What is PCOS?
Polycystic ovarian syndrome, or PCOS, is an endocrine and metabolic disorder affecting up to 20% of women of childbearing age making it the most common hormonal disorder and cause of infertility in women of reproductive age.
PCOS involves hyperandrogenism (high androgen production from the ovaries or adrenals) and chronic anovulation (meaning fewer than 10 periods in one year or cycles of over 35 days).
This syndrome requires a diagnosis of exclusion, meaning doctors need to rule out other possibilities such as hypothalamic amenorrhea, hypothyroidism, and hyperprolactinemia in order to properly diagnose PCOS in a patient.
In order to receive a proper diagnosis, you need to exhibit 2 of the following:
Irregular or missing periods (fewer than 10 periods in one year or cycles of over 35 days)
Excess androgen levels on blood test or symptoms of excess androgens
Polycystic cysts on ultrasound
PCOS is characterized by:
Irregular or missing ovulation
Increased LH to FSH on blood test
Decreased SHBG (Sex Hormone Binding Globulin)
Hair loss or thinning of hair
Hirsutism (excess hair growth on facial area, chest, belly, back..)
Polycystic ovaries (they look like a string of pearls on ultrasound)
To receive a diagnosis you need to assess:
Blood tests (FSH, LH, total testosterone,estradiol, progesterone, DHEA-S, SHBG, prolactin, thyroid panel, fasting insulin, glucose, lipid profile)
Commonly, with a diagnosis, patients are given pharmaceuticals such as the birth control pill, metformin, spironolactone, or clomiphene citrate.
However, they are not taught about how nutrition and lifestyle habits make a significant impact on the development and severity of PCOS.
Though PCOS is a complex disorder with no known causes, genetic and environmental influences have been studied and noted as potential triggers for PCOS.
When it comes to understanding PCOS and reversing symptoms, we need to address the core underlying imbalances, not just apply a band-aid.
Underlying foundations to address
Chronic low grade inflammation is a central factor to PCOS and plays a key role in symptoms such as acne, weight gain, hirsutism, irregular cycles, and cardiovascular risk.
Inflammation can stem from intestinal permeability, insulin resistance, toxin exposure, obesity, chronic stress, poor diet, and medications.
Inflammatory chemicals can damage our own cells while also disrupting hormones, damaging egg quality, worsening mental health, damaging the intestinal barrier, and promoting androgen production from the ovaries. Inflammation can be seen as a byproduct but also a trigger for PCOS, which is why it’s so important to address in any PCOS plan.
How do we calm inflammation?
Common allergenic foods such as corn, wheat, gluten, dairy, sugar, and soy can worsen intestinal permeability, but these foods will differ from person to person. A good way to identify which foods are problematic for you is to do an elimination diet. You may need to find a nutritionist or dietitian to follow this properly. Foods to avoid at all costs are trans fats, hydrogenated oils, processed foods, and refined carbs and sugars. These contribute to inflammation in everyone and should be avoided with PCOS.
I love using anti-inflammatories such as a good quality omega 3 supplement, quercetin, or curucmin for PCOS, however supplements are useless unless we address where the inflammation is coming from. This is where a diet and lifestyle analysis comes into play.
In cases of intestinal permeability, healing foods such as bone broth, turmeric, leafy greens, and fermented foods are recommended along with the elimination of inflammatory foods listed above. Intestinal healing supplements include probiotics, digestive enzymes, and L-glutamine.
The scientific evidence is becoming overwhelming in terms of how the microbiome influences our overall health. In addition, PCOS women have been shown to have a lower amount of bacterial diversity than women without the syndrome regardless of them being overweight or not.
The gut microbiome has a real influence on how PCOS can manifest as dysbiosis can worsen factors such as insulin resistance, inflammation, and obesity.
Studies are increasingly pointing towards targeting the gut microbiota to achieve results with PCOS and see shifts with inflammatory, cardiovascular, and metabolic markers.
Foods rich in fiber such as beans, legumes, non-starchy vegetables, oats, etc as well as prebiotics such as onions, garlic, asparagus, dandelion greens, artichoke, etc are an important part of a PCOS diet in order to provide the fuel for the beneficial microbes, alongside fermented foods or a good quality probiotic supplement.
Stress is a significant factor for PCOS. Not only do PCOS symptoms cause stress but the underlying imbalances are also worsened by stress and create further stress on the body. It is a vicious cycle. Most women with PCOS produce androgens from the ovaries and to a lesser extent, the adrenals. Regardless whether you make up one camp or the other, women with PCOS are much more affected by stress and high cortisol levels then non PCOS women. When we are under chronic stress we see higher cortisol levels which result in hormonal imbalances like low progesterone, excess estrogen, and high androgens.
Another factor to consider is that women with PCOS are actually more prone to producing higher levels of stress hormones than women without while also have more difficulty coping with stressors. This is why stress management is a central strategy to managing PCOS.
How do we manage stress with PCOS?
If you are practicing intense workouts with lots of cardio… bring it down a notch. Take up yoga or pilates, include walking into your daily routine, and give yourself some rest days!
Adopt a bedtime routine. Sleep is such an important component of a healthy PCOS lifestyle in order to bring down cortisol levels and regulate the circadian rhythm. Aim for 7-9 hours per night. Avoid electronics 1 hour before bed and create a relaxed environment before bedtime.
Practice meditation. This practice has been shown to lower stress hormones, improve mood, bring down inflammation and support the immune system.
Avoid or reduce coffee. Caffeine has a stimulatory effect on the adrenals and can worsen hormonal imbalances like PCOS. If you find yourself depending on your coffee to start your day or get through the afternoon slump, this is a sign you are relying on it. Find alternatives like dandelion, chicory root, or herbal blends like Four Sigmatic.
Alongside lifestyle changes, supplements such as rhodiola, ashwagandha, and magnesium bisglycinate can all help bring down cortisol and stress levels in the body.
Insulin resistance is present in about 50-70% of women diagnosed with PCOS. Though it is more common in obese and overweight individuals it can also be present in lean PCOS women who do not have problems with their weight.
This is important to note when assessing the core imbalances for PCOS and explains why testing is so important. Women with PCOS are more prone to insulin resistance due to genetic factors and the underlying chronic low grade inflammatory state.
Insulin resistance happens when cells do not respond properly to the hormone insulin to let glucose enter the cells to be used as energy. Also known as prediabetes, insulin resistance is mainly caused by lifestyle factors such as lack of exercise and poor diet consisting of refined carbs, hydrogenated oils, and excess sugars.
With PCOS the overproduction of insulin in the bloodstream triggers androgen production in the ovaries which can stall ovulation and promote symptoms like hirsutism, acne, and hair loss.
Signs and symptoms of blood sugar and insulin problems include abdominal adiposity, stubborn weight loss, dark pigmentation of skin folds, increased hunger and cravings, and skin tags.
One of the first things to do when it comes to balancing blood glucose and insulin with PCOS is to eliminate refined carbs and sugars which are void of nutrients and cause blood sugar spikes and crashes.
In addition, many of us don’t know that there are foods that spike insulin specifically, but not blood sugar, such as dairy and red meat. So it’s important to be aware that carbohydrates are not the only macronutrients to pay attention to.
Always aim for a balanced plate of protein, carbs, non starchy vegetables, and a healthy fat to ensure blood sugar and insulin remain balanced.
Strength training has been shown to benefit women with insulin resistant PCOS tremendously by increasing insulin sensitivity and reducing glucose levels.
I love inositol, chromium, and cinnamon as natural supplements to use alongside a healthy diet that support the regulation of insulin and may help increase sensitivity of receptors while balancing out blood sugar levels.
Environmental toxins have been shown to play a role in the development of PCOS. Exposure to toxins such as BPA in utero increases the risk of PCOS which means that if the mother was exposed to toxins during pregnancy, there is a greater chance of her daughter showing signs of PCOS later in life.
Research has confirmed elevated levels of BPA in patients with PCOS in comparison with healthy controls.
BPA and other endocrine disrupting chemicals contain estrogen-mimicking compounds (xenoestrogens) that increase our body’s supply of the hormone. This worsens PCOS symptoms and can contribute to obesity by altering fat storage, energy balance and promoting leptin and insulin resistance.
Though we don’t have much control over our mother’s health as an unborn child, we can support our detoxification pathways and limit our exposure to these chemicals.
Fibre is especially important in order to bind to and eliminate excess hormones via bile and the colon. So eat your vegetables at every meal!
Though we can’t control every toxin that we come into contact with, there are many ways to reduce exposure to endocrine disrupting chemicals at home. Switch out conventional beauty and body care products for organic brands or make your own, use ceramic, stainless steel or glass containers and water bottles, open the windows everyday to filtrate the air inside your home, keep shoes at the door to avoid toxins being brought into the home, and clean your clothes and sheets with cleaner brands.
I always recommend my clients use ewg.org to verify their current products and find alternative clean brands.
Some supplements that can support PCOS and detoxification include NAC, turmeric, and ALA.
My favourite foods for PCOS
Fermented foods contain beneficial bacteria that nourish our gut and provide many positive body wide effects. As women with PCOS are more prone to dysbiosis and have a lack of bacterial diversity in the gut, it is so important to include probiotics through the diet or with supplementation. Fermented foods like sauerkraut, kimchi, miso, tempeh, and kombucha can all be beneficial additions to a PCOS diet.
Green tea is a great substitute to coffee for PCOS women as it contains less caffeine but also the amino acid L-theanine, which is calming to the nervous system. You can find the compound, Epigallocatechin gallate or EGCG, that acts as a potent antioxidant and has been shown to decrease testosterone levels which triggers symptoms of androgen excess. It also has great results as an alternative to metformin in reducing fasting glucose levels and improving metabolic markers.
Flax seeds not only contain omega 3 fatty acids, they also provide fiber and lignans which have been shown to reduce androgen levels and thus reduce symptoms like hirsutism. Flaxseeds are a great addition to the diet to increase fiber status which can help with weight loss efforts and detoxification of toxins via the colon. Make sure you eat ground flax seeds if you also want to receive the omega 3 benefits and store in the fridge to avoid rancidity.
Leafy greens such as spinach, kale, chard, collard, arugula, mustard greens, bok choy, dandelion greens, and cabbage are definitely missing in the SAD diet. High in folate, B vitamins, magnesium, calcium, and fibre, they provide important nutrients that are needed for healthy ovaries and the female cycle. Green vegetables are highly alkaline and anti-inflammatory while also being lower glycemic which make them an ideal addition to a healthy PCOS diet.
Wild fatty fish
Wild fatty fish, like salmon, are a potent source of omega 3 fatty acids. Not only do they lower inflammation, they also can improve the androgenic profile in PCOS women by decreasing testosterone levels. Omega 3 foods and supplementation improves menstrual regularity, mood and brain function, insulin regulation, and the stress response by the adrenal glands.
Berries are my favorite fruit for PCOS! Low glycemic, anti-inflammatory, rich in antioxidants, high in fiber, berries are also high in flavonoids which have anti-inflammatory and antioxidant benefits. This is especially beneficial for PCOS to lower the chronic low grade inflammatory state.
Coconut oil is made up of medium-chain fatty acids (MCFA’s) which has been shown to actually helps us lose weight, lower cholesterol, improve diabetic conditions and reduce the risk of heart disease. For those who have trouble digesting fats, coconut is a great option as the body can utilize these fats immediately for energy, bypassing the liver and gallbladder. It also contains antimicrobial and antifungal properties, great for immunity and gut health, as well as helps increase metabolic rate.
Rich in monounsaturated fatty acids that protect heart health, reduce inflammation, and increase nutrient absorption such as fat soluble vitamins. It also contains a good amount of fiber to stabilize blood sugar and support the removal of toxins and weight loss.
What about soy?
Soy is a very controversial food especially when it comes to female hormones and PCOS, however research has shown promising results when it comes to PCOS. Studies show that soy isoflavones intake can be associated with lowered insulin levels, androgens, and triglycerides while improving markers of oxidative stress and BMI in PCOS women. Overall these phytoestrogens seem to produce protective effects on metabolic and hormonal abnormalities of women with polycystic ovary syndrome.
That being said, quality and quantity are important. Soy protein isolate and processed and GMO soy should be avoided, so choose instead organic and fermented soy products like tempeh, natto, tamari soy sauce, and miso. Soy is a common allergen and there is talk that excess consumption of soy products may interfere with thyroid hormone, therefore you may want to assess whether you do well with soy or not and stick to moderate consumption.
The bottom line? If you are going to eat soy opt for fermented and organic products in moderate quantities and avoid the processed soy products at all costs.
What about problem foods for PCOS?
Though diet is specific to each person, the following foods are commonly eliminated in a PCOS diet to improve symptoms and phenotypes:
Dairy can be problematic with PCOS due to its inflammatory effects. Many people have trouble digesting lactose in dairy products but also the protein casein. A1 casein is particularly problematic because it promotes inflammation and can interfere with metabolic function. Milk naturally contains small amounts of hormones (even more so in conventional products) including testosterone, progesterone, insulin, and the growth hormone called IGF-1, or insulin growth factor. IG-F is problematic as it stimulates insulin and causes the ovaries to over produce testosterone. For these reasons, I usually recommend clients avoid dairy as much as possible and I see a lot of success going dairy free. Goat’s milk is a good alternative to cow’s milk in moderation as it contains less lactose and contains A2 casein, which doesn’t trigger inflammation like A1 does.
The gluten-free movement is becoming a real health trend but this protein can actually cause a lot of problems with PCOS. Though celiac disease is rare, gluten sensitivity and intolerance is on the rise with the increased use of pesticides like glyphosate and the over processing of grains such as wheat. Not to mention, gluten has been shown to trigger intestinal permeability in the intestines which can lead to autoimmunity, malabsorption, decreased nutrient status, but also increase insulin and leptin resistance. Opt for naturally gluten free grains and starches like quinoa, rice, sweet potatoes, and yams.
Sugar and refined carbohydrates are usually the first foods I recommend ditching with PCOS. As up to 70% of PCOS women struggle with insulin resistance, their ability to process glucose is impaired. Which means they can’t handle processed sugars. This kind of sugar causes a spike in blood sugar and insulin, drives up inflammation, depletes important micronutrients, and feeds the pathogenic bacteria in the gut. This is a disaster for PCOS and only worsens symptoms like energy crashes, brain fog, weight gain, and acne.
Understanding and managing PCOS by Elizabeth Howe
8 Steps to Reverse Your PCOS By Fiona McCulloch