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Food Surgery with Aveen Bannon

Friday, 8 May 2009

Over the next three weeks Aveen will discuss foods to eat and foods to avoid in order to help minimise the symptoms of specific conditions. This week's condition is Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects an estimated 5-10% of reproductive aged women.
It can occur amongst all races and nationalities, is the most common hormonal disorder among women of reproductive age and is a leading cause of infertility.

How do we recognise if we have Polycystic Ovary Syndrome?
The principal features of PCOS include;
1. weight problems particularly weight gain and/or obesity,
2. Absent or irregular menstruation.
3. acne
4. excess body hair (hirsutism)

What causes polycystic ovary syndrome (PCOS)?
The exact cause of PCOS appears to be unclear but there are a few factors that seem to be important.Genes are thought to be one factor. Women with PCOS tend to have a mother or sister with PCOS although they may have different symptoms.
PCOS may also be caused by higher than normal levels of certain hormones. One of these hormones includes Insulin. Insulin is a hormone that regulates our blood sugar level and helps control the change of carbohydrate rich foods into energy for the body to use or store.

Many women with PCOS have what is described as insulin resistance which means that they need to produce more insulin than normal to help control blood sugar levels. Excess insulin appears to increase the body's production of testosterone. Levels of testosterone that are higher than normal can lead to acne, excessive hair growth, weight gain, and problems with ovulation. Excess body fat can make insulin resistance worse, increasing your insulin level and therefore aggravating symptoms.
High levels of another hormone called luteinising hormone (LH) can also be found in women with PCOS. LH acts together with insulin to increase levels of testosterone in the body and the symptoms associated with increased testosterone production.
The symptoms and severity of the syndrome can vary greatly among women.

Common symptoms of PCOS include
1. Oligomenorrhea, amenorrhea - irregular, few, or absent menstrual periods.
2. Infertility, generally resulting from anovulation (lack of ovulation).
3. Hirsutism - excessive and increased body hair
4. Hair loss appearing as thinning hair on the top of the head
5. Acne, oily skin, seborrhea.
6. Overweight and/ or obesity (weight is more commonly abdominal fat): one in two women with PCOS is obese.
7. Depression.

At what age can this affect women?
PCOS can present in any age during the reproductive years although typically symptoms appear in late teens or 20's.
Women with PCOS can also be at risk of the following:
1. Insulin resistance/Type II diabetes
2. High blood pressure
3. Dyslipidemia (disorders of lipid metabolism - cholesterol and triglycerides)
4. Cardiovascular disease
5. Weight gain

o History-taking, specifically for menstrual pattern, obesity, acne and hirsutism.
o Pelvic ultrasound
o Serum (blood) levels of androgens (male hormones).

Treatment can be lifestyle modification or a combination of medication and lifestyle modification to help control the symptoms of PCOS. Your treatment plan will be individual to you and worked out with your doctor.
Lifestyle modification; First step in treating PCOS is looking at diet and exercise. Eating a balanced diet and exercising regularly can help ensure you are a healthy weight and manage some of the common symptoms in PCOS e.g. insulin resistance.
Maintaining a healthy weight by eating a low Glycaemic index (GI) balanced nutritious diet can have a very positive effect on women with PCOS by easing their symptoms and reducing long-term health risks.3 Eating fewer processed foods, confectionary and foods with added sugars while encouraging more whole-grain products, fruits, vegetables, pulses, and lean meats to help lower blood sugar (glucose) levels, improve the body's use of insulin, and normalise hormone levels in the body. Controlling portion sizes and sustained regular exercise is imperative alongside a healthy balanced diet.
Even a 5-10 percent loss in body weight can restore a normal period and make a woman's cycle more regular. Where PCOS is associated with overweight or obesity, successful weight loss is probably the most effective method of restoring normal ovulation/menstruation.
Certain vitamins and minerals have been shown be effective in controlling PCOS symptoms. For example Chromium: Essential trace mineral needed for insulin activity. Optimal dietary intake may reduce insulin resistance.
Dietary Sources of Chromium includes brewer's yeast, meat, wholegrain cereals, pulses, legumes & nuts.
B vitamins: important in helping metabolise protein and carbohydrate rich foods and therefore help release energy from food. Good sources include fruits, vegetables, oats, bananas, nuts and seeds

Zinc: important immune boosting mineral that is also necessary for the correct action of many hormones, including insulin. Good sources include meat, dairy, nuts and seeds.
Omega-3 fatty acids: the essential fatty acids are important for healthy hormone function and can also help alleviate a number of symptoms associated with PCOS.e.g.
. Insulin resistance
. Chronic inflammation
. Higher risk of heart disease
. High blood pressure
. High blood fats
. Higher risk of diabetes
. Depression
. Stress
Oily fish are especially rich in omega-3 fatty acids; salmon, mackerel, sardines, herring, tuna. Plant sources include linseed, nuts, and soya.
Medical treatment discussed with your doctor;
Birth control pills; for women who don't want to become pregnant, birth control pills can control menstrual cycles, reduce male hormone levels, and help to clear acne.
Diabetes medications; The medicine metformin is used to treat type 2 diabetes. It also has been found to help some with PCOS symptoms. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. Abnormal hair growth will slow down, and ovulation may return after a few months of use.
Fertility medications; Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant.

12 point PCOS Diet:
1. Low sugar/ no added sugar diet
2. Avoid foods with a high glycaemic index i.e. white breads, cereals, confectionary
3. Increase fruit and vegetables
4. Increase intake of oily fish, nuts and seeds
5. Base diet around complex carbohydrates - wholegrains like brown rice, oats, high fibre breakfast cereals
6. include plant sources of protein; soya bean, chickpeas, kidney beans, lentils etc
7. Chose low fat dairy foods
8. Drink enough hydrating fluids
9. Regular meal pattern; try to eat every 4 hours and avoid long gaps between meals
10. Avoid inappropriate diets e.g. low carb diets
11. Reduce alcohol as it is empty calories.

1. PCOS Ireland ;
2. harris, chung, 'The ultimate pcos handbook' 2006
3. marsh, miller, 'The optimal diet for women with polycystic ovary syndrome?, BJN 94:154-165, 2005
4. online ref