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Kyle J. Norton
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By Kyle J. Norton
at http://kylejnorton.blogspot.ca/
Kyle J. Norton
(Unedited)
By Kyle J. Norton
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Kyle
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Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome is defined as endocrinologic diseases among reproductive-age women caused by undeveloped follicles clumping on the ovaries that interferes with the function of the normal ovaries associated with a high risk for metabolic disorder(1) as resulting of enlarged ovaries(2), leading to hormone imbalance(excessive androgen and anti-müllerian hormone (AMH) )(1)(3)(4)(5), induced Hirsutism(6)(7), reproductive disorder(10(12)), risks of type 2 diabetes(9)(10)(11), metabolic syndrome(10)(12) and early cardiovascular disease(8)(13), acne(10)(14), endometrial cancer(18)(19),weight gain and obesity(15)(16)(17). The syndrome effects over 5% of women population or 1 in 20 women.
Unfortunately,
according to studies, women with PCOs after the reproductive age, are
associated to continuously
increase risk of type II
diabetes, with no increasing altered
glucose tolerance(20), CVD and
hypertension(21)
The symptoms
Women
with PCOs may experience some of the symptoms below
1.
Irregular(22), oligomenorrhea(23)or absent menstrual periods(26)
2.
Male pattern hair growth(22)
3.
Acne(22)
4.
Weight gain(22)
5.
Obstructive sleep apnea(27)
Closure
of the upper airway, causing stop breathing while sleeping
6.
Difficult to conceive(22)
7.
Anxiety(23)
8.
Emotional disturbance(22)
9.
Poor quality of life(22)
10.
Menstrual cycle disturbances(22)
11.
Depression(24)
12.
Autonomic dysfunction(25)
13.
Problematic eating(28) and general psychosocial dysfunction(28)
14.
Etc.
The Risk factors
1.
Family history
Risk
of PCOs is increase if your mother or sister has PCOS(29). According to North Staffordshire Hospital
2.
Reproductive age women
Polycystic
ovary syndrome (PCOS) affects 4% to 18% of reproductive-aged women(31)
3.
Environment risks
a.
Eating plastic-packaged food(32), fruit with pericarp(32) and drinking
alcohol(32) were associated to the independent risk factors for PCOS. According
to the Second Affiliated Hospital of Nanjing Medical University, risks of
PCOs increased with the use of disposable plastic cup for drinking,
cooking oil fume and indoor decoration(33).
b.
Exposure to industrial products such as Bisphenol A (BPA)(36)were found
to exacerbate the clinical course of PCOS(34) as they exhibited impairment
of normal reproductive function and metabolic regulation(35).
4.
Dietary factor
Over-nutrition
with foods in advanced glycated end products (AGEs) is found to associated
to risk of PCOs(34).
5. Metabolic
perturbations begin early in adolescence are also found to elevate risk of PCOs(37).
6.
Psychotropic medication
Prolonged
period uses of psychotropic
drugs such as mood
stabilizers, lithium are also induced higher risk of PCOs(38). Women with
epilepsy are also at risk of developed polycystic ovary syndrome (PCOS) if
treated by valproate sodium (VPA) therapy(39)(40).
7.
Genetic mutations
Although
it is uncleared, genetic mutation of certain genes may be associated to the
risk of PCOs, according to studies, such as the zona pellucida 4 (ZP4)(41)
gene, polymorphism of FXIIIVal34Leu gene(42), C/T single nucleotide
polymorphism at exon 17(43), single nucleotide polymorphism-56 of
calpain-10 gene(44), vaspin rs2236242 polymorphism(45), etc.
The Diagnosis
If
you have experienced some of above symptoms, it is for your benefit to visit
your doctor or gynecologist immediately. PCOs is easy to identify through your
1.
Medical history, including
question of your symptoms, such as menstrual irregularity, weight change, skin
and sleep patterns, as well as all symptoms may contribute to the susceptible
PCOs.
a.
History of pregnancy including difficulty to conceive, miscarriage, poor
neonatal and maternal pregnancy outcomes(46)(47) ...
b.
Medication may influence the development of PCOs
2.
Physical exam
The
aim of the physicam exam is to check for PCOs symptoms, such as pelvic exam for
enlarge and abnormal ovaries, male pattern hair growth, acne, weight gain, body
mass index (BMI)(48)(49) etc., and risk of diseases caused by PCOs, such as
hypertension, thyroid abnormality(50)(51).
(Please
check citations in the topics of symptoms and risk factors)
3.
Pelvic ultrasound
The
aim of the test is to check for enlarge ovaries(2) and cysts(52).
Unfortunately, many women with PCOs do not show these abnormalities.
4.
Blood test
The
blood test includes testing of
a. Dehydroepiandrosterone(DHEA), is a
test for excess adrenal precursor androgen (APA) production(53)(54) found in
approximately 20-30% of women with PCOS(53).
b
Abnormal testosterone(55) levels
may interference with the follicle incubation medium(55)(56).
c.
Sex hormone-binding globulin (SHBG)(57)
is a surrogate marker of insulin resistance
Lower
levels of SHBG are found in women with PCOs(58)
d.
Follicle-stimulating hormone (FSH)/LH ratio(LH(58) and FSH ratio(58)(59)). Dr. Li Y and the research team at Second Affiliated
Hospital of Sun Yat-sen University, said "PCOS patients with higher LH/FSH ratio are primarily caused by
hypothalamic-pituitary dysfunction, while the PCOS patients with normal LH/FSH ratio are mainly caused by metabolic
disorders"(60).
e.
Thyroid-stimulating hormone (TSH)
The
aim of the test is to check for levels of TSH (> or =2.5 mIU/l) as the
hormone has shown to significantly alter endocrine and metabolic changes(64)
Thyroid dysfunctionis found to be associated
to independent risks of ovarian failure and pregnancy related complications in
women with Polycystic ovarian syndrome (PCOS)(61). It is said that both PCOS patients
combined with SCH have higher risk of cardiovascular risk factors(62)and
subclinical hypothyroidism (SCH) is more common in women with PCOs(63).
f.
IGTT level (fasting insulin)(65)(66) and several other androgens(67)(68) are used to evaluate adrenal function. If
there are abnormal secretion of certain hormones, you may be at a high risk of
having PCOs.
Low
birth weight may contribute the causation of hyperandrogenism and insulin resistance in adolescents with PCOS, according to the joint study in Italy
The Causes
The
causes of polycystic ovarian syndrome are still unknown(69)(70), but there are
some suggestions
1.
Genetic predisposition
A
genetic predisposition is defined as a genetic mutation of some women who were
born predisposed to certain health problems(75). In this case, it is polycystic
ovarian syndrome(70)(71)(72)(73)(74) .
2.
Insulin resistance(82)
Insulin
resistance is defined as abnormal levels of insulin in the blood of a person
found to be associated to women with PCOs(83). It may be caused by certain
health problems such as diabetes(76)(77), abnormal function of pancreas(78)(79)
or caused low numbers of the insulin sensitivity of cells(79)(80), which impair
the process of glucose in energy conversion(81), induced high blood glucose
levels in the body, cause of increasing the risks of ovarian cysts development(83).
3.
Obesity(84)
Obesity
is defined as a person whose BMI index is over 24. As we known, obesity women
in most cases are associated to clinical feature of insulin resistance(76).
According to Università Cattolica del Sacro Cuore, low 25(OH)D levels(86)
accompanied with the degree of adiposity may induce the causation of PCOs(85).
4.
Hyperandrogenism
Hyperandrogenism
is a medical condition characterized by excessive production and/or secretion
of androgens leading to male pattern hair growth, probably due to mutation in
the polymorphism rs12720071 in women(88). According to Erciyes University
Hirsutism
develops when follicles in androgen sensitive areas start to form thick,
pigmented hair as opposed to thin, short, non-pigmented hair normally seen in
those areas in women with PCOs(89). Evaluating terminal hair growth on the chin
or lower abdomen may be a reliable source for predicting hirsutism, according
to Ahvaz Jundishapur University of Medical Sciences(90).
5.
Environmental chemicals
Environment
chemicals endocrine
disruptors(91)(92), such as such as
xanoestrogen, and lifestyle(91)(92) can
causes over production of certain hormone and reduction of others, leading to
abnormal function of the reproductive organs including the development of
follicles and increasing the risk of PCOs(93).
6.
Food adulteration
Food
adulteration, including mixing, substituting, concealing the quality of food by
mislabeling, putting up decomposed or expired food, and adding toxic
substances(94) can lead to hormone imbalance(98) and distort the natural
process of women reproductive system(97) and in same cases, result in
death(95)(96).
7.
Chronic inflammation
Prolonged
inflammation, known as chronic inflammation, leads to a progressive shift in
the type of cells which are present at the site of inflammation and is
characterized by simultaneous destruction and healing of the tissue from the
inflammatory process(99)(100)(101).
8.
Disorders of cortisol metabolism
Cortisol
is usually referred to as the stress hormone, presented in high levels in
patients with schizophrenia and bipolar disorder(104) as it is secreted in
large volume for our body to response to stress and anxiety(103). Disorders of
cortisol metabolism is defined as a condition of which cortisol hormone has
lost its function in restoring glucose homeostasis(105) in balancing insulin and glucagon in the blood
stream(106)(107). According to University College London Hospitals, altered
cortisol metabolism does not seem to be the primary cause of PCOS(102).
Diseases associated to PCOs
1.
Hyperprolactinemia
Hyperprolactinemia and polycystic ovary syndrome (PCOS)
are on the list of the most frequent causes of female infertility(109).
Prolactin,
produced by the anterior pituitary gland primarily plays important breast
development during pregnancy and milk production after birth.
Hyperprolactinaemia in women with polycystic ovary syndrome (PCOS) effects the
normal function of the hypothalamus and pituitary gland(110), leading to
ovulatory infertility(111), decreasing in menstruation and sometimes lost of
menstruation(112) and sexual desire(114). In men, hyperprolactinemia has shown
a reduction in seminal volume and total sperm count accompanied with a decrease
in libido and lost spontaneous erections. and sexual
desire(113). But according to Medical University of Lodz, and Medical Centre of
Postgraduate Education, " Hyperprolactinemia does not seem to be more frequent in PCOS women
than in healthy subjects and it should not be considered as characteristic
feature of PCOS - both are distinct clinical
entities...."(108).
Chinese
medical herbs-Huiru Yizeng
Yihao(NO.1 HRYZ), has shown effectively for treatment of sex hormone disorder
of hyperprolactinemia and HMG mice models(149).
2.
Vagina bleeding
Women
with polycystic ovary syndrome (PCOS) associated to dysfunctional uterine bleeding (DUB) are more common in their
extremes of reproductive life(115)(116). According to study, Oral contraceptive
pill has a significantly therapeutic effect for treatment in DUB and
metrorrhagic forms of PCOS(117)(118). Chinese formulated herbs product (Kuntai) has shown effectively
in alleviating menopausal symptoms of irregular bleeding(150).
3.
Ovarian cysts
Women
with PCOs Have shown to susceptible to dysfunctional follicular development, with small
follicles and cysts(119) of which
may interfere with normal conception(120)(121)(122), probably due to angiogenic factors and factors of
communication of the interactions between luteal vascular and nonvascular
tissues(123). Oral contraceptive users have found to have a lower incidence of
ovarian cysts(124)(125)(126). Chinese herbs,
Penyan Kang (formula for treating pelvic inflammation) showed effectively in
treating of ovarian cyst with no abnormality and adverse
effect(127)(128).
Warming
acupuncture plus moxibustion combined with oral administration of Quyu
Decoction in Chinese traditional medicine therapy significantly increased the
cured rate for ovarian cysts,
according to Shandong Provincial Institute of TCM,(151).
4.
Uterine cancer
According
to a joint study, PCOS might increase the risk of uterine cancer in a PCOS cohort consisted of 3,566 patients,
and the comparison cohort consisted of 14,264 matched control patients without PCOS(129). But according to David
Geffen School of Medicine at UCLA, there are insufficient data to evaluate any
association between PCOS and vaginal, vulvar and cervical cancer or uterine leiomyosarcoma(130). Therefore, a
large-scale, well-designed studies are necessary to confirm the association
between PCOS and gynecological cancer risk(129). Herbal Scutellaria barbata
D. Don (SB) has been found effectively in anti-tumor proliferation against
human uterine leiomyoma(152).
5.
Fatty liver diseases(NAFLD)
Women
with PCOs, especially to those women are BMI > 25 kg/m², glucose level
> 80 mg/dL, E2/T < 80 and ALT > 19 IU/L (134) have shown to associated
to nonalcoholic fatty liver disease(131)(132)(133) as a result of abnormal lipid handling
by the liver, due to higher triglyceride and cholesterol
and lower HDL level(133). Lifestyle interventions and weight loss, accompanied
pharmacologic interventions have shown effectively for treatment of NAFL(129).
Total alkaloids in herbal Rubus aleaefolius Poir (TARAP)(153), Celastrus
orbiculatus Thunb. (COT(154), hawthorn fruit(155) showed effectively in
ameliorating high-fat diet-induced NAFLD through antioxidant activities.
6.
Hypertension
The
prevalence of hypertension was 19.2% in the women with PCOS, which was much higher than
healthy women, in a study of Han Chinese population(136). Young women with PCOS and higher BMI may be
at an increased risk of hypertension,
according to the from survey 4 in 2006 (n = 8,612, age of 28-33 years(135) but
this result has been challenged by the study at Serviço de Endocrinologia do
Hospital das Clínicas da Universidade de São Paulo(137). Certain medical herbs
and spices, such as Molle (Schinus molle), Maca (Lepidium meyenii Walp), Caigua
(Cyclanthera pedata) and ginger (Zingiber officinale) were found to have
highest anti-hypertension through their phenolic profiles, antioxidant
activities(156).
7.
Insulin resistance(IR)
Epidemiologically(138)(139)(140)(141),
strong evidences linking insulin resistance in women with PCOs
may
be resulted of pathogenesis involved several associated hormonal pathways(139),
including autoimmune thyroid disease(142)(143) or phenotypes(141). Life style
interferences, including modest reduction in dietary carbohydrate may be
beneficial on body composition, fat distribution, and glucose metabolism,
according to University of Alabama Birmingham
8.
Cushing's syndrome
PCO
and PCOS are common in women with Cushing's syndrome(146). The mimic symptoms such as obesity and insulin resistance,
menstrual abnormalities and hyperandrogenism in women with polycystic ovary syndrome (PCOS) and Cushing's syndrome (CS) have caused confusing in
diagnosis(147). According to Charles Drew University of Medicine and Science,
testosterone levels of <1.39 nmol/L may be useful to discriminate between
mild CS and PCOS(148) and hirsutism and menstrual
abnormalities were found more common in initial PCOS diagnosis
than in CS(145).
(146).
9.
Obesity
In
US, 80% of women with PCOs are found be either over weight of obese, according
to statistic(158). Obesity also exhibited complication of some features of PCOS including
hyperandrogenism, hirsutism, infertility and pregnancy (159) and exacerbated
many aspects of the phenotype, especially cardiovascular risk factors such as
glucose intolerance and dyslipidemia(159). According to Karolinska Institutet,
lifestyle interventions to induce weight loss and adjuvant pharmacologic
treatments may be the most successful strategy to improve symptoms of
PCOS(160). Pi transportation, dampness resolving and phlegm expelling herbs
(PTDRPEH) in traditional Chinese effectively reduce body weight and TNF-alpha
in the adipose tissue, inhibit fat diet-induced obesity and insulin resistance
(IR), through attenuating leptin resistance, and elevating serum levels of
leptin and adiponectin(161).
10.
Amenorrhea
Polycystic
ovary syndrome was found to be the most common cause of secondary amenorrhea in
Korean women(163) and women in US.(164) with secondary of severe
hyperthyroidism. Herbal extracts including Vitex agnus-castus, Cimicifuga
racemosa, Tribulus terrestris, Glycyrrhiza spp., Paeonia lactiflora and
Cinnamomum cassia in TCM has shown more efective in treating polycystic ovary
syndrome (PCOS) associated oligo/amenorrhoea and hyperandrogenism than
pharmaceutical agents bromocriptine (and Vitex agnus-castus) and clomiphene
citrate (and Cimicifuga racemosa)(162).
11.
Miscarriages
Epidemiologically,
linking miscarriage and recurrent miscarriage to PCOs are
inclusive(165)(166)(167), but some researchers still insisted that raising
levels luteinising hormone (LH), one of the complications in women with PCOs
may be associated with increased rates of miscarriage(168)(169)(170). According
to Net doctor, Women with raised LH have a 4 fold increased risk of
miscarriage(170).
12.
Metabolic syndrome
Metabolic
syndrome, a collection of
symptoms that can lead to diabetes(174)(175) and heart disease(175)(176)(177)
has found to be associated to women with PCOs, probably due to genetic mutation
of certain genes(171)(172), increased
accumulation of adipose tissue and insulin resistance(173). Herbal Coccinia
indica and American ginseng, Gymnema sylvestre, Aloe vera, vanadium, Momordica
charantia, and nopal and supplement Chromium may be the alternative options for
glucose control in patients with diabetes(178),
and TCM herbs and herbal formula Ligusticum chuanxiong Hort., Dalbergia
odorifera T. Chen and Corydalis yanhusuo WT Wang may also be effective for the
treatment of CVD(179).
13.
Infertility
Infertility
is condition of inability of a couple to conceive after 12 months of
unprotected sexual intercourse or can not carry the pregnancy to full term. It
effects over 7 millions couple alone in the U. S.
*
Number of women ages 15-44 with impaired fecundity (impaired ability to get
pregnant or carry a baby to term): 6.7 million
*
Percent of women ages 15-44 with impaired fecundity: 10.9%
*
Number of married women ages 15-44 that are infertile (unable to get pregnant
after at least 12 consecutive months of unprotected sex with husband): 1.5
million
*
Percent of married women ages 15-44 that are infertile: 6.0%
*
Number of women ages 15-44 who have ever used infertility services: 7.4
million)(180).
The
infertility rate of women with polycystic ovaries is very high, due to lack of
ovulation and others unknown etiology. Medication used for treatment of PCOs
infertility include clomiphene citrate(183)(184)(189), metformin(183)(186), letrozole(184)(85)(186)(189),
tamoxifen(185)(189), anastrozole(187)(188)....... Traditional Chinese medicine
(TCM) recipes formulated by Shen-replenishing herbs or acupuncture to reinforce
Gan-Shen, regulate Chong-Ren Channels are found effectively in treating
infertile and sub fertile PCOs women(191) when they are used alone or in
conjunction with Western medicine(190).
14.
Irregular menstruation
Menstrual
irregularity and/or elevated androgen levels are found to be associated to
women with PCOs(192)(193) due to hormone imbalance. According to a self
questionnaire survey, irregular menstrual not only already presents in
adolescence in women with PCOS and but also induced infertility in later
life(194). Medication used for treatment of PCOs irregular menses include oral
contraceptive pill(195) and metformin(195)(196). Herbal extracts such as
Vitex agnus-castus, Cimicifuga racemosa, Tribulus terrestris, Glycyrrhiza spp.,
Paeonia lactiflora and Cinnamomum cassia, may be used for treatment
in regulation of ovulation, improved metabolic hormone profile(196).
15.
Diabetes
The
prevalence of insulin resistance in women with polycystic ovary syndrome
(PCOS), is found to be associated to the critical risk for Type 2
diabetes(198)(199)(200). Insulin-sensitizing medication, such as
pioglitazone(202), metformin and thiazolidinediones(203). may be a
promising and unique therapeutic option for chronic treatment of PCOS(201).
Traditional Chinese acupuncture(204) and herbal formula danzhi
xiaoyao pill have shown effectively in reduced PCOs complicated insulin
resistance(IR)(205)
16.
Acromegaly
Acromegaly
is defined as over production of growth hormones caused by a benign(some may
behave more aggressive(209) tumor of the pituitary gland(208) and in rare case,
it may be caused by tumors of the pancreas, lungs, and adrenal glands, leading
to excess GnRH(210), resulting in male pattern hair growth(207). According to University of Athens
17.
Etc.
PCOs Complications
1.
Cardiovascular diseases
Beside
cancer, heart disease kills more than 2,000 Americans everyday. Approximately
60 million Americans have heart disease. Women with PCOs have found to
have increased risk of CVD due to hyperandrogenism in aggravation of abdominal
obesity(211), insulin resistance forming(211), metabolic syndrome(212), type 2
diabetes(212)(213), altered plasma lipid profile(215), sympathovagal
imbalance(216),.... According to University of Western Australia
Conflictingly,
according to the study by Division of General Internal Medicine, Mayo Clinic,
although women with PCOS weighed more than controls, there was
no increased prevalence of other
CV risk factors(218). The study also insisted that data on the incidence of CV
events are lacking in PCOs' population(218)
2.
Stroke
Besides
cancer and heart diseases, stroke is the third leading cause of death.
Approximate 1/4 of all stroke victims die as a direct result of the stroke or
it's complications. Epidemiological evidences suggested that women with
PCOs are at increased risk of stroke(220)(221). According to the review of 1340
articles, 5 follow-up studies published between 2000 and 2008 conducted by Leiden University Medical Center
3.
Endometrial cancer
Endometrium
is the inner lining of the mammalian uterus and very susceptible hormone
change, particular to menstrual cycle. Endometrial cancer is a late adulthood
cancer defined as a condition of which the cells of the endometrial lining of
uterus have growth uncontrollable or become cancerous as a result of the
alternation of cells DNA. It's the fourth most common cancer among women
overall, after breast cancer, lung cancer, and bowel
cancer.
women
with polycystic ovary syndrome (PCOS) with altered estrogen and/or abnormality
of levels progesterone (P4) at gene level(222), mutation
gene(223)(227), abnormal levels of hormone (gonadotropins, estrogens,
androgens, prolactin, andserotonin and progesterone),(228),
hyperandrogenism(224), abnormal menstrual pattern(225), insulin
resistance(228) associated with PCOS and obesity(226)(228), may contribute
to increased endometrial cancer risk(222). Metformin(229) and
combination of metformax, bromcriptine mesylate and metformin showed to
improve clinical and metabolic syndrome in women with PCOS(230) with metformin
alone through up-regulated tumor suppressor gene such as p53, cyclin D2 and
BCL-2)(229).
4.
Dyslipidemia
Dyslipidemia,
one of metabolic syndrome has found to be associated to many patients with
polycystic ovary syndrome (PCOS)
risk factor(233), chracterized by elevated low-density lipoprotein (LDL),
triglyceride levels and decreased high-density lipoprotein (HDL)(234), probably different
metabolic aetiologies depending on DHEA-S metabolism, independent to insulin
concentrations(235).
According
to University of Brescia, Italy, use of the oral contraceptive
for suppressed gonadotropin and androgen values and increased the levels of
sex hormone binding globulin in women with PCOs showed a significant
increase in triglycerides, high density lipoprotein (HDL) cholesterol
system(232). Phytochemicals Berberine and monacolin showed effectively
in a balanced lipid profile, through improve lipid metabolism in oral
contraceptive induced hypercholesterolemia in women with or without PCOS(231).
5.
Pregnancy risk
Women
with PCOs are associated to higher rate of early pregnancy loss in comparison
to women with reproductive problems(237). According to joint study
conducted by Norwegian University
Adding
phytochemical Cimicifugae Racemosae to clomiphene-induction cycles with
timed intercourse significantly improved cycle outcomes and pregnancy rates in
women with polycystic ovarian(241). Traditional Chinese formula, Danzhi
Xiaoyao Pill (DXP) effectively enhanced the ovulation rate and the clinical
pregnancy rate of 60% in anovulation infertility patients with PCOS complicated
IR(242).
Dr.
Ried K. at National Institute of Integrative Medicine, Hawthorn, Melbourne Australia
6.
Infertility(See diseases associated to PCOs)
7.
Higher risk of Gestational diabetes
Epidemiologocal
studies, linking higher incidence of gestational diabetes mellitus (GDM) for
women with PCOs has porduced inconsistent result(243)(244). Aristotle
University suggested a improve properly designed studies are necessary
before any recommendation to pregnant women with PCOS in regard to the risk of
GDM(245), But according to Imperial College School of Medicine, there is a
higher prevalence of polycystic ovarian morphology in women with a history of
gestational diabetes(246).
8.
Depression
Women
with PCOS are found to have a higher rate of depression in comparison group
women without(247)(248)(250). Psychologically, according to Institute of Psychology Eötvös Loránd University
9.
Liver diseases
Women
with PCOS are associated to high risk of NAFLD(251)(252)(253). The suggested
that some women with PCOS particularly those with an evidence of metabolic
syndrome. should be considered to be screened for liver disease at an earlier
age(254).
10.
Diabetes(See diseases associated to PCOs)
The prevention and management
Polycystic
ovary syndrome (PCOS) is unpreventable in Western medicine. Early diagnosis and
treatment may reduce risk of its complications, including infertility,
metabolic syndrome, obesity, diabetes, cardiovascular diseases, stroke, etc.
The
General Approaches to prevent the unpreventable?
Although PCOS cannot be completely avoided, strengthening immunity has shown a significant reduction of chronic inflammatory diseases(266)(267)(268).
1.
Healthy lifestyle(255)(256)(257)(258)
According
to Shahid Beheshti University of Medical Sciences, women with unhealthy life
style are associated to increased risk of chronic diseases(260), including PCOs
in comparison to those of healthy women(259), probably due to nutrient
deficiency effects of immune functioning(261).
2.
Balanced diet
Epidemiological
data suggest that dietary patterns strongly affect inflammatory processes(265).
Balancing
diet(257)(258) with high in veggies and fruits(257) and less in meats not only
provides sufficient nutrients to your body but also enhances the immunity in
fighting against inflammatory diseases(264), including PCOs(264),
irregular cell growth(263) and oxidative stress(262). Reduced intake of trans and saturated fats and increased
intake of omega-3 and omega-9 fatty acids(257) and eating anti-inflammatory foods
(fiber(272)(273), omega-3 fatty acids(269), vitamin E(270), and red
wine(271) should also be emphasized(255)(265).
3.
Moderate exercise(257)
Moderate
exercise not only increases blood flow to strengthen the body tissues(274)(275)
and organs(276), including the reproductive system but also enhances the
immunity(277) in fighting against inflammatory process(277)(278) due to
irregular cell growth(281)(282) and foreign invasion(279)(280).
4.
Yoga
Yoga
is a physical, mental, and spiritual practice in Hinduism, Buddhism.
According
to studies holistic yoga therapy showed a significant effects in reducing
anti-müllerian hormone (AMH-primary outcome), luteinizing hormone (LH),
testosterone, hirsutism, and improving menstrual frequency, glucose,
lipid, and insulin values(284) with nonsignificant changes in body weight,
FSH, and prolactin in adolescent PCOS(283).
The Vitamins
1.
Vitamin B2
Vitamin
B2 required for a wide variety of cellular processes, plays a key role in
energy metabolism, enhances the digestive system in absorbing nutrients and
supports the immune system(285)(286)(287)in fighting against irregular cell
growth causes of chronic inflammatory disease(288).
2.
Vitamin C
Vitamin
C, a water-soluble vitamin and an antioxidant found in high concentrations in
immune cells, is not only important in aiding the digestive system in absorbing
nutrients, but also enhances the production of white blood cell(289)(290) of
the immune system in protection of the body against oxidative stress, harmful
bacteria(291) and virus induced inflammation.
3.
Vitamin A
Retinoic
acid, appears to maintain normal skin health by switching on genes and
differentiating keratinocytes (immature skin cells)(292) into mature epidermal
cells and helps to detoxify liver(293), and enhances the immune
system(294)(295) in protecting our body through its anti tumor functions (296).
4.
Vitamin E
Vitamin
E is fat-soluble compounds included both tocopherols and tocotrienols. It
besides is an polyphenol antioxidants(296)(297)(302) in scavenging free radicals,
but also promotes the immune system in enhanced functions of
B-cells(298)(299)(300), the immune cells(301)(303) in production of antibodies
to destroy irregular cell proliferation.
5.
Vitamin D
15
minutes in the the Sun daily has shown to provide necessary vitamin D for the
body. Over 68% of women with PCOs had vitamin D deficiency.(304).
According to Medical faculty of P.J.Šafarik University Košice, women with
vitamin D deficient PCOs are exhibited a significantly higher body mass
index (BMI), fasting insulin, and homeostasis model assessment-insulin
resistance and borderline higher glycemia in comparison to controls(305).
The Top 5 Anti inflammatory
Foods
According to Medical University Innsbruck, the interactions between diet, immunity, and the microbiota, may be necessary for the develop food-based approaches to prevent or treat many diseases(285).
1.
Garlic
Garlic
(Allium sativum) is
a species in the onion genus, belongings to family Amaryllidaceae, native to
central Asia, used popularly in traditional and Chinese medicine to treat
common cold and flu(306), digestive disorders(313), diabetes(322)(323)(324),
therosclerosis,(325), cardiovascular
diseases(326)(327), strengthen immunity(319) against irregular cell growth
suach as tumors(314)(315)(316)(317)(318), bacterias(310)(311)(312),
fungii(310)(311) and virus(320)(321), lower blood pressure(328)(329)(330) and
cholesterol levels(310)(331), etc. Recent studies also showed that garlic
exhibits its anti-inflammatory effects
against chronic inflammatory disease(307)(308)(309) through
phytochemical allicin(307) and other machenisms(308)(309).
2.
Ginger
Ginger
(Zingiber officinale) or ginger root
is the genus Zingiber, belongings to the family Zingiberaceae, native to
Tamil, used in traditional and Chinese medicine to treat
dyspepsia(332)(333), gastrointestinal disorder(334) such as nausea and
vomiting(335), constipation(337), gastric ulcer(338),.... edema(339)(340),
difficult urination(340), colic and diarrea(341), etc.... Strong evidences in
Western studies also showed that ginger also induce some mechanisms for
treatment of pschological symptoms, such as anxiety(342). depression(343),...,
diabetes(344)(345), hypertension(346), irregular cell growth such
as tumors(347)(348)(349), and rheumatoid arthritis(352) and
osteoarthritis(336) through its anti inflammatory, antioxidant and
immune-modulatory effects(346)(350)(351), speed up wounding healing(352)(353),
etc.
3.
Turmeric
Turmeric is a perennial plant in the genus Curcuma, belongings to the family
Zingiberaceae, native to tropical South Asia . The herb
has been used in traditional medicine as anti-oxidant(354)(355),
hypoglycemic(356)(357), colorant(358), antiseptic(359)(360), wound healing(361)
agents, and to treat flatulence(362), bloating(363), and appetite loss(364),
ulcers(365), eczema(366), inflammations(367), etc. Epidemiological studies also
found that the efficacy of turmeric for treatment for diabetes(369)(370),
microbial infection(359)(371)(372), gastrointestinal diseases(359)(373) and
irregular cell growth such as cancer(374)(375)(376) through its anti
inflammatory(367)(368), antioxidant(377)(378) and immunmodulatory(379)(380)
activities.
4.
Green tea
Green
tea contains more amount of antioxidants than any drinks or food with the same
volume, and is the leaves of Camellia sinensis, undergone minimal oxidation
during processing, originated from China
5. Shiitake
mushrooms
Shiitake
mushroom is an edible mushroom, genus Lentinula, belonging to
family Marasmiaceae,native to East Asia and widely cultivated for consumption for its health benefits and
commercial purpose in many Asian countries. The herb has been used in
traditional medicine as blood tonic agent
and to strengthen immune system)403)(405), treat colds(407), measles(407),
bronchial inflammations(407), etc. Recent
studies showed that Shiitake mushrooms are also consisted properties of anti
cancers(403)(404), anti microorganisms(407)(408) such as HIV)410)(411)and
hepatitis virus(407)(412), enhanced immune system(403)(405)(406) against
inflammation(413)(414) causes of chronic inflammatory diseases(415) and the
development of free radicals(414)(416), lowering cholesterol
levels(407)(417)(418), treating heart disease(407)(419), diabetes(407)(420),
etc....
The Immunity Boosting Minerals
Recent
studies showed that deficiencies of zinc, iron, copper, and selenium lower
resistance to disease either due to impaired immune response or faulty white
blood cells' function(421)
1.
Magnesium
The
mineral, magnesium plays a key role in the immune response, by acting as a
co-factor for immunoglobulin synthesis(422) that significantly increases for
both IgA and IgG, the antibody molecules
that protect our body against
bacterial and viral infections(423) and the lining of the respiratory passages,
gastrointestinal and genitourinary tract(423).
The
mineral also found to increase neutrophil function and enzyme peroxidase activity and reduce the incidence of health
disorders by boosting immunity(424), including chronic inflammatory
disease(425)(426). Low serum magnesium (Mg) is often associated with
incidences of insulin resistance (IR), cardiovascular problems, diabetes
mellitus, hypertension and other components of metabolic syndrome(428) in
patients with polycystic ovary syndrome (PCOS)(427).
2.
Selenium
Selenium,
a trace mineral plays an important and indirect role as an
antioxidant(429)(430) by fulfilling its function as a necessary constituent of
glutathione peroxidase(431)(432) and in production of glutathione(432), that
inhibits the damage caused by oxidation of free radical hydrogen peroxide(433).
Extensively
epidemiological studies suggested that selenium also benefits to health
aspects, including anti cancers(434)(435), lowering cholesterol(436)(438),
hypertension(439)(440), treating heart disease(427)(438), boosting immunity(441)(442)
against microbial invasion(443)(444) and anti chronic inflammatory
disease(445)(446).
3.
Zinc
Zinc
besides is an important mineral in boosting immune system activity(447)(449).
Its nano-structure zinc(II) coordination compounds, has been used in zinc
therapy to treat candida overgrowth(449) by promoting metallothionein
(MT)(found in high concentration in intestinal mucosa)synthesis(450) through
its anti inflammatory activity(451), including chronic inflammation(453)(454)
via immune modulatory effects(452)(453)(454).
4.
Manganese
Manganese
is an essential trace nutrient in all forms of life. It is well known for its
role in helping the body to maintain healthy skin(455)(456) and bone
structure(457)(458), but also acts as cofactors for a number of enzymes(459) in
higher organisms, where they are essential in iexhibting its antioxidant
effects against free radicals(450)(451). Recent studies suggested that
manganese also benefits in controlling bood glucose(452)(453), alleviating
neuro symptoms such as anxiety, and depression(454) and treatment of high
cholesterol levels(456), hypertension(455), infertility(457),
cardiomyopathy(458), reduced oxidative stress, amyloid deposition, and memory(459) and boosting immune system anti
microbial infections and inflammation(460).
In
larger amounts, manganese can be poisoning to neurological damage(451)(462).
5. Iron
A
mineral plays a vital role
for production of hemoglobin(463)(464)utilised by the body for oxygen transport
and energy production(467), for maintaining healthy bones(465) and
neurotransmission(466), synthesizing of some hormones and connective
tissue(467)(468)(469) and maintaining heart health(470). Deficiency of iron
causes low level of hemoglobin, nervous tension((473)(474)), cognitive
dysfunction(471)(476), heart disorders(472)(475), heavy menstrual
bleeding(479)(480), iron deficiency anemia, etc.,.. Recent studies suggested
that trace mineral iron improves immunity(481)(482) fighting against
microbial infection(481) and inflammatory disease(483)(484), including certain
types of chronic inflammatory diseases(486)(485) due to low levels of
hemoglobin impaired cell-mediated immune response and bacterial activity of
leukocytes(421).
3.
Copper
Copper
is vital in maintaining the production of antibodies(487)(488), white blood
cells(489)(490), antioxidant enzymes(491)(492), for increasing the immune
function in fighting against infection(487)(488) and inflammation(493)(494),
including certain chronic inflammatory diseases(495)(496). The mineral also acts
as a modulator of neuronal transmission(497),
regulates production of certain hormones(498). Deficiency of copper may cause
metabolic liver disease(502), copper deficiency anemia(503),.... Excess of
copper levels can induce cognitive disorders(504)(505), reduced antioxidant
status(506) and deficiency and excess can may persuade infertile(499), low
libido and sexual issues(500), low quality sperm production(499)(500),
disrupted nervous function(501), etc.,...
The
Antioxidants
1.
Bilirubin
Bilirubin
is a prosthetic group helped
to break down molecules into smaller units in releasing energy, excreted in
bile and urine. It is a cellular antioxidant(511), by reverting to biliverdin,
a green tetrapyrrolic bile pigment, once again when oxidized, it inhibits
the effects of mutagens(512). The
antioxidant showed to inhibit digestive proteases like trypsin and
chymotrypsin(504), benefit heart health(505) and nonalcoholic fatty liver
disease(507), reduce risk of diabetes(506). Recent studies also found that the
antioxidant exhibits its anti inflammatory effects(511) against certain chronic
inflammatory diseases, including psoriasis(508), chronic obstructive
pulmonary disease(509), .... and enhances immunity activities(510)
2.
Carotenoids
Carotenoids
are organic pigments, occurring in the chloroplasts and chromoplasts(513) of
plants and some photosynthetic organisms like algae and bacteria(514).
a.
Beta-carotene
Beta-carotene,
an organic compound classified as a terpenoid, is a strongly-coloured red-orange
pigment in plants and fruits, stored in liver for the production of vitamin A.
Epidemiological evidences sugested that beta-carotene neutralizes singlet
oxygen before giving rise of free radicals(515) which can damage of DNA,
leading to improper cell DNA replication(516)(517), causing irregual cells
growth, such as cancers(518)(519)(520). The phytochemical also promotes
immunity(521)(522) against foreign invasion and symptoms of chronic
inflammatory disease(523)(524) and improve low-density lipoprotein cholesterol
resistance to oxidation causes of cardiovascular disease related to
atherosclerosis(527) through its antioxidant anti inflammatory
activities(525)(526).....
b. Alpha-carotene
Alpha-carotene,
one of the most abundant carotenoids in the North American diet, is a form of
carotene with a β-ring at one end and an ε-ring at the other, not only protects
cells from the damaging effects of free radicals(526) and enhances the
immune system(528) in fighting against bacteria and virus infection and inflammation(529)(530),
but also inhibits irregular cell growth(531)(532) cause of benign tumors(531)
and cancers(532).
c.
Beta-cryptoxanthin
Chemically
Beta-cryptoxanthin is a xanthophyll which protects our cells from
oxidation(538) and provides a source of vitamin A. The phytochemical showed
to enhances the immune system functioning(533)(534) against
infectious(537) and inflammatory diseases(535)(536) and reduces insulin
resistance(536) and cancers(539)(540) risks
d.
Lycopene
Lycopene
is a red carotene of the carotenoids group found in tomatoes, watermelons, and
grapefruits. This antioxidant is believed to be a powerful fighter against
irregular growth(543), such as prostate cancer(541)(542), breast
cancer(544)(545) and liver diseases(546)(547). Lycopene has many
anti-aging(549) capabilities as well as enhancing immune function(548) against
oxidative stress(550)(551) and inflammatory diseases(551)(552).
3.
Flavonoids
Flavonoids
also known as Vitamin P and citrin are
a yellow pigments having a structure similar to that of flavones occurred in
varies plants. used in human history for over thousands of years for breakage
of capillaries causes of swelling and obstruction of blood flow(553).
Flavonoids
process a property as antioxidants for neutralization of many of reactive
oxygen species (ROS)(554)(555), including singlet oxygen(556), hydroxyl(557)
radicals involved chronic inflammatory diseases(558)(559).
Although
nitric oxide is considered a free radical produced by immune system to destroy
bacteria induced infection(561), over production can cause increased
peroxynitrite which may attack protein, lipid and DNA(560). Flavonoids inhibit
NO production of peroxynitrite through various antioxidant enzymes(562).
a.
Quercetin
Quercetin is a plant-derived flavonoid
found in fruits, vegetables, leaves and grains and studies show that quercetin
may have anti-inflammatory(563)(564) and antioxidant(565)(566) properties as a
antioxidant, quercetin scavenges free radicals(567), which damage cells (568)
and cause mutation of cells with tampering DNA(569)(570).
b.
Rutin
Rutin
is a citrus flavonoid glycoside found in buckwheat and glycoside of the
flavonoid quercetin. It inhibits platelet aggregation(571), decreases the
capillary permeability(572), makes blood thinner and improves circulation. As
an antioxidant, it also reduces the cytotoxicity of oxidized LDL cholesterol(573) triggered
atherogenesis and the risks of other chronic inflammatory
diseases(574)(575)(576).
c.
Catechin
Catechin
is a natural phenol antioxidant and natural anti-bacterial substance. Study
showed catechin as good free radical scavenging power inhibits ROS
production(577), may be be useful to the development of alimentary strategies
to prevent ochratoxin A (OTA) cytotoxicity in human(578). As an antixidant,
catchin also process anti inflammatory effects against many chronic
inflammatory illness(579)(580)(581)(582).
d.
Etc.
4.
Coenzyme Q10
Coenzyme
Q10 is discovered by Dr. Karl Folfers in 1957, serves as fuel for the
cells(583) and acts an antioxidant to prevent the generation of free radicals
during this process(584) induced numbers of chronic inflammatory diseases, such
as diabetes(585)(586), cardiovascular(587)(588)
and Parkinson's disease(589)(590).
The antioxidanr also was found effectivetively in the treatment of
clomiphene-citrate-resistant PCOS patients through improving ovulation and
clinical pregnancy rates when use combination with clomiphene citrate(591).
The Phytochemicals
1. Tanshinone
Tanshinones,
a class of phytochemicals found abundantly in Salvia miltiorrhiza (Danshen or
Tanshen in Chinese) has shown to process several pharmacological effects
including anti-inflammatory(596), antioxidative stress(595)(597), antisenile
dementia(598), antiplatelet aggregation(593), anti atherosclerosis(599),
hypertension(600), and ischemic stroke(594) and anticancer
activities(592)(593), etc. Recent study if a total of 100 eligible women with
PCOs meeting certain criteria recruited from four centers in China, conducted
by First Affiliated Hospital of Heilongjiang University of Chinese Medicine,
suggested that tanshinones ameliorate excessive androgens by inhibiting steroid
hormone produced by the theca cells in the ovary(601)(602) and improve insulin
resistance and glucose metabolism(602)(603). Dr. Wenjuan Shen and the research
team also said " CHM can regulate and strengthen the hormonal systems of
the whole body and is a natural approach for treating PCOS. The significant
advantages of CHM are that it provides several options for the safe, effective,
multitargeted treatment of various aspects of PCOS including hyperandrogenism
and poor quality of life"(604).
2.
Berberine
Berberine,
a phytochemical found in many herbs, including Berberis aquifolium (Oregon
grape), Berberis vulgaris (barberry), Berberis aristata (tree turmeric)],
Hydrastis canadensis, etc., has been used in traditional medicine over thousand
years for treatment of microbial infections(605)(606)(607)(608),
trachoma(609), ,leishmaniasis(610).. Epedemiological studies suggested that the
phytochemicals may also be effective for treatment of diabetes(611)(612),
dyslipidemias(613)(614), hypertention(615), insulin
resistance and the metabolic syndrome(616). cancers(617)(618)(619), etc.
Recent
studies also showed that berberine
also exerts its health benefits by improving some of the metabolic and hormonal
derangements in a group of Eighty-nine subjects with PCOS and
IR Chinese women with PCOS(620).
When compare to metformin (MET), the phytochemical Berberine showed decrease in waist circumference and
waist-to-hip ratio, fasting plasma glucose, fasting insulin, homeostasis model
assessment for IR, area under the curve of insulin, cholesterol and
triglycerides as well as increase in high-density lipoprotein cholesterol
and sex hormone-binding(621). In combination with Letrozole for
treatment of PCOs, the phytochemical showed the effectiveness in lowering
blood sugar levels in db/db mice and exerted anti-dyslipidemia in human(622)
3. Curcimin
Turmeric is a perennial plant in the genus Curcuma, belonging to the family
Zingiberaceae, native to tropical South Asia . (See Turmeric in the top 5 anti
inflammation foods for the
use of the herb in traditional medicine).
Immunohistochemical
expression of VEGF may be associated to the pathophysiology of PCOS(623) as
VEGF concentrations are found to increase in women with polycystic ovaries(624). Curcumin, according
to the First Affiliated Hospital Chongqing Medical University
The differentiation of Possible PCOs Diet
1.
High Protein Diet with Low-Glycemic-Load Hypocaloric Diet
Diet
with 30% of protein is now considered reasonable, high protein diet is the term
reserved for consumption of 50% or more.
Suggestions
in linking High Protein Diet with Low-Glycemic-Load Hypocaloric Diet to control
and combat polycystic ovary syndrome (PCOS) have drawn attention in scientific
community over last decade. It may be due to its effect in lowing density
lipoprotein cholesterol( LDL-C ), reduction of insulin sensitive and androgen
levels in PCO patients(626a). But epidemiological studies focusing the benefit
of diets in treating obese and overweight patients have produced an inclusive
results. The National Nutrition and Food Technology Research Institute
showed that both composition may lead to significantly reduced body
weight and androgen levels. Compared with a conventional diet, the
combination of high-protein and low-glycemic-load foods and Hypocaloric diett also found
to be effective in enhanced insulin sensitivity and decreased hsCRP level
(626). But the alternation of metabolic rate of hypocaloric diet
in glucose utilization and decreased antioxidant defenses, in some cases may
result in life-threatening(634).
2.
Hypocaloric diet
Comparison
with Metformin in the same subjects, hypocaloric(low calories) diet showed a
reduction of 5-10% of weight on markers of insulin resistance with equal
efficacy with Metformin in decreasing serum hs-CRP levels(627) and improving
inflammatory biomarkers and adipokines independently of dietary
composition(628). A 20 weeks of a high-protein energy-restricted diet to
evaluate the Markers of endothelial dysfunction, including elevated markers of
endothelial dysfunction, presented in overweight and obese women with
polycystic ovary syndrome, showed an significant weight loss, improved
testosterone, sex hormone-binding globulin and the free androgen index (FAI)
and insulin resistance(629). Sibutramine(the hydrochloride monohydrate salt) removed from the market because of the
concerns of risk of heart attack and stroke. A comparison test with hypocaloric
diet, showed a significant weight
loss in overweight and obese women with PCOS
andimprovement in hyperandrogenemia and insulin sensitivity after 6 months of
treatment(630). Clomiphene citrate (CC) used conjunction with hypocaloric diet
with structured exercise training (SET) after 6 weeks in overweight and obese
CC-resistant PCOS patients, enhanced the probability of
ovulation under CC treatment, through a significant improvement in clinical and
biochemical androgen and insulin sensitivity indexes(631).
A
comparison of a hypocaloric low-fat diet with
those of a very low carbohydrate diet,
showed the positive effects in both diets in significant
improvements in BMI, WC, and menstrual function and induced weight loss through
targeting both the menstrual dysfunction and risk factors for long-term
morbidity associated with PCOS in adolescents(632). Short-term hypocaloric diet including high protein (HP: 30% protein, 40%
carbohydrate, and 30% fat) or high carbohydrate (HC: 15% protein, 55%
carbohydrate, and 30% fat) showed
a significant weight loss reduction and improvement in their reproductive
and metabolic abnormalities with no increased benefit to a high-protein diet(633).
Some
researchers suggested that Hypocaloric (low-calorie) diets can alter your
metabolic rate in glucose utilization and decreased antioxidant defenses, in
some case may result in life-threatening(634).
3. Low-carbohydrate diet
A high-fat, adequate-protein, low-carbohydrate diet has been used in medicine primarily to treat
difficult-to-control (refractory) epilepsy in children with purpose to induce
the body to burn fat other than carbohydrate. A PCOs women 24 weeks study with limit carbohydrate intake to 20 grams or less per day,
showed non-significant decreases
in insulin, glucose, testosterone, HgbA1c, triglyceride, and perceived body
hair but improvement in weight,
percent free testosterone, LH/FSH ratio, and fasting insulin in women with
obesity(635). According to the University
of Padova study, "Epidemiological studies over last decade or so has provided
evidence of the therapeutic potential of ketogenic diets in many pathological conditions,
such as diabetes, polycystic
ovary syndrome, acne, neurological diseases, cancer and the amelioration of
respiratory and cardiovascular disease risk factors"(636). Some
researchers insisted that the presence of high levels of insulin in the blood
causes unnecessary water
retention in the body(637) and the diet may produce a short term effect through
eliminating excess body fat but may cause dehydration as an early-onset
complication(638)
4. Low glycemic index diet
Glycemic
index diet originally is developed to help improve blood sugar control in
diabetes by choosing foods Low-GI foods (55 and under) for steadier rise in blood sugar. A
Twenty-six participants recruited at baseline, 22 commenced and 21 participants
completed the low-GI dietary
intervention phase, low glycemic diet improved insulin sensitivity, changes of
lipids(639). Comparison of low glycemic index with a conventional healthy diet in overweight and obese premenopausal
women, low glycemic index attendants showed to
improve more in glucose tolerance
through oral-glucose-tolerance test (ISI(OGTT)), menstrual cyclicity, with
serum fibrinogen concentrations significant differences between diets(640). Researchers
also suggested that longer term compliance needs more evaluation in subsequent
studies to reduced long term health risks to women with PCOS on
a low GI diet(642).
In comparison of low-carbohydrate, ketogenic diet versus a low-glycemic index
diet on glycemic control in type 2 diabetes mellitus, some researchers
suggested that the diet containing fewer carbohydrates, the low-carbohydrate,
ketogenic diet, was more effective for improving glycemic control than the low
glycemic diet(641).
5. High-protein diet
High-protein
diet is a diet mostly recommended
for people who want to build
muscle and lose fat. A comparison of a high
protein (HP) and a normal protein
(NP) diet on patients with polycystic ovary
syndrome (PCOS) in 8-week randomized trial, showed a significantly reduced body
weight, body mass index (BMI), waist circumference, percent of body fat,
decreased total testosterone in PCOs(643). In
fact, increased dietary protein-to-carbohydrate ratios showed no differences in
testosterone, sex hormone-binding globulin, and blood lipids between the groups
after 6 months, but adjustment for weight changes led to significantly lower
testosterone concentrations in the standard-protein (SP) diet group,
according to the University of Copenhagen
7. High monounsaturated fat diet
High
monounsaturated fat diet is a
diet high in monounsaturated
fatty acids (HMUFA) for a replacment of daily intake of bad fat. In
a comparison of Carbohydrate-restricted diets high in either monounsaturated
fat or protein, showed that magnitude of weight loss was smaller in the LF-HP
group than in the HF-SP(647). The Mediterranean diet, a High monounsaturated fat diet is characterized by a high intake
of olive oil, plant products, fish and seafood; a low intake of dairies, meat
and meat products; and a moderate ethanol intake, but unfortunately, exploring the relationship between the Mediterranean diet and overweight/obesity is complex with
inclusive results. Some studies indicated a significantly related to less
overweight/obesity or more weight loss but many found no evidence of this
association(648).
8.
Low fat diet
Low
fat diet restricts consumption of fat and stresses
foods high in carbohydrates, mostly recommended to patients with some
gallbladder conditions. A comparison of hormonal and metabolic markers after a
high-fat, Western meal versus a low-fat,
high-fiber meal in women with polycystic ovary syndrome, showed a reduction of
free testosterone within 2 hours after both meals, however, the levels of
testosterone remained below premeal values for 4 hours after the
isocaloric low-fat, high-fiber
meal (HIFIB) meal and 6 hours after the a high-fat, Western meal (HIFAT)
meal. Levels of glucose was higher for 1 hour after the HIFIB meal
compared with the HIFAT meal. DHEAS decreased 8%-10% within 2-3 hours after
both meals, then increased during the remainder of the study period. Cortisol
decreased during the 6-hour period after both meals(649). Suggestion of individuals on a low-fat vegan must ensure adequate intakes
of of vitamin D, vitamin K, folic acid, calcium, magnesium, zinc, vitamin
B12, phosphorous, and selenium(650).
Taking
all together, there are subtle differences but correlation between diets, a
monounsaturated fat-enriched diet induced greater weight loss, a low-glycemic index diet enhanced menstrual regularity, a
high-carbohydrate diet increased free androgen index, a low-carbohydrate
or low-glycemic index diet induced greater reductions in insulin
resistance, fibrinogen, total testosterone, and high-density lipoprotein
cholesterol, a low-glycemic index diet improved
quality of life, a high-protein diet.improved
depression and self-esteem for a high-protein diet.
Maximize weight loss control is important for women with PCOS regardless
of dietary composition which should target all overweight women with PCOS through
reducing calories with adequate nutritional intake and healthy food choices
irrespective of diet composition(651).
(See the references page for citations)1. The Holistic Prevention, Management of PCOs analysed through Conventional Medicine Research and Studies(Part I) - The Prevention
2. The Holistic Prevention, Management of PCOs analysed through Conventional Medicine Research and Studies (Part II)- The Conventional Supplement page
3. The Holistic Prevention, Management of PCOs analysed through Conventional Medicine Research and Studies(Part III) - The Weight loss approach
5. The Holistic Prevention, Management of PCOs analysed through Conventional Medicine Research and Studies(Part V) - The TCM approach
7. The Holistic Prevention, Management of PCOs analysed through Conventional Medicine Research and Studies(References page of 700 -1499)
