What is PCOS?
PCOS stands for Polycystic Ovarian Syndrome. PCOS is a reproductive disorder caused by elevated levels of androgens in women. Insulin resistance, irregular periods, acne, cravings, cysts on the ovaries and difficulty losing weight are all reported in PCOS.
While PCOS used to be thought of as one condition, it’s now recognised that there are actually different types of PCOS with different root causes.
1. Insulin Resistant PCOS, in which high fasting blood sugars may be present.
2. Post Pill PCOS, in which hormones and cycle have not yet regulated one year after stopping the contraceptive pill.
3. Adrenal PCOS, which involves low energy availability, high energy expenditure and high stress.
4. Inflammatory PCOS.
As there are different categories of PCOS, there isn’t one dietary strategy or supplement regime that suits everyone. This is why it’s really important to work with a professional with experience in the area to determine the root cause and find an approach that works for you. Regardless of the root cause, lifestyle and dietary modifications can majorly help with its management, improving insulin resistance and weight loss.
Can Nutrition Help?
Fats are essential for maintaining hormonal health, so low fat diets are NOT suitable in PCOS. Choosing mono- and polyunsaturated fats, such as oily fish, olive oil, nuts and seeds, over trans and saturated fats will be important in managing hormonal balance and inflammation.
If insulin resistance and high fasting blood sugars are present, favouring a higher fat, higher protein and lower carb dietary approach might be useful to help regulate blood sugar levels.
Carbohydrates have received a lot of attention in PCOS given their connection with insulin secretion. While a low carb diet has benefits, a low glycaemic index (GI) diet has also been linked with improved insulin resistance, improving hormone levels and regulating periods in women with PCOS. Low GI foods are carbohydrates that have a low glycaemic index and therefore a low impact on blood sugar balance. Low GI carb sources include brown rice, wholegrain bread, quinoa and oats.
Protein and Fibre
Consuming lean protein sources spaced throughout the day alongside plenty of fibre can help promote satiety and weight loss. This can also help stabilise blood sugar levels and minimise food cravings. Good sources of protein include chicken, fish, meat, eggs and dairy. Beans, peas, lentils, fruit and vegetables are all great fibre sources to include.
While heavy, prolonged periods are not actually a hallmark symptom of PCOS as is commonly believed, many sufferers still report having long periods when they do come. If heavy, long periods are an issue then increasing intake of iron rich foods such as red meat, eggs and green leafy vegetables may also be important.
It’s also possible that altering meal patterns may aid in the management of PCOS through the promotion of blood sugar management. One study found that eating most calories at breakfast, followed by lunch then dinner, improved fertility, insulin and hormone levels in women with PCOS. This meal pattern is proposed to be better suited to our body’s natural circadian rhythm, which can in turn help with insulin resistance and inflammation.
Overall, a Mediterranean or anti-inflammatory type diet can be helpful in managing inflammation and symptoms of PCOS. This encompasses all the elements mentioned above - including mono- and polyunsaturated fats, plenty of fruit, vegetables, beans and pulses, while minimising saturated/trans fats and sugary carbohydrates.
What about Supplements?
Alongside dietary modifications, supplements can also play a useful role in reducing insulin resistance and managing PCOS..
Research is promising for the use of inositol in PCOS to reduce insulin resistance alongside improved period regularity and reduced testosterone levels. Inositol is a supplement which we’ve had great success with our own clients with PCOS and works incredibly well in girls with insulin resistant PCOS. We recommend this one, as it also contains magnesium.
Low levels of magnesium have also been reported in PCOS. Magnesium also plays an important role in regulating insulin levels. Low magnesium levels can contribute to PMS as well as headaches, disturbed sleep and muscle cramps. Magnesium is found in foods such as sunflower and pumpkin seeds and brazil nuts. A supplement of magnesium citrate or biglysinate can be useful for replenishing levels and supporting the nervous system. We recommend this one, as it also contains inositol.
Several studies have reported low levels of vitamin D in those with PCOS. The main source of vitamin D is sunlight with smaller amounts found in egg yolk, oily fish and fortified foods. Coupled together, sunlight and dietary sources are not enough to maintain sufficient vitamin D levels in the majority of the population. So supplementing with vitamin D is a good idea for the majority of people but especially women with PCOS. This is not surprising given the important role vitamin D plays in insulin metabolism. Vitamin D supplementation is associated with reduced inflammation and insulin resistance in PCOS. 2000-4000IU daily throughout the winter months and 1000IU in the summer months is recommended. We recommend this one.
Low levels of zinc have also been reported in PCOS. The contraceptive pill, which is commonly as treatment for PCOS, also reduces zinc absorption. The best sources are shellfish and red meat. Zinc can also be supplemented at a dose of 15-30mg of zinc citrate daily. Optimising zinc status can help with PMS, acne, hair loss and excess facial hair growth in PCOS. We recommend this one.
Omega-3 Fish Oil
Omega-3 fats are associated with reducing inflammation, insulin resistance and cholesterol concentrations in women with PCOS. Including oily fish in the diet will provide you with these fatty acids but a supplement may be beneficial. If supplementing, make sure to choose a pure omega-3 supplement with no omega-6 to help manage inflammation. Omega-6 and omega-3 fatty acids compete for enzymes in the body, with high intakes of omega-6 promoting inflammation.
Results from a study that supplemented 200µg of chromium picolinate in women reported reduced blood sugar levels and increased insulin sensitivity. Chromium supplementation is especially useful in women with insulin resistant PCOS. We recommend this one.