Optimum Nutrition - Autumn 2021 - PREVIEW

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daughter is now seven months old.”
Dr Caroline Overton, a spokesperson
for the Royal College of Obstetricians
and Gynaecologists, explains that
because symptoms of PCOS can
come and go, and because there is a
varying scale of symptoms, it can make
it difficult for women like Lovell and
Hawary to receive a diagnosis.
“The length of time to diagnosis can
mean that women suffer for far longer
than they should with their symptoms,”
she says. “We would always encourage
women to speak to their doctor if they
are having symptoms and ask to have
a second opinion or be referred to a
gynaecologist if they feel that they are
not getting answers.”
She adds that whilst there is no cure
for PCOS, there are ways in which
women can manage their symptoms.
“Medical treatments aim to manage
and reduce symptoms which, when
coupled with a healthy lifestyle, can
reduce any long term health risks,” she
says.
“Leading a healthy lifestyle is one of
the main ways to reduce the risks of any
long term health issues associated with
PCOS. This includes eating a balanced
and healthy diet, eating regular meals,
and regular exercise.
“Maintaining a healthy BMI [body
mass index] can help to manage
symptoms of PCOS, and can reduce
the risk of heart problems, high blood
pressure and cancer. Having a healthy
weight can also increase the likelihood
of having regular periods and increase
fertility.”
Insulin resistance
According to research, between 50 to
70% of women with PCOS have insulin
resistance, 3 which is when cells stop
responding to the hormone insulin.
Insulin is a hormone that regulates
blood sugar. When we eat, food is
broken down into sugar (glucose),
which enters the bloodstream and
WHAT IS PCOS?
PCOS is a condition that can affect periods, fertility and aspects of appearance.
According to NHS guidelines, at least two of the following three criteria should
be present in order for a diagnosis to be made: 2
• Excess androgens; a name given to a group of hormones that includes
testosterone, DHEA-S and androstenedione. High levels of these hormones
can result in excessive facial or body hair, oily skin, acne, thinning or hair loss,
weight gain and mood changes.
• Polycystic ovaries; these are egg follicles that haven’t been released upon
ovulation and end up ‘stuck’ on the ovaries.
• Irregular or absent periods; caused by a lack of ovulation.
When it comes to specific nutrients…omega-3 fatty acids, vitamin D,
zinc, vitamin A and adequate protein can support inflammation, skin
and gut health to better manage PCOS symptoms...
signals the pancreas to release insulin.
The insulin then lowers the blood
glucose levels by stimulating uptake into
cells, where it can be stored as glycogen
until it’s needed for energy.
With a lot of glucose in the
bloodstream, however, the pancreas has
to produce more insulin to get it into
the cells. Over time, cells can eventually
stop responding to the insulin,
becoming insulin resistant, which is a
precursor to type 2 diabetes.
When it comes to PCOS, Lovell
explains that excess insulin can impair
ovulation, causing the ovaries to
produce more androgens and resulting
in associated symptoms such as acne
and hair thinning. “High insulin also
reduces sex hormone binding globulin
(SHBG),” she says. SHBG is like a
sponge for excess hormones, so if there
are lower amounts in the body then
there will be more androgen hormones
running free.
According to Lovell, balancing blood
sugar and insulin levels are therefore key
in the management of PCOS. “Avoiding
refined carbohydrates and too much
sugar is helpful,” she says. “An antiinflammatory,
Mediterranean-style
diet with plenty of colourful fruits and
vegetables for fibre, micronutrients and
antioxidants, plus good quality protein
and healthy fats can support PCOS.”
When it comes to specific nutrients,
she says that omega-3 fatty acids,
vitamin D, zinc, vitamin A and adequate
protein can support inflammation, skin
and gut health to better manage PCOS
symptoms. “I might also consider
nutrients like magnesium, alpha-lipoic
acid [found in yeast, liver, kidney,
spinach and broccoli] and myo-inositol
[vitamin B8] which can help to regulate
insulin sensitivity,” she adds.
The breakfast club
Women with PCOS and insulin
resistance might also benefit from
enjoying a bigger breakfast, according
to a study from Tel Aviv University,
Israel. 4
Sixty women suffering from PCOS
with a normal BMI were randomly
assigned to one of two calorie
maintenance diets with identical foods
for 12 weeks. One group consumed
more of their calories at breakfast and
reduced their calorie intake through the
rest of the day, whilst the other group
had a smaller breakfast and consumed
the majority of their calories in their
evening meal.
Neither group experienced a change
in BMI, but whilst participants in
the ‘big dinner’ group maintained
consistently high levels of insulin and
testosterone throughout the study,
those in the ‘big breakfast’ group
experienced a 56% decrease in insulin
resistance and a 50% decrease in
testosterone. These reductions led to a
50% rise in ovulation rate by the end of
the study.
Professor Oren Froy, the study’s
lead author, said: “The research
clearly demonstrates that indeed the
amount of calories we consume daily
is very important, but the timing as to
when we consume them is even more
important.”
Gut health
Increasingly, research also highlights
the importance of gut health. According
to Lovell, imbalances in bacteria within
the gut microbiome can contribute to
inflammation and associated metabolic
disorders. The growth of so-called ‘bad’
bacteria can also “impede the proper
excretion of hormones from the body”,
she says, “which can drive PCOS and
make symptoms worse”.
Investigating the impact of gut
bacteria on PCOS, researchers from the
University of California’s San Diego
School of Medicine, USA, found that
women with PCOS had less diverse
populations of gut bacteria compared
to those without the condition and
compared to those with polycystic
ovaries but no other features of PCOS. 5
This lack of diversity in gut bacteria,
the researchers said, was also linked to
elevated testosterone levels, suggesting
that testosterone and other androgen
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