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PCOS - What actually is it and how do we treat it ?

With Holly, Clinical Nutritionist at Kaptured Nutrition

Firstly, what is PCOS?

PCOS stands for Polycystic Ovarian syndrome, and as the name implies, it doesn’t necessarily mean you have to have cysts on your ovaries to be diagnosed. It is the leading cause of anovulatory infertility (meaning there is no ovulation to release an egg) (Cena et al., 2020). It affects 1 in 10 women causing disruption to menstruation and ovulation.

Basically, PCOS is broken down into 4 main types, however excessive production of androgens (for example testosterone), due to a increased production of luteinizing hormone (LH) and anti-Müllerian (AMH) from the pituitary gland in the brain, and lowered FSH (follicle stimulating hormone). This can also lead to a range of metabolic conditions such as elevated cholesterol and disturbed lipid profile despite body weight.

Typical symptoms include amenorrhoea (missing periods) or irregular periods, infertility (due to lack of ovulation), acne, hirsutism (Excessive hair growth around nipples, chin and cheeks), hair loss or thinning and weight gain.

The types

There are four main categories that PCOS can be broken into

1. Insulin resistant PCOS

Insulin resistant PCOS is where excess insulin drives androgen excess, driving testosterone production from the ovaries rather than oestrogen.

2. Post-pill PCOS

Oral contraceptive pill use can interrupt the HPO axis and lead to anovulation aswell as PCOS, through miscommunication from our brain to our ovaries.

3. Adrenal PCOS

Adrenal PCOS is when androgens such as testosterone are within range, however DHEAS (adrenal hormones) are elevated. This type is driven by stress and HPA (Hypothalamic pituitary adrenal) axis.

4. Inflammatory PCOS

This type of PCOS is driven by inflammation and exposure to environmental toxins, contributing to androgen production from the adrenals and the ovaries.

Treatment options

At Kaptured Nutrition, we prioritise a ‘test don’t guess’ mentality, where we order testing to establish what is exactly going on to enable us to give you the most individualised and effective treatment.

Here are some of Holly’s favourite treatment options

1. Insulin resistant PCOS

The biggest contributor to insulin resistance is sugar consumption, and therefore blood sugar regulation is a must. Treatment includes reducing refined sugar intake aswell as encouraging balanced and regular meals with protein, fats and carbohydrates (particularly complex carbohydrates like sweet potato and wholegrains). High fibre foods are also important. Adequate sleep and regular activity are essential for blood sugar uptake and utilisation.

Myo-inositol – Evidence suggests inositol reduces insulin and supports its functioning while also decreasing androgens and some metabolic markers making it perfect for PCOS (Unfer et al., 2016). It has also been shown to support ovulation in women taking inositol.

Alpha-lipoic acid, NAC and omega 3 fatty acids – They all have anti-inflammatory and antioxidant activity to improve insulin sensitivity (Genazzani et al., 2018; Song et al., 2020; Yang et al., 2018).

Vitamin D – Deficiency is often seen in PCOS and it has an important role in hormonal and metabolic modulation (Lerchbaum et al., 2012).

2. Post-pill PCOS

Eating nutrient dense foods including adequate fats and proteins to support the body and restore hormonal balance. This is while also supporting adrenal health through food and lifestyle.

B vitamins – B vitamins are depleted by the pill so it is important to top up stores where necessary.

Magnesium, zinc and vitamin C – These are also nutrients depleted by the pill and are also essential in hormonal production and hormonal balance.

3. Adrenal PCOS

Restoring the HPA axis and improving resilience to stress through blood sugar regulation, increasing fibre rich foods, regular meals and investigating drivers of sources of stress.

B-complex – B vitamins are essential for adrenal functioning and are depleted by stress.

L-glycine – An important amino acid for neurotransmitter synthesis while also being shown to be associated with decreased occurrence of metabolic complications in PCOS (Ye et al., 2022).

4. Inflammatory PCOS

Focusing on a Mediterranean diet full of healthy fats and protein including fish, nuts, seeds, legumes and wholegrains (packed with fibre), while limiting foods contributing to inflammatory load such as dairy, gluten and large amounts of red meat.

Omega 3 fatty acids – Essential source of omega 3 and EPA/DHA to reduce proinflammatory prostaglandin synthesis contributing to inflammation (Yang et al., 2018).

Curcumin – The active ingredient in turmeric, curcumin is a potent anti-inflammatory aswell as being investigated for reducing androgen production (Kamal et al., 2021).

NAC – N-Acetyl Cysteine converts to glutathione with is a potent antioxidant. It has also been compared to metformin for efficacy in PCOS (Song et al., 2020).

Let us know if any of this resonated with you and if you need any further support bookings with Holly are available here.

Kaptured Nutrition.

Reference List

Cena, H., Chiovato, L., & Nappi, R. E. (2020). Obesity, Polycystic Ovary Syndrome, and Infertility: A New Avenue for GLP-1 Receptor Agonists. The Journal of clinical endocrinology and metabolism, 105(8), e2695–e2709.

Genazzani, A. D., Shefer, K., Della Casa, D., Prati, A., Napolitano, A., Manzo, A., Despini, G., & Simoncini, T. (2018). Modulatory effects of alpha-lipoic acid (ALA) administration on insulin sensitivity in obese PCOS patients. Journal of endocrinological investigation, 41(5), 583–590.

Kamal, D., Salamt, N., Yusuf, A., Kashim, M., & Mokhtar, M. H. (2021). Potential Health Benefits of Curcumin on Female Reproductive Disorders: A Review. Nutrients, 13(9), 3126.

Lerchbaum, E., & Obermayer-Pietsch, B. (2012). Vitamin D and fertility: a systematic review. European journal of endocrinology, 166(5), 765–778.

Song, Y., Wang, H., Huang, H., & Zhu, Z. (2020). Comparison of the efficacy between NAC and metformin in treating PCOS patients: a meta-analysis. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 36(3), 204–210.

Unfer, V., Nestler, J. E., Kamenov, Z. A., Prapas, N., & Facchinetti, F. (2016). Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials. International journal of endocrinology, 2016, 1849162.

Yang, K., Zeng, L., Bao, T., & Ge, J. (2018). Effectiveness of Omega-3 fatty acid for polycystic ovary syndrome: a systematic review and meta-analysis. Reproductive biology and endocrinology : RB&E, 16(1), 27.

Ye, Z., Zhang, C., Wang, S., Zhang, Y., Li, R., Zhao, Y., & Qiao, J. (2022). Amino acid signatures in relation to polycystic ovary syndrome and increased risk of different metabolic disturbances. Reproductive biomedicine online, 44(4), 737–746.

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