Macros & Calories Don't Count? Better Food Choices Make Diet More Than 10x More Effective for PCOS Sufferers

Normal-weight women can have PCOS, too. Recently, Macruz et al. did DXA scans on young women with PCOS and a normal BMI and found increased truncal and leg fat compared to healthy controls in a similar age (12–39 years) and BMI range (at least 18.5 but below 25 | Macruz. 2017). More evidence that weight alone doesn't explain PCOS.

PCOS is by no means an issue only obese women suffer from. Yes, obesity is and will always be the #1 risk factor for developing the polycystic ovarian syndrome (PCOS = a condition in which a woman's levels of the sex hormones estrogen and progesterone are out of balance; this leads to the growth of ovarian cysts (benign masses on the ovaries); PCOS can cause problems with a women's menstrual cycle, fertility, cardiac function, and appearance), but eventually it seems as if both occurred in response to the same hitherto not fully elucidated triggers.

In that, it is unquestionable that a woman's diet plays a minor part in the development of PCOS. Accordingly, scientists all over the world are currently trying to determine the optimal diet for people like the 60 overweight or obese patients with PCOS who participated in a recent study from the Kashan University of Medical Science in Iran (Foroozanfard 2017).

Learn more about the (often ;-) small but significant difference at the SuppVersity

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The study was designed to evaluate the effects of the Dietary Approaches to Stop Hypertension (DASH diet) on weight loss, anti-Müllerian hormone (AMH) and metabolic profiles in women with polycystic ovary syndrome (PCOS). To this ends, the scientists conducted a randomized controlled clinical trial among 60 overweight or obese patients with PCOS. Patients were randomly assigned to receive either a low-calorie DASH (N=30) or control diet (N=30; designed to mirror the traditional Iranian diet) for 12 weeks. What is particularly interesting is that both diets had identical macronutrient compositions: 52-55% carbohydrates, 16-18% proteins, and 30% total fats.

Table 1: Constituents of the DASH and control diets in the study; data are presented for a calorie intake of 1800 kcal/day - (b) at least 3 servings of whole grains in the DASH diet; (c) low-fat (lower than 2%) in the DASH diet; (d) 4 servings of lean meat in the DASH diet and 2 servings in the control diet (Foroozanfard 2017).

However, the DASH diet was designed to be rich in fruits, vegetables, whole grains, low-fat dairy products, and low in saturated fat, cholesterol and refined grains (cf. Table 1). Both diets were equicaloric. Physical activity was monitored and identical in both groups. To further promote the comparability between the study arms, all subjects were...

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[...] provided with 7-day menu cycles that were individually planned using a ‘calorie count’ system. To facilitate the compliance to the diets, participants were given and instructed an exchange list. 

[...] Compliance with the consumption of diets was controlled once a week through phone interviews. The compliance was also double-monitored by the use of 3- day dietary records completed throughout the study. 

[...] To control for dietary intakes of subjects throughout the study, the dietitian was calling the participants to resolve their probable problems" (Foroozanfard 2017).

The significant difference in the study outcomes you can see in Figure 1 are thus a function of the foods and not the macronutrient composition or the total energy intake of the women.

Figure 1: Anti-Müllerian hormone and metabolic profiles at baseline and after the 12-week intervention in women with polycystic ovary syndrome; p-values indicate stat. significance of the inter-group difference (Foroozanfard 2017).

More specifically, there was almost no change in glucose management in the control, but significant benefits in the DASH group; a further increase in the hallmark features of PCOS, i.e. anti-Müllerian hormone (AMH) and the free androgen index (FAI), but a significant decrease of these indices in the DASH group; and no change and a small improvement in heart-healthy NO and inflammation, respectively, in the control, but a huge increase in NO and decrease in inflammation (MDA) in the DASH diet group.

The detailed micronutrient breakdown shows that one of the reasons of the health benefits could be an increased intake of potassium, magnesium & co - eventually, that's yet not enough to explain the benefits of making better food choices - 'cause food ≠ macros.

Improving your health by eating healthy ≠ weight loss! Despite the impressive inter-group differences in all relevant health markers that were assessed in the study, the weight loss in both groups was identical, with the subjects' BMI dropping by -1.2±0.7 and -1.6±0.5 kg/m², respectively. That goes against the mantra that the best diet was always the one that produced the greatest weight-loss. Especially in people who are battling inflammation and insulin resistance, major health improvements can be achieved without concomitant weight loss... OK, usually you would expect anthropometric changes like a reduction in waist circumference as well as body and esp. visceral fat (Ehsani 2016; Orio 2016), but, unfortunately, these parameters were not assessed in the study at hand | Comment!

References:

• Ehsani, Behnaz, et al. "A visceral adiposity index-related dietary pattern and the cardiometabolic profiles in women with polycystic ovary syndrome." Clinical Nutrition 35.5 (2016): 1181-1187.
• Foroozanfard, Fatemeh, et al. "The effects of DASH diet on weight loss, anti‐Müllerian hormone and metabolic profiles in women with polycystic ovary syndrome: a randomized clinical trial." Clinical Endocrinology (2017).
• Macruz, Carolina F., et al. "Assessment of the body composition of patients with polycystic ovary syndrome using dual‐energy X‐ray absorptiometry." International Journal of Gynecology & Obstetrics (2017).
• Orio, Francesco, et al. "Obesity, type 2 diabetes mellitus and cardiovascular disease risk: an uptodate in the management of polycystic ovary syndrome." European Journal of Obstetrics & Gynecology and Reproductive Biology 207 (2016): 214-219.