Optimise your health and manage your Polycystic Ovarian Syndrome Symptoms with our nutrition tips

Polycystic Ovarian Syndrome (or PCOS) is an endocrine disorder wherein in an imbalance of hormones causes disruptions to the body’s normal functioning. PCOS affects around 1 in 10 people born with a uterus, with 70% going undiagnosed.¹

The cause of PCOS is not entirely clear but it appears to be a combination of genetic and environmental factors.

In a well-functioning body, the brain produces gonadotropin-releasing hormone (GnRH), which triggers the release of luteinizing hormone (LH) and follicle-stimulating-hormone (FSH). LH and FSH are both involved in stimulating ovulation.

In people with PCOS, the release of GnRH malfunctions, causing higher-than-normal levels of LH and lower-than normal levels of FSH. This disrupts ovulation, causing the ovaries to develop small cysts and to produce excess testosterone. High levels of testosterone trigger many of the symptoms associated with PCOS, including excess body hair, acne, irregular periods and mood disturbances.

There is a vast amount of fatphobic and confusing dietary advice out there regarding the management of PCOS.  So we’re here to tell you that you do NOT need to lose weight or go on a restrictive diet in order to manage your symptoms.

Why you shouldn’t attempt weight loss with PCOS

Much of the nutrition advice relating to PCOS focuses on weight loss, as the hormonal imbalance that is characteristic of PCOS slows metabolism and often leads to weight gain.² However, research shows that dietary restriction can further impair metabolism – in fact, dieting is actually the strongest predictor of weight gain. This means that attempting to lose weight with PCOS may have the opposite effect than what you intended!

Of additional concern is a study published in 2016 that found that people with PCOS are six times more likely to develop an eating disorder.³ Given that we know that 1 in 4 people who diet will develop an eating disorder, this is even more reason to tread with caution.

Weight loss advice is often given with good intention, as research has found a link between a higher body weight and PCOS.⁴ However, correlation is not the same as causation. What we mean by this is that just because two things are associated, it does not necessarily mean that one causes the other.

One example of this is the high prevalence of people with yellow teeth also having emphysema. Does this mean that having yellow teeth causes emphysema? Of course not! The missing link in that situation is tobacco smoking.

Similarly, the missing link between a higher weight and PCOS is the imbalance of hormones, as well as other determinants like genetics, and social and environmental factors.

Furthermore, the majority (around 65%) of people with PCOS also experience insulin resistance and hyperinsulinemia.⁵ Essentially, this means that the body does not respond to insulin (a hormone made by the pancreas) the way it should, and excess amounts circulate the bloodstream, leading to unstable blood sugar levels.

High levels of insulin make weight loss incredibly difficult, meaning extreme (and likely dangerous) measures would need to be taken to achieve it. Additionally, dietary restriction and low blood sugar levels trigger a response in the body that can lead to a binge-eating episode. This causes a rapid spike in blood sugar levels known as hyperglycaemia, which can have serious complications.

Management strategies for PCOS

INSULIN RESISTANCE

Insulin resistance is believed to be a root cause of PCOS, as higher-than-normal levels of insulin increase inflammation, inhibit ovulation and cause the ovaries to produce excess testosterone. As such, stabilising blood sugars is a key strategy for managing PCOS and its associated symptoms. Three ways to balance your blood sugar levels through diet are:

ONE: Eat regularly and enough

Eating a meal or snack every three to four waking hours is one way of keeping blood sugar levels stable. By waiting long periods of time between meals, blood sugar levels can drop below the ideal range. This can cause the body to respond by triggering extreme hunger and carbohydrate craving, which often leads to a binge eating episode. A binge can result in a rapid shift in blood sugar levels in the opposite direction, resulting in hyperglycaemia.

TWO: Spread carbohydrate intake out across the day

Contrary much of the advice available on the internet for PCOS, there is no need to reduce or avoid carbohydrates. Carbohydrates are an essential source of energy for the body – in fact, the brain can only use carbohydrates for fuel!

Instead, by spreading out your intake of carbohydrate-containing foods (think grains, fruit, vegetables and dairy) across the day, your body can receive a slow and steady stream of sugar into the blood, which is much more easily managed.

THREE: Slow down the absorption of carbohydrates

When the digestion, absorption and metabolism of carbohydrates is slower, the effect on blood sugar levels is less extreme. This can be done in two ways:

Firstly, eating carbohydrates with a source of fat or protein not only slows down absorption, but is key for healthy hormone production and function.

Secondly, consuming carbohydrates with a source of fibre can help keep blood sugar levels stable – for example, wholegrain bread is absorbed more slowly than white bread. As an added bonus, fibre helps the body to excrete estrogen, which can support regular menstruation.

INFLAMMATION

Chronic low-level inflammation is a key contributor to the development of PCOS. Although the exact relationship is not fully understood, research shows that people with PCOS experience a decrease in antioxidant levels and an increase in inflammatory markers.⁶ Inflammation works to exacerbate symptoms and complications of PCOS by:

• Stimulating the overproduction of testosterone by the ovaries
• Worsening insulin resistance and increasing the risk of diabetes
• Increasing the risk of cardiovascular disease (people with PCOS have a 19% higher risk of developing cardiovascular disease than those without)⁷

To reduce inflammation in the body, try upping your intake of omega-3 fatty acids, found in foods like olive oil, flaxseed and salmon. Studies show that increasing your dietary intake of omega-3 is more effective than taking a supplement, so eat up!⁸

Increasing your intake of antioxidants is another way of decreasing levels of inflammation by counteracting oxidative stress. Some research has even found antioxidant supplements may improve insulin sensitivity in PCOS but more research is needed in this area.⁶ Antioxidants are found most abundantly in plant-based foods, like colourful fruit and vegetables, nuts, legumes and even foods like dark chocolate and green tea.

Inflammation can also be reduced through stress management, which will be discussed below.

CHRONIC STRESS

Chronic stress is thought to contribute to PCOS symptoms in a number of ways, mainly due to high levels of cortisol (also known as the ‘stress hormone’).

Firstly, prolonged high levels of cortisol increase inflammation in the body, which affects PCOS in the ways described above.

Secondly, cortisol has been shown to increase insulin levels, which can trigger inflammation and the overproduction of testosterone.⁹

Thirdly, cortisol has a vital role in regulating the sleep-wake cycle. In people with healthy levels of stress, cortisol peaks upon waking and then progressively declines throughout the day until bedtime. When this rhythm is disrupted, sleep patterns can be disturbed, which in turn can contribute to insulin resistance and intense carbohydrate cravings.

Management of chronic stress focuses on self-care and relaxation strategies. Some evidence-based ways of lowering cortisol levels include:

• Yoga
• Mindfulness meditation
• Deep breathing techniques
• Physical activity
• Spending time in nature

SUPPLEMENTATION

There is a plethora of supplements on the market that claim to assist with the management of PCOS – some of them backed by research and some not!

As an overview, some of the supplements that are commonly suggested for managing PCOS symptoms include:

OMEGA-3

Supplementing omega-3 has been shown to reduce inflammation and oxidative stress, and can also reduce testosterone levels and regulate the menstrual cycle.¹⁰ It may also be helpful in improving insulin sensitivity, but more research is needed to confirm this.^10,11 

VITAMIN D

This nutrient is essential for reproductive health, and deficiency is common in people with PCOS.¹¹ The exact mechanism linking vitamin D supplementation with the improvement of PCOS symptoms is not completely understood, but it is thought that it may be related to its role in decreasing inflammation in the body. Additionally, there is some evidence that supplementing vitamin D could assist in improving insulin sensitivity and the reduction of testosterone levels in PCOS, but more research is needed.^6,12

INOSITOL

Research has found that the supplementation of inositol can aid in the improvement of reproductive abnormalities, regulate testosterone levels and improve insulin sensitivity.^11,13

ZINC

This mineral is important for reproductive health, including the synthesis and metabolism of a range of hormones. Zinc deficiency in common in people with PCOS, and studies indicate that supplementation can assist with decreasing inflammation and improving symptoms like alopecia and excess body hair.¹⁴ Evidence suggests that supplementation of vitamin D may also reduce insulin resistance in this group – however, once again, more evidence is needed to confirm this as results vary.^11,14

N-ACETYL CYSTEINE

Also known as NAC, this supplement is well-researched for its effect on PCOS symptoms. It has been shown to act in a similar fashion to metformin (a common medication prescribed for PCOS) by improving insulin sensitivity, decreasing testosterone levels and reducing oxidative stress.^6,11

The best supplement for you will depend on your symptoms and deficiencies, so you should discuss this with your doctor before beginning any supplementation.

PCOS is an incredibly complex condition that can have widespread effects on a person’s quality of life. However, there are ways to manage your symptoms without having to go on a diet! If you feel you would benefit from more support, please reach out to us at [email protected].

Karli Battaglia MDiet, APD

EHL Team x

References

1. Boyle J, Teede H. Polycystic Ovary Syndrome. Australian Family Physician. 2012;41(10):752-756.
2. Georgopoulos N, Saltamavros A, Vervita V, Karkoulias K, Adonakis G, Decavalas G et al. Basal metabolic rate is decreased in women with polycystic ovary syndrome and biochemical hyperandrogenemia and is associated with insulin resistance. Fertility and Sterility. 2009;92(1):250-255.
3. Bernadett M, Szemán-N A. Prevalence of eating disorders among women with polycystic ovary syndrome. Psychiatr Hung. 2016;31(2):135-45.
4. Sam S. Obesity and Polycystic Ovary Syndrome. Obesity Management. 2007;3(2):69–73. 
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6. Amini L, Tehranian N, Movahedin M, Tehrani F, Ziaee S. Antioxidants and management of polycystic ovary syndrome in Iran: A systematic review of clinical trials. Iran J Reprod Med. 2015;13(1):1-8.
7. Glintborg D, Rubin K, Nybo M, Abrahamsen B, Andersen M. Cardiovascular disease in a nationwide population of Danish women with polycystic ovary syndrome. Cardiovascular Diabetology. 2018;17(1).
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9. Muharam R, Purba J, Hestiantoro A, Elvira S. Profile on personality types and cortisol in polycystic ovarian syndrome. Middle East Fertility Society Journal. 2018;23(3):189-194.
10. Nadjarzadeh A, Firouzabadi R, Vaziri N, Daneshbodi H, Lotfi M, Mozaffari-Khosravi H. The effect of omega-3 supplementation on androgen profile and menstrual status in women with polycystic ovary syndrome: A randomized clinical trial. Iran J Reprod Med. 2013;11(8):665-72.
11. Günalan E, Yaba A, Yılmaz B. The Effect of Nutrient Supplementation in Management of Polycystic Ovary Syndrome Associated Metabolic Dysfunctions: A Critical Review. Journal of the Turkish-German Gynecological Association. 2018;19(4):220-32.
12. Ratnabali Chakravorty D. The Relationship between Vitamin D, Insulin Resistance and Infertility in PCOS Women. Gynecology & Obstetrics. 2015;05(05).
13. Bizzarri M, Carlomagno G. Inositol: history of an effective therapy for Polycystic Ovary Syndrome. Eur Rev Med Pharmacol Sci. 2014;18(13):1896-903.
14. Jamilian M, Foroozanfard F, Bahmani F, Talaee R, Monavari M, Asemi Z. Effects of Zinc Supplementation on Endocrine Outcomes in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial. Biological Trace Element Research. 2015;170(2):271-278.