Eating a Nourishing Diet for PCOS

Polycystic Ovarian Syndrome (PCOS) is a common hormonal condition affecting 1 in 10
women. For women of reproductive age, it affects 12-18% of individuals. 

Polycystic means “many cysts.” Ovarian means the ovaries. Therefore, PCOS means many cysts within the ovaries.  A diagnosis doesn’t rely on there being cysts. Some women may not have cysts in their ovaries.

The diagnosis involves having any two of these three factors: 

1. Lack of ovulation causing irregular menstrual cycles. 
2. Excess male hormone production (e.g. testosterone) detected through a blood test. 
3. Cysts on the ovaries detected via ultrasound. 

Other symptoms can include: hair growth/loss, skin changes (e.g. acne or darkening of the skin), weight gain, anxiety, depression, sleep apnoea and difficulty conceiving. 

PCOS increases the risk of other health conditions such as type 2 diabetes, cardiovascular disease and endometrial cancer. There is no cure for PCOS, however lifestyle changes you can make will help manage the symptoms. 

Insulin Resistance 

Around 85% of women with PCOS experience insulin resistance. 

Insulin resistance is the reason why the risk of type 2 diabetes is increased. When the body is less able to remove glucose from the blood there are raised insulin levels and potentially higher blood glucose levels as well. 

A lot of the steps in managing PCOS involve attempting to reduce insulin resistance or the effects of it. 

Overall, aim for a nourishing and healthful diet 

Enjoy a wide variety of nutritious foods with an emphasis on fruits, vegetables and lean protein sources. 
The Mediterranean diet for PCOS is recommended as it is high in vegetables, fruits, legumes, wholegrains, fish, poultry and healthy fats such as extra virgin olive oil, avocado, nuts and salmon (see below). 

Weight Management 

Weight loss can be beneficial for PCOS. While some individuals are lean with PCOS they will benefit from adopting these nutritional strategies. If an individual is carrying more body fat than ideal, weight loss could help manage the symptoms of PCOS. In the case of insulin resistance decreasing body fat is strongly linked to decreased insulin resistance. Keep in mind that it can be potentially harder to lose weight with PCOS due to reduced metabolic rate. The same rules still apply. To lose weight, a lower energy intake is required. 

Decreasing Carbohydrate Intake 

There are nutritional advantages in keeping carbohydrates in the diet. Good quality carbohydrate sources add fibre and micronutrients, they can also help from a quality of life perspective and enjoying food. Intake should not be excessive due to the fact that carbohydrates break down to glucose and need insulin to do so, this can be more difficult with insulin resistance. 

Some may consider a ketogenic diet as there is some evidence that it can reduce symptoms. The reason for this is the energy deficit created leads to weight loss which in turn improves hormone levels and a reduction in insulin levels. Keep in mind that structured diets are difficult to maintain in the long term and there may be a risk of entering a dieting cycle.
       

Aim for Lower GI Carbohydrates 

Aiming for lower GI carbohydrates as your main carbohydrate source is recommended as this helps to manage insulin resistance and may reduce the risk of complications in the future. 

Anti-Inflammatory Style Diet 

The Mediterranean diet is high in monounsaturated fats, omega 3’s, fibre and antioxidants to help manage the symptoms of PCOS. It has also been strongly linked with reduced symptoms of anxiety and depression. 

Antioxidants 

Many of the symptoms of PCOS are linked with oxidative stress. In women with PCOS there are reduced levels of antioxidants and overall nutrient levels. Increasing intake of foods rich in anti-oxidants can help manage symptoms. 

Supplements 

When it comes to PCOS, there are quite a few supplements that can help but keep in mind that prioritising your overall nourishment is far more helpful than individual supplements however some supplements may be of some value. Supplements are only beneficial if there is a deficiency or inadequate intake. 

Inositol 

There is good evidence on how Inositol can help for people with PCOS. It improves insulin sensitivity, lowers testosterone and aids fertility. The recommended dosage is 2-4g per day of myo-inositol. 

Magnesium 

Magnesium can help improve insulin sensitivity and if taken at night reduces fasting blood glucose levels. The recommended dosage is 300mg taken 1hr before bedtime, however if you meet your magnesium needs through food, this won’t be necessary. The vast majority of people do not meet the RDI for magnesium through food, which indicates that this may be a worthwhile supplement. 

Omega 3’s 

Omega 3’s can help reduce inflammation and improve metabolic markers such as cholesterol and blood pressure. It may also aid in reducing testosterone and regulate the menstrual cycle. Omega 3 is obtained by consuming fish 2-3 times per week, mostly oily fish (wild salmon, tuna, sardines, and mackerel) or consuming plant-based options such as seeds or walnuts. If you are supplementing, the recommended dosage is 1000-3000mg daily. 

Zinc 

Zinc can be effective for reducing hair growth or reducing hair loss associated with PCOS. It can also may help lower insulin resistance. The dosage used in research is 50mg/per day, which is higher than the RDI of 8mg/day, indicating that it would be difficult to meet this level through food since most people also do not reach the RDI consistently. 

Cinnamon 

Cinnamon may help under certain circumstances, it can potentially help menstrual cycle irregularities and also improve blood glucose control by improving the use of glucose in cells and also slowing the rate at which glucose enters the blood. The recommended dosage is 1-2g per day. 

N-Acetylcystein (NAC) 

Some limited evidence indicates that NAC may lead to improved pregnancy and ovulation. The dosage commonly used in research is 1200-1800mg per day. 

Berberine 

Berberine is a Chinese medicinal herb. It may help with insulin resistance and other metabolic markers.

The dosage recommended for PCOS is 1.5g daily. 

Chromium 

Chromium may potentially help reduce insulin resistance and testosterone.

The recommended dosage is 200µg of chromium picolinate per day. 

Vitamin D 

Vitamin D is another supplement that may improve insulin resistance. Either way, supplementation will only likely be beneficial if you are deficient. The first step should be to get a blood test for deficiency.

The recommended dosage is 1000IU per day, or higher if your doctor recommends it. 

Summary 

Although PCOS isn’t curable, taking some of these steps could significantly reduce the symptoms associated with PCOS. There are many different nutritional strategies that can be utilised, but these tips mentioned are likely to help significantly if implemented. 

Mediterranean diet – in a nutshell 

The Mediterranean diet is based on the traditional foods that people used to eat in countries like Italy and Greece back in 1960. 

Researchers noted that these people were exceptionally healthy and had a low risk of many lifestyle diseases. Numerous studies have shown that the Mediterranean diet can cause weight loss and help prevent heart attacks, strokes, type 2 diabetes and premature death. 

There is no one right way to follow the Mediterranean diet, as there are many countries around the Mediterranean sea and people in different areas may have eaten different foods. Consider this as a general guideline, not something written in stone. It can be adjusted to your individual needs and preferences. 

The Basics 

• Eat: Vegetables, fruits, nuts, seeds, legumes, potatoes, whole grains, breads, herbs, spices, fish, seafood and extra virgin olive oil. 
• Eat in moderation: Poultry, eggs, cheese and yogurt. 
• Eat only rarely: Red meat. 
• Limit: Sugar-sweetened beverages, added sugars, processed meat, refined grains, refined oils and other highly processed foods. 

Limit These Foods 

• Added sugar: Soda, candies, ice cream, table sugar and many others. 
• Refined grains: White bread, pasta made with refined wheat, etc. 
• Trans fats: Found in margarine and various processed foods. 
• Refined oils: Soybean oil, canola oil, cottonseed oil and others. 
• Processed meat: Processed sausages, hot dogs, etc. 
• Highly processed foods: Anything labeled “low-fat” or “diet” or which looks like it was made in a factory. 

Read food labels carefully if you want to avoid these ingredients. 

Foods to Eat 

Exactly which foods belong to the Mediterranean diet is controversial, partly because there is such variation between different countries. 

The diet is high in healthy plant foods and relatively low in animal foods. However, eating fish and seafood is recommended at least twice a week. 

The Mediterranean lifestyle also involves regular physical activity, sharing meals with other people and enjoying life. 

You should base your diet on these, unprocessed Mediterranean foods: 

• Vegetables: Tomatoes, broccoli, kale, spinach, onions, cauliflower, carrots, Brussels sprouts, cucumbers, etc. 
• Fruits: Apples, bananas, oranges, pears, strawberries, grapes, dates, figs, melons, peaches, etc. 
• Nuts and seeds: Almonds, walnuts, macadamia nuts, hazelnuts, cashews, sunflower seeds, pumpkin seeds, etc. 
• Legumes: Beans, peas, lentils, pulses, peanuts, chickpeas, etc. 
• Tubers: Potatoes, sweet potatoes, turnips, yams, etc. 
• Whole grains: Whole oats, brown rice, rye, barley, corn, buckwheat, whole wheat, whole-grain bread and pasta. 
• Fish and seafood: Wild salmon, sardines, trout, tuna, mackerel, shrimp, oysters, clams, crab, mussels, etc. 
• Poultry: Chicken, duck, turkey, etc. 
• Eggs: Chicken, quail and duck eggs. 
• Dairy: Cheese, yogurt, Greek yogurt, etc. 
• Herbs and spices: Garlic, basil, mint, rosemary, sage, nutmeg, cinnamon, pepper, etc. 
• Healthy Fats: Extra virgin olive oil, olives, avocados and avocado oil. 

Whole, single-ingredient foods are the key to good health. 

What to Drink 

Water should be your go-to beverage on a Mediterranean diet. 

This diet also includes moderate amounts of red wine — around 1 glass per day. 

However, this is completely optional, and wine should be avoided by anyone with alcoholism or problems controlling their consumption. 

Coffee and tea are also completely acceptable, but you should avoid sugar-sweetened beverages and fruit juices, which are very high in sugar. 

By Diane Rennard, Senior Dietitian