Nutritional Approaches to PCOS
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) represents one of the most prevalent conditions (in fact it is the most common endocrine disorder) that women (and potentially in girls as young as 11) suffer from in the U.S. today. This disorder forces one in 10 women to endure its devastating symptoms and struggle to live a normal life every day. In addition to the direct symptoms patients experience, PCOS puts women at higher risk for a myriad of associated condition. Fortunately, there are nutritional approaches that can provide tremendous relief for PCOS patients.
Symptoms and Associated Conditions
So, what are the symptoms that patients will walk in with that will indicate PCOS? While there are less specific symptoms such as fatigue and weight gain (although, it is said that 50 percent of PCOS patients are overweight/obese and/or have trouble losing weight, which means that the other 50 percent are normal weight or underweight), there are definitely more telling symptoms that point to PCOS.
Symptoms include:
• Hirsutism (unwanted hair growth): More than 70 percent of women experience excess hair growth. Areas affected include the face, arms, back, chest, thumbs, toes and abdomen. 5-alpha reductase is considered the underlying driver of this symptom by increasing the conversion of testosterone to the more potent dihydrotestosterone (DHT). With an increase in insulin in the blood, this in turn can increase the level of 5-alpha reductase. 5-alpha reductase inhibitors, such as saw palmetto or green tea extract, can be applied to support healthy DHT levels.
• Thinning hair on the head: DHT can also cause destruction to the hair follicle itself and impair/decrease the level of hair thickness on the head. Also look at 5-alpha reductase inhibitors, such as saw palmetto or green tea extract, can be applied to support healthy DHT levels.
• Acne: Hormonal changes related to androgens and androgen receptors within the skin tissue can lead to acne problems, particularly along the jawline (the same area as the hirsutism, which can be a confirmatory indication of androgen excess). Younger patients will often exhibit more severe acne.
• Pelvic pain and irregular menstrual cycles: Pelvic pain may occur with periods, along with heavy bleeding. It may also occur when a woman isn’t bleeding.
Which can lead to:
• Infertility: PCOS is currently viewed as one of the leading cause of female infertility. Two driving factors are ovulation disruption and hormonal imbalance. In order to conceive, some women require fertility treatments or have Metformin to prescribed in order to increase insulin sensitivity and regulate hormone levels.
• Mood changes: The stress of the condition, the chronic inflammatory process as well as the hormonal shifts can result in the likelihood of mood swings, depression and anxiety.
o Potential Nutritional Approach: L-theanine is considered a “go-to” for healthy brain function as are methylated B vitamins such as methylfolate and methylcobalamin.
• Dyssomia: Hyperactive adrenal glands and/or dysregulation of circadian rhythm can lead to insomnia. Weight gain/obesity (for that 50 percent of the patient population) can result in sleep apnea.
o Potential Nutritional Approach: Liposomal melatonin is an option that has data, limited as it is, to help support sleep cycles more effectively than standard melatonin capsules or tablets. Adrenal supportive botanicals such as Sensoril Ashwagandha are also something to potentially apply to those patients who need circadian rhythm support.
• A 4-7X increase in risk for a heart attack/cardiovascular disease
o Potential Nutritional Approach: CoQ10 and magnesium are obvious options to support CV health, but research is also quite compelling with regard to vitamin K2 in supporting vascular integrity and pliability.
• Metabolic syndrome/diabetes: Increased risk for diabetes (as well as gestational diabetes in pregnant women), high blood pressure, high cholesterol (specifically LDL, with lower than normal HDL).
Diagnostic Testing Needed to Diagnose
A typical diagnosis of PCOS relies on at least two of these three symptoms:
• Elevated androgen levels
• Irregular menstrual cycles
• Cysts or ovarian volume larger in one ovary as seen on ultrasound (although this is not required for diagnosis)
A comprehensive pelvic exam, ultrasound examination and blood work including lipid panel (including triglycerides), serum insulin level and male hormones are all necessary to confirm diagnosis.
PCOS Nutritional Intervention Must Haves:
Inositol
Inositol has a very specific mechanism at play relative to ovary health, involving the physiology of insulin. Insulin receptors are present on every cell wall and operate as a lock and key. If insulin is not binding effectively to the receptor, the body’s feedback loop stimulates the production of more insulin. The body is then flooded with insulin leading, ultimately, to insulin resistance. The level of insulin in the blood serves to dictate the level of testosterone in the blood. Specifically, sex hormone binding globulin (SHBG) acts as a testosterone “sponge,” binding to excess testosterone and preventing it from causing these problems. However, insulin resistance reduces the amount of SHBG, thereby increasing testosterone levels. Inositol supports this entire process by supporting the binding of insulin to its receptor, thus regulating this aspect of metabolism, supporting the level of SHBG and, subsequently, the level of testosterone.
Chromium
Where inositol provides a more structural impact on insulin (lock and key), chromium supports effective signaling of insulin, specifically by mediating insulin potentiating activity. In one study published in 2016, 100 women were chosen at random out of a pool of 400 PCOS patients to assess the efficacy of chromium on insulin sensitivity as well as ovulation potential. The results showed that the use of chromium for six months was associated with significant reduction of BMI (body mass index) and fasting serum insulin, and significant rise in fasting glucose insulin ratio. Chromium significantly increased the chances of ovulation and regular menstruation by almost twofold after the fifth month of treatment. The conclusion of the study stated that chromium is useful in PCOS to reduce insulin resistance and stimulate ovulation.1 While the level of chromium in this particular trial was 1,000 mcg/day (divided during the day into five doses of 200 mcg) there are forms on the market that have equally impressive data at lower levels.
Turmeric (Curcuma longa) Root Extract
Curcumin continues to demonstrate its powerhouse capabilities on various systems in the body. Like other antioxidant compounds such as N-acetylcysteine (NAC), we’re looking at the free-radical fighting capacity of this botanical extract as well as its ability to support liver function, which has a direct link to insulin metabolism. Additionally, we’ve all seen the published data on the efficacy of curcumin in terms of inflammation, which is emerging as a potential underlying driving force in PCOS as demonstrated by hs-CRP.2
Magnesium, CoQ10 & NAC
While it was demonstrated in a 2012 study looking at magnesium concentrations in the blood not being associated with insulin resistance in PCOS patients,3 it was included in a 2018 study that showed the opposite.4 This trial found that both fasting blood glucose was significantly elevated in PCOS patients and that magnesium levels were significantly lower than those in the placebo group. So while there is contradiction in the data (when isn’t there?), magnesium remains a very important nutrient to include in a PCOS protocol.
In terms of CoQ10, we all know the cardiovascular support it lends, but one 2017 study concluded that in patients that demonstrated ovarian challenges specifically, CoQ10 worked effectively to support glucose metabolism and healthy serum levels of total and LDL cholesterol.5
NAC is one of the most potent antioxidant precursors and should certainly be considered with any PCOS patient. Oxidative stress is viewed as an imbalance between the production of reactive oxygen species (ROS) and their elimination by protective mechanisms, which can ultimately lead to chronic inflammation. We know that inflammation plays a key role in PCOS, so it goes without saying that an antioxidant is a worthwhile inclusion. With an increase oxidative stress (OS) in the body, it has also been shown that DNA mutations and alterations induced by oxidative stress are involved in cancer pathogenesis, tumor cell survival, proliferation, invasion, angiogenesis, and so on. As it stands, PCOS patients are at an increased risk for endometrial cancer, so the additional insult from further OS is all that much worse. In 2015, the connection between OS and the application of NAC to improve ovulation and pregnancy was demonstrated in Obstetrics and Gynecology International journal.
There is a great deal of more information that could be written about this condition; how crippling it is for so many who suffer from it and how it can overtake every aspect of a woman’s life. There is also far more expansive lifestyle approaches that can be implemented to help manage PCOS. I encourage you to seek out these additional resources and build on this abbreviated overview. But hopefully, as brief as this summary was, it will provide information you can apply immediately, enabling you to administer the best possible nutritional options to those with PCOS who so deeply need it.
References:
1 J. Obstet. Gynaecol. Res. Vol. 42, No. 3: 279–285, March 2016.
2 Biomedical Research (2017) Volume 28, Issue 5.
3 Gynecol Endocrinol. 2012 Jan;28(1):7-11.
4 International Journal of Advances in Scientific Research, Vol 2, No 2 (2016).
5 Clin Endocrinol. 2017.
Dr. Adam Killpartrick earned his degree from Palmer College of Chiropractic in Davenport, IA. His primary practice focus has been a synergistic blend of NUCCA (upper cervical chiropractic) with Cranial Release Technique, for which he has attained lead instructor status. Dr. Killpartrick furthered his education in clinical nutrition, functional diagnostics and lifestyle medicine, and has since successfully integrated this blend of specialized chiropractic care and functional medicine into his New Hampshire private practice. This practical experience led him to clinical consulting for numerous nutritional supplement companies. He is currently the chief scientific officer for DaVinci Laboratories.