In PCOS, Preventing Chronic Disease Requires Multi-Pronged Approach

Woman eating salad
Woman eating salad
Nutrition and lifestyle modifications form cornerstone of therapy.

NEW ORLEANS — Strategies to prevent chronic disease in women with polycystic ovary syndrome (PCOS) should include individualized diet strategies and may involve a combination of insulin sensitizers, healthy eating, supplements and lifestyle changes, according to Angela Grassi, MS, RD, LDN, who is with The PCOS Nutrition Center in Bryn Mawr, Pennsylvania.

Grassi and co-presenter Hillary Wright, MEd, RDN, LDN, discussed this complex topic during a presentation at AADE 2015, the annual meeting of the American Association of Diabetes Educators.

Health professionals, she said, play an important role in the treatment of PCOS, noting the underdiagnosis and undertreatment are significant problems.

“Women with PCOS are at an increased risk for impaired glucose tolerance (IGT) and type 2 diabetes. Research suggests up to 50% of women with PCOS will have prediabetes or diabetes by age 40,” said Grassi.

“The Androgen Excess and PCOS Society recommends screening women with normal glucose every 2 years with an oral glucose tolerance test (OGTT) and yearly in those with IGT. Once a woman with PCOS develops IGT, there is a fast progression to type 2 diabetes. Diet and lifestyle modifications are the first-line approach for treating PCOS.”

Treatment Strategies

Grassi said all women with PCOS should receive nutrition counseling with a registered dietitian nutritionist to prevent the onset of diabetes and other chronic diseases associated with the condition.

However, while diet and lifestyle are the primary treatment approaches to managing PCOS, newer medications like the glucagon-like peptide-1 (GLP-1) agonists have been shown to be more effective than metformin in helping women lose weight and abdominal fat in particular, she added.

“In addition, functional nutrition plays an important part in managing PCOS. For example, inositol, specifically myo-inositol and d-chiro inositol, has been shown to be an effective treatment for regulating menses, restoring hormone balance, reducing insulin and even improving egg quality, and it can do this all without the adverse effects that we see with other drugs like metformin or [GLP-1 agonists],” Grassi told Endocrinology Advisor.

“Also, NAC (N-acetylcysteine) has been shown in one randomized long-term study to be equally effective as metformin in regards to improving BMI, hirsutism, fasting insulin, free testosterone, cholesterol and menstrual irregularity.”

She said vitamin D may play an important role in insulin regulation as well. Studies in PCOS have shown an inverse relationship between vitamin D and metabolic risk factors, such as insulin resistance, BMI, triglycerides and HDL cholesterol.

Challenges for Women With PCOS

Unfortunately, women with PCOS have other unique challenges that can make weight loss more difficult than the average population, according to Grassi. These challenges include increased hunger and cravings, impaired levels of appetite-regulating hormones and hypoglycemia. Therefore, working with a registered dietitian nutritionist is essential to help women understand the nutrition requirements for PCOS and to provide the support to make lasting lifestyle and dietary modifications.