Emma Cannon & Victoria Wells co-authors of FERTILE look what What Causes PCOS.
It is thought that PCOS affects 1 in 10 women of reproductive age and it is something that I increasingly come across in clinic. Rather like IBS (irritable bowel syndrome) has been used to define any digestive disorder, PCOS seems to be used to define any ovaries that have the appearance of cysts.
Ovulatory problems are actually the biggest cause of infertility in the UK, despite the reporting in the media who tends to focus solely on age as the cause of infertility. This can often make younger women who may well have been trying to conceive since their 20’s frustrated and isolated. The main problems traditionally associated with PCOS are menstrual cycle disturbances, including irregular or absent periods, weight gain, excess hair growth and skin conditions. Increasingly though I see slim women who often have a history of over exercising and excessive weight loss. PCOS is often a tricky condition to treat but we get good results from combining acupuncture with dietary advice.
In line with our ethos of integrated health we work collaboratively with a number of medical experts in this field and have many years of experience and success in supporting women with this condition.
Dietary advice for PCOS and insulin resistance aims to manage blood glucose and avoid insulin spikes. It is important to keep under control the insulin levels in your body through the type and timing of food consumed. The optimal diet for women with PCOS is unclear but women who follow a low glycemic index diet have better insulin sensitivity and this can help regulate menstrual function.
Insulin resistance in PCOS is independent of obesity (Attaran, 2010). Some lean women have insulin resistance but not all do. It is far less common in lean women with PCOS compared with obese women with PCOS but even without insulin resistance there may be impaired glucose tolerance.
Caloric balance and timing of meals
A study published in 2013 compared whether meal timing and calorie distribution influences insulin levels and androgen production in lean women with PCOS. The study compared a so-called breakfast diet (high caloric intake at breakfast, medium caloric intake at lunch and a low caloric intake at dinner) with a so-called dinner diet (low caloric intake at breakfast, medium caloric intake at lunch and a high caloric intake at dinner). The women on the breakfast diet had improved insulin sensitivity, lower androgens and improved ovulation rates whereas there was no change in these parameters observed in the women on the dinner diet. Although a small study of 60 women it indicates that meal timing and distribution is a consideration for women with PCOS.
A study in 2010 looked at the beneficial effects of a high-protein, low-glycemic load diet and concluded that increasing protein intake and lowering carbohydrate intake had a significant increase in insulin sensitivity in women with PCOS.
Dairy may trigger insulin production and diary contains insulin like growth factor 1. Women with PCOS can have higher than normal levels of IGF-1 and may respond to small amounts of IGF-1 in the diet.
The ovaries are oversensitive to IGF-1 and this may stimulate the production of male hormones causing acne and hirsutism. When these PCOS symptoms are present following a dairy free diet may be recommended.
A Word about Sugar
I will never forget more than 25 years ago Professor Wu saying to me “sugar makes the ovaries cystic”; back then I did not have the experience to really understand the mechanism behind his words. But now all these years later I believe there is so much wisdom in this statement. My generation lived on a diet of chardonnay and Haribos in a bid to not eat fat! As we all know, this information turned out to be misguided a perfect recipe for causing hormonal imbalances and yes, cystic ovaries. Thankfully the message is getting out there and these days there is much more awareness around food; but skipping meals, drinking juices, excessive alcohol all disrupt the hormonal system and add to the problem.
And as Prof Wu would say “eat little and regularly, chew your food well, eat mostly food that grows from the earth, eat the majority of your food early in the day and most importantly eat with joy in your heart”
Recommended supplement programme
Supplements have the potential to support the diet to improve egg quality, correct nutrient deficiencies and improve overall health and may help improve symptoms of PCOS. In addition to good quality fertility multi-vitamin to support reproductive hormones and prepare for a healthy conception and pregnancy the following supplements are recommended:
Omega-3 fatty acids
Good sources of omega-3 fatty acids in the diet reduce and control inflammation, improve insulin sensitivity, promote beneficial prostaglandins and may improve egg quality. Omega 3 fish oil supplement may help women with PCOS with beneficial effect on menstrual cyclicity and insulin resistance.
Vitamin D deficiency is common in women with polycystic ovary syndrome (estimated 85% of women with PCOS may be vitamin D deficient). Vitamin D deficiency may exacerbate PCOS symptoms with observational studies suggesting vitamin D deficiency is associated with insulin resistance, ovulatory and menstrual irregularities, lower pregnancy success, hirsutism, hyperandrogenism, obesity and elevated cardiovascular disease risk factors.
Many women with PCOS have an inositol deficiency. Inositol is active in cell to cell communication, important for the development and maturation of eggs and regulates hormone meditated functions including insulin pathway.
There is evidence that supplementing with myo-inositol may improve menstrual regularity, ovulation rate and improve insulin sensitivity and glucose tolerance.
Choose a brand providing myo-inositol not D-chiro-inositol (that may worsen the quality of oocytes (egg cell).
A balanced microbiome is important for the health of your digestive system. It regulates the immune response and inflammation, produces vitamins, protects against bacteria that cause disease, controls appetite and helps maintain a healthy weight and supports emotional health.
There are many factors that influence our gut microbiome. It is largely genetic but also influenced by nutrition and lifestyle. Antibiotics and poor dietary choices can compromise the balance of the gut microbiome. The key to a gut-friendly diet is fibre and variety and good probiotic food sources. It only takes a few days of a low fibre diet for the microbe population in the gut to change and other factors affect it including stress and sleep deprivation. Avoid probiotic drinks that can have added sugar and artificial sweeteners.
Taking a probiotic supplement can help restore gut health and is helpful whilst gradually introducing probiotic foods into the diet and recommended when travelling or after a course of antibiotics to help repopulate the gut. I recommend taking a supplement for three months to help regulate bowel movement and increase beneficial bacteria to improve gut health.
Environmental hormone disrupters
I advise women with PCOS to reduce exposure to commonly used chemicals that are potential hormone disrupters. This includes BPA used in the manufacture of plastic including the lining of food tins and the plastic cups used to serve hot drinks.
The Mind and PCOS
Frustration, irritability and depression are all signs that the Qi energy of the body, in particular the Liver, is Stagnant and congested which may affect the release of an egg. Feelings of anguish or anxiety particularly affect the Heart energy, which may also delay ovulation since in Chinese Medicine theory the Heart is very much connected to our reproductive systems. So in any program that supports PCOS it is important to support yourself emotionally and reduce stress and anxiety.
I often say to patients “there are 2 kinds of stress, stress that we can not avoid and stress of our own making”. Stress of our own making is the stress that you need to reduce; this is actually the most damaging stress. Research demonstrates that when we worry about being stressed this causes more harm to the system than say the stress of getting to work or the stress caused by external influences. Acupuncture is the perfect tool to help you address these issues and reduce the impact of stress on the body/mind system.
Emma Cannon & Victoria Wells co-authors of FERTILE (Vermillion 2017)