Diet and lifestyle play a major role in the management of PCOS, and in my practice I have seen women drastically improve by changing their diet and adjusting lifestyle factors like exercise, sleep, and stress management. The idea is to give your body all the tools it needs to heal and come to a state of hormone balance. Because of biochemical individuality (in other words, everyone is different) and PCOS manifests differently in different people, not everyone responds identically to every therapy. Ideally, you incorporate multiple strategies to manage your PCOS.
According to the Rotterdam criteria, PCOS is diagnosed if at least 2 of the following 3 factors are present:
1. Irregular cycles with irregular ovulation or anovulation (lack of ovulation).
2. Elevated androgen/testosterone levels.
3. Many small cysts on the ovaries (1).
Women with PCOS can be thin or overweight and present with either 2 or 3 of these criteria. PCOS can make getting pregnant more difficult, because your eggs don’t fully mature each month, and many women with PCOS ovulate irregularly or not at all. Even if you aren’t trying to get pregnant, women with PCOS are a higher risk for type 2 diabetes, cardiovascular disease, and endometrial cancer than the general population. The good news is that there are many ways to address and manage your PCOS with the food you eat, supplements, and your lifestyle choices. I’m not going to go into all the intricacies of the hormonal issues that can be present in PCOS, but instead I want to give you some actionable steps to start making a difference in the management of your PCOS.
1. Limit your sweets as much as possible including sugar-sweetened beverages, desserts, and sweetened yogurts, granola and energy bars. Check out my book Breaking the Sugar Habit to learn more on this topic.
2. Eliminate artificial sweeteners. There’s evidence that artificial sweeteners like sucralose or splenda may affect how your body responds to carbohydrates or sugar when you have them. Your insulin may actually go higher after having sucralose than it would without the sucralose (2). In addition, because artificial sweeteners are so much sweeter than sugar, they often serve only to increase sugar cravings.
3. Eat low glycemic carbohydrates and limit your portions of starches/grains. Limit your grain or starch to 1/4 of your plate of sweet potatoes, rice, quinoa, carrots, butternut squash, beets, or pasta.
4. Include protein at all your meals and snacks. Protein is the number one macronutrient (among carbs, protein, and fat) that will make you feel full and satisfied. Protein sources include meat, fish, eggs, legumes (like black beans, kidney beans, lentils, etc.), nuts and seeds, and dairy. I don’t recommend overdoing the dairy, and some women do better with no dairy at all, but that’s a topic for another day.
5. Try going gluten free. Some women see really significant results including weight loss by eliminating gluten from their diet. I’ll have a more detailed post on going gluten free in the future.
1. B-complex: B-vitamins are essential to the process of ovulation, so taking a B25 or B50 B-complex is a great idea. Alternatively, if you take a prenatal vitamin or multivitamin that provides ample levels of B-vitamins, then a separate B-complex may not be necessary.
2. Fish oil: The omega-3 fatty acids in fish oil are important for calming inflammation, as PCOS is an inflammatory condition. Flaxseed oil is not a viable substitute, as it provides alpha-linolenic acid (ALA), a type of omega-3 fatty acid found in plants. Only small amounts of ALA are converted by the body to EPA and DHA, thus you really need a fish oil or algae-based EPA and DHA supplement to reap the benefits.
3. Vitamin D: See my recent post on this topic. Take 2000-4000IU of vitamin D daily, and make sure to ask your doctor to test your blood level of vitamin D as many women with PCOS are vitamin D deficient and a higher dose under medical supervision may be necessary.
4. Probiotics: You may think probiotics are only to support digestion, but the impact of probiotics on a variety of different conditions is an exploding area of research. Your gut and digestion affect your health on many different levels. Without good digestion and absorption, it’s very difficult to achieve balance and vibrant health. Instead of “you are what you eat,” I subscribe to the idea that “you are what you digest and absorb.” In a study of pregnant women, taking a probiotic along with nutritional counseling helped to promote better blood sugar regulation during and after pregnancy (3). In addition, animal studies have noted improved blood sugar regulation with probiotic supplementation.
5. Myo-inositol: This supplement has been studied extensively in PCOS, and may help to reduce insulin and testosterone levels and restore more regular menstrual cycles. It has also been shown to reduce risk of gestational diabetes in women with PCOS (4). If you are pregnant, check with your doctor before taking myo-inositol.
As far as lifestyle goes, there are a few key areas to work on:
1. Lose weight if you need to. This can greatly improve your blood sugar regulation, reduce insulin levels, and promote hormone balance and more regular menstrual cycles. This previous post includes some high impact strategies for weight loss.
2. Manage your stress levels. Stress has been linked to greater difficulty getting pregnant. In a study that came out last month of 400 couples trying to conceive, women with the highest levels of salivary alpha-amylase, a stress marker, had a 29% lower probability of getting pregnant than those with lower levels of these stress markers. Aside from getting pregnant, stress can raise cortisol levels, which raises blood sugar and insulin levels making weight loss and/or hormone balance more difficult to achieve.
3. Sleep. Lack of sleep tends to increase cortisol levels, hunger, sugar cravings, and insulin levels throughout the day. High cortisol can also cause increased free radical damage and depletion of B-vitamins in the body (5), which remember are important for the ovulation process.
4. Reduce your exposure to hormone disrupting chemicals like BPA and phthalates in food packaging and personal care products. I will be writing more about this in the future, but for now check out the Environmental Working Group for more information.
I know I’ve given you a long list of PCOS diet and lifestyle factors to consider, and this is only the beginning. Please don’t feel overwhelmed! Instead choose 1 or 2 items to start with until you are able to make these your daily habits. Then move on to the next item. And above all, let me know how I can help! Is there a resource you’re looking for or a question I can answer. If so, please let me know!
1. New Guidelines for Polycystic Ovarian Syndrome: Medscape. Available at: http://www.medscape.org/viewarticle/467811. Accessed March 27, 2014.
2. Pepino MY, Tiemann CD, Patterson BW, et al. Sucralose affects glycemic and hormonal responses to an oral glucose load. Diabetes Care. 2013;36(9):2530-2535.
3. Laitinen K, Poussa T, Isolauri E. Probiotics and dietary counseling contribute to glucose regulation during and after pregnancy: a randomized controlled trial. Br J Nutr. 2009;101(11): 1679-1687.
4. D’Anna R, Di Benedetto V, Rizzo P, et al. Myo-inositol may prevent gestational diabetes in PCOS women. 2012;28(6): 440-442.
5. Gottfried, S. The Hormone Cure. Scribner;2013.