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Up to half of obese women with PCOS in the US will have metabolic syndrome. What does this mean for your health, how do you know if you meet the diagnostic criteria, and what can you do to improve your health?

If you've recently been diagnosed with polycystic ovary syndrome or think you may have PCOS, you may have heard something about metabolic syndrome. Research indicates that over half of PCOS sufferers in the US have it, and it's another thing that adds to your risk of heart disease and diabetes. 

What exactly is metabolic syndrome, though, and what do you need to know about it if you have PCOS?

So, what is metabolic syndrome?

A "syndrome" is, itself, a collection of symptoms that are seen together. The symptoms of metabolic syndrome, also sometimes called dysmetabolic syndrome or syndrome X, increase your risk of heart disease and are related to the functioning of your metabolism. They include:

  • Central obesity — fat deposits around the abdomen, specifically a waist circumference of over 35 inches
  • Insulin resistance
  • Hyperglycemia (high blood sugar levels) as a result of impaired glucose metabolism — this means fasting blood sugar levels of 100 mg/dL or more
  • High triglyceride levels — over 150 mg/dL
  • Low levels of HDL cholesterol, the "good" one, at  50 mg/dL or below
  • Hypertension

To be diagnosed with metabolic syndrome, people will have at least three of these symptoms. While the root causes of PCOS and metabolic syndrome alike are still unclear, we do know that insulin resistance plays a key part in the effect both will have on your body. High insulin levels are associated with high levels of androgens — "male" hormones — which leads to many of the symptoms of PCOS as well as increasing your risk of adverse health outcomes. 

If you have been diagnosed with polycystic ovary syndrome and are obese, you may have up to 14 times the risk of developing metabolic syndrome compared to people without these risk factors. What do you do with that information?

1. Women with PCOS should be screened for metabolic syndrome

As you'll have seen from the list of possible symptoms of metabolic syndrome, central obesity — excess fat around the abdomen — is the only sign you'll be able to easily spot yourself. Finding out whether you meet the other diagnostic criteria requires lab work and blood pressure checks. 

Because you may have metabolic syndrome without knowing it, you should be screened every two to three years if you are an overweight or obese woman with PCOS. If metabolic syndrome goes undiagnosed, it silently increases your risk of heart disease. 

Should your doctor determine that you do have metabolic syndrome, medications are available — but your doctor will encourage you to make lifestyle changes before suggesting this step. A lot of these changes are diet-related, but regular exercise and stress reduction are also important.

2. Weight loss: The best thing you can do for metabolic syndrome and PCOS

If you're dealing with PCOS, metabolic syndrome, and obesity, losing weight should be a top priority, as it can prevent a lot of problems down the line.

While achieving weight loss certainly won't be easy as your body is working against you, the good news is that losing a relatively small amount of weight can have a huge impact. Shedding as little as five percent of your total body mass goes a long way toward reducing symptoms — meaning lower blood pressure, better insulin sensitivity, and lower androgen levels. This amount of weight loss also increases menstrual frequency and improves your odds of ovulating, important if you would like to get pregnant. 

3. Cutting down on the calories you take in

Yes, cutting down on calories and making sure the ones you do get are good ones is pretty much an unavoidable part of any weight loss plan, but you'll improve your overall health by doing this even if you do not lose any weight. That is because a healthier diet will lower your insulin levels, blood pressure, and "bad" cholesterol. 

Creating a calorie deficit — burning more calories than you take in — is essential for weight loss, but make sure to do it responsibly. Definitely avoid any temptation to go on a starvation diet, and instead see where you can cut "empty" calories that don't offer any nutritional benefits. Try, for instance:

  • Cutting (way) down on added sugars — if you take sugar in your coffee or tea, that stuff adds up fast, but you'll find a lot of sugar in almost all processed foods.
  • Saying no to enormous quantities of things like salad dressings, gravy, pasta sauce, or bread spreads. I know they're tasty, but large quantities of calories hide out here!
  • Using a smaller plate — this way, you won't feel the need to finish off a portion that was really too big.
  • Making vegetables and salads the main part of your meals. 
  • Say no to empty carbohydrates — you know the ones, white bread, pasta, and rice.
  • If you have to have a snack between meals, make it a handful of nuts or some celery with peanut butter, rather than something, well, bad. 

4. Do food and you need 'relationship counseling'?

Sustained weight loss and then weight maintenance isn't about a short-term diet, but about a healthy relationship with food. If you're used to eating what you want, when you want it (like I used to be!), that can take a while. It's important that your meals are both healthy (and that includes the right portion sizes) and tasty. If they're only healthy, you won't enjoy your food and this will set you up for failure. 

Meal planning is a great way to start — if you buy the ingredients you'll need in the amounts recipes call for, it's harder to eat more than you should, or to get take-outs. Planning meals to make from scratch while shunning processed foods that come out of packages also means you'll know exactly what's in your meals. 

Do keep healthy snacks on hand, though, whether it's fruits, nuts, some cucumber, or sunflower seeds. This way, you will have something to munch on when you feel like it and you'll be able to avoid unhealthy binge eating that adds to your insulin resistance. 

5. Talk to your doctor or nutritionist about special diets

Diets rich in vegetables, fruits, whole grains, lean protein, and low-fat dairy — and as low as possible in saturated and trans fats and salt — are good for almost everyone. If you suffer from high blood pressure, other cardiovascular disease, or diabetes, you may benefit from a specialized diet, however, and people with metabolic syndrome may find these diets have a positive impact as well:

  • A low glycemic index diet is one in which you choose foods that won't cause radical blood sugar spikes. While you will become more familiar with the foods included as you go along if you choose this diet, they include the majority of fruits, green veggies, carrots, and chickpeas. A low GI diet will be beneficial if you have metabolic syndrome, and it is also very suitable for people with diabetes and heart disease. 
  • The benefits of a Mediterranean diet have been discussed a lot in recent years. It includes lots of "real" foods like vegetables, fruits, nuts, and whole grains, but also olive oil. Many people will choose this kind of diet for taste as well as health, and research has shown that it can encourage weight loss, reduced inflammation, lower insulin levels, and a lower blood pressure.
  • The DASH diet specifically aims to keep your blood pressure under control — it stands for "dietary approaches to stop hypertension". It focuses on a low salt intake and a higher intake of potassium, magnesium and calcium, minerals that lower your blood pressure. In addition to helping with blood pressure, the DASH diet will also reduce your cholesterol levels, improve your blood sugar levels, and stimulate weight loss.

6. Why exercise is so important

We've already looked at the ways in which weight loss can benefit you if you have metabolic syndrome, and exercise is an important part of that. It's not the whole story, mind you, as even people who exercise regularly but do not lose weight can expect reductions in blood pressure, cholesterol, and insulin levels. 

Women with PCOS should ideally exercise five times a week, choosing both cardio exercise and strength training. If you can work physical activity into your day naturally, such as by cycling, walking, or jogging to wherever you're going, doing gardening, engaging in vigorous housework, or having a job that is quite physical, that also absolutely counts!

8. Working to relieve stress

Stress is bad for you, of course, but research has shown that it also makes you more vulnerable to metabolic syndrome, insulin resistance, high triglyceride levels, and even further weight gain. Stress relief is, then, important for pretty much every aspect of your body. If you're stressed, consider:

  • Meditation
  • Therapy
  • A fun sport
  • A new hobby
  • Making self-care a priority — that means not overworking yourself and generally taking the time to do the things that increase your health and wellbeing

8. When is it time for medications?

While lifestyle changes are essential if you want to reduce your risk of developing cardiovascular disease, medications can help you if the steps you've taken haven't brought the results you and your doctor are looking for. If you have PCOS and metabolic syndrome, your doctor may suggest:

  • Metformin, a diabetes drug
  • Birth control pills to regulate your hormones and your menstrual cycles
  • Statins to improve your lipid profile 

  • Sharpless, J. L. (2003). Polycystic Ovary Syndrome and the Metabolic Syndrome. Clinical Diabetes, 21(4), 154–161
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