Unlock the Power of the Mediterranean Diet to Transform PCOS Symptoms Naturally!

Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder, affecting up to 18% of women of reproductive age. It is characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries. Obesity, low-grade chronic inflammatory status, and insulin-resistance (IR) often coexist in PCOS. Lifestyle modification, including a healthy diet, is considered first-line treatment for management of clinical symptoms.

Understanding Polycystic Ovary Syndrome (PCOS)

PCOS is a multifactorial endocrine metabolic disorder characterized by a spectrum of different phenotypes. Diagnosis is based on the presence of at least two of the three Rotterdam criteria:

Clinical hyperandrogenism (hirsutism, acne, seborrhea, and alopecia) and/or high circulating androgens levels. The Ferriman-Gallwey score is an efficient tool for assessing hirsutism, which is commonly correlated with biochemical hyperandrogenism.
Presence of ovarian cysts assessed by ultrasound examination.
Oligo-amenorrhea with oligo-anovulation.

Beyond hormonal derangements, obesity, insulin-resistance (IR), with associated compensatory hyperinsulinemia, and a low-grade chronic inflammatory status often coexist with PCOS. Obesity and obesity-related low-grade inflammation both contribute to the onset of IR, amplifying metabolic and reproductive outcomes. IR and compensatory hyperinsulinemia might empower androgenic activity, while high levels of androgens may further blunt IR through alterations of body composition, leading to a general worsening of this pathological status.

Metabolic and endocrine derangements of PCOS both contribute to making women with PCOS more prone to develop metabolic syndrome, type 2 diabetes mellitus, and infertility. Since obesity worsens the clinical presentation of PCOS, weight management is one of the main treatment strategies.

The Mediterranean Diet (MD)

The Mediterranean diet (MD) is commonly recognized as a health-promoting dietary pattern due to its peculiar features, including the regular consumption of unsaturated fats, low glycaemic index carbohydrates, fiber, vitamins and antioxidants, and moderate amount of animal-derived proteins. It's an anti-inflammatory dietary pattern, which is rich in complex carbohydrates and fiber, and high in monounsaturated fat.

Read also: Guide to PCOS Exercise

In general, the Mediterranean Diet emphasizes:

Lots of vegetables, fruit, beans, lentils and nuts.
A good amount of whole grains, like whole-wheat bread and brown rice.
Plenty of extra virgin olive oil (EVOO) as a source of healthy fat.
A good amount of fish, especially fish rich in omega-3 fatty acids.
A moderate amount of natural cheese and yogurt.
Little or no red meat, choosing poultry, fish or beans instead of red meat.
Little or no sweets, sugary drinks or butter.
A moderate amount of wine with meals (but if you don’t already drink, don’t start).

Researchers have linked these eating patterns with a reduced risk of coronary artery disease (CAD). Today, healthcare providers recommend this eating plan if you have risk factors for heart disease or to support other aspects of your health.

Benefits of the Mediterranean Diet

The Mediterranean Diet has many benefits, including:

Lowering your risk of cardiovascular disease, including a heart attack or stroke.
Supporting a body weight that’s healthy for you.
Supporting healthy blood sugar levels, blood pressure and cholesterol.
Lowering your risk of metabolic syndrome.
Supporting a healthy balance of gut microbiota (bacteria and other microorganisms) in your digestive system.
Lowering your risk for certain types of cancer.
Slowing the decline of brain function as you age.
Helping you live longer.

The Mediterranean Diet has these benefits because it:

Limits saturated fat and trans fat.
Encourages healthy unsaturated fats, including omega-3 fatty acids.
Limits sodium.
Limits refined carbohydrates, including sugar.
Favors foods high in fiber and antioxidants.

Mediterranean Diet Food List

The Mediterranean Diet encourages you to eat plenty of some foods (like whole grains and vegetables) while limiting others. Here are some examples of foods to eat often with the Mediterranean Diet.

Read also: PCOS Diet Recipe Guide

Mediterranean Diet and PCOS

Adherence to a Mediterranean diet (MedDiet) has been shown to decrease cardiometabolic disease risk and attenuate depressive symptoms, particularly in patients with metabolic perturbations. Observational evidence suggests an inverse relationship between MedDiet adherence and PCOS features, particularly insulin resistance and hyperandrogenemia. The exact mechanisms are complex and multifaceted, likely related to the anti-inflammatory potential of the dietary pattern, underpinned by anti-inflammatory bioactive constituents present in the MedDiet, including carotenoids, polyphenols and n-3 polyunsaturated fatty acids (PUFAs).

The pathophysiology of cardiometabolic disease risk in PCOS is complex and multifaceted, involving interplays between hormonal imbalances, IR, chronic low-grade inflammation and obesity. IR is a hallmark feature of PCOS and occurs in at least 75% of cases, independent of body weight, resulting in impaired glucose metabolism.

Reproductive dysfunction observed in PCOS, encompassing irregular menstrual cycles, anovulation and subfertility, originates from an intricate interaction among hormonal dysregulation, IR and putative inflammatory pathways. Notably, PCOS emerges as the principal aetiology of anovulatory infertility across the lifespan of the female.

Chronic low-grade inflammation may also impair fertility by impeding oocyte maturation. Obesity, IR and hyperandrogenism are thought to collectively contribute to the pro-inflammatory state observed in women with PCOS. Women with PCOS have a heightened prevalence of depression and anxiety compared to those without PCOS.

How the Mediterranean Diet Helps PCOS

The Mediterranean Diet could be a promising therapeutic dietary intervention to attenuate short and long-term symptoms associated with PCOS and may aid in reducing the longer-term risks associated with cardiometabolic diseases and reproductive and psychological dysfunction. A novel direct association between the adherence to MD and the clinical severity of the disease was reported in women with PCOS. This association could support a therapeutic role of foods and nutrients of the Mediterranean dietary pattern in the PCOS pathogenesis likely involving their inflammatory status, IR, and hyperandrogenemia.

Study on Mediterranean Diet Adherence and PCOS

One study aimed to evaluate the adherence to MD, the dietary intake, and the body composition and their association with PCOS clinical severity in a cohort of treatment-naïve women with PCOS when compared with a control group of healthy women matched for age and body mass index (BMI).

Methods

In this case-controlled, cross-sectional study, 112 patients with PCOS and 112 controls were enrolled. The degree of adherence to the MD and dietary pattern were evaluated using the PREvención con DIetaMEDiterránea (PREDIMED) questionnaire and seven-day food records, respectively. Body composition was evaluated by bioelectrical impedance analysis (BIA) phase-sensitive system. Testosterone levels and Ferriman-Gallwey score assessed the clinical severity of PCOS. C-reactive protein (CRP) levels were determined with a nephelometric assay with CardioPhase high sensitivity.

Results

PCOS women showed higher testosterone levels, Ferriman-Gallwey score, fasting insulin and glucose levels, and Homeostatic Model Assessment (HoMA)-IR when compared with the control group. Additionally, they consumed less extra-virgin olive oil, legumes, fish/seafood, and nuts compared with control group. Despite no differences in energy intake between the two groups, the PCOS women consumed a lower quantity of complex carbohydrate, fiber, monounsaturated fatty acids (MUFA), and n-3 polyunsaturated fatty acid (PUFA), and higher quantity of simple carbohydrate, total fat, saturated fatty acid (SFA), PUFA and n-6 PUFA than the control group. The PCOS women also had an adverse body composition when compared with controls, with the lowest values of phase angle (PhA) and fat-free mass.

After adjusting for BMI and total energy intake, testosterone levels showed significant negative correlations with PREDIMED score and consumption of protein, complex carbohydrate, fiber, MUFA, n-3 PUFA, and positive associations with CRP levels, simple carbohydrate, SFA, n-6 PUFA, and PUFA. The cut-off for PREDIMED score ≤ 6 could serve as a threshold for significantly increased risk of high value of testosterone levels.

Conclusion

A novel direct association between the adherence to MD and the clinical severity of the disease was reported in women with PCOS. This association could support a therapeutic role of foods and nutrients of the Mediterranean dietary pattern in the PCOS pathogenesis likely involving their inflammatory status, IR, and hyperandrogenemia. Additionally, a different body composition that is characterized by lower PhA and fat-free mass than controls was reported.

Specific Considerations for a PCOS-Friendly Mediterranean Diet

While the Mediterranean diet offers numerous benefits, some adjustments may be necessary to optimize it for women with PCOS.

Lower Carbohydrate Intake

Women with PCOS often have insulin resistance, making it beneficial to consume fewer carbohydrates than what’s "normal" for a Mediterranean diet. Aim for a macronutrient balance of around 20% carbs, 60% fat, and 20% protein. The reduction in carbs should be offset by increases in healthy fats.

Focus on Healthy Fats

The Mediterranean diet promotes the consumption of certain high-fat foods like nuts, seeds, olive oil, and fatty fish. Eating fatty cuts of meat makes it much easier to achieve the best macros for PCOS. The health effects of whole food sources of animal fats have also been misrepresented by health authorities.

Consider Eliminating Gluten and Dairy

Inflammation is one of the underlying drivers of all PCOS symptoms. Gluten-containing grains are a problem for many women with PCOS, as studies show that gluten can cause “leaky gut” in predisposed people and negatively affects intestinal permeability even in healthy people. A similar argument can be made for dairy.

Prime Diet Quality Score (PDQS) and PCOS

The Prime Diet Quality Score (PDQS) is a validated dietary quality index (DQI) based on food consumption patterns. It comprises 14 healthy food groups (e.g., dark green leafy vegetables, cruciferous vegetables, carrots, other vegetables, citrus fruits, other fruits, legumes, nuts, poultry, fish, eggs, whole grains, low-fat dairy, and liquid vegetable oils) and seven unhealthy food groups (e.g., red meat, processed meats, potatoes, refined grains and baked goods, sugar-sweetened beverages, fried foods away from home, and sweets and ice cream) [16].

One study aimed to investigate the relationship between both the Med-Diet and PDQS and the odds of PCOS, and to compare the strength of these associations. The study included 472 women aged 18-45, with 180 PCOS cases and 292 controls. Higher adherence to both the Med-Diet and PDQS was significantly associated with lower odds of PCOS.

Creating a Mediterranean Diet Meal Plan for PCOS

It’s important to consult with a primary care physician (PCP) or dietitian before making drastic changes to your diet or trying any new eating plan. They’ll make sure your intended plan is best for you based on your individual needs.

General Meal Guidelines

Breakfast: Steel-cut oats with fresh berries and ground flaxseed; Whole-grain toast with nut butter and a nutritious smoothie; Greek yogurt topped with fruit and walnuts; Egg white omelet with fresh, seasonal veggies.
Lunch: Salads with grilled fish or chicken, drizzled with extra virgin olive oil; Whole-grain pita bread with hummus and veggies; Leftovers from dinner.
Dinner: Baked or grilled fish with roasted vegetables and quinoa; Chicken stir-fry with plenty of vegetables and brown rice; Lentil soup with whole-grain bread.
Snacks: A handful of nuts and seeds (low salt or no salt added); Fresh fruit, ideally local and in-season; Nonfat Greek yogurt and a small piece of dark chocolate (at least 70% cacao); Whole-grain crackers with hummus; Raw veggies with a nonfat Greek yogurt dip.

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