Managing PCOS through food choices

This is a re-post from Stephanie Paver’s blog. To view the original pieces, visit her blog here!

The word "diet" implies a temporary, restrictive eating plan based on lists of 'approved foods' and 'foods to avoid.' In this context, there is no such thing as a PCOS diet because PCOS is not temporary! It is a lifelong condition that will require a long-term commitment to making healthy choices. Learning to adopt principles of healthy eating is essential, while a "diet" is only suitable for as long as you're sticking to it.

“Diet” can also refer to a regular eating pattern or the typical foods a person consumes. In this context, research shows that diet and lifestyle modification are a first line approach to managing PCOS (1). In most cases of PCOS, changing your way of eating is necessary.

What the research says

The available evidence from diet studies in women with PCOS tells us that there is no one perfect diet. Instead, many different approaches can work to achieve the same goals: improved ovulation, weight loss, normalized hormone levels, improvement in insulin resistance, and reduced hair growth (2).

PCOS and a Low Dairy Diet

In one small research study, PCOS women who consumed a low dairy (1 oz of cheese per day) and grain-free diet over eight weeks showed improvement in weight, body composition, insulin resistance, testosterone, and hair growth (3). The idea behind these findings is that dairy evokes a higher insulin response than other foods.

PCOS and a Low Glycemic Index (GI) Diet

A study in 2010 verified that the type of carbohydrate can make a significant difference in insulin resistance and regularity of menstrual cycles. Researchers studied various metabolic factors by giving two groups of women with PCOS similar diets with the same amount of carbohydrate, fat, and protein over 12 months or until they achieved 7% weight loss.

The only difference in the diets was one group consumed low-GI foods such as oranges, apples, whole-grain bread, pears, and Asian noodles, and the other group had higher-GI foods such as whole-meal bread, cantaloupe, bananas, watermelon, and brown rice. The group who ate lower GI foods showed significant improvements in insulin resistance and more regular menstrual cycles (4).

PCOS and the Dash Diet

The DASH diet is one that revolves around high fiber foods such as fruits, vegetables, and whole grains. The DASH diet is low in saturated fat, cholesterol, and refined grains and high in nutrients such as fiber, magnesium, and potassium. This diet is traditionally used to treat high blood pressure and remains one of the healthiest diets science has studied.

The DASH diet may also be beneficial to women who have PCOS according to a study done in 2014. In the study, 48 women with PCOS were given either the DASH diet or a regular diet. Both diets were low-calorie. The women who followed the DASH diet lost significantly more weight than the ones who followed the low-calorie diet (5).

In 2018, a cohort study observed an association between insulin resistance, high androgens, and inadequate fiber intake in women with PCOS. This suggests that more high fiber foods, as patterned in the DASH diet, may help with reducing insulin resistance in women with PCOS (6).

PCOS and a High Protein Diet

A high protein diet may help with psychological symptoms common to PCOS. A study in 2007 gave 25 women either a high protein, low carbohydrate diet or a low protein, high carbohydrate diet and tested weight loss and psychological symptoms using Hospital Anxiety and Depression Scale scores and the Rosenberg Self-esteem Scale. Although the weight loss between the two diets was comparable, the women who followed the high protein, low carbohydrate diet showed more significant improvements in self-esteem, depression, and anxiety (7).

PCOS and a Calorie-Restricted Diet

A study conducted in 2003 tested the effect of a calorie-restricted, high protein diet compared to a calorie-restricted, high carbohydrate diet on weight loss and biochemical parameters in twenty-six obese women with PCOS. Both groups had a similar degree of weight loss (3.6-4.2% body weight lost). A decrease in testosterone, fasting insulin, and fasting leptin levels were seen in both groups. Both calorie-restricted diets were successful in helping these women decrease their weight and improve hormone levels (8).

PCOS and the Anti-Inflammatory Diet

Inflammation is concerning for women with PCOS due to the adverse effect it has on ovulation. Naturally, researchers were curious to see if an anti-inflammatory diet would decrease inflammation for women with PCOS.

The anti-inflammatory diet used in this study focused around legumes, fish, low-fat dairy, moderate fiber, liberal and frequent use of herbs and spices, and green tea. Red meat was allowed only twice per month, chicken meat was allowed once per week, and fish was allowed at least twice a week.

Seventy-five women with PCOS completed the study, and as expected, this diet was effective for weight loss, lowering lipid levels, decreasing insulin resistance, decreasing inflammation, decreasing free testosterone, increasing sex hormone binding globulin, and improving menstrual regularity (9).

From theory to practice

The main finding from the research is that improvements in insulin resistance and menstrual regularity in PCOS can be achieved with weight loss. The type of diet, “low carb”, “high carb”, “high protein”, etc. isn’t as important as the composition of the diet, meaning the types of foods you include. Quality is more important than quantity.

That said, this research also shows that while diet change can help to improve PCOS, there is no one perfect diet or one-size-fits-all solution that works for everyone.

Making a lot of changes can be overwhelming, so let's keep it simple. To help you make small shifts in how you think about food, follow these basic guidelines.

Break out of your diet mentality.

The diet mentality is restrictive and implies short-term changes. For PCOS, a life-long shift is essential to controlling metabolic and reproductive functions. Focus on daily habits to set yourself up for automatic success. You don't have to make all the changes at once. Instead, you can add in new healthy habits over time to curate a healthy lifestyle that best supports your health.

Focus on the quality of your meal over quantity.

Focus on all the nutrients your meal is providing you. When you consume high-quality foods, your body is going to be satisfied with much less, and you will control your portions naturally without a calculator. By eating more vegetable-based and high-quality meals, you will naturally decrease calories. The best way to control the quality of your meal is to make it yourself. Shifting from eating out less and preparing more meals at home can be overwhelming. The trick here is to start with small changes and stay consistent for long-term success.

Stop restricting carbs.

Diets ranging from 40% to 52% of carbohydrates are effective in managing PCOS. The quality of carbs and the quality of the source of the food matters more than total carbs. Choose whole grains instead of refined ones, and eat less processed foods.

Whole grains such as brown rice, quinoa, barley, oatmeal, and whole grain gluten free bread and starchy foods such as potatoes (white and sweet) and root vegetables are great examples of the types of complex carbohydrates your body needs. These foods are packed with fiber, which will help with your weight loss goals.

Focus on whole foods.

Can you trade boxed cereal for oatmeal or choose to make scrambled eggs with spinach and mushroom instead of picking up a breakfast sandwich from Starbucks?

How about swapping the afternoon M&Ms for a handful of fruit and nuts?

Consuming natural foods will ensure you are getting optimal nutrients with every choice you make. This helps to steady hormones related to appetite regulation, sugar balance, and stress.

Eat the rainbow: aim for 3 colors per day.

Think ROYGBIV. ROYGBIV stands for Red, Orange, Yellow, Green, Blue, Indigo, and Violet. Each fruit and vegetable has color because of the different phytonutrients they contain. Phytonutrients are non-energy yielding nutrients that have powerful disease prevention and anti-inflammatory abilities. For optimal health, aim for three to four different colors per day and all seven colors per week!

Vegetables should be the star of the plate.

Instead of having a plate of pasta and meat as the entree with a bite of broccoli, try doing it the other way around. Make the majority of your plate veggies and complement it with a small side of your carb of choice and a "palmful" of protein.

Don't like the taste of vegetables? Learn to bake them, roast them, sauté them, steam them. Put them in soup, add them to your rice dishes. Season them. Add butter, oil, salt, pepper, and other herbs and spices. However, you like them, eat them at every meal, and don’t forget to eat the rainbow!

Template for a balanced meal

To provide you with structure, here is a template to help you construct a meal with ease and confidence. The purpose of this template is to help guide you while also allowing you leeway to choose the foods you like.

I often get asked which fruits and vegetables are "better" and which ones to avoid. While the glycemic index of a meal can be a way to measure how much a food will affect your blood sugars, and some research supports using the glycemic index to manage PCOS (1), I encourage you to eat more fruits and vegetables as a starting point. It comes down to balance and variety. Also, it's essential to eat the foods you enjoy!

• Visualize your plate! Fill 1/2 of your plate (or more!) with veggies. This includes leafy greens: spinach, romaine, green leaf, red leaf, watercress, microgreens; and cruciferous vegetables: cabbage, broccoli, cauliflower, Brussels sprouts, kale, bok choy, collard greens, arugula
• Make 1/4 of your plate grains, root veggies, or fruit for quality carbohydrates. Grains: whole oats, buckwheat, rice, and quinoa; root vegetables: sweet potatoes, white potatoes, onion, carrot, radish, turnip, beets, celery root, and rutabaga; low glycemic fruit: berries, peaches, oranges, and grapefruit.
• Make 1/4 of your plate quality protein. Fish: wild-caught salmon, tuna, halibut, cod; poultry: pastured chicken, turkey, eggs; meat: lean pork, beef, lamb; plant-based proteins: lentils, beans, edamame, tofu, tempeh.
• Include quality fat at every meal for flavor, satiety, and enhanced nutrient absorption. Contrary to popular belief, eating fat does not make you fat. The following are examples of foods that provide healthy fats. Oils: cold-pressed extra virgin olive oil, avocado oil, and virgin coconut oil are good choices. Use to flavor veggies and grains. Seeds: flax, hemp, chia, sunflower, pumpkin, sesame. Use to top oatmeal, salad, soup, or add to a smoothie. Nuts: almonds, pine nuts, hazelnuts, Brazil nuts, cashews, pistachios, walnuts, nut butter. Use to make hummus, trail mix, top oatmeal, and salad, or add to a smoothie. Other: avocado, grass-fed butter.

These guidelines imply that you're making the majority of your meals from scratch. However, you can follow this template as a checklist when ordering out as well.

Making changes to your food routine can sometimes be overwhelming. That’s where nutrition specialists like dietitians can come into play. Check out my PCOS page for more information!

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