Nutrition

Polycystic Ovary Disease

Polycystic Ovary Disease or PCOD is a common syndrome affecting women of reproductive age and is a cause of infertility.It is associated with obesity, hyperinsulinemia, elevated luteinizing hormone (associated with ovulation) production, elevated androgen (male hormone) production, hirsutism (male hair growth), follicular atresia (ovarian growth failure), ovarian growth and cyst formation, anovulation (failure to ovulate), and amenorrhea (absence of menstruation).Insulin resistance or hyperinsulinemia is associated with abdominal fat, hypertension, and hyper or dyslipidemia (increased cholesterol, triglycerides, LDL, and decreased HDL).These clustered characteristics just described have also been described as syndrome X.These characteristics may increase the individual's risk for gestational diabetes and Type 2 Diabetes or may coexist with already diagnosed Type 2 Diabetes.

The following describes some of the risks which may be associated with PCOD (you may not have all of them) and recommended lifestyle changes:

Insulin Resistance or Hyperinsulinemia
When carbohydrates (sweets, starches, fruits, milk) are consumed, blood glucose rises, and insulin, a hormone, is secreted by the pancreas.Insulin reduces the blood glucose level to normal by helping the excess glucose in the blood gain entry into the liver, muscle, and fat cells.If an individual overeats carbohydrate foods, blood glucose levels rise and excess insulin is secreted.Insulin resistance means the body produces more insulin than is normally necessary to reduce the blood glucose to normal.Eating only moderate amounts of carbohydrates can help reduce the rise in blood glucose after eating.Losing weight, eating low fat foods, and exercising can improve the effectiveness of insulin and reduce insulin blood levels.Excess insulin or insulin resistance is unhealthy for the blood vessels.

Hypertension
Hypertension is high blood pressure.Normal blood pressure is 120/80.High blood pressure is usually defined as 130/85.

Hyper or dyslipidemia
Hyperlipidemia or dyslipidemia is elevated cholesterol, triglyceride, LDL (low density lipoprotein or bad cholesterol), and low HDL (high density lipoprotein or good cholesterol).Recommended blood levels:cholesterol <200, triglyceride <150, LDL <130 or 100 if diabetes, and HDL > 35 mg/dL.

Diabetes
About 90-95% of persons with diabetes have Type 2 Diabetes.Persons tend to be overweight, over the age of 40 years and have a family history of Type 2 Diabetes.Type 2 Diabetes is controlled by diet, pills, or insulin injections (about 40% of Type 2 patients will require insulin).Your risks for Type 2 Diabetes can be reduced with weight reduction and exercise.

Type 1 Diabetes occurs in 5-10% of persons with diabetes, occurs earlier in life (less than 30 years), requires insulin injections (or the pump), and is caused by inadequate or no production of insulin by the pancreas.Type 1 Diabetes (in genetically predisposed individuals) may be caused by an autoimmune response when antibodies attack the insulin producing beta cells of the pancreas instead of the intended foreign substance or virus.

Recommendations include lifestyle management of weight, exercise, low fat intake with emphasis on monounsaturated fats, and reduced carbohydrate and sodium intake.If the insulin resistance, hypertension, and hyperlipidemia do not respond to lifestyle changes, medications will need to be prescribed

Weight Reduction
A modest weight reduction of 5-8 lbs. or 10% of current body weight can give significant improvements in abdominal fat, insulin resistance, hypertension, and hyperlipidemia.

Exercise
Modest increases in exercise (walking, for example) can improve insulin effectiveness.Walking that extra flight of stairs, parking the car farther from the store, and just being more active can help.Ideally, exercise should be 1/2 hour or so most days, but even 10 minutes could make some difference.

Low Fat Food Intake
Read the food labels.It is recommended to eat foods with < 3 grams fat per serving and of course, eat the serving size or amount recommended.Most recommended food portions are smaller than what we actually eat.Avoid the high ticket items such as croissants, biscuits, cream soups, fatty cheeses, fatty meats, large amounts of meats, and fried foods.Choose low fat dairy foods.Limit the total amount of fats added to foods (mayonnaise, gravy, margarine, butter, dressings, etc.).Choosing mono-unsaturated fats (olive, canola, peanut oils) more often may actually reduce your triglycerides, LDL, and increase your HDL.Try the tub margarine made with liquid canola oil, salad dressings made with olive, canola, peanut oil, or use these fats when cooking/preparing foods.

Reduced Carbohydrate Intake
It has been the observation of many clinicians that most Americans are indeed eating too much food and are underestimating their carbohydrate intake.The portions are larger than needed, and we are gaining weight since excess foods eaten will eventually be stored as fat.Excess carbohydrates can increase blood glucose levels and may contribute to excess secretion of insulin and triglycerides.Carbohydrates include sweets, starches, fruits, and milk.

Low Sodium Intake
If you have hypertension, reducing the salt you add to your food and avoid eating high sodium foods may help decrease your blood pressure.Foods high in sodium include cured foods (ham, bacon), sauerkraut, pickles, chips, olives, nuts, condiments (steak sauce, worcestershire sauce), and foods that are instant, packaged, canned and frozen.Convenience foods are generally high in sodium.Choosing foods from the perimeter or the outer walls and not the aisles of the grocery store, beginning with the produce sections, can be a good start...eat fresh, whole foods as much as possible.For example:baked chicken -- pasta, rice or potato -- fresh cooked broccoli, -- low-fat milk or sodium-free beverage instead of fried/breaded chicken -- macaroni and cheese from a box -- canned vegetables -- corn -- bread -- regular soda.Putting it all together...PLEASE NOTE THE SUGGESTED PORTION...

*The Strelitz Diabetes Institutes, Maternal-Fetal Medicine, EVMS - January 2000