What is PCOS?
Polycystic Ovary Syndrome (PCOS) affects 12-18% of females of reproductive age and up to 21% in some high-risk groups, such as Indigenous Australian women (Jean Hailles). However, it is estimated that up to 70% of women with the condition remain undiagnosed!
PCOS is a hormonal disorder which can present as a combination of the following symptoms:
- Irregular or infrequent periods – longer than 35 days
- Lack of ovulation
- Skin changes, specifically acne & darkening of the skin
- Hair changes, specifically excessive hair growth and/or hair loss
- Weight gain
- Increased anxiety and depression
- Multiple ‘cysts’ (or partially formed follicles/eggs) on the ovaries visible with a pelvic ultrasound (not present for all people with PCOS)
- Difficulty becoming pregnant
- Sleep apnoea
How to Diagnose PCOS
Despite the name, many women with PCOS do not present with “cysts” aka follicles on their ovaries. To get a diagnosis of PCOS 2 of 3 of the following symptoms must be present:
- Irregular periods or infrequent periods (lack of ovulation)
- High levels of androgens (male hormones e.g. testosterone), can be detected through a blood test or may present with acne, excess hair growth (chin, jaw line, belly, back, legs or arms) or hair loss (head).
- Cysts present on the ovaries have been detected on an ultrasound.
People with PCOS may experience difficulty conceiving due to these hormonal imbalances.
Excess androgens can also contribute to excessive hair growth and raised insulin levels. This can affect both menstruation and ovulation, either by completely or by reducing the frequency of regular ovulation.
What is Lean PCOS?
Lean PCOS is a type of PCOS where individuals are within a body weight range that is natural and healthy for them, and weight loss is not considered an appropriate or effective management strategy for this condition. Despite this, individuals with lean PCOS often experience similar symptoms to other forms of PCOS (including insulin resistance), and the dietary and lifestyle changes outlined below can still be highly beneficial in managing and improving these symptoms.
Read more about lean PCOS here or listen to podcast.
How Does Diet Affect PCOS?
Diet can significantly influence the management of insulin resistance in PCOS while also providing essential nutrients to help reduce symptoms. However, research emphasises that there is no single “best” dietary pattern for managing PCOS.
Nutrition should be individualised, working alongside health professionals to determine what works best for your body, lifestyle, and needs.
How Effective is Diet for PCOS Symptoms?
Naturally, when we make changes we want to know how effective they can possibly be. We can say having seen hundreds of people with PCOS how transformative the right diet and lifestyle strategies can be to PCOS symptoms and also fertility potential too.
But, don’t just take our word for it, a 2010 study compared the effectiveness of medical therapy (clomiphene citrate or “clomid”, metformin, or both) versus lifestyle intervention (diet & exercise) in treating those with PCOS.
The results were in favour of the lifestyle intervention, with this group showing higher pregnancy rates and a reduction in waist circumference, total androgen levels and lipid profile.
Considering the low-cost and minimal invasiveness of lifestyle interventions, along with their potential to positively affect other aspects of life including improving their relationship with food and mental health, lifestyle modification could well be used as a first-line therapy in improving fertility outcomes in those with PCOS.
What is Insulin Resistance?
Insulin Resistance (IR) is the term used to describe when some people’s bodies do not respond to insulin effectively. Insulin is a hormone produced by the pancreas that helps our bodies regulate the sugar or glucose levels in our blood.
Almost 85% of people with PCOS also have insulin resistance, and whilst it isn’t a diagnostic criteria it is a key driver of the underlying hormonal dysfunction contributing to bothersome symptoms of PCOS.
When we eat carbohydrates, our body breaks them down into glucose, a type of sugar.
Carbohydrate containing foods include grains such as bread, rice and pasta, fruits and starchy vegetables (think potatoes, sweet potatoes, peas and corn), legumes & beans as well as those treat foods such as lollies, chocolate, chips and cakes plus so much more! Foods that contain negligible carbohydrates include plain meat, fish, eggs, chicken or eggs and plain fats such as oils and non-starchy veggies like leafy greens, mushrooms, and onions (anything that is not potato, sweet potato, corn, peas or legumes).
After we eat these foods, the levels of glucose in our blood starts to rise. It is here, where insulin is released to help move glucose into all of our cells to provide energy and essentially give them the energy they need to help you get about your life.
However, if you have insulin resistance, your cells resist the actions of the insulin. Instead of the sugar being in your cells, it sits in your blood. So, your body has to work harder to produce more insulin. In the end, you just feel low in energy, sleepy after eating, craving dessert after a main meal, gaining weight around your mid-section and more.
Why do we want to improve insulin Resistance for PCOS?
Insulin Resistance (IR) can increase your risk of developing type 2 diabetes later in life. IR can also contribute to weight gain, especially around the mid-section.
Research has shown that weight gain can lead to changes in your ovulation and menstrual cycle meaning longer times to conception and a higher risk of miscarriage (Silvestris et al., 2018). Weight gain can also lead to a decreased response to fertility treatments such as IVF.
Carbohydrates and PCOS: Go Low or Low GI?
Don’t worry, we are not telling you to cut out carbohydrates altogether from your life, because who can live without pasta?!
The goal is to help slow down how much glucose is going into the bloodstream and have glucose levels rise and fall more smoothly throughout the day so you can feel your best, and your hard-working pancreas can keep up with what you’re eating too!
To achieve this, it is best to eat moderate amounts of carbohydrates spread out across the day. For example, porridge made with oats or quinoa flakes at breakfast, a wholemeal bread sandwich at lunch and some brown rice at dinner. Rather than skipping breakfast, having a tuna salad for lunch and then eating a whole pizza and garlic bread for dinner. You can see that the spread of carbohydrates across the day are a little different in each of these examples
To manage insulin resistance for PCOS it is also important to consider the glycaemic index (GI) of foods and aim to include more low GI sources of carbohydrates.
Low GI Carbohydrates for PCOS
Low GI carbohydrate foods slowly release glucose (the byproduct of carbohydrate breakdown in the digestive system) into your blood stream. This prevents rapid spikes in your blood glucose levels and therefore your insulin is more likely to keep up with the glucose load entering your body and getting it to the cells in your brain, muscles and liver to keep you going.
A few simple low GI swaps include:
- Swapping white Jasmine rice for Brown Basmati Rice or long grain Doongara Rice
- Swapping your afternoon cracker snack with nuts & seeds
- Swapping a white potato for sweet potato
- Swapping a chocolate bar for a hot chocolate (the milk will slow down the release of glucose into your bloodstream)
- Swapping white bread for a grainy wholemeal, rye or sourdough variety
Mediterranean Diet for PCOS
The Mediterranean diet heralded for its heart-healthy, fertility-promoting and brain-friendly benefits, is also appropriate for people with PCOS.
I’ve spoken about this dietary pattern before, however a quick run-down, the dietary pattern compromises of:
- Extra Virgin Olive Oil (EVOO)
- Plenty of colourful vegetables
- Seasonal fruit
- Legumes, pulses, beans & lentils
- Plenty of seafood especially oily fish like salmon
- Wholegrains
- Nuts & seeds
- Moderate amounts of poultry, red meat, eggs
- Moderate amounts of fermented dairy (yoghurt & cheeses)
If you’re trying to fall pregnant and you’re living with PCOS, the Mediterranean diet is a favourable dietary pattern to follow. The Mediterranean diet promotes lots of essential omega-3 fats and monounsaturated fats, as well as an overall “anti-inflammatory” style of eating with antioxidants from fruits, veggies and high-quality EVOO, helping to keep your eggs in tip-top shape and keep the underlying low-grade chronic inflammation associated with PCOS at bay.
If you’re trying to manage mental health issues alongside PCOS, the Mediterranean diet can be a great dietary pattern to use alongside any other treatments you’re receiving from your doctor or mental health professional. The Mediterranean diet has shown benefits for depression, as well as anxiety (Jacka et al., 2017). One size does not fit all, seek professional advice to tailor your nutrition to your needs.
What about Supplements for PCOS?
Whilst we always recommend diet & lifestyle changes as the first port of call when it comes to PCOS, we are constantly getting asked about the best supplements to take for PCOS based on the latest science.
There are so many supplements lining the shelves of supermarkets and pharmacies today, not to mention the overwhelming amount of advice online about what to take and what to avoid—it’s all just so confusing!
So, as always, here are a few supplements that have scientific research behind them.
Remember, supplements aren’t your saving grace, just the icing on a cake, built on a solid foundation of good nutrition, regular movement, adequate sleep and managing your stress well. 🍰
Disclaimer: Always speak to your medical and health care professional about any supplements before starting to ensure they are right for you and your body.
Inositol for PCOS
Inositol is a chemical compound and B vitamin-like nutrient.
Inositol can help manage PCOS through improving insulin resistance and many women report less sugar and carbohydrate cravings which are common in women living with PCOS. Additionally, a recent study found that inositol may promote ovulation and menstrual regularity in women experiencing fertility issues with PCOS (Kamenov et al., 2015).
There is also some evidence around it helping to reduce certain lipids in the blood including triglycerides as well as blood pressure in women with PCOS (Tabrizi et al., 2018; Iuorno et al., 2002). It has also been shown to help egg and embryo quality too.
Where can I find inositol?
Of course, prioritising food sources if important, so inositol can be found naturally in beans, fruit, wholegrains and nuts. However, it can be much easier to reach the required dosage of 2-4 grams per day through supplementation.
Cinnamon for PCOS
Cinnamon can help to reduce insulin levels in women with PCOS. As well as improve menstrual irregularities.
With that in mind, load up on cinnamon! We like to put it in my smoothies, on oats, French toast or on toast with banana and peanut butter, and in baking too!
Zinc for PCOS
Zinc has been shown to be effective in reducing hair growth and hair loss. It has also been suggested that it may help reduce insulin resistance in people with PCOS.
Chromium for PCOS
More research is needed in this area, however chromium supplementation has been seen to be beneficial in regulating insulin, free testosterone and reducing body weight in those with PCOS.
Omega-3s For PCOS
Omega-3 fatty acids have anti-inflammatory properties in the body which can assist in reducing the inflammation seen in those with PCOS. They have also been shown to assist in improving insulin sensitivity, cholesterol levels and ovulation.
berberine for PCOS
Berberine is a compound extracted from plants such as Goldenseal, Oregon Grape. Barberr, Phellodendron and Chinese Goldthread. You cannot get berberine from your diet. Berberine has been shown to assist in improving insulin resistance, reducing body fat & improving cholesterol resulting in improved ovulation.
Are Supplements Really Necessary for PCOS?
If you’re open to supplements and find them helpful, that’s great, it is essential to consult your healthcare team first. If not, no worries! A balanced diet can provide all the nutrients needed to support PCOS management.
Bottom line: Always check with your healthcare professional before starting any supplements to ensure they’re right for you.
PCOS and Gut Health – Is there a link to Irritable Bowel Syndrome (IBS)?
A 2010 paper highlighted the link between PCOS and Irritaible Bowel Syndrome (IBS). They found that there are greater rates of IBS in women who suffer from PCOS when compared to those that did not have PCOS.
More research is starting to emerge on gut health, the microbes (or bacteria) that live in our large intestine and the potential links to PCOS, you can read more about it here.
The Bottom Line: Diet for PCOS
PCOS is a lifelong condition that can be managed using dietary and lifestyle strategies. There isn’t a one-size-fits-all dietary approach to managing PCOS. Nutrition should be personalised in collaboration with health professionals to find what best suits your body, lifestyle, and unique needs.
Whether you’re newly diagnosed, have been managing PCOS for a while, or have been told to “just lose weight” by someone in the past, it’s time for a fresh, modern approach to PCOS nutrition—one that puts you at the centre of the conversation!
Are you ready to embrace a new path to PCOS management? Book a consultation with our expert PCOS dietitians today and unlock the full potential of nutrition in your journey to wellness!
