Dietary Management of Polycystic Ovarian Syndrome (PCOS)
What is PCOS?
PCOS is a syndrome (a collection of symptoms) due to hormonal imbalance which is estimated to affect 1 in 5 women of child bearing age. According to the Rotterdam Criteria, PCOS is defined by the presence of two or more of the following:
Oligomenorrhoea (infrequent periods) – which means you do not ovulate regularly
Hyperandrogenism (Excess Androgens) – high levels of "male" hormones which may cause excess facial or body hair
Polycystic Ovaries – your ovaries become enlarged and contain fluid-filled sacs that surround the eggs. It is important to note that cysts on the ovaries do not necessarily mean you have PCOS. Ovarian cysts and PCOS are different things. Hormonal imbalance is a part of the PCOS diagnosis.
Other common symptoms of PCOS include:
· thinning of scalp hair or male-pattern baldness
· acne
· food cravings, particularly for carbohydrate or sugary foods
· difficulty losing weight and/or easily gaining weight
· fertility problems (difficulty getting pregnant)
· depression and anxiety
· binge eating
· body image concerns
· sleep disturbances or sleep apnoea
Many of these symptoms are related to an imbalance of reproductive hormones (FSH, LH, oestrogen and progesterone) and high hormone levels of androgens and insulin. Insulin is a hormone which helps the body use energy from food. Insulin also increases testosterone levels. Having even slightly increased levels of testosterone can upset the balance of hormones in the body and lead to acne, excess hair and irregular periods
Weight Loss
A gradual weight loss, in those with a BMI that is greater than 25, of approximately 5-10% has also been linked with normalising periods, reducing inflammation and improving fertility.
However while weight loss can improve some of PCOS symptoms, it is difficult for those with PCOS to lose weight. Restrictive diets can be more harmful to health and lead to a developing poor relationship with food. In addition, restrictive diets and stress about weight can increase our stress hormones which can make it more difficult for those with PCOS to lose weight. Although you may have read about various fad diets for managing PCOS, international guidelines recommend adopting healthy lifestyle behaviours, including healthy eating and regular activity. Support from a dietitian can help in adopting a long-term, sustainable weight management plan tailored to your needs.
How can food help manage PCOS symptoms?
Regular Meal Pattern
Eating balanced meals regularly helps keep blood sugar levels stable reducing insulin resistance. A balanced meal contains protein, fibre and a measured portion of low GI (Glycemic Index) carbohydrate and a source of healthy fats.
Low GI Carbohydrates and Carbohydrate Portion Sizes
Following a regular meal pattern with balanced meals including the right amount of low GI carbohydrate has been linked to improved insulin resistance, hormone regulation and management of symptoms of PCOS.
All carbohydrates are broken down into glucose in our blood stream which stimulates the pancreas to release insulin to allow glucose to enter our cells and provide us with energy. They key point here is that low GI carbohydrates are broken down more slowly providing a steady release of glucose into the blood stream. Adding protein, fibre and healthy fats alongside a low GI carbohydrate help to slow down this breakdown of glucose into our blood stream further. This results in a steadier release in insulin and can helps to keep reproductive hormones and blood sugar levels more stable.
As a general guide portion out food at meal times as follows; ½ plate vegetables, ¼ plate protein and ¼ plate carbohydrates to ensure you are getting the right quantity of different food groups on your plate.
Below is a summary of low GI carbohydrate options:
Carbohydrate food Lower GI choice
Bread Multigrain, granary, rye, seeded, wholegrain, oat, sourdough Potatoes New potatoes in their skins, sweet potato
Pasta All pasta, cook until al dente and noodles
Rice Basmati rice, long grain and brown rice
Other grains Bulgur wheat, barley, couscous and quinoa
Breakfast cereals Porridge, Weetabix, most oat and bran-cereals
Omega 3
Omega-3 polyunsaturated fatty acids, have potent anti-inflammatory effect in the body and can improve some of the metabolic and inflammatory disorders of PCOS such as insulin resistance, inflammation of endothelial cells, dyslipidaemia and fertility issues. Aim for one to two portions of oily fish per week (salmon, sardines, mackerel). Other sources of omega-3 which are easily added to oats or yoghurt for breakfast or as a snack include chia and flaxseeds, and walnuts. Olive oil is another source and can be used in salad dressings or when cooking.
Vegetables, Legumes and Fruit
Vegetables, legumes and fruit are rich in antioxidants and are a source of soluble and insoluble fibre. Antioxidant rich foods can help reduce some of the inflammatory symptoms of PCOS. Their high fibre content also makes them a low GI food and therefore can help with insulin resistance and balancing blood sugar levels. Here are ways to increase fibre intake;
Aim for half of your plate to be full of vegetables at meal times
Include antioxidant rich fruit such as berries at breakfast and snack time
Add frozen berries to a smoothie
Add chickpeas into a home made curries
Add kidney beans or lentils to a chilli or Bolognese (see recipe for red lentil curry)
Add mixed beans/chickpeas/kidney beans/lentils to a salad or soup
Include hummus as snack (see homemade hummus recipe on website)
Vitamin D
Vitamin D deficiency may exacerbate some PCOS symptoms. The main source of vitamin D is through sun exposure, however in Ireland the sun’s rays are only strong enough for us to produce vitamin D between September and April. Therefore, it is recommended that adults in Ireland take a 15µg daily vitamin D3 supplement during these months. It is important to note that too much vitamin D can be toxic, so it is not advised to take more than 20µg vitamin D from supplements daily.
Exercise
Research has shown that for women with PCOS, aerobic exercise, particularly sessions that involve high intensity activity can have significant impact on reducing insulin resistance and improves the uptake of glucose into cells.
The general recommendations for exercise are 30 minutes of moderate-intensity physical activity 5 days per week, plus strengthening exercises on at least 2 days per week. Regular strength training has been found to have positive impact on insulin sensitivity of cells and also help reduce androgen levels. Finding an exercise regime that you enjoy is a key factor as this is what you will be most likely to stick to long term. If you do not have a structured exercise regime in place start small but be consistent. Even starting with 10 minutes walking from your front door and back daily, increasing this slowly and incorporating a few minutes of fast-paced walking can help to slowly build fitness levels. If you are getting started with strength training reach out for support to get a basic set of exercises you can do regularly at home if you do not have the time to get to a gym.
Stress
Stress can exacerbate hormonal imbalances and many women with PCOS find that their symptoms are worsened when they are stressed. Activities that can help reduce stress include meditation, deep breathing, yoga and exercise.
A good free resource for stress management is stresscontrol.ie.
Sleep
Women with PCOS are at an increased risk of sleep disorders. When we are sleep deprived we often feel more hungry and have increased sugar cravings. Some sleep tips include:
Avoid all screen for 2 hours before sleep
Dim lights in the house 1-2 hours before sleep-time
Avoid all caffeinated drinks after 12pm
Have a warm bath before bed about 10 drops of lavender
Practice a little Meditation /Breathing Exercises for even 10 minutes daily
Try a Herbal tea before bed e.g. Chamomile; Night-time tea
These are some suggestions but trial different things to find what routine works best for you