2. What is PCOS
is a complex disorder that usually begins during
puberty and affects women of reproductive age
characterized in most cases by multiple small cysts
that develop on the ovaries.
the ovaries are firm and globular with a thick,
white capsular surface that may show bulges from
underlying cysts . (Ginsberg & harvard,1976)
3.
4. Introduction
Causes :
Polycystic ovary syndrome is related to an
imbalance in sex hormones.
Female sex hormones include :
1) estrogen
2)progesterone
3) male hormone called androgene
(Ginsberg and Havard,1977)
6. Introduction
Concentration of LH increase relative to that of
FSH the ovary synthesise androgen
Increase androgen production in women with
PCOS is augmanted by increase LH and is
assossiation with anovulation .
7. Introduction
Possible Complications
1)Increased risk of endometrial cancer
2) Infertility
3) Obesity (BMI over 30 and waist circumferance
greater than 35)
4) conditions, such as high blood pressure, heart
problems, and diabetes
5)Possible increased risk of breast cancer
8. Introduction
Diagnosis
Difficult to diagnosis
Heterogeneous symptoms
Vary over time
Transvaginal ultrasound is one of the main tools to
diagnosing PCOS. The images found on the ultrasound, in
conjunction with the results of blood tests and a thorough
patient history and physical, are used to diagnose this
syndrome.
10. Symptoms of PCOS
•The feature of (PCOS) usually begins around
menarche (Ehermann, 2005).
•The typical biochemical features of PCOS include
hyperandrogenaemia and an increase of serum
luteinising hormone (LH) and testosterone with
normal follicle stimulating hormone
11. Symptoms of PCOS
pcos symptoms
Insulin resistance
Histrutism
Acne
Amenorrhoea Low HDL
High tostosterone
High Triglyceride
Obesity
15. PCOS & Obesity
More than 40% of PCOS patients are obese
(Guzick .2004).
Even in individuals with a non obese BMI, a higher waist-to-
hip ratio is seen in those with PCOS
At least one abnormal lipid level is seen in 70% of women
with PCOS The pattern of dyslipidemia (sharpless ,2003 ).
weight loss may be expected to have several beneficial effects
upon clinical, endocrinological and metabolic features of
obese women presenting with PCOS(barber,2006 )
17. Study : heterogeneity in the responsiveness to long-term life style
intervention and predictablity in PCOS women
Methods One hundred PCOS women meeting the
criteria for selection were invited to participate and
65 of them agreed. Lifestyle intervention had
consisted of a 1200–1400kcal/day diet for 6 months,
followed by mild calorie restriction and physical
activity. The protocol, which was similar at
baseline and follow-up, included anthropometry,
clinical evaluation, pelvic ultrasound, and
laboratory investigations. The mean follow-up
period was 20.4±12.5 months.
18. Results After the follow-up period, women were
reclassified into three groups according to the
persistence (group 1, 15.4%), partial (group 2, 47.7%),
or complete (group 3, 36.9%) disappearance of the
categorical features of PCOS (hyperandrogenism,
menses, and ovulatory dysfunctions).
Duration of the follow-up and extent of weight loss
were similar among the three groups, as were fasting
and glucose-stimulated insulin and indices of insulin
resistance. Baseline waist circumference, waist to hip
ratio (WHR), and androstenedione blood levels were
negatively correlated with a better outcome .
19. Conclusions Responsiveness to weight loss in
overweight/obese PCOS women varies
considerably and more than one third of
women may achieve full recovery. These
findings add new perspectives to the impact of
obesity on the pathophysiology of PCOS.
(Pasqulali et.al ,2010)
20. PCOS & NUTRITION
►dietary management of insulin resistance
▪ Reducing glycaemic load (GL) can reduce postprandial
glucose levels and the resulting hyperinsulinaemia that
characterizes this condition.
▪ the best way to achieve a reduction in GL – reducing
glycaemic index (GI) or reducing carbohydrate intake
(Moran et.al ,2003) .
▪ Low GI foods for everyday use include: dense, whole
intact grain/fruit breads; muesli and porridge; legumes,
pasta and noodles; orchard fruits; low-fat dairy products.
21. ▪ Moderate GI foods for occasional use include: wholemeal
bread; basmati rice; couscous; baby potatoes; tropical fruit;
dried fruit; sugar (white, raw, brown).
▪ High GI foods that should be avoided include: short-grain
rice; millet; any food made from refined white wheat and rice
flours (e.g. white breads, sweet biscuits and crackers); any
breakfast cereal made with puffs, bubbles, flakes and
extruded shapes or processed foods with glucose, glucose
syrup or maltose as ingredients.
(legro et.al ,2005)
▪ If carbohydrate intake is reduced, it must be replaced by
either fat or protein – both of these strategies have potential
problems for women with PCOS
(Marsh & Miller ,2005)
22. Dietary intervention Reduce carbohydrate
– replace with
MUFA
Reduce
carbohydrate
– replace
with protein
Reduce GI of diet
Effect on GL Reducing carbohydrate
from 55 to 40 % and
replacing with MUFA
will reduce GL by
about 40 units
Reducing
carbohydrate
from 55 to 45 %
and increasing
protein from 12
to 25 % , will
reduce GL by
about 35 units
Maintaining a higher-
carbohydrate diet ,
but reducing
average GI from 70 to 50
will reduce GL by
about 50 unit.
Possible benefits ▪ Increased HDL
▪ Reduced TG
▪Traditional Mediterranean
diets have been
associated with a reduced
risk of CVD
and some cancers
▪Reduced TG
▪ Increased weight
loss
▪ Increased satiety
▪ Increased satiety
▪Increased HDL
▪Reduced TG
▪Improved insulin
sensitivity
▪Reduced risk of type 2
diabetes mellitus
▪Reduced risk of CVD
▪Reduced risk of some
cancer
23. Dietary
intervention
Reduce
carbohydrate –
replace with MUFA
Reduce carbohydrate
– replace with protein
Reduce GI of diet
Possible risks
▪Possibility of weight
gain or reduced
weight loss with
higher fat intake
▪Higher risk of type 2
diabetes associated
with higher red meat
intake
▪Effects on kidney
function and bone
mineral density remain
unclear
▪Increased risk of some
cancers with higher
intake of animal protein
and reduced intake of
whole grains, fruit and
vegetable
)Marsh &miller ,2005(
24. ► Fat and PCOS
▪ LC n−3 PUFA supplementation reduced plasma bioavailable
testosterone concentration.
(phelan et.al ,2010)
▪ PUFAs and their products, might serve as natural ligands for
peroxisomal proliferator-activated receptor (PPAR y) .as
syanthetic (PPAR y) are used for treatment of insuline
resistance of PCOS .
(Kasim-Karacas et.al,2004 )
▪ each 2 % increase in energy intake from trans fats when
substituted for unsaturated fats or carbohydrates, the risk of
ovulatory infertility increased by (50-73)%
25. The long chain (LC) n-3 PUFA : EPA ,DHA and ALA (alpha
linolinc acid ) have emerged as particularly potent biological
regulators
DHA and EPA together aid PCOS and fertility because they
can help with hormone regulation and they are anti-
inflammatory
Fish oil contains fatty acids EPA , DHA. while ALA is rich in
ground flax seeds 1 tablespoon per day of ground flax seed is
recommended to achieve 2 grams of ALA per day, and between
500-1000 mg. each of DHA , EPA and ALA is recommended to
help with symptoms of PCOS.
(ward ,1977)
26. Fish oil is harvested from cold water fish like salmon,
mackerel, sardines, trout, herring, tuna, eel and anchovies.
These fish are high in omega-3 essential fatty acids (EFAs),
which break down into (EPA) and (DHA).
Fish oil, when used as a supplement, has been shown to
have insulin-sensitizing effects
Fish oils in conjunction with vitamin E have been shown to
decrease levels of insulin and growth hormone it was
shown that when women lost 5% or more of their body
weight
(cusson et.al ,2009)
27. Study: Differential effects of walnuts vs. almonds on improving
metabolic and endocrine parameters in PCOS
Objective: was to compare the effects of MUFA- rich almonds
vs. n-3/n-6 PUFA-rich walnuts on metabolic and endocrine
parameters in PCOS.
28. Methods: Thirty-one PCOS patients randomly
received either walnuts or almonds containing 31g
of total fat per day for 6 weeks. At the beginning and
at the end, anthropometric parameters, fasting
lipids, phospholipids-fatty acids, inflammatory
markers, androgens, oral glucose tolerance tests
(OGTT) and frequently sampled
29. Results:
• Weight remained stable.
•Walnut
•Within group, walnuts increased the n-3/n-6
essential PUFA in the diet and plasma
phospholipids.
•Walnuts decreased low-density lipoprotein-
cholesterol by 6%
•Walnuts increased insulin response during OGTT by
26%.
•Walnuts increased sex hormone-binding globulin
from 38.3±4.1 to 43.1±4.3nmol/l
30. Almonds
1) low-density lipoprotein-cholesterol by 10%
2) Almonds reduced free androgen index
from 2.6±0.4 to 1.8±0.3
Conclusion Nut intake exerted beneficial
effects on plasma lipids and androgens in
PCOS. (Kalgonkar et.al,2010(
31. ► PCOS & vitamins
● vitamin A : play a role in the treatment of PCOS-related
acne. Literature supports that individuals with severe acne
have low serum vitamin A levels.
● vitamin D : Addition of vitamin D to theca cells removed
from the ovaries resulted in decreased androstenedione
production basally and in the presence of (LH)
precaution of vitamin D :Increased consumption of milk
products to increase vitamin D and calcium intake is not
recommended in the PCOS population
● vitamin E: Vitamin E lowered C-reactive protein levels and
therefore improved the inflammation status of PCOS patients
32. Major mineral and trace mineral in PCOS
Element Function based on
literature review
reserch Recommended
supplementation
Magnesium and
highcalcium
:magnesium
ratio
Literature shows that
PCOS patients have
lower serum magnesium
levels than normal
controls. Low levels are
associated with insulin
resistance,
cardiovascular
problems, diabetes
mellitus,hypertension.
Magnesium, 300
mg twice daily for
insulin resistance in
PCOS
Calcium Calcium is required for
the interrelationship of
calcium metabolism, egg
maturation, and normal
follicular development.
1000-1300mg/d
(RDA for age)
33. Element Function based on literature
review
research
Recommended
supplementation
Boron
Low levels induce
hyperinsulinemia in vitamin D–
deprived rats. Adequate boron
enhances efficacy of vitamin D
Boron may enhance vitamin D
effect on PCOS patients.
Not able avail
Chromium Daily supplementation of
chromium has been shown to
improve glucose tolerance in
PCOS patients
A small study (5
women) found a
38%improve in
glucose disposal
rates with1000
_g/d trivalent
chromium
200 _g/d
Zinc High levels of zinc have been
shown to increase
testosterone levels in zinc
deficient individuals.
Zinc supplementation
should be
discouraged in PCOS
patients.
Nutrition in clinical practices ,2008 .page 67
34. PCOS & functional food
► spearmint tea
▪ The study population consisted of females with PCOS and
hirsutism with documented levels of elevated androgen
hormone levels .
▪ Patients were randomized to two groups. The first were
asked to drink two cups of spearmint tea for a period of 30
days. The second group were given a placebo tea.
▪ Methods: At the beginning and end of the trial period all
patients had their serum androgens checked, their clinical
degree of hirsutism was assessed and the patients were
given a questionnaire regarding their hirsutism .
35. • Result : The research trial demonstrates that the use of
spearmint herbal tea has significant measurable anti-
androgen effects in patients with hirsutism due to PCOS.
•continued with the treatment for a longer period of time
then the reductions in androgen hormone levels would have
translated into improvements .
(Grant,2008)
36. ► Dairy product
▪ Studies show that high intake of milk and dairy products may
increase the risk of infertility due to ovulatory dysfunction.
In addition dairy foods may be beneficial to ovarian function,
and that not all dairy foods have the same relation to fertility.
▪ intake of low-fat dairy foods, but not high-fat dairy foods, has
been associated with clinical manifestations of androgen
excess , a component of PCOS which may also lead to
anovulatory infertility ( chavarro et.al ,2007)
▪ intakes of skim milk, low-fat milk, sherbet and cottage cheese to
be associated with an increased frequency of physician-
diagnosed acne (Adebamowo et a,2005)
37. ►Herbal & pcos
● Licorice :
▪the testosterone-lowering effects of licorice appear
to have been helpful in the treatment of PCOS
▪ might be useful for other expressions of androgenization, such as
alopecia, hirsutism, or other effects, including those following
menopause (Bargener ,1999)
▪ its also initiate ovulation, normalise follicle development
and improve fertility and support adrenal function
(Bolloush ,2003)
38. ▪ its help in the Initiate ovulation, normalise follicle development, and
improve fertility and reproductive system .
Tribulus Wild yams Rehmannia Unicort rootShatavari
Gymnema Goats rue Fenugreek sarsaparilla Siberian ginsengBitter herbs
▪have a significant effect with reduce insuline resistance
)Bolloush ,2003(
39. PCOS & medical treatment
● Metformin : long-term treatment with metformin added to
hypocaloric diet induced, in comparison with placebo, a
greater reduction of body weight and abdominal fat,
particularly the visceral depots (pasquaki et.al ,2000)
●Clomiphene citrate (Clomid, Serophene) : fertility medicines
and gonadotropin injections (LH and FSH)
● Androgen-lowering spironolactone (Aldactone) :
This reduces hair loss, acne, and abnormal hair growth on
the face and body (hirsutism).
40. Conclusion
Women with PCOS should consider her diet as an
important treatment , as it can highly impact her ability to
cope with this syndrome and affect her future health and
overall quality of life. increasing the percentage of healthy
fats and protein in the diet and decreasing refined
carbohydrates (sugar, sweets, white bread / baked goods,
white rice and pasta, soda, etc.) will aid in glucose control.
In addition,exercise, both aerobic and strength training,
can significantly improve insulin sensitivity ,weight loss
and glucose control.
