Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting individuals of reproductive age. It is a lifelong condition that often leads to varied symptoms, such as irregular menstruation, weight gain, and excessive hair growth. While there is no permanent cure for PCOS, nutrition interventions and health-promoting behaviors can help manage symptoms and improve metabolic health. Registered dietitians (RDs) play an essential role in identifying and addressing nutrition concerns in individuals with PCOS. To provide comprehensive care, an interdisciplinary team should be involved in the management of PCOS, including, but not limited to, endocrinologists, gynecologists, and mental health professionals.
Understanding PCOS
To be diagnosed with PCOS, an individual must meet two of the following three criteria:
- Oligoovulation or anovulation (infrequent or absent ovulation)
- Hyperandrogenism (high levels of androgens, like testosterone)
- Polycystic ovary morphology (ovaries with multiple small cysts)
At its root, PCOS is a hormonal imbalance problem primarily caused by high testosterone levels. High testosterone levels change the signal to the ovary to release an egg on time every month. Because if you're not releasing an egg on time every month, then you're not going to get regular periods.
Many women will also have cosmetic effects of the high levels of testosterone. These can be really bothersome, increased acne, increased hair growth, particularly on the face, the chest, the back, and it really can cause a lot of body image issues.
In addition to the testosterone, the insulin disorder that is part of PCOS is important. The high insulin levels and the insulin resistance can actually contribute to the higher testosterone levels. They basically feed back and make each other worse. We know that women who have insulin resistance are at higher risk for diabetes and heart disease because of the damage of the blood sugar to these tiny blood vessels in the system, as well as high cholesterol.
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The Role of Diet in Managing PCOS
While there may not be one specific diet for PCOS, a balanced and nutrient-dense eating pattern, paired with regular movement and other behavioral strategies, can have a powerful impact on metabolic and hormonal health. Adjusting what you eat may help offer some balance within your system to maybe help manage the condition.
Even losing 10% of your body weight in PCOS sometimes can get your periods to go back to normal without any other hormonal treatment. There's really that balance of the insulin, your sugar levels, and then how that interplays with your testosterone production. It's all interconnected.
Choosing low-glycemic index and low-glycemic load carbohydrates like vegetables, whole fruits, legumes, and whole grains can support insulin sensitivity and the mitigation of comorbidities.
Prioritizing Protein
Protein plays a role in satiety, blood sugar regulation, and hormone health. Maintaining protein intake is especially important for clients pursuing intentional weight loss to preserve muscle mass. Lean protein like chicken, turkey, fish, tofu, eggs, and even low-fat Greek yogurt keeps blood sugar levels stable, promotes muscle health, and reduces cravings that often accompany PCOS.
Emphasizing Omega-3 Fatty Acids
Omega-3 fatty acids have been shown to support a healthier lipid profile and improve fasting blood glucose in women with PCOS. RDs should encourage food sources, such as fatty fish, walnuts, flaxseeds, hempseeds, chia seeds, navy beans, and soybeans.
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Addressing Vitamin D Deficiency
Vitamin D deficiency is common in individuals with PCOS and may be associated with insulin resistance. RDs can encourage intake of vitamin D-rich foods, such as fortified dairy products, eggs, and fatty fish.
Dietary Strategies for PCOS Management
To maintain lower levels of insulin, dietary changes should include reducing sugar-containing foods and refined carbs. Choose foods that provide nutrition first. Reduce or eliminate sugar-sweetened beverages, sweets, desserts, and baked goods. Also limit simple carbohydrates that are considered things like white bread, white pasta, white rice, and white crackers.
The difference between a simple and a complex carb is that simple carbs are broken down very immediately and quickly into glucose or sugar, which then leads to a rise in insulin. Where complex carbohydrates provide fiber, maybe a little protein.
The best PCOS diet focuses on whole foods and keeping blood sugar stable. Prioritizing high-fiber vegetables, lean proteins, and healthy fats - while limiting refined carbohydrates and added sugars - can reduce inflammation and support better insulin function.
Foods to Include
- Whole Foods: High-fiber foods and good sources of lean protein.
- Whole Grains: Quinoa, brown rice, steel-cut or rolled oats, lentils, black beans, chickpeas, and other whole-grain foods contain complex carbohydrates that are digested more slowly than refined grains (e.g., white rice or white flour), preventing spikes in blood sugar and insulin.
- Fresh Fruits and Vegetables: A variety of colorful produce.
- Nuts and Seeds: Excellent sources of healthy fats and fiber.
- Beans and Legumes: High in fiber and protein.
- Lean Meats: Chicken, turkey, lean beef or pork, fish or seafood.
- Healthy Fats: Extra virgin olive oil, avocados, nuts, and seeds.
Foods to Limit or Avoid
- Sugar-Sweetened Beverages: Sodas, energy drinks, sweetened teas, and even store-bought fruit juices often contain high amounts of simple carbohydrates.
- Refined Grains: Foods like white bread, white rice, white pasta, and baked goods made from refined flour digest quickly and cause sharp blood sugar spikes.
- Processed Snacks: Crowd favorites like French fries and fried chicken, along with many packaged snacks, typically contain trans fats, excess sodium, and additives that can trigger or increase inflammation.
- Processed Meats: Sausages, bacon, deli meats, and similar products have been linked to inflammation and hormonal imbalances.
The Importance of Lifestyle Changes
Despite weight loss often being emphasized in PCOS management, many improvements, like insulin sensitivity, menstrual regularity, and inflammation, can occur through lifestyle interventions regardless of changes in body weight.
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Physical Activity
Physical activity not only improves insulin sensitivity but may also support reproductive health and mood. Encourage clients to increase their physical activity level as appropriate and with consideration for individual goals. Recommendations increase to at least 250 minutes of moderate-intensity or 150 minutes of vigorous-intensity activity per week and two days of resistance or weight-bearing exercise for modest weight loss or prevention of weight regain.
Sleep Hygiene
Sleep disturbances and PCOS often go hand in hand, and the relationship may be bidirectional. Prioritize establishing a consistent sleep schedule and creating a relaxing bedtime routine.
Addressing Emotional Eating
Many individuals with PCOS experience difficulty losing weight or preventing weight gain. RDs should have an increased awareness that PCOS features can negatively impact body image and that the potential for eating disorders and disordered eating patterns exists regardless of weight status.
Emotional eating is basically consuming these processed high-sugar, high-fat foods, and really, it's trying to buffer your feelings. You're eating not because of hunger but because of what you're feeling.
Try to come up other ways to soothe. We replace the food with another soothing event or distracting event. Soothing may be taking a hot bath, maybe simply taking some deep breaths. Distraction could be calling a friend or going on a walk.
Food journaling can help individuals see when they are not having the willpower that they want over their eating. It can help identify patterns and triggers for emotional eating.
Sample Meal Plan
To help you see how these food choices can come together in real life, consider the following sample meal plan:
Breakfast: Oatmeal with berries and nuts, or a protein shake with fruit and spinach.
Lunch: Salad with grilled chicken or fish, or a lentil soup with whole-grain bread.
Dinner: Baked salmon with roasted vegetables and quinoa, or a stir-fry with tofu and brown rice.
Snacks: Greek yogurt with fruit, a handful of almonds, or sliced vegetables with hummus.
Seeking Professional Guidance
While general tips on PCOS nutrition can be a helpful starting point, remember that PCOS affects everyone differently. Working with registered dietitians who specialize in PCOS and hormone health can provide compassionate, evidence-based care tailored to individual needs.
A nutritionist can assess an individual's sleep patterns, stress levels, and overall lifestyle to create a personalized dietary plan that supports quality sleep and stress management. They can identify potential obstacles to healthy eating and physical activity by analyzing an individual's work schedule, social commitments, and personal preferences. A specialist in metabolic health can assess individual metabolic rates, hormonal balance, and nutrient utilization, providing valuable insights into how the body processes and stores energy.