The PCOS Diet Plan : A Natural Approach to Health for Women with Polycystic Ovary Syndrome

The PCOS Diet Plan "A nutrition-based PCOS book that uses diet and exercise to manage the female hormonal disorder"--Provided by publisher. Full description

Chapter 1

The Mystery of PCOS
 
Many people are unfamiliar with the strange-sounding condition of polycystic ovary syndrome (PCOS). From infertility to heart disease, the broad reach of PCOS can intimidate and overwhelm even the most health-conscious women who are up to speed on the connection between their diet, lifestyle, and health. There’s a lot to learn, and a lot we still don’t understand about the syndrome. Common reactions to a diagnosis of PCOS include the following:
 
· Confusion. What exactly is this condition that has the potential to affect so many aspects of my health, but that many health-care providers seem to know so little about?
 
· Frustration. Why, after complaining about my symptoms to health-care providers for years, am I just now finding out what this is? (For those trying to get pregnant, the timing couldn’t be worse.) Now I have to figure out how to manage this complex condition in the hope a new diet and lifestyle will help me get pregnant.
 
· Stress. All the information is confusing, and none of it sounds good. Feeling like I have to change so many things about my lifestyle to get better is overwhelming and even paralyzing.
 
· Relief. Even though I’m not happy about having PCOS, now at least I know what I’m dealing with.
 
· Motivation. PCOS could have lasting effects on my health and fertility. I want to get a grip on my symptoms and participate fully in my care.
 
Although certainly no one hopes for a diagnosis of PCOS, if you’ve finally received the diagnosis, rest assured that this is a condition you can do something about. The diet and lifestyle changes that can help you manage your PCOS are not extreme recommendations. If more Americans in general (both men and women, old and young) adopted these recommendations, we’d see a decline in nearly every chronic health problem: heart disease, diabetes, obesity, high blood pressure, cancer, and possibly many others. Eating well and leading an active lifestyle have such far-reaching effects on one’s health and quality of life: more energy, improved mood, better sleep, improved self- and body image, better sex, and less stress, to name just a few benefits.
 
A certain amount of the stress many people feel comes from the knowledge that they’re not doing all they can to protect their health. Starting to chip away at the list of things we know we should be doing offers a certain amount of relief in itself. The diet and lifestyle recommendations outlined throughout this book are solid, healthful ideas that anyone can follow. With a diagnosis of PCOS, you just have more of an incentive to make these changes.
 
The Facts about PCOS
 
PCOS is the most common female hormonal disorder and the primary cause of anovulatory infertility (infertility caused by lack of regular ovulation). The syndrome has been recognized as having damaging lifelong health effects. PCOS is estimated to affect 5 to 10 percent of all women during their reproductive years. According to the 2000 U.S. Census, there are more than 140 million females in the United States—that’s up to 14 million women who may develop the condition during their lifetime. Research suggests that up to 30 percent of women experience some symptoms of the disorder, referred to as nonclassic or variant PCOS. With the dramatic increase in childhood obesity, which often leads to earlier onset menstruation, PCOS is starting to show up in younger girls. That means more years to live with the damaging health consequences of this syndrome that never goes away. It is a lifelong, chronic condition.
 
The cause of PCOS is not clearly understood, but it’s believed to be a complex genetic disorder likely involving multiple genes. The genes involved may be those that regulate function of the hypothalamus, the pituitary gland, and the ovaries, as well as those genes responsible for insulin resistance, which is believed to be the driving force for most of the signs and symptoms of the disorder. In fact, women with PCOS experience similar risk for the development of metabolic and cardiovascular problems as those diagnosed with metabolic syndrome, another common and complex health problem that is escalating in the U.S. population and driving the national epidemic of diabetes and heart disease. This makes sense: insulin resistance is a contributing factor in both conditions.1
 
Depending on the research you read, anywhere from 50 to 80 percent of women with PCOS are overweight or obese. The incidence of PCOS in the U.S. population has paralleled the increase in obesity, suggesting a strong connection between body weight and the severity of the condition. Although obesity has not been identified as a cause of PCOS, carrying around excess weight worsens its signs and symptoms. Women with the syndrome often store fat around the middle, known as visceral adiposity, which basically means that they tend to wrap excess body fat around their internal organs. This type of body fat storage is genetic, known to aggravate insulin resistance, and raise blood pressure and the risk of heart disease.
 
PCOS can also trigger a host of physical symptoms, most of which are caused by excessive production of androgens, or male-type hormones, like testosterone. The hallmark of insulin resistance is higher circulating levels of insulin, which can have a seriously toxic effect on hormone production in the ovaries. Higher circulating insulin levels increase the release of an important reproductive hormone called luteinizing hormone (LH) from the pituitary gland. Both LH and insulin then stimulate the theca cells in the ovaries to produce testosterone, which is toxic to egg development. Production of testosterone doesn’t make you any less of a woman. All women make some testosterone (and all men produce some estrogen), but in the ovaries estrogen should predominate over testosterone. When excess insulin stimulates a cascade effect where testosterone predominates over estrogen, eggs don’t develop normally.2 Physical signs that androgen levels may be atypical include excess hair growth on the face, chest, and back (male-pattern growth); thinning of the hair on the crown of the head; acne; and a tendency to gain much-maligned “belly fat” (an apple-shaped body as opposed to the healthier pear-shaped body, where body fat is stored more in the buttocks and thighs).
 
Women with PCOS are also at greater risk of a number of life-threatening chronic health problems. Most concerning is the connection between PCOS and type 2 diabetes. Diabetes is exploding in the U.S. population. Type 2 diabetes has increased 40 percent since the early 2000s. Undiagnosed diabetes is seven times more likely in women with PCOS, compared with similar-age women without the condition. In fact, 30 to 40 percent of women with PCOS have prediabetes (that is, they don’t yet have full-blown diabetes, but they are already showing signs of insulin resistance, which causes type 2 diabetes). As many as 10 percent of women with PCOS develop full-blown diabetes by age forty.3 A recently released report published in the journal Diabetes Care suggests that over the next twenty-five years, the number of Americans living with diabetes will nearly double, increasing from 23.7 million in 2009 to 44.1 million in 2034. Over the same period, spending on diabetes will almost triple, rising from $113 billion to $336 billion, even with no increase in the prevalence of obesity.4
 
Heart disease continues to be the number-one killer of both women and men in the United States, and women with PCOS have a four to seven times higher risk of heart attack than women of the same age without the syndrome.5 Endometrial cancer is also a risk for women with PCOS. The hormone estrogen triggers the growth of cells that line the uterus, which are usually shed once a month due to the opposing effect of the hormone progesterone. But in cases of PCOS, where periods are inconsistent or absent, the lining of the uterus builds up, raising the risk of endometrial hyperplasia (overgrowth of the endometrium), which down the road may lead to endometrial cancer. Hyperinsulinemia (elevated blood levels of insulin due to insulin resistance) is common in PCOS and can encourage the growth of potentially cancerous cells. If left untreated, research suggests that endometrial hyperplasia advances to endometrial cancer in as many as 30 percent of cases.6
 
With many women having children later in life, the number of women requiring fertility treatment is also on the rise, and the hormonal changes seen in PCOS have been recognized to be a major player in the world of infertility. If a woman with PCOS does become pregnant, she’s at higher risk of gestational (pregnancy-induced) diabetes, which presents a risk to both the mother and the developing baby. Some research suggests that women with PCOS are three times more likely to miscarry than women without the disorder.
 
Another threatening aspect of PCOS is that although 5 to 30 percent of women may have PCOS or some of its symptoms, awareness about the syndrome—even among many health-care providers—remains inadequate. The emergence of information on the prevalence of the syndrome is very much like what happened with fibromyalgia and hypothyroidism in the 1990s. Prior to these disorders being recognized as affecting large numbers of women, many women—and clinicians—failed to recognize the symptoms as a collection of complaints caused by one underlying health problem. Today, both disorders are widely recognized as treatable, as is PCOS.
 
A Historical Look at PCOS
 
In the medical literature the earliest mention of polycystic ovary syndrome dates back more than 150 years to France, where the first official description of polycystic-appearing ovaries was made in 1845. In the early 1900s a few isolated reports began to emerge describing a procedure called a wedge resection (the removal of a section of the ovary) used to treat cystic changes in the ovaries, but knowledge was still very much isolated to treating the ovarian cysts. An understanding of the systemic reach of the condition was still years away.7 In 1935 the American gynecologists Irving Stein and Michael Leventhal published a paper on their findings in seven women with amenorrhea (the absence of menstruation), hirsutism (excessive thick hair growth in male-pattern areas), obesity, and cystic-appearing ovaries. This was one of the first descriptions of the complex condition known today as PCOS, which at the time was termed Stein-Leventhal syndrome after the trailblazing physicians who had first tied the symptoms together.8 Because of the ovary’s cystic appearance, Stein and Leventhal referred to the condition as polycystic ovarian disease, but as more was learned about PCOS, the term “syndrome” began to emerge.
 
Although it is appropriately named a syndrome, the fact that PCOS is a syndrome as opposed to a disease contributes to much of the confusion around diagnosing it. What is the difference between a syndrome and a disease? Let’s start by looking at technical definitions of the two terms: a disease is a pathological condition of a part, organ, or system of an organism resulting from various causes and characterized by an identifiable group of signs or symptoms; a syndrome is a group of symptoms that collectively indicates or characterizes a disease or another abnormal condition, the cause of which may or may not be known, and for which no single test is diagnostic.
 
While these definitions basically sound the same, the difference is in the details. A disease has an “identifiable group of signs or symptoms” that you either have or you don’t. To be diagnosed with a disease, you have to meet all the criteria. A syndrome is different in that there could be a number of signs and symptoms that vary between individuals, and potentially indicate a condition, but not all signs and symptoms have to be met to make a diagnosis. In other words, there may be a list of potential signs and symptoms, and if you have enough of them, your clinician may say you have the condition. (A similar condition is IBS, irritable bowel syndrome, where physicians generally rule out more serious gastrointestinal diseases and end up with a diagnosis of IBS.) It is critical to be evaluated by a physician who’s used to seeing patients with PCOS—his or her clinical judgment and experience seeing hundreds of women presenting with a similar constellation of symptoms may allow the physician to pull together a clinical picture that might not be as apparent to someone with less experience diagnosing the condition. That doesn’t mean all those doctors who missed the diagnosis were bad doctors; they likely weren’t used to seeing a lot of women with PCOS. In their defense, it’s only been since the early 2000s or so that the prevalence and importance of treating this syndrome has come to light.
 
Symptoms of PCOS and Getting a Diagnosis
 
A woman may see her doctor for several reasons that may ultimately result in a diagnosis of PCOS. Her menstrual periods may not come on a regular basis—or at all—a condition called amenorrhea. Or she’s been trying to get pregnant without success. She may be experiencing unwanted hair growth, severe acne, or weight problems—all of which are negatively affecting her body image and self-esteem. She may have been diagnosed with some metabolic abnormality, such as elevated blood sugar (glucose), high cholesterol, or high blood pressure, often at a young age. She may just have a feeling that “something isn’t right” with her body, and she’s hoping a doctor can pull it together for her.
 
Scientists don’t know exactly what causes PCOS. No single factor can account for the array of abnormalities seen in the syndrome, but research suggests that the underlying primary cause in most cases is insulin resistance—a condition that responds strongly to weight loss, exercise, a healthful diet, and medications when necessary. We do know that PCOS is a genetic condition, likely complicated by ovarian and metabolic abnormalities that, when taken together, can create a potential firestorm of health risks. This is particularly true when environmental factors like obesity, an unhealthy diet, and a sedentary lifestyle are stirred into the mix. Further complicating matters, it appears there are different phenotypes or genetically different forms of PCOS.9 Some phenotypes are at higher risk of diabetes and other metabolic problems (those with apple-body obesity and signs of insulin resistance), and others appear at lower risk (thin women with PCOS and no evidence of androgen excess). Women with classic PCOS—those with spotty or absent periods and androgen excess—are more likely to have more severe insulin resistance and other metabolic problems.
 
There are differing opinions on the criteria for a diagnosis of PCOS. Regardless of criteria used, the first step is to rule out related disorders, such as Cushing’s Syndrome and Congenital Adrenal Hyperplasia (CAH). The main criteria used to diagnose the syndrome tends to run along continental lines, with physicians in the United States preferring criteria set during the 1990 National Institutes of Health (NIH) International Confere...