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PCOS, Diet and Nutrition: How Diet Can Increase Your Fertility Factor
Dr. Jessica Bauer, MD, MS, FACOG
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Around 116 million women worldwide have been diagnosed with polycystic ovarian syndrome.
PCOS. VICTORIA BECKHAM has it. So does Kate Pearson, the beloved character on the NBC drama "This Is Us."
Polycystic ovarian syndrome, first described in the 20th century, is one of the most common yet complex metabolic and endocrine disorders diagnosed in women of childbearing age.
To date, the best estimate of the prevalence of PCOS is somewhere between 6% to 10% of the female population, and approximately 116 million women have been diagnosed worldwide. Although the exact cause of PCOS has not been determined, its origins are multifactorial. In addition to the hormonal aspect, there is emerging evidence that genetics, the environment and the interaction between these two, play a role in the pathogenesis of PCOS.
Some classic features of the syndrome include irregular periods, male hormone excess and polycystic-appearing ovaries. The problem is that not every woman has the classic signs. Not every woman with PCOS has unwanted hair or is overweight. Not everyone has polycystic ovaries, and some women with cysts don't have PCOS. Some women have no periods. Others have abnormally heavy or irregular periods. In fact, some women with PCOS ovulate regularly. The lack of classic signs can cause confusion and misdiagnosis, complicated by the fact that there is currently no single test in existence to diagnose PCOS.
There in one thing women with PCOS often have in common: difficulty conceiving.
In fact, PCOS is one of the leading causes of infertility. Irregular periods may make it difficult to get pregnant. The imbalance in female sex hormones, coupled with an abnormal increase in testosterone, may prevent the development and release of mature eggs needed for ovulation and pregnancy. If ovulation does occur, the hormone imbalance may prevent proper egg implantation.
PCOS may not be curable but it is treatable. In our Miami practice, we use both oral and injectable medications coupled with close monitoring, in the form of vaginal ultrasound and blood work, to carefully guide our PCOS patients through a menstrual cycle. This process allows us to optimize the timing of ovulation and exposure of the egg to sperm in an effort to increase the chance of pregnancy.
Excess weight can be a cause or an effect of PCOS, a PCOS Catch-22. About 50% to 85% of women with PCOS are overweight or obese, which can exacerbate the features of PCOS. Another prominent, yet variable, clinical feature of PCOS is metabolic dysfunction, including abnormalities in the function of insulin, an important hormone that regulates the levels of blood sugar in your body. The development of insulin resistance increases the risk for the development of Type 2 diabetes, high blood pressure and even heart disease. Interestingly, the insulin resistance seen in patients with PCOS can occur independently of obesity, highlighting the inherent metabolic dysfunction associated with PCOS. Glucose metabolism dysfunction can also lead to obesity by promoting weight gain and thwarting weight loss.
PCOS is a common diagnosis in our practice. While there are medications and treatments to overcome the hormonal abnormalities that accompany PCOS, it's important for patients to understand how focusing on nutrition and weight loss can improve outcomes in PCOS. With just a 10% reduction in body weight, many women who don't ovulate on a regular basis can start to have regular periods and improve their chances of conceiving. A diet low in sugar can not only aid in weight loss but also slow the progression of the insulin resistance process to becoming Type 2 diabetes. Understanding what foods have sugar and the type of sugar you consume is important for everyone, but especially for PCOS patients.
Carbohydrates, including bread, pasta, rice and potatoes, are ultimately metabolized to sugar that the body utilizes as an energy source. Any amount of sugar not consumed for energy production is superfluous and contributes to higher circulating levels of glucose and, therefore, an increased demand for insulin. Limiting the amount of carbohydrates consumed is an excellent way of reducing sugar. Fortunately, protein, including fish, chicken, tofu and beans, are ultimately metabolized to their component amino acids, which the body also has the ability to utilize as an energy source. When a diet is rich in protein and limits carbohydrates, blood glucose is generally lower and easier to control.
How can you reduce carbohydrates and increase protein in your diet? I have a special interest (and degree) in nutrition, so let's break this down meal by meal. For breakfast, eggs are a great option – prepared any way you like. The addition of vegetables and low-fat cheese will not only keep you full but also make a delicious omelet. Reducing sugar in your morning coffee or tea by opting for a sugar-free creamer or reducing the amount you normally put in by half can also make a difference. When you get the munchies before lunchtime, consider a handful of raw almonds to get you through. These high protein nuts are a great source of protein. For lunch, focus on a big salad with a lean protein, like tuna, on top. Skip the croutons and be aware of the salad dressing you choose. Many have lots of sugar; olive oil and red wine vinegar create a healthy choice. For your afternoon slump, grab some nonfat Greek yogurt with berries. As far as fruits go, berries are generally lower in sugar compared to fruits like apples and bananas. Dinner should again focus on a lean protein like chicken or fish and vegetables. If you can't eliminate carbohydrates, make an effort to significantly reduce your intake. If rice usually takes up most of your plate, cut back gradually. Love ice cream and cookies? Satisfy your sweet tooth by munching on frozen fruit.
Making changes to your diet can be really difficult. But incorporating small, meaningful alterations to lower sugar in your diet and lose weight are well worth the effort. We've seen our patients rise to the challenge, and we've seen the fruits of their labor.
This article was originally published June 6, 2019, at 6:00 a.m. in the U.S. News & World Report. A link to the original article can be found here and a PDF version can be downloaded here.
