ROLE OF DIET IN THE MANAGEMENT OF POLYCYSTIC OVARIAN SYNDROME (PCOS)

Dr Yasmin Mohd Ali 1 , Dr Bushra 2 and Dr Tanzim 3 . 1. Asst Professor Dept of Gynaecology and Obstetric, Drmijt Unani Medical College. 2. Asst Professor Dept of Preventive Medicine, Dr Mijt Unani Medical College, Mumbai. 3. Associate Professor in Dept of Ilaj Bit Tadbir Drmijt Mumbai. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 10 February 2019 Final Accepted: 12 March 2019 Published: April 2019

Polycystic Ovarian Syndrome (PCOS) is hyteregenous, multisystem with Ovarian endocrinopathy in woman of reproductive age with ovarian expression of various metabolic disturbances. The prevalance of PCOS is general population has been estimated to be 5 -10%.
The classical presentation is characterized by features of anovultion, amenorrhea, oligomenorrhea or irregular cycles in combination with signs of androgen excess, acne, hersuitism or alopecia. It is associated frequently with insulin resistance. It is the commonest cause of infertility due to anovultion. PCOD affects 5 -10%. Of reproductive age woman rising till 15% in woman with infertility. In this paper we will discuss the role of diet in the management of PCOS.
PCOS has been attributed to several causes including changes in lifestyle, diet and stress. Genetic and familial environment factors were added as aetiological factor in development of PCOS.
Approximately 50% patients are hirsute and 30-75% are obese. Presumptive diagnosis of PCOS can often be made based of history and initial examination. According to an international consensus group, the syndrome can be diagnosed if at least 2 of following condition is present :-1. Oligomenorrhea Or Amenorrhea 2. Hyperandrogenism and 3. Polycystic ovaries on ultrasound PCOS is presumably related to hypothalamic pituitary dysfunction and insulin resistance. The clinical features of PCOD are menstrual irregularities, signs of androgen excess and obesity. It can give rise to long term complication like infertility, cardiovascular ailments, type 2 diabetes and carcinoma of breast and endometrium.

ISSN: 2320-5407
Int. J. Adv. Res. 7(4), 674-680 675 Weight loss is key in decreasing insulin resistance in obese woman. It shows that lower glycaemic diet may play important role in helping to control insulin and promote weight loss.
Dieto therapy in PCOS PCOS patients are not always markedly overweight but PCOS is strongly associated with abdominal obesity & insulin resistance. Effective approaches to nutrition & exercise improve endocrine feature reproductive function & cardio metabolic risk profile even without marked weight loss. Recent studies allow us to make recommendations on macronutrient intake. Fat should be restricted to or <or =30% of total calories with a low proportion of saturated fat.
High intake of low GI carbohydrate contributes to dyslipidemia & weight gain and also stimulates hunger and carbohydrate craving. Diet & exercise need to be tailored to the individuals need & preferences calorie intake should be distributed between several meals per day with low intake from snacks and drinks. Use of drugs to either improve insulin sensitivity or to promote weight loss are justified as a short term measure, and are most likely to be beneficial when used early in combination with diet & exercise.
Weight loss, accompanied by an increase in insulin sensitivity has proven to be successful treatment for the metabolic and hormonal abnormalities characteristics of PCOS population.
Until recently diet was not brought of as an important adjunct in treatment. However since the fairly recent discovery regarding the role of insulin resistance plays many experts believe that diet should be part of treatment plan.
It is believed that diet can help reduce insulin resistance cure which help to regularise menses, hersuitism & acne and also decrease the risk of heart disease and diabetes as well.

Green Leafy Vegetables
Leafy vegetables have maximum nutrients per calories compared to other foods and also rich in calcium, iron, potasium, magnesium along with vitamins K, C and E and most importantly essential B vitamins which plays an imperative role in managing the symptoms of PCOS. B vitaminsespecially B2, B3, B5 and B6 help in better sugar and fat metabolism, improve thyroid functioning and render better hormone balance, improve fertility all of which are essential for PCOS management.
The minerals help to neutralize the acidity caused by inflammation and impaired glucose tolerance. Calcium helps in egg maturation and follicle development in ovaries; potassium is needed for FSH (Follicle Stimulation Hormone) production. It helps to reduce PMS symptoms and also promotes weight loss.

Coloured Vegetables
Brightly colored vegetables not only makes for an appetizing salad but also helps in controlling PCOS and must be included in the PCOS diet plan. Colourful vegetables are loaded with powerful antioxidants that help to neutralize the harmful effects of oxidative stress in women suffering from PCOS.
Some of the healthiest colored vegetables include red and yellow bell peppers, sweet potatoes, tomatoes, carrots, eggplant, etc.

Fruits
This is the next set of healthy foods that must be included in PCOS diet recipes. Although most women suffering from PCOS are reluctant to include fruits in their diet because of the fructose content that causes a sudden spike in blood sugar levels and consequently insulin levels, fruits are really rich in phytonutrients, vitamins, minerals and fibres so it should not be avoided entirely.

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Include fruits that have low GI such as lime, strawberries, apricot, grapefruit, lemon, cantaloupe, guava, pear, oranges, watermelon, blueberries, nectarines, apples and kiwifruit and also eat a handful of nuts or seeds with the fruits for the much needed protein boost that helps to control the sudden sugar spike caused by fruits.

Healthy Fats
Not all fats are unhealthy and harmful for women suffering from PCOS. Healthy fats and essential fatty acids are indispensable for maintaining the cells and removing toxins from the body as well as promoting hormonal balance and weight management. Healthy fats also hold an important place in PCOS fertility diet. Healthy fats are found in seeds, nuts, avocado, olive oil and oily fishes like tuna and salmon.
Salmon is an amazing source of healthy fats and vitamin D that helps relieve certain problems related to PCOS. Tuna is rich in B vitamins and vitamin D both of which are essential for women with PCOS.

Organic Meat
Because weight gain is a major issue related to PCOS, it is important to include lean proteins in a PCOS weight loss diet in order to control body weight.

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Meat is one of the powerful natural sources of protein.

Low GI Carbohydrates
It is not necessary to completely shun carbohydrates even if you have PCOS, you just need to choose the carbohydrates judiciously. Carbohydrates with high Glycemic Index such as instant breakfast cereals, white breads, white bagels and white rice cause fast rise and blood sugar levels which in turn increase the release of insulin from the pancreas in order to use the glucose for energy, but high levels of insulin in the body eventually leads to insulin resistance and obesity which worsens PCOS symptoms.
Therefore, it is suggested to opt for healthy carbohydrates with low Glycemic Index that takes longer to break down and digest, causing slow and consistent release of blood glucose in the body. Low GI foods also aid to keep you satiated for longer and prevent cravings. Most legumes, beans, and lentils and non-starchy vegetables have low GI rating.

Conclusion:-
1. Although there is no known cure for PCOS yet, following a few simple guidelines and bringing about a few changes in the lifestyle can help a lot in managing PCOS symptoms naturally. 2. Consume whole grains instead of processed and refined foods and whole fruits instead of fruit juices in order to maintain blood glucose and insulin levels. 3. Eating foods rich in fiber also lead to a slower, consistent and controlled rise in blood sugar and insulin levels.