PCOS: Diet’s Role in This Women’s Health Threat

Dietary strategies can help manage this underdiagnosed condition that affects both reproductive and metabolic health.

About one in 10 women have polycystic ovary syndrome (PCOS), a health condition that affects women and girls from adolescence to the post-menopausal years. PCOS receives significant attention because it’s a top cause of infertility. A research review in the October 2015 issue of Endocrine Reviews found that PCOS is associated with increased risk of diabetes, heart disease, endometrial cancer, and other health problems, making it an important health issue for women of all ages.

PCOS is characterized by overproduction of testosterone and other androgens (male hormones), which usually causes numerous tiny cysts (polycysts) to surround the ovaries. The hormone imbalances can interfere with ovulation, causing missed menstrual periods, and lead to infertility. For diagnosis, a woman must meet at least two of these criteria: high levels of androgens, fewer than eight menstrual periods a year, or polycystic ovaries. Some women have PCOS for years before being diagnosed.

Foods And Nutrients To Help Manage PCOS

Choose more of these foods in your diet pattern, and discuss these supplements with your health-care practitioner.

Low glycemic, moderate-to-high fiber carbs

  • Beans and lentils
  • Whole grains
  • Vegetables and fruits

Healthy fats and protein

  • Cold-water fish
  • Avocados and nuts
  • Olives and olive oil
  • Low-fat dairy

Supplements

  • Vitamin D
  • Vitamin B12
  • Probiotics
  • Myo-inositol and D-chiro inositol

Treating PCOS. Diet and lifestyle are the primary treatments for reducing the symptoms and complications of PCOS, says Angela Grassi, MS, RDN, LDN, author of The PCOS Workbook. While there’s no single dietary plan for PCOS, Grassi reports that women with PCOS benefit from a whole foods, anti-inflammatory eating pattern that’s individualized to meet their needs.

Two examples of dietary patterns that research shows may help PCOS are the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets, both of which include a variety of vegetables, fruits, whole grains, beans, lean proteins, and healthy fats. Grassi suggests three balanced meals, with snacks if needed, and distributing carbohydrates with fat and protein throughout the day.

A review in the June 2015 issue of Nutrients found that vitamin D deficiency is related to metabolic and hormonal dysfunction in women with PCOS. Grassi also recommends that women who take the drug metformin—often used in PCOS treatment—have their B12 levels checked every year. Research shows that myo-inositol and D-chiro inositol—relatives of the B vitamins—in a 40:1 ratio may improve nearly all PCOS-related problems.

PCOS, Weight, and Well-Being. Women with PCOS have a tendency to gain weight around the waist, which can further increase health risks. Although weight loss has been shown to improve PCOS, that’s not always easy. “Despite diet and lifestyle being the primary treatment approach for women with PCOS, the main advice given to women with the syndrome is ‘just lose weight,’” Grassi says. “This is so infuriating to women with PCOS because, in the first place, most of them want to lose weight and have been trying to lose weight unsuccessfully.”

Insulin resistance is common with PCOS, often causing low blood sugar and intense carbohydrate cravings. Grassi says these cravings may even follow a satisfying meal, sometimes right after breakfast. Cravings, along with higher levels of the stress hormone cortisol, impaired levels of appetite hormones, and possibly a slower metabolism can also make it difficult to lose weight. Because of this, Grassi says that many women with PCOS have a history of yo-yo dieting, which can worsen health and increase weight over time.

PCOS can also cause embarrassing physical symptoms, including excessive hair growth on the face, chest and back, thinning of the hair on the head, and dirty looking, velvety patches of skin on some parts of the body. This can take a toll on self-esteem and body image, and women with PCOS are more prone to depression and other mood disorders.

PCOS Nutrition Myths. Grassi says that women with PCOS are exposed to a lot of inaccurate nutrition advice. Three myths are that people with PCOS should avoid dairy, gluten, and soy. “I think a lot of women are scared that soy has phytoestrogenic properties and can increase estrogen more,” Grassi says. Women with PCOS tend to have constantly circulating levels of estrogen. “But studies actually show that soy intake significantly improves insulin resistance as well as triglycerides, LDL cholesterol, and total cholesterol.”

The Bottom Line. Grassi recommends focusing on health-promoting behaviors rather than only weight. This means avoiding quick fixes in favor of sustainable diet and lifestyle changes and good self-care, including pleasurable food, joyful movement, better sleep, and stress management.

—Carrie Dennett, MPH, RDN

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