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Polycystic Ovarian Syndrome

Key Takeaways

PCOS is the most common hormonal abnormality in young women and a common cause of infertility, menstrual dysfunction, excess body hair growth and scalp hair loss.

The main signs of PCOS are: cysts in the ovaries seen in ultrasound, irregular or skipped periods, abnormal hormone levels.

AGEs (Advanced Glycation End products) might be the cause of this syndrome.

Main source of AGEs are a diet rich in animal foods cooked with dry heat. We can reduce our AGEs exposure with a diet limited in animal products prepared with proper cooking methods and by quitting smoking.

We can also protect ourselves and accelerate detoxification of AGEs with a diet high in anti-oxidants and an active lifestyle. A whole food plant based diet can also reverse obesity and type II diabetes often accompanied by PCOS.

The excess of male hormones in female patients suffering from PCOS leads to them developing male pattern hair loss.

Polycystic Ovarian Syndrome (PCOS)

PCOS is the most common hormonal abnormality in young women and a common cause of infertility, menstrual dysfunction, excess body hair growth and scalp hair loss. It is a hormonal imbalance disorder affecting women of reproductive age (15 – 44 years old). This condition effects about 6% to 9% of young women (in the US) and its incidents are rising.  Most women suffering from this condition have mild symptoms and are simply unaware of it. In fact, this study found that up to 70% of the women with this condition were not diagnosed.  

Ovaries are female reproductive organs that produce hormones such as estrogen and progesterone (which regulates the menstrual cycle) as well as a small amounts of male hormones. The ovaries are responsible for releasing eggs and regulating the menstrual cycle.

Women with this condition have a compromised ovarian function. This leads to the ovaries developing small fluid filled sacs (called cysts) inside. These cysts contain immature eggs which were not released and did not trigger ovulation. As a result, women with PCOS have irregular or skipped periods and abnormal hormone levels with patients experiencing lower levels of estrogen and progesterone and a higher levels of male hormones such as testosterone and DHT.

 

Symptoms

The main identifying signs and symptoms of PCOS are:

  • Cysts in the ovaries seen in ultrasound
  • Irregular or skipped periods
  • Abnormal hormone levels
  • Excessive body and facial hair growth
  • Scalp hair loss in a pattern similar to male AGA
most common form of hair loss in men with More than 50% being affected.

Since PCOS leads to elevated male hormones, it leads to other symptoms such as excessive body and facial hair growth (hirsutism), increase in acnes and scalp hair loss. The excess of male hormones in female patients suffering from PCOS leads to them developing male pattern hair loss. Women with this condition will begin to notice hair thinning in their temples and vertex in a pattern similar to male pattern hair loss. 

PCOS is a common hormonal abnormality in young women and a common cause of excess body hair growth and scalp hair loss.

Causes

Often in medical literature, PCOS is referred to as a condition whose exact cause is complicated and still unknown. Doctors often associate PCOS with genetic factors and more often to obesity and insulin resistance (Diabetes) since many PCOS patients also do suffer from obesity and insulin resistance as well. While genetics do play a role in this disease, it does not explain the rising cases in recent decades. Women who are suffering from obesity and type II diabetes are at a higher risk for PCOS as this meta-analysis discussed. This study also proves a direct link between insulin resistance and PCOS. However, the exact cause of PCOS is still not well understood until we take a closer look at diet and its biochemistry.

Over the last two decades, increasing evidence has shown that AGEs, also known as Advanced Glycation End products (a substance produced during cooking of mainly animal products), are responsible for causing chronic inflammation and play a role in many chronic illnesses. This study found that women suffering from PCOS are found to have nearly twice the levels of AGEs in their blood stream.

What are AGEs?

AGEs (Advanced Glycation End products) also known as glycotoxins are a diverse group of toxic compounds which are made when sugars react with proteins or fats. Although AGEs are produced in our bodies as a natural part of metabolism, the dietary and lifestyle sources are a significant mode of exposure that can be controlled. AGEs occur naturally in raw animal based products and to a much lesser extend raw in plant foods as well. However, it is the cooking process that produces a significant amount of AGEs since heat accelerates the reaction of sugars with proteins and fats leading to the production of AGEs. Foods rich in fat and protein (mainly from animal sources) that are cooked with dry heat methods such as grilling, frying, roasting and broiling tend to have the highest levels of AGEs in contrast to low fat high carbohydrate foods. 

AGEs are known to cause oxidative stress and inflammation throughout the body and are linked to many chronic illnesses. This is mainly due to their ability to react and cross link body’s proteins together causing serious chronic diseases throughout the body. In the brain, they are shown to increase the rate of Alzheimer’s disease and cognitive decline, In the eye they cause cataracts through macular degeneration, In the arteries they cause hypertension, arteriosclerosis, heart failure and stroke. They cause kidney disease and renal failure, and are linked to anemia. In the bones they cause osteoporosis and muscle loss, are also linked to the development of diabetes and finally PCOS. As a result, AGEs are known to accelerate the aging process causing multi-system decline in body’s functions.

applying dry heat (BBQ, Frying, baking, Broiling and etc.) to animal products results in generation of significant amounts of AGEs

How do AGEs Cause PCOS?

In order to make sure that PCOS is caused directly by AGEs and not as an indirect result of an unhealthy diet and life style, these researchers checked the levels of AGEs in women suffering from PCOS who were not insulin resistant (lean women). A similar link between AGEs and PCOS was found in lean women as well, making AGEs a possible cause of PCOS.

More importantly, this study found that AGEs build up inside the cysts themselves which suggest that AGEs play a role in the initiation of this disease. This study also showed that ovaries are more sensitive to AGEs due to a higher expression of the AGE receptors in the ovarian tissues. This means that the ovaries have an affinity to absorb and build up AGEs from the blood. This shows that AGEs might be the cause of PCOS directly and therefore reducing dietary AGEs might help with this condition.  

Treatments

 

Multiple approaches are used by doctors to treat PCOS. These include life style recommendations, hormone treatments, medications and etc. Here we will briefly elaborate on the most common options. if you are suffering from PCOS, visit a specialist for a detailed examination and a comprehensive treatment plan.

This study showcases a detailed plan for PCOS treatment depending on the patient’s needs. In short, to deal with anovulation and infertility, medications such as Clomiphene, Letrozole, hormonal contraception and Metformin are prescribed. Metformin is also used to deal with insulin resistance. However, as we will discuss in the diet section, insulin resistance and obesity can be completely reversed through a healthy diet and life style, eliminating the need for life long medications. To deal with the body hair growth and scalp hair loss, Finasteride is recommended along with hormonal contraception and metformin. Finally, topical therapies might be used to treat acnes as well.

AGEs play a key role in the process of PCOS and therefore eliminating their intake and accelerating their detoxification should help with the treatment of this disease. This can be achieved through multiple lifestyle and dietary changes that are incredibly effective.

As for the scalp hair loss, once the underlying cause of PCOS is dealt with the hormone levels should return to normal and scalp hair loss should cease. The hair loss treatment protocol is similar to that of male pattern hair loss. Much like male AGA, the sooner the treatment begins, the higher the chance of recovery for lost hairs. With that in mind, typical treatment options include Minoxidil and a Hair Transplant.

Lifestyle Changes

Lifestyle changes can play a major role in not only treating the cause of PCOS (through elimination of AGEs), but also in reversing the other often accompanied conditions that many PCOS patients also suffer from such as obesity and type II diabetes. Any lifestyle changes targeted at eliminating AGEs should focus on firstly reducing our exposure in the first place, secondly reducing the formation of AGEs within the body and finally accelerating the body’s elimination of AGEs.

It is well known that obesity can be reversed (Although the information on the right type of diet is often not based on evidence and is misleading). But it is less known (even to specialist doctors in this field) that insulin resistance and type II diabetes can be reversed with a proper diet and lifestyle as well. Here we will present the evidence for this through peer reviewed clinical trials which is the basis of evidence based medicine.  

Exercise

Exercise has a multi factor impact on the treatment of PCOS. Firstly, it is no secret that exercise is effective at helping with insulin resistance and obesity which are common in PCOS patients. As this metal-analysis shows, losing weight also helped improve spontaneous ovulation and enhanced natural pregnancy rates as well as improving insulin resistance and weight loss in PCOS patients.

Moreover, exercise can help body’s excretion of AGEs as well. This study conducted in HIV positive patients shows a significant reduction of AGEs levels after a short term 3 month physical training routine.

Quit Smoking

Tobacco smoke is rich in AGEs according to this study examining AGEs formation. This is probably due to the curing conditions of tobacco that leads to the creation of AGEs. The study clearly shows that smokers have a significantly higher levels of AGEs in their blood stream than nonsmokers. Therefore, quitting smoking should be the first step in reducing AGEs levels for patients with PCOS.

exercise can help body’s excretion of AGEs and help with PCOS hair loss

Dietary Changes

Dietary changes that are most effective at lowering AGEs levels should have the following characteristics:

1) Eliminate the intake of high AGEs containing foods and change cooking methods to reduce the initial exposure

2) Increase the intake of foods known to help eliminate AGEs from the body

3) Increase intake of foods known to prevent their formation in the first place

4) Increase the intake of foods rich in anti-oxidants to help combat their negative effects

5) Increase the intake of unrefined plant foods to help with obesity and insulin resistance 

Reducing AGEs Exposure

Diet is a very effective way of controlling the intake of AGEs as well as reducing long-term chronic disease risk. This study showed that even a single high AGEs containing meal can significantly impair arterial function within just 2 hours after consumption. This shows the impact diet has on AGEs levels and consequently chronic disease.

Foods rich in fat and protein (mainly from animal sources) that are cooked with dry heat methods such as grilling, frying, roasting and broiling tend to have the highest levels of AGEs in contrast to low fat high carbohydrate foods. Therefore, boiling is the safest method of cooking with the least amounts of AGEs being produced.

Although cooking method impacts the AGEs production, the type of food itself is a major risk factor as well and may be even more important. This large database of 549 foods tested, shows the level of AGEs in different food groups with specific cooking methods. The table shows the AGEs levels in the top 15 foods as well as some other plant and animal based foods for comparison.

plants are naturally low in AGEs and can help with PCOS hairloss

It is clear that the type of food we eat has the most impact since the top 15 foods with the highest levels of AGEs are all animal based with the highest being Roasted BBQ chicken Thigh skin. Cooking process has a major impact as well, comparing the boiled chicken (1,089 kU/serving) versus roasted BBQ chicken (7,920 kU/serving) shows the amount of AGEs differ almost 8 times!

This is also seen in plants where raw apple (13 kU/serving) has lower AGEs than baked apple (45 kU/serving), Although even baked apple has almost negligible AGEs in contrast to chicken or other animal based foods. However, the same cannot be said about white potatoes. Boiled potato (17 kU/serving) has a low AGEs level while deep frying that the same potato will result in a significantly higher AGEs level (694 kU/serving).    

It is clear that animal foods contain a significantly higher levels of AGEs than plant foods. Even uncooked animal foods have a very high AGEs level such as dairy and cheese products. We can compare a veggie burger (20 kU/serving) to a fast food hamburger (4,876 kU/serving) and the difference is simply staggering. We can also compare one of the healthiest animal based foods (Boiled Chicken 1,089 kU/serving) to one of the unhealthiest plant based foods (Deep Fried Potatoes 694 kU/serving) and we can still see that the healthiest animal based food still exceeds the unhealthiest plant based food (Although deep fried potatoes are incredibly unhealthy as well and should be avoided).

herbs & spices can prevent formation of AGES and help PCOS hair loss

Foods That Help Prevent the Formation of AGEs and Detoxify Them

As mentioned earlier, our bodies produce AGEs as a result of natural metabolism. However, certain foods are shown to have anti-glycation effects which prevents the formation of AGEs in the first place as mentioned in this study and as seen in this review article. These foods mainly consist of herbs and spices such as Turmeric, cinnamon, parsley, thyme, clove and extracts from a variety of other culinary herbs and spices. 

Furthermore, other foods such as brown rice and mushrooms are shown to be effective at accelerating the body’s detoxification of AGEs.

Another food group that can help with faster detoxification of AGEs appear to be cruciferous vegetables. A compound called Sulforaphane (an isothiocyanate formed in the cruciferous vegetable family) is a very powerful anti-oxidant and has the potential to help patients with PCOS. Sulforaphane is shown to activate body’s detoxification pathways leading scientists to believe that it might help with the excretion of AGEs. Sulforaphane is also believed to prevent the formation of AGEs in the first place due to its powerful anti-oxidant capacity. This research group in Japan put this idea to the test. In their intervention trial, they fed 25 grams of broccoli sprouts daily for 2 months to 25 adult volunteers and found a significant reduction in serum AGEs as a result.

Sulforaphane is found in the cruciferous vegetable family (Broccoli, Cauliflower, Cabbage, Kale, Bok choy, Brussels sprouts and etc.). However, Broccoli Sprouts are shown to have the highest concentration of Sulforaphane offering around 250 milligrams per 100 grams (about 10 – 100 times higher than the concentration of Sulforaphane found in broccoli or other cruciferous vegetables.

sulforaphane in broccoli sprouts can detoxify AGEs and help with the recovery of PCOS related hair loss.

Anti-Oxidants

 

Foods high in anti-oxidants play a key role in protecting us against free radical damage and preventing chronic illnesses. AGEs cause chronic inflammation and disease due to their oxidative nature and therefore a diet high in anti-oxidants will counter act the negative impacts of AGEs. This study catalogs the antioxidant levels of more than 3100 common foods which is the most comprehensive study done on antioxidant levels by far. Plant foods on average have 64 times higher antioxidants levels than animal products. The food groups with the highest antioxidant levels are herbs and spices with levels so high that even small amounts taken daily will be beneficial.   

This study focused on the effects of marjoram tea on the hormonal profile of women with PCOS and after a one-month intervention of drinking 2 cups daily, they saw an improvement in the hormonal profiles of these patients. Although it should be noted that this study did not last very long to see if this intervention would actually improve the symptoms of PCOS as well.

With this in mind, foods high in antioxidants (plant foods) should be helpful in controlling the oxidative damage caused by AGEs and therefore may help with PCOS directly as well. 

In short, eliminating high AGEs containing food and cooking methods (eliminating animal based foods), increasing the intake of foods known to help eliminate AGEs (brown rice, Mushrooms, Broccoli Sprouts etc.), consuming foods with anti-glycation effects to prevent the formation of AGEs (herbs and spices) and finally consuming foods rich in anti-oxidants to help combat their negative effects should help reduce AGEs levels. It is not surprising that researchers in this study concluded that a diet low in meat that is prepared with moist heat (soups and stews) as well as a diet rich in plant foods should effectively cut the patients exposure to AGEs in half. Furthermore, this study found that a vegetarian diet is consistently associated with reduced AGEs levels.

Now that we have established the powerful impact of diet on lowering AGEs levels, the question remains, is there any proof that a low AGEs diet can help with PCOS?

This study looking at the levels of AGEs in diet and their impact on metabolic and hormonal biomarkers in women with PCOS found that dietary AGEs directly impact hormonal and metabolic markers in these patients and lowering AGEs through diet will result in improvements in insulin, testosterone, and oxidative stress levels of PCOS patients. 

reducing the intake of AGEs and detoxifying the existent AGEs, hair loss cased by PCOS can be treated as well.

 

In conclusion, we can reduce our AGEs exposure with a diet limited in animal products (vegetarian diet). However, we can further reduce our exposure to AGEs by eliminating all animal based products (since even vegetarian foods such as dairy and cheese are high in AGEs). Since plants have a significantly lower levels of AGEs (even with the unhealthy cooking methods) in comparison to animal based foods, and since plants are a rich source of anti-oxidants, adapting a whole food plant based diet as well an active lifestyle and termination of smoking habits is the most effective intervention for patients suffering from PCOS as well as obesity and type II diabetes. A whole food plant based diet is the most effective diet for obesity and the reversal of type II diabetes and reducing the AGEs levels which would lead to a significantly lower rate of chronic illnesses and a longer life expectancy.

 

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