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Nutrition Strategies for Polycystic Ovary Syndrome (PCOS)

Written by
Team Nutrisense
Reviewed by
Kara Collier
RDN, LDN, CNSC
a note with PCOS written on it

Polycystic Ovary Syndrome (PCOS) is a mixed endocrine and reproductive condition. In this article, we’ll look at how it affects how the body handles glucose and what steps can be taken to manage those changes. Food is a critical part of any management plan and our focus today. Our companion article looks at the non-dietary lifestyle techniques that can be deployed to manage these changes, and both approaches should be used in combination to achieve an optimal result. 

PCOS and Insulin Resistance

Most people with PCOS also have insulin resistance, which means they are less able to handle sugars than someone without it. The result is that blood glucose levels become elevated above normal levels, with two significant consequences. First, the glucose is now not available to be used by tissues, which will have to resort to other energy sources like muscle and fat. Second, elevated glucose levels will eventually contribute to inflammation and small blood vessel damage, although these are both beyond the scope of this article. The vital thing to know is that persistently high blood glucose levels are harmful for many reasons and to be managed in consultation with a professional.

General Nutrition Still Applies Here

Like most people, those with PCOS should pay close attention to eating whole foods, minimizing sugar and processed fats, and eating a reasonable amount of food in a day. People with PCOS should also be vigilant about sugars, finding the right type and balance of carbohydrates for their body. However, there are easy first steps like avoiding refined sugar that would also apply to most people in typical circumstances.

a boiled egg, salmon, broccoli, beans, nuts and an avocado

Low Carbohydrate or Ketogenic Diet

If someone has PCOS, is actively managed by a healthcare professional, and knows they don’t have any signs of insulin resistance, then they most likely don’t need a low carbohydrate diet. Since most people with PCOS will develop some form of insulin resistance, they should be familiar with managing carb intake just in case. This diet seeks to replace carbohydrates with proteins and fats that can be metabolized into ketone bodies, which many but not all organs can use as fuel instead of glucose. The amount of carbohydrates you are able to tolerate will depend upon your level of insulin resistance, but many people with PCOS have a lower carbohydrate tolerance. 

Caloric Restriction

One important caveat here is that PCOS is a prevalent cause of infertility, and if a woman with PCOS is trying to get pregnant, a caloric restriction would likely not help them. If food intake is very high, for example, double the recommended amount adjusted for height and age, it can exacerbate some problems. Sluggishness and malaise may be worsened by putting large amounts of food into the gut at once. When that food gets broken down, insulin resistance may be further exacerbated by large spikes in blood sugar.

different legumes and powder made of them

Gluten Free Diet

To be sure, there is no known link between PCOS and Celiac Disease, but sometimes during the workup for PCOS, there is an incidental discovery through diet experimentation or blood work. The populations most at risk, younger women mostly unknown to chronic healthcare, also have considerable overlap. If you are experiencing a lot of gut issues and GI distress or having high levels of inflammation, it is worth removing gluten from the diet for several weeks to see if these symptoms improve. 

Dairy Free Diet

Like with the gluten free diet, there is no hard link between PCOS and lactose intolerance, for example. Many women with PCOS also have problems with acne due to high testosterone levels. Elimination of dairy can help with this for some individuals. If someone does have lactose intolerance, then feelings of bloating and sluggishness can worsen the similar constellation of symptoms associated with hypercortisolemia related to PCOS,

an image showing consumption of wine

Consider Reducing Alcohol

One of the central problems associated with PCOS is that cortisol levels are often persistently elevated. This will unfortunately generally translate into higher feelings of stress as well as the long-term consequences of chronic biological stress. Stress is often “self-medicated” with alcohol, which can be particularly harmful in the case of PCOS. In PCOS, the body is less able to handle the sugars in many alcoholic drinks, specifically mixed drinks. Pure ethanol does not require insulin to be broken down, but it can worsen sleep and mask healthier strategies.  

Consider Reducing Caffeine

The combination of sluggishness and high levels of cortisol can be challenging to navigate with caffeine. On the one hand, caffeine can boost energy levels in the short to medium term. Still, high baseline levels of cortisol combined with caffeine can lead to significant side effects like feeling jittery or irritable. In other words, it can soften one problem (low energy) while making another one (feeling stressed) completely unmanageable.

The Intuitive Eating Approach

Some people can get so focused on how to diet, what exactly to eat, when to eat it, etc. If the stress associated with strict adherence to a nutritional regime presents more problems than solutions, it may be time to rethink this approach. Intuitive eating holds that separating physical from emotional hunger is the essential question, rather than following a rigid schedule and list of foods to include or avoid.

Address Intolerances and Allergies

Although mentioned earlier, it’s worth emphasizing that specific foods can have an outsize influence on energy levels, inflammation, and stress. If someone with PCOS has a known allergy or intolerance, this is often the single most impactful change they can make in their diet.

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