liver Disease (NAFLD), PCOS & Metabolic Syndrome.
Certain environmental pollutants including chemical exposure may potentially lead to endocrine dysfunction which may further lead to PCOS. This is a new area of research and includes a vast array of variables like industrial pollutants, vehicular exhausts, household cleaning agents, cosmetics, hair dyes, sunscreens, deodorants, plastic, etc.
Women of childbearing age especially those with a family history of PCOS, are obese and have insulin resistance seem to have the highest risk of developing PCOS. While it is assumed that obese women have a higher risk, women of normal weight may also develop PCOS.
Diagnosis of PCOS
PCOS is generally diagnosed by a gynaecologist through the use of modern tools like ultrasound and blood tests, in addition to physical symptoms like hirsutism and skin pigmentation.
The Rotterdam criteria, established in 2003, confirms for PCOS with having at least two of the following three diagnosis:
- Clinical or biochemical hyperandrogenism
- Irregular menstrual cycles
- Polycystic Ovary Morphology (PCOM)
Knowing the cause of PCOS for a patient can go a long way in recommending a diet for them. Different women may get diagnosed with PCOS due to different causes like Insulin resistance, hypothyroidism, genetic, etc., or may have to combination of multiple causes.
Diet in PCOS
Knowing the cause of PCOS can be helpful in giving individualized nutritional advice. For someone who developed PCOS due to hypothyroidism, they would be better off following the recommendations that can manage their thyroid function which may eventually lead to reduction in symptoms. Similarly, if someone develops PCOS due to Insulin resistance (IR) with a normal thyroid function, a diet catered to managing insulin levels would be helpful. Likewise, for either inflammation or stress or even genetics being the cause of getting a PCOS diagnosis, an individualized approach would be recommended to cater to the individual cause of the condition.
Some foods which can have a beneficial effect during PCOS are citrus fruits, curd, gluten free foods, mushrooms, non-starchy vegetables, unprocessed whole grains & millets.
A common traditional practice is to consume seeds in a seed cycling fashion during PCOS. It is claimed that this would balance out the hormones by regulation of estrogen and progesterone in the first and second half of the menstrual cycle, respectively. However, there is no scientific evidence to verify this claim.
Below is a sample diet plan, as an example for PCOS + Insulin Resistance + Obesity
Early Morning
- 1 – 2 glasses of water (can add lemon)
Breakfast
- Orange/kiwi/kinnow/Pomegranate
- Soaked nuts (almonds, walnuts)
- Gluten free oats cooked in water with flaxseeds & pumpkin seeds
- 1 cup green tea/cinnamon tea/lemon tea
- Boiled eggs/sprouts
Lunch
- Lentil & spinach curry
- Millet roti
- Cucumber curd
Mid Evening
- Turmeric & Cinnamon Milk
Dinner
- Cooked chicken/paneer/fish
- Cooked seasonal vegetable
- Whole wheat chapati
Exercise
Exercise is one overlooked aspect during PCOS which can have immense benefit not just for better management of PCOS symptoms but for general health and wellbeing as well. A standard recommendation would be to perform moderate intensity exercise for at least 150 minutes each week. This can be split up into smaller sessions of either 30 minutes for 5 times per week or 50 minutes for 3 times per week or in any other fashion depending on the individual patient’s daily schedule.
A combination of resistance training and cardiovascular exercise would be a better option in comparison to just cardio alone.
Clinical Dietitian Keshav || MSc Dietetics (DFSM), PGND, CNCC
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