Polycystic Ovary Syndrome (PCOS): Nutritional Interventions

Polycystic Ovary Syndrome (PCOS) is an endocrine disorder that affects 5 to 17% of women of reproductive age. This is a complex genetic disease because it does not have a single definite cause. The literature indicates that it is probably a condition of multigenic etiology, influenced by environmental factors that affect steroidogenesis, ovarian follicle development and metabolism. In addition, it is often associated with insulin resistance, obesity, infertility and long-term consequences such as type 2 diabetes, endometrium cancer, and cardiovascular disease. Therefore, it is characterized by hyperandrogenism, chronic anovulation, and polycystic ovaries. Understand below how to act and what nutritional interventions to apply to your pcos patient. Due to being associated with physiological mechanisms, changes in lifestyle such as physical activity, adequate dietary intervention and supplementation are effective strategies for the management of the condition. Studies indicate that women with PCOS have a question regarding nutritional preferences. However, they also have hormonal changes that affect the neuroendocrine circuits responsible for appetite control. Thus, these patients seem to have a higher point of satiety and increased appetite compared to women without the syndrome. Table of Contents Toggle Nutritional interventions in PCOS Micronutrients PCOS and Homocysteine Clinical practice Bibliographic references Nutritional interventions in PCOS Nutritional intervention is important for women with PCOS, as it leads to weight loss and improvement of metabolic and clinical characteristics. Low carbohydrate (CHO) diets consist of a daily intake of CHO not exceeding 20% of the patient’s total energy needs (NET), this dietary model gained popularity in the medium due to significant weight loss. Studies compared a diet low in CHO with one rich in monounsaturated fat and another comparison with a standard diet, and it was possible to observe that the first comparison resulted in greater weight loss among patients and the second led to a greater decrease in fasting insulin. Another dietary model that became popular was the ketogenic diet, characterized by strict reduction of carbohydrates (about 130g/day). Associated with the increase of other macronutrients (proteins and lipids) and consequent production of keones, used as an energy source by tissues, for studies evaluating the results of this diet, there was an improvement in testosterone indices and also in insulin sensitivity. However, the most solid evidence indicates that in addition to higher proportions of one macronutrient over another, caloric restriction (low-calorie diet) is the most effective dietary intervention for women with PCOS, since it promotes weight reduction, reflecting improvements in hirsutism, insulin resistance, circulating androgen rate and menstrual cycle pattern. Micronutrients Several studies suggest interactions between insulin resistance and some minerals (magnesium, chromium, calcium). Thus, all those who refer to the recession of the framework, becomes viable. In what is treated magnesium deficiency is a commonly observed characteristic in obese patients, type 2 diabetes, with insulin resistance and in hypertensive patients. Physiologically, the increase in insulin concentrations reduces the ability of cells to accumulate this micronutrient. Chromium is also related to insulin resistance. This is due to primary or secondary loss of calcium in the urine resulting from high levels of insulin. However, its importance goes beyond since adequate levels of chromium elevates free and total testosterone in women with PCOS. Another ally of the nutritionist is to check and maintain the appropriate zinc levels. This should be done due to vital functions that are linked to it such as fertility, reproduction, decreased inflammatory profile and oxidative stress. The literature indicates doses of 30mg/day. Furthermore, n-acetylcysteine (NAC) supplementation has been increasingly studied for its antioxidant effect. Therefore, it assists in reducing homocysteine levels and improves lipid profile and L-carnitine. These are important in transporting long-chain fatty acids to the mitochondrial matrix, making them available for b-oxidation and energy production. Proving the benefits of NAC and L-carnitine, studies have shown that women with PCOS had a significantly reduced level of total L-carnitine compared to the healthy group. While in another study conducted with 37 women with PCOS and insulin resistance, supplemented with NAC, reduced testosterone levels, low values of free androgen index and decreased insulin resistance were found. PCOS and Homocysteine Homocysteine is an intermediate amino acid formed by the breakdown of the amino acid methionine. In individuals with vitamin deficiency, mainly B12 and folic acid, there are gaps in the enzymatic pathways of homocysteine, causing the accumulation of this amino acid to occur. However, high plasma levels of this substance are positively associated with insulin rates in some conditions such as type 2 diabetes, metabolic syndrome, hypertension, and PCOS. Clinical practice A specific custom diet has not yet been established for women with PCOS, but the general rules are relatively clear. It is recommended to hypocaloric diet, i.e. caloric restriction of 500–1000 Kcal per day. In addition to reduced amount of carbohydrates, not exceeding the amounts of 200g or no more than 30% of the NET. However, supplementation of nutrients such as magnesium, chromium, calcium, zinc, N-acetylcysteine (NAC), L-carnitine and B-complex vitamins is also feasible. Bibliographic references Reading Suggestion:

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Article: SOP and nutritional interventions: Neves LPP, Marcondes RR, Maffazioli GN, Simões RS, Maciel GAR, Soares JM Jr, Baracat EC. Nutritional and dietary aspects in polycystic ovary syndrome: insights into the biology of nutritional interventions. Gynecol Endocrinol. 2020 Dec;36(12):1047-1050. doi: 10.1080/09513590.2020.1822797. Epub 2020 Sep 22. PMID: 32960105. Classifique esse post #sop #homocisein #micronutrients #diet #vitaminB #zinc #calcium #methionine #magnesium #lowcarb #chromium