Nutrition Diva listener Angie writes:
I was recently diagnosed with PCOS and I’ve been trying to learn about it. There seems to be a lot of confusing advice out there and a few sources suggest that a healthy diet for someone with PCOS is different than a healthy diet for someone without this condition. Is this true?
What is Polycystic ovarian syndrome (PCOS)?
Unfortunately, Angie, you’ve got plenty of company. Polycystic ovarian syndrome, or PCOS, is a condition that affects up to 1 in 10 women of child-bearing age. In a nutshell, PCOS is characterized by hormonal imbalances, involving not just the reproductive hormones (like estrogen and testosterone) but also hormones that regulate blood sugar, fat storage, and appetite.
Symptoms of PCOS may include painful or irregular periods, acne, abnormal hair growth, increased appetite, weight gain, and difficulty losing weight. Women with PCOS often develop metabolic syndrome, which increases your risk of heart disease and diabetes. And the reverse is also true: Women with metabolic syndrome are more likely to develop PCOS. PCOS is also a leading cause of infertility.
PCOS is strongly linked with obesity—and as obesity levels have risen, PCOS has become a more common diagnosis. But there are also lean women who suffer from PCOS. Almost all women with PCOS, however, have some degree of insulin resistance, which is also known as pre-diabetes.
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The first-line therapy for PCOS is a diet and lifestyle makeover with the primary goal of improving the body’s sensitivity to insulin. Here are 3 ways to start on a virtuous path.
3 ways to improve insulin sensitivity and alleviate PCOS symptoms
Tip #1: Lose weight (if you need to)
Weight loss improves insulin sensitivity and you don’t necessarily have to reach your goal weight to get this benefit. Even a modest amount of weight loss can begin to reverse symptoms of PCOS. For example, if you are 50 pounds overweight, losing 10 pounds can make a big difference in your PCOS symptoms, even though you might still be significantly overweight.
Above all, you want to lose weight at a pace you can maintain long-term. Crash diets that produce fast weight loss followed by the inevitable rebound weight gain do more harm than good.
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Tip #2: Be more active
Exercise is also a great way to improve insulin sensitivity. It also helps rebalance reproductive hormones. As a bonus, it can also help with weight loss. A combination of aerobic exercise (anything that gets your heart rate up for 30 minutes a day) and strength training will work best.
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Tip #3: Eat regularly but not too frequently
Although some people claim that eating every 2-3 hours is ideal, spacing your meals out more can help improve insulin sensitivity. Instead of having a small meal or snack every few hours, try to get used to eating a more substantial meal and then waiting 4-5 hours before eating again. For tips on how to choose foods that will keep you full longer, review my episodes on satiation and satiety.
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What diet is best for PCOS?
You don’t necessarily have to follow a low-carb diet. But because of the increased risk of insulin sensitivity, the best diet for PCOS appears to be one that is lower in carbohydrates (especially sugar and grain-based foods).
PCOS is also associated with low-grade systemic inflammation. Following an anti-inflammatory diet may be helpful. Oily fish, lean meat, colorful fruits and vegetables, olive oil, avocado and nuts, turmeric, ginger, and garlic all contain anti-inflammatory nutrients.
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What About Dairy?
Some websites suggest that people with PCOS should avoid dairy. Studies have found no clear link between dairy consumption and PCOS risk. However, if you choose to consume dairy products, it’s probably best to avoid skim and non-fat products. Women who consume whole milk and yogurt are more likely to maintain a healthy body weight and less likely to have PCOS than those who consume nonfat dairy products.
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PCOS and the microbiome connection
There also appears to be a connection between the microbiome and PCOS. Women with PCOS tend to have fewer strains of beneficial bacteria in their gut. You may well wonder whether this is cause or effect. Does having the condition change the composition of your intestinal bacteria, or do certain conditions in the gut increase your risk of developing the condition?
There’s preliminary research to suggest that it may be the latter, and improving the health of the gut microbiome might be a way to treat or even prevent the syndrome. And the most reliable way to improve the health of the microbiome is to increase the amount and variety of fiber in the diet.
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Foods to eat and foods to avoid
Taking all of this into consideration, here’s a quick and dirty guide to what to eat and what to avoid if you have PCOS.
- Wheat and oat bran
Eat in moderation:
- Lean cuts of meat and poultry
- Whole or reduced-fat dairy
- Whole and dried fruit
- Whole grains
- Olive oil
- Nuts, seeds
- Foods with added sugars or sweeteners, including yogurt, cereal, meal replacement bars
- Sweetened beverages
- Fruit juice
- Artificial sweeteners
- White bread and other foods containing refined flour
- Baked goods
Nutritional supplements for PCOS
Most of you know I’m not a big fan of vitamin supplements—I’d prefer that you get your nutrition from foods. But there are times when targeted supplementation can be useful, and PCOS appears to be one of them. Although the diet and lifestyle changes I just outlined are by far the most important things you can do, the following nutrients could be a useful addition to your regimen.
- Vitamin D3. Women with PCOS tend to have low vitamin D levels—especially when they are also overweight. Some preliminary studies have shown that taking high-dose vitamin D as a supplement improves symptoms of PCOS. The doses used in these studies are more aggressive than I would recommend taking without a doctor’s supervision. If you have PCOS, ask your doctor whether he or she would recommend a vitamin D supplement and how much.
- Myo-inositol. Inositol is a family of nutrients often lumped together with the B vitamin family. One particular form, called myo-inositol, has been found to help women with PCOS improve insulin sensitivity and other symptoms. You can buy myo-inositol as a bulk powder online or from a vitamin store. The recommended amount is two tablespoons a day. Try adding it to your morning smoothie.
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There are also some drugs that may help, which Dr. Sanaz Majd discussed in her episode on PCOS.
The good news is that PCOS is treatable—and often without medication! But a lot of it is up to you, and making lifestyle changes can be challenging. For extra support from women who know what you’re going through, check out the groups and forums at PCOSupport.com and PCOSFoundation.org.
And for more support for sustainable weight loss, check out the resources I’ve collected at weighless.life.