A Weighty Issue

PCOS is a hormonal disorder that can cause weight gain—and hurt fertility.

by Claire Sykes

June 2011

Rose Fellini plays killer racquetball, pedals a spinning bike several times a week and runs a monthly 5K. She has always been athletic—and overweight. “That’s the frustrating part,” says the 31-year-old teacher from Carver, Massachusetts.

Fellini is among the 5% to 10% of women who have been diagnosed with PCOS, or polycystic ovarian syndrome. Marked by pearl-sized cysts that swarm the ovaries, PCOS is the most common female hormonal disorder. Thirty percent of all women who have it show at least some symptoms; up to 80% are overweight. But with the right lifestyle, they can do something about it.

Low Fertility, Excess Insulin

Many women don’t know they have PCOS until they try to conceive. “PCOS is the primary cause of infertility due to ovulation problems,” says Hillary Wright, MEd, RD, director of nutritional counseling at the Domar Center for Mind/Body Health in Waltham, Massachusetts. These women find that their irregular or nonexistent periods stabilize when they’re on oral contraceptives, often as early as puberty; once off the pill, their menses go haywire again.

Luckily, Fellini learned she had a problem early by seeing an endocrinologist at age 12 after going without a period since her first, three years before. Blood tests revealed higher testosterone and lower estrogen levels, which explained her arm and stomach hair. And an ultrasound showed her ovaries to be coated with cysts. All the signs pointed to PCOS.

Fellini showed another sign of PCOS called insulin resistance. This condition occurs when insulin’s ability to move glucose out of the bloodstream and into the cells is impaired, forcing the pancreas to work ever harder in an effort to produce more insulin.

As a result energy levels fluctuate, causing insistent hunger and cravings for sweets and other carbohydrates. If not treated, insulin resistance exhausts the pancreas so it can’t produce as much insulin as needed. This traps glucose in the blood, leading to diabetes.

The cause of PCOS is unknown. But scientists believe that genetics play a part, and that PCOS contributes to insulin resistance, “which is triggered by being overweight, especially before puberty. However, we can’t answer which comes first, insulin resistance or weight gain,” says Jennie Brand-Miller, PhD, professor of human nutrition at Australia’s University of Sydney and author of The Low GI Guide to Living Well with PCOS (Da Capo Press).

“Insulin resistance may drive most of PCOS’s symptoms and signs,” says Wright, author of The PCOS Diet Plan (Celestial Arts). Fellini’s excess body hair and spotty periods are often linked with this disorder; other signs include high cholesterol, sleep problems and depression. Most women with PCOS accumulate belly fat, which Wright says aggravates insulin resistance and may raise blood pressure.

Brand-Miller notes, “Untreated women with PCOS are four to seven times likely to get a stroke or heart attack. They face a 40% chance of spontaneous miscarriage in the first three months of pregnancy. And 40% of them will be pre-diabetic by age 40.” The irregular periods seen in PCOS, which keep the uterus from shedding its lining on a regular basis, can lead to endometrial cancer.

Fighting Ovarian Dysfunction

The first step in dealing with PCOS is getting a definitive diagnosis. Start by seeing an endocrinologist who specializes in this disorder. (Try contacting the American Association of Clinical Endocrinologists: www.aace.com, 904-353-7878.) To reduce insulin resistance, he or she may prescribe the diabetes drug metformin, “which you can possibly wean yourself off of with the right diet and exercise,” says Wright.

Under Wright’s guidance, Fellini eats more vegetables and quality carbohydrates, such as unrefined grains, whole-wheat bread and fresh fruit instead of juice. She combines carbs with protein and heart-healthy fats from avocados, salmon and nuts. Several small meals a day means less sugar circulating in Fellini’s blood and therefore less demand for insulin.

Brand-Miller suggests eating foods with a low glycemic load (GL). Because they are digested more slowly, they produce a gradual rise in blood glucose and insulin, instead of causing levels to spike sharply before crashing. Choose 100% stone-ground whole wheat, converted rice and non-starchy vegetables. Avoid higher-GL choices such as rye bread, quick oats and brown rice; or worse, white bread, corn flakes, crackers and pineapple. Generally, a food’s GL increases the riper, more processed or cooked it is.

Supplementation can play an important role in PCOS treatment. Wright says a daily multivitamin/mineral “gives you a little added assurance that you’ve covered all the bases,” even on days when your diet isn’t perfect, and helps ensure a steady supply of folic acid, a B vitamin that helps prevent birth defects. “Accumulating research has linked low levels of vitamin D with PCOS,” Wright adds. Separate studies in Fertility and Sterility have found cinnamon to help reduce insulin resistance (7/07) and the B vitamin inositol useful for women undergoing induced-ovulation treatments (2/5/11 online). Omega-3 fatty acids have reduced liver fat in women with PCOS (Journal of Clinical Endocrinology and Metabolism 10/09).

Increased activity is essential. “Exercise is a natural insulin sensi­tizer,” says Wright. “Do at least 30 minutes of cardio most days of the week—it could be as simple as walking—and double that if weight loss is your goal. Also include strength training, to build up your muscles. Studies tell us that losing just 5% to 7% of your weight may be enough to improve fertility and stave off diabetes.”

Controlling insulin resistance makes it easier to lose weight. “Work with a nutritionist, exercise physiologist and psychologist, and aim for moderate goals,” Brand-Miller says. “Try losing 5% over three to six months. Maintain that for three months before losing another few pounds.”

Fellini says, “Weight has always been my biggest issue. I can do all the right things and nothing’s working.” But having the right attitude helps. “I try to look at the positives: I stay physically active and eat well, and my blood pressure is good. I may have PCOS, but everything else about me is healthy.”

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