A Functional Approach to Polycystic Ovarian Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is an endocrine condition associated with hyperandrogenism, infertility because of lack of ovulation, menstrual disturbances, and metabolic dysfunction. Women with PCOS have lower serum sex hormone-binding globulin and increased BMI, waist: hip ratio, luteinising hormone, ratio of luteinising hormone: follicle-stimulating hormone, testosterone and free androgen index (FAI) (Tsai et al., 2013). PCOS often clinically manifests during adolescence with maturation of the hypothalamic pituitary ovarian axis. However, the genesis of the syndrome may be as early as in utero. Diagnosis of this condition can be complicated by other major physiological condition. Weight management through diet, supplementation, and exercise are fundamental and successful in management and reversal of PCOS (Jeanes, Barr, & Hart, 2009). Functional nutrition may also reduce risk for developing chronic diseases associated with PCOS such as obesity, diabetes, heart disease, high blood pressure, cholesterol abnormalities, and endometrial cancer (Moral, Escrich, Solanas, & Vela, 2011; Hoeger, 2007).

A Functional Approach to Polycystic Ovarian Syndrome (PCOS). Polycystic Ovary Syndrome (PCOS) is a condition that affects 5-10% of women of childbearing age. PCOS is associated with: irregular menstrual cycles, abnormal hair growth or loss, abdominal obesity, elevated insulin levels, elevated testosterone levels, polycystic ovaries, dark patches of velvety skin, acne, and infertility. PCOS can be related to diabetes, heart disease and endometrial cancer (Hoeger, 2007).

It is critical to understanding the endocrine system and specifically the menstrual cycle in the diagnosis and treatment of PCOS. With maturation of the hypothalamic pituitary ovarian axis at adolescence the process/cycle begins. The hypothalamus is a master in endocrine function. Under it in the chain of command is the pituitary gland, which is located at the base of the brain. The pituitary gland produces hormones that direct the function of the ovaries. Ovaries contain a woman’s lifetime supply of eggs. These eggs are immature and are stored in tiny fluid filled structures called follicles. Each month the pituitary gland secretes follicle stimulating hormone (FSH) into the blood stream. After it reaches the ovaries it initiates the development of several immature eggs expanding the size of the follicles, as the eggs mature the follicles secret estrogen. When the estrogen in the blood reaches a certain threshold the pituitary gland sends a surge of luteinizing hormone (LH) to the ovary. This causes the most mature follicle to open and release the egg in a process called ovulation. The free egg travels through the fallopian tube where it awaits fertilization. Eventually the remaining immature follicles dissolve. If the egg is not fertilized the egg and the lining of the uterus is shed during the next menstrual period.

For women with PCOS, the pituitary gland releases abnormally high amounts of LH into the blood stream upsetting the balance of many sex hormones and the normal monthly cycle. As a result the follicles do not mature and ovulation does not occur. This prevents fertility. Some of the immature follicles do not dissolve and remain fluid filled sacks – cysts, hence, the name polycystic ovary syndrome.

Having PCOS raises your risk for type 2 diabetes, heart disease, high blood pressure, cholesterol abnormalities, and endometrial cancer. It is the high levels of insulin, a hormone produced by the pancreas, that put PCOS patients at risk for diabetes and obesity related disease. Too much insulin combined with high levels of LH can lead to excess production of testosterone in the ovaries. Testosterone hinders ovulation and can cause many of the physical characteristics associated with PCOS such as acne, abnormal hair growth or loss, skin tags, brown discolorations on skin, obesity and ovarian cysts.

The etiology of PCOS is unknown but research has discovered some increasing evidence for a genetic basis. There is evidence for PCOS being caused by an abnormality in ovarian folliculogenesis or excessive androgen exposure as early as in fetal development. According to Franks, McCarthy, & Hardy (2006) rhesus monkeys or sheep that have been exposed prenatally to high does of androgen develop PCOS because of abnormal luteinizing hormone secretion and insulin resistance. Humans as well that were exposed to excess androgen between fetal developments of the ovaries to the onset of puberty lead to characteristics of PCOS (Franks, McCarthy, & Hardy, 2006).

There is no traditional medical cure for PCOS however; the medical approach of management is though medications or surgery. Hormonal birth control pills regulate the menstrual cycle and reduce testosterone levels in the ovaries. Anti-androgen drugs can be given to reduce abnormal hair growth or loss and acne. Diabetes medication such as Metformin may be administered to lower insulin levels, which helps to normalized cycle. Finally, doctors may encourage fertility through fertility drugs that stimulate ovulation or a surgery called Laparoscopic Ovarian Drilling Procedure. This may be preformed in case all other medications have not succeeded in restoring ovulation. During this surgical procedure a needle is inserted into the ovary and an electrical current is used to destroy small areas of ovarian tissue where testosterone is produced. Over time testosterone production diminishes and ovulation may occur. Obviously, the risks should be considered in all forms of treatment.

Functional nutrition provides an alternative with favorable results in PCOS treatment but many women are not informed or utilizing this option. Research reveals PCOS shows improvement with nutritional and life style alterations. While studies show that women with PCOS recognize the importance of diet, generally only about 15% see a dietitian (Jeanes, 2009). This is unfortunate because nearly 50% of women with PCOS are overweight or obese (Hoeger, 2007). Weight management or loss is fundamental in the naturopathic treatment of PCOS. By simply modifying the types of fats consumed, quantity and quality of carbohydrates, supplementations, and levels of activity there is optimized management or prevention of this disease (Barr, Hart, Reeves, Sharp, & Jeanes, 2011).

Incorporating exercise may reduce risk for developing chronic diseases associated with PCOS. Exercise may generate a weight loss and can increase metabolism when muscle mass is increased. Convincing research goes further to reveal that physical activity actually improves insulin sensitivity and PCOS symptoms improve when levels of physical activity were increased (Jeans, Barr, Smith & Hart, 2009). At least 150 minutes of moderate or vigorous activity per week is a diabetic prevention (Hoeger, 2007). However, these effects have not yet affected behavior. In a study by Barr, Hart, Reeves, Sharp, and Jeanes (2011) a 7-day activity and food diary and a questionnaire were given to over 200 women with PCOS with a mean body mass index (BMI) of 27.4. Half were not achieving sufficient physical activity for treatment or weight loss.

There is a correlation between greater amount of fat tissue and a greater imbalance of hormones. This is because adipose tissue, one of the most endocrine rich tissues within the body (Gosman, Katcher, & Legro, 2006), is a significant mediator between energy balance and female reproduction. It is the excessive energy stores that hinder ovulatory function (Gosman, Katcher, & Legro, 2006). A study by Tsai, et al. (2013) investigated dietary intake, glucose metabolism/tolerance, and sex hormones in women with infertility. There were 45 women with PCOS and 161 controls without PCOS infertility. Both groups revealed that the amounts of free androgen index (FAI) correlated with BMI, waist circumference and glucose metabolism. Women with PCOS had lower sex hormone-binding globulin but increased BMI, waist:hip ratio, luteinising hormone, ratio of luteinising hormone:follicle-stimulating hormone, testosterone, and they also had higher FAI. After-meal glucose, fasting insulin and insulin resistance were elevated in women with PCOS yet, they consumed fewer calories and carbohydrates compared with those with non-PCOS-related infertility. Obese women with PCOS have a higher glycemic Index (GI) than healthy weight women with PCOS (Jeans, Barr, Smith & Hart, 2009).

A low glycemic index diet is one of the best ways to reverse PCOS according to Jeanes, Barr, Smith and Hart (2009). When lower energy intake is combined with a low glycemic diet there are even greater signs of improvement (Jeanes, 2009). Excess sugar induces hyperlipdemia, insulinemia, uric acid production, and raises estrodiol levels (Schliep et al., 2013). Plus, the many forms of fructose sugar, processed sugars and soft drinks play a contributing roll to obesity and ovulatory disorders (Cheng et al., 2012). Reducing sugary substances in the diet, according to these studies, increase the body’s ability to loose weight. Participants feel fuller and receive fewer calories from nutrient rich whole grains, fruits, vegetables, and proteins. This switch from processed carbohydrates to whole foods is beneficial in the management of PCOS and promotes overall health. This intervention reduces weight and improves the anthropometric and clinical characteristics in PCOS women (Toscani, et al., 2011).

Type 2 diabetes mellitus is a major risk for women with polycystic ovary syndrome and a sugar imbalance. Diabetes and PCOS can walk hand and hand because of excess insulin and insulin resistance. Vitamin D, chromium, cinnamon, and gymnema are all beneficial in the prevention and maintenance of a diabetes presence in PCOS patients. Vitamin D plays a role in glucose metabolism (Murray, 2010). Studies have shown that people with type 2 diabetes are often deficient in vitamin D (Robinson & Estell, 2012). Good source of vitamin D is: 15 to 20 minutes of sunlight per day. Licorice supports healthy insulin levels and chromium is a trace mineral that enhances the action of insulin (Murray, 2010). Foods that are high in chromium are onions, tomatoes, brewer’s yeast, and whole grains. Cinnamon also reduces insulin resistance in women with PCOS. It also slows the breakdown process of carbohydrates, which is important for people with diabetes and women with PCOS (Murray, 2010). Gymnema is used to reduce high blood sugar. This herb blocks the typical paths that sugar molecules take during digestion, delaying the absorption of sugar. Gymnema also appears to have a lipid-lowering effect, which aids in weight loss (Murray, 2010).

Protein at each meal is recommended for women with PCOS. Protein has a stabilizing effect on the sugar released from carbohydrates into the blood. It balances insulin levels, which balance hormones, which then increases fertility. Protein can be found in leafy greens, sprouts, beans, nuts and seeds (Hoeger, 2007). In long-term nutritional treatment, more than 6 months, evidence suggests greater loss of weight and body fat with protein rich (30%) diet (Toscani, et al., 2011).

Women with PCOS usually have low-grade inflammation constantly present in the body, it is important to support the body by promoting healthy inflammation response. Food allergies and sensitivities trigger an inflammatory response (Murray, 2010). Healthy digestion is needed for improved estrogen metabolism. Essential fatty acids decrease the risk of inflammation, especially omega 3. Royal Jelly and Bee Propolis have been shown to reduce inflammation and naturally boost the body’s immune system.

Because PCOS patients are at risk for heart disease and cancer it is also important to address these issue when looking at treatment. Dietary oil choices have the potential to act protectively towards the cardiovascular system and may act as a cancer preventative (Moral, Escrich, Solanas, & Vela, 2011). Moral, Escrich, Solanas, and Vela (2011) recommend the use of uncooked olive oil as a preferred fat source because diets rich in corn oil can stimulate mammary carcinogenesis, earliest appearance of tumors, and the highest tumor incidence when compared to diets that use olive oil. Diets rich in olive oil and omega 3’s instead of corn oil, unprocessed foods, whole fruits, vegetables, nuts, and whole grains have the most beneficial effect hormonally, assisting in weight loss, cancer prevention, and cardiovascular health. Calcium is also beneficial to cardiovascular health (Murray, 2010). Calcium can be found in kale, turnip, collard, and mustard greens, kelp and seaweeds. Some seaweeds have 10 times more calcium than a glass of milk (Murray, 2010).

Supplements are effective in helping those with PCOS maintain hormonal balance. Licorice root helps maintain proper hormone production and supports liver health for hormonal balance support (Murray, 2010). Vitex Extract (Chaste Tree Berry) works to balance hormones while not containing hormones itself. This hormonal balance is achieved by affecting the hypothalamic-pituitary-ovarian axis (hormonal feedback loop), and working to correct the problem at the source (Murray, 2010). Maca is a superfood that works to balance the estrogen and progesterone in the body, for a healthy menstrual cycle. Maca does not contain any hormones itself; it works by nourishing and balancing the endocrine system (Murray, 2010). Royal Jelly and Bee Propolis aid in hormonal balance through endocrine system support (Murray, 2010). White Peony and Licorice Root lower testosterone levels. Eating essential fatty acids (EFA’s) have been shown to support hormonal balance and production (Murray, 2010).

Additionally, supplements and stress management help support regular ovulation and boost fertility. This is achieved with the promotion of hormonal balance and support of regular ovulation. White Peony and Licorice Root when combined with perform better to relax muscles and reduce painful menstruation (Murray, 2010). Natural Progesterone Cream can help to oppose the estrogen dominance that occurs with PCOS. By using progesterone cream you are able to mimic a natural cycle and help the body to establish its own cycle, including ovulating (Murray, 2010). DIM promotes healthy estrogen metabolism. It aids in the breakdown and removal of excess estrogen which is vital to regulation of the menstrual cycle. (Murray, 2010). Vitex Extract (Chaste Tree Berry) is one of the most powerful herbs for women’s fertility and menstrual health. Tribulus may normalize and encourage ovulation when used prior to ovulation. This herb aids women with menstrual irregularities, acting as a nourishing tonic for the reproductive system, especially the ovaries, and improving timing of the menstrual cycle (Murray, 2010). Eating essential fatty acids (EFA) helps to produce balanced hormones and creates a healthy environment for conception.

Endocrine support is important in the reversal and treatment of some of the male characteristics associated with PCOS. Hirsutism is a Royal Jelly and Bee Propolis aid in hormonal balance through endocrine system support (Murray, 2010). Saw Palmetto has been found to inhibit hirsutism in women with PCOS. This herb also helps to reduce hormonal acne symptoms (Murray, 2010).

Conclusion. While traditional medical diagnosis and treatment is important to polycystic ovary syndrome, research from functional nutritional shows a significant reduction in PCOS. Supplementation, increase in health and weight management through diet, and exercise are fundamental and successful in management and reversal of PCOS (Jeanes, Barr, & Hart, 2009). Functional nutrition may also reduce risk for developing chronic diseases associated with PCOS such as obesity, diabetes, heart disease, high blood pressure, cholesterol abnormalities, and endometrial cancer (Moral, Escrich, Solanas, & Vela, 2011; Hoeger, 2007). Women with PCOS could benefit from increased awareness and education about the positive results from diet and lifestyle modifications.

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