Polycystic Ovary Syndrome (PCOS) Diet
by Sue Kira, Naturopath & Clinical Nutritionist
Lifestyle and exercise to support PCOS
Case study: Treating PCOS naturally
What is PCOS?
Polycystic ovary syndrome (PCOS) is, as the name implies, multiple cysts on the ovaries which are caused by an overproduction of hormones called androgens (male hormones). Along with the cysts, women with PCOS often have irregular periods or no menstruation at all, weight issues, and trouble conceiving a pregnancy.
Along with these symptoms, other common symptoms include acne, hirsutism (hairiness) and male pattern baldness. PCOS unfortunately also increases the risk of heart disease, endometrial cancer, diabetes, and high blood pressure.
PCOS is called a ‘syndrome’ because the cysts are just a sign, not a cause of this condition. Syndrome relates to the other symptoms often present along with the cysts.
Thus, PCOS is entirely a women’s condition (at least until men start developing ovaries).
What causes PCOS?
Scientists don’t really know what causes polycystic ovary syndrome, but there are certain factors that may play a role in creating PCOS, such as excess insulin or insulin resistance, low grade inflammation, hormone imbalance, hereditary factors, and diet.
Excess Insulin & Insulin resistance
Insulin is the hormone produced by the pancreas to allow our cells to use glucose for energy. With insulin resistance, your ability to use insulin effectively is impaired and your pancreas must secrete more insulin to make glucose available to cells.
High insulin can lead to a lot of the symptoms of PCOS such as increased hair growth, weight gain, skin tags, fatty liver, high cholesterol, polycystic ovaries, and an irregular menstrual cycle – not to mention increased hunger and sweet food cravings.
Excess insulin also affects the ovaries by increasing androgen production, which may interfere with the ovaries’ ability to ovulate, in turn leading to issues with conception.
Excess weight
Interestingly, excess weight can be a cause or a symptom of PCOS and unless you have studied the history of a person with PCOS it may be difficult to discern the ‘chicken from the egg’.
For example, if a girl is overweight during childhood, when she reaches puberty she has a higher risk of developing PCOS. On the other hand, a slim girl may go on the contraceptive pill at puberty and continue taking it for many years until she decides to ‘fall pregnant’. Then when she comes off the pill, she suddenly starts to put on weight and wonders why she can’t fall pregnant, or maybe not even get a period. Medical investigations may reveal PCOS.
In either situation, the wrong diet can cause PCOS from eating high GI, high sugar, high carbohydrate foods, or maybe drinking lots of alcohol in late teens and early adult years. Then hey presto, PCOS via insulin resistance and weight gain.
Dramatic weight loss
PCOS is all about hormone imbalance, where testosterone (more of a male hormone) is usually elevated over the female hormone’s estrogen and progesterone. Fast weight loss can trigger this hormonal imbalance because the body thinks that you are starving and stressed, so it shuts down reproduction in favour of fighting and running from danger, which is more of a male hormone driven need at that moment in your life.
Low body fat and over exercising can have the same effect. We need a certain amount of fat for effective hormone conversion.
Stress hormones in PCOS
If your body feels any sort of stress, be it emotional or a physical stress such as overexercising, inflammation, bingeing, or restrictive eating, then the body interprets this as a need for stress hormone release rather than sex hormones release.
Consequently, estrogen and progesterone levels fall, along with luteinising hormone (LH), follicle stimulating hormone (FSH) and sometimes testosterone, while stress hormones such as cortisol and DHEA increase.
DHEA is a male sex hormone (along with testosterone) and PCOS occurs when male sex hormones are elevated over female sex hormones in a woman’s body. Cortisol hormone triggers fat storage because it the body’s way of dealing with what it thinks is impending starvation.
Some of my clients had PCOS with high testosterone. Others had relatively low testosterone but high DHEA and cortisol, which is a great indicator that stress was a trigger for their PCOS.
When under stress, the body feels that it’s not the time to have a baby, because there must be something bad going on that needs to be dealt with in a masculine way.
Back in the ‘cave man’ days, men were physically designed to run and hunt and take care of danger. Men have more testosterone for bigger muscles so that they can do these tasks more easily and were given a little estrogen so that there was still tenderness and gentleness to care for their loved ones.
Women are gentle, caring, nurturing souls that are physically designed for the more delicate roles – even though we can do pretty much anything. Women have a little testosterone, but more estrogen to bear children and bring balance to a harsh world.
Although there is more equality today, we see many women taking on (choosing) more male driven energy, perhaps in a misguided effort to have more ‘equality’. Now I’m not saying that women cannot do what a man does, but care needs to be taken that women don’t ‘harden’ at the expense of straying from their true essence.
Women have a natural inbuilt strength, resilience and power which can be maintained without hardening. Hardening creates stress on the body – for both women and men. For many women, this can be a contributing factor for developing PCOS.
Worth considering?
Other hormones in PCOS – thyroid
There is a strong link between hypothyroidism and PCOS, as all hormones need to be balanced for fertility and good health. Ladies with PCOS who have stopped ovulating and have subclinical levels of thyroxin, often begin ovulating again once normal thyroid function has been achieved.
If needed, thyroid hormone replacement can reduce excess testosterone, as well as increase ovarian volume to make you more fertile. Really there isn’t a hormone in the body that can be left out when looking at contributing factors and ways to treat PCOS.
Environmental hormone disruptors
We all need a good level of estrogen in our bodies – not too much, not too little, and the right type.
Estrogen in the form of chemicals, also known as xenoestrogens, mimic the action of estrogen produced in our body and can alter hormonal activity, so it is important to be aware of the effects of estrogens in our environment.
Xenoestrogens are classified as hormone disrupters because they do just that – disrupt our hormone balance. Where do we get these toxins from? Almost all non-organic fruits and vegetables are covered in chemicals that act as xenoestrogens in the body. These toxins can have a major impact on our reproductive systems, not to mention our general health levels.
Some foods are more contaminated than others. The best way to avoid them is to eat organic where possible. You can also peel vegetables, wash the skin with organic soap, or soak produce in vinegar for several minutes as vinegar binds with some of these toxins which helps to remove them from the vegetable skins.
This doesn’t help if toxins have soaked into the produce but is better than nothing if you can’t get organic produce. Dr David Suzuki has a list of what he calls the clean 15 and the dirty dozen. The clean 15 foods usually don’t need heavy pesticides to grow them, while the dirty dozen are foods that use the most sprays. Some foods, especially fruit, are almost impossible to grow organically in large amounts without using sprays, so these are on the dirty dozen list.
A second well known endocrine disruptor is BPA which is a highly toxic polymer leached from plastics, along with other chemicals. These disrupt endocrine function in a way not entirely understood yet but appear to have negative effects on hormone balance.
Research has shown that BPA can get into the body in high doses from eating or drinking from the wrong containers, such as cans that are lined with BPA on the inside. Other sources of environmental toxins that act like estrogen are found in many personal care items such as shampoo, conditioner, face creams and soaps. Even cash register receipts are very high in BPA.
Low-grade inflammation and PCOS
Research indicates that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens. Certain foods can increase inflammation in the body such as gluten, grains, sugar, dairy products for some, processed foods, high fat, deep fried foods, artificial sugars, preservative, colours, chemicals in non-organic foods, and red meat, particularly for those with a weak digestive system.
Tests for inflammation makers include: C-reactive protein (CRP); sensitive C reactive protein (sCRP) even better than CRP; tumor necrosis factor (TNF); interleukin-6 (IL-6); interleukin-18 (IL-18); monocyte chemotactic protein-1 (MCP-1); and acute phase serum amyloid A (APSAA). These markers are more likely to be more elevated in women with PCOS compared to women without PCOS.
Oxidative stress (OS) and PCOS
Oxidative stress is considered a factor in PCOS along with other influences such as insulin resistance, obesity, androgen excess, and inflammation. Oxidative stress is where the body is unable to balance the effect of free radicals created by toxins with antioxidants.
Many investigations have revealed that OS levels are significantly increased in women with PCOS compared with women without PCOS, but oxidative stress is also observed with obesity, insulin resistance, hyper-androgenemia, and chronic inflammation independent of PCOS.
Having said that, it is still an important marker to be concerned about. If you are unsure if you have OS, then you can get any of the following tests done to see if this is an issue.
Oxidative stress can be tested by measuring circulating markers such as: malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPx). The reason why this is mentioned is because OS has been highly linked with an increased risk of developing other diseases and especially cancer.
Oxidative stress is bad for your body. It can be supported by adding anti-oxidant rich foods to the diet.
Hereditary factors and PCOS
If your mother or sister has PCOS then you have a greater chance of PCOS. Genetic methylation disorders, where the liver converts hormones on the wrong pathways rather than healthy pathways could be linked to PCOS. For more info, go to the article What is Methylation?
Other hereditary risk factors linking to diabetes, weight issues, cardiovascular weaknesses and other hormonal imbalances can pre-dispose you to PCOS. For example, one person’s genetic weakness for insulin resistance can develop into diabetes and yet another will develop into PCOS, maybe due to other genetic strengths and weakness combinations.
It is important to note that ‘methylation’ is what switches on or switches off certain genes that control our destiny of illness and disease. These methylation factors come from the foods we eat, so with good nutrition and good digestion, then our body can best support us to do what it innately does so well…look after us.
Things don’t just ‘go wrong’ by themselves; they must be triggered by something. So even if we have dodgy genes, we can still make adjustments that support us. We call this epigenetics.
Digestion and PCOS
Certain foods can affect your digestive system and then your liver where your hormones are converted.
If you don’t digest certain foods well, that can be due to poor digestion or not chewing food properly, or because some foods don’t agree with your body. Undigested foods can ferment in your digestive system and become toxic. The toxins then have to be cleared by your liver (that’s its job). The liver also has the role of converting your hormones to the correct pathways and to the correct types. See more about this in the Diet to Increase Estrogen.
If hormones are out of balance, then it is harder to clear PCOS. Thus, it is critical to look after and take care of the digestive system and liver.
Make sure you have the guidance and support of a health practitioner experienced in this area to ensure that all ‘bases’ are covered when treating PCOS.
Foods to avoid with PCOS
There are many factors that can contribute to PCOS or any hormonal imbalance. Diet has one of the most critical roles. There are many foods to beware of and many foods that can support the healing of PCOS.
It is important to ensure that your insulin doesn’t get too high by having a low GI type diet, or at least one that is not high in the types of carbs that stimulate insulin secretion. There are also certain foods that are excellent to keep your blood sugar balanced and support the right hormone pathways.
Here are some foods to beware of that may contribute to hormone imbalance:
Grain fed meat
In many countries, conventional meat is injected with Bovine Growth Hormone, (which can increase insulin-like growth factor 1 in humans). Other hormones such as estrogen and testosterone are injected into the animals via an earpiece.
In animals there is a certain ratio of omega 3 fats to omega 6 fats. Omega 6 fats are more pro-inflammatory and omega 3’s are anti-inflammatory. Grass fed animals have a higher ratio of the healthier omega 3’s. Grain fed animals have more of the pro-inflammatory omega 6 fats. Grain fed meat, especially beef is also a testosterone booster.
Farmed fish that are fed pellets with grain have less Omega 3 fats than wild caught fish or fish farmed and fed pilchards (like their normal diet).
Cruciferous vegetables
(Broccoli, cabbage, cauliflower, Brussels sprouts, kale). These types of greens can act as goitrogens which can decrease thyroid function when eaten raw and/or in very high doses. If you have thyroid issues as well as PCOS then it’s best to avoid these vegies until balance has been restored.
However, if you don’t have any thyroid aspect to your PCOS, then cruciferous vegetables are very helpful because they contain sulphuraphanes which aid good hormone conversion. The key is to eat low quantities of cooked cruciferous vegetables.
Dairy
Pregnant cows produce a protein that inhibits testosterone binding mechanisms and as such makes dairy the most androgenic (male hormone inducing) food we can eat. This includes butter, milk, yogurt, cream and any product from a pregnant cow or other animal’s milk.
Dairy from any animal contains high quantities of casein which is a difficult protein for the digestive system to break down at the best of times. Dairy also gives a significant insulin response which can irritate acne and PCOS.
Grains
Grains are very acidic, contain phytates (anti-nutrient), and are difficult to fully digest, subsequently increasing inflammation in the body. They are not advisable foods for PCOS, especially if associated with auto-immune hypothyroid.
Soy
Soy is another food that can be troublesome for some people, especially if they have hormone conversion issues. Soy has also been implicated in delayed ovulation. There are good and bad reports about soy products, but at this stage, we will go for safety and I suggest not to have soy products with PCOS or any hormonal imbalance (except menopause).
Other foods to avoid with PCOS
- Foods high in refined carbohydrates exacerbate insulin resistance. These include pasta, bread, pastries, and muffins – all should be avoided. Pastas made from bean or lentil flour are a great alternative.
- Sugary snacks, desserts, and drinks. When reading food labels look for sugar’s various names. These include sucrose, high fructose corn syrup, and dextrose. Sugar is also prevalent in many drinks such as soda and juice.
- Inflammatory foods such as processed meats or any processed foods in general, deep fried foods, and hydrogenated fats like margarine should be avoided, as well as any additives like nitrates/nitrites and anything artificial.
- Starchy foods, such as potatoes and corn are not helpful for PCOS
- Eggs and chicken are best avoided until your hormones and symptoms are balanced
Foods to support PCOS
Green, leafy vegetables
These have more nutrients per calorie than any other food. When fresh, green leafy vegetables are rich in iron, calcium, potassium, magnesium, vitamins K, C, E, and many of the B vitamins.
The B group of vitamins play a vital role in managing PCOS symptoms because they are responsible for sugar and fat metabolism, thyroid function, and general hormone balance. They are also rich in valuable anti-oxidants which are important to support any oxidative stress in the body.
Be wary about eating cruciferous vegetables such as kale if you have a thyroid imbalance.
Fruit
Many women with PCOS are reluctant to eat fruit as it can cause a spike in blood sugar levels and therefore create insulin. However in small amounts, especially if eaten with some nuts and seeds for sugar balance, fruit with a low GI value including cherries, berries, grapefruit, pears, apples, coconut, coconut milk, kiwi fruit, and papaya (pawpaw) are a great way to get extra phytonutrients, anti-oxidants and a sweet treat that won’t blow the diet.
Remember we need lots of anti-oxidants for clearing oxidative stress. There are some people who do better by avoiding all fruit and find a ketogenic (low carb) diet helpful.
Colourful vegetables
As well as the green vegetables, brightly coloured vegies are an important source of valuable anti-oxidants for those with PCOS (and indeed for everyone).
Good fats
Many people are still afraid of fats when trying to control their weight. It is true that if you have more fat than your body needs then it will be stored. But it’s also very important to eat enough good fats to provide energy, protect organs, maintain cell membranes, help the body to absorb and process nutrients, and maintain good hormone balance.
We also need good fats for weight loss. Yes, it sounds like a contradiction, but good fats help us to burn excess fat stores. Find out more in the article about the Weight Loss Diet. Healthy fats are found in nuts and seeds including coconut products, oily fish, avocado and olive oil.
Grass fed animals
While on the topic of fats, you may remember (above) that grain fed animals can promote inflammation. On the flip side, any animal you choose to consume should be grass fed and preferably organic if possible.
If you feel that you can’t afford organic meats, then try smaller servings or choose a dish where a small amount goes a long way, such as stir fries or salads. If you want healthy hormones, the extra cost for organic can pay great dividends by increasing good fats and decreasing chemicals in your body.
If you still feel that you cannot afford these meats, then there are plenty of meat free protein foods to choose from as an alternative.
Fibre rich foods
Because fibre is needed to keep your bowel working efficiently and to clear excess toxins and hormones that are being detoxified, it is important to have enough fibre rich foods in a diet for PCOS and for your general good health. Constipation is a leading cause of hormones being recycled back into the body’s system if they can’t be cleared efficiently via the bowels.
Antioxidant – glutathione
Fruits and colourful vegetables contain specific nutrients that act as powerful anti-oxidants. One of these is glutathione. Glutathione is THE most powerful anti-oxidant that the liver uses to clear and detoxify toxins from our blood, and the liver commonly runs out of this valuable nutrient.
I saw this often with clients’ live blood screenings where the red cells had ‘Heinz bodies’. These are little organelles in the red cells that are precipitations of Haemoglobin (iron) which are created because there was not enough glutathione to act as the red cells anti-oxidant. This was probably due to the excessive toxins in many of my clients’ bodies, which meant the liver had to use glutathione to bind to those toxins, which would rob their bodies of glutathione.
Glutathione rich foods are: broccoli, cauliflower, cabbage, Brussels sprouts, garlic, parsley, spinach, and beetroot/beets. As indicated earlier, some of these veggies are not suitable for those with a thyroid condition, however within this list of ‘Foods to support PCOS’ are non-goitrogens, so there is something for everyone to help boost their glutathione levels.
Anti-inflammatory foods for PCOS
Because inflammation is part of the PCOS story it is important to avoid foods and substances that increase inflammation (see above) while at the same time, include anti-inflammatory foods in the diet where possible. These include foods such as tomatoes, kale (take care with thyroid), spinach, almonds, walnuts, olive oil, coconut oil, blueberries, strawberries, cherries, and fatty fish (preferably wild caught) such as salmon, trout, and sardines.
Lifestyle and exercise to support PCOS
Diet is super important to support PCOS, but do not disregard other lifestyle contributing factors including:
Exercise
Exercise regularly, but not too hard or it can increase oxidative stress. Regular exercise has been shown to reduce androgens, induce ovulation, improve fertility, reduce anxiety and depression, and increase energy.
There have been many studies on the types of exercise that can help PCOS and they all seem to help, but the most important thing is consistency.
It’s best to include some type of physical activity every day for at least 20 min and build this up over time to around 1hr a day. This can be broken up into smaller sessions spread across the day, such as going to the gym, a brisk walk in the park, walking upstairs at work etc. A mixture of cardio and light strength training with weights is recommended.
Consider activities you enjoy such as aerobic, pump, or dance classes. But be gentle on yourself – embrace exercise as a joyful activity and love the gradual changes in your body.
Reduce excess body weight
By reducing excess weight you will also reduce insulin resistance, help regulate your cycle, normalise hormones more easily, feel much better and have more energy and vitality.
Stress management
Consider implementing a stress management program incorporating self-care and relaxation, a healthy diet and regular exercise.
Let’s call it the ‘RED program’…
Relax: ensure you schedule quality time to relax and nurture yourself
Exercise: initiate and maintain regular cardio and weight bearing exercises
Diet: enjoy healthy, nutritious foods to regain and maintain your vitality
This combo can have a significant impact on the symptoms of PCOS, insulin resistance, and your general good health and vitality.
To summarise
Go for a low sugar, low carb (avoid grains), moderate protein diet with good amounts of healthy fats and lots of colourful veggies and salads. This will help you to lose weight if needed and improve insulin balance, which can restore ovulation, increase fertility, and improve hormone balance attributed with PCOS.
A good balanced diet including all the good foods listed above combined with exercise and self-care can have a huge impact on eradicating PCOS and infertility and bring you back into natural balance.
Important:
Before you commence your diet, see your medical or health care professional for qualified guidance about what foods and supplements are best for your body. While on the diet do not stop any medications or supplements previously prescribed unless advised otherwise by your medical or health care professional.
During the early stages of a new diet, you may experience symptoms such as fatigue, headaches, or body aches, which may occur because your body is detoxifying. However, if you are unsure about a symptom at any time, check immediately with your medical or health care professional.
Case study: Treating PCOS naturally
Client name and identifying information changed
Gail was a head-strong business woman with an ideal of how she wanted her life to play out, but things weren’t going to plan. Gail had worked hard to build her empire and assets so that she could step back from work and financial stress and have her first child by the age of 28.
However, Gail was 32 when she saw me and felt life’s clock was ticking by without being able to fall pregnant. Gail hardly had any periods, which at first seemed to be a good thing for her, but not when she was trying to conceive.
Distracted by her heavy work load Gail hadn’t been medically checked for some time, but just prior to seeing me the first time she saw a doctor who diagnosed PCOS.
Gail wasn’t a typical PCOS sufferer – she was not overweight and had no facial hair or other outward signs of PCOS. But she was often very tired and ran herself on adrenaline with ‘help’ from lots of coffee with sugar and ‘energy drinks’.
Gail was one of those PCOS women who drive themselves with masculine energy and push their stress hormones to the edge. She was ‘the boss’ – at work, the gym and home. While there’s nothing wrong with being in control of your life, pushing yourself too hard can have its consequences. For Gail, it definitely affected her hormones.
Reviewing Gail’s diet, even though it was relatively healthy I could see there was room for improvement. Being a gym junkie, Gail drank protein shakes made with whey and mixed with milk. Because this was a potential testosterone driver, I suggested replacing the protein shakes with a protein rich breakfast after her workout and be mindful not to push herself too hard at the gym.
Gluten and other grain products were dropped, in exchange for more vegetables, salads and quality proteins. For snacks Gail had coconut oil and berries (her choice from the list I provided).
The coffee, sugar and soft drinks (sodas) had to go as these drained her adrenal glands (stress hormones) and most likely created an insulin problem. Instead she had herbal teas, mineral water or plain water with lime juice.
My big challenge was to convince Gail that she needed to look at how she lived her life in such a driven way…and to do something about it. Fortunately she was determined to do what was needed so she would be healthy enough to have a baby.
Gail progressed well with her diet and initially I saw her weekly to check how she was progressing with being less rushed and racy, and gentler and kind to herself. It took a while, but eventually something clicked and she realised what she needed to do.
Gail let go of some tasks and delegated more, rather than attempt to do everything herself. I also encouraged her to speak up for herself in a loving way, rather than react to situations.
One day Gail came in and was proud of herself for how she handled a situation and wondered why she hadn’t been doing this forever. In her words, “Life is so much easier now”.
The other thing we discussed was for her to observe (feel) her body in response to certain foods. Up to that point she was unaware that she had any digestive complaints because she was too busy to notice.
Gail became more aware of and in touch with her body, and felt when a food didn’t agree with her.
That way she refined her diet to one that suited her exactly. Within three months she was having a normal period and two months later she was pregnant.
Gail had two healthy children and now works part-time and loves her life. She was pleased she was diagnosed with PCOS because it helped her to realise that was her body’s way of talking to her so that she could make the changes necessary to have a healthy body, healthy babies and of course a better and more harmonious way of life.