1. + Differential Effects of Walnuts vs Almonds on Improving Metabolic and Endocrine Parameters in PCOS European Journal of Clinical Nutrition 2011; 65:386-393. Brooke Beasley and Ruth Sullivan

2. + Polycystic Ovary Syndrome Signs and Symptoms Menstrual irregularities Infertility Masculinizing hormones - acne and hirsutism Fluid-filled ovarian cysts Metabolic Syndrome Insulin resistance Dyslipidemia Increased inflammation

3. + Study Objective & Methods Compare the impact of MUFA in almonds to PUFA in Walnuts On metabolic and endocrine components of PCOS Randomized prospective study 31 women participated Individual packets of nuts containing 31 g of fat 46 grams almonds 36 grams walnuts daily 6 weeks

4. + Data Collected Anthropometric Weight Height Sugar Insulin OGTT HgbA1C Dyslipedemia Total Cholesterol HDL TG Leptin Adiponectin Inflammatory Markers CRP TNF IL Masculinizing Hormones Total testosterone Sex hormone binding globulin (SHBG) Free Androgen Index (FAI)

5. + Significant Findings Walnuts reduced HgbA1C levels PUFAs stimulated insulin secretion Both walnuts and almonds increased adiponectin helps control insulin sensitivity Both decreased circulating androgen levels Walnuts increased SHBG Almonds decreased FAI

6. + Strengths and Weaknesses Strength Well controlled re: compliance of nut intake Collected unused portions Weakness Small sample size: 31 individuals No control group with PCOS without nuts

7. + Database Research on PCOS The Natural Standard database: PCOS Treatment: Promote normal weight status High intake of fruits, vegetables, whole grains No estrogen-rich food sources (tomatoes, nonorganic red meat/dairy) Low carb High carb  weight gain  estrogen stored in fat cells High estrogen promotes ovarian cysts *No reference regarding fat quantity/quality http://www.naturalstandard.com/databases/conditions/condition-pcos.asp

8. + Database Research on Metabolic Syndrome The Natural Standard Database News, December 2008: “Eating a Mediterranean diet rich in nuts may help reverse Metabolic Syndrome.” http://www.naturalstandard.com/news/news200812017.asp

9. + Our Treatment Strategy for PCOS Promote optimal body weight Low glycemic/anti-inflammatory diet Organic animal proteins MUFA and n-3 PUFA rich food sources (nuts) Liver support (cruciferous vegetables) Decrease phytoestrogens (soy) & caffeine Spearmint tea for hirsutism Reduce stress/toxic environmental exposure

10. + In Conclusion A general anti-inflammatory or Mediterranean diet including MUFA and PUFA rich almonds and walnuts appears to be helpful in managing metabolic and endocrine symptoms in PCOS.