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.