There Polycystic ovary syndrome it is a health problem that more and more women have to live with. There PCOS (Polycystic ovary syndrome) it does not only affect the ovary, as it could be deduced from the name, but determines a negative impact on the entire state of health of the woman of childbearing age. In general, it can be of interest between 5 and 20% of women of reproductive age and is characterized by a spectrum of different phenotypes: some women in fact have more severe symptoms with the coexistence of hirsutism, acne and seborrhea alopecia, menstrual irregularities and ovarian cysts; others, on the other hand, may present milder symptoms, but still important from a clinical point of view, which should not be underestimated.
A link more and more direct exists between PCOS and weight gain: this is what recent scientific studies on the subject confirm, in particular by Luigi BarreaAssociate Professor of Clinical Nutrition at the Pegaso Telematic University and Specialist in Food Science at the Endocrinology Unit of the Federico II University Hospital of Naples and recently winner of the award “Best endocrinology researcher under 40” established by the Italian Society of Endocrinology chaired by the Professor Annamaria Colao.
As part of the congress Feed Meheld in Milan on PCOS, presented the work entitled Fenotype of Metabolically Healthy Obesity (MHO) vs. Phenotype of Metabolically Unhealthy Obesity (MUO) in Polycystic Ovary Syndrome (PCOS): Association with the Endocrine-Metabolic Profile, with the Adherence to the Mediterranean Diet and with the Body Compositionwhich won him the award as “NutriMi Nutrition Professional 2022”.
“In this study we have shown that not all women with obesity and PCOS are the same, for the same weight – explains Professor Barrea – There are apparently healthy women who, however, already have very high inflammation, high levels of insulin resistance and a body composition characterized by excess fat mass and muscle mass deficit, defined therefore women with “unhealthy” obesity, compared to women who have the same weight, but have a much better and defined metabolism, therefore “healthy” women with obesity.
The identification of a healthy / unhealthy phenotype is important for the Food Science Specialist since in unhealthy ones, dietary strategies more aimed at weight loss, but above all at improving metabolism, should be implemented much earlier.
The results of this study underline theimportance of nutritional status assessment to refer women with PCOS and obesity to a personalized and intensive weight loss program early and stress the importance of collaboration between endocrinologists and nutritionists as a synergistic combination in the complex clinical management of PCOS patients with obesity ».
But let’s try to make the point, Professor Barrea: what exactly does Polycystic Ovary Syndrome or PCOS consist of?
«The Polycystic Ovary Syndrome (PCOS) can be defined as a endocrine and metabolic disorder among the most frequent in women of reproductive age characterized by alterations in menstrual cycles (sometimes they are absent, a condition called amenorrhea), infertility (inability of the woman to become pregnant) and various metabolic disorders (such as predisposition to develop diabetes mellitus type 2) “.
Tell us more about the link between PCOS and obesity …
“PCOS very often coexists with a state of excess weight, from overweight to obesity, which appears to be both a risk factor for the development of this syndrome and an aggravating factor. In addition to hormonal alterations (such as an excess of male hormones, androgens), obesity, insulin resistance and a state of outright inflammation often coexist in PCOS.
In particular, obesity leads to the production of substances (called cytokines) that “turn on” the inflammatory processes, thus contributing to the onset ofinsulin resistance (i.e. an excessive production of insulin by the pancreas which, however, fails to reduce blood sugar levels, thus predisposing women to developing diabetes).
Inflammation and insulin resistance in turn also lead to alterations in body composition, i.e. an increase in fat mass and a reduction in muscle mass which worsens the endocrinological picture of these patients and makes them refractory to weight loss“.
What is the role of the nutritionist in this syndrome, then?
«According to international guidelines, the weight management is the main one treatment strategy of women with PCOS. In fact, one diet-induced weight loss of at least 5% improves hormonal and inflammatory parameters and insulin resistance, as well as obviously reducing body weight. However, to date, it is not yet fully understood what the best dietary approach is for the treatment and management of PCOS.
Surely, it is clear that a high intake of carbohydrates, especially derived from bread and pasta, are associated with an increase in body weight, greater inflammation and insulin resistance, the three mechanisms underlying the pathophysiology of PCOS. The close association between diet with obesity, inflammation and insulin resistance makes the adoption of specific dietary treatments the primary “therapeutic” tool in women with PCOS “.
What type of diet should be followed to reduce the incidence or symptoms of this syndrome?
«In this scenario, recently, the ketogenic diet has been proposed as a dietary strategy for the management of obesity. This dietary “therapy” has proved effective from a metabolic point of view (ie it reduces insulin resistance and inflammatory state, two conditions at the basis of PCOS), but also endocrine and reproductive (some studies have in fact reported the reduction of hormones male in these women, androgens, which are the cause of alterations in menstrual cycles and manifestations such as acne and alopecia) ».
What is the ketogenic diet?
«The ketogenic diet is a real one “Diet therapy” which is characterized by a marked reduction of carbohydrates (bread and pasta, but not only) in the diet, with a high daily content of fats (those of vegetable origin) and with a protein content within the physiological limits (therefore we are not talking about diets high-protein!).
In particular, low-calorie ketogenic diets (very low calorie ketogenic diet, VLCKD) have a restriction of daily kilocalories below 800. These diets induce the production of substances called ketones (acetoacetate, β-hydroxybutyrate and acetone) which are formed from the fats accumulated in the adipose tissue thus leading to rapid weight loss “.
Can anyone go on a ketogenic diet?
“Absolutely not! The ketogenic diet is serious business and should be considered therapy. Like any therapy requires strict medical monitoring, along with adequate supplementation of micronutrients and vitamins. For this reason, contraindications to its use should be carefully considered by an experienced nutritionist before prescribing. “
Polycystic ovary syndrome: is it really difficult to get pregnant?
The ketogenic diet: what it consists of and why you can’t follow it alone
Source: Vanity Fair
