Gestational Diabetes Symptoms & Constipation Remedies

PCOS is a set of symptoms that result from a hormonal imbalance affecting women and girls of childbearing age. Women with PCOS usually have at least two of the following three conditions:

• Absence of ovulation, leading to irregular menstrual periods or no periods at all.
• High levels of androgens (a type of hormone) or signs of high androgens, such as having excess body or facial hair.
• Cysts (fluid-filled sacs) on one or both ovaries—"polycystic" literally means "having many cysts"1.

According to a study by Nidhi R et al (2011), the prevalence of PCOS, in Indian adolescents is 9.13%3.

 

Pathophysiology of PCOS :

• Clinical signs of PCOS include elevated luteinizing hormone (LH) and gonadotropin–releasing hormone (GnRH) levels, whereas follicular-stimulating hormone (FSH) levels are muted or unchanged. As a result of the increase in GnRH, stimulation of the ovarian thecal cells, in turn, produces more androgens. Follicular arrest can be corrected by elevating endogenous FSH levels or by providing exogenous FSH.1
• The clinical presentation of PCOS varies widely. Women with PCOS often seek care for menstrual disturbances, clinical manifestations of hyperandrogenism, and infertility. Menstrual disturbances commonly observed in PCOS include oligomenorrhea, amenorrhea, and prolonged erratic menstrual bleeding. 2

 

MNT in PCOS

 

Energy: Energy requirement depends upon weight, activity and 24-hour recall calories of an individual. Short periods of calorie restriction lead to decrease in androgen & this is sufficient for some patients to restore normal menstruation. Modest ?5% weight loss helps in improving insulin sensitivity & reducing cardio-vascular risk. A deficit of 500kcal/day is needed for an average person to lose 0.5kg/week. An overweight sedentary individual suffering from PCOS requires 20-25kcal/kg PBW (present body weight) while moderately active individual needs 25-30kcal/kg PBW. 4,5

 

Carbohydrates: 50 – 60% of the total calories should come from carbohydrates. Reducing Glycaemic load can help to control post-prandial glucose levels and resulting hyperinsulinemia levels. Low GI, high fibre, whole grains should be consumed because insulin resistance is manifested in PCOS and so there are chances of high blood sugar. Refined carbohydrates & sugars should be consumed in limited quantity because it leads to weight gain thereby affecting insulin resistance. Phytonutrients found in whole grains, beans, nuts, fruits & vegetables helps in improving insulin resistance. 4,5

Good sources: Whole Grains, legumes, pulses, vegetables and fruits

 

Protein: 10-15% of the total calories should come from protein. Good quality protein like animal products (lean portions of meat, egg & fish), whey protein should form a major part of one’s protein intake. Adequate protein intake gives satiety and improves insulin sensitivity. 4,5 

 

Fat: 20- 25% of the total calories should come from fat. Good quality fat should be included like monounsaturated fatty acids and polyunsaturated fatty acids. Saturated fats like butter, ghee etc. should be around<7% of the total calories. Avoid trans-fats like vanaspati. Fat should be consumed in restricted amounts as it can worsen the insulin resistance which is already present in PCOS. 4,5

 

Omega 3 supplementation of 3g/day helps to reduce serum concentrations of testosterone and regulate menstrual cycle.6 Omega-3 fatty acids have significant cardio metabolic syndrome protective effects. 

Good sources of omega 3 fatty acids: Fatty fish like mackerel, salmon, tuna, fish oils, flaxseeds, flaxseed oil, canola oil, walnuts and chia seeds 

 

Other nutrients:

 

D-chiro-inositol: A relative of common inositol (a B vitamin), is found in small concentrations in the human body and in some foods. It is a compound that has been reported to affect the action of insulin & decrease serum free testosterone concentration.11 Myo-inositol, 2 grams/day, significantly reduces LH/FSH ratio, FSH, prolactin, androstenedione, testosterone, insulin. 14,15

Good Sources: Fresh fruits and vegetables, beans, grains, and nuts. 

 

Vitamin D: Deficiency appears to occur frequently in women with PCOS and may be a contributing factor to some of the biochemical abnormalities seen in this condition. Vitamin D intake improves glucose tolerance, that may be the mechanism for producing benefits in PCOS. A reasonable dosage is 800 to 1,200 IU per day for several months is recommended.16

Natural sources include exposure to sunlight. Also, foods fortified with Vitamin D are available in the market and can be considered. Supplementation works best to increase vitamin D levels.

 

Chromium (Cr): It is an essential trace mineral and required by the human body for normal carbohydrate, protein and lipid metabolism. The possible mechanism of action of chromium is, it is involved in the activation of PI3 (phosphoinositide -3) kinase expression and in Akt (Protein kinase B) phosphorylation and stimulates GLUT– 4 translocations, leading to increased insulin sensitivity. The dosage recommended in the studies are 200 mcg of Cr per day.17

Good Sources: Lentils, whole wheat, chicken, brewer’s yeast.

 

Antioxidants: Increased oxidative stress and decreased antioxidant capacity may contribute to the increased risk of cardiovascular disease in women with PCOS, in addition to known risk factors such as insulin resistance, hypertension, central obesity, and dyslipidemia. According to Fenkci V et al (2003), total antioxidant status (TAOS) was significantly lower in women with PCOS.18

Good Sources: Fruits, vegetables, nuts, whole grains, spices and herbs.

 

Zinc: helps to controls Appetite, Thyroid Hormone

Good Sources: Spinach, Pumpkin Seeds, Oats, Sunflower Seeds

Iodine:  Regulates Androgen Release

Good Sources: Cheese, Cow’s Milk, Eggs, Soy Milk, Iodized Table Salt

Magnesium: Maintains Normal Glucose Metabolism

Good Sources: Sesame Seeds, Wheat Bran, Almonds, Cashews

 

SuperFoods

 

1. Quinoa: - Quinoa contains about 1.9% of 20-hydroxyecdysone, the main phytoecdysteroid found in plants. 20-hydroxyecdysone decreases epididymal adipose tissue, reduces lipid storage capacity in the adipose tissue. Extract from seeds of quinoa decreases food intake, fat deposition, body weight and thereby improves insulin sensitivity. (7).
2. Fenugreek seeds: - It is found that fenugreek seeds contain phyto-chemicals, saponins which may have an effect on the production of sex hormones and may help the body maintain normal testosterone levels. Fenugreek increases the number of insulin receptors in red blood cells and improve glucose utilization in peripheral tissues, thereby increasing insulin sensitivity in PCOS. (8)
3. Soy: - Soy phytoestrogens are structurally similar to endogenous estrogen and have affinity to estrogen receptors. Many studies showed that the consumption of soy phytoestrogens have favourable effects on glucose and lipid metabolism, thus having beneficial effects on cardiovascular system, obesity, diabetes and hyper-lipidemia which are risk factors for cardiovascular diseases.There are various types of phytoestrogens such as isoflavones, prenylated flavonoids, and coumestans. The isoflavone content in soy has lipid lowering effect. It provides favourable benefit of reducing LDL-cholesterol and cardiovascular events in PCOS individuals. It helps in reducing testosterone, luteinizing hormone, triglycerides and dehydroepiandrostronesulfate. So, soy phytoestrogen has possible advantages in patients with PCOS and is favourable in reducing its complications. 9,10
4. Cinnamon :- Cinnamon and components of cinnamon have been shown to have beneficial effects on metabolic syndrome, insulin sensitivity, glucose, lipids, antioxidants, inflammation, blood pressure, and body weight.20 Cinnamon supplementation also improves menstrual regularity and may be an effective treatment option for some women with PCOS. 21

 

Dietary guidelines:

 

• A nutritionally balanced meal is advised including all major food groups.
• Small frequent meals should be taken as that helps in appropriate distribution of the calories throughout the day.
• Whole grains, bran, sprouts should be included in the diet. Avoid refined food like maida& its products like bread, biscuits and simple carbohydrates like sugar, honey, jaggeryas they are high in empty calories which can lead to weight gain and insulin resistance.
• Plenty of colourful fruits & vegetables, green leafy vegetables should be included in the diet as they provide essential vitamins, minerals and fibre required for normal metabolism of the body.
• Avoid carbonated beverages, pickles, ketchups, canned foods, ready to eat packets because they are high in sodium.
• Fried food stuffs, outside food should be completely avoided because they increase overall fat consumption.
• Sufficient quantity water should be consumed which helps in removing toxins and prevents weight gain.
• 150 minutes of moderate physical activity per week is recommended. There has to be a gradual increase in the level and time of physical activity in order to lose weight. This helps in increasing metabolism of the body thereby reducing deposition of fat. (19)

People whose BMI is <18kg/m² are considered as underweight. The causes could be reduced food intake, diseases like tuberculosis, diabetes, malabsorption syndrome or cancer, psychological factors (anorexia nervosa), behavioural factors (people who are nervous, tense, active), pathological conditions like fevers, GI disturbances where the digestion and absorption capacity is reduced or hyperthyroidism¹.

 

MNT in Underweight

 

Any underlying cause of underweight must be dealt with as a first priority. A wasting disease or malabsorption requires treatment. Activity should be modified, and psychological counselling should be started if necessary. Nutrition and dietary changes are effective along with treatment for the underlying cause of underweight or if the cause of being underweight is merely inappropriate or inadequate food intake.

 

Energy:- The calorie requirement varies depending upon activity. For increasing weight the total caloric intake should be in excess of the energy requirement. There has to be a gradual increase in energy from 30-35 kcal/ kg ideal bodyweight initially to 35-45 kcal/ kg ideal bodyweight without causing any digestive disturbances. Stepping up the calorie intake by 500kcal per day is recommended. Adequate energy can be obtained by increasing the quantity and frequency of the meals. In addition to larger meals, snacks are usually necessary to adequately increase the energy intake^1,4.

 

Carbohydrate:- 55-63% of the total energy should come from carbohydrates. High carbohydrate sources must form the basis of the diet. Complex carbohydrates like whole grain cereals, millets, pulses, fruits and vegetables must be a part of every meal. Refined carbohydrates like sugary foods, refined flour should not be consumed in excess since high amount of sugar increases fat content in the body even for underweight individuals. Soups and salads should be avoided with the meal, because they contain fibre and water content which contributes to early satiety^1,3.

 

Protein:- 1-1.2g/kg body weight is recommended for tissue building depending on the activity level. Protein can constitute 12-15 % of total calorie intake. Good quality protein like eggs, milk & its products, lean meat, fish and whey protein should constitute fifty percent of the total protein. In the process of weight gain in an underweight individual this good quality protein facilitates muscle building (muscle gain) rather than increase in fat mass (fat gain).

 

Fat:-30% of the total calories should come from fat with the majority from monounsaturated and polyunsaturated fat sources. Nuts can be included in the diet since they are calorie dense with good quality fats. Excessive consumption of fried and fatty foods is not recommended as it increases the overall body fat content. Target for a weight gain individual should be more of muscle gain rather than fat gain (visceral and subcutaneous region) which can lead to metabolic disorders¹.

 

Vitamins & Minerals:-Vitamins & minerals should be given according to the RDA. Vitamins & minerals play an important role in various metabolic reactions in the body. As the intake is less, diet can be made nutrient dense by incorporating vitamin & mineral rich foods like fruits, vegetables, whole grains and pulses, nuts and oilseeds³.

 

Superfoods

 

1. Nuts:- Nuts which include walnuts, almonds, pistachios, cashewnuts make a  very good mid meal snack for individuals who are underweight as they are calorie dense foods rich in unsaturated fatty acids, high-quality vegetable protein, fiber, minerals, tocopherols, phytosterols, and phenolic compounds^2.
2. Banana:-Consuming 2-3 bananas daily or having a glass of banana milkshake as a  midmeal snack is beneficial for healthy weight gain. In addition to being tasty and easily affordable fruit ,banana is a calorie rich fruit with essential nutrients like magnesium, potassium, vitamin B6, and fibre⁵.
3. Eggs:-Eggs are an excellent source of high biological value proteins required for muscle building which is the aim for weight gain. Egg yolk is a rich source of readily absorbable and usable iron which is an important nutrient, as most underweight individuals are also anaemic. Eggs provide other important nutrients like choline, biotin, vitamin B12 and vitamin A. Eggs should be combined with carbohydrate sources like chapatti in form of egg roll as a breakfast option or snack to ensure good protein-carbohydrate combination which helps to increase weight.

 

Dietary guidelines:

• Diet should comprise of three major meals and about 3-4 in between snacks to ensure a continuous nutrient and calorie intake. Meals should be energy dense.
• Caloric dense fruits like banana, chikoo, seetaphal, mango, grapes & dried fruits like fig, raisin, dates etc. can be included.
• Sugar sweetened products, high amounts of jaggery, honey is not recommended because they are source of  empty calories which increases fat deposition.
• Nuts like almond, walnut, pistachios, groundnuts etc provide good quality fats and are calorie dense and so should be included in the daily diet . Nuts could also be powdered and added to milk to make an energy dense midmeal snack option.
• Emphasis should be on eggs, milk& its products, lean meat, fish and whey protein because they are the source of good quality protein which helps in muscle building.
• Fluid should not be provided before or during a meal to avoid early satiety.
• Synthetic drinks, soft drinks, alcohol, aerated drinks, too much tea & coffee are high in sugar, sodium, caffeine. They reduce appetite and hence, should be avoided.
• Intake of fried food stuffs and outside food should be limited.
• Regular outdoor exercises are important because it helps in stimulating appetite. Resistance training can help in building muscle.