Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women in their childbearing age around 18 -25% of women all over the world suffering from this syndrome.

PCOS SYMPTOMS

Women with this PCOS can represent different symptoms, most common are following;

• Irregular periods
• Excess facial hair growth (HIRSUTISM)
• Infertility or difficulty getting pregnant ( because of irregular ovulation or failure to ovulate)
• Obesity
• Acne and skin problems like Dermatitis.
• Depression, anxiety, bipolar disorders and eating disorders.
• Metabolic syndrome; hypertension, diabetes and coronary artery diseases

How to diagnose PCOS??

This condition should invite early diagnosis and intervention because there is considerable evidence that women with PCOS are at increased risk of
infertility, dysfunctional uterine bleeding, metabolic syndrome, type II diabetes, and cardiovascular disease. A Rotterdam criterion is widely used as a diagnostic assessment for PCOS. It requires two of the following three features;

• Irregular or skipped periods
• Anovulation
• Multiple cysts in ovaries on ultrasound
• Higher levels of Androgens; either manifested by symptoms like Hirsuitism, Acne or balding or biological evidence like raised levels of Testosterone in their blood tests.

Causes and risk factors;

The exact cause of this syndrome remains elusive however excess androgens production and insulin resistance may cause this syndrome. A Genetic factor is also important as several studies reported an increase incidence among first degree relatives. It is reported by studies that around 50-70% of women with PCOS have insulin resistance meaning their cells are not able to use insulin effectively. To keep body glucose normal, the body tries to pump out the high level of insulin. This hyperinsulinemia is associated with weight gain and increase production of androgen hormone testosterone. Insulin resistance makes it harder to lose weight, that’s why women with PCOS experience this issue.

lifestyle interventions for PCOS management;

According to international PCOS guideline 2018, lifestyle interventions like diet, exercise, behaviour or combined are recommended as first line management for PCOS. Several studies reported the higher prevalence of obesity and overweight in women with PCOS as compared to the general population so these prevention opportunities are particularly relevant for the management of PCOS symptoms.

How the intervention might work

Lifestyle intervention is therefore anticipated to work because a reduction in the Body Mass Index (BMI) will be associated with a reduction in insulin resistance, which will, in turn, lead to an improvement in the reproductive and metabolic features of PCOS. Weight loss of as little as 5-10% has been demonstrated to correct oligo anovulation and improve the ability of women with PCOS to conceive.

PCOS nutrition ;

its is frequently asked by women with PCOS that which diet is best for curing their symptoms but unfortunately there is no such miracle diet. Research shows that diet which reduces insulin resistance like some carbs, proteins and healthy fats may help in improving menstrual irregularities and obesity.

➡️choose your carbs wisely as all carbs are not bad… carbohydrates with high fibre content like whole grains, lentils, legume and beans are helpful in reducing weight and risk of type 2 diabetes in women with PCOS.

➡️ Food with a low glycemic index (a ranking system indicate how rapidly blood sugar level rises after eating carbohydrates) may reduce insulin resistance as reported by several studies.

➡️ Protein may helps in cravings, balance hormones levels and aid in weight reduction, examples are lean meat, egg, seafood and plant based proteins. some evidence has suggested the beneficial effect of a diet with higher ratio of protein to carbohydrates.

➡️ Food that reduces inflammation as; tomato, spinach, olive oil, walnuts, almonds, blueberries and strawberries.

Food to avoid;

• Food high in refined carbs like white bread, Muffins, white pasta
• sugary drinks like soda and juices as they increase blood sugar levels, which can lead to weight gain and worsen the symptoms of PCOS.
• Processed food and red meat.

Review the stress in your life;

stress increases cortisol level and this high level is linked with insulin resistance and weight gain. yoga and meditation can reduce stress as reported by studies.

Make sure you are getting enough sleep:

Several studies observed that short sleep duration is significantly associated with metabolic abnormalities, including higher BMI, raised fasting insulin levels, and increased risk of insulin resistance. Make sure you are getting enough and good quality sleep.

Get active;

Regular physical activity may help in reducing insulin resistance. studies have shown that low intensity exercise like walking or cycling reduces levels of cortisol and helps in reducing insulin resistance.

Consider supplements;

certain supplements like vitamin D, Myo inositol may help manage weight and other symptoms of PCOS though there is very little research is available to recommend these supplements for PCOS.

Take-home message;

PCOS is distressing for most of the women due to its symptoms and it is suggested by clinicians and dietitians that life style modification is the first line treatment for overweight and obese women.However due to diversity of symptoms one size does no fit for all. Make healthy food choices and create workout plan that suits your body and your PCOS….

Bloating is swelling or distention of the abdomen (belly area) after eating.it is very frequent and normal for the majority of people. About 16-30% of people report that they regularly experience bloating after eating. But for some, it is quite painful and makes them sluggish and uncomfortable.

• 

Causes of bloating;

➡️ Some medical conditions like; celiac disease, irritable bowel syndrome, eating disorders, hormone flux and food intolerance.

➡️ Serious causes like; ovarian cancer, pancreatic cancer, stomach cancer liver diseases and kidney diseases but remember, bloating in these conditions is associated with other specific symptoms.

➡️Large meals: eating large potion means our body produces more gas during digestion and that process can lead to our tummy being larger.

➡️Food sensitivity: some food like beans, pulses, lactose, wheat, veggies high in FODMAP may cause bloating in some people.

➡️ fizzy drinks, drinking through a straw and talking during eating may increase the amount of swallowed air.

➡️Stress and anxiety may also cause bloating, poor sleeping habits can have an impact.

➡️Drinking too much caffeine or alcohol

How to reduce bloating;

👉Small meal and proper chewing: proper chewing may reduce the amount of swallowed air and makes you eat slower.

👉Check your fibre: fibre intake should be adequate. too little or too much fibre can make bloating worse.

👉Food records: food diaries may help to identify the patterns of symptoms and food you eat.

👉 Fermented food; eating fermented food like kimchi, tempeh, pickles and kefir may reduce bloating as they are full of probiotics and natural way to boost good bacteria in our gut.

👉 Stay well hydrated: As constipation is one of the main cause of bloating and could be triggered by not drinking enough fluid. Aim to drink 1.5 litres of water a day and cut down on hydration robbers like caffeine, alcohol, fizzy drinks.

👉Avoid chewing gums and carbonated drinks.

👉Regular exercise: A short walk after a meal can alleviate bloating. Aim for 30 minutes mild exercise. gentle exercise and stretching can help diffuse trapped gas like yoga

👉 Check your hormonal cycle; many women experienced bloating and constipation when their period is due, because of higher levels of progesterone. Overcome any hormonal hurdle by staying active, drinking plenty of water and eating a healthy diet.

👉Herbal tea can also helpful; peppermint tea or peppermint oil has been shown to relax our gut muscles and help relieve bloating triggered by trapped gas. several studies suggest that peppermint oil in IBS is helpful as it has an antispasmodic effect which means it relax our gut and reduce tummy pain and bloating associated with IBS.

▶️Take-home Message: it is important to remember that occasional bloating is normal but If bloating is associated with diarrhoea and other medical conditions you should consult with the doctor.

Carbohydrates one of the important macronutrient found in food along with fats and protein, but the most misunderstood nutrient. People often say carbs as fattening and linked to various diseases, but this is not a real story. Let’s examine their role and bust this myth surrounding this hotly debated topic.

Types of carbohydrates:

Simple carbohydrates; simple carbohydrates consist of molecule called glucose. They rapidly degraded inside the body and raises blood glucose level. examples are honey, maple syrup, fruits and vegetables. Added sugar in cakes,candies and fruit juices is also simple carbs.

Complex carbohydrates; complex carbohydrates are starch and fibre. These are consist of long chain of glucose molecules. Examples are potatos, corn. Refined carbohydrates like white bread and pastries are also strach. Fibre is a plant derived indigestible carbohydrate.

Why we need carbohydrates:

• Primary source of energy; The main function of carbohydrates is to provide energy. carbs are quicker to process and provide fuel to our body.our brain consume more than 20% of total energy intake and glucose is the main fuel for brain cells.unused glucose is stored in muscles and liver in the form of glycogen.
• Important for Gut health; Fibre is helpful in digestion and improves our gut health. Our gut is the host of around 1 trillion microorganisms. several studies show that these microorganisms are crucial for various aspects of our health. Dietary fibers are indigestable and feed our gut microbiota and promote growth of GOOD bacteria.
• Carbohydrates helps preserve muscles mass; carbohydrates prevent the breakdown of protein for energy and preserve muscles mass.
• They influence heart diseases and Diabetes; carbohydrates enrich with fibre, reduces the risk of heart diseases, diabetes and some form of cancer. One study shows that people eating cereal based fibre have a decreased risk of colon cancer. Oats and barely contain a special chemical called Beta glucan which may helps to reduce blood cholesterol levels.

How much carb do we need

Daily recommended intake for carbohydrates is 45-65% of total caloric intake and 130gm of glucose is needed for adequate supply of energy to the brain.

Why people think carbs are bad for our health;

Carbohydrates have a bad reputation as people think eating carb means they are eating an unhealthy diet and may gain weight, but all carbohydrates are created not equally. What makes a carb good choice for our health. complex carbohydrates are good for our health as they are

• lower in calories
• nutrient dense like minerals vitamins and fibre
• lower in salt and fats

while simple carbohydrates like sugar, processed food, candies, fizzy drinks fruit juices and pastries.They ae not good for our health as they are

• lower in nutrients
• higher in calories
• higher in salt and fat

These carbohydrates are linked to obesity and other chronic dieaeses as reported by studies. These carbs increase blood glucose levels rapidly and to combat this hyperglycemia, our body releases insulin. insulin promotes glucose storage in muscles and liver and allows the entry of glucose into fat cells by converting glucose into fatty acids. long term intake of a diet high in refined carbs may cause insulin resistance and increase the risk of obesity and type 2 diabetes. Moreover, sugary drinks are a leading cause of tooth decay in children and adults.

what’s the answer to carbohydtrates;Eating the right type of carbs with moderation.

• Look for carbohydrates which makes you fuller for longer with minium calories like wholegrains, fruits and vegetables.
• Avoid refined or procesed carbohydters.limit the intake of added sugars.
• Take note of your body; whats makes you happy and energize and what food makes you lethargic and bloated. Notice pattern of your body, adjuct accordingly and choose your carb wisely.

”Do not eat less, eat right ”.

”Sleep is the golden chain that ties health and our bodies together.”

~ Thomas Dekker

Sleep: the important pillar of health is forgotten by many of us…. constantly tired, puffy eyes and hands holding a cup loaded with caffeine is a common picture of this modern era. Sleep form around one- third of human life, so the shut-eye must be doing some restoration work which improves brain and body health.

What is Circadian rhythm;

it is 24 -hrs biological clock which regulate our sleeping pattern along with other vital functions like feeding , hormones production and body temperature. Normally this rhythm rises in morning time causes wakefullness and alertness, with the onset of darkness it dropped down to the lowest level and helps in sleeping.

Impact of sleep deprivation on our health;

Good sleep is as important as eating a healthy diet. Our body needs good sleep for maintaining brain health, mood stabilization and to fight against diseases. The cost of sacrificing sleep is very high, lack of sleep and disturbed sleep pattern are linked with health issues like obesity, depression, increased risk of diabetes and hypertension. Sleep deficiency does have a negative impact on work performance.

• Sleep deprivation and Physical health; there is a growing body of evidence that sleep deprivation is associated with hypertension, coronary heart diseases (CHD), and diabetes mellitus(DM). Increased sympathetic nervous system activity is considered to serve as common pathophysiology in sleep deprivation’s relationships with these diseases.

• Poor sleep and Obesity; The majority of studies found positive association between short sleep (<6 hrs/night) and obesity. Sleep deprivation is associated with altered metabolic and endocrine mechanism resulting in increased appetite and late-night cravings. Moreover, insufficient sleep makes you tired and less active, over time reduced physical activity may cause weight gain and obesity.

• Poor sleep and Depression; Lack of sleep or disturbed sleep pattern has a direct link with psychological issues like depression and anxiety and suicide. Sleep deprivation causes decreased production of serotonin, a mood regulator chemical produced by our brain. Reduced level of serotonin causes depression and anxiety.

• Poor sleep and work life: Short duration sleep may have a negative impact on a person’s work life. Poor sleep can impair people creative capacities and reduces motivation to learn and generate new ideas.

How much sleep do we really need?

Although there is no perfect sleep number to fit each individual, National sleep foundation published a report updating sleep recommendation for all ages.

How to imrove sleep hygiene ;

• Food and drink; Avoid eating foods that are spicy and fatty as they are tough for the stomach and may disturb sleep. Timing of meal is also an important factor for having a good sleep. Avoid excessive consumption of alcohol and caffeine before going to bed.
• Day light exposure; it is reported by some studies that daylight helps keep our circadian rhythm healthy.
• Regular physical activity; According to National sleep foundation, people who exercise regularly have better sleep than those who do not. Some other studies suggested that exercise increases body temperature and increases production of Adenosine a chemical which causes drowsiness and improves circadian rhythm.
• Maintaining good sleeping habits; Avoid day time sleep, stop using elecronic gadgets (cell phones, laptops, tv) 30 minutes before going to bed. Smartphone light distrub production of Melatonin a chemical produced by our brain, which plays a vital role in regulating sleep-wake cycles.
• Make a regular sleep cycle: Regular sleep pattern may also help in improving sleep quality and duration. Waking up and going to the bed at the same times each day improves our wakeup/sleep cycle.
• Bedroom environment; Minimize noises, external light exposure. Try to make your sleeping environment quiet, relaxing and clean.
• Clear your mind before going to bed; Several relaxing techniques like meditation, reading a book and relaxing massage may improve sleep quality and duration.

Take-home message ;

Sleep is the third pillar of a healthy life and good sleep is important for our physical and mental health. Everyone has occasional disturbed sleep but if you are struggling with lack of sleep for prolong period, contact your doctor for identifying and treating any underlying cause.

”Happiness in simplicity can be achieved with a flexible mindset and nine hours of sleep each night.” – Dalai Lama

A balanced diet is essential for mental and physical wellness. Our brain has a high metabolic rate so it requires a large proportion of energy and nutrient intake. Diet deficient in vitamins and minerals has detrimental effects on brain health.

People are probably familiar with Vitamin B6, Folic acid and B12 but actually, there are eight different B vitamins. They are water-soluble so our body can not store them like fat-soluble Vitamins. Each member of B group has unique and diverse functions in our body. They have a paramount role in regulating metabolic pathways of protein, carbohydates and fats. Moreover, they are essential for red blood cell poduction, cell repair and DNA synthesis.

Vitamins in this goup are a:

• Thiamine (B1)
• Riboflavin (B2)
• Niacin (B3)
• Pantothenic Acid (B5)
• Pyridoxine (B6)
• Biotin (B7)
• Folic Acid (B9)
• Cobalamine B12)

Among all vitamin B, certain vitamins are linked to mental health like: B1, B6, B12 and Folic acid. It is suggested by several studies that low levels of vitamins B like B3, B6,  and B12  may lead to depression and anxiety. One study concluded that having a diet high in fruits, vegetables, whole grain nuts and olive oil is associated with low levels of depression.
Some studies have compared “traditional” diets like the #Mediterranean diet and the #traditional Japanese diet, high in vegetables and fruits, fish and seafood to a typical “Western” diet rich in processed, refined food and sugars and have shown that the risk of depression is 25% to 35% lower in those who eat a traditional diet.

Thiamine (B1): Thiamine is necessary for converting glucose into fuel for our body and cells in the brain. Thiamine also plays an important role in muscle contraction and nerve conduction. Its deficiency is very rare although chronic alcohol consumption may lead to thiamine deficiency.

Symptoms of Thiamine deficiency: Loss of sensation in hands and feet, loss of muscles and paralysis of lower leg. Thiamine deficiency also causes speech difficulties and mental confusion

Dietary sources of thiamine: thiamine is found in a variety of food so its deficiency is rare in people who are eating a healthy and balanced diet.

• Beef liver
• Black beans,lentils, fortified breakfasr cereal
• Pork
• Asparagus

Pyridoxin (B6); Pyridoxin has an important role in cell metabolism and nervous system . its deficiency may cause symptoms like:

• Depression
• Irritability
• Neuritis
• Difficulty in walking
• Carpal tunnel syndrome (loss of feeling or pins and needles in the hands caused by swelling of connective tissue in the wrist which presses on nerves)

Dietary souces of B 6; Pyridoxine or B6 found in a wide variety of foods like:

• Poultry like chicken or turkey
• Bread, whole grain cereals such as oatmeal,wheat germ and brown rice
• Eggs
• Vegetables
• Soybeans

Cobalamine (B12); It is essential for red cell production , DNA synthesis and integrity of myelin ( a component of nerve cell). its deficiency may cause symptoms like

• Anaemia
• Neuropathies
• Depression
• Memory loss

Dietary source of B12; This vitamin is exclusively found in food derived from animal hence vegan and vegetarian are increased risk of its deficiency.

• Liver
• Meat
• Fish
• Diary products

Niacin (B3); it is important for the production of chemical responsible for mood and emotions. serotonin is a mood regulator chemical produced by our brain and niacin is essential fo converting tryptophan into serotonin. its deficiency can directly impact mood and emotions due to impaired production of serotonin.

Dietary source of vitamin B 3

• Liver, chicken, salmon
• whole wheat, Bran
• Mushrooms,peanuts, legume Nutritional yeast
• coffee

Folic Acid or Folate; it is essential for DNA synthesis,Red cell production and its deficiency may cause Neural tube defects in the fetus.

• Green leafy vegetables
• Fortified breakfast cereals
• whole- grain bread
• Dried beans

Who needed vitamin B supplements; as vitamin B is normally found in wide vaierty of food and deficiencies are rar if you are eating a balanced diet, however people who are following a vegan diet may encounter deficiency .

• Pregnant women
• Lactating mothers
• Older patients
• People with certain medical conditions like celiac diseaes and inflammtory bowel diseases.
• People who are on certain medications like Metformin and anticonvulsants.
• People who had weight- loss surgeries.

What is the Bottom line .…

Mental wellness is associated with eating a balanced diet and by moving more. A good diet is proven to help you sleep better, make you more focused on good mood and better energy levels so choose your food wisely ………..
Eat plenty of #fruits and #vegetables. 
Nuts and grain but avoid processed one 
Lean protein like Fish good sources of vitamins and omega 3 fatty acids. sweets and fatty food should be special treats not staples of your diet.

”Every time you eat is an opportunity to nourish your body ”