Polycystic Ovarian Syndrome or PCOS, as most of us may know it, is a reproductive health condition which impacts between 8-10% of the female population and is responsible for 30% of sub-fertility in couples.  

In brief, what is PCOS?

Polycystic ovaries refers to many cysts.  This condition can evolve into PCOS, which is a reproductive disorder that can manifest in various symptoms including acne, hirsutism (hairiness), baldness, weight gain, inability to lose weight easily, irregular or abnormal periods, mood changes such as anxiety and depression, sleep issues and may lead to infertility.  It is also associated with many metabolic processes such as insulin resistance, obesity, type 2 diabetes, high blood pressure and cardiovascular disease in older age.

A person with PCOS is unlikely to suffer from all these symptoms, for example, they may suffer from acne and irregular periods but not necessarily be overweight.

What hormones are impacted by PCOS?

Those suffering from PCOS are likely to have hormonal imbalance. The main hormones which are impacted are:

  • Androgens, like testosterone, are likely to be elevated in those suffering from PCOS.  Excessive amounts of hormone can lead to acne, weight gain and impact fertility.  Elevated estrogen levels can impact menstrual cycles, leading to bloating and mood swings.

  • Insulin is the hormone produced by the pancreas and is responsible for managing blood sugar levels. Insulin resistance occurs when the body’s cells do not respond normally to the production of insulin (particularly the muscles and the liver) leading to excessive production of insulin to keep the body’s blood glucose levels normal.  As the glucose cannot enter the cells as easily it builds up in the blood.

  • Progesterone, the sex hormone involved in the menstrual cycle, is the hormone responsible for thickening the lining of the uterus each month.  PCOS reduces the production of progesterone which can lead to irregular menstruation and possible infertility.

What diet plan can someone with PCOS implement to manage and improve their symptoms and reduce the associated metabolic processes?

  1. Increase intake of high fibre foods - high fibre foods help with managing insulin resistance, are slowly digested and help balance blood sugar levels and improve the microbiome.  Through improving the microbiome we can increase nutrient absorption, reduce inflammation and improve the metabolism. Some foods to include are almonds, pumpkin, spinach, beans, lentils, broccolini, sweet potato and fruits, such as avocado, apples, bananas, raspberries (these are great as they are also low in natural sugars and have 8g of fibre per cup!). We want to have around 25-30g of fibre per day.  

  2. Increase foods contain “healthy fats” - foods such as oily fish (salmon or tuna), avocado, nuts and seeds, and chia seeds, all assist with balancing hormones and reducing inflammation, as there is evidence that most women with PCOS are in a chronic inflammatory state.

  3. Increase intake of the “right carbohydrates”, whole grains and reduce intake of refined carbohydrates - quinoa, wild rice, basmati rice, brown rice, buckwheat, barley, oats and sweet potato can be the “right carbohydrates” because they are all slowly digested which balances blood sugar levels, sugar cravings and improves insulin resistance. These should be included in every meal.

  4. Avoid inflammatory foods and increase intake of anti-inflammatory foods - vegetable oils, red meat, caffeine, alcohol, refined sugar, processed food, and sometimes gluten (if you are gluten intolerant or suffer from celiac disease) and some dairy (particularly if you are lactose intolerant) can create inflammation in the body.  As chronic low-grade inflammation has been found to be present in many PCOS sufferers and chronic inflammation can increase the risk of metabolic and systemic diseases, it is important to manage this inflammation. Eliminating or reducing these foods can help improve the immune system as the body does not sit in a constant state of low-grade inflammation. Some anti-inflammatory foods include oily fish, berries, kale, olive oil, almonds and walnuts.

  5. Include protein in every meal - PCOS sufferers have been found to have insufficient daily protein intake, which can put them at risk of further nutritional deficiency and insulin resistance.  Protein is important for PCOS sufferers as it can minimise the effect of insulin in the body and help contribute to weight loss. Include lean proteins such as fish, chicken and eggs.  

  6. Avoid “dieting” - try to stay away from fad diets or dieting as this may lead to further nutritional deficiencies, increase inflammation, increase stress and insulin resistance if not done under the supervision of a professional. Most fad diets may provide short term weight loss but are not long term or sustainable.  

These dietary tips are suitable for those with PCOS looking to lose some weight or conceive. They are recommendations and should not replace any advice provided to you by your doctor.  

Some lifestyle tips...

Lifestyle choices are just as important as diet when it comes to management of PCOS.  Here are a couple which will help:

  1. Move - make exercise a priority when planning your week, whether it is high or low intensity.  Exercise helps management of insulin resistance, is likely to lead to better food choices, improve sleep and reduce stress.

  2. Reduce stress - reducing stress helps keep our hormones balanced. Try incorporating daily slow breathing exercises, do yoga and/or practice meditation.  A few of my favourite apps for meditation and breathing exercises are “Calm”, “Headspace” or “Smiling Mind”.

Should you take supplements?

That is for you to decide.  Supplements are not there to replace a healthy diet or act as a quick fix.  They are there to “supplement” a healthy and balanced diet. What they are very helpful for is improving nutritional deficiencies and are a great addition when our bodies sometimes need that little bit more.

When it comes to PCOS, studies have shown that women are at high risk of calcium, potassium, magnesium, vitamin C, vitamin B12 and zinc deficiencies, which contribute to the exacerbation and continuation of the symptoms.  Supplements can help with managing these deficiencies.

Talk to your healthcare practitioner or doctor before starting on supplements, particularly if you are on medication like Metformin to make sure they do not contraindicate the medication.

And one last thing…

A dynamic overhaul of diet and lifestyle can be tricky and we can sometimes relapse into our old habits. Remember to practice compassion and be patient with yourself.  Things will take time to improve, so don’t give up!