PCOS and

People’s
By: Emily Hulse
Dietetic Intern
Overview
Introduction

Importance/Significance

Current Literature/Ideas
www.images.google.com

Interdisciplinary Treatment

Nutritional Recommendations and Concerns

Possible Supplementation/Further Research

Conclusion
Importance and Significance
Prevalence of PCOS

- Still unknown: 1,585.1 per 100,000¹ or about 5 to 10% of women²

- More than likely to be from the South, have taken OCPs¹
- Risks of developing: Metabolic Syndrome, infertility, dysfunctional uterine
bleeding, endometrial carcinoma, insulin resistance, diabetes mellitus,
hypertension, dyslipidemia, cardiovascular disease¹
- Incidence of insulin resistance is higher in Mexican American PCOS
patients (compared to white PCOS patients)³
Current Ideas: Causes, Diagnosis, Treatment
Causes: genetic (CAPN10, Cytochrome pf450 family, AR, FTO, FSHR discussion)
and environmental (lifestyle, dietary, chemicals, stress/trauma)⁴

Diagnosis: Rotterdam criteria vs. Androgen Excess and PCOS Society

(menstrual irregularity, hyperandrogenism, polycystic ovary morphology
suggested) and addition of phenotype expression⁵

Treatment: medicinal (OCPs, Spironolactone, Metformin, DHT blockers),

complementary and alternative (acupuncture, massage therapy), and lifestyle
(weight maintenance)⁵
Interdisciplinary Treatment
- 2018 study including 261 physicians (66%), RDNs (22%), fertility specialists,
researchers, NPs or PAs, educators, counselors⁶
- 24% wanted multidisciplinary involvement, 30% wanted to expand
nutrition and exercise programs
- Barriers to goals included money/resources, insurance reimbursement,
difference of opinions, and time/length of visit
- Benefits of goals included integrated care, better results/long-term care
outcomes, greater convenience, better communication between providers
- People’s CAN overcome these barriers
Role of the RDN and Nutritionist
- Only 15% of patients with PCOS ever see a dietitian, only 3% see a
dietitian twice or more⁶
- Weight management suggested as first-line treatment for PCOS
- Even a 5 to 10% weight reduction in overweight/obese may significantly impact symptoms
- Different dietary compositions may be optimal for weight management
- Referral to RDN (Genesis Valdes) helps provide
individualized Medical Nutrition Therapy
- Referral to Nutritionist (Diana Guerra) helps
provide healthy eating skills and practice

www.images.google.com
Nutritional Recommendations
- Lower glycemic index⁷
- Insulin sensitivity increased
- Greater menstrual regularity
- Faster + greater weight loss
- Emphasis on fiber⁷
- Found in whole grains, whole fruits, whole
vegetables, and some proteins
- Correlated with increased insulin sensitivity
- Increased whole fruit and vegetable
intake⁸ www.images.google.com

- Correlated with increased insulin sensitivity

- Preferred: whole fruits and vegetables of a
moderate to low glycemic index
https://extension.oregonstate.edu/sites/default/files/documents/1/glycemicindex.pdf
http://www.glycemicindex.com/foodSearch.php

Food Serving Size Glycemic Index Value

White baguette 30 g 95

Pumpernickel bread 30 g 56

Cornflakes 30 g 93

Steel cut oatmeal 250 g 55

White rice 150 g 89

Brown rice 150 g 50

Watermelon 120 g 72

Apple 120 g 39

Black beans 150 g 30

Chickpeas 150 g 31

Peanuts 50 g 7

Baked russet potato 150 g 111

Baked sweet potato 150 g 70

Nutritional Concern - Vit B12 and Metformin
- Longer duration of Metformin use, increased risk of vitamin
B12 deficiency⁹
- Higher neuropathy prevalence in Metformin users with low
vitamin B12 levels⁹
- Deficiency may also occur in a dose dependent manner¹⁰
- Multivitamins may not provide the amount needed to correct www.images.google.com

vitamin B12 deficiency, solo supplement may be needed¹¹

- Vitamin B12 deficiency symptoms: anemia, weakness,
fatigue, glossitis, difficulty walking, tingling in extremities¹²
 www.pcosnutrition.com

Possible Nutrition Supplementation

- Myo-inositol and D-Chiro-Inositol¹³
- 2017 meta-analysis explains that a 40:1 ratio of myo:d-chiro acts as, “an intracellular
second messenger,” regulating TSH, FSH, and insulin; improves the metabolic profile of
PCOS
- Spearmint¹⁴
- 2010 randomized controlled clinical trial explains that 2 cups per day for 30 days
decreased free and total testosterone, increased LH and FSH
- Cinnamon¹⁵
- 2018 randomized controlled clinical trial explains that 1500 mg cinnamon for 8 weeks
decreased serum glucose and insulin, increased HDL and lowered LDL
- Others: Vitamin D, fish oil, N-acetylcysteine, zinc, magnesium,
berberine, coenzyme Q-10, and more¹⁶
Conclusion
- Many changes in the causes, diagnosis, and treatment of PCOS
- Continued changes in the future; need for continued education
- Weight management is primary lifestyle focus
- RDN, nutritionist, and all team members can help
- Focus on fiber, low glycemic index, high fruit and vegetable intake
- Monitor possible vitamin B12 deficiency
- Support patients in a variety of ways

Any questions? www.images.google.com

References
1. Okoroh, E. M., Hooper, W. C., Atrash, H. K., Yusuf, H. R., & Boulet, S. L. (2012). Prevalence of Polycystic Ovary Syndrome Among the Privately Insured, United States, 2003 to
2008. American Journal of Obstetric and Gynecology, 207(4). Doi:10.1016/j.ajog.2012.07.023.

2. Unfer, V., Nestler, J. E., Kamenov, Z. A., Prapas, N., & Facchinetti, F. (2016). Effects of Inositol(s) in Women with PCOS: a Systematic Review of Randomized Controlled Trials.
International Journal of Endocrinology, 2016, 1-12. Doi:10.1155/2016/1849162

3. Kauffman, R. P., Baker, V. M., Dimarino, P., Gimpel, T., & Castracane, V. (2002). Polycystic Ovarian Syndrome and Insulin Resistance in White and Mexican American Women: a
Comparison of Two Distinct Populations. American Journal of Obstetrics and Gynecology, 187(5), 1362-1369. Doi:10.1067/mob.2002.126650

4. Ajmal, N., Khan, S. Z., & Shaikh, R. (2019). Polycystic Ovary Syndrome (PCOS) and Genetic Predisposition: a Review Article. European Journal of Obstetrics & Gynecology and
Reproductive Biology: X, 3, 100060. Doi:10.1016/j,eurox.2019.100060

5. Goodman, N. F., Cobin, R. H., Futterweit, W., Glueck, J. S., Legro, R. S., & Carmina, E. (2015). American Association of Clinical Endocrinologists, American College of
Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review Guide: Guide to the Best Practice in the Evaluation and Treatment of Polycystic Ovary
Syndrome - Part 1. Endocrine Practice, 21(11), 1291-1300. Doi:10.4158/ep15748.dsc

6. Wolf, W., Wattick, R., Murray, P., Clemmer, M., & Olfert, M. (2018). Future Implications of Using Registered Dietitians in Multidisciplinary Polycystic Ovary Syndrome Treatment.
Healthcare, 6(4), 144. Doi:10.3390/healthcare6040144

7. Marsh, K. A., Steinbeck, K. S., Atkinson, F. S., Petocz, P., & Brand-Miller, J. C. (2010). Effect of a Low Glycemic Index Compared with a Conventional Healthy Diet on Polycystic
Ovary Syndrome. The American Journal of Clinical Nutrition, 92(1), 83-92. Doi:10.3945/ajcn.2010.29261

8. Asemi, Z., & Esmaillzadeh, A. (2014). DASH Diet, Insulin Resistance, and Serum hs-CRP in Polycystic Ovary Syndrome: a Randomized Controlled Clinical Trial. Hormone and
Metabolic Research, 47(03), 232-238. Doi:10.1055/s-0034-1376990
References (Continued)
9. Aorda, V. R., Edelstein, S. L., Goldberg, R, B., Knowleer, W. C., Marcovina, S. M., Orchard, T. J., Crandall, J. P. (2016). Long-term Metformin Use and Vitamin B12 Deficiency in the
Diabetes Prevention Program Outcomes Study. The Journal of Clinical Endocrinology & Metabolism, 101(4), 1754-1761. Doi:10.1210/jc.2015-3754

10. Liu, Q., Li, S., Quan, H., & Li, J. (2014). Vitamin B12 Status in Metformin Treated Patients: a Systematic Review. PLoS ONE, 9(6). Doi:10.1371/journal.pone.0100379

11. Reinstatler, L., Qi, Y. P., Williamson, R. S., Garn, J. V., & Oakley, G. P. (2011). Association of Biochemical B12 Deficiency with Metformin Therapy and Vitamin B12 Supplements:
the National Health and Nutrition Examination Survey, 1999-2006. Diabetes Care, 35(2), 327-333. Doi:10.2337/dc11-1582

12. Skerrett, P. J. (2019, February 11). Vitamin B12 Deficiency Can Be Sneaky, Harmful. Retrieved August 14, 2019, from
https://www.health.harvard.edu/blog/vitamin-b-12-deficiency-can-be-sneaky-harmful-2013001105780

13. Unfer, V., Facchinetti, F., Orru, B., Giordani, B., & Nestler, J. (2017). Myo-inositol Effects in Women with PCOS: a Meta-Analysis of Randomized Controlled Trials. Endocrine
Connections, 6(8), 647-658. Doi:10.1530/ec-17-0243

14. Grant, P. (2009). Spearmint Herbal Tea has Significant Anti-Androgen Effects in Polycystic Ovarian Syndrome: a Randomized Controlled Trial. Phytotherapy Research.
Doi:10.1002/ptr.2900

15. Borzoei, A., Rafraf, M., & Asghari-Jafarabadi, M. (2018). Cinnamon Improves Metabolic Factors without Detectable Effects on Adiponectin in Women with Polycystic Ovary
Syndrome. Asia Pacific Journal of Clinical Nutrition, 27(3), 556-563. Doi:10.1186/s12937-015-9.2008/581348

16. Articles/Blog. (n.d.). Retrieved August 14, 2019, from https://www.pcosnutritio.com/articles-blog/