In the past, polycystic ovary syndrome has been looked at primarily as an endocrine disorder. Now we know that polycystic ovary syndrome is a metabolic, hormonal, and psychosocial disorder that impacts a patient’s quality of life. It is extremely important to holistically treat these patients early on to help them deal with the emotional stress that is often overlooked with polycystic ovary syndrome.
PCOS is a common female endocrine disorder with prevalence ranging from 2.2% to 36%. Most reports have studied adult women with ages ranging from 18 to 45 years. (2015-17 data)
It is important to understand the long-term health risks associated with the disease, which include:
1.Infertility or subfertility
6.Obstructive sleep apnea
Common signs and symptoms of PCOS/PCOD
1.Irregular menses & Infertility
3.Acne & Hair loss
4.Central obesity & Heart disease
Exact reason is still unknown, likely due to a steady state of high estrogen, androgen, luteinising hormone and insulin level. High insulin levels may lead to increased testosterone leading to symptoms like hirsutism.
Early diagnosis and long term management can help control polycystic ovary syndrome so that women can still live a healthy active life and avoid long-term complications such as metabolic syndrome and cardiovascular diseases.
The prime challenges faced by women with PCOD are summarised below, that I have observed over the past three years, having served more than 100 PCOD clients across the country.
Challenges in PCOD in different age:
3. Effect on mental health (Emotional angle):
Both physical health consequences and the emotional impact of PCOS have been ignored. PCOS and its influence on quality of life is an issue that needs to be taken seriously as this syndrome affects many women across the world. Measuring the quality of life of patients is often hard to do accurately. What one person may feel is a poorer quality of life may be very well suitable for another person.
With diagnosis of any disorder, disease, or syndrome it is reasonable to say that a patient may have anxiety. The causes of this added anxiety in life is most attributable to obesity, hirsutism, irregular menses, and infertility.
Common challenges faced:
Poor body image
Lower socio-economic condition
4: Diet & Lifestyle changes in managing the symptoms
PCOS/PCOD can’t be cured but 50-70% of the symptoms can be managed by incorporating necessary modification in terms of diet, workout and lifestyle changes.
The quality of diet interferes with the metabolic and endocrine abnormalities of PCOS/PCOD. There is in fact a complex interrelationship between different nutritional factors and endocrine status. It is known that diet plays an important role in the regulation of the metabolism of steroids and LH secretion. High fibre diet reduces serum oestrogen concentrations in pre-menopausal women, and a low fibre–high lipid diet may increase circulating oestrogen and androgen concentrations.
Women with PCOS usually weigh more than women without PCOS. Women with PCOS seem to have a greater appetite, consume more energy-dense high glycemic index (GI) foods and saturated fat, have inadequate fiber intake and have inadequate knowledge for PCOS-related quality of life.
Primary dietary modification for PCOS/PCOD
Following a proper diet regime to supply and support our system with vital nutrients.
Consistency to ensure long term habit building.
Regular workout to boost metabolism by release of endorphin and other metabolic promoters.
A. Calorie/Energy intake:
Critical to establish Negative Energy balance (Energy food intake should be less than the amount of energy/calorie burnt in a given day.) BMR (Basal Metabolic Rate) and Workout both will define the calorie expenditure.
B. Macro Nutrients:
Carbohydrate: (50% of total calorie)
High fibre carb (whole grains: Brown rice and long grain rice, oats, millets like ragi, jowar, bajra) should be incorporated in the diet to improve insulin resistance and to boost metabolism.
Simple carbohydrates like sugar, refined flour, corn syrup needs to be avoided.
Gluten(Wheat and it’s by products) is a contraindication due to it’s hormone disrupting property.
Protein: (20% of total calorie)
High biological value protein (egg, chicken, fish) needs to be incorporated, vegetarian sources include pulses and legumes.
Dairy is a contraindication due to insulin resistance and interrelation with c-peptide.
Fat: (20-30% of total calorie)
Moderate amount of dietary fat needs to incorporated in the plan, oils rich in PUFA (Sunflower, Suffolar, Soybean, Mustard) & MUFA (Olive oil, Canola Oil) along with Omega 3 and Omega 6 fatty acids to be included in the plan which is beneficial in improving glucose metabolism in turn will improve insulin resistance.
Vitamin D3, Vitamin B12, Zinc and Magnesium have a beneficial effect in terms of improving the hormonal imbalance and insulin resistance.
With careful dietary and lifestyle intervention moderate weight loss can be achieved. Depending on the individuals’ preferences, culture, habits and metabolic needs (ie, moderately low-carbohydrate diets [45-50% of energy] or substitution of carbohydrates for MUFA or PUFA in the diet) plan has to be incorporated as a part of the daily routine. As well as alternative dietary modification, including increased meal frequency and regular meal timing, with the majority of carbohydrates consumed during day time, offer the evidence-based nutritional support strategy of management and treatment of PCOS.
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