The Effects of 
                                                     Nutrition and 
                                                           Exercise on 
                                          Polycystic Ovary 
           http://www.fssc.com.au/ivf-treatment-              Syndrome   
           programs/polycystic-ovarian-
           syndrome/ 
                                                  By Alicia Benner 
                           Introduction 
        Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder as it is prevalent in 5-10% of premenopausal 
        women (Dunaif, 2013).  The clinical and biochemical markers of PCOS vary, but it is most commonly defined as the 
        association of hyperandrogenism and anovulation in women. Hyperandrogenism is characterized by elevated serum 
        levels of androgens, specifically androstenedione and testosterone. There is also hypersecretion of luteinizing 
        hormone, which triggers ovulation and the development of the corpus luteum in females, and abnormally low serum 
        levels of follicle stimulating hormone, which promotes the formation of ova in females.  The clinical symptoms of 
        hyperandrogenism are alopecia (male-patterned baldness), hirsutism (abnormal facial and body hair in women), and 
        acne. Chronic anovulation varies from oligomenorrhea (infrequent menstruation), amenorrhea (an absence of 
        menstruation), and dysfunctional uterine bleeding. These disturbances in menstruation commonly manifest themselves 
        at menarche and lead to infertility (Franks et al, 2014). Polycystic ovaries, defined as having eight or more subscapular 
        follicular cysts that are less than 10 mm in diameter and an increased ovarian stroma, are no longer a requirement to 
        make a diagnosis of PCOS (Dunaif, 2013).  
                       Link to video describing PCOS and the PCOS Foundation: 
                       http://www.youtube.com/watch?v=FTPIItOWB94 
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                                                                                                Insulin Resistance and 
                                                                                                                                   Obesity 
                                                                                        Insulin resistance is commonly                                    Studies have been conducted to 
                                                                                        seen in women with PCOS. In                                       determine whether 
                                                                                        1980 a study conducted by                                         hyperinsulinemia contributes to 
                                                                                        Burghen et al. concluded that                                     hyperandrogenism or vice 
                                                                                        PCOS is associated with                                           versa. A study in female rats 
                                                                                        hyperinsulinemia. Many studies                                    puts forth the idea that high 
                http://bestcancerfightingfoods.blogspot.com/2                           have been conducted to explore                                    levels of androgens may result 
                010/05/female-upper-body-fat-and-pcos.html                              the connection between insulin                                    in an increase of type II b 
                                                                                        resistance and PCOS. A                                            skeletal muscle fibers, which 
                                                                                        significant positive correlation                                  are less sensitive to insulin.  
                                                                                        between increased levels of                                       There are also studies showing 
                  Rotterdam Criteria                                                    androgens and insulin                                             that decreased level of insulin 
                                                                                        resistance is seen, which may                                     result in decreased levels of 
                                                                                        suggest that insulin resistance                                   androgens. Supporting this 
                                                                                        plays an etiological role in                                      theory, insulin has been found 
                                                                                        PCOS. Hyperthecosis, which is                                     to be more dominant in 
                                                                                        enlargement of the ovary and                                      regulating sex hormone binding 
           Clinical diagnoses of PCOS is based                                          the presence of luteinized cells                                  globulin (SHBG) than sex 
           on the Rotterdam criteria, which                                             in the ovary that produce                                         steroids. SHBG is a protein that 
           requires that 2 of these 3 symptoms                                          androgens, is found to be more                                    transports sex hormones and is 
           are present in the individual: 1)                                            extensive in PCOS women that                                      a factor in regulating the 
           anovulation or oligo-ovulation 2)                                            have insulin resistance. This                                     amount of free hormone in the 
           clinical and or biochemical signs of                                         indicates that insulin has an                                     plasma. It has been found that 
           hyperandrogenism 3) polycystic                                               effect on ovarian morphology                                      both obese and lean PCOS 
           ovaries. There must also be an                                               and function.                                                     women have lower insulin 
           exclusion of other etiologies such as                                        Obese PCOS women have a                                           sensitivity, but the debate 
           androgen-secreting tumors, Cushing’s                                         30% higher rate of insulin                                        remains over the interaction 
           syndrome, or congenital adrenal                                              resistance than lean PCOS                                         between insulin resistance, 
           hyperplasia (Bruner et al, 2006).                                            women. Isolated adipocyte cells                                   obesity, and PCOS.  
           Obesity is common in PCOS women,                                             from PCOS women have shown 
           although not every PCOS woman is                                             a significant decrease in insulin                                 Long-term complications of the 
           obese. Obesity has been linked to                                            sensitivity. It is clear that                                     disorder are increased risks of 
           hyperandrogenism, as women who                                               obesity plays a factor in insulin                                 developing type II diabetes, 
           have upper body obesity are more                                             resistance, and it is                                             endometrial cancer, 
           likely to have higher levels of                                              hypothesized that obesity                                         cardiovascular disease, and 
           androgens than lower body obese                                              combined with genetic defects                                     impaired glucose tolerance 
           women (Dunaif, 2013).                                                        in insulin produce glucose                                        (Dunaif, 2013). Lifestyle 
                                                                                        intolerance in PCOS women.                                        changes seem to be an effective 
                                                                                        Research seems to point that                                      way to manage the symptoms 
                                                                                        insulin resistance is an intrinsic                                and potential complications of 
                                                                                        factor of PCOS rather than a                                      PCOS.  
                                                                                        result of the disorder.                                            
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                                                                                       “However, it has been shown that 
                                                                                                         
                                                                                        alterations in body composition 
                       Literature Review                                              are more beneficial as compared to 
                                                                                                 weight loss” 
          Lifestyle modifications, specifically diet and exercise, have been 
          proven to effectively manage the symptoms and decrease the risk 
          factors that are associated with PCOS. Many people claim that 
          this is more effective than medication. Most of the studies that 
          have been conducted explore the effect of diet and exercise on 
          obese PCOS women, and it has been found that weight loss is an 
          important factor for favorable results. Diets with restrictive caloric 
          intakes that result in weight loss have been shown to improve 
          hormone concentrations, cardio metabolic risk factors, and 
          reproductive functioning in obese PCOS women.  
          In a study conducted by Bruner et al studying weight loss through 
          diet compared to weight loss through diet and exercise it was 
          concluded that both groups reduced their body fatness and fasting 
          insulin levels. Bruner et al referenced a study conducted by                 http://studiofitnessmorrobay.com/fitness
          Speroff et al that found that fat deposition in the abdominal region         /its-time-to-cut-ties-with-the-scale/ 
          is correlated with decreased levels of SHBG and increased levels 
          of androgens (Bruner et al, 2006). Lass et al conducted a study on 
          obese PCOS adolescent girls. They provided a one-year                       effective, and can be attained by 
          intervention, which included exercise, nutritional guidance, and            incorporating exercise into their 
          behavior therapy. They found that the participants that                     lifestyle. Banting et al surveyed 
          successfully lowered their BMI significantly improved insulin               153 women and found that PCOS 
          resistance, decreased levels of free testosterone, LH, and LH/FSH.          women are less active than non-
          SHBG levels were increased. These results indicate that                     PCOS women, and though they 
          testosterone and SHBG are connected to hyperinsulinemia (Lass,              have a medical incentive to 
          2011).                                                                      exercise, they are hindered by a 
          However, it has been shown that alterations in body composition             lack of self-confidence. PCOS 
          are more beneficial as compared to weight loss. Endurance and               women also have higher rates of 
          resistance exercise training decreases fat mass but increases free          depression and anxiety than 
          fat mass. Bruner et al found that though weight loss was similar            controls (Banting et al, 2014). 
          between the nutrition group and nutrition and exercise group, the           The knowledge that weight loss 
          nutrition and exercise group had a 12% decrease in fat mass                 in itself is not the goal, but rather 
          compared to only a 3% decrease in fat mass in the nutrition group.          a reduction in fat mass and 
          The nutrition and exercise group resulted in a 39% increase in              increase in free fat mass may 
          SHBG levels as compared to only an 8% increase in the nutrition             encourage PCOS women to 
          group. Exercise results in an increase in free fat mass, which              integrate exercise into their daily 
          raises the resting metabolic rate, and will contribute to sustained         lives.  
          weight management whereas dieting may decrease the levels of                Specific dietary guidelines have 
          free fat mass in an individual. Indeed, a 10% increase in RMR               been studied and found to 
          was seen in the diet and exercise group as compared to a decrease           positively impact PCOS 
          in RMR in the nutrition group (Bruner et al, 2006).                         symptoms. Eating foods with a 
          These findings are of great importance because obese PCOS                   low glycemic index, consuming 
          women may be discouraged by the difficulty they experience in               omega 3, raw red onion, and the 
          losing weight. However, changing their body composition is more             timing of caloric consumption are  
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          all effective in improving the 
          syndromes of PCOS.                                                                  PCOS women are 7.4 times 
          Marsh et al studied the effects of                                                  more likely to experience 
          a healthy, low caloric diet as                                                      heart disease than non-PCOS 
          compared to a healthy, low                                                          women, and it is estimated 
          caloric and GI diet in obese PCOS                                                   that 70% of PCOS women 
          women. They found that 95% of                                                       have abnormal lipid profiles, 
          the women eating the low GI diet                                                    with cholesterol being the 
          had improved menstruation as                                                        most common. Consuming 
          opposed to only a 63%                                                               raw red onion was found to 
          improvement in the general                                                          decrease cholesterol levels 
          healthy diet. Also, insulin                                                         (Ebrahimi et al, 2014).  
          sensitivity improved three times                                                     
          more in the low GI diet than in            https://www.chfa.ca/resources/what-you-should-
                                                     know-about-omega-3-fatty-acids-and-fish-oil/ 
          the general healthy diet (Marsh et 
          al, 2010).                                 Jakubowicz et al studied the 
          Outadsahelomadarek et al studied           effect of the timing of caloric 
          the effect of omega 3 on PCOS              intake on 60 non-obese PCOS 
          induced female rats. Omega 3 is            women. One group of women 
          an antioxidant that combats                consumed the majority of 
          oxidative stress, which is an              their 1800-calorie diet at 
          imbalance between the amounts              breakfast (980 Calories), and 
          of free radicals and neutralization        the other groups consumed a 
          of them in the body. This                  980 Calorie dinner. A change 
          imbalance may lead to subfertility         in BMI was not detected in 
          and can occur due to                       either group, however the 
          hyperglycemia and excessive                breakfast group saw an 8% 
          weight. The female rats that               decrease in mean serum 
          consumed omega 3 experienced               fasting glucose and a 53% 
          an improvement of production of            decrease in insulin 
          oxidative enzymes, which led to a          concentration. The dinner 
          reduction in oxidative species.            group saw no change in these 
          Testosterone was lowered and               parameters. The breakfast 
          FSH levels were also increased             group also experienced a 2-
          (Outadsahelomadarek et al,                 fold increase in SHBG and 
          2014). These results indicate that         50% decrease in free 
          omega-3 consumption can have a             testosterone concentration. 
          positive effect on the hormonal            Again, the dinner group 
          balance of PCOS women.                     experienced no change. By 
                                                     the third month of the study 
                                                     50% of the women in the 
          “95% of the women eating                   breakfast group ovulated, and 
          the low GI diet had improved               only 20% of the women in the 
                                                     dinner group experienced 
          menstruation as opposed to                 ovulation (Jakubowicz et al, 
          only a 63% improvement in                  2013).                                 http://skinnychef.com/blog/shopping-
          the general healthy diet.”                                                        cooking-eating-healthier 
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