Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, characterized by a range of symptoms including irregular periods, elevated androgens, and/or multiple cysts on the ovaries. Many women with PCOS experience irregular periods, lack of ovulation, acne, unwanted facial hair growth, mood disorders, and hair loss. While the etiology of PCOS appears to be multifactorial, it is often associated with insulin resistance, increasing the risk for type 2 diabetes and other serious health problems. Adrenal PCOS, a subtype of PCOS, involves the adrenal glands producing excess androgens (DHEA-S), contributing to symptoms like acne, infertility, and hair loss. The adrenal glands, located above the kidneys, produce hormones that help regulate various bodily functions, including the stress response.
Understanding PCOS and Its Types
PCOS is diagnosed via the Rotterdam criteria, requiring the presence of two out of three characteristics: irregular periods, elevated androgens, or multiple cysts on the ovaries. However, it's crucial to understand the other conditions at play, such as insulin resistance and inflammation. There are several types of PCOS, including:
- Insulin-Resistant PCOS: Characterized by symptoms related to blood sugar challenges, sugar cravings, and weight gain.
- Inflammatory PCOS: Marked by chronic inflammatory symptoms like fatigue, joint pain, skin issues, gut issues, and thyroid conditions like Hashimoto's thyroiditis.
- Post-Birth Control PCOS: Occurs in women who experience PCOS symptoms only after coming off oral contraceptives.
- Adrenal PCOS: In this type, the adrenal glands produce excess androgens (DHEA-s), contributing to acne, infertility, and hair loss.
It is common for there to be overlap between these PCOS types, especially as it relates to challenges with inflammation and insulin resistance. As many as 30% of those diagnosed with polycystic ovary syndrome (PCOS) have elevated levels of DHEA-S due to adrenal androgen excess. In addition, upwards of 70% of those with PCOS struggle with insulin sensitivity.
The Role of Adrenal Glands in PCOS
The adrenal glands are always at play in PCOS, and are responsible for at least 20-30% of the elevated androgens that are seen. The primary difference between PCOS and adrenal PCOS is the source of androgen production. In Adrenal PCOS, DHEA is the main androgen that is elevated. DHEA is primarily produced by the adrenal glands, compared to testosterone, which is made primarily by the ovaries. The adrenal glands are responsible for cortisol production, as the final player in the HPA axis, and rely heavily on minerals, namely sodium and potassium, and vitamin C in order to function optimally.
The Adrenal PCOS Diet: A Food-Based Approach
The adrenal fatigue diet is a food-based approach to improving stress on the adrenal glands. Although adrenal fatigue is not a true medical diagnosis and is not endorsed by most healthcare professionals, it’s purported to occur when your adrenal glands can’t function properly. The adrenal fatigue diet is believed to promote the proper functionality of the adrenal glands. The adrenal glands are two small glands that sit on top of each kidney and are responsible for the production of cortisol, DHEA, epinephrine, norepinephrine, and aldosterone. Adrenal health includes the optimal functioning of the adrenal glands, along with the hypothalamic-pituitary-adrenal (HPA) axis. Chronic stress can contribute to HPA dysregulation, commonly referred to as adrenal fatigue.
Read also: Balanced Cortisol Diet
General Dietary Guidelines
This adrenal fatigue diet provides guidelines similar to other balanced diets, which generally include:
- Lean sources of protein
- Vegetables
- Whole grains
The purported goal is to increase your energy levels naturally so you don’t burn stored nutrients. Keep in mind that the adrenal fatigue diet has not been evaluated for its ability to decrease stress on the adrenal glands. But it has been proven that eating a more balanced diet and adopting certain lifestyle changes can make you feel better physically and mentally. That being said, if you believe you may have adrenal fatigue, it’s best to talk with your doctor to determine whether other health problems could also be contributing to your symptoms.
Foods to Limit
Some foods to limit include:
- White sugar
- White flours
- Soda
- Fried food
- Processed food
- Artificial sweeteners
Meal Timing and Blood Sugar Management
It’s also recommended to time your meals properly to help manage your blood sugar levels. It may help to eat breakfast, and eat regularly throughout the day. Skipping breakfast and lunch forces your body to burn stored nutrients and may reduce your energy levels. If you eat regular, balanced meals and snacks, you can maintain your energy levels all day.
Importance of a Balanced Diet
A well balanced diet recommended to address adrenal fatigue may be helpful in increasing energy levels and regulating blood pressure because it promotes healthier eating habits. This diet also encourages a variety of nutrient-dense foods and doesn’t require any major dietary restrictions that could harm your health. For best results, you should combine the diet with other lifestyle changes, like establishing a healthy sleep schedule, managing your stress levels, and getting plenty of physical activity. Additionally, you should always talk with your doctor before changing your eating habits to ensure your nutritional needs are met.
Read also: Benefits of Thorne Adrenal Cortex
Cortisol and Blood Sugar Connection
Cortisol production and blood sugar balance are intimately connected. Just as we want to avoid moments of hyperglycemia, or elevated blood sugar, we also want to avoid times when our blood sugar drops too low, or hypoglycemia. When our blood sugar is too low, that triggers a stress response and the release of cortisol in order to free up stored glucose from the tissues. Eating regular meals and snacks throughout the day will support your cortisol levels and adrenal glands so you avoid fatigue, stress and other symptoms. Meal and snack times are meant to be an enjoyable and relaxing event, not rushed. Practice mindfulness as you eat by focusing on the flavor and texture of your food.
Specific Dietary Recommendations for Adrenal PCOS
Based on research and expert recommendations, a diet that supports adrenal health and manages PCOS symptoms should include the following:
Prioritize Protein Intake
Prioritizing protein and spreading protein intake throughout the day effectively helps to regulate blood sugar balance and insulin sensitivity. Consuming protein every 3-5 hours, whether in a meal or snack, also helps maximize muscle protein synthesis, or muscle rebuilding. Protein in all of your meals and snacks will have a stabilizing effect on your blood sugar, which, in turn, can help you overcome cravings for caffeine and sugars. Nuts, seeds, beans and other plant proteins are good choices. Women typically need between 60-70 total grams of protein per day.
Focus on Low Glycemic Index (GI) Carbohydrates
Several randomised controlled trials have shown that a low glycaemic index (GI) diet for PCOS can be effective for weight loss, reducing abdominal fat and improving hormone profiles. Low GI carbohydrates provide slow energy release to maintain blood sugar control - e.g. porridge oats, wholegrain bread or pasta, brown rice. The carbohydrate products selected for the diets were characterized by lowered glycemic index (GI).
Increase Fiber Consumption
Looking at the quality rather than quantity of carbohydrates is a more approachable and effective way of managing PCOS. Fibre is a nutrient that most of us don’t consume in large enough quantities, with low fibre intake correlated with worsening insulin resistance and higher androgen (male hormone) levels in women with PCOS. Fruits and vegetables are a great way of getting more fibre.
Read also: Adrenal Gland Diet
Include Healthy Fats
Good quality fats are essential building blocks for hormone production. We can get anti-inflammatory omega-3 fatty acids from salmon, flax seeds, chia seeds, and walnuts.
Incorporate Anti-Inflammatory Foods
Antioxidants help to reduce free radicals in the body and protect against oxidative stress, both of which are drivers of inflammation. While not all individuals with inflammatory PCOS have sensitivities to gluten or dairy, these can be helpful foods to avoid to help lower any inflammation that may be coming from these food sources.
Support Liver Function
Another way to support lowering inflammation is by supporting liver function and the liver’s innate detoxification processes.
Nutrient-Dense Foods
Eating a nutrient dense diet with emphasis on quality protein and fiber is an important aspect of managing blood sugar and PCOS symptoms.
Foods That May Be Beneficial
- Foods like apple cider vinegar and other bitters promote the release of stomach acid and digestive juices.
- Fruits and vegetables low in glycemic index and usually non-starchy (such as artichokes, asparagus, bean sprouts, brussels sprouts, broccoli, cabbage, cauliflower, celery, cucumber, eggplant, mushrooms, onions, peppers, salad greens, spinach, tomato, turnips, zucchini, melons, berries like strawberries, raspberries, blackberries and blueberries, citrus fruits like oranges, tangerines, grapefruit and lemons, peaches, plums, apricots, cherries, and pears)
- Low-fat dairy in small quantities
- Fish rich in Ù3 fatty acids
- Lean red meat and poultry (e.g., chicken, turkey) in small quantities
- Fatty acids (olive oil-olives, vegetable oils, fish oils), (almonds, pumpkin seeds, sunflower seeds, sesame seeds, poppy seeds)
- Legumes
- Whole grain products
- Alcohol in moderate amount (150 mL of red wine per day)
Consider Gluten-Free Options
As you begin to balance your adrenals, stay away from any form of wheat, rye or other gluten-containing grains. Many people have inflammatory reactions to gluten. Turn to gluten-free grains like wild rice, quinoa, “pure” buckwheat and amaranth and see how you feel.
Clean Eating
Whenever possible, eat fresh, whole foods, preferably organic or locally grown, without colors, dyes, chemicals, preservatives or added hormones.
Manage Caffeine Intake
Caffeine can overstimulate the adrenals and disrupt sleep patterns. But if you find yourself craving caffeine, it may be that your cortisol or blood sugar is low or that serotonin is imbalanced. Either way, you may not have much energy and your body probably needs rest.
Address Salt Cravings
Women with adrenal fatigue often crave salt. Yes, salt can increase blood pressure, but low blood pressure (hypotension) is a very common sign of adrenal insufficiency. If you feel lightheaded when you get out of bed in the morning, stand up quickly or get up out of a bath, you may very well have low adrenal function.
Key Nutrients for Adrenal Health
- Vitamins C, E, and B vitamins (especially pantothenic acid and B6): Crucial roles in the production and actions of stress hormones. Good sources include red and orange fruits and colorful vegetables (Vitamin C), avocados, hazelnuts, almonds, seeds, spinach, and asparagus (Vitamin E), and Brewer’s yeast, sunflower seeds, wheat germ, fish (tuna, salmon, trout), liver, and beans (Vitamin B6).
- Magnesium: Provides necessary energy for your adrenals and every cell in your body to function properly. Good sources include dark green leafy vegetables, fish, nuts, seeds, and whole grains. Supplementation with +/- 500 mg daily may be beneficial.
- Calcium and trace minerals (zinc, manganese, selenium, and iodine): Produce calming effects in the body, which will help restore normal cortisol levels. Good sources include dairy foods, dark leafy greens, and soy.
Lifestyle Changes to Support Adrenal Health and PCOS Management
Stress Management
Chronic stress can contribute to HPA dysregulation, commonly referred to as adrenal fatigue. It's now recognized that lifestyle changes should be the first line of treatment for PCOS, including stress management. Techniques can decrease anxiety, improve mood, and reduce stress levels in women with PCOS.
Exercise
Exercise helps elevate your mood, reduces stress, and has a positive impact on hormones. This is so important to build and maintain lean muscle, which helps to reduce insulin resistance. Exercise can also increase sex-hormone binding globulin (SHBG) levels, a hormone that is able to bind testosterone, making it less potent. There’s no best exercise for PCOS. The best exercise is the one that they enjoy and the one they’re going to stick to for the long-term. The only thing I would advise against is excessive amounts of high-intensity interval training. It’s great for 15-20 minute bursts a few times per week, but not long daily sessions, because that adds too much stress on your body and can also negatively impact your hormones.
Yoga
This can be a great way of combining exercise and mindfulness, and in fact, a study of 90 girls with PCOS in India showed that practising one hour a day for 12 weeks not only improved their menstrual cycle regularity, but also blood hormone profiles.
Sleep Hygiene
Lack of sleep can contribute to inflammation, anovulatory cycles, insulin resistance and increased cortisol production, and worsening symptoms. Sleep hygiene is important to ensure adequate sleep quantity and quality, the lack of which can further disrupt hormone function. Sometimes natural sleep support or calming herbs like lemon balm, passionflower, and valerian can aid in getting more restful sleep.
Avoid Smoking
Given the increased risk of heart disease with PCOS and from smoking - it’s a ‘no’ from me!
Adaptogenic Herbs
Adaptogenic herbs such as Rhodiola, Holy Basil and Ashwaghandha can help support a healthy cortisol response. Look for a blend that also provides necessary nutrients for adrenal function like vitamin C and pantothenic acid. You'll find these in the Dr.
Myo-Inositol and D-Chiro-Inositol
Myo-inositol and d-chiro-inositol have been shown to improve insulin sensitivity and support regular menstrual cycles.
Considerations for Exercise Intensity
While there are people who will tell you that you should never engage in high-intensity interval training (HIIT) if you have PCOS, this isn't entirely true. Or any activities that do not push you into maximum output. The best way to gauge this is to exercise at a level where you can still hold a conversation (but not easily) while working out. This is what it will look like during a healing phase. But this is not what it will look like for your entire life.
Research on Diet and PCOS
Research indicates that diet plays a vital role in the clinical picture and laboratory findings of PCOS. Changes in women’s diets have shown positive results in terms of the clinical appearance of the syndrome.
- Pohlmeier et al. (2014): A low-starch and dairy diet improved fasting insulin and the two-hour insulin curve.
- Phy et al. (2015): A low starch and dairy diet led to weight loss, improved insulin sensitivity, and reduced testosterone.
- Szczuko et al. (2017): A diet containing five meals a day with low glycemic index carbohydrates, lean protein, and healthy fats showed no significant difference between the two phenotypes of PCOS.
- Barrea et al. (2019): Adherence to the Mediterranean diet was directly correlated with women with PCOS and a different body composition characterized by low polyhydroxyalkanoates (PHAs) and no fat.
- Shishehgar et al. (2019): A low-calorie hypocaloric diet led to similar benefits in the anthropometric and metabolic characteristics of obese women with or without PCOS.
- Kazemi et al. (2020): The aMED and DASH diets improved the appearance of the ovaries.
- Paoli et al. (2020): A ketonic Mediterranean diet with plant extracts improved insulin, cholesterol, and triglycerides levels.