Dietitian Jheel A. Jhaveri is Certified Clinical Dietitian, Child Nutrition Specialist, and Founder of Neutriful. She has studied BSc Applied Nutrition, PG Clinical Dietetics with Pediatric Nutrition. She also hold a Fellowship from The International Society of Pediatric Oncology (SIOP) and Certified by The Indian Academy of Pediatrics. She has been associated as a Clinical Dietitian with Sion Hospital, Surana Sethia Hospital & Research Centre, Bhatia Hospital & various government health centers of Community Nutrition. She worked as a Pediatric Dietitian with a Child-centric fitness company in the past. She has written various articles and reviews based on medical nutrition therapies and nutritious living.
In an exclusive conversation with Zotezo, she has spoken about Polycystic Ovary Syndrome (PCOS). Here is the edited excerpts of the interview.
Team Zotezo: What is PCOS?
Dt. Jheel: Polycystic ovary syndrome (PCOS) is a common endocrinopathy affecting 5-10% of women of reproductive age. It is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With PCOS, ovulation may not occur or the developed egg may not get released like it is in a normal cycle. PCOS can cause missed or irregular menstrual periods that can lead to infertility (inability to conceive) Development of cysts (small fluid-filled sacs) in the ovaries PCOS are of two types, the most common being overweight or obese PCODs and lean PCODs. Between 5% and 10% of women between 15 and 44, or during childbearing years, one can have PCOS. It gets detected in the early 20s and 30s, or while having problems in getting pregnant. PCOS can happen at any age after puberty. Women of all races and ethnicities are at risk of PCOS.
Team Zotezo: What causes PCOS?
Dt. Jheel: Although the exact cause of PCOS is unknown, it is understood to be a multifactorial condition with a genetic component. However high levels of stress due to work pressure, anxiety, changes in lifestyle, junk food intake adds to the genetic susceptibility in women to cause PCOD. Genetics and lifestyle changes together cause changes in the hormone levels along with obesity in many women that causes rapid disturbances in the menstrual cycle and cause PCOD. Increased androgen levels and insulin levels cause associated symptoms of acne and hersuitism. Anovulation or lack of menstruation can be due to the formation of multiple cysts in the ovaries that do not allow a regular flow of menstrual cycles. Insulin resistance and irregular blood sugar levels can further cause diseases like DM and CVD.
Team Zotezo:What are the symptoms of PCOS?
Dt. Jheel: Irregular menstrual cycle. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come every 21 days or more often, too much hair on the face, chin, or parts of the body where men usually have hair seen in a condition called as Hirsutism, Acne on the face, chest, and upper back, thinning hair or hair loss on the scalp; male-pattern baldness, Weight gain or difficulty losing weight, Darkening of skin, particularly along neck creases, in the groin, and underneath breasts skin tags, which are small excess flaps of skin in the armpits or neck area. Other symptoms are PCOS typically involves hormonal imbalances, insulin resistance, and metabolic abnormalities, which significantly increase the risk of infertility, type 2 diabetes, and cardiovascular disease (CVD) and affect the quality of life. Higher levels of depression and psychological distress as a result of physical symptoms can affect feminine identity. Women with PCOS suffer from greater body dissatisfaction and have increased mood swings, generalized anxiety, and eating disorders.
Team Zotezo: How does PCOS affect fertility?
Dt. Jheel: Having PCOS does not mean women cannot get pregnant. PCOS is one of the most common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation). The concerned doctor can guide with ways to help normalize ovulation and increase the chances of conceiving. PCOS is the most common cause of anovulatory infertility. Most women with PCOS have elevated levels of luteinizing hormone and reduced levels of follicle-stimulating hormone (FSH), coupled with elevated levels of androgens and insulin. These imbalances can lead to the formation of tiny cysts in the ovaries causing reduced to no menstruation. Women with PCOS who become pregnant are at higher risk than those without PCOS of developing gestational diabetes mellitus or suffering a first-trimester spontaneous abortion. As a part of treatment, PCOD women are put on birth control drugs, insulin sensitizing drugs or hormones for a stipulated time period to ensure ovulation is normal.
Team Zotezo: How is PCOS diagnosed?
Dt. Jheel: For diagnosis, at least two of the following symptoms must be present. Increased androgen levels, Irregular periods, including periods that come too often, not often enough, or no menstruation and Cysts in the ovaries.
Additional tests: Physical exam to check for blood pressure, body mass index (BMI), and waist size. Skin examination for extra hair on the face, chest or back, acne, or skin discoloration. The doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland). Pelvic exam – It is conducted to check for signs of cysts or abnormal growth or swellings in the female reproductive tract. Pelvic ultrasound (sonogram), this test uses sound waves to examine PCOM. Blood tests- Blood tests check androgen levels, cholesterol, TG, blood sugar, insulin, and risk factors for diabetes and CVD. Also, a thyroid test may be conducted for further assurance.
Team Zotezo: Is it mandatory to undergo surgery for PCOS?
Dt. Jheel: If a woman wishes to become pregnant, the doctor may prescribe medications to regulate menstrual periods and encourage ovulation. Treatment initially includes preconception guidelines, such as lifestyle changes (weight loss), behavioral modification techniques and halting the consumption of tobacco and alcohol. The first-line pharmacological treatment for inducing ovulation consists of a clomiphene citrate treatment for timed intercourse. The second line of treatment includes the administration of exogenous gonadotropins or laparoscopic ovarian surgery also called ovarian drilling. Laparoscopic ovarian surgery should be second-line therapy in women with polycystic ovary syndrome who are clomiphene citrate resistant, anovulatory, and infertile, with no other infertility factors. Finally, a high-complexity reproduction treatment in vitro fertilization is the third-line treatment and is recommended when the previous interventions fail.
Team Zotezo: Are there any homemade remedies for PCOS?
Dt Jheel: Many studies suggest medicinal properties from selected herbs and plants can have a positive effect on the treatment of PCOD. However, their clinical trials require further intervention. Some most commonly used and widely known ingredients are based on Indian Ayurvedic medicine. Asparagus Racemosus (Shatavari): It helps in promoting normal development of ovarian follicles, regulates the menstrual cycle and revitalizes the female reproductive system mainly due to its phytoestrogen (natural plant-based estrogen). It also helps in combating the hyperinsulinemia. Use: As a blanched preparation in salads or vegetable preparation. Foeniculum vulgare (Shatapushpa or Fennel seeds): They are a rich source of phytoestrogens that helps in reducing insulin resistance and in bringing down the inflammation in PCOS. Use: Chew dry or mix in water for a decoction in water. Ocimum tenuiflorum (Holy Basil): traditionally known as Tulsi has excellent anti-androgenic properties to decrease androgen production. Use: Boil in hot water for a decoction or mix it with other ingredients in tea.
Team Zotezo: What diet should one follow in the case of PCOS?
Dt. Jheel: PCOD treatment starts with lifestyle changes like weight management, diet & exercise. Approximate 5-10% reduction in body weight helps maintain regular menstrual cycles. It helps improve other symptoms of PCOD, decrease cholesterol, insulin, decrease risks of DM and CVD risks. Institute weight management program of diet and exercise include restricted refined carbohydrates in a low glycemic index diet and restrict total calories. Refined sugars, starchy food, aerated beverages, fruit juices, packed and processed sugary foods must be avoided. Increase high fiber foods like vegetables, whole grains; DGLV’s, nuts & oilseeds are low GI foods. Additional nutrients like Omega-3 helps reduce inflammation in PCOD. Consider supplementation with chromium, vitamin D3 (cholecalciferol), foods or supplements with selenium and iodine. Thyroid hormone replacement drugs for PCODs with thyroid under doctor’s prescription.
Team Zotezo: Can diet prevent PCOS? If yes suggest a diet.
Dt. Jheel: 9. Can diet prevent PCOS? If yes, please suggest a diet? Dietary intervention or pharmacotherapy or exercise regimes cannot work individually to obtain complete results in PCOD. All three components play an equal role in the treatment modality and avoid relapse of PCOD post-treatment. As a part of diet regimes, it is important to include: Restricted total calories, complex carbohydrates, low GI diet, rich in proteins, fiber, low to moderate unsaturated fats with other micronutrients like Omega-3, chromium, selenium, folic acid, iodine, zinc, and iron should be given along with D3 supplementation. A small frequent meal is suggested. General Guidelines on diet: -Early Morning: 1 tsp walnuts/multi seeds with warm water -Breakfast: 1 portion egg/protein food or 1 portion complex CHO from millets like ragi, jowar, buckwheat etc + 1 portion low fat milk or milk product -Mid-Morning snack: 1 fruit or 1 portion salad -Lunch: 2 small to medium portion multigrain roti/ red or brown rice + 1 portion dal/curry with vegetables -Evening Snack: 1 small portion mixed nuts or fruit -Dinner: Same as lunch -Pose dinner: 1 glass milk daily post-dinner for effective control of blood sugar levels at night.
Note: Diet cannot be based only on general guidelines suggested and should be prescribed only by a Clinical Dietitian after knowing the individual’s age, gender, body composition, medical history, eating habits and lifestyle pattern. Along with Diet, Exercise regime should be followed that helps reduce weight around the abdominal region to regulate hormone control and decrease androgen levels. Endurance and resistant training should be a part of the workout plan. Aerobic exercise, walking, yoga, cycling, circuit training, and meditation can also be beneficial.
Team Zotezo: Suggest a post PCOS surgery diet?
Dt. Jheel: Along with the dietary guidelines following measures need to be considered. A structured transitional diet from pre to post-surgery should be considered that may include a weight management program involving diet, physical activity and interventions to improve the overall well-being of the patient. Diet control for monitoring cholesterol, insulin, glucose, blood pressure, hormones & triglycerides should be undertaken. Pre & Post conception guidelines should be explained to women wanting to conceive in the future. Nutritional deficiencies should be monitored post-surgery and accordingly, foods rich in those nutrients should be incorporated in the diet plan given post-surgery. Regular follow-ups with the doctor and the dietitian must be taken by the patient to avoid any relapse. In case of relapse or repeated history of PCOD, it is imp to check with your doctor and dietitian and other concerned experts on an urgent basis. At no given time one should resort to quick-fix methods from the internet or self-medicate.