Polycystic ovary syndrome (PCOS) is effectively treated with the right diet and lifestyle changes

Summary: the hormonal and menstrual irregularities, metabolic dysfunction and adverse cardiovascular changes of PCOS (polycystic ovary syndrome) can be effectively treated with the right dietary and lifestyle interventions according to two recent studies. This is not surprising considering that excessive levels of insulin promote the development of ovarian cysts.A study recently published in The Journal of Clinical Endocrinology & Metabolism offers excellent evidence that the metabolic and cardiovascular irregularities of PCOS respond well to the appropriate lifestyle changes. The authors state:

"Polycystic ovarian syndrome (PCOS) is associated with cardiovascular risk factors (CRF). Lifestyle intervention is regarded as therapy of choice even if studies in adolescent girls with PCOS are scarce...Our objective was to analyze the impact of lifestyle intervention on menses irregularities, hyperandrogenemia, CRF, and intima-media thickness (IMT) in adolescent girls with PCOS."

They examined 59 obese girls with PCOS aged 12–18 years for menstrual irregularities,IMT (thickening of the inner layer of the arteries), waist circumference, blood pressure, fasting lipids, insulin, glucose, testosterone, dehydroepiandrosterone sulfate (DHEA-S), androstenedione, and SHBG (sex hormone binding globulin) before and after a one year intervention of nutrition education, exercise training, and behavior therapy. The results were instructive:

"In contrast to the 33 girls without weight loss, the 26 girls reducing their body mass index during the lifestyle intervention (by a mean of −3.9 kg/m2) improved most CRF and decreased their IMT (by a mean of −0.01 cm). Testosterone concentrations decreased (by a mean of −0.3 nmol/liter) and SHBG concentrations increased (by a mean of +8 ng/ml) significantly in girls with weight loss in contrast to girls with increasing weight. The prevalence of amenorrhea (−42%) and oligoamenorrhea (−19%) decreased in the girls with weight loss. The changes in insulin in the 1-yr follow-up were significantly correlated to changes in testosterone and SHBG."

These results illuminate the role of insulin resistance and its association with obesity and PCOS. The authors conclude:

"Weight loss due to lifestyle intervention is effective to treat menses irregularities, normalize androgens, and improve CRF and IMT in obese adolescent girls with PCOS."

These results add savor to another study published shortly afterward in The American Journal of Clinical Nutrition that offers evidence for the most effective protein/carbohydrate ratio for PCOS. The authors state:

"Some evidence has suggested that a diet with a higher ratio of protein to carbohydrates has metabolic advantages in the treatment of polycystic ovary syndrome (PCOS)...The objective of this study was to compare the effect of a high-protein (HP) diet to a standard-protein (SP) diet in women with PCOS."

They assigned 57 PCOS women to either a high protein (HP) diet (>40% of energy from protein and 30% of energy from fat) or a standard protein (SP) diet (<15% of energy from protein and 30% of energy from fat). Both diets were without caloric restriction, but dietary counseling was given monthly. At baseline and 3 and 6 mo, They took anthropometric measurements and collected blood samples at the beginning and after 3 and 6 months. The results support the replacement of carbohydrates with protein for women with PCOS:

"The HP diet produced a greater weight loss (mean: 4.4 kg) and body fat loss (mean: 4.3 kg) than the SP diet after 6 mo. Waist circumference was reduced more by the HP diet than by the SP diet. The HP diet produced greater decreases in glucose than did the SP diet, which persisted after adjustment for weight changes. There were no differences in testosterone, sex hormone–binding globulin, and blood lipids between the groups after 6 mo. However, adjustment for weight changes led to significantly lower testosterone concentrations in the SP-diet group than in the HP-diet group."

Considering that PCOS is driven by elevated insulin levels associated with insulin resistance the authors' conclusion offers sound guidance:

"Replacement of carbohydrates with protein in ad libitum diets improves weight loss and improves glucose metabolism by an effect that seems to be independent of the weight loss and, thus, seems to offer an improved dietary treatment of PCOS women."