PCOS

IF simply involves switching between fasting and eating on your normal schedule.
This method could help you manage your weight and ward off chronic diseases if monitored and done effectively.

BASIC CONCEPTS
Before going into this practice, it is important to know what it entails.
Some basics to know:
– you have to skip one meal
– you can still have your favourite healthy meal while fasting
– you can drink water while fasting
– you can have no-calorie beverages while fasting. Examples include coffee, green or black tea.

So for everyone that has heard about IF or has practised it before, normally, you would skip breakfast while fasting, because it feels easier.
-But, according to a research carried out by USDA economic research service, it was noticed that skipping dinner, reduced more daily calories and lowered diet quality the least when compared to skipping breakfast or lunch.
-Also note that your night fast should be longer than 2 hours and shorter than 24 hours

TYPES OF IF
There are basically 3 popular types of IF:
– 16:8 method
– 5:2 method
– eat-stop eat method.
Others include OMAD, and warrior diet.

16: 8 METHOD

This method involves restricting your eating to just 8 hours windows in a day. you have to fast for the remaining 16 hours of that day.
– It is the most popular and preferred style
– A 2016 study found that when combined with resistance training, the 16/8 method helped decreased fat mass and maintain muscle mass in male participants.
– A more recent study found that the 16/8 method did not impair gains in muscle or strength in women performing resistance training

5:2 METHOD

This method involves eating normally for 5 days in a week, then restricting your calorie intake to 500 calories for the remaining 2 days.
– According to a 2018 study, the 5:2 diet is just as effective as daily calorie restriction for weight loss and blood glucose control among those with type 2 diabetes.

EAT-STOP-EAT METHOD
This method involves fasting for 24 hours twice or thrice a week.
– Fasting for 24 hours would lead to a metabolic shift and ause your body to use up fat
– But staying off food for 24 hours might lead to binging and overconsumption.

IF AND YOUR HORMONES
– IF positively affects the human growth hormone (HGH), especially when done adequately. These hormone levels increase when you do IF, and higher levels of this hormone facilitate fat burning and muscle gain.
– IF also increases the amount of norepinephrine in our bodies which help to breakdown body fat and facilitate it use for energy
– intermittent fasting decreases androgen markers (i.e., testosterone and the free androgen index (FAI)) while increasing sex hormone-binding globulin (SHBG) levels in premenopausal females with obesity.
– fasting may prove to be a valuable tool for treating hyperandrogenism in females with polycystic ovarian syndrome (PCOS) by improving menstruation and fertility.

BENEFITS
– WEIGHTLOSS: A 2014 review of scientific literature found that IF can cause 3–8% weight loss over 3–24 weeks, which is a significant amount. Also, participants lost 4-7% of their waist circumference.
– CAN REDUCE INSULIN RESISTANCE: IF can help reduce insulin resistance. According to research, it can help reduce blood sugar by 3–6% and fasting insulin levels by 20–31%.
– HEART-HEALTH: IF may help to reduce bad cholesterol, and blood triglycerides.
– OXIDATIVE STRESS: IF may help reduce inflammation (a key factor in disease processes) and oxidative stress.
– BRAIN HEALTH: may increase the brain hormone brain derived neurotrophic factor (BDNF) and may help in the growth of new nerves. it also may help prevent alzemheirs
– DECREASE IN APPETITE: according to research, time-restricted fasting (16 8), decreased mean ghrelin levels, increased fullness in participants, and decrease the desire to eat.
Also, in the first 12 hours of fasting, there is a slight increase in ketone bodies, this helps in appetite suppression.

POSSIBLE DOWNSIDES
– Malnutrition: if not done properly, intermittent fasting could lead to serious malnutrition. some very vital micronutrients and electrolytes might be lacking in your diet if not monitored.
– Dehydration: during a fast, your body tends to release water and salt via the urine. if this water isn’t replenished, you get dehydrated.
– Bad breath: during fasting, fat is used up majorly as fuel. fat metabolism leads to acetone formation which can affect your breath
-fatigue and low energy: when fasting, especially if you are not adequately monitored, with an inadequate intake of calories, you tend to be fatigued due to a low intake of calories
5. Headaches and lightheadedness: this is most common in intermittent fasting and occurs within the first few days especially if you’re a newbie.
6. Hunger and cravings: normally you’d feel hunger cues during your fasting. they tend to be heavier if you don’t do it well.
Most of these side effects should disappear in 2 weeks,

TIPS TO NAVIGATE EFFECTIVELY
• Know your nutrient needs
• Always incorporate proteins into your eating window
• Know your energy requirements
• Always stay hydrated
• Avoid overeating/undereating
• Maintain a balanced diet
• Try out the different types of IF
• Keep track of your journey
• Adapt a suitable workout routine
• Plan meals
• Speak to a registered dietitian

WHO SHOULD NOT BE ON IF?
• If you are underweight
• If you have a history of an eating disorder
• If you are pregnant
• If you are breastfeeding
• If you are on insulin (type 1)
• Anyone with immunosuppression
• Transplant patients
• Chronic kidney diseases
• Poorly controlled diabetes (unless an endocrinologist is involved).
• Adolescents and kids
• Elderly (muscle mass)

SUMMARY
The intermittent fasting pattern of eating is quite a beneficial one with side effects that can easily be managed. But, it is important that you are monitored by health practitioners before delving into this type of diet.
Also, before starting, be sure of the type of fast that would suit your lifetyle and schedule.

SOURCES:
-https://www.hopkinsmedicine.org/health/wellness-and-prevention/intermittent-fasting-what-is-it-and-how-does-it-work
– https://www.healthline.com/nutrition/6-ways-to-do-intermittent-fasting
– https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680567/
– https://pubmed.ncbi.nlm.nih.gov/31525701/

In all indications, diet changes and physical activity are lifestyle changes that are recommended for women with polycystic ovary syndrome, but some investigators have evaluated the effects of a ketogenic diet on some selected population of patients.
With this write up, we will see the outcome of the intervention.

According to a new study findings in the International

Journal of Environmental Research and Public Health, the ketogenic diet showed great promise as adjuvant treatment alongside pharmacological therapy in the treatment for women with polycystic ovary syndrome (PCOS), especially for women classified as obese.

Some common comorbidities that comes with of PCOS includes insulin resistance, dyslipidemia, and obesity. When these conditions are not managed effectively, they could increase the risk of diabetes and metabolic syndrome among women with the endocrine disorder.

In this study, seventeen women whose mean (SD) age was 28.5 (5.38) years (fertile age, according to the investigators) with PCOS and who were classified as obese (body mass index [BMI] > 25) were used; all were enrolled at the University Medical Service of Dietetic and Metabolic Diseases of the Faculty of Medicine and Surgery of the University of Foggia, in Italy.
The most therapeutic and suitable prescription with evidence for women who were obese and had PCOS was lifestyle correction according to this study. “This is the first study on the effects of the ketogenic diet on PCOS.” This type of diet adopted included one with increased fat intake, reduced carbohydrate intake, and adequate protein. For this study, daily intakes were set at 600 kcal for calories, 1.1 to 1.2 g of protein per kilogram body weight, 30 g for carbohydrates, and 30 g for fats.

“Following a 45-day dietary protocol, baseline/first visit findings were compared with 45-day/final visit results for gynecological evaluation of oligo/amenorrhea status, nutritional status, body composition, biochemical measurements, and diet administration.

The baseline overall average total body weight was 81.5 (13.56) kg and the baseline BMI, 31.84 (5.85) kg/m2”.

There were decreases in the following measures:
• Average weight: 9.4 kg (P < .0001)
• Average BMI: 3.6 kg/m2 (P < .001)
• Waist circumference: 9.4 cm (P < .001)
• Hip circumference: 8.1 cm (P < .001)
• Fat mass: 7.90 kg (P < .001)
• Free fat mass: 1.41 kg (P < .05)
• Muscle mass: 1.32 kg (P < .05)
• Total body water: 1.32 kg (P < .01)
• Basal metabolic rate: 67 kcal (P < .001)

There was improvements in several of the metabolic parameters (all P < .001) as shown below:
• Mean blood and urinary concentrations of ketones rose to 1.7 (0.58) mmol/L and 83 (54.34) mg/dL, respectively, from zero at baseline for both
• Mean blood glucose decreased 10.07 mg/dL
• Blood insulin dropped 12.90 mcU/mL
• C-peptide blood concentration decreased 0.87 ng/mL
• Triglycerides fell to 70 mg/dL
• Total cholesterol dropped to 40 mg/dL
• LDL cholesterol dropped to 35 mg/dL
• HDL cholesterol rose to 15 md/dL

Changes in endocrine parameters, were recorded as:
• Luteinizing hormone (LH) decreased to 4.6 mIU/mL (P < .001)
• Free and total testosterone decreased to 0.17 and 7.34 ng/dL, respectively (P < .001)
• LH/follicle stimulating hormone (FSH) ratio decreased to 1.32, from 2.72 at baseline (P < .01)
• FSH value increased to 1.46 mIU/mL (P < .05)
• Sex hormone binding globulins 12.43 nmol/L (P < .001)
• Positive correlations were seen between LH/FSH and weight, BMI, and fat mass
• Negative correlations were seen between LH/FSH and weight, BMI, and fat mass
• Positive correlations were seen between glycemia and LH and FSH
• Negative correlations were seen between LH/FSH and glycemia

For some patients, say about 5 of them, regular menstrual cycles reappeared “after years of amenorrhea,” while for the other 12 patients, there was restoration of regular menstruation—5 of whom when on to become pregnant naturally.

According to recorded results, using the ketogenic diet alongside medical intervention was effective in managing PCOS. So, by reducing the amount of carbohydrates and inducing therapeutic ketosis, PCOS patients can have a better life as the diseases is also influenced by lifestyle.

Even though this study came out positive, it is important to note that it is the first ever of its kind and further studies are needed to elucidate the effects of the ketogenic diet and its mechanism.

Reference
Cincione RI, Losavio F, Ciolli, et al. Effects of mixed of a ketogenic diet in overweight and obese women with polycystic ovary syndrome. Int J Environ Res Public Health. Published online November 27, 2021. doi:10.3390/ijerph182312490

Generally, one major factor considered to affect fertility is age. As you grow older, your organs, hormones and system seem to deteriorate.

But apart from this, there are other external and non-modifiable lifestyle factors that also affects the fertility of a woman and they include smoking, elevated consumption of caffeine and alcohol, stress, agonist sports, chronic exposure to environmental pollutants and other nutritional related issues.

In addition to the aforementioned, other metabolic disorders like diabetes, obesity, and hyperlipidaemia which are associated to an intake of high caloric diet could also interfere with a woman’s fertility.

Infertility is defined as the inability to conceive after one year of unprotected intercourse.
Infertility has really become a thing of concern in the modern society and its recurrence affects about 20-30% of the female population globally.

In Nigeria, about 10-30% of couples are saddled with the burden of infertility
The World Health Organization (WHO) reporting up to 80 million women world-wide having been affected by this disease to date, with a prevalence of ~50% of all women in developing countries.

There are possible gynaecological issues or systemic diseases that poses a threat female fertility, but asides these, unbalanced nutrition and unhealthy diet also interfere with reproduction processes in women.
Gradually, inadequate weight gain due abnormal energy supply, extreme restrictions, and inadequate intake of nutrients (both macro and micro), have a detrimental impact on the normal functioning of the ovaries.
Taking a proactive approach could help curb emotional stress and even cut financial costs attached to infertility problems.
Your odds at getting pregnant might just be improved by being intentional about your diet, effectively dealing with stress and being more active.

POSSIBLE LIFESTYLE FACTORS THAT AFFECTS FERTILITY
1. SMOKING: Smoking, be it first or second-hand smoke, can have a negative impact on the reproductive process for women. Cadmium and cotinine are two specific toxins found in tobacco smoke which can reduce egg production.
2. ALCOHOL: there are no safe levels for alcohol if you’re planning to conceive
3. BMI: for females wanting to conceive, body weight is of the essence and should not be overlooked. A BMI higher than 30 could impact hormonal imbalances and affect fertility processes.
4. RECREATIONAL DRUGS: use of some illicit drugs could have a great impact on fertility for women. Women who are expectant shouldn’t use heroin, ecstasy, marijuana and other illicit drugs.

WHAT ARE SOME POSSIBLE CAUSES OF INFERTILITY?
– Unexplained Infertility: reason of infertility is unknown and can’t be linked to any external or internal factors. Most times, more than a year of trying to conceive.
– Endocrine Disorders (PCOS (Polycystic Ovary Syndrome): these sort of disorders leads to an alteration of sex hormones in the female body thereby leading to elevated insulin levels and overproduction of testosterone (male hormone).
– Anatomical Abnormalities & Anomalies (Endometriosis, Uterine Irregularities): conditions where similar tissues to the ones inside your uterus, grows outside of the uterus. These conditions subject the uterus to be shaped in abnormal ways; heart shaped, unicorn shaped etc. (fibroids and polyps also included)

HOW DOES DIET AFFECT FERTILIY?
A number of dietary considerations should be considered in order to curtail hormonal fluctuations in females. The adequacy of a diet totally influences the functionality of hormones in the female body, especially fertility related hormones,
Let’s see some dietary considerations that directly affects hormonal response in the female body.
1. WHOLE GRAINS: whole grains are lower in glycemic index (their ability to increase blood glucose per time), and help increase chances of reduced insulin resistance in females. Insulin resistance poses a huge threat of inflammatory disorders and weight gain which directly affects hormonal balances in the female body. Whole grains include oatmeal, millet, bulgur, corn etc.
2. PROTEINS: getting most of your proteins from plant sources could help women with ovulatory issues. Isoflavones contained in soy products have been shown to positively affect ovulation and also helps women undergoing ART (assisted reproductive technology). Also, a higher intake of dairy products has been linked to decreased risk of endometriosis. Successful incorporation of dairy products into the diet of females, would have a great impact on fertility.
3. HEALTY FATS: trans-fat negatively affects fertility, enhance inflammation, and also play a role in egg quality and implantation. It’s very important to know the types of fats which are healthy and take out the unhealthy ones. Fats from nuts, avocado, seeds and fatty fish are healthy fats.
Also, supplementation with omega-3 fatty (500-1000mg) acid may help reduce the amount of male hormones circulating in the system (testosterone), thereby reducing risks of developing PCOS and regulating menstrual cycle.
4. SUPPLEMENTATION: supplementing with vitamins like folate, vitamin D, and vitamin B12 has been shown to improve better embryo quality and reduce risks of ovulatory infertility. Antioxidants also has shown to support and provide the eggs with adequate nutrition. Other supplements of importance include glutathione and CoQ10.

SUMMARY
A correct balance of proteins, fats, carbohydrates and vitamins in the daily diet helps provide optimum female reproductive health and reduce risk of infertility possibly caused by inflammation and hormonal imbalances.

SOURCES:

Does diet really affect fertility? – A few useful tips from Fertifa’s nutrition expert

https://www.todaysdietitian.com/marketing/webinars/fertility/TDFinalRecorded.pdf
https://www.insider.com/how-healthy-and-unhealthy-diets-can-impact-fertility-2018-4

Nutrition and Fertility: 5 Things to Know

https://www.todaysdietitian.com/newarchives/050113p38.shtml