A Reduced Carbohydrate Diet Intervention for Polycystic Ovary Syndrome (PCOS)
A Reduced Carbohydrate Diet Intervention for Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) affects 5-10% of women of reproductive age, and is
 associated with infertility, risk for obesity and type 2 diabetes, and impaired quality of
 life. The elevated insulin characteristic of PCOS is likely to play a major role in its
 symptoms. Manipulation of dietary carbohydrate quantity and quality (glycemic load; GL) may
 lower insulin and improve both reproductive and metabolic outcomes. The purpose of this study
 is to determine if a lower GL diet intervention is more effective than a standard (STD) diet
 in improving reproductive and metabolic outcomes of women with PCOS in the absence of weight
 loss.
Polycystic ovary syndrome (PCOS) is a heterogeneous syndrome affecting 5-10% of women of
 reproductive age. It is characterized by elevated circulating insulin, reduced insulin
 sensitivity, infertility, hyperandrogenism, and a multitude of symptoms that result in a
 decreased quality of life. The elevated insulin characteristic of PCOS is likely to play a
 major role in its pathogenesis by reducing insulin sensitivity and stimulating testosterone
 (T) production and increasing its free fraction. Although many women with PCOS are
 overweight/obese (10-50%), those who are non-obese suffer from the same symptoms as their
 obese counterparts. Thus, it is likely that the metabolic disturbances associated with PCOS
 predispose to weight gain, which in turn exacerbates PCOS by worsening insulin resistance.
 Manipulation of dietary carbohydrate quantity and quality (glycemic load; GL) may lower
 insulin and improve both reproductive and metabolic outcomes. No study has tested the
 efficacy of a lower GL diet among non-obese women with PCOS.

 The Specific Aim of this proposal is to determine if a lower GL diet intervention is more
 effective than a standard (STD) diet in improving reproductive and metabolic outcomes of
 women with PCOS (both normal-weight and overweight/obese). We hypothesize that, in the
 absence of weight change, the lower GL diet will be more effective than the STD diet in
 decreasing insulin secretion, increasing insulin sensitivity, decreasing free T, decreasing
 fat from metabolically harmful sites, decreasing inflammation, and improving menstrual
 cyclicity and ovulation. Further, the lower GL diet will increase perceived fullness and
 decrease hunger, effects mediated via gut hormones.

 Development of a diet that optimizes reproductive and metabolic health among women with PCOS
 will reduce reliance on pharmacologic treatments and improve quality of life, even in the
 absence of weight loss. This project is novel in being the first to conduct a highly
 controlled nutrition intervention in non-obese women with PCOS under weight stable
 conditions, utilizing robust measures of insulin secretion and action, fat distribution,
 inflammation, hunger/fullness, the gut hormone profile, and reproductive function. The
 results from this study can be used as a starting point from which to explore optimal diets
 for overweight women with PCOS.
Inclusion Criteria:

 -  Diagnosed with PCOS

 -  Body mass index 18.5-35 kg/m2

 Exclusion Criteria:

 -  Cushing's syndrome

 -  Type 1 or 2 diabetes

 -  Self-reported claustrophobia

 -  Androgenic tumors or adrenal hyperplasia

 -  Hyperprolactinemia

 -  Implanted metal items

 -  Use of metformin or other diabetes drug

 -  Women using oral contraceptives will not be excluded, but will be required to
 discontinue use of these agents 3 months prior to testing.