For patients with PCOS, a common household ingredient may help improve symptoms of the disorder. However, lifestyle modifications that support weight loss and healthful eating remain key to improving symptoms.
Polycystic ovary syndrome (PCOS) is a perplexing hormonal disorder affecting women of reproductive age. It is estimated that 5% to 10% of women in their reproductive years have PCOS, but only up to 30% of those with the disorder have symptoms. Many times, women present with an isolated complaint, such as an inability to conceive or weight gain.
A common diagnostic criterion for PCOS is clinical and/or biochemical signs of hyperandrogenism, the etiology of which is not completely understood. This hormonal imbalance results in the symptoms of PCOS, which include infertility, menstrual irregularities (oligomenorrhea, amenorrhea, anovulation), ovarian cysts, weight gain and/or difficulty losing weight, thinning or loss of scalp hair, and excessive growth of body hair (eg, face, chest).
Women with PCOS also are at increased risk for diabetes, heart disease, and uterine cancer, which makes good nutrition a very important part of PCOS management.
The correlation between PCOS and insulin resistance has been well established. In fact, nearly all overweight women with PCOS have high insulin levels. Many women with PCOS have been treated with reasonable success with metformin, but the drug’s adverse effects, which can include gastrointestinal discomfort, respiratory issues, and musculoskeletal pain, can be intolerable for some patients.
Recently, there has been much attention given to minimizing PCOS through diet and weight loss. Up to 80% of PCOS patients are obese, and weight loss is a mainstay of treatment. Since nearly all of these women have high levels of insulin, managing insulin levels and reducing weight can lead to significant symptom improvements.
A weight loss of only 5% can reduce androgen levels which, in turn, can result in improved menstrual function and cholesterol levels and other related cardiovascular benefits. The reduced symptoms experienced by many of my patients with PCOS who have committed to lifestyle changes for weight loss are evidence that this option does work.
A sustainable weight loss program includes both a healthy diet and exercise. Women with PCOS should engage in some form of rigorous exercise for up to 1 hour daily most days of the week. Your patients must be motivated by, committed to, and educated about the benefits of a regular exercise routine. For some patients, the idea of going from sedentary to exercising 1 hour a day can be overwhelming, so a less daunting short-term goal may be more reasonable. Prescribing 15 minutes of exercise per day initially may be more effective than overwhelming a patient with an exercise goal of 1 hour.
Women today are busy, with more that 50% juggling the demands of careers, children, and home life. Along those lines, most women consider their ob/gyn to be their primary care doctor. Therefore, it is imperative that we start the conversation about initiating these healthful lifestyle changes.
Merely referring patients to a nutritionist or certified dietician not only “passes the buck” but also adds another item to our patients’ already long to-do list, which itself may be an obstacle in convincing our patients to adopt a lifestyle change. Furthermore, insurance coverage issues may add to their expenses, which may be an additional impediment. Simple guidelines (as those put forth here) along with educational materials may be just the impetus some patients need to commit to change. Remember to schedule follow-up visits so that they are incentivized to report progress to you.
White meat chicken
Foods With Low Glycemic Index
Whole grain bread
A general PCOS diet should be low in fat, predominantly plant-based, and comprised of lean protein and heart-healthy fats. Saturated and trans fats should be avoided, as should “junk food”-all of the obvious foods, including sugary drinks, sugared cereals, candy, cakes, cookies, ice cream, and salty and processed foods. Very importantly, patients should choose carbohydrates that have a low glycemic index (GI). Good carbohydrate choices, or those with a low GI, include whole-grain and high-fiber foods. (Whole grain foods are those made from the entire grain seed, which includes bran, germ, and endosperm.)
GI is a measurement of the potential of foods to raise blood glucose levels. Therefore, if a woman has insulin resistance because of PCOS, her ability to maintain normal to low blood glucose levels and to avoid spikes in blood glucose levels will have a direct affect on certain PCOS symptoms.
Most recently, there has been interest in the use of cinnamon to reduce insulin resistance in PCOS and even improve menstruation and fertility. Cinnamomum cassia’s active component, cinnamaldehyde, is most likely responsible for this biochemical interplay.
Cinnamon is available in a supplement powder or capsule, and the typical daily dose is 1 to 6 g. One teaspoon of cinnamon extract equals 3 g. Misuse of cinnamon is not benign. Significantly larger doses may cause gastrointestinal irritation, causing nausea, vomiting, and diarrhea. If cinnamon powder is inhaled, upper respiratory tract irritation may occur.
The benefits of cinnamon have been studied in patients with type 2 diabetes mellitus. However, in 2013, an FDA double-blinded clinical trial examining the use of cinnamon in patients with PCOS was performed at Columbia University Medical Center in New York City. The trial included 45 women with PCOS who were given either 1500 mg cinnamon supplements or placebo for 6 months. Although only 16 patients completed the trial-11 in the treatment group and 5 in the placebo group-the findings were encouraging. Patients who were randomized to the cinnamon group had improved menstrual cyclicity at the end of 6 months compared with those in the placebo group (3.82 cycles vs 2.2 cycles, respectively). Furthermore, 2 spontaneous pregnancies occurred in the treatment group.
PCOS, as with many other medical disorders today, may be reasonably managed with lifestyle modifications (weight loss, regular exercise, and a low GI diet) and perhaps even naturally with cinnamon. As clinicians, we must educate and encourage our patients accordingly.
Lobo RA. The complexities of polycystic ovarian syndrome. In: Advances in Gynecology. New York, NY: New York–Presbyterian; Oct/Nov 2013.
Redfern J. Combating polycystic ovary disease through diet. March 23, 2012. Available here. Accessed February 12, 2014.
Thompson J, Manore M. Nutrition for Life. 3rd ed. Upper Saddle River, NJ: Pearson Education, Inc; 2012.