Polycystic ovary syndrome (PCOS) is a prevalent hormonal disorder affecting women of reproductive age, impacting their reproductive system and overall appearance. Characterized by excess androgens (male hormones), PCOS can lead to a variety of symptoms, including infertility, irregular periods, and metabolic disturbances. While there is no cure for PCOS, its symptoms can be effectively managed through a combination of lifestyle changes and medical interventions. Nutrition plays a vital role in managing PCOS, with dietary modifications often recommended as a first-line treatment.
Understanding PCOS
PCOS is a complex condition that affects individuals differently and with varying severity. It is the most common female endocrinopathy, affecting as many as 15% to 18% of women of reproductive age. Individuals with PCOS produce excess androgens, which can cause numerous symptoms, including infertility. Many women with PCOS have insulin resistance, which means the body’s cells don’t respond properly to insulin, resulting in elevated glucose levels.
The definition of PCOS changed in 2003, when representatives of the European Society of Human Reproduction and American Society of Reproductive Medicine met in Rotterdam, The Netherlands. Currently, it is defined as a heterogeneous group with different phenotypes, which pose challenges in its treatment.
The Role of Insulin Resistance
Insulin resistance is a key factor in the development of PCOS. Many women with PCOS have insulin resistance, which means the body’s cells don’t respond properly to insulin, resulting in elevated glucose levels. Insulin is a hormone produced by the pancreas that helps the body turn sugar (glucose) into energy. When the body becomes resistant to insulin, it may try to pump out high levels of insulin to keep blood sugar levels typical. Too high levels of insulin can cause the ovaries to produce more androgens, like testosterone.
Over time, insulin resistance can lead to elevated blood sugar levels, weight gain, chronic inflammation, and diabetes. Insulin resistance may also be caused by having a higher body mass index. Insulin resistance can make it harder to lose weight, which is why people with PCOS often experience this issue.
Read also: The Hoxsey Diet
The Impact of Androgens
With PCOS, the ovaries produce too much of male sex hormones called androgens. Individuals with PCOS produce excess androgens (sometimes referred to as “male hormones”), which can cause numerous symptoms, including infertility, hirsutism (male-patterned hair growth) and acne.
The Importance of Diet and Lifestyle
Health optimization in people with PCOS is sensitive to a lot of things - especially the things we eat and drink, our sleep-wake cycle, and physical activity. As with many health conditions, adopting healthier lifestyles can improve the symptoms of PCOS. In fact, losing just 5% of body weight can improve symptoms and boost fertility. Aside from making changes in your diet, increasing physical activity can help improve PCOS symptoms.
Lifestyle change is the first line of treatment for the management of women with PCOS but is not an alternative to its pharmacological treatment. Regular physical activity, maintaining appropriate body weight, following healthy dietary patterns and avoiding tobacco use is vital in prevention and treatment of metabolic disorders, and is included in clinical guidelines for various conditions.
General Dietary Recommendations
Start with a balanced diet of whole, fresh foods as much as possible and limit ultra-processed foods. The best diet for PCOS includes small healthy meals throughout the day. Nutrition for PCOS is similar to nutrition for people with diabetes. The two most important factors are the types of foods you eat and the times of day you eat.
Try to pair carbs and sugars with protein and fiber. This can slow the release of glucose into your bloodstream, which lessens the amount of insulin your body releases. Many people tend to eat their heaviest meal at night, right before they go to sleep. Eating your largest meals just before your more active times of day is recommended. Cautions against fad diets, intermittent fasting, and binge eating.
Read also: Walnut Keto Guide
Foods to Include in a PCOS Diet
Non-starchy fruits and vegetables: These have a low glycemic index, meaning they release glucose slowly into the bloodstream and prevent sudden rises in blood sugar.
Lean protein: Eating a higher protein diet can help improve insulin resistance along with a reduction in carbohydrates.
Healthy fats: Monounsaturated and polyunsaturated fats can help improve insulin resistance. Olive oil is the primary source of fat and provides monounsaturated fat, which lowers total cholesterol.
Whole grains: Processed slower than simple, refined carbs, they do not cause spikes in blood sugar and insulin, and they have a lower glycemic index.
High fiber foods: Consuming more high fiber foods can help manage PCOS symptoms. Soluble and insoluble fiber, like whole grains, fruits, vegetables, beans, legumes, nuts, and seeds are beneficial.
Read also: Weight Loss with Low-FODMAP
Foods to Limit or Avoid
Processed foods and simple carbs: These are made of sugars, such as fructose and glucose, and can cause a sudden rise in blood sugar and insulin production, which can lead to health issues. The biggest culprit of insulin resistance is eating a lot of processed foods and simple carbs. Refined carbohydrates cause inflammation, exacerbate insulin resistance, and should be avoided or limited significantly. These include highly processed foods like white bread, muffins, breakfast pastries, sugary desserts and anything made with white flour.
Sugary beverages: Soda and juice can contain enough sugar to spike your blood sugar. Drinking soda might seem obvious when it comes to sugary-beverage examples, but you may not realize your morning smoothie, especially if it comes from a bottle at the store, can still contain enough sugar to spike your blood sugar. Instead, stick to eating whole fruits instead of juices.
Unhealthy fats: Diets high in trans and saturated fats can increase insulin resistance and inflammation in the body.
Excessive dairy: Decreasing your dairy intake might help reduce your PCOS symptoms. One study indicated that drinking milk has a direct effect on people with PCOS.
The Glycemic Index (GI)
The glycemic index (GI) is a scale from 1-100. The lower the score, the longer that food takes to raise a person’s blood sugar levels. In foods with a low glycemic index, glucose is slowly released into the bloodstream after being digested. This can help prevent sudden rises in blood sugar.
Low GI (LGI) diets decreased homeostatic model assessment for insulin resistance (HOMA-IR), fasting insulin, total and low-density lipoprotein (LDL) cholesterol, triglycerides, waist circumference, and total testosterone compared with high GI (HGI) diets without affecting fasting glucose, HDL cholesterol, weight, or the free androgen index.
Anti-Inflammatory Foods
Anti-inflammatory foods are also beneficial to PCOS patients. Many of the foods listed above are anti-inflammatory. Types and quality of food should also include anti-inflammatory foods, such as cold-water fish, olive oil, avocados, red wine, dark chocolate, soluble and insoluble fiber, like whole grains, fruits, vegetables, beans, legumes, nuts, and seeds, pomegranates, onions and garlic.
Specific Dietary Approaches
Mediterranean Diet
Your San Antonio OBGYN may recommend the Mediterranean diet as a good starting point. Mediterranean meals are built around vegetables, beans and whole grains, with fish or poultry for protein. Olive oil is used instead of butter for preparing food and fruit is served for dessert.
Low-GI Diet
A reduced-calorie diet with a low GI is a significant factor in improving PCOS symptoms. Low-GI meals reduced ghrelin and increased glucagon in women with PCOS. Diets with a low GI may influence appetite-regulating hormones including ghrelin and glucagon.
Ketogenic Diet
It seems that another reduced-GI diet modification is the ketogenic diet, which limits the consumption of total carbohydrates in favor of plant-based fat. The ketogenic diet (KD) improves the menstrual cycle, reducing blood glucose and body weight, improving liver function, and treating fatty liver in women with PCOS and liver dysfunction who were obese. The anthropometric and body composition measurements revealed a significant reduction in body weight, body mass index (BMI), and fat-free body mass. A significant decrease in glucose and insulin blood levels was observed, together with a significant improvement in HOMA-IR scores. A significant decrease of triglycerides, total cholesterol and LDL were observed along with a rise in HDL levels. The LH/FSH ratio, LH total and free testosterone, and DHEAS blood levels were also significantly reduced. Estradiol, progesterone and SHBG increased. The Ferriman Gallwey Score was slightly, although not significantly, reduced.
The Role of Supplements
There are three key therapeutic dietary supplements for PCOS: Inositol, Berberine, and L-Carnitine.
Inositol
Inositol is a vitamin-like substance found in many plants and animals. Research shows that taking inositol reduces fasting blood glucose, fasting insulin, total cholesterol, triglycerides, and testosterone levels. Another study showed myo-inositol is similarly effective to Metformin for improving fasting insulin, insulin resistance, androgen levels, and body mass index (BMI), but with a much lower risk for adverse effects.
Berberine
Berberine’s lipid-lowering and insulin-resistance improving actions have been demonstrated in numerous randomized clinical trials. Research shows that berberine may improve some metabolic characteristics in PCOS patients and insulin resistance. Berberine seems to improve lipid parameters, including LDL cholesterol and total cholesterol, when compared with Metformin.
L-Carnitine
L-carnitine is an amino acid that is produced in the body and helps the body turn fat into energy. L-Carnitine supplementation reduces body weight, BMI, waist circumference, and hip circumference when compared with placebo in women with PCOS. There were also noted improvements in markers of glycemic control and insulin sensitivity.
Additional Lifestyle Modifications
Your diet is only one part of managing life with PCOS.
- Exercise: Exercise can help lower levels of blood sugar, so regular exercise can go a long way in treating or preventing symptoms of PCOS. It can help your body produce less insulin, which in turn tells your body’s cells to reduce your blood sugar. Many experts agree that at least 150 minutes per week of exercise is ideal. Daily activity, low sugar intake, and a low-inflammation diet may also lead to weight loss. People may experience improved ovulation with weight loss.
- Get enough sleep: Unfortunately, if you have PCOS, you may notice you have difficulty sleeping. Some people with PCOS experience insomnia and sleep apnea.
- Managing your stress: The symptoms of PCOS can be stressful. Taking steps to reduce your stress can help manage your symptoms and positively impact your health overall. Try practicing yoga, meditation, or deep-breathing exercises. Journaling or taking a daily walk in nature can also help. Regular mindful yoga practice can be a useful complementary therapeutic option for people with PCOS, particularly for improving serum androgen levels. Yoga practices can help with anxiety and depression as well.
- Stress reduction techniques: Stress reduction techniques, which help calm the mind and let you connect with your body, can help. These include yoga and meditation. In addition, speaking with a therapist or another healthcare professional may be beneficial.
Medical Treatments for PCOS
Your healthcare provider will determine treatment based on your symptoms, medical history and other health conditions, and if you want to get pregnant. Treatments can include medications, lifestyle changes or a combination of both.
If you don’t plan to become pregnant, treatments include:
- Hormonal birth control: Options include birth control pills, patches, shots, a vaginal ring or an intrauterine device (IUD). Hormonal birth control helps to regulate your menstrual cycle, some forms will also improve acne and help with excess hair growth.
- Insulin-sensitizing medicine: Metformin is a drug used to treat diabetes. It works by helping your body process insulin. Once insulin is under control, some people with PCOS see improvements in their menstrual cycles.
- Medications to block androgens: Some medications can block the effect of androgens. This helps control acne or hair growth. Talk to your healthcare provider about whether such treatment is right for you.
If you want to become pregnant now or in the future, treatment for PCOS includes:
- Drugs to induce ovulation (releasing an egg): A successful pregnancy begins with ovulation. Certain drugs have been proven to induce ovulation in people with PCOS. The medications clomiphene and letrozole are taken orally, while gonadotropins are given by injection.
- Surgery: A surgical procedure can help restore ovulation by removing tissue in your ovaries that produces androgen hormones. With newer medications available, surgeons rarely perform this procedure.
- In vitro fertilization (IVF): This is an option for people with PCOS when medication doesn’t help with ovulation. Your provider fertilizes your egg with your partner’s sperm in a lab before transferring it to your uterus.
Long-Term Management and Considerations
Does PCOS ever go away?
While there isn’t a cure for PCOS, your healthcare provider can help you manage your symptoms. The effects of PCOS may change over time so that you become less aware of the condition. However, there isn’t a treatment that permanently cures it.
Can you be in menopause and have PCOS?
The hormone changes you experience during menopause often resolve the symptoms of PCOS. It doesn’t matter how old you are - if your symptoms affect your quality of life, talk to your healthcare provider.
Can I get pregnant if I have PCOS?
Yes, you can get pregnant if you have PCOS. PCOS can make it hard to conceive while also increasing your risk for certain pregnancy complications, but many people with PCOS do get pregnant on their own. Your healthcare provider will work with you to develop a treatment plan to help you ovulate.
Risks Associated with PCOS
According to research from 2019, 33% to 83% of people living with PCOS also have overweight or obesity. People with PCOS, particularly when symptoms are not managed, may also be at greater risk of heart disease, endometrial cancer, diabetes and high blood pressure.
Seeking Professional Guidance
Before removing certain foods from your diet, it’s best to consult with a healthcare professional. They can recommend an eating plan that is right for you and your individual needs. Collaboration with a team of healthcare professionals is so important for people with PCOS. Patients should seek out a multidisciplinary team, including a nutrition professional and a mental health professional. It is so important to be advocating for yourself on your journey to healing by requesting copies of your routine lab work to be able to discuss the results with your doctor. That way you will be able to monitor the effectiveness of your treatment plan and hard work while educating and empowering yourself along the way!
tags: #diet #for #polycystic #ovary #syndrome