Polycystic ovary syndrome: the diabetes of bearded women

Poly­cys­tic ovary syn­drome is a major cause of infer­til­i­ty among young women in the Unit­ed States. It’s also nature’s way of telling women that they’re eat­ing the wrong kinds of food. Cut­ting her fat intake to 10% or less of her total calo­ries can restore the woman’s fer­til­i­ty and is impor­tant for pro­tect­ing her health, espe­cial­ly if she becomes preg­nant.

A woman with poly­cys­tic ovary syn­drome has irreg­u­lar peri­ods or may have stopped hav­ing men­stru­al peri­ods alto­geth­er. Because she sel­dom ovu­lates, it might take a long time for her to become preg­nant. Besides hav­ing irreg­u­lar peri­ods, the woman may also be over­weight and have acne and facial hair. The infer­til­i­ty, acne, and facial hair result from an excess of male hor­mones, which in turn result from abnor­mal­ly high lev­els of the hor­mone insulin. In oth­er words, poly­cys­tic ovary syn­drome should be viewed as a mild form of type 2 dia­betes. As far back as 1921, some French researchers referred to this prob­lem as “the dia­betes of beard­ed women” (la dia­bète des femmes a barbe).

Dia­betes mel­li­tus, or sug­ar dia­betes, means that the per­son tends to pass large amounts of a sug­ar called glu­cose in the urine. This hap­pens when the amount of glu­cose in the blood­stream has reached tox­ic lev­els. There are sev­er­al types of sug­ar dia­betes. Since the terms that Amer­i­cans use for the dif­fer­ent kinds of dia­betes are con­fus­ing, I’ll use the French terms, whose mean­ing is obvi­ous.

Back in the 1870s, French researchers divid­ed cas­es of sug­ar dia­betes into two gen­er­al cat­e­gories: thin dia­betes (dia­bète mai­gre) and fat dia­betes (dia­bète gras). Thin dia­betes was a cat­a­stroph­ic, incur­able prob­lem that often occurred in chil­dren and young adults. These patients wast­ed away and died with­in a few weeks, regard­less of treat­ment. At autop­sy, you could usu­al­ly see that some­thing had gone wrong with their pan­creas. Even­tu­al­ly, some Cana­di­an researchers fig­ured out that the pan­creas of peo­ple with thin dia­betes had lost the abil­i­ty to make a hor­mone called insulin. The Cana­di­an researchers devel­oped a way to iso­late the insulin from ani­mal pan­creas­es to use as a drug for human dia­bet­ics.

The devel­op­ment of insulin ther­a­py was a life-sav­ing mir­a­cle for peo­ple with thin dia­betes, often enabling them to live a near-nor­mal lifes­pan. How­ev­er, insulin has much less of an effect on blood sug­ar in peo­ple with fat dia­betes. Fat dia­betes is a com­par­a­tive­ly mild con­di­tion that tends to occur in over­weight, usu­al­ly mid­dle-aged to elder­ly peo­ple. It could be cured by weight loss and exer­cise. Peo­ple with fat dia­betes can make their own insulin. In fact, they typ­i­cal­ly have abnor­mal­ly high lev­els of insulin in the blood. Their bod­ies just don’t respond nor­mal­ly to insulin. They have insulin resis­tance.

Insulin acts as a key that unlocks an impor­tant door on the sur­face of cells. Unless that door opens, a cell can­not take in glu­cose. Peo­ple with thin dia­betes can­not make their own insulin. Unless they take insulin by injec­tion, their cells will starve even as those cells’ favorite fuel builds up to tox­ic lev­els all around them. Although peo­ple with fat dia­betes may make exces­sive amounts of insulin, their cells don’t respond nor­mal­ly to it. It takes a huge amount of insulin to pry open the doors to let glu­cose into their cells.

In women, the abnor­mal­ly high insulin lev­els cause the body to pro­duce abnor­mal­ly large amounts of male hor­mones. Besides caus­ing acne and facial hair, these male hor­mones dis­rupt the devel­op­ment of eggs in the ovary. Nor­mal­ly, each egg cell devel­ops in a tiny flu­id-filled fol­li­cle, which bursts to release the egg. The release of the egg is called ovu­la­tion. If the woman doesn’t ovu­late, she can’t become preg­nant. If the egg fol­li­cles stop devel­op­ing before ovu­la­tion, these lit­tle flu­id-filled cysts build up in the ovary. You can actu­al­ly see them if you look at the ovary with an ultra­sound machine. That’s why the con­di­tion is called poly­cys­tic ovary syn­drome.

Since women with poly­cys­tic ovary syn­drome sel­dom ovu­late, it can take a long time for them to become preg­nant. Doc­tors typ­i­cal­ly tell women with poly­cys­tic ovary syn­drome to lose weight. Doc­tors may also pre­scribe a drug called met­formin, which reduces the body’s resis­tance to insulin. Unfor­tu­nate­ly, the met­formin doesn’t solve the prob­lem. In the long run, it may make the prob­lem worse, because it tends to pro­mote weight gain!

Fat dia­betes results from fat: fat in the body and fat in the diet. Sci­en­tists have known since the 1930s that eat­ing a high-fat diet caus­es insulin resis­tance. Eat­ing a low-fat, high-car­bo­hy­drate diet restores the body’s sen­si­tiv­i­ty to insulin. If the woman switch­es to a low-fat (<10% of calo­ries), high-car­bo­hy­drate (>75% of calo­ries), high-fiber diet, she will cor­rect her insulin resis­tance and will prob­a­bly lose weight while eat­ing as much as she wants. In con­trast, met­formin tends to pro­mote fur­ther weight gain, which could make the insulin resis­tance worse in the long run.

If a woman is infer­tile because of poly­cys­tic ovary syn­drome, met­formin could help her become preg­nant. How­ev­er, it will not remove the cause of the insulin resis­tance. If the woman becomes preg­nant, her insulin resis­tance may get worse. She may even devel­op a full-blown case of ges­ta­tion­al dia­betes! In con­trast, a change to a healthy diet will not only help her become preg­nant, it will improve her health through­out the preg­nan­cy and increase her chances of hav­ing a healthy baby.

Pho­to by Warm­Sleepy

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