Written by: Jordan Robertson ND
Polycystic ovarian syndrome is the most common hormonal condition in women and affects both metabolic hormones such as insulin and sex hormones such as estrogen, progesterone and testosterone1. The hallmark feature of PCOS is elevated insulin levels, which interferes with ovulation, elevates free testosterone and contributes to central weekend and increased cardiovascular risk factors2. Women with PCOS may experience irregular or absent menstrual cycles, signs of elevated testosterone such as unwanted hair growth or acne or struggle with weight management2.
The diagnosis of PCOS includes a history of irregular menstruation, signs of high testosterone and bloodwork that confirms high testosterone. Women with PCOS benefit from a thorough assessment once diagnosed, to assess her ovulation, insulin resistance3 and signs of inflammation through testing markers such a CRP4, ferritin5 and white blood cells6. Women with PCOS have lower levels of vitamin D than other women and when women with PCOS are treated for their vitamin D deficiency7, they see improvement in symptoms8.
Nutrition and lifestyle recommendations are important pillars in the health plan of women with PCOS at all stages of life. Women with PCOS are at a higher risk for miscarriage and pregnancy complications9 as well as cardiovascular disease and diabetes as they age3. Supporting women with nutrition and lifestyle recommendations that encourage minimal processed foods10 and a Mediterranean style diet11 as well as encouraging daily movement12 and exercise decrease insulin resistance and encourage ovulation and better hormone regulation.
Women with PCOS may benefit from the addition of nutrients to their health plan such as inositol, fish oil and vitamin D.
Inositol is a b-vitamin like nutrient that can be made in the body or ingested through food and supplement sources. Inositol acts as an insulin second-messenger, reducing fasting insulin levels, improving blood sugar and restoring ovulation in women with PCOS13. Inositol has been researched widely in the PCOS population and supports regulating menstruation14, egg quality15 and reduces the risk of gestational diabetes in women when they fall pregnant16.
Fish oil has supports cardiovascular risk factors and has anti-inflammatory actions in women with PCOS17. Studies have shown that adding fish oil to the diet and lifestyle of women with PCOS helps reduce their markers of insulin resistance and elevated androgens8,18. Perhaps most importantly, fish oil has been shown to reduce the symptoms of low mood8,18 in women with PCOS, which is a common concern in women with PCOS.
Vitamin D is commonly deficient in women with PCOS and should be tested as part of a comprehensive work up in these patients19,20. Vitamin D deficiency worsens insulin resistance and may contribute to the worsening of other symptoms of PCOS such as irregular cycles, acne and low mood7,8. When women with PCOS are treated with vitamin D in combination with dietary and lifestyle advice they have improvements in blood markers associated with PCOS21.
Given the multifactorial impact PCOS has on the body, it requires an equally multifaceted approach. Combining thorough assessment, dietary and lifestyle advice and the addition of key nutrients such as inositol, fish oil and vitamin D, women with PCOS can improve their symptoms and their overall experience of their condition.
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