Nutrition for PCOS (Polycystic Ovary Syndrome)
PCOS, short for Polycystic Ovary Syndrome, is a health condition estimated to affect around 8-13% of females of reproductive age (Jean Hailes Organisation). It is a chronic condition which means that if you have PCOS, you are always going to have it. However, there are treatment options to manage the symptoms.
What is PCOS?
PCOS is a complex hormone disorder that mainly involves the reproductive hormones, but has effects beyond the reproductive system. Common symptoms of PCOS include:
Periods that are irregular or absent
Lack of ovulation
Difficulty conceiving
Excess body hair growth e.g. facial hair (called hirsutism)
Hair loss on the scalp
Acne
Darkening of the skin
Weight gain and/or difficulty losing weight
Anxiety and/or depression
Other common features of PCOS that you can’t see but may appear on a blood test are insulin resistance (high blood glucose levels) and elevated testosterone and androgens (a hormone imbalance).
PCOS should be investigated and diagnosed by your doctor and/or an endocrinologist.
How diet can affect PCOS
Did you know that lifestyle and nutrition strategies form part of the internationally-recognised evidence based guidelines for the management of PCOS? That’s right, diet really is an important aspect in managing PCOS symptoms and is part of the first line treatment options.
Many women with PCOS experience insulin resistance. Insulin is a hormone secreted by your pancreas that regulates how much sugar (glucose) is in your blood; it helps your cells take in glucose from the food you eat and use it for energy.
When our cells don’t respond to insulin very well, glucose builds up in our blood. This can aggravate PCOS symptoms because it makes our bodies produce more testosterone. It can also make it more difficult to lose weight, which can also worsen the symptoms of PCOS.
Now let’s take a look at how nutrition can help manage PCOS.
(1) Moderate your carbohydrate intake with protein and fats
I am NOT saying to cut out the carbs completely! This is unnecessary. Plus, it’s unhelpful and will often end up backfiring, because if you try to cut something out completely it’s usually going to come back as a craving with a vengeance.
Rather, a strategy that is effective for PCOS is to have a moderate carbohydrate intake by having meals and snacks that include protein + fats alongside a serving of carbohydrates, which naturally means you lower your carbohydrate intake to an extent to make room for the other macronutrients.
For example, if you wanted to have oats for breakfast, make an oatmeal bowl using ⅓ cup of rolled oats paired with some high-protein Greek yoghurt, berries and walnuts, rather than having oats with banana and honey.
To give an example of a snack, a handful of whole-grain crackers with a boiled egg rather than a handful of rice crackers and some grapes.
Even though both options in these examples are not unhealthy, in each situation the meals/snacks have a different distribution between carbs/fats/protein.
Much of the research in this area refers to “low carbohydrate” diets for PCOS however I prefer to use the term “moderate carbohydrate” because I think this more accurately describes what to aim for. When studies say “low carbohydrate” they are generally referring to between 30-45% of energy still coming from carbohydrates, which is not super low (Zhang et al., 2019). So yes, foods like bread, rice and pasta are still on the menu!
(2) Choose low-GI carbohydrates
When it comes to choosing carbs another strategy that has been shown to be helpful for PCOS is to choose carbohydrates with a low glycaemic index (GI). The GI of food is a rating of how quickly a food raises blood glucose levels after you eat it. High GI = quickly raises blood glucose and requires the body to produce lots of insulin. Low GI = slower effect on blood glucose.
Studies of women with PCOS indicate low GI diets may improve insulin sensitivity and may also help to improve menstrual regularity (Marsh et al., 2010; Barr et al., 2013).
Low GI carbohydrates include rolled oats, untoasted muesli, grainy/seeded breads, traditional sourdough, wholemeal pita, wheat pasta, legumes (lentils, chickpeas, kidney beans etc), white or brown long grain rice (such as Basmati, Mahatma or Doongara rice), quinoa, buckwheat, sweet potato, corn kernels and grainy crackers like Vita-Weats.
(3) Load up on anti-inflammatory, antioxidant-rich foods
Research indicates that women with PCOS may have higher levels of oxidative stress and persistent low grade inflammation compared to women without PCOS (Mohammadi, 2019; Hyderali & Mala, 2015; Gonzalez, 2012).
Oxidative stress means there is an imbalance between free radicals and antioxidants in the body. Some bodily processes produce free radicals, and these free radicals are neutralised by antioxidants. When there are lower levels of circulating antioxidants to combat the free radicals, this leads to oxidative stress which can cause cell and DNA damage and may contribute to the development of chronic health conditions.
Inflammation is assessed by looking at certain blood markers which reflect an increase in the amount of cells, hormones and chemical messengers involved in the body’s inflammatory processes.
Following an anti-inflammatory style diet has shown some promising results in women with PCOS, improving blood sugar, reducing cardiovascular disease risk factors and helping to restore the regularity of menstrual cycles (Salama et al., 2015).
There have also been some studies looking at the effect of antioxidant supplementation in women with PCOS. So far these have been quite small studies and further research is definitely needed, however what seems to be emerging is that an increase in antioxidant intake may also be beneficial for PCOS.
(4) Practical ways to increase anti-inflammatory, antioxidant-rich foods
A lot of the research examining anti-inflammatory diets has used the Mediterranean Diet as the base and this includes research showing positive results for PCOS (Barrea et al., 2019). The name is a bit misleading, it’s not really a “diet” but more an eating pattern! Some of the key features are listed below, and this gives some practical guidance on how to get in those beneficial foods.
Whole-grains, legumes (beans, lentils), vegetables, fruit, nuts and seeds are the mainstay of the Mediterranean Diet, they are eaten every day.
Extra virgin olive oil is the predominant fat source and is used daily.
Fish is eaten regularly around 2-3 times/week (and ideally you’d make sure some of this is oily fish like sardines, salmon, trout or mackerel for maximum anti-inflammatory benefits).
Dairy products and poultry are eaten in moderation (dairy is mostly yoghurt and cheeses).
Red meat and sweets are eaten the least often.
By eating in this style you are naturally eating a diet that is high in antioxidants too, as getting in a variety of colourful plant foods is the best way to maximise your dietary sources of antioxidants. The Mediterranean Diet absolutely prioritises plant foods!
Key points on nutrition for PCOS
Aim for a moderate carbohydrate intake, balance your meals and snacks with a combination of carbohydrates, protein and healthy fats.
Choose low GI carbohydrates as often as possible.
Load up on colourful vegetables and fruit - the more colour and variety in your plant food intake, the bigger and better your exposure to naturally-occurring antioxidants.
Go Mediterranean and enjoy lots of legumes, nuts, seeds and seafood (these are all great protein sources). And don’t forget the extra virgin olive oil!
Feeling uncertain about how to make the best dietary changes to support your hormones and your menstrual cycle? I work with women one on one to optimise their diet for PCOS and many other conditions too. Book a FREE 15 minute discovery call with me and let’s chat about how I can help.
