Table of Contents
- What is PCOS?
- Does PCOS have a cure?
- 1) Find out if you are insulin resistant or if you have any blood sugar issues before cutting carbs
- 2) Figure out your food sensitivities
- 3) Don’t starve yourself
- Hypothalamic amenorrhea
- 4) Count your macros too, not just calories
- 5) Don’t forget your micronutrients
- 6) Take into consideration any other conditions that might influence your diet
- The bottomline
Have you been diagnosed with polycystic ovary syndrome (PCOS)? Are you looking for nutrition tips to best manage your PCOS? In this article, I’ll define PCOS and provide you with six nutrition tips to best manage this condition!
What is PCOS?
PCOS, or polycystic ovarian syndrome, is an endocrinological disorder affecting 15-20% of women of reproductive age.1
Because it is a syndrome, it comes with many symptoms, which can vary significantly among women. However, there are a few characteristics that present in most women suffering from PCOS.
Irregular or absent periods, hair loss, hirsutism, weight gain (especially around the midsection), and acne are common symptoms.
PCOS is also associated with obesity, heart and liver issues, insulin resistance, and an increased risk of type 2 diabetes.2
On top of that, women with PCOS often suffer from a high degree of inflammation, which can manifest as unexplained fatigue, poor stress tolerance, joint pain, low immunity, and more.3
Does PCOS have a cure?
Unfortunately, there is no cure for PCOS. However, simple diet and lifestyle changes can help manage symptoms and improve fertility. If you search for the best diets for PCOS, you’ll likely be overwhelmed with contradictions: avoid all the carbs, don’t avoid carbs, intermittent fast, don’t intermittent fast, quit gluten, eat gluten. The list goes on, and it’s long enough to drive anyone crazy.
The key is not to adhere to a strict diet, where you obsessively think about every bite you take. The key is to find a balanced, sustainable lifestyle that allows you to feel well and optimize your quality of life. Here are a few tips to help build a diet in a simple, nourishing way:
1) Find out if you are insulin resistant or if you have any blood sugar issues before cutting carbs
Because many women with PCOS are insulin resistant, the most common diet advice is to limit or eliminate carbs. There are a few issues with this.
First, if you’re not insulin resistant, there is little evidence that avoiding all carb sources or embarking on a keto diet is beneficial.
Secondly, carbs are not created equal. Complex carbohydrates give you energy, and they are found in foods usually very rich in nutrients.
They are digested at a much slower rate in the body compared to simple, refined carbs. Thus, they have less impact on blood sugar and insulin. Complex carbs are also high in fiber, which means they are more filling and support healthy digestion.
We encourage you to speak to your doctor about getting your fasting insulin, fasting blood sugar, and A1c tested. This information will help you create a diet based on specific metrics, rather than simply eliminating foods out of fear. Following a very-low carbohydrate diet is unnecessary if your blood sugar and insulin labs are within normal limits.
2) Figure out your food sensitivities
Elimination diets are common recommendations in PCOS, specifically a gluten-free, dairy-free, and sugar-free diet. It’s true that these foods, in excess, can cause issues. In moderation, however, they might not be as bad as many think. The main reason for this recommendation is that all these foods are, to some degree, inflammatory.4
While an anti-inflammatory diet will help your PCOS5, it might be unnecessary to remove all these foods from your diet. There are lots of food sensitivity and food allergy panels available today; however, they’re not all created equal. An allergist may be able to offer testing covered by insurance. If this isn’t an option, then a temporary elimination diet may be an excellent place to start. Elimination diets, under the supervision of a registered dietitian, can help identify food sensitivities without the overhead cost of testing.
The first step of an elimination diet is to avoid common allergenic foods for a specific period, usually 4-6 weeks. Common allergenic foods include gluten, dairy, tree nuts, peanuts, soy, and corn. During this time, it’s essential to keep a detailed food and symptom log to track changes and progressions. After the 4-6 week elimination, you enter the reintroduction phase wherein you add foods, one-by-one, back into your diet. A food and symptom log is highly encouraged during this phase to help identify possible food triggers.
If interested in an elimination diet, we recommend you work with your doctor or dietitian to create a realistic plan for you.
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3) Don’t starve yourself
The most common (and often detrimental) advice women with PCOS receive is to lose weight. Some are encouraged to go on strict diets, despite being a healthy weight.
Losing weight is not a cure for PCOS. Yes, if you’re overweight or obese, you might see some symptom improvement with weight loss. Weight loss may also improve insulin sensitivity. However, strict diets are typically unsustainable, and they certainly don’t support longterm health. We know that individuals who embark on a very low-calorie diet are prone to weight cycling, binge eating, and yo-yo dieting. We recommend working with your doctor and dietitian to create a well-balanced, nourishing plan for your unique situation.
Extremely low-calorie diets can also lead to other hormonal issues, including hypothalamic amenorrhea (HA).
There are two types of amenorrhea: primary and secondary. Primary amenorrhea occurs when a female doesn’t start menstruating by age 16 despite normal growth and development. According to AAFP, “secondary amenorrhea is defined as the cessation of regular menses for three months or the cessation of irregular menses for six months.”
Hypothalamic amenorrhea (HA) is a class of secondary amenorrhea and is caused by three main triggers: overexercise, weight loss (including anorexia), and stress. However, HA can appear in women at any weight and any level of activity.6 Women with PCOS are susceptible to hypothalamic amenorrhea.
The cause of HA involves miscommunication between the hypothalamus and the pituitary gland in the brain, and the ovaries. Over time, this results in low sex hormones, specifically estrogen, which can eventually lead to amenorrhea.
A very low calorie, ultra-restrictive diet in combination with intense exercise can negatively impact the hypothalamic-pituitary-ovarian axis and lead to hypothalamic amenorrhea. This is a fairly obvious trigger for HA. However, women with PCOS often have irregular or missing periods, so the first signs of HA might be very hard to see.7
How to avoid HA
The best way to support the hypothalamic-pituitary-ovarian axis is to focus on a well balanced, nutrient-dense diet. A very low calorie or a very low carbohydrate diet is not recommended for hypothalamic support. However, if weight loss is a goal, focus on small, simple changes you can implement over time. First, focus on including lean protein, healthy fat, and fiber-rich vegetables at every meal. If interested, you can use a calorie-tracking app, like MyFitnessPal or LoseIt, to help guide your progress. There are also several online calorie calculators out there, like this one, to help determine your caloric needs.
Beyond this calculation, there are a few clear signs that you’re not eating enough. For example, low energy, anxiety, and dizziness are signs of undereating. If your cycle changes, that’s another sign your lifestyle adjustments are not beneficial for your body.
4) Count your macros too, not just calories
One of the biggest mistakes in any diet is focusing solely on calories. Macronutrients matter, too! Macronutrients are protein, carbohydrates, and fat, and their ratio can impact your health. If you only count calories, you might end up with a very unbalanced diet.
Some say the ideal macro ratio for women with PCOS is 40% fat, 35% protein, and 25% carbs. However, this doesn’t apply to everyone. For individuals without insulin resistance, a higher carb percentage and lower fat percentage is preferred.
Regardless of diet and macros, try not to obsess over numbers. It will end up being exhausting very quickly. Focus on balanced meals, including complex carbs, lean protein, and healthy fat. Focus on how you feel first, and then dial in your calories and macros.
When your diet is well-balanced, you’ll experience minimal cravings and consistent energy. If you find yourself reaching for treats or coffee mid-afternoon, or if you crash 1-2 hours after a meal, it could be a sign that you’re likely not eating enough, or your diet is slightly unbalanced.
Here are a few questions to ask to see if your current eating pattern is in balance:
- Do you often feel tired and groggy?
- Do you frequently crave sweets or salty foods?
- Do you feel like your energy level is inconsistent, rising and then dropping throughout the day?
If you answered yes to the above, you may need to make adjustements to your diet. Speak to your doctor and dietitian about creating a plan to improve your symptoms.
5) Don’t forget your micronutrients
Nutrition for PCOS isn’t all about weight loss. It’s about eating foods that nourish the body, stabilize blood sugar, and successfully manage symptoms. Macronutrients play an essential role, but micronutrients, like vitamins and minerals, are equally as important. While there are many supplements on the shelves today, it’s best to get vitamins and minerals from whole, real food.
You may ask “how do micronutrients impact PCOS?” There’s some clear evidence:
A 2018 study showed an improvement in hormonal profiles and biomarkers of inflammation in women with PCOS following a supplementation protocol with magnesium, zinc, calcium, and vitamin D. The clinical trial involved two groups of women with one supplemental group and one placebo group for 12 weeks. Results showed a reduction of hirsutism, C-reactive protein, and plasma malondialdehyde. The sample size was small with only 60 women but the results are still promising. 9
Another similar study showed the same benefits from magnesium and vitamin E supplementation.10
While both studies used supplementation, they prove the importance of micronutrients in women with PCOS. This is another reason why it’s so critical to focus on food beyond calories. Micronutrients are essential for overall health, especially in managing PCOS symptoms.
6) Take into consideration any other conditions that might influence your diet
It’s important to take a whole-body approach and consider all aspects of wellness, not just PCOS. For instance, potassium-rich, protein-dense diets aren’t ideal for people suffering from kidney issues. If you’ve ever suffered from an eating disorder, intermittent fasting is risky and may trigger old patterns from the ED. The ketogenic diet also has its contraindications. If you have a history of pancreatitis, or elevated triglycerides, active gallbladder disease, liver disease, advanced kidney disease, or a history of kidney failure, the keto diet may not be a constructive diet for you.
Simple diet and lifestyle changes can certainly help manage PCOS symptoms, including improved fertility, reduced inflammation, consistent menstrual cycle, more energy, and overall improved health.
Insulin resistance and inflammation, both very common in PCOS, can be reduced through correct nutrition. Eliminate inflammatory foods, maintain a stable blood sugar level, and make sure you’re consuming a balanced diet full of vitamins and minerals.
In the end, don’t turn your new lifestyle into a life-sacrificing obsession. Focus on whole foods, with lots of veggies, lean protein, and healthy fats. Exercise regularly in a way that feels good to you and choose a lifestyle that’s supportive of your goals while still offering realistic flexibility.
Author bio: Laura is a health & nutrition life coach and a fitness trainer, and she is the blogger behind Crimson Confidence, a website for and about women’s hormonal struggles. Laura helps women with PCOS take charge of their health by finding a sustainable lifestyle, that makes them feel strong, confident, and happy.
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- A.-M. E. J.-B. G. e. a. Sowińska-Przepiera E, “Functional hypothalamic amenorrhoea — diagnostic challenges, monitoring, and treatment,” Endokrynol Pol, vol. 66, pp. 252-260, 2016.
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- E. T. e. a. Trexler, “Metabolic adaptation to weight loss: implications for the athlete,” Journal of the International Society of Sports Nutrition, vol. 11, no. 1, 2014.
- M. e. a. Maktabi, “Magnesium-Zinc-Calcium-Vitamin D Co-supplementation Improves Hormonal Profiles, Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial,” Biological trace element research, pp. 21-28, 2018.
- M. a. Z. A. Shokrpour, “The Effects of Magnesium and Vitamin E Co-Supplementation on Hormonal Status and Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome,” Biological trace element research, vol. 191, pp. 54-60, 2018.