Is our Diet responsible for PCOS & NCDs : Dr Sharda Jain

1. PCOS & NCDs
Is our Diet responsible for
Dr. Sharda Jain

2. Do you want prevent PCOD &
Non communicable disease

3. PCOS Lets Recap
• Leading cause of Female Infertility + adol blues
• Assoc. with NCDs --Co-morbidities:
: Type 2 Diabetes, Insulin Resistance
: Psychiatric Disorders, Cardiovascular disorders
: Endometrial Hyperplasia and Cancer
• Globally 15% women suffer from PCOS
India 1/3rd of Adolescent
→ lack of clarity of origin of PCOS.
Ref. Dumesic, D.A. et al.Endocr.Rev. 36, 487–525

4. Heriditory -Children of PCOS Mothers at Puberty
• Intrauterine environment has been implicated in the origin of
PCOS in Girls / women.
• Daughters of PCOS mothers (PCOSd) have PCOS & been
investigated  found to have reproductive and metabolic
disorders when they reach Puberty.
Ref. Nicolas Crisosto et.al. Research Open Access, 2017, 607-613

5. EXACERBATED BY POOR DIETARY CHOICES
( HIGH IN REFINED CHO & SUGARS 
INCREASE INSULIN PROD  >IR
INSULIN RESISTANCE KEY Factor

8. Unhealthy Nutrition
• Obesity
• Glucose intolerance
• Insulin Resistance
LEAN PCOS / OBESE PCOS

9. HARMONAL IMBALANCE
IS HALLMARK OF PCOS
HIGH SUGARY FOODS
FLUCTUATION IN INSULIN &
GLUCOSE
EFFECT SEX HARMONES –LH/FSH
> ANDROGENS

10. FATHER , SIBLINGS
ARE
WARNED
NCDs ( 2023 )

11. Low Birth
weight due to
undernutrition
- ↑ risk of developing Metabolic Syndrome in
adulthood
- Obesity /PCOD /DM
- Hypertension
- Insulin Resistance
Ref. Desai 2013 et.al. Current Diabetes Reports 13 27–33.
Contd….
Large Birth weight
due to excessive
maternal nutrition
In Adult life
Due to epigenetic changes
in genes resp. for energy
conservation
Intra uterine Effect in PCOS

12. Ref. Dumesic DA, et.al. Clinical Endocrinology and Metabolism 101 4178–4188, Manneras-Holm L, et.al. Journal of Clinical
Endocrinology and Metabolism 96 E304–E311., Chang R & Dumesic D 2018 Clinical Management,
8th ed. Longo M, et.al. Diabetologia 61 369–380.
Normal glucose /Insulin
homeostasis
Normal weight Over weight
Small SC abdominal
adipocytes
↑ large adipocytes
protect fetus against insulin
resistance in humans
↑ regional Fat Depots
bet. 14-28 wks.
↑ abd. obesity
Hence abd. fat is
developmentally
programmed during early-
to-mid gestation
Effect of Maternal Obesity on baby of PCOS women

13. PCOD -Metabolic Phenotypes
The phenotypes are usually identified using surrogate markers of insulin resistance, the number of metabolic
syndrome components, the amount of visceral fat, or the composition of cardiovascular risk factors.
Although many different definitions are used for metabolic health, insulin resistance is
regarded as the core pathophysiology
Lower degree of IR , <2
metabolic risk factors or
favourable metabolic
profiles even in patients
with BMI >25kg/m2
Higher degree of IR &
adiposity , >2 metabolic
risk factors even in
patients with BMI
<25kg/m2
Higher degree of IR &
metabolic abnormalities
>2 metabolic risk factors
in patients with BMI
>25kg/m2
BMI <25 kg/m2
and <2 metabolic risk
factor
Lee Et Al. Changes In Metabolic Health Status Over Time And Risk Of Developing Type 2 Diabetes. Medicine.2015, Metabolic Health And Weight: Understanding Metabolically Unhealthy Normal Weight Or Metabolically Healthy Obese
Patients. M E T A B O L I S M C L I N I C A L A N D E X P E R I M E N T A L 6 5 ( 2 0 1 6 ) 7 3 – 8 0. Indulekha Et Al. Metabolic Obesity, Adipocytokines, And Inflammatory Markers In Asian Indians—cures-124
JM 2022
Metabolically
Healthy Non-Obese
(MHNO)
Metabolically
Healthy, Obese
(MHO)
Metabolically
Unhealthy, Non-Obese
(MUHNO)
Metabolically
Unhealthy, Obese
(MUHO)

14. Genetic
Predisposition
 Sedentary Lifestyle
 Mechanised Transport
 Sleep Deprivation
 Increased Screen Time
 Free Radical damage
(Smoking. environmental
pollution, aging)
 Energy dense &
Nutrient poor diets
 Increased availability
of processed & fast
foods
 Endocrine disruptors
 Dietary AGE
Thin-Fat Indian Phenotype of our Young Women
JM 2019
Papalou O, Kandaraki EA, Papadakis G and Diamanti-Kandarakis E (2019) Endocrine Disrupting Chemicals: An Occult Mediator of Metabolic Disease. Front. Endocrinol. 10:112.Clarke et al. Dietary Advanced Glycation End Products and Risk Factors for Chronic Disease: A Systematic
Review of Randomised Controlled Trials. Nutrients 2016
Yajnik 2004; Kurpad A, Kiruba V, Aerbeli I 2011, Misra A, Vikram NK, 2009
● Indians have higher body
fat and visceral fat
percentages at similar
BMIs- “Thin-Fat” Indian
diabetes phenotype.
● This leads to - Early onset
of diabetes mellitus and
metabolic derangements
Non-Asian Asian
% Body
Fat for
same
BMI
BAD Metabolic Health: Maladaptation to the Modern World
its Civilization
Genetic
Factors
Lifestyle Factors Dietary Factors

15. Typical Day’s Diet of Indian Adolescents & Young Adults
 Unhealthy snacking patterns, skipping
meals (60%) and snacking in between
meals (70%) was observed among
adolescents and young adults.
 More than three- fourth (90%) of the
adolescents and young adults consumed
HFSS snacks and 35% consumed ultra-
processed snacks.
Jagmeet Madan1, Sharvari Desai2, Panchali Moitra1, Sheryl Salis1, Rekha Battalwar1, Soumik Kalita1, Ajay Phatak2, Shobha Udipi2, Rama Vaidya2, Ashok Vaidya Snacking Pattern and Its Association with Body Composition in Young Adults of Mumbai, India, Sir Vithaldas Thackersey College
of Home Science (Autonomous), SNDT Women’s University, Mumba, 2Kasturba Health Society’s Medical Research Centre, Mumbai, India
HFSS snacks & UPFs
Refined CHOs & Saturated fat
Meat
Dairy
Fruits Veggies Legumes
Cereals
Nuts

16. HFSS Snacks ?
Such foods referred to as Junk Foods are categorized as
HFSS foods i.e. foods that are
'High in Fat, Salt and Sugar’
by the World Health Organization (WHO).
Globally , OLD term Junk Foods  food items with little or no nutritional
value but high in salt, sugar and fat.

17. UPFs  Ultra Processed Food
Foods in the UPF category include
biscuits, mass-produced buns and breads, sweetened
cereals, margarines and spreads, packaged snacks, ice
cream, flavoured yogurts, soft drinks, powdered meals,
ready-made meals, and instant sauces and stocks.

18. Are refined carbohydrates worse than saturated fat?
An uptake in consumption of saturated fat does
not increase saturated fat levels in the blood,
but consuming more carbohydrates (SMALL
FREQUENT MEALS )is related to higher fat 
adverse health outcomes,

19. Does refined carbs increase cholesterol ?
Highly processed carbohydrates play a role in high
cholesterol. Carbohydrates more than 60% of your daily
calories from carbohydrates can increase your cholesterol
levels because your liver thinks it's time to make more
cholesterol.

20. Factors related to > waist circumference in Indians.(USP)
Potential Factors Related to Waist Circumference in Urban South Indian Children, R Kuriyan et al, Indian Pediatr 2012;49: 124-128
Games
 Sleep
TV
FBMI
MBMI
Fish
Chicken
SD
IFF
FF
Bakery
SBF 
EO
TV
 Sleep
Games
FBMI
MBMI
Fish
Chicken
SD
FJ
C
Egg
Sweets
Bakery
FF
SBF
EO

21. Snacking in IndiaIS BADIR ROOT CAUSE
60% of
Indian
consumers
snack
more than twice a day,
15% of them are
“super snackers”
who snack more than
four times a day.
The COVID  further boosted these figures

22. Results
Snacking
Patterns in
Adolescent
and Young
Adults
(Girls and Boys)
(Girls and Boys)
(Girls > Boys)

23. Metabolic Syndrome Criteria and India
Five Criteria of Metabolic Syndrome
● Waist circumference over 35 inches
(women),
● Blood pressure over 130/85 mmHg,
● fasting triglyceride (TG) level
over 150 mg/dl,
● Fasting high-density lipoprotein (HDL <
50 in women)
● FBS >100MG
25%
(approximately
31% in women and
18.5% in men).

24. ● PCOD is one of the many many
● Manifestation on METABOLIC SYNDROME
IR INTERN CAUSE >70 DISEASES
Like
PCOD
Diabetes
hearth attack
Stroke & others

25. INFLAMMATION

26. Inflammatory Markers > with Bad Metabolic Health
Indulekha et al. Metabolic Obesity, Adipocytokines, and Inflammatory Markers in Asian Indians—CURES-124. DIABETES TECHNOLOGY & THERAPEUTICS Volume 17, Number 2, 2015.
JM 2022
Metabolically
Healthy Non-Obese
(MHNO)
Metabolically
Healthy, Obese
(MHO)
Metabolically
Unhealthy, Non-Obese
(MUHNO)
Metabolically
Unhealthy, Obese
(MUHO)

27. Metabolic Health: d-AGE
P. ANGOORANI ET AL.Dietary consumption of advanced glycation end products and risk of metabolic syndrome. International Journal of Food Sciences and Nutrition. 2016
Dietary Advanced glycation end products (d-AGEs) also known as Glycotoxins are INDUSTRY GIVEN
d-AGEs  predispose individuals to oxidative stress (OS) and inflammation, which play a major role in the
causation of chronic diseases like NCDs
d-AGE
Plasma levels of AGE
Weight gain / obesity
Pre-Diabetes & diabetes
CV Atherosclerotic lesions
Risk of Renal Failure
Low-grade inflammation
Oxidative damage
Adipocyte Hypertropy
Metabolic & Cardiovascular Disease

28. GUT HEALTH  PCOS
Bad DIET INFLUENCE
 GUT MICROBIOTA

29. d-AGE : Inflammation & bad Cardiometabolic Health+ Ageing
Yamagishi et al. Pathologic role of dietary advanced glycation end products in cardiometabolic disorders, and therapeutic intervention. Nutrition 32 (2016) 157–165
P
C
O
D

30. Ultra Processed Food and
Metabolic Health in PCOS
PCOD

31. High sugary Fructose Corn Syrup Intake  Negative effect on
Metabolic Health
Fructose metabolism pathway is
uncontrolled.
This causes a fall in ATP  oxidative
stress, and mitochondrial
dysfunction,
This can further induce obesity,
insulin resistance, and fatty liver that
eventually manifest in global
metabolic syndrome.
Mai BH, Yan LJ. The negative and detrimental effects of high fructose on the liver, with special reference to metabolic disorders. Diabetes Metab Syndr Obes. 2019;12:821-826. Published 2019 May 27. doi:10.2147/DMSO.S198968

32. It is well known that a healthful diet is essential for supporting and
maintaining a diverse and stable gut microbiome. Vegetables, fruits,
high-quality proteins, and healthy fats are the foundation of a gut-
healthy diet.
Emulsifiers r Trending

33. We use sauces, dressings, condiments, breads spread as convenience foods , we use
left & right to prepare tasty-foods often contain ingredients that might be
Sabotaging our gut health / obesity :
Emulsifiers r Trending

34. Effects of Synthetic Emulsifiers on Human Health
Partridge, D., Lloyd, K. A., Rhodes, J. M., Walker, A. W., Johnstone, A. M., & Campbell, B. J. (2019). Food additives: Assessing the impact of exposure to permitted emulsifiers on bowel and
metabolic health - introducing the FADiets study. Nutrition bulletin, 44(4), 329–349.
Leaky
Gut

35. High Trans-Fat Intake  Sterile Inflammation
Oteng, A. B., & Kersten, S. (2020). Mechanismsof Action of trans Fatty Acids. Advances in nutrition(Bethesda, Md.), 11(3), 697–708. https://doi.org/10.1093/advances/nmz125
In a randomized controlled trial in
healthy people a diet containing
8% of daily energy from industrial
trans fatty acids caused a 3.4-fold
increase in plasma concentrations
of C-reactive protein (CRP)
after 5 wk of intake compared to a
control diet with no trans fatty
acids.

36. Diet High in Ultra-Processed Food Bab Met Health
All Spectrum is related to PCOD also

37. FSSAI and Ultra Processed Foods
Every packaged food except those exempted
from nutritional information under these
regulations, shall display the prescribed
format (INR) on front of pack calculated on
the basis of contribution of energy (in kilo
calories; kcal), saturated fat (g), total sugar
(g) and sodium (mg) and the positive
nutrients per 100 g of solid food or 100 ml of
liquid food on a “as sold‟ basis
Indian Nutrition Rating (INR)
FSSAI guidelines on pachaged food to avoid HFSS
“Processed food product which has high levels of saturated fat or total sugar or sodium. The declared values of these
ingredients on the product is must

38. Indian Nutrition Rating (INR): 1 to 5 Star Rating
1 star (least healthy) to
5 stars (healthiest).
More stars indicate the food product is better
positioned to provide for the daily human need of
nutrients.

39. Dietary Antioxidants
and Metabolic Health
(Fruits and Vegetables)
50-75
%
Big tip for PCOD patient Plant
Protein

40. WEIGHT MANAGEMENT
MANTRA : NORMALISE WEIGHT ( HEALTHY WT )
• DIET : PLENTY FRUITS + RAW VEGETABLES + VEGGIES + LEAN
PROTEINS +WHOLE GRAINS ( MOTA AANNAZ  SHREE ANN )

41. What does healthy eating look like?
Close to
Natural food
No
processed
food

43. To Eat
1. Fibrous fruits
2. Vegetables,
3. Lean protein such as
fish, chicken and
yoghurt.
4. focus on plant
proteins
Not To Eat
1. Processed meat,
2. Starchy vegetables,
3. Sugary foods (cakes, pastries,
ice-creams, fizzy drinks etc)
4. Fried foods,
5. Processed and refined grains,
Vegetable oils
6 .Emulsifiers

45. CHO Quality(GI)
Metabolic Health PCOD

46. Blood Sugar PEAKING NOT GOOD  All complications of NCDs
https://ihealthlabs.com/blogs/education/different-carbohydrates-and-their-effects-on-blood-glucose
Blood
Sugar
PEAKING
Is related
to
glycemic
index

47. Resistant Starch / Fibre r needed for good Gut health
JM 2022
Data presented as mean ± SD
Resistant starch? 25 gms
Resistant starches
are carbohydrates that do
not break down into sugar
and are not absorbed by the
small intestine.
Similar to insoluble fibre,
they pass through most of
the digestive system
unchanged

48. Nigudkar, Curr. Res. Nutr Food Sci Jour., Vol. 2(2), 73-83 (2014)
Food Sample RS (g/100g)
Basmati Rice 20.22
Kolam Rice 27.67
Whole Wheat
Flour
0.50
Refined Wheat
Flour
0.65
Whole Moong 4.52
Kabuli Chana 1.93
Chana Flour 1.98
Knowledge of Resistant Starch (fibre) in Indian Foods

50. Effect of Almond Consumption on Glucose
Metabolism, Hyperinsulinemia and
Selected Markers of Inflammation was
positive:
A Randomized Controlled Trial in
Adolescents and Young Adults in Mumbai,
India

51. Conclusion:
- Almonds → Beneficial effect on HbA1C, hyperinsulinemia, IR, lipid
profile & inflammatory markers at an early stage that even precede
prediabetes
- Inclusion of almonds as a part of a balanced diet has the potential
to be a nutritional food based strategy to prevent progression to
further metabolic dysfunction, prediabetes & further into T2DM

52. Take Away Message of this Lecture
Prioritize your Food,
Health and Lifestyle …. It's
Worth it !!!
01
Know the Important
Nutrients and Every Day
Foods.
02
Do Not Make ‘Sometime
Foods’ your ‘Every Day
Foods’.
03
Get Nutrient Density in
small portions.
04
Plan your week for nutrient
dense food options and
feel proud about it !!
05
EAT HEALTHY BABY
TO AVOID PCOD
06
Create a window of
activity break throughout
the day every 45 minutes.
07
Find time for 45 minutes of
exercise every day !!!... its
a PRESCRIPTION TODAY…
08
Be positive, Grateful and
smile !! Spend 15 to 20
minutes just with yourself
before you retire to bed.
09
Disease of civilization can be prevented / reversed by lifestyle changes

53. Your Diet is responsible for
PCOS
Dr Sharda Jain
EAT RIGHT
BABY
TO AVOID
PCOD

54. Please Remember
PCOD can be prevented / reversed

55. CAN BE REVERSED
PCOS

56. D
I
E
T

57. : CAN IT PREVENTED ?
PCOS
TODAY

58. INFLAMMATION
• CAN BE INFLUENCED BY DIET RICH IN ANTIOXIDANTS &
ANTIINFLAMMATORY FOODS SUCH AS
• FRUITS
• VEGETABLES
• OMEGA 3 FA
• INFLAMMATION & ALLEVIATE SOME PCOS SYMPTOMS