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Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome
November 10, 2010 Patrick Nemechek, D.O.

Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is the most common hormone disorder among women of reproductive age.  PCOS affects approximately 5-14% of women (depending on the definition used).  here is no significant difference between white and black women with regard to incidence of PCOS when controlling for BMI and age.

PCOS is often associated with symptoms of excess testosterone: irregular or absent menses, excessive body hair, and infertility. PCOS is also associated with medical abnormalities such as central obesity, elevated blood insulin levels, type 2 diabetes mellitus, and abnormal triglyceride and HDL cholesterol levels.  All of these conditions are the result of insulin resistance, and insulin resistance is felt to be the driving force of PCOS as outlined in this review.

Insulin Resistance

As I have posted before, insulin resistance is metabolic disorder that causes many medical disorders such as diabetes, high blood pressure, chronic kidney disease, heart attacks, sleep apnea as well as breast, colon, uterine and prostate cancers.

Older studies have associated obesity with the development of these diseases but recent studies (here and here) are clarifying that it is the excessive carbohydrate intake that often accompanies obesity that is the true driving force of insulin resistance.

If it is specifically the carbohydrates in our diet and not obesity that is causing these diseases, one would expect to see an growing incidence of insulin resistance in persons not classified as obese but with high levels of carbohydrate intake.

Traditional Treatment Options

There are no known curative therapies for PCOS although anti-diabetic medications that lessen insulin resistance (e.g., metformin) do improve many of the metabolic abnormalities of PCOS.  Weight reduction and increased exercise also have some impact reversing insulin resistance as well as the metabolic and physical changes associated with PCOS.

The important aspect of weight loss programs is that they all result in a disproportionate amount of carbohydrate reduction.  Think about it.  You generally eliminate the high carbohydrate junk food whenever you try to lose weight even if the diet is considered a low fat diet.

In other words, many of the health benefits you see from weight loss are really due to reduction in carbohydrates that occur with a decrease in caloric intake rather than the decrease in total weight per say.   The increases or decreases in person’s total weight not only represent changes in their caloric intake but also is a marker for an increase and decrease in their relative carbohydrate intake.

Carbohydrate Reduction and Polycystic Ovarian Syndrome

Recent studies have shown that a low carbohydrate diets which are effective in reversing many other aspects of insulin resistance.  A reduction in carbohydrates is felt to also be an effective approach in reversing the metabolic and physical symptoms associated with PCOS as well.

The carbohydrate reductions in these diets range from moderate reduction of less than 100 grams of carbohydrates per day to the ketogenic range (i.e., ketone-producing Atkins diet) of less than 20 grams of carbohydrates per day.   In a recent pilot study, most patients begin experiencing improvements within 4-8 weeks but complete resolution their symptoms in my experience can take several months.

The other nice thing is that these studies didn’t require women to reduce their caloric intake as part of there carbohydrate.  But in every study, the women spontaneously lost weight even without counting calories.  This is a common phenomena of lowering the amount of carbohydrates in your diet; you loose weight without even trying.

Conclusion

So if you know or even think you might have Polycystic Ovarian Syndrome, you should consider reducing the carbohydrates in your diet to less than 100 grams per day. Waiting a few months for your symptoms isn’t such a bad thing especially when you noticing your losing weight without having to count calories.

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