Premature ovarian insufficiency (POI), also known as premature ovarian failure (POF), is a condition characterized by the cessation of ovarian function before the age of 40. It is a significant cause of infertility in women and is increasingly recognized as a complex metabolic disorder. POI affects approximately 1.1% to 3.7% of women under the age of 40 worldwide. This article explores dietary recommendations that may help mitigate the risk and manage the symptoms of POI.
Understanding Premature Ovarian Insufficiency (POI)
POI is characterized by the ovaries ceasing to function normally before the age of 40. This condition affects approximately 1% of women and can manifest through a variety of symptoms and risk factors. Women with POI are at an increased risk of developing osteoporosis due to decreased oestrogen levels, which can leave bones vulnerable over extended periods.
Symptoms and Risk Factors
Family history plays a significant role, as women with a mother or sister diagnosed with POI have a higher likelihood of developing the condition themselves. Some women with POI may opt to freeze their eggs for potential future use.
The Role of Diet in Managing POI
Dietary habits have emerged as a significant modifiable factor affecting ovarian function. High-fat and high-sugar (HFHS) diets have been linked to the accelerated decline of ovarian function, potentially increasing the risk of POI through multiple mechanisms, including oxidative stress, chronic low-grade inflammation, and metabolic disturbances. Conversely, specific dietary patterns, such as those rich in antioxidants, omega-3 fatty acids, and phytoestrogens, have been associated with enhanced ovarian function and a delayed onset of POI.
Key Dietary Considerations
For women with a family history of POI or those exposed to known risk factors (such as autoimmune conditions or chromosomal abnormalities), dietary modifications may represent a promising strategy for mitigating the risk of disease onset and progression.
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Dietary Recommendations for Women with POI
General Dietary Principles
An optimal diet for patients and survivors is one that serves one’s own individual nutritional needs. A diet for patients currently in treatment may look different than for those who have just finished treatment or are long-term survivors.
While you don’t have to go vegetarian or vegan, a diet that is plant-based is recommended. "Make plants the star of your plate instead of starting with an animal protein.” Making vegetables, fruits, beans, nuts, and grains such as whole wheat, oats, brown and black rice, and quinoa the basis of your meal is a good start.
Plant-Based Foods
Plant-based foods - such as citrus fruits, garlic, nuts, seeds, spinach, melon, dried herbs and spices, berries and mushrooms - are important for immune function.
Protein Sources
A healthy immune system also feeds off of protein. Adding foods rich in proteins like fish, tofu, beans, and eggs, to your diet is recommended.
Foods to Limit or Avoid
Optimal dietary patterns minimize red meats. “Anything that has four legs is considered a red meat, nutritionally speaking.” Minimizing cold cuts and processed meats like pepperoni, sausage, ham, bacon, and hot dogs is also recommended. Limiting intake of baked goods, cookies, ice cream, and sweetened drinks like soda can support overall health.
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High-Fat Dairy Products
Consumption of butter and full-fat dairy products was strongly associated with an increased risk of primary ovarian insufficiency (POI). Women who consumed butter had nearly ten times the risk of developing POI, while full-cream milk was associated with an even greater risk. Interestingly, semi-skimmed milk, despite its lower fat content, also showed a significant positive association with POI.
Foods to Include
Dietary patterns including oily fish and pork were protective against POI. Oily fish, rich in omega-3 fatty acids, was linked to a reduced risk of POI, and pork consumption also showed a protective effect.
Oily Fish
Regular consumption of oily fish, which is rich in omega-3 fatty acids, was associated with a significantly reduced risk of POI. Omega-3 fatty acids, abundant in oily fish, have well-established benefits for cardiovascular and metabolic health, and these properties may extend to ovarian function.
Specific Nutrients and Supplements
While it’s best to tread with caution when it comes to supplements, many individuals can be at risk of vitamin D deficiency.
Calcium
Calcium, found in milk, yoghurt and cheese have always been known to be great sources of calcium. But let’s not forget about all our non-dairy foods high in calcium i.e.
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Addressing Common Dietary Questions
Common questions from cancer patients include: “Can I eat pizza?” “Should I go vegan or vegetarian?” “Should I avoid sugar?” “Can I eat red meat?” And while it is emphasized that “too much of anything can be a bad thing,” it is also underscored that a very restrictive diet can be more harmful than helpful.
Hydration
Hydration is always important, but it can play a key role in optimizing treatment effectiveness and managing side effects like constipation and diarrhea. At least two liters of water a day is recommended, which can include other drinks like plain seltzers, sparkling or mineral waters, hot teas or cocoa, and unsweetened iced teas. Adding lemon, lime, cucumber, or mint to water and drinking through a straw can help facilitate intake while adding flavor.
Managing Treatment Side Effects
For those experiencing diarrhea, limiting raw vegetables, fruit juices, and fried, greasy, or oily foods is advised. If experiencing constipation, it is important to gradually increase fiber intake. Fiber-rich foods can include whole grains like bran and quinoa; vegetables such as broccoli, artichokes, and carrots; fruits including berries, pears, avocado and apples; and beans such as lentils and chickpeas.
Whether experiencing constipation or diarrhea, it is important to get enough hydration. If experiencing diarrhea, trying electrolyte-rich fluids is recommended. Trying foods or drinks that are cool, cold, or frozen - such as smoothies or fresh fruits like watermelon, sliced apples, or strawberries - can help combat nausea. Additionally, bland foods like potato chips, saltine crackers, or dry toast - while not substantial long-term - can be helpful in managing acute symptoms.
Some patients may experience changes in taste, including a metallic taste in the mouth. Adding flavors such as lemon, lime, or mint to water and small amounts of salt, sugar, honey, or fresh and dried herbs to foods is recommended. Cool, creamy, soft, and bland foods like yogurt or homemade smoothies and shakes can facilitate the healing of mouth sores. Additionally, trying baking soda or saline mouth rinses is recommended.
When it comes to loss of appetite, trying different flavors, textures, and temperatures to see what is most appealing is suggested. Prioritizing high-protein foods such as eggs, beans, yogurt, peanut butter, and fish is important. Using protein-rich nutrition supplement drinks or making homemade shakes and smoothies can be helpful if it is easier to drink than to eat solid foods. It is ok to choose favorite foods or foods that are most appealing and to not force any particular food.
To manage fatigue, it is recommended to “keep it simple.” Having easy-to-prep foods on hand such as yogurt cups, instant oats, canned tuna or salmon, frozen vegetables, or already prepared foods is suggested. Even though it may sound counterintuitive, limiting caffeine to the early part of the day and drinking it in moderation can help mitigate fatigue and facilitate healthy sleeping patterns.
Latest Research Findings
The latest research findings have underscored the significance of nutrition in influencing reproductive and metabolic health. Specific dietary patterns, such as those rich in antioxidants, omega-3 fatty acids, and phytoestrogens, have been associated with enhanced ovarian function and a delayed onset of POI. Conversely, a high intake of processed foods, refined sugars, and trans fats has been linked to accelerated ovarian aging.
Mendelian Randomization (MR) Studies
Mendelian randomization (MR) offers a powerful approach to assess the causal impact of dietary factors on POI risk. By using genetic variants as instrumental variables (IVs), MR minimizes confounding and reverse causality, providing more reliable causal estimates than traditional observational studies.
The Broader Impact of Lifestyle on POI
Lifestyle factors, including diet, low energy availability and BMI, can increase the risk of POI.
The Importance of Sleep and Exercise
Immune systems need enough sleep and exercise. The CDC recommends getting at least seven to eight hours of sleep each night. Small amounts of moderate exercise every day have been shown to help our immune systems perform at their best. This doesn’t have to be rigorous workouts; it can be going for a walk or walking up and down a flight of stairs a few times each day.
Food Safety and Sanitation
The way we handle our food can be just as important as the food we put into our bodies, especially during cancer treatment. Certain cancer treatments can weaken our immune systems, making food safety and sanitation an important priority. Basic sanitation like washing hands before prepping a meal and thoroughly rinsing fresh fruits and vegetables with water are little things that can help protect health.
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