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Insulin Management

Nutritional Pearls: Polycystic Ovary Syndrome

Sara is a 45-year-old female who has recently been diagnosed with polycystic ovary syndrome. She visits you today to ask if there are any dietary adjustments you would recommend to better control her high insulin levels and obesity to prevent the onset of type 2 diabetes.

How would you advise her?

What is the correct answer?
(Answer and discussion on next page)

 

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Answer: The DASH diet helps treat effects of PCOS.

Polycystic ovary syndrome (PCOS) affects as many as 18% of women worldwide. Despite its name, it is an endocrine disorder that is not directly caused by the ovaries—it is a combination of several different hormonal and metabolic disorders.

What is PCOS?

In PCOS, multiple cysts on the ovaries are believed to represent failed ovulation, which is also reflected by the infrequent or completely absent menstruation and infertility that is a symptom of the syndrome. Women with PCOS might not necessarily have cysts on their ovaries, but they do usually have increased levels of androgen (symptoms of which include hirsutism or acne) and some level of metabolic syndrome—which includes high insulin levels, insulin resistance, and a tendency toward abdominal obesity, and put them at higher risk of developing type 2 diabetes.

This combination of disorders leads to poor lipid panels as well as higher markers of oxidative stress—which likely contributes to a higher risk of breast, endometrial, and ovarian cancers.
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Treatment

There is no specific cure for PCOS, but some of the symptoms of the disease may be relieved by weight loss and exercise along with oral contraceptives and metformin. Researchers in Iran noted that there have been reports that a 5% loss of body weight in obese women with PCOS seemed to help alleviate symptoms, as did a low-glycemic index diet.1 Since the Dietary Approaches to Stop Hypertension (DASH) diet has been shown to help treat type 2 diabetes and metabolic syndrome in addition to high blood pressure, would the same diet also help treat the symptoms of PCOS?1

The Research

To find out, researchers recruited 96 clinically overweight or obese women with PCOS (ages 18 and 40) to participate in an 8-week dietary trial. The women were randomly assigned to either a low-glycemic index diet or the DASH diet. Both diets were designed to provide 52% of calories from carbohydrates (18% from protein and 30% of calories from total fat) and were calibrated for each woman’s caloric needs at levels designed to induce moderate weight loss.

Each woman was counseled with respect to the requirements of their assigned diet and was given sample 7-day menus to help them with meal planning. Every 2 weeks the participants filled out 3-day food diaries to help researchers assess their adherence to their assigned diet. Researchers measured the participant’s blood sugar levels, cholesterol scores, antioxidant capacity, glutathione levels as well as weight at the start and conclusion of the study.

The Results

After assessing the participants’ food diaries at the conclusion of the 8-week study, the researchers could see that the 2 groups ate essentially the same amounts of carbohydrates, protein, and fats. Individuals following the DASH diet consumed more whole grains (although fewer grains overall), far less sugar, and more vegetables, fruits, nuts, seeds, and legumes. Individuals on the DASH diet lost more weight (average 2x as much) and had lower triglycerides and insulin levels along with higher levels of antioxidant capacity and higher levels of glutathione.

What’s the “Take Home”?

It's good to see more specific dietary recommendations for PCOS other than “lose weight.” The DASH diet can be a valuable tool for these particular patients. Here are some resources to learn more about the practical application:

Reference:

1. Asemi Z, Samimi M, Tabassi Z, et al. Effects of DASH diet on lipid profiles and biomarkers of oxidative stress in overweight and obese women with polycystic ovary syndrome: a randomized clinical trial. Nutrition. 2014;30(11-12):1287-1293.