PCOS which stands for Polycystic Ovarian Syndrome is one of the most common hormonal conditions affecting women. It is thought to affect 1 in 10 women in the UK although many do not show any symptoms. Nutrition can play a key role in managing PCOS symptoms. However there are a lot of arguments about what the best diet for PCOS is. In this article I will summarise the current research on nutrition for PCOS.
Symptoms of PCOS
Some of the most common PCOS symptoms include:
- Irregular or missing periods
- Anovulatory cycles
- Hair loss (male pattern baldness) or thinning
- Excessive hair growth on the face and body (hirsutism)
- Weight gain
- Acne and oily skin
Clinical markers for PCOS include high androgens (male hormones) in the blood and multiple cysts visible on the ovaries during a pelvic ultrasound exam.
Source: NHS
Causes of PCOS
PCOS is a complex hormonal and metabolic condition with no one specific cause. There appears to be a genetic element to a woman’s risk of developing PCOS. Environmental and lifestyle factors such as diet, exercise and exposure to endocrine disrupting chemicals also play an important role. Together these lead to imbalances in reproductive hormones, particularly increased testosterone production in the ovaries.
Source: https://academic.oup.com/jes/article/3/8/1545/5518341
Insulin resistance is also common in women with PCOS. This is where the cells become less sensitive to insulin and so levels in the blood are higher than usual. Diabetes, high cholesterol and obesity are also associated with increased risk of PCOS. For this reason blood sugar and weight management is an important part of the diet for PCOS.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922706/
Diet for PCOS management
The key principles of the diet for PCOS are:
- Blood sugar balancing
- Ensuring adequate nutrient intake
- Healthy weight management
- Eating anti-inflammatory foods
These are simple principles of good nutrition and do not need to be taken to the extremes. A balanced diet which is rich in fresh fruit and vegetables, whole grains, starches, low fat dairy, legumes, nuts and seeds with smaller amounts of fish, lean red meat and poultry is the most recommended diet for PCOS management.
Dietary patterns such as the Mediterranean diet, the DASH diet and the UK Eatwell Guide are all examples of diets for PCOS management. These diets have in common a balance of carbohydrates, fats and protein rich foods to support blood sugar balance. They also highlight the importance of balancing energy intake and output through activity to maintain a healthy weight range.
A wide variety of nutrient dense and anti-inflammatory plant-based foods make up 75% of the diet. Animal-based foods then provide additional nutrients including omega-3 fats and iodine from oily fish and key minerals such as calcium, iron and zinc from meat and dairy. It is possible but not necessary to adapt the diet for PCOS to a vegetarian or vegan lifestyle.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8643565/
Low carb diet for PCOS
More recently there has been a trend towards recommending a low carb diet for PCOS management. This idea fits within the principles of lowering insulin levels as diets which eliminate carbohydrates naturally lead to lower insulin levels. Many people have had short term success with energy-restricted, low carb diets such as the keto diet for PCOS management. Such diets can support weight loss, improvement in menstrual cycle regularity and acne symptoms in women with PCOS.
Source: https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-019-0420-1
However, I see this as sticking a plaster on an injury rather than letting it truly heal. I think in the long term it’s better to maximise the types of foods we eat from natural sources. This way we can ensure a variety of nutrients and our bodies become more adaptive and resilient. Therefore I think a healthy, balanced diet for PCOS including all macro-nutrients is most sustainable in the long-term.
Diet for PCOS or Hypothalamic Amenorrhea?
Finally, something that I think is important to share is the common misdiagnosis of PCOS in women who are experiencing Hypothalamic Amenorrhea (HA). This is when a woman stops menstruating due to under-eating, over-exercising or too much stress. Both PCOS and HA are marked by a lack of ovulation which can lead to cyst formation on the ovaries.
In HA, reduced hormone levels mean eggs may start to mature and not quite “make it” leading to the appearance of cysts on the ovaries. Therefore a doctor may diagnose PCOS from an ultrasound scan without doing blood tests to check androgen levels. This is what happened to me and this false PCOS diagnosis delayed my recovery process by a couple of years as I continued to control my diet for PCOS and exercise daily, based on my doctors’ advice.
If you have been diagnosed with PCOS yet you are underweight and have a history of dieting and intense exercise, it’s important to make sure you get the correct diagnosis. The treatment for PCOS and HA are completely opposite. The diet for PCOS focuses on low calorie density food and controlling energy intake whereas to recover from HA it’s necessary to increase calorie intake, sometimes dramatically. Exercise plays a role in managing PCOS but in HA recovery, rest should be the priority.
Over to you…
If you would like to work with me to balance your hormones and improve your health, contact me to set up a free 15 minute discovery call. I am a nutritionist, yoga teacher and women’s wellness coach. We work together using a combination of modalities to support your individual needs and help you to feel your best.
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