Written by Marilyn Shannon
From time to time I have been asked to offer nutritional suggestions for women who have contacted me about polycystic ovaries. Most often, their charts have displayed long to very long cycles, with less fertile mucus patches interspersed with more fertile mucus. The levels of the preovulatory and postovulatory temperatures have been normal, but short luteal phases have followed ovulation, at least in some. I have seen such charts in women who have actually had the diagnosis made. I also suspect that I have looked at charts of other women who have had irregular cycles or infertility due to undiagnosed polycystic ovaries.
What is polycystic ovary syndrome?
Defined classically, polycystic ovary syndrome (PCOS) is a reproductive dysfunction in which a woman ovulates infrequently or not at all because her ovarian follicles become arrested in their growth. The small follicles accumulate on her ovaries; hence the name. Besides the menstrual cycle disruption due to the arrested follicles, obesity and hirsutism (a masculine pattern of body hair) are also part of the classic symptoms. It tends to begin early in a woman’s reproductive years and is a chronic condition.
However–and this is important for readers with irregular cycles or infertility– a woman can have PCOS and ovulate more or less regularly; she can have PCOS and not be overweight; she can have PCOS and not have hirsutism. She can have PCOS with or without infertility. It may begin later in her reproductive years rather than earlier. There is a considerable variation in the severity of the disorder, which partly explains the variation in the symptoms. Equally as important, a woman can have irregular cycles without PCOS, can be overweight without PCOS, and can have hirsutism without PCOS. She can even have cysts on her ovaries due to factors other than this syndrome! For example, PCOS is not at all the same as the single large “follicular cysts” that women of childbearing age occasionally experience.
Small wonder that the condition is often undiagnosed. Irregular cycles and evidence of elevated “male” hormones, however, confirmed by the presence of cysts on the ovaries, allow for definitive diagnosis.(1)
Because PCOS is one of the most common endocrine disorders of women of childbearing age, women with irregular cycles or infertility may wish to consider whether or not it might be involved with their cycle or fertility problems. If you believe it may be involved, I recommend that you try the self-help described below for six to nine months before seeking medical intervention. Even if PCOS is not the diagnosis, the improved nutrition will benefit your health generally, and may still improve your cycles.
Could PCOS contribute to your cycle problems?
Long cycles, anovulatory cycles or amenorrhea, along with overweight and a tendency to a masculine pattern of hair growth, should certainly make you suspect PCOS. If you are experiencing very long cycles with prolonged mucus without being overweight or without having inappropriate body hair, consider PCOS if your temperatures are in the normal range and if you are not underweight. Why? Low temperatures may be a sign of low thyroid function, which is known to prolong the cycle. Underweight or a lack of body fat due to vigorous exercise is another common cause of long cycles. When neither of these is involved, it is possible that PCOS underlies your cycle problems. (Prolonged, severe stress could conceivably cause long cycles and failure to ovulate, but it really does take truly severe stress of a truly prolonged duration to disrupt a cycle enough to delay ovulation for a lengthy time period.)
What is the root cause of PCOS?
PCOS is often characterized by high levels of LH, which seem to cause the problem. While LH is necessary to mature the follicle, this hormone also causes the follicle to stop growing and to change in preparation for ovulation. When the levels of LH are too high, the follicle stops growing too soon. This abnormality may cause the secretion high levels of “male” hormones (androgens), which cause some women to develop a masculine pattern of hair growth. While these factors have been known for some time, newer research is showing that elevated levels of the hormone insulin may in fact be at the root of PCOS. The high insulin may increase the LH levels and may also adversely affect the follicle directly.(2)
Risk factors associated with PCOS
High insulin levels are a risk factor for a number of other conditions: obesity, noninsulin-dependent diabetes (adult-onset or Type II diabetes), and high cholesterol levels which predispose to heart disease. These are exactly the risk factors which affect women with PCOS; these risk factors relate more to the high insulin levels than to the problems within the ovaries themselves. (3) My interpretation is that PCOS is just one more manifestation of a whole constellation of disease states brought about by elevated insulin levels, which in turn are related to a problem called insulin resistance.
Insulin resistance refers to an abnormality in which many of the body’s cells decrease in their ability to respond to insulin. The receptors for insulin on the cells fail to transmit the message that insulin normally signals, which is to allow the cells to admit glucose. To compensate, the pancreas must increase its insulin to stimulate the cells to allow glucose to enter. Insulin levels may increase as much as four times normal. In summary, insulin resistance causes elevated levels of insulin, which underlie the risk factors mentioned above. (4) And insulin resistance is found, along with elevated levels of insulin, in women with PCOS. (5)
4 Self Help Strategies for PCOS
- Try losing weight if you are overweight.
- Moderate exercise to decrease insulin.
- Avoid specific foods that elevate blood glucose levels.
- Consider supplements that increase insulin sensitivity.
Self-help Strategies for PCOS
Until recently I believed that PCOS did not respond to nutrition. However, the research suggesting that high insulin is the culprit in this disorder has changed that. Lately the topic of insulin resistance has received increasing attention, and there are now a number of published nutritional approaches to decreasing insulin resistance and thereby lowering the high levels of insulin.
1) First, lose weight if you are overweight.
A study conducted in Great Britain showed that dropping only 5% of their body weight resulted in improved cycle regularity in 9 of 11 obese women with PCOS, as well as 5 pregnancies in 7 previously infertile women with PCOS. Women who lost less than 5% of their body weight showed no such improvement. Weight loss in obese women is known to improve insulin levels and insulin sensitivity (the opposite of insulin resistance), and insulin levels in fact dropped in the women in this study who lost weight and regained cycle regularity and fertility. (6) Incidentally, a 5% weight loss in a 200-pound individual is only a 10-pound loss.
2) Moderate exercise may also increase insulin sensitivity and decrease insulin. (7)
Brisk walking or jogging for half an hour several times a week are examples of moderate exercise. Try combining one of these with taking stairs, not elevators, parking far away from shop entrances, and other such changes to increase your activity. Naturally, this will help with weight loss.
3) Avoid specific foods and eating habits that rapidly elevate blood glucose levels.
High blood glucose levels are the trigger for the secretion of insulin. Some foods and eating patterns stimulate the release of insulin more than others. In 1981, researcher David Jenkins developed a list of foods, the “Glycemic Index,” based on how rapidly they increased blood sugar levels. Since then the list has been modified, but in general simple sugars and refined starches are highest on the list and are therefore to be avoided. Common breakfast cereals, whole wheat bread, white or brown rice, potatoes and corn are foods that are high on the glycemic index. Apples, pears, ice cream and milk are fairly low in their ability to trigger release of insulin. (8) Surprising? In general, starches and sugars by themselves will quickly raise the blood glucose levels. On the other hand, fats and proteins slow the digestive processes down, which results in a slower release of glucose into the blood, stimulating less insulin. That explains why ice cream, a food containing substantial amounts of sugar, is lower than whole wheat bread or brown rice. Its protein and fat slow the release of the glucose into the blood.
Should you avoid eating the healthy but high-glycemic foods in the first list? My answer is not necessarily. Instead, cut down on junk foods such as soft drinks, cakes, and candy. Combine healthy whole grains, fruits and vegetables with foods containing protein and natural fat (for example, cheese, eggs, meat, fish, or nuts). As I have written in my booklet, Managing Morning Sickness: “Make every meal and every snack a combination of protein, complex carbohydrates, and fat.” (9) This booklet is based on my belief that morning sickness is related to low blood sugar levels caused in part by high insulin, and in essence it offers a number of strategies to keep blood glucose levels steady– that is, to keep the insulin levels down. You may find it helpful whether you are seeking pregnancy or not.
4) Consider supplements that increase insulin sensitivity.
Because so many factors are involved in blood glucose levels, a high-quality, comprehensive multi-vitamin/multi-mineral such as Professional Prenatal Formula, Optivite, or Androvite * is a basic starting point. Managing Morning Sickness explains the role of various vitamins and minerals in blood sugar control. Additionally, magnesium (1,000 mg per day), chromium, and vanadium are involved directly in regulation of the levels of insulin and the cellular response to insulin. Dr. Julian Whitaker recommends 400 mcg of chromium picolinate daily, and 30 mg of vanadium daily for insulin resistance related to overweight. As always, discuss these recommendations with a nutritionally-aware health professional, particularly if you are seeking pregnancy. (11) (Dr. James Balch, author of Prescription for Nutritional Healing, points out that chromium picolinate is so effective at improving insulin sensitivity that individuals with diabetes should check with a nutritionally-aware physician before using it, as it may necessitate a change in their medication (12 ).
The essential fatty acids, especially the hard-to-get “omega-3″ fatty acids, also improve the cells’ sensitivity to insulin. (13) The richest source of the omega-3 essential fatty acid, alpha linolenic acid, is flax oil. One to six 1-gram capsules a day may be helpful. Flax oil, which is a food, can be taken by the spoonful; I have seen 1 tablespoon per day (15 grams) commonly recommended. I recommend the capsules because of the strong taste.
A final note
Please note that these recommendations are much like the general recommendations CCL has made for a long time for cycle irregularity or infertility: Improve your diet by replacing refined foods with whole foods; approach your ideal weight; exercise moderately; take a good multi-vitamin/multi-mineral; add essential fatty acids. We regularly get reports that cycle and fertility problems have improved when women have tried such a common sense approach. I don’t doubt that some women with undiagnosed PCOS have been helped to achieve better cycles and better fertility by following these general guidelines. My hope is that the new research relating high insulin levels to PCOS will allow women to “fine tune” their self-help strategies to better deal with this difficult problem.
1. Lobo, R. A. Prevalence and Clinical Impact of Polycystic Ovary Syndrome (from Harrison’s Online http://www.mwdscape.com.HOL/articles/2000/04/hol11/hol11.html) 2. Franks, S., S. Robinson, and D. Willis. Nutrition, insulin and polycystic ovary syndrome (Reviews of Reproduction 1:47-53, 1996) 3 . Franks et al. 4 .Whitaker, J., M.D. Weight Loss Is Not Just About Fat (Health and Healing 7(1):5-8, 1997) 5 and 6 . Franks et al. 7. Whitaker, J., M.D. 8.Gittleman, A.L. Get the Sugar Out (New York: Crown Trade Paperbacks, 1996) pp. xviii-xxi 9.Shannon, M. Managing Morning Sickness, 2nd ed. (Cincinnati: The Couple to Couple League, 1998) p. 8 10 and 11 . Whitaker, J., M.D. Dr. Whitaker believes that 400 mcg of chromium is safe during pregnancy. (Personal Communication to the author, October 12, 1996) 12 .Balch, J., M.D., and P.A. Balch. Prescription for Nutritional Healing, 2nd ed. (New York: Avery Publishing Group, 1997) pp. 24, 231. 13.Erasmus, U. Fats That Kill, Fats That Heal (Burnaby, BC, Canada: Alive Books) p.342.