PHYSIOLOGY OF POLYCYSTIC OVARY SYNDROME: ITS CLINICAL AND NUTRITIONAL INTERVENTIONS

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PHYSIOLOGY OF POLYCYSTIC OVARY SYNDROME: ITS CLINICAL AND NUTRITIONAL INTERVENTIONS

  1. 1. PHYSIOLOGY OF POLYCYSTIC OVARYSYNDROME: ITS CLINICAL ANDNUTRITIONAL INTERVENTIONS POULAMI DASGUPTA MSc.FOOD AND NUTRITION PREVIOUS
  2. 2. PCOD vs. PCOS WHAT IS PCOD?•This disease exists where there is an imbalance ofhormones which cause cysts to develop•There is a gathering of developing or mature eggs, which areinside the ovary, but for some reason, cannot be released•This cycle continues every month and finally results in quite a fewhealth issues for women•A number of incidents can trigger a shift in the normal flow ofhormones such as stress, poor diets, and including too much or notenough insulin•The symptoms involve irregular periods, hair loss, temporaryinfertility, 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 thename of U.S.gynaecologist I.F.Stein and ObstetricianM.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, difficultyconceiving, and skin irritationOf the two diseases, PCOS is the most serious, although bothconditions 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 ofinfertility. However, these symptoms will not show up inwomen 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 (Nobels 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 someevidence suggests that patients have a functionalabnormality of CYTOCHROME P450 C17 whichis the rate-limiting enzyme in androgen biosynthesis•CYTOCHROME P450C17 is active in theadrenals and ovaries, and excess activity of thisenzyme could explain the increased androgenproduction
  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 cancerUNLIKELY Breast cancer
  8. 8. TESTS FOR DETECTING PCOS•An enlarged clitoris (very rare finding) and enlargedovaries•Diabetes, high blood pressure, and high cholesterol arecommon findings, as are weight gain and obesity•Increased Weight & BMI, and abdominal circumference arehelpful in determining risk factorsLevels of different hormones that may be testedinclude:•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 glucoseintolerance 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, andpossibly biopsy the ovaries
  10. 10. SYMPTOMS CHANGES IN THE MENSTRUAL CYCLE•Absent periods, usually with a history of having one or more normalmenstrual periods during puberty (secondary amenorrhea)•Irregular menstrual periods, which may be more or less frequent, andmay 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 asaround 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 VULGARISAND HIRUTISM
  12. 12. ANXIETY, MOOD DISORDERS IN ALL WOMEN WITH PCOS•Low self-esteem, poor body image, and fears about future healthproblems, including infertility, and perceived lack of effectivetreatment, 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 phobiain women with PCOS and•one of two studies reported a higher prevalence of obsessivecompulsive disorder (OCD)However studies say more research is needed to clearly define theprevalence 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 normalranges 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 ovarianhyperandrogenism.
  14. 14. INSULINRESISTANCE
  15. 15. TREATMENT•Losing weight (which can be difficult) has been shown to helpwith diabetes, high blood pressure, and high cholesterol. Even aweight loss of 5% of total body weight has been shown to helpwith the imbalance of hormones and also with infertilityMedications used to treat the abnormal hormones andmenstrual cycles of polycystic ovary syndrome include:•Birth control pills or progesterone pills, to help make menstrualcycles more regular
  16. 16. METFORMIN : can improve the symptoms of PCOSand sometimes will cause the menstrual cycles tonormalize•also makes cells more sensitive to insulin, and mayhelp make ovulation and menstrual cycles moreregular, prevent type 2 diabetes, and add to weight losswhen a diet is followed•Use of LH-releasing hormone (LHRH) analogs•Anti-androgen medications, unwanted hair removalusing laser-non laser light sources, treatment withMYO (L-Myo-Inositol-1-Phosphate), PELVICLAPAROSCOPY to treat anovulation and infertilityare 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 haveimpaired glucose tolerance should have a comprehensiveprogram of diet and exercise to reduce their risk of developingdiabetes 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 beenrecommended for PCOS patients•Increased fiber; decreased refined carbohydrates (LOW GIFOODS), Tran’s fats, and saturated fats; increased omega-3 andomega-9 fatty acids•However, others have shown that in obese patients with PCOS,weight loss improves menstrual regularity; the type of diet useddid not matter
  19. 19. •Omega-3 fatty acid supplementation has beenshown to reduce liver fat content and othercardiovascular risk factors in women withPCOS, including those with hepatic steatosis,although these effects have not yet been provento translate into a reduction in cardio metabolicevents•Women with abnormal lipid profile need to becounseled on ways to manage the dyslipidemia.Such measures include eating a diet low incholesterol and saturated fats and increasingphysical activity
  20. 20. MULTIVITAMIN AND MINERAL VITAMIN DEvidence suggests that vitamin D deficiency may contribute tothe development of the metabolic syndrome, and one studyfound insufficient levels of 25-hydroxyvitamin D (< 30 ng/ml)in almost three quarters of PCOS patients, with lower levels inthose with the metabolic syndrome than in those without (17.3vs. 25.8 ng/ml, respectively)
  21. 21. B VITAMINS•Vitamins B2, B3, B5 and B6 are particularly useful for controllingweight•Vitamin B2 helps to turn fat, sugar and protein into energy•B3 is a component of the glucose tolerance factor (GTF), which isreleased every time blood sugar rises, and vitamin B3 helps to keepthe levels in balance•B6 is also important for maintaining hormone balance and, togetherwith B2 and B3, is necessary for normal thyroid hormone production• So any deficiencies in these vitamins can affect thyroid functionand consequently affect the metabolism
  22. 22. CHROMIUM/CHROMIUM PICOLINATE•It helps to encourage the formation of glucose tolerance factor (GTF) which is asubstance released by the liver and required to make insulin more efficient•A deficiency of chromium can lead to insulin resistance, which is a key problemin the case of PCOS; too much insulin can be circulating but it is unable tocontrol one’s blood sugar (glucose) levels•Chromium is the most widely researched mineral used in the treatment ofoverweight•It helps to control cravings and reduces hunger, also helps to control fat andcholesterol in the blood•One study showed that people who took chromium over a ten-week period lostan average of 1.9kg (4.2lb) of fat while those on a placebo (sugar tablet) lost only0.2kg (0.4lb) Warning:A diabetic and on medication, one should speak to their doctor before takingchromium
  23. 23. ZINC•Important mineral for appetite control and a deficiency can cause a loss of taste andsmell, creating a need for stronger-tasting foods, including those that are saltier, sugaryand/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 hormoneMAGNESIUMMagnesium levels have been found to be low in people with diabetes and there is astrong link between magnesium deficiency and insulin resistance. It is, therefore, animportant mineral to include magnesium if suffering from PCOSCO-ENZYME Q10This vitamin-like substance, is important for energy production and normalcarbohydrate metabolism .One study showed that people on a low-fat diet doubled their weight loss when theysupplemented with Co-Q10 as compared to those who did not take it. Co-Q10 has alsobeen proved useful in controlling blood sugar levels
  24. 24. HERBS : SAW PALMETTOSaw palmetto works by inhibiting 5 alpha reductase, akey enzyme in the breakdown of testosterone intodihydrotestosterone (DHT) and hence can keepandrogen levels low STINGING NETTLEThere is some evidence that Stinging nettle can helpreduce the conversion of testosterone intodihydrotestosterone, a more potent form of thehormone
  25. 25. GARCINIA CAMBOGIAGarcinia cambogia is a small tropical fruit called the Malabartamarind’It contains HCA (hydroxy-citric acid) which enables carbohydrates tobe turned into usable energy instead of being deposited as fatThe HCA in this fruit seems to curb appetite, reduce food intake andinhibit 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 5thEdition 5)International Journal of Obesity (2004) 28, 1026–1032.doi:10.1038/sj.ijo.0802661 Published online 25 May 20046)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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