Polycystic Ovarian syndrome, also known as PCOS, is the most common endocrine disorder among reproductive age women (1).
PCOS is characterized by a state of hyperandrogenism as well as hormonal and metabolic alterations.
Symptoms of PCOS can vary among individuals but may include:
- polycystic ovaries on ultrasound
- hirsutism
- acne
- menstrual irregularities
- infertility
- central obesity
- thinning hair
- skin tags
- dark skin patches
The name polycystic ovarian syndrome was given to describe the numerous small cysts that often form like a string of pearl in the ovaries, however these cysts are not diagnostic of PCOS.
The conventional treatment of PCOS is most often focused on anti-diabetic and anti-androgenic medications as well as oral contraceptives.
Recent and emerging research has improved our understanding of this condition that is significantly influenced by dietary and lifestyle choices.
The mechanisms underlying this condition including insulin resistance, gut dysbiosis, inflammation, and chronic stress can be largely addressed by nutrition, shown to make a significant difference in the PCOS pathology and severity of symptoms.
Low carbohydrate diets like keto have become quite popular recommendations especially to combat insulin resistant types of PCOS however it's important to address this from a sustainable and individual root cause approach.
Dietary strategies will differ from person to person and there are also certain foundational strategies that are important in order to treat the underlying imbalances in the PCOS condition.
Dietary strategies for PCOS
Anti-inflammatory
Due to the inflammatory nature of this condition, it's essential that we "put out the fire" with our diet and not exacerbate it (2). Unfortunately the Standard American or Western Diet is not doing us any favors because it is characterized by pro-inflammatory foods such as vegetable oils, refined sugars and carbohydrates, trans fats, and processed meats.
Adopting an anti-inflammatory way of eating is one of the most important factors to address and the best place to start when it comes to managing any sort of condition, including PCOS.
Removing sources of inflammation is just as important as adding anti-inflammatory foods to your diet. Foods that are particularly pro-inflammatory include:
- vegetable oils
- refined flours and carbohydrates (cookies, muffins, cupcakes, cereal, cakes)
- refined sugars
- soft drinks
- processed meats
- alcohol
On the other hand, the Mediterranean diet is a great example of an anti-inflammatory diet shown to benefit the PCOS condition by improving insulin resistance, obesity, hyperandrogenism, blood sugar control, and inflammation (3)(4).
This diet is characterized by a higher consumption of foods like fresh vegetables, fish, fruits, poultry, extra-virgin olive oil, and nuts and seeds.
Research suggests that the elevated intake of omega 3 fatty acids in the Mediterranean diet may be particularly important for women with PCOS (5).
Omega 3 fats are naturally anti-inflammatory and have been shown to improve the PCOS pathogenesis by reducing insulin resistance, improving lipid profiles, and regulating the androgenic profile (6)(7).
Wild fatty fish are the highest food sources of omega 3 fats in the diet which you can obtain from mackerel, salmon, sardines, anchovies, and herring.
Omega 3 fatty acids can also be obtained from plant foods such as algae, flaxseeds, walnuts, and chia seeds, though most of these will typically be less bio-available and potent than seafood sources.
If you want to follow an anti-inflammatory way of eating a good rule of thumb is to avoid packaged and processed foods and choose whole foods that are found naturally in nature instead.
Nutrient rich
It's no question that our diet should be the main supplier of our nutrition on a micronutrient level. The food we eat can provide many healing nutrients that the body can naturally recognize.
Of course supplementation can help to bridge any gaps or correct any nutrient deficiencies however it should never replace our diet which should always be our primary focus.
Zinc
Zinc is a mineral that is naturally anti-androgenic, shown to reduce the effects of inflammation, insulin resistance and high testosterone in women with PCOS (8)(9).
Research suggests that zinc status may be particularly low among PCOS women and play a role in the pathogenesis of the condition as well as long term complications (10)(11).
This supports the importance of including zinc rich foods in the diet which may include seafood, pumpkin seeds, meat, cashews, and eggs (12).
Magnesium
Magnesium is a natural anti-inflammatory mineral required for healthy estrogen and progesterone production, making it particularly critical for women with PCOS. Magnesium is an important mineral for insulin function and deficiency has been associated with insulin resistance as well as hyperandrogenism (13).
Dietary sources of magnesium include raw almonds, bananas, cacao, seeds, leafy greens, raw pumpkin seeds, spinach, cashews, soybeans, edamame, raw peanuts.
Magnesium deficiency is quite common and supplementation is often required to achieve optimal mineral status.
Inositol
Inositol is a relative of the B vitamin family and a popular recommendation for PCOS, and for good reason.
This nutrient has been shown to be low in PCOS women, and more particularly among those with insulin resistance (14).
Research suggests that inositol may provide improvements in almost all pathologic parameters and symptoms in PCOS including (15)(16)(17):
- sensitizing insulin and regulating blood sugar
- improving ovarian function, ovulation and pregnancy rates
- reducing serum androgen levels
- regulating menstrual cycles
- improving metabolic profiles
Though supplementation is often required to reach therapeutic levels, inositol can also be found in foods such as grpaefruits, apples, oranges, cantaloupe, beans, brown rice, peanut butter, almonds, apples, buckwheat, and organ meats.
Melatonin
Melatonin's role in sleep regulation is well known however it also affects hormonal factors such as ovulation by decreasing oxidative stress and protecting the quality of ovarian follicles as well as supporting progesterone production. Women with PCOS have been shown to have reduced melatonin levels in their follicles while also experiencing reduced sleep quality (18)(19)(20).
Melatonin has been shown to be beneficial for PCOS by improving metabolic functions, fertility, mood, sleep, and weight management (21).
Though melatonin is available in supplement form it can also be found in foods like cherries, bananas, almonds, grapes, broccoli, corn, and mushrooms.
Vitamin C
This antioxidant vitamin not only reduces oxidative stress, protecting tissues from damage, it can also help to raise progesterone levels which is commonly low in PCOS (22).
But that's not all, vitamin C is an essential nutrient for the adrenal glands to produce healthy amounts of hormones and can help to decrease cortisol levels. PCOS sufferers tend to produce higher levels of cortisol which can increase androgens, promoting symptoms like menstrual irregularities, acne, hirsutism, hair loss, and weight gain (23).
Vitamin C is depleted faster under high stress conditions which makes it an important nutrient to regularly replenish through the diet or supplementation.
Vitamin C can be found in fruits and vegetables such as citrus fruits, bell peppers, tomatoes, broccoli, spinach, kale, kiwi, parsley, and brussels sprouts.
Swap your coffee for green tea
Coffee is a polarizing topic as it is very dear to many people and can provide many health benefits, however there are also some factors to consider when it comes to coffee and hormones.
Higher levels of caffeine can cause blood sugar levels to spike and stimulates the adrenal glands to release more cortisol, that are most often already elevated among PCOS women (24)(25)(26).
Depending on coffee or other stimulants to get through the day or wake up in the morning is a common sign of HPA axis dysfunction.
When stress is already a contributing factor to hormonal imbalances, it is preferable to avoid additional stimulants like caffeine that only add fuel to the fire. Most often our bodies are asking for rest, not more stimulation to keep going at a pace that might not actually be working for us anymore.
Some individuals are more sensitive to caffeine than others and the best way to assess whether coffee is benefitting you or not is to remove it for at least a week and see how you feel.
If you don't want to give up your caffeine entirely, green tea might be just the swap for you!
Though green tea does contain caffeine it is much lower than a typical cup of coffee while providing therapeutic effects that are particularly beneficial to PCOS.
Green tea may help to normalize the stress response by modulating the HPA axis while also supporting the healthy removal of estrogen from the body (27).
Green tea is particularly rich in catechins, anti-inflammatory compounds that decrease oxidative stress and that are linked to beneficial effects including improved glycemic control, decreased body weight, and lowered androgens in PCOS (28)(29).
A study found that after 12 weeks of green tea consumption, overweight and obese women suffering from PCOS experienced a decrease in weight as well as insulin and testosterone levels (30).
Choose the right carbohydrates
Though low carb diets have been shown to benefit many women with PCOS in the short-term, long term adherence to a low carb way of eating can negatively impact women's hormones.
This is because the female endocrine system needs sufficient glucose in order to function optimally. Chronic low carbohydrate intake can impact the thyroid, HPA axis, menstruation, and even fertility.
Not eating enough, including carbs, can be considered a stressor and contribute to HPA axis dysregulation especially among women, impacting the production of sex hormones. Eating low carb can increase cortisol levels and for someone who is already stressed this could make things worse hormonally (31).
It's important to note that some women may need more carbs than others, such as those who fall under the "adrenal PCOS" type.
The type of carbohydrate and the quantity that you consume also makes all the difference.
Whole food complex carbohydrates that are rich in fiber are slow releasing into the bloodstream and also act as fertizers or food for our good gut microbes in the form of prebiotics.
This is especially important for women with PCOS who have been shown to lack diversity in their gut microbiomes, a factor that is associated with the pathology of PCOS (32)(33)(34).
A variety of foods high in fiber are good sources of prebiotics and include artichoke, onions, apples, cruciferous vegetables, cherries, berries, oats, jicama, peas, legumes, green tea, cacao, green bananas, cooked and cooled potatoes.
A higher fiber diet has been linked to decreased markers of inflammation, which may ameliorate insulin resistance as well as hormonal parameters among women with PCOS (35)(36)(37).
A study found that the consumption high glycemic carbohydrates was associated with lower chances of conception compared to higher fiber intake which was associated with faster time to conception (38).
Though every body is bio-individual, in terms of carbs you don't have to throw them all out. If you are wanting to best support your hormones avoid the refined carbohydrates and sugars and choose nutrient dense whole food carbohydrates that are rich in fiber instead.