What is PCOS?

What is Polycystic Ovarian Syndrome (PCOS)?

A bunch of varied symptoms designates PCOS. Some of the PCOS symptoms are painful, heavy, abnormal, or irregular menstrual cycles, infertility, increased body hair, dark skin spots, mood disturbances. Women with PCOS generally have at least two of the three main characteristics of:

- androgen excess that can pose as increased body hair

- chronic oligo-/anovulation that can represent as irregular or absent menstrual cycle

- the presence of polycystic ovaries

However, underlying these main characteristics are just two common components of metabolic diseases: inflammation and insulin resistance.

See: Diet Therapy For Healing Polycystic Ovary Syndrome PCOS

Insulin resistance symptoms in females

Insulin resistance and inflammation are included in the PCOS symptoms, and the connection of PCOS to other conditions like obesity, dyslipidemia, type 2 diabetes (T2D), non-alcoholic fatty-liver disease (NAFLD). Women with PCOS have a 2-4 times higher risk of developing obesity, prediabetes, Type 2 Diabetes, and gestational diabetes.

The hormonal and metabolic signals within PCOS often exacerbate a vicious cycle, which aggravates the symptoms. 

As scientific understanding of the function and impact of insulin resistance keeps growing, we learn of an increasing number of diseases that are influenced by impaired insulin action. The level of insulin impact on those conditions may vary, but factors that reduce insulin resistance tend to have a beneficial effect on symptoms and effects. There is increasing evidence that insulin resistance is tightly linked to the intricate group of defense and repair mechanisms called inflammation.

Insulin resistance and PCOS are often found together in women. Managing PCOS symptoms includes regulating insulin during exercise and diet. Polycystic ovary syndrome (PCOS) may seem like a disease of the uterus, but it is not. While PCOS does influence ovulation and ovaries, it is a full-body endocrine and metabolic syndrome that's closely tied to insulin resistance.

Insulin resistance is a prominent element in the majority of PCOS cases. Many women suffer from PCOS and its various presentations long before they are officially diagnosed. Because of this, they experience chronic, debilitating symptoms, and fertility conditions that can be extremely tough emotionally and physically. A PCOS analysis is often centered around fertility and the reproductive system. Still, the metabolic element for this syndrome is an essential consideration for short and long-term health and fertility.

See: Functional medicine for PCOS

What is insulin resistance?

What does insulin resistance mean? 

Under ordinary conditions, the hormone insulin increases briefly after ingestion. Insulin stimulates the liver and muscles to take up sugar from the blood and convert it to energy. That then causes blood glucose to fall, then insulin to decline. With regular insulin sensitivity, both glucose and insulin are normal on a fasting blood test.

With insulin resistance, blood glucose might be normal, but insulin is high. Why does that happen? Since the pancreas needs to make more and more insulin to try to get its message through. Too much insulin creates inflammation and causes weight gain. It can also cause Type 2 diabetes and cardiovascular disease. Too much insulin can also be an inherent physiological catalyst of PCOS.

Even though the specific cause of polycystic ovary syndrome (PCOS) is unknown, insulin resistance and hyperinsulinemia appear to affect many women with PCOS. This effect contributes to more severe symptoms, problems maintaining a healthy weight, and increased risks of developing other chronic ailments. You can help your patients with handle PCOS symptoms by providing some tips on nutrition and exercise.

See: Insulin resistance and adiposity in relation to serum?-carotene levels.

Insulin resistance and PCOS

Insulin resistance and PCOS relationship

Insulin resistance is an integral characteristic of both lean and obese PCOS. It happens in 70-95% of people with obese PCOS and 30-75percent of individuals with lean PCOS. High insulin isn't simply a symptom of PCOS, but it is also a significant driver of this illness. High insulin may impair ovulation and cause the ovaries to create extra testosterone. One research study observed an increasing rate of PCOS correlates with a rise in obesity and weight reduction during the previous ten years. Managing PCOS symptoms is vital to help women have a good quality of life and feel less burdened with the status. Controlling insulin levels is a critical component, as females can quickly find themselves in a cycle of spiking insulin levels, which contributes to more cravings for carbohydrates and sweets.

Insulin resistance and impaired glucose tolerance are found in a large percent (ranging from 44-70%) of women with PCOS. Insulin resistance is an integral contributor to metabolic disturbance and is a catalyst in the pathogenesis of PCOS. One of the effects of this chronic elevation in insulin is higher signaling to the ovaries and increased androgen production.

Due to the effect of insulin resistance in PCOS, frequent treatments involve insulin-sensitizing drugs, such as metformin. Dietary changes and exercise are also sometimes advocated as a way to enhance insulin sensitivity. Insulin signaling is known to influence fertility and weight reduction and has a powerful interwoven connection with inflammation. 

Obesity can increase the potential for complications. But, regardless of BMI, some degree of insulin resistance is found in most women with PCOS. Because insulin resistance is essential to the evolution of prediabetes and T2D, there is an increase in the potential risk of those conditions with PCOS. 

Research in Fertility and Sterility discovered that about 65 to 70 percent of women with PCOS have insulin resistance. Even though it's more prevalent among obese women, the study confirmed that insulin resistance appears to have an independent connection to PCOS and isn't wholly caused by obesity. Frequent PCOS symptoms include heavy bleeding, painful or irregular periods, and infertility. PCOS can also cause an increase in facial hair, acne, weight gain, and dark patches of skin. High blood glucose levels worsen these symptoms by causing women to make more testosterone. This increase leads to more acne, hair growth, and irregular or absent periods. Women with insulin resistance are also at higher risk for developing chronic conditions such as diabetes, obesity, cardiovascular disease, and hypertension.

See: Naturopathic Medicine Treatment For PCOS

Diet & lifestyle treatment for PCOS

Managing PCOS Symptoms With Diet & Lifestyle

Diet and exercise are effective ways for women with PCOS to control insulin levels and control their symptoms. Participating in at least moderate exercise for thirty minutes per day to regulate blood sugar levels can help.

PCOS Nutrition: According to the American Diabetes Association, PCOS affects about 5-10 percent of women in the USA.  The quality of life dramatically diminishes when symptoms are not controlled. It is crucial to know the connection between PCOS and insulin resistance. The importance of diet and exercise can help keep such symptoms in check.

Healthy eating tips:

- Choose whole foods. This choice implies whole fruits and vegetables, lean meats, and healthy fats such as oils, seeds, nuts, and avocados. Dates and other dried fruit help suppress a sweet tooth.

- Eat regularly throughout the day. Eating every few hours helps maintain blood sugar levels stable. Fasting and calorie restrictions aren't advisable for women with PCOS and insulin resistance.

- Stick to whole grains. Decide on whole wheat, brown rice, and oats instead of white bread or processed bread and biscuits. But make sure to remind them that carbs still have to be restricted and balanced with protein, fruits, and vegetables.

- Limit sweets. Controlling sugar, of course, is important for managing PCOS symptoms. 

- Read food labels. Learn how to read food labels to understand fat, protein, and calories, in addition to how to search for added sugars and refined carbohydrates.

See: Keto diet benefits for weight loss, diabetes & PCOS

Supplements for insulin resistance and PCOS

Insulin resistance and PCOS treatment

Conventional therapy recommendations for the insulin resistance element of PCOS include weight loss, aerobic exercise, and the diabetic drug metformin, enhancing insulin sensitivity. Resistance training may also be effective, but more research is required. Oral contraceptives are another officially-recommended remedy for PCOS, but they can interfere with glucose regulation and insulin resistance that underlies PCOS.

Fructose role in insulin resistance

For many women with PCOS, sometimes the best dietary intervention is to decrease fructose.

Fructose itself isn't a problem; just a high amount can lead to harm. For instance, low-dose fructose from fruit doesn't induce insulin resistance and is rather beneficial for insulin sensitivity and wellness. High-dose fructose from desserts, soft drinks, and fruit juice has a very different impact. There's a basic physiological difference in how larger and smaller quantities of sugar are processed in the body. In a high dose, fructose may overwhelm the standard processing pathways in the gut and can get to the liver, where it can create inflammation and impair insulin sensitivity. More research is required here.

Supplements for insulin resistance and PCOS

- Inositol is an intracellular messenger involved in insulin signaling and may be taken as a nutritional supplement (Myo-inositol and di-chiro inositol). A 2018 meta-analysis of ten randomized trials found that inositol significantly improves markers of insulin resistance and "seems to regulate menstrual cycles, improve ovulation, and cause metabolic changes in polycystic ovary syndrome." The dosage in the majority of the randomized trials ranged from 1.2 to 4 g each day.

- Magnesium is a good nutritional supplement for insulin resistance. It works to correct the widespread subclinical magnesium deficiency that some researchers suspect might be contributing to insulin resistance and cardiovascular disease. Magnesium deficiency impacts at least one-third of people, and likely more, and can't be readily or reliably diagnosed by a blood test. A recent meta-analysis concluded that magnesium supplementation is effective for treating insulin resistance in people with magnesium deficiency. One small study found that co-supplementation of magnesium, zinc, calcium, and vitamin D improved the insulin metabolism of PCOS patients. 

See: Vitamin D supplementation reduces insulin resistance in Japanese adults: a secondary analysis of a double-blind, randomized, placebo-controlled trial.

Well-formulated ketogenic diet for PCOS

Benefits of a Well-Formulated Ketogenic Diet on PCOS

The use of inflammation and insulin in PCOS has been researched. A well-formulated ketogenic diet may help some women who suffer from this syndrome. The expression well-formulated ketogenic diet (WFKD) was coined by two scientists Drs Stephen Phinney and Jeff Volek, who have worked continuously researching low-carbohydrate nutrition for over 30 years. The beneficial effects of long-term supplements ketosis include reduced inflammation, improved insulin sensitivity, decreased cravings, and hunger, in addition to enhanced metabolic health and weight loss. A proper comprehension of a WFKD is essential in achieving maximum benefits of nutrient ketosis.

A well-formulated ketogenic diet (WFKD) has been demonstrated to reverse insulin resistance, decrease inflammation, and facilitate weight loss. Therefore, women may have the ability to use a WFKD to improve some of the strong signals contributing to PCOS with no side effects of pharmaceutical therapy.

Women with PCOS often exhibit oxidative stress in response to glucose ingestion. To make things worse, the hyperandrogenism that's characteristic of the syndrome seems to increase the inflammatory response to sugar.

The reduction in carbs with a WFKD enhances insulin sensitivity and help lower inflammation and the signaling into the ovaries that increases androgen production. Ketones (beta-hydroxybutyrate, (BOHB) especially ) aren't just used for fuel but also have been shown to possess antioxidant effects. Painful periods and inflammation proceed awry, so reducing chronic low-grade inflammation can help with the quality of life and fertility.

See: [Of berberine and puerarin on dexamethesone-induced insulin resistance in porcine ovarian thecal cells].

Well-Formulated Ketogenic Diet Research

Hormone status is also significant concerning fertility concerns. Two small studies indicate a WFKD can enhance women's hormonal profile with PCOS and increase their likelihood of conception. It has to be emphasized that these two pilot studies were very small and non-randomized. Nevertheless, it's promising that 4 out of 9 patients in these two studies could keep a ketogenic diet for six months conceived by natural means (a 40-50% success rate).

Behavioral and environmental factors also have to be considered in the treatment of PCOS. Reduced satiety and increased cravings for sweets are noted in women with PCOS and are probably a contributing element to weight gain. A calorically appropriate, well-formulated ketogenic diet has been proven to enhance satiety for nutritional ketosis.

PCOS is usually associated with increased inflammation and insulin resistance, and a WFKD has been proven to have very powerful effects reducing both of them. And unlike many drugs, a WFKD has few if any lasting side-effects, with improvements in weight, blood pressure, blood sugar control, and dyslipidemia.

But for women hoping to conceive, what are the risks of conceiving while following a ketogenic diet? Despite both small published studies suggesting that organic conception may occur in 40-50% of women with PCOS after a ketogenic diet, no large studies demonstrate the safety of carrying a pregnancy to term when following a WFKD. Therefore, the standard of care within the health care community is to advocate quitting a ketogenic diet if a woman gets pregnant.

See: How much protein on keto diet

Summary

PCOS consequences are both physical and psychological. Although this condition can manifest differently among women, many patients have some degree of insulin dysregulation and inflammation that result in the syndrome. Many women, however, may be unaware of the underlying metabolic concerns. Addressing these variations with a well-formulated ketogenic diet can have a potent impact on insulin and inflammation without the side effects which may be related to pharmaceutical interventions.

See: Ayurvedic herbs to heal PCOS

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See: Progesterone For PCOS

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