Title: How to Leverage a Vegetarian Diet to improve PCOS
If you've been following along, then you've read about the link between PCOS and Advanced Glycation End Products (AGEs) in the diet. Today we're going to explore what exactly AGEs are, where they come from, and how we can reduce our intake of them to improve our symptoms of PCOS.
Keep an eye out for coming articles on how to combat the underlying insulin resistance and metabolic dysfunction that commonly accompanies PCOS.

What are Advanced Glycation End Products? "Advanced glycation end products (AGEs) are proteins or lipids (fats) that become glycated after exposure to sugars" (1). Glycation means that sugar in the blood stream binds to them, forming a pro-inflammatory molecules. Certain foods are inherently higher in AGEs and the cooking process can alter the amount of AGEs a food contains.
Dietary AGEs are concerning because they are pro-inflammatory and cause oxidative stress, linking them in the pathogenesis of many chronic illnesses (2). For example, those of us living with Type 2 Diabetes frequently monitor a type of AGE called hbA1c, which is short for glycated hemoglobin (an AGE that we can test for in the blood). This is one of the reasons potentially explaining why PCOS is so tightly linked to metabolic conditions like insulin resistance, cardiovascular disease, and more. Read more about that here.
"RAGE": Receptors for AGEs
So what do AGEs have to do with PCOS? Our ovaries have AGE receptors, which are particularly sensitive to AGEs in the diet. Those of us with PCOS are thought to have more of the AGE receptors in our ovaries (they're up-regulated), meaning that we more sensitive to the amount of AGEs that we eat (3). A 2008 study of 193 women (100 of them with clinically diagnosed PCOS) suggests that high AGEs in the blood are a distinct finding in women with PCOS (3). Interestingly, high AGEs in the blood stream are found in those of us living with PCOS regardless of our weight or underlying insulin resistance (3)(5).
It wasn't until 2014, when researchers asked the question, does modifying AGEs in the diet lead to changes in the hormonal and metabolic profile of women living with PCOS? (4). The short answer is, yes.
The researchers "showed that a HA (high AGE) diet increased serum levels of AGEs, insulin, testosterone, insulin resistance and oxidative stress in women with PCOS" (4). How long did it take to see these changes? The researchers had the women consume a low AGE diet for 2 months (4).

Where do we find AGEs in the diet and what does a low AGE diet look like? AGEs are found in "foods rich in both protein and fat, mostly of animal origin, and cooked at high and dry heat, such as in broiling, grilling, frying, and roasting, tend to be the richest dietary sources of AGEs, whereas low-fat, carbohydrate-rich foods tend to be relatively low in AGEs" (2).
As the title of this article suggests, we can leverage a plant-predominant whole foods vegetarian diet to reduce the AGEs we are consuming. Why? Because a plant predominant vegetarian diet pattern is inherently low in AGEs.
Let's take a look at two different breakfasts...
omnivorous: 2 eggs (1,237 kU/egg), 2 slices of whole wheat toast (16 kU/slice), 1 serving of bacon (11,905 kU/serving)
vegetarian: 1 serving of steel cut oats (4 kU/serving), 1 apple (13 kU/apple), 1 tablespoon ground chia seeds (unknown), 30 grams of hemp seeds (unknown).
The omnivorous breakfast contains an estimated 14,411 kU of AGEs while the oatmeal contains less than 100 (2).
Want to explore how many AGEs you are consuming? Here is a link to a chart of average AGEs per serving (scroll to the end of the PDF). You'll notice that roasting nuts can significantly increase the AGEs, which is why raw nuts are preferred over roasted (2).

As always, what do I think? There appears to be a significant link between women with PCOS and elevated AGEs in the diet. The vast majority of AGEs come from the foods that we eat. Choosing a plant predominant dietary pattern, packed with high antioxidant plant foods is a surefire way to lower dietary AGEs. To put this in perspective, even air-fried tofu and vegetables don't even come close to the AGEs in boiled chicken breast.
If we are going to continue to consume high AGE foods, then we can choose to use moist cooking methods (boiling, microwaving or steaming), avoid overcooking them or charring, and add ingredients to these foods during the cooking process that lower AGE formation (like acids: lemon juice and vinegar are the ones that come to mind).
Do I think that dietary AGEs cause PCOS? As with most of medicine, there are likely a multitude of contributing factors to PCOS. Given that AGEs are persistently found to be elevated in women with PCOS, it is worth trialing a log AGE dietary pattern for at least 3 months to see if we will benefit. A vegetarian plant predominant dietary pattern not only lowers dietary AGE consumption, it also reduces the chances of other metabolic conditions linked to PCOS (like Type 2 Diabetes and Cardiovascular Disease).
If you are ready to explore a plant predominant dietary pattern and you're looking for both medical and peer support to help make these changes, then check out our 12 week weight loss and wellness therapeutic group programs. Our 12 week programs are designed to lower dietary AGEs, insulin resistance, cardiovascular disease risk, and chronic weight gain by addressing the underlying cause of chronic illness. We screen all women with PCOS for insulin resistance and monitor our markers of systemic inflammation (hs-CRP) throughout our journey. While reducing AGEs in the diet does not guarantee reversal of PCOS, this is low-risk intervention that could likely improve our symptoms and reduce the risk of developing the corresponding metabolic dysfunction associated with PCOS.
Have questions? Schedule a FREE new patient consult to discuss the 12 week program. Our next session begins on April 7th, meeting every Sunday for 12 weeks at 10am EST. Learn more here.
References
Advanced Glycation End Products: Sparking the Development of Diabetic Vascular Injury. Goldin, et al. Journal Circulation. (2006) https://doi.org/10.1161/CIRCULATIONAHA.106.621854
Dietary Advanced Glycation End Products and Their Role in Health and Disease. Uribarri, et al. Advances in Nutrition. (2015) https://doi.org/10.3945%2Fan.115.008433
Increased serum advanced glycation end-products is a distinct finding in lean women with polycystic ovary syndrome (PCOS). Diamanti-Kandarakis, et al. Endocrinology. (2008) https://doi.org/10.1111/j.1365-2265.2008.03247.x
Impact of dietary modification of advanced glycation end products (AGEs) on the hormonal and metabolic profile of women with polycystic ovary syndrome (PCOS). Tantalaki, et al. Journal Hormones. (2014) https://www.hormones.gr/pdf/Hormones_2014-65.pdf
Increased levels of serum advanced glycation end-products in women with polycystic ovary syndrome. Diamanti-Kandarakis, et al. Clinical Endocrinology. (2004) https://doi.org/10.1111/j.1365-2265.2004.02170.x
Advanced Glycation End Products: Link between Diet and Ovulatory Dysfunction in PCOS? Garg & Merhi. Nutrients. (2015) https://doi.org/10.3390%2Fnu7125524
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