NutriMediaJune 2015

Role of Nutraceuticals

in PCOS

Dietary Modifications, Nutrition and Exercise in

PCOS

The Interlink between

PCOS, and Obesity

Fertility

NutriMedia

From the Editor ’s Desk

E d i t o r i a l B o a r d

In today’s times, women are at the forefront of every frontier previously dominated by their male counterparts. Women not only are the authors of their own career success stories but shoulder family responsibilities with ease. All this multi-tasking leaves them with very little time to focus on themselves and their health has suffered a setback. The 3 ‘S’ factors: Stress, Sloppy nutrition and Sedentary habits have taken a major toll on women’s wellness. Many metabolic and hormonal disorders are on the rise. PCOS is one such endocrine disorder which should be controlled effectively because it is usually accompanied with other serious issues like insulin resistance, diabetes, and obesity. Moreover, PCOS is one of the leading causes of female infertility and can adversely affect the quality of life and psychological well-being of a woman as well as her physical health.

In this issue, we have discussed various aspects of PCOS management including weight management, diet modification, exercise, proper nutrition and requisite supplementation.

We hope this issue will prove to be informative and interesting.

S. Nanditanutrimedia.mm@gmail.com

Scientific Substantiation of Claims for Functional Foods

1

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Indicative product categories that can be tested :

Energy Drinks

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High Fibre Supplements

Premixes, SprinklersBiscuits

Snacks

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Examples of studies:

Glycemic Index Testing

Positive Nutrition

Nutriticosmetic Evaluation

S. Nandita Dr. Sherrill Sellman

Dr. Mahesh JukarDr. Debasis Bagchi

Sheldon Baker

Geetanjali Chitale

Shilpa Joshi

Dr. R. K. Sanghavi

Priti Mohile

Dr. Jagmeet Madan

- Editor , N. D. With a degree in lifesciences and a masters in healthcare, she is a prolific scientific Senior Editor of the TotalHealth Magazine, USA, she has authored many books for writer. Nandita has been contributing number of articles to consumer and trade women's conditions and hosts radio and television shows in the USA.magazines in India.

M. S. General Surgery, M. Sc. Applied Sport and Exercise Science (U.K.). A Debasis Bagchi, PhD, MACN, CNS, MAIChE, is a Professor in the Dpt. of qualified surgeon by education, Dr. Jukar is now a practising sports physician and Pharmacological and Pharm. Sciences, Univ of Houston College of Pharmacy, TX; fitness consultant in Mumbai.Chief Scientific Officer of Cepham Research Center, NJ; and Adjunct Faculty in Texas Southern University, Houston. He has served as Senior VP. R&D of InterHealth Nutraceuticals Inc, Benicia, CA, Director of Innovation and Clinical Sheldon is the Co-Principal of Baker Dillon Group, the award-winning nutaceutical Affairs of Iovate Health Sciences, Oakville, ON. Dr. Bagchi received the Master of brand marketing firm based in California, USA. He is the Past President of CANI American College of Nutrition Award in October 2010. He is the Past Chairman of and the San Francisco Bay Area Publicity Club.International Society of Nutraceuticals and Functional Foods (ISNFF), Past President of American College of Nutrition, and Past Chair of the Nutraceuticals and Functional Foods Division of IFT. He is serving as a Distinguished Advisor on With a M. Sc. in Clinical Nutrition and Post Graduation in Dietetics, she has over 15 the Japanese Institute for Health Food Standards (JIHFS) and is a Member of the years experience as a consulting dietician and has expertise in clinical trials. She Study Section and Peer Review Committee of the National Institutes of Health has been writing for various consumer health and food magazines and new papers. (NIH). Dr. Bagchi is the Associate Editor of the Journal of Functional Foods, Journal of the American College of Nutrition, and Archives of Medical and Biomedical Research, and also serving as Editorial Board Member of numerous other peer Shilpa Joshi is a post-graduate in Microbiology with a PG Diploma of Dietetics from reviewed journals. SNDT Women's Univ., Mumbai. She is a Registered Dietician with the IDA and is

Treasurer of IDA, Mumbai Chapter. She is currently the Consultant Dietician and Educator at Mumbai. She has 12 publications in peer reviewed journals and has presented nationally and internationally, including at the American Diabetes M.B.,B.S., M.C.P.S., F.A.I.M.S., F.C.G.P., M.D. (Acu), has an experience of 25 years Association. She is also master trainer "Diabetes Conversation Maps", International in Medicine and extensive expertise in the pharma medico- marketing area. He is Diabetes Federations' initiative for diabetes education. responsible for introducing the Indian market to the nutraceuticals such as

Isoflavones, Fish oils, Glucosamine-chondroitin, St John's Wort, Coenzyme Q10, and Evening Primrose Oil. In addition, he also brought chelates of iron and calcium and active moieties of numerous vitamins. He is serving the post of Chairman of Co-founder & M. D. of MediaMedic Communications Pvt. Ltd., based in Mumbai, IDMA (Indian Drug Manufacturer's Association) Medical Subcommittee. she is a post-graduate in Pharmacology and in management studies. She is also

qualified in preventive and promotive healthcare. She has been the past Hon. Joint Secretary of the Indian Pharmaceutical Association.

With a PhD., she is the Principal and Professor (Department of Food & Nutrition) at SVT College, SNDT Women's University, Mumbai. She was awarded the ‘Young Scientist award’ in 1993 by the NIN, Hyderabad. She is the current President of Indian Dietetic Association (IDA ), Mumbai Chapter.

NutriMedia

PCOS, that is polycystic ovarian syndrome, is a hormonal dysfunction can contribute to the development of 4abnormality which affects an alarmingly high number of PCOS.

Indian women; almost 1 out of 3 Indian women in the Besides, obese women are more likely to have menstrual reproductive age group fall prey to this disorder. In irregularity and anvolatory infertility than normal-PCOS, there are many poorly developed follicles within weight women. the ovaries which contain undeveloped eggs. These The other side of the picture has also proven to be immature eggs cannot be released, hence they form equally true. Obesity occurs in a burgeoning 30-75% of

5cysts. PCOS presents with a wide spectrum of signs and women with PCOS. PCOS is associated with increased symptoms in women, which can range in severity from accumulation of central fat. Moreover, independent of the mild to the severe; some of the common ones being BMI, women with PCOS have been reported to have a hirsutism (growth of hair in a male pattern), acne, hair high prevalence of upper-body obesity as loss, deepening of voice, menstrual irregularity and demonstrated by increased waist circumference and subfertility. waist-hip ratio compared to BMI-matched control

1There are two aspects to the manifestation of PCOS; the women. metabolic aspect and the reproductive aspect. One of

the metabolic features of this syndrome is a Interlink between PCOS, insulin resistance

predisposition to obesity or excessive fat accumulation. and obesityObesity is a common finding in women with PCOS and PCOS may increase the predisposition to insulin between 40-80% of women with this condition are

61 resistance (IR) , a condition where the natural hormone reported to be overweight or obese. Another common insulin becomes less effective at lowering blood sugar. metabolic aspect is defective insulin action and beta-cell Insulin resistance plays a pathophysiologic role in both dysfunction that may cascade into a substantially the metabolic and the reproductive complications of increased risk for glucose intolerance and type 2

2 PCOS.diabetes.

Insulin has pivotal importance in normal metabolism. The reproductive aspect of PCOS includes increased Insulin resistance disturbs the balance of lipids, raises androgen production and chaotic gonadotropin

7blood sugar and can culminate in Type II Diabetes.secretion leading to menstrual irregularity, hirsutism, 1

As many as 70% women with PCOS are insulin resistant and infertility. 8and 10% have diabetes.

Moreover, excess insulin can stimulate ovarian The link between PCOS and obesityandrogen and testosterone production, leading to the Western imitation, sedentary lifestyle, faulty nutrition

9development of PCOS.and junk food preference have brought about a bulge A two-way relation exists between insulin resistance and literally in the obesity statistics of India; and women obesity: insulin resistance may not only contribute to the carry the biggest burden of obesity. 2 in 3 women in

10development of obesity but can be caused by obesity.Indian cities are reported to be obese and rural areas 3

Excessive fat may cause altered levels of hormones to be reflect the same change.

secreted by adipose tissue called as adipokines that may Reproductive disturbances are more common in obese 11lead to the development of PCOS. Another theory women. Obesity can be the precursor to PCOS.

states that in obese women, the subcutaneous adipose Obesity has been linked to abnormal function of the tissue fails to expand to store more fat subcutaneously. hypothalamic-pituitary-ovarian (HPO) axis and this This results in lipotoxicity and the deposition of fat in

2

THE INTERLINK BETWEEN

PCOS, FERTILITY AND OBESITY- Deepti Sangelkar

NutriMedia

3

other tissues like liver, muscles, and pancreas.

Lipotoxicity drives hyperandrogenism and subsequently 12leads to PCOS.

On the other hand, chronic exposure to higher

testosterone levels in women with PCOS may modify 1body fat distribution and lead to obesity. Besides,

women with PCOS tend to have larger-sized abdominal

fat cells predisposing them to abdominal accumulation 1of adipose tissue and consequently visceral adiposity.

Thus, PCOS, obesity and IR form a vicious cycle that can

be broken down only by conscious effort at weight

reduction, thoughtful nutrition, strenuous exercise and

decrease in portion size.

The real danger behind these co-existing conditions is

the fear of infertility. Every woman dreams of being a

mother. Motherhood makes a woman's life feel 2BMI of 24 kg/m and continues to rise with increasing complete. Any deterrent to pregnancy can have far-

1BMI. Additionally, obesity has been linked with reaching consequences on the emotional and increased androgen (male hormone) production and psychological health of a woman. low concentrations of sex hormone-binding globulin PCOS is the cause of anovulatory infertility in 70%

1813 (SHBG) in women which can diminish fertility chances.women. Additionally, if or when pregnancy does occur,

Overweight and obese women have poorer outcomes the first trimester miscarriage rate is as high as 30% to 14 following fertility treatment. They respond poorly to 50%. One of the reasons behind this may be higher

clomiphene induction of ovulation and require higher mid-follicular luteinizing hormone (LH) in PCOS women doses of gonadotrophins for ovulation induction and compared with normal women. It is essential that

6superovulation. The reason behind this may be that follicular maturation should occur in an environment higher BMI is associated with a decrease in serum free from elevated LH levels to enhance the fertilization adiponectin levels which may stimulate hyperandro-and pregnancy rates. The increased levels of luteinizing genaemia elevating the chances of subfertility. Thus hormone can lead to inability to fertilize the egg or

15 these two crucial deterrents, obesity and PCOS, make a miscarriage if fertilized. Moreover, PCOS is commonly double onslaught and elevate the risk of infertility. associated with hyperandrogenaemia, which may

16contribute to subfertility. The conclusion from all these observations is that there

exists a cause-and-effect relationship between obesity The epidemic increase in the prevalence of obesity in and PCOS and both can independently and India owing to Western emulation, urbanization, and synergistically increase the chances of infertility. Even if mechanization, has brought about a corresponding PCOS cannot be cured, it can be effectively managed upsurge in the development of PCOS and related with a healthy lifestyle including balanced nutrition, infertility. Weight loss regularizes menstrual cycles and daily exercise, weight reduction and several long-term increases the chance of spontaneous ovulation and medications. conception in anovulatory, overweight and obese

women. A weight loss as small as 5% of the initial weight Refs: 1. Obes Manag. 2007 Apr; 3(2): 69-73. 2. Panminerva Med. 2008 Dec;50(4):315-25. 3.

15timesofindia.indiatimes.com 4. Semin Reprod Med. 2012 Dec; 30(6): 496-506. 5. J Hum has been associated with positive effects.Reprod Sci. 2010 May-Aug; 3(2): 62-67. 6. Womens Health(Lond Engl) 2015 Mar; 11(2): 137-

Another aspect to be noted is that obesity is an 49. 7. Obes Rev. 2009 Mar; 10 Suppl 1: 24-33. 8. World J Diabetes. 2011 Mar 15; 2(3): 33-40. 9.

Metabolism. 2008 Oct; 57(10): 1355-1360. 10. J Clin Invest. 2000 Aug 15; 106(4): 473-481. 11. independent risk factor for infertility and is associated International Journal of Endocrinology, Volume 2014 (2014). 12. Journal of Obesity, Volume

2011 (2011). 13. Med Clin North Am. 2008 Sep;92(5): 1163-92. 14. Clin Med Res. 2004 Feb; with lower fertilization rates, poor quality embryos and 2(1): 13-27. 15. J Hum Reprod Sci. 2008 Jul-Dec; 1(2): 65-72. 16. Pediatr Endocrinol Rev. 2006

17 Jan;3 Suppl 1: 198-204. 17. J Hum Reprod Sci. 2010 May-Aug; 3(2): 62-67. 18. Obes Surg. higher miscarriage rates. In reproductive-age women, 2006 Sep;16(9): 1214-20.

the relative risk of anovulatory infertility increases at a

Diagnostic hormonal changes noted in the serum of 1,2patients with Polycystic Ovarian Syndrome (PCOS)

Luteinizing

hormone (LH)

Androstenedione 4.9-9.0 nmol/L Increased

Testosterone 6-86 ng/dL Increased

Dehydropiandrosterone 12-535 mg/dL Increased

sulfate (DHEAS)

Follicle-stimulating 3-26 mIU/mL Decreased

hormone (FSH)

Sex hormone-binding 27-109 nmol/L Decreased

globulin (SHBG)

Hormone Normal Status in

laboratory value PCOS

2-14 IU/L Increased

4

Dietary Modifications, Nutrition and Exercise in

P C O S

NutriMedia

- S. Nandita3

losing weight by exercise than lean PCOS patients. A

persistent 30 minute regimen of brisk jogging, walking,

cycling, gym, swimming or aerobics can help. This exercise

regimen can be split into three 10 minute increments too.

Nearly 50% of the women suffering from PCOS are 4

overweight or obese. Weight loss is considered the first

line intervention in overweight women with PCOS. Weight Polycystic Ovary Syndrome (PCOS) is a common hormonal

loss can improve practically every parameter of PCOS. It disorder that affects 4-12% women of reproductive age.

can restore ovulation and pregnancy rates, decrease Poly means ‘many’ and women who suffer from this

insulin levels, lower testosterone levels and raise sex condition usually have several cysts on their ovaries. These 3hormone binding globulin (SHBG) level. A weight loss of cysts are dysfunctional follicular sacs that contain

5% can bring about positive effects and trigger normal immature ovules which cannot be secreted from the body. 5menses and ovulation. For weight management, a three-PCOS may be accompanied by other serious metabolic

pronged action namely diet control, reduction of portion conditions like insulin resistance and high cholesterol; and

size and exercise has to be initiated.can cascade into high blood pressure, diabetes, and heart

Since, insulin resistance and hyperglycemia are inevitable disease.risks of PCOS; a low calorie, low glycemic index (GI) diet can

Heredity may have a role to play in the occurrence of PCOS go a long way in reducing some of the health risks

however environmental factors such as nutrition, lifestyle associated with PCOS. A study has confirmed that a low GI

choices are believed to have an influence on its diet can, not only lower insulin levels, but has multiple

development and progress.benefits in PCOS like reduction in testosterone levels,

There is no cure for PCOS so far. However, PCOS can be improvement in hirsutism and acne, improvement in

6managed well with lifestyle changes like weight reduction, menstrual function and control of dyslipidaemia. Diet

diet control, exercise, proper nutrition and medications.modification i.e. switching from unhealthy to healthy

ingredients will surely be helpful. Switching from white

bread and pastas to whole grain, from breakfast cereals to

oats, bran or barley, adding more fruits and vegetables, Physical activity is a key element in the management of and reducing potato consumption are some easy diet PCOS. PCOS usually co-exists with insulin resistance. modification measures. Physical activity improves the way the body reacts to

insulin and lowering of insulin improves ovulation.

Insulin resistance is associated with marked abnormalities

of lipoprotein size and subclass particle concentration.

Moderate intensity exercise improves lipoprotein profiles 1

of women with PCOS. PCOS and obesity share a cause-

effect relationship and exercise can keep weight gain in

check. Thus, exercise can prove to be the cornerstone in

PCOS therapy and facilitates fitness, cardiovascular,

hormonal, reproductive and psychological outcomes. The

three most consistent improvements included improved 2ovulation, reduced insulin resistance and weight loss. It is equally important to follow a proper dietary pattern

The effectiveness of exercise in controlling PCOS depends through portion size control, consumption of small but upon regularity. Another factor to be noted is that women frequent meals, and choosing to have high caloric intake at of different BMI respond differently to exercise. It was breakfast followed by a moderate lunch and a light dinner.found that obese PCOS patients show more difficulty in

Diet modification

Exercise

GLYCEMIC INDEX CHART

< 55LOW GI

>70HIGH GI

56-69MEDIUM GI

5

NutriMedia

Nutrition

Vitamin D

Fiber

Calcium

Protein

Vitamin B12 and folic acid

Complex carbohydrates

Mono-saturated fats

Another study revealed that a low carbohydrate diet, high

in fiber, and enriched with mono-saturated fat improved Nutrition may be the vital key factor to control PCOS. Since 10

the metabolic profile of women with PCOS within 16 days.obesity and PCOS are invariably interlinked; fried, sugary, Good sources of MUFA include fatty fish like salmon, olive starchy and oily food-stuffs should be avoided. A low-oil, avacados etc.calorie based nutritional intake incorporating whole

grains, lean meat, green vegetables, fresh fruits, legumes,

pulses and lentils is necessary.

Vitamin D supplementation can decrease hyperinsulin-11

aemia and have a protective effect on blood pressure. 7 Vitamin D sources include sunlight, mushrooms, cheese, Fiber can go a long way in controlling PCOS. The dietary

fatty fish and fish oils.sources of fiber include oats, bran, barley, fenugreek, fruits

and vegetables.

Supplementation of Calcium and Vitamin D has a positive

effect on weight loss, follicle maturation, menstrual Increasing protein intake may improve weight loss and regularity, and improvement of hyperandrogenism, in glucose metabolism. Research comparing a glucose based

12infertile women with PCOS.and a protein based diet in PCOS has revealed that

protein intake suppressed ghrelin (hunger hormone)

significantly longer than glucose, producing a prolonged

satietogenic effect beneficial to weight management. Vitamin B12 and folic acid supplementation is

Moreover, the glucose based diet caused significantly recommended if PCOS is being treated with metformin

more hyperinsulinemia and stimulated cortisol and DHEA because this can reduce homocysteine levels and has a

(dehydroepiandrosterone) production which can lead to potential beneficial effect in terms of reducing the

undesirable testosterone production. All these findings incidence of long-term adverse cardiovascular events in

13support the intake of a high-protein low-sugar diet in patients with PCOS. Dietary sources of Vitamin B12

8PCOS.

include soya and meat

whereas fol ic acid is

abundant in citrus fruits

and greens.Inclusion of complex carbohydrates is important for PCOS

management because they provide a feeling of satiety, Thus, the symptoms of reduce appetite cravings and help in weight management. PCOS can be managed well

with focused effort towards Both simple and complex carbohydrates turn into glucose diet control , physical (blood sugar) in the body to be used as energy. However, activity and the right complex carbohydrates are non-refined and unprocessed nutrition.and get released into the bloodstream slowly and

consequently do not cause sugar spikes like simple Refs: 1. Med Sci Sports Exerc. 2009 Mar; carbohydrates. The best complex carbohydrates come 41(3): 497-504. 2. Hum Reprod Update. 2011

from whole grains, vegetables, fruits, beans, legumes, nuts, Mar-Apr;17(2):171-83. 3. Asian J Sports

Med. 2010 Mar; 1(1): 35-40. 4. Int J Obes and seeds. Relat Metab Disord. 2002 Jul;26(7):883-96.

5. J Hum Reprod Sci. 2010 May-Aug; 3(2):

62-67. 6. BMC Res Notes. 2011; 4: 53. 7. Br J

Nutr. 2005 Aug; 94(2):154-65. 8. Am J Clin

Nutr March 2007 vol. 85no. 3 688694. 9. Asia

Pac J Clin Nutr. 2012;21 (4):511-8. 10. Fertil As reported in the Asia Pacific Journal of Clinical Nutrition, Steril. 2006 Mar; 85(3):679-688. 11. Fertil

Omega-3 fatty acids had some beneficial effects on serum Steril. 2014 Jun;101(6):1740-6. 12. J Res Med

Sci. 2014 Sep; 19(9):875-880. 13. Diabetes adiponectin levels, insulin resistance and lipid profile in Care. 2010 Feb; 33 (2): 246-251.

PCOS patients and may contribute to the improvement of 9metabolic complications in these patients.

NutriMedia

6

PCOS is a serious health condition that can have a In PCOS patients with MBS, serum androgen and free

lasting effect on a woman's life. Yet, PCOS is something testosterone concentrations have been shown to be

that can improve if the right management options are higher and serum SHBG concentrations significantly

used. A holistic approach to management includes lower than those found in non-MBS PCOS patients, even 1dietary changes, exercise, medication as well as when correcting for BMI and age. Hence, management

'nutraceuticals'. that aims to control all these risk factors play a

significant role.

The American Nutraceutical Association states that the

term "nutraceutical" itself comes from a combination of It is this area in which ‘nutraceuticals’ are helpful. These

pharmaceutical and nutrition. In short, it is a substance are mainly derived from food, but are not present in

that is part of food or food itself that provides some sufficient quantities in the daily food intake to produce

health benefits. effect, hence need to be supplemented. Presumably,

they influence various biochemical pathways to produce

an effect that can reduce the incidence and severity of Considering that various factors like hormonal many chronic illnesses. imbalance, obesity, insulin resistance etc play a role in

PCOS, nutraceuticals that address one or more of these

issues can help to supplement the management. This Various nutraceutical ingredients that have been shown

may also help to manage the metabolic syndrome seen to be useful are:

in PCOS.

While the underlying pathophysiology in PCOS is not These include biotin, chromium, cinnamon, inositol, fully understood, subjects with PCOS have been shown D-chiro-inositol, magnesium, N-acetylcystine (NAC), to have an increased incidence of metabolic syndrome fish oil and vitamin D.(MBS). MBS is a clinical diagnosis in which the following

4 risk factors exist in a patient: insulin resistance,

hypertension, abnormal serum cholesterol levels and These include green tea, inositol, magnesium, 1 abdominal obesity. Apridonidze et al reported that vitamin D, 5 HT, and CLA.

women with PCOS who were between 20 and 39 years

old displayed a 4-fold increase in MBS; a subset of the

younger women showed an 8-fold increase when These include D-chiro-inositol, inositol, saw compared with matched controls. The most prevalent palmetto, vitamin D and fish oil.MBS factors noted were high BMI and low serum HDL-C.

• Those helping to control insulin or glucose levels

• Those helping weight loss

• Those helping to regulate hormones

Role of

Nutraceuticalsin PCOS- Priti Mohile

HEALTHY RECIPE

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7

Women with PCOS need to watch their weight and

incorporate low-fat ingredients in their diet. Moreover, since

insulin resistance can be an issue in PCOS, low- GI foods are

a must. Calcium-rich ingredients may also be beneficial in

PCOS for the regulation of menstrual cycles.

Two super foods that can fulfil all these requirements are

bajra (black millet) and broccoli as they are low-cal, low-fat

options and rank low on glycemic index. Moreover, broccoli

is one of the best dairy-free source of calcium.

Ingredients1 cup chopped Broccoli

1 cup whole Bajra, soaked for 8 hours and drained

2 tsp. Olive oil

1 tsp. finely chopped Garlic

1 tsp. chopped Ginger

2 finely chopped Onions

Salt

Method1. Cook the soaked Bajra with salt with 2 cups of water in a

pressure cooker.

2. Drain the water and keep aside.

3. Heat the olive oil/ ghee in a non-stick pan, add garlic,

ginger, onions and saute on a medium flame till the

onions become translucent.

4. Add the Broccoli, mix well and cook for 5 minutes, while

stirring occasionally.

5. Add the Bajra, salt as per taste and mix well and cook for

another 1 to 2 minutes, while stirring occasionally.

6. Serve hot with low fat curds.

Bajra Broccoli Khichdi

Tackle PCOS by these simple lifestyle

modification tips

Keep your weight in check

Consider dietary changes

Choose low glycemic index foods

Be active

• One of the major problems associated with PCOS is

unwanted weight gain. Obesity worsens insulin

resistance. Weight loss can regulate insulin as well as

hormonal levels and restore normal menstrual cycles.

• Calorie-control is essential. Choose low-cal food

options like low fat cream, toned milk and lean meat.

• Limit fried, salty and sugary snacks. Instead snack on

nuts and fruits.

• Try to restrict portion size by using smaller plates and

bowls, eating only till stomach is full and resisting the

urge for second helpings.

• Consult your doctor and discuss your diet plan with

your dietician for help to attain your ideal weight goals.

• Dietary modification by making healthy food choices is

a must.

• Instead of totally restricting carbohydrates, choose

complex carbs that can add fibre to your diet because

fibre can delay gastric emptying, increase satiety and

reduce sugar levels. High-fibre carbohydrates include

whole-grain breads and cereals, whole-wheat pasta,

barley, brown rice, and beans.

• Limit simple carbohydrates found in sugary sodas,

cake, candy, ice cream, burgers and pizzas.

• The glycemic index is a measure of how quickly a food

increases blood sugar and insulin levels.

• Replace potatoes with sweet potatoes or raw bananas.

• Choose whole-grain breads, brown rice, oats, barley etc

and dried beans and fruits such as berries.

• Exercise helps lower blood sugar levels. Increasing your

daily activity and participating in a regular exercise

program is essential for controlling insulin resistance,

weight management and regulation of sugar levels.

• Add more steps to your daily routine by parking a short

distance away from your destination or taking the stairs

instead of the elevator.

• Go for walks, jog, and swim or join a gym. Play a sport.

• Cultivate active hobbies like gardening or aerobics.

NutriMedia

8

MICRONUTRIENTS IN FOCUSand inositol-phosphoglycan (IPG), mediators of insulin Myo-inositol (MI)

1-4action.Inositol is a compound that has several different forms. The A study published in the Natural Medicine journal most well-known form is "myo-inositol." It is thought of as confirmed that myo-inositol administration improves a member of the B-vitamin family. However, it is technically endocrine parameters and insulin sensitivity, more so in not a vitamin because the body can manufacture inositol women with higher fasting insulin levels, defined by a and is not required to get it from the diet.

5fasting insulin level greater than 12 µU/mL.It supports the membranes of cells and is crucial to many It is also a fat-solublizing agent that helps to transport fat biological processes. It influences essential "signaling from the liver. For those overweight PCOS women who may molecules." The role of myo-inositol in the have a problem with fatty liver congestion, this can be pathophysiology of PCOS has been the focus of recent helpful.studies. It has been suggested that insulin resistance in

PCOS women can be attributed to a deficiency of myo- Refs: 1. Gynecol Endocrinol. 2008;24:139-144. 2. Hum Reprod. 2008;23(6):1439-1446. 3. N

Engl J Med. 1999;340(17):1314-1320. 4. Adv Pharmacol. 1993;24:21-50. 5. Gynecol Endocrinol. inositol's intracellular metabolites, D-chiro-inositol (DCI) 2012;28(12):969-973.

functional improvements; 86% of the treated women were D-chiro-inositol (DCI)ovulating at the end of the study, compared with only 27% D-chiro-inositol is a stereoisomer of myo-inositol, but they

3of those on placebo.belong to two different signal cascades and regulate 1 Due to the beneficial effects of both ingredients, a 2012 different biological processes. D-chiro-inositol has one of

study has suggested that the combined administration of the strongest androgen-lowering effects in women with MI and DCI in physiological plasma ratio (40:1) should be PCOS, as well as improvement in insulin sensitivity.considered as the first line approach in PCOS overweight In a study conducted in obese women with PCOS, the level patients, being able to reduce the metabolic and clinical of serum free testosterone, plasma triglyceride and blood alteration of PCOS and, therefore, reduce the risk of pressure was found to be decreased and most of them (19

1 2 metabolic syndrome. As reported in the Archives of out of 22 women) were ovulated.

Gynecology and Obstetrics 2013, “The data clearly showed Researchers at Virginia Commonwealth University that only the combined therapy was able to improve oocyte randomized 44 obese women with PCOS to receive either and embryo quality, as well as pregnancy rates in PCOS placebo or 1,200 mg of D-chiro-inositol daily for eight

4women undergoing IVF-ET.”weeks. Those taking D-chiro-inositol had a marked

increase in insulin sensitivity, as well as a 55% reduction in Refs: 1. Eur Rev Med Pharmacol Sci. 2012 May;16(5):575-81. 2. J Clin Endocrinol Metab

1985;61:946-51. 3. N Engl J Med. 1999; 340: 1314-1320. 4. Arch Gynecol Obstet. 2013 mean serum free testosterone. This translated directly into Dec;288(6):1405-11.

Recent research has revealed that patients often show Chromiumimprovement in these conditions with chromium Chromium is a mineral that is required in very small

3supplementation. A 2005 study showed that in women amounts for maintaining health. Some vegetables, meat with polycystic ovary syndrome, chromium picolinate (200 and whole-grain products, are relatively good sources of mcg/d) improves glucose tolerance compared with chromium. Absorption from the intestine is low and could placebo but does not improve ovulatory frequency or be further affected by conditions like age, stress,

4hormonal parameters. The results of a new pilot study pregnancy, infection, etc., resulting in deficiency.funded by the National Institutes of Health (NIH) showed Chromium appears to have a beneficial role in the

1 that daily supplementation with 1,000 mcg of chromium as regulation of insulin action. Chromium is available in chromium picolinate significantly enhanced insulin supplements form such as chromium picolinate, chromium

5sensitivity.chloride, chromium nicotinate and chromium citrate. 1 The latest reported 2015 clinical study in adolescents with Chromium picolinate is the most efficacious form ,

polycystic ovary syndrome, found that the number of consisting of trivalent chromium, and is an extremely safe 2 patients with oligo/amenorrhea decreased with treatment and highly tolerable trace mineral.

(83%). Significant reduction in mean ovarian volume, total Studies show that chromium picolinate -6

2 follicular count and free testosterone was also observed.• Effectively reduced insulin resistanceThis suggests that chromium might be beneficial in the • Treated hyperinsulinemia as well as hyperandro-

2 management of PCOS.genemia2

Refs: 1. Diabetes Educ. 2004;Suppl:2-14. 2. Iran J Reprod Med. 2013 Aug; 11(8): 611-618. 3. • Improved the glucose tolerance in women with PCOSNutrition Today: July/August 2005 - Volume 40, (4),189-195. 4. Fertil Steril. 2005

• Helped reduce the risk of cardiovascular disease and Dec;84(6):1755-7. 5. Fertility and Sterility, Sept 2003. 6. J Pediatr Adolesc Gynecol. 2015

1Apr;28(2):114-8.type 2 diabetes

NutriMedia

9

suggested that the correlations between vitamin D status Vitamin Dand hyperandrogenism may be due to the reduction in The sunshine vitamin, Vitamin D is essential for overall SHBG (Sex Hormone Binding Globulin) that results from health. It appears to regulate at least 1,000 genes. Hence a

2, 4obesity. deficiency has been implicated in many chronic conditions

like diabetes, heart disease, immunity, various cancers,

hypertension, PCOS and infertility as well.

Vitamin D deficiency is commonly seen in women with

PCOS. Studies show that 67-85% of women with PCOS 1having sub-optimal levels of Vitamin D. Many other

studies have reported inverse associations between body

weight (BMI, body fat and waist measurements) and serum 2,3,4,525OHD levels in women with PCOS, with reports of

levels 27-56% lower in obese women with PCOS compared

with non-obese women with PCOS.

Vitamin D is essential for egg development and

maturation. Optimal levels of Vitamin D also maintain

healthy blood sugar levels and thus prevent insulin

resistance. Hence lower levels have been linked to insulin

resistance, ovulatory and menstrual irregularities, lower

pregnancy success, hirsutism, hyperandrogenism, obesity 1and elevated cardiovascular disease risk factors.

Higher vitamin D levels are associated with an increased Evidence is accumulating that vitamin D plays an important likelihood for successful pregnancies, and there is evidence role in reproductive function. Vitamin D receptors have

6 for a beneficial effect of vitamin D supplementation on been found in the ovary, endometrium and placenta. 1menstrual dysfunction.Vitamin D deficiency is associated with calcium

Refs: 1. Clin Endocrinol. 2012;77(3):343-350. 2. Experimental and Clinical Endocrinology and dysregulation, which contributes to the development of Diabetes 2006; 114, 577-583. 3. Archives of Gynecology and Obstetrics 2009; 280, 559-563. 4.

Metabolism: Clinical and Experimental 2011; 60, 1475-1481. 5. Clinical Nutrition 2012; follicular arrest in women with PCOS and results in PMID:22260937. [Epub ahead of print]. 6. American Journal of Obstetrics and Gynecology 7menstrual and fertility dysfunction. It has also been 1989; 161, 1375-1384. 7. Clin Endocrinol. 2012;77(3):343-350.

7The role of vitamin D deficiency in the pathology of PCOS

Development of follicular arrest

Calcium dysregulation

$ SHBG

Anovulatoryinfertility

Menstrual abnormalities

# PTH$ 1,25OHD

Obesity$ Insulin receptor

$ Insulin secretion

Insulin

resistance

Hyperandrogensim

hirsutism acne#Testosterone

Infertility & menstrual

dysfunction

# Inflammation

Vitamin D deficiency

Reduced serum levels of folate and vitamin B12 and L-methyl-tetrahydrofolate (L-MTHF)increased serum Hcy levels are seen in patients with L-methyl-tetrahydrofolate is the biologically active form of

3,4,5 diabetes. Increased homocysteine levels are known to folic acid that is found in circulation and transported across increase cardiovascular risk. Polycystic ovary syndrome is membranes into tissues and across the blood-brain barrier. one of the conditions that are associated with elevated L-MTHF is helpful in preventing neural tube defects in the homocysteine levels, hence this simple intervention can go developing fetus as well as in regulating homocysteine

1 a long way in PCOS management. A recent study has (Hcy) levels and promoting normal ovarian function. confirmed that the Hcy levels of hyperhomocysteinemic As such, the common conditions associated with PCOS are women with PCOS were reduced after 3 months of folic factors that increase cardiovascular risk.acid supplementation, and the rate of reduction was higher

26Conditions associated with PCOS among women without insulin resistance.

• Insulin resistance • Type 2 diabetes

• Hypertension • DyslipidemiaRefs: 1. PLoS One, 2013; 8(4):e59570. 2. Adv.Stud.Med., 2003; 3(8A): S733-S739. 3. J Diabetes

• Cardiovascular disease • Cancer (endometrial, Complications. 2008 Mar-Apr; 22(2):104-11 4. Atherosclerosis. 2008 Aug; 199(2):362-7. 5.

Atherosclerosis. 2003 Mar; 167(1):105-9. 6. Int J Gynaecol Obstet. 2008 May;101(2):156-60.breast, ovarian)

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