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Diet and PCOS

Diet and PCOS

How can diet help with PCOS?

Polycystic ovary syndrome (PCOS) is one of the most common hormonal conditions amongst women and can put them at greater risk of heart disease due to glucose sensitivity and is also a leading cause of infertility.

Research has suggested that many women are not even aware they have the condition which may be due to misdiagnosis or a lack of awareness about PCOS. There is no cure for PCOS and whilst access to information about the disorder has become more freely available, many women still feel unsupported and confused about the best way to manage the condition.

What is PCOS?

This is a health problem that affects women of childbearing age and is considered to be the most common hormonal condition.  Women with PCOS have a hormonal imbalance and problems with their metabolism which can affect their overall health and appearance.

What causes PCOS?

Exactly what causes PCOS is not fully clear but the majority of experts believe that genetics have a role to play in the development of the condition.  PCOS is linked to abnormally high levels of androgens (hormones such as testosterone that regulate the development and maintenance of male traits in the body) which can prevent the ovulation every month and cause extra hair growth and acne.

The condition is also associated with high levels of insulin which is the hormone that helps to regulate blood sugar levels. Many women with PCOS are resistant to the activity of insulin and so their body compensates by producing more.  The effect of this is that it increases the production and activity of testosterone which exacerbates the symptoms associated with PCOS.  Being overweight or obese also increases the amount of insulin the body produces.

Who is affected by PCOS?

Estimates have suggested that the global prevalence of PCOS falls between 6% and 10%.  In the UK it has been estimated that around 1 in 10 women are affected by PCOS.  Prevalence in the US is thought to be similar to the UK although it could vary significantly by region.

US prevalence figures are tricky to gather effectively as a result of the conflicting criteria used to diagnose the condition.

In a study published in the American Journal of Obstetrics and Gynaecology  the authors concluded that women with PCOS are more likely to than those without PCOS to be 25-34 years old, be from the Southern States, be infertile, have metabolic syndrome and have been seen by an endocrinologist (1).

This same study estimated a much lower national prevalence in the US of just 1.6% but admitted that this was likely to be a significant underestimation given the retrospective nature of the study and the fact that PCOS is often undiagnosed.

What are the symptoms of PCOS?

Signs and symptoms of PCOS normally become apparent during late teens and early 20’s and include:

  • Irregular periods (or none at all)
  • Difficulty getting pregnant (due to irregular periods)
  • Excessive hair growth (hirsutism) on the face, chest, back or buttocks
  • Weight gain
  • Thinning hair or hair loss
  • Oily skin
  • Acne

How is PCOS diagnosed?

If any rare causes of the same symptoms of PCOS have been ruled out and you meet at least 2 of the following criteria, then a diagnosis of the condition is normally confirmed as being PCOS.

  • You have irregular or infrequent periods – indicating that your ovaries are not regularly releasing eggs (anovulation).
  • Blood tests indicate high levels of “male hormones” such as testosterone.
  • Scans indicate you have polycystic ovaries.

 How can you treat PCOS?

Fertility medications are available to help treat the symptoms of PCOS such as excessive hair growth, irregular periods and fertility problems.

Making changes to your diet and losing weight can also have a significant impact on the effects of the condition.

Losing weight may help to lower your blood glucose levels and improve the way your body reacts to insulin.  Just a 10% loss in body weight has been shown to improve the regularity of periods and chances of pregnancy in some women with PCOS.

What should women with PCOS be choosing to eat?

The two key ways that diet can help with PCOS is through weight management and blood sugar control (insulin production).  Managing insulin levels is the best way women with PCOS can use food to help manage their condition.

A few different diets are often recommended for PCOS and they all share a similar set of foods which are rich in fibre and protein to help balance out blood sugar levels and lessen the production of insulin.  These diets can also be used as a way of managing or losing weight and are all cardioprotective.

A low glycaemic index diet (GI)

Foods with a low GI are digested more slowly which means they do not cause insulin levels to spike in the same way as they do with other carbohydrate foods such as sugar.

Low GI foods include wholegrains, beans, pulses, lentils, fruits, vegetables, starchy vegetables (sweet potato, yam, corn), basmati rice, quinoa and dairy foods.  Some foods do not have a GI value but are also included such as meat, fish, nuts, oils, herbs and spices.

Many people recommend monitoring the glycaemic load of a food as unlike the GI this takes into account the amount of food eaten (portion size).

The anti-inflammatory diet

This is a balanced diet that includes foods that may help to quell inflammation such as berries, oily fish and extra virgin olive oil.  Many of these foods form a key part of the Mediterranean diet.

Foods that cause inflammation (these foods should be avoided or limited)

  • Refined carbs – sugar, white bread, pasta and pastries
  • Sugary drinks
  • Convenience foods such as chips, crackers and crisps
  • Red and processed meats
  • Spreads and oils rich in omega 6 such as margarine and vegetable oil
  • Alcohol

Foods that help to quell inflammation

  • Vegetables, especially dark green leafy vegetables
  • Fruits, especially deeply coloured varieties such as berries, grapes and cherries
  • Beans, pulses and lentils
  • Wholegrains and psuedograins such as barley and quinoa
  • Extra virgin olive oil
  • Nuts and seeds
  • Oily fish
  • Dried spices

The DASH diet (dietary approaches to stop hypertension)

This is a diet designed to reduce the impact of heart disease and as such is often recommended to women with PCOS who are at greater risk of the condition.  This diet is rich in fruits, vegetables, lean poultry, wholegrains and low-fat dairy produce whilst discouraging foods that are high in salt and saturated fat.

Adopting a healthy approach to the way you eat appears to be beneficial for women with PCOS.  Following an anti-inflammatory way of eating such as that illustrated by the Mediterranean diet is a good place for all women with PCOS to start.

References

  1. Okoroh EM, Hooper WC, Atrash HK, Yusuf HR, Boulet SL. Prevalence of polycystic ovary syndrome among the privately insured, United States, 2003-2008. Am J Obstet Gynecol. 2012;207(4):299.e1-299.e2997.