PHYSIOLOGY OF POLYCYSTIC OVARY
SYNDROME: ITS CLINICAL AND
NUTRITIONAL INTERVENTIONS
POULAMI DASGUPTA
MSc.FOOD AND
NUTRITIO...
PCOD vs. PCOS
WHAT IS PCOD?
•This disease exists where there is an imbalance of
hormones which cause cysts to develop
•Th...
WHAT IS PCOS?
Also known as STEIN-LEVENTHAL SYNDROME (in the
name of U.S.gynaecologist I.F.Stein and Obstetrician
M.L.Le...
 Excessive ovarian stimulation caused by the
progressively rising insulin and insulin like
growth factor - I (IGF-I) leve...
CAUSES
•The cause of PCOS is unknown, although some
evidence suggests that patients have a functional
abnormality of CYTOC...
DEFINITE
 Type 2 diabetes
 Dyslipidemia (Hypercholesterolemia with
diminished HDL2 and increased LDL)
 Endometrial canc...
POSSIBLE
 Hypertension
 Cardiovascular disease
 Gestational diabetes mellitus
 Pregnancy-induced hypertension
 Ovaria...
TESTS FOR DETECTING PCOS
•An enlarged clitoris (very rare finding) and enlarged
ovaries
•Diabetes, high blood pressure, an...
Other blood tests that may be done include:
•Fasting glucose and other tests for glucose
intolerance and insulin resistan...
SYMPTOMS
CHANGES IN THE MENSTRUAL CYCLE
•Absent periods, usually with a history of having one or more normal
menstrual per...
ACNE
VULGARIS AND
HIRUTISM
ANXIETY, MOOD DISORDERS IN ALL WOMEN WITH
PCOS
•Low self-esteem, poor body image, and fears about future health
problems, ...
ENDOCRINE ABNORMALITIES
GONADOTROPINS
Elevated mean serum concentrations of LH
ANDROGENS
Elevated Serum concentrations o...
INSULIN
RESISTANCE
TREATMENT
•Losing weight (which can be difficult) has been shown to help
with diabetes, high blood pressure, and high chol...
METFORMIN : can improve the symptoms of PCOS
and sometimes will cause the menstrual cycles to
normalize
•also makes cells ...
NUTRITIONAL
INTERVENTIONS
IN PCOS:
MACRONUTRIENTS,
MICRONUTRIENTS
AND
HERBS
DIET
•Patients with polycystic ovarian syndrome (PCOS) who have
impaired glucose tolerance should have a comprehensive
pro...
•Omega-3 fatty acid supplementation has been
shown to reduce liver fat content and other
cardiovascular risk factors in wo...
MULTIVITAMIN AND MINERAL
VITAMIN D
Evidence suggests that vitamin D deficiency may contribute to
the development of the me...
B VITAMINS
•Vitamins B2, B3, B5 and B6 are particularly useful for controlling
weight
•Vitamin B2 helps to turn fat, sugar...
CHROMIUM/CHROMIUM PICOLINATE
•It helps to encourage the formation of glucose tolerance factor (GTF) which is a
substance r...
ZINC
•Important mineral for appetite control and a deficiency can cause a loss of taste and
smell, creating a need for str...
HERBS : SAW PALMETTO
Saw palmetto works by inhibiting 5 alpha reductase, a
key enzyme in the breakdown of testosterone int...
GARCINIA CAMBOGIA
Garcinia cambogia is a small tropical fruit called the 'Malabar
tamarind’
It contains HCA (hydroxy-cit...
REFERENCES
1)www.nutritionandmetabolism.com
2)www.nutritionj.com
3)Introduction to Human Nutrition 2nd Edition Ed. Gibney,...
PHYSIOLOGY OF POLY CYSTIC OVARY-CLINICAL MANIFESTATIONS AND NUTRITIONAL INTERVENTIONS
PHYSIOLOGY OF POLY CYSTIC OVARY-CLINICAL MANIFESTATIONS AND NUTRITIONAL INTERVENTIONS
PHYSIOLOGY OF POLY CYSTIC OVARY-CLINICAL MANIFESTATIONS AND NUTRITIONAL INTERVENTIONS
PHYSIOLOGY OF POLY CYSTIC OVARY-CLINICAL MANIFESTATIONS AND NUTRITIONAL INTERVENTIONS
PHYSIOLOGY OF POLY CYSTIC OVARY-CLINICAL MANIFESTATIONS AND NUTRITIONAL INTERVENTIONS
PHYSIOLOGY OF POLY CYSTIC OVARY-CLINICAL MANIFESTATIONS AND NUTRITIONAL INTERVENTIONS
PHYSIOLOGY OF POLY CYSTIC OVARY-CLINICAL MANIFESTATIONS AND NUTRITIONAL INTERVENTIONS
PHYSIOLOGY OF POLY CYSTIC OVARY-CLINICAL MANIFESTATIONS AND NUTRITIONAL INTERVENTIONS
PHYSIOLOGY OF POLY CYSTIC OVARY-CLINICAL MANIFESTATIONS AND NUTRITIONAL INTERVENTIONS
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PHYSIOLOGY OF POLY CYSTIC OVARY-CLINICAL MANIFESTATIONS AND NUTRITIONAL INTERVENTIONS

  1. 1. PHYSIOLOGY OF POLYCYSTIC OVARY SYNDROME: ITS CLINICAL AND NUTRITIONAL INTERVENTIONS POULAMI DASGUPTA MSc.FOOD AND NUTRITION PREVIOUS
  2. 2. PCOD vs. PCOS WHAT IS PCOD? •This disease exists where there is an imbalance of hormones which cause cysts to develop •There is a gathering of developing or mature eggs, which are inside the ovary, but for some reason, cannot be released •This cycle continues every month and finally results in quite a few health issues for women •A number of incidents can trigger a shift in the normal flow of hormones such as stress, poor diets, and including too much or not enough insulin •The symptoms involve irregular periods, hair loss, temporary infertility, or fat collection in the abdominal area •The simplest treatment is hormone medication
  3. 3. WHAT IS PCOS? Also known as STEIN-LEVENTHAL SYNDROME (in the name of U.S.gynaecologist I.F.Stein and Obstetrician M.L.Leventhal) (Taber’s Medical Dictionary,20th Edition) Hormone inconsistencies results in no release of ovum The ovaries starts to produce high levels of testosterones, causing the hormones to cause imbalance Increase in weight, irregular cycles, loss of hair, difficulty conceiving, and skin irritation Of the two diseases, PCOS is the most serious, although both conditions can be treated with pills and intravenous medication COMPARISON Both conditions are contributors of unstable hormones, irregular cycles, loss of hair, weight gain, and some form of infertility. However, these symptoms will not show up in women until they are well into their twenties
  4. 4.  Excessive ovarian stimulation caused by the progressively rising insulin and insulin like growth factor - I (IGF-I) levels during puberty induces a PCOS in predisposed girls (Nobel's and Devailly Fertil Steril 1992)  5-alfa reductase activity is stimulated by iGF-I. This intensifies the hirsute response in hyper androgenic patients (Speroff 1993)
  5. 5. CAUSES •The cause of PCOS is unknown, although some evidence suggests that patients have a functional abnormality of CYTOCHROME P450 C17 which is the rate-limiting enzyme in androgen biosynthesis •CYTOCHROME P450C17 is active in the adrenals and ovaries, and excess activity of this enzyme could explain the increased androgen production
  6. 6. DEFINITE  Type 2 diabetes  Dyslipidemia (Hypercholesterolemia with diminished HDL2 and increased LDL)  Endometrial cancer
  7. 7. POSSIBLE  Hypertension  Cardiovascular disease  Gestational diabetes mellitus  Pregnancy-induced hypertension  Ovarian cancer UNLIKELY  Breast cancer
  8. 8. TESTS FOR DETECTING PCOS •An enlarged clitoris (very rare finding) and enlarged ovaries •Diabetes, high blood pressure, and high cholesterol are common findings, as are weight gain and obesity •Increased Weight & BMI, and abdominal circumference are helpful in determining risk factors Levels of different hormones that may be tested include: •Estrogen levels •FSH levels •LH levels •Male hormone (testosterone) levels •17-ketosteroids
  9. 9. Other blood tests that may be done include: •Fasting glucose and other tests for glucose intolerance and insulin resistance •Lipid levels •Pregnancy test (serum HCG) •Prolactin levels •Thyroid function tests Other tests may include: •Vaginal ultrasound to look at the ovaries •Pelvic laparoscopy to look more closely at, and possibly biopsy the ovaries
  10. 10. SYMPTOMS CHANGES IN THE MENSTRUAL CYCLE •Absent periods, usually with a history of having one or more normal menstrual periods during puberty (secondary amenorrhea) •Irregular menstrual periods, which may be more or less frequent, and may range from very light to very heavy •Development of male sex characteristics (Virilization) •Decreased breast size •Deepening of the voice •Enlargement of the clitoris •Increased body hair on the chest, abdomen, and face, as well as around the nipples (called hirsute) •Thinning of the hair on the head, called male-pattern baldness OTHER SKIN CHANGES •Acne that gets worse •Dark or thick skin markings and creases around the armpits, groin, neck, and breasts due to insulin sensitivity
  11. 11. ACNE VULGARIS AND HIRUTISM
  12. 12. ANXIETY, MOOD DISORDERS IN ALL WOMEN WITH PCOS •Low self-esteem, poor body image, and fears about future health problems, including infertility, and perceived lack of effective treatment, all of which may make them anxious (Dr. Dokras et.al. November 29 , online report in Fertility and Sterility) •Two of three studies reported a higher prevalence of social phobia in women with PCOS and •one of two studies reported a higher prevalence of obsessive compulsive disorder (OCD) However studies say more research is needed to clearly define the prevalence of anxiety disorders in adolescents with PCOS
  13. 13. ENDOCRINE ABNORMALITIES GONADOTROPINS Elevated mean serum concentrations of LH ANDROGENS Elevated Serum concentrations of testosterone and androstenedione ESTROGENS Serum concentrations of estradiol (both total and free) lie within the normal ranges for the early follicular and mid-follicular phases of the cycle PROLACTIN AND GROWTH HORMONE Less common hyperprolactinemia and impaired secretion of growth hormone. The prevalence has been reported to be between 5 and 30 percent METABOLIC ABNORMALITIES Characterized by extreme insulin resistance associated with ovarian hyperandrogenism.
  14. 14. INSULIN RESISTANCE
  15. 15. TREATMENT •Losing weight (which can be difficult) has been shown to help with diabetes, high blood pressure, and high cholesterol. Even a weight loss of 5% of total body weight has been shown to help with the imbalance of hormones and also with infertility Medications used to treat the abnormal hormones and menstrual cycles of polycystic ovary syndrome include: •Birth control pills or progesterone pills, to help make menstrual cycles more regular
  16. 16. METFORMIN : can improve the symptoms of PCOS and sometimes will cause the menstrual cycles to normalize •also makes cells more sensitive to insulin, and may help make ovulation and menstrual cycles more regular, prevent type 2 diabetes, and add to weight loss when a diet is followed •Use of LH-releasing hormone (LHRH) analogs •Anti-androgen medications, unwanted hair removal using laser-non laser light sources, treatment with MYO (L-Myo-Inositol-1-Phosphate), PELVIC LAPAROSCOPY to treat anovulation and infertility are some of the treatments for PCOS
  17. 17. NUTRITIONAL INTERVENTIONS IN PCOS: MACRONUTRIENTS, MICRONUTRIENTS AND HERBS
  18. 18. DIET •Patients with polycystic ovarian syndrome (PCOS) who have impaired glucose tolerance should have a comprehensive program of diet and exercise to reduce their risk of developing diabetes mellitus •In addition, obese women with PCOS can benefit from a low- calorie diet for weight reduction •A diet patterned after the type 2 diabetes diets have been recommended for PCOS patients •Increased fiber; decreased refined carbohydrates (LOW GI FOODS), Tran’s fats, and saturated fats; increased omega-3 and omega-9 fatty acids •However, others have shown that in obese patients with PCOS, weight loss improves menstrual regularity; the type of diet used did not matter
  19. 19. •Omega-3 fatty acid supplementation has been shown to reduce liver fat content and other cardiovascular risk factors in women with PCOS, including those with hepatic steatosis, although these effects have not yet been proven to translate into a reduction in cardio metabolic events •Women with abnormal lipid profile need to be counseled on ways to manage the dyslipidemia. Such measures include eating a diet low in cholesterol and saturated fats and increasing physical activity
  20. 20. MULTIVITAMIN AND MINERAL VITAMIN D Evidence suggests that vitamin D deficiency may contribute to the development of the metabolic syndrome, and one study found insufficient levels of 25-hydroxyvitamin D (< 30 ng/ml) in almost three quarters of PCOS patients, with lower levels in those with the metabolic syndrome than in those without (17.3 vs. 25.8 ng/ml, respectively)
  21. 21. B VITAMINS •Vitamins B2, B3, B5 and B6 are particularly useful for controlling weight •Vitamin B2 helps to turn fat, sugar and protein into energy •B3 is a component of the glucose tolerance factor (GTF), which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance •B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid hormone production • So any deficiencies in these vitamins can affect thyroid function and consequently affect the metabolism
  22. 22. CHROMIUM/CHROMIUM PICOLINATE •It helps to encourage the formation of glucose tolerance factor (GTF) which is a substance released by the liver and required to make insulin more efficient •A deficiency of chromium can lead to insulin resistance, which is a key problem in the case of PCOS; too much insulin can be circulating but it is unable to control one’s blood sugar (glucose) levels •Chromium is the most widely researched mineral used in the treatment of overweight •It helps to control cravings and reduces hunger, also helps to control fat and cholesterol in the blood •One study showed that people who took chromium over a ten-week period lost an average of 1.9kg (4.2lb) of fat while those on a placebo (sugar tablet) lost only 0.2kg (0.4lb) Warning: A diabetic and on medication, one should speak to their doctor before taking chromium
  23. 23. ZINC •Important mineral for appetite control and a deficiency can cause a loss of taste and smell, creating a need for stronger-tasting foods, including those that are saltier, sugary and/or spicier (in other words, often more fattening!) •Also necessary for the correct action of many hormones, including insulin •Also functions together with vitamins A and E in the manufacture of thyroid hormone MAGNESIUM Magnesium levels have been found to be low in people with diabetes and there is a strong link between magnesium deficiency and insulin resistance. It is, therefore, an important mineral to include magnesium if suffering from PCOS CO-ENZYME Q10 This vitamin-like substance, is important for energy production and normal carbohydrate metabolism . One study showed that people on a low-fat diet doubled their weight loss when they supplemented with Co-Q10 as compared to those who did not take it. Co-Q10 has also been proved useful in controlling blood sugar levels
  24. 24. HERBS : SAW PALMETTO Saw palmetto works by inhibiting 5 alpha reductase, a key enzyme in the breakdown of testosterone into dihydrotestosterone (DHT) and hence can keep androgen levels low STINGING NETTLE There is some evidence that Stinging nettle can help reduce the conversion of testosterone into dihydrotestosterone, a more potent form of the hormone
  25. 25. GARCINIA CAMBOGIA Garcinia cambogia is a small tropical fruit called the 'Malabar tamarind’ It contains HCA (hydroxy-citric acid) which enables carbohydrates to be turned into usable energy instead of being deposited as fat The HCA in this fruit seems to curb appetite, reduce food intake and inhibit the formation of fat and cholesterol It seems to be particularly helpful when teamed with chromium AGNUS CASTUS (VITEX/CHASTETREE BERRY) This is one of the most important herbs for PCOS because it helps to stimulate and normalize the function of the pituitary gland, which controls the release of LH (luteinizing hormone)
  26. 26. REFERENCES 1)www.nutritionandmetabolism.com 2)www.nutritionj.com 3)Introduction to Human Nutrition 2nd Edition Ed. Gibney,Lanham New,Vorster 4)Gropper,Smith,Groff Advanced Nutrition and Human Metabolism 5th Edition 5)International Journal of Obesity (2004) 28, 1026–1032. doi:10.1038/sj.ijo.0802661 Published online 25 May 2004 6)Daya S: Luteal support: progestogens for pregnancy protection. Maturitas 2009, 65 Suppl 1:S29-S34. 7)Alpert PT, Shaikh U: The effects of vitamin D deficiency and insufficiency on the endocrine and paracrine systems.Biol Res Nurs 2007, 9(2):117-129.

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