Strategies to prevent chronic disease in women with polycystic ovary syndrome (PCOS) should include individualized diet strategies and may involve a combination of insulin sensitizers, healthy eating, supplements and lifestyle changes, according to Angela Grassi, MS, RD, LDN, who is with The PCOS Nutrition Center in Bryn Mawr, Pennsylvania.
Grassi and co-presenter Hillary Wright, MEd, RDN, LDN, discussed this complex topic during a presentation at AADE 2015, the annual meeting of the American Association of Diabetes Educators.
Health professionals, she said, play an important role in the treatment of PCOS, noting the underdiagnosis and undertreatment are significant problems.
“Women with PCOS are at an increased risk for impaired glucose tolerance (IGT) and type 2 diabetes. Research suggests up to 50% of women with PCOS will have prediabetes or diabetes by age 40,” said Grassi.
“The Androgen Excess and PCOS Society recommends screening women with normal glucose every 2 years with an oral glucose tolerance test (OGTT) and yearly in those with IGT. Once a woman with PCOS develops IGT, there is a fast progression to type 2 diabetes. Diet and lifestyle modifications are the first-line approach for treating PCOS.”
Strategies to prevent chronic disease in women with polycystic ovary syndrome (PCOS) should include individualized diet strategies and may involve a combination of insulin sensitizers, healthy eating, supplements and lifestyle changes, according to Angela Grassi, MS, RD, LDN, who is with The PCOS Nutrition Center in Bryn Mawr, Pennsylvania.Treatment Strategies
Grassi said all women with PCOS should receive nutrition counseling with a registered dietitian nutritionist to prevent the onset of diabetes and other chronic diseases associated with the condition.
However, while diet and lifestyle are the primary treatment approaches to managing PCOS, newer medications like the glucagon-like peptide-1 (GLP-1) agonists have been shown to be more effective than metformin in helping women lose weight and abdominal fat in particular, she added.
“In addition, functional nutrition plays an important part in managing PCOS. For example, inositol, specifically myo-inositol and d-chiro inositol, has been shown to be an effective treatment for regulating menses, restoring hormone balance, reducing insulin and even improving egg quality, and it can do this all without the adverse effects that we see with other drugs like metformin or [GLP-1 agonists],” Grassi told Endocrinology Advisor.
“Also, NAC (N-acetylcysteine) has been shown in one randomized long-term study to be equally effective as metformin in regards to improving BMI, hirsutism, fasting insulin, free testosterone, cholesterol and menstrual irregularity.”
She said vitamin D may play an important role in insulin regulation as well. Studies in PCOS have shown an inverse relationship between vitamin D and metabolic risk factors, such as insulin resistance, BMI, triglycerides and HDL cholesterol.
Challenges for Women With PCOS
Unfortunately, women with PCOS have other unique challenges that can make weight loss more difficult than the average population, according to Grassi. These challenges include increased hunger and cravings, impaired levels of appetite-regulating hormones and hypoglycemia. Therefore, working with a registered dietitian nutritionist is essential to help women understand the nutrition requirements for PCOS and to provide the support to make lasting lifestyle and dietary modifications.
Grassi, who is the author of PCOS: The Dietitian's Guide, said women with PCOS tend to be yo-yo dieters, suffer from intense cravings and have impaired levels of ghrelin and leptin. Hypoglycemia, a higher prevalence of eating disorders and increased anxiety, depression and bipolar disorder are also common.
Grassi, who has also written a cookbook for women with PCOS, said medical nutrition therapy should include long-term goals of reducing body weight if the person is overweight, maintaining the weight loss after weight reduction and engaging in 30 minutes or more of moderate intensity activity most days of the week.
Effective Eating Plans
Endocrinologists now have many more tools to improve fertility, resolve metabolic syndrome and reduce risk factors for type 2 diabetes and cardiovascular disease (CVD), according to Grassi. Eating plans that have shown favorable effects on weight loss and metabolic parameters in PCOS include modifying glycemic index and glycemic load and modifying carbohydrate intake.
One study involving 27 women with PCOS compared a high-protein diet (>40% protein and 30% fat) with a standard-protein diet (<15% protein and 30% fat) and found that the high-protein diet decreased weight, body fat, waist circumference and glucose levels.1
However, the controlled trial was only 6 months long and demonstrated no differences between the two diets in terms of lipids or hormones.
Another study looked at a low glycemic index diet vs. a conventional diet in 96 overweight or obese women with PCOS. The 12-month study demonstrated that the low glycemic index diet resulted in better menstrual regularity and better insulin sensitivity.2
Additionally, a study involving 48 women with PCOS showed that the DASH diet significantly reduced insulin and C-reactive protein levels as well as waist and hip circumference measurements.
Grassi said overall helpful eating strategies include reducing carbohydrate intake, with an emphasis on low glycemic index carbohydrates, avoiding sugary and refined foods, and spreading intake of carbohydrates evenly throughout the day.
Clinicians may also want to measure vitamin D levels, according to Grassi, since one study suggested that supplementing vitamin D and calcium for 3 months had the potential to significantly decrease testosterone and blood pressure in women with PCOS. Fish oil, which can improve triglycerides, risk for nonalcoholic fatty liver disease, fertility and depression, may also be considered.
Disease prevention is vital, Grassi said, and that requires an empathetic, supportive and encouraging approach. She also advocates focusing on healthy eating and exercise rather than weight loss.
Written by: John Schieszer, MA
http://www.endocrinologyadvisor.com/aade-2015/aade-polycystic-ovary-syndrome-diabetes/article/431656/2/
References
Sørensen LB et al. Am J Clin Nutr. 2012;95(1):39-48.
Marsh KA et al. Am J Clin Nutr. 2010;92:83-92.
Asemi Z et al. Horm Metab Res. 2014;47(8):565-570.
Wright H, Grassi A. T20 – The Link Between PCOS, Prediabetes and Diabetes: Nutrition Strategies for Prevention. Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.
Sørensen LB et al. Am J Clin Nutr. 2012;95(1):39-48.
Marsh KA et al. Am J Clin Nutr. 2010;92:83-92.
Asemi Z et al. Horm Metab Res. 2014;47(8):565-570.
Wright H, Grassi A. T20 – The Link Between PCOS, Prediabetes and Diabetes: Nutrition Strategies for Prevention. Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.