PCOS and Nutrition and Behavior Interventions
- erdma278
- Feb 3, 2023
- 5 min read
Updated: Apr 3, 2023
PCOS, or Poly Cystic Ovary Syndrome, is a complex hormonal disorder that occurs in women of reproductive years. PCOS is characterized by 4 pillars that are all interrelated and have bidirectional effects on each other. These pillars an insulin resistance, hyperandrogenism, irregular menstrual cycles, and cysts on the ovaries. (1) These pillars can lead to less-than-desirable symptoms such as infertility, obesity, excess hair growth or male pattern baldness, acne, and many more. Nutrition plays a critical role in managing PCOS and the symptoms that come along with it. Controlling blood glucose is going to be critical in order to help with insulin resistance, this can be accomplished through exercise, eating adequate fiber, limiting processed food, eating balanced meals consistently throughout the day, and getting the micronutrients in.
The 4 Pillars:
1) Insulin Resistance
Insulin resistance, also known as insulin insensitivity, occurs when the body has built up a tolerance to insulin and no longer uses the hormone efficiently. (2) Insulin is a hormone produced by the pancreas and is responsible for transporting glucose to cells to be used as energy. When insulin resistance occurs, cells are not able to get glucose from the blood for energy. This then causes blood sugar to be high since it is not able to get into the cells. This can then to symptoms like excessive thirst and hunger, fatigue, and frequent urination. Check with your physician if you are experiencing any of these! These symptoms can then lead to obesity, high blood pressure, high triglycerides, and even depression. Which are all associated with PCOS.
2) Hyperandrogenism
Hyperandrogenism is the presence of excess male sex hormones like testosterone, androsterone, and androstenedione in women. (3) This is found in women with PCOS due to many different mechanisms, one of them being, insulin resistance. When insulin resistance occurs, more insulin is produced to try and bring glucose to the cells which causes the production of the hormone SHBG (sex hormone binding globulin) in the liver to decrease. SHBG is responsible for binding to sex hormones like estrogen and testosterone. When SHBG is low, less binding occurs, freeing up testosterone and creating an excess of it. (1) Excess male hormones can cause acne, hirsutism, ovulation issues, and male pattern baldness. (1) Hiristim is excess hair growth in male-like patterns.
3) Irregular Menstrual Cyles
75-85% of women with PCOS will experience irregular menstrual cycles. (4) A normal menstrual cycle occurs anywhere from 23-35 days. Women with PCOS may experience long or irregular cycles. This is due to the high levels of androgens circulating as well as the low levels of SHBG. This affects LH (Luteinizing hormone) and FSH (follicular stimulating hormone) which modulates the cycle, causing women with PCOS t to have irregular cycles.
4) Cysts on the Ovaries
Having cysts on the ovaries is a SYMPTOM of PCOS, not a cause. Meaning, PCOS is what causes the cysts to occur, not the other way around. One does not have to have cysts on the ovaries to be diagnosed with PCOS. These cysts also have an effect on the ovaries and can make them unable to release an egg, therefore preventing ovulation. (5)
Dietary Interventions:
Diet is so intertwined with PCOS and plays a significant role in the development and management of this condition. The following dietary tips have been shown to help correct insulin resistance and better manage PCOS symptoms.
Eating well-balanced meals consistently throughout the day, without skipping any!
Consuming fiber and complex carbohydrates
Limiting refined sugars and high-fat diets
Getting adequate Omega-3 intake
1) Eating well-balanced meals
A well-balanced meal consists of:
a complex carbohydrate (potatoes, rice, whole grain pasta and bread, starchy vegetables)
protein (chicken, ground beef, pork, salmon, tilapia, tofu, turkey, ham)
healthy fat (avocado, nuts, olive oil, butter)
vegetables (broccoli, cauliflower, carrots, green beans, spinach, cucumber)
fruit (apples, bananas, blueberries, strawberries, tomatoes, grapes)
and fiber (which can be found in complex carbs, vegetables, or fruits).
A general rule of thumb is to fill half the plate with vegetables, a quarter with protein, and a quarter with complex carbs and have the fats sprinkled throughout and fruit incorporated inside the dish or on the side.
Eating 3 meals around the same time each day has been shown to help your body better manage glucose and regulate insulin levels, easing insulin resistance and the consequences that come with that.
2) Consuming fiber and complex carbohydrates
As mentioned above fiber and complex carbohydrates are ideal!
Fiber has been shown to lead to greater insulin sensitivity which will help control blood glucose. (1). Fiber also delays gastric emptying, which is how fast the food is digested and absorbed. Delaying emptying will lead to greater satiety and further control of blood sugar.
Fiber also has key nutrients like phytochemicals, which have been shown to lower blood sugar and increase insulin sensitivity. Fiber also has positive effects on the gut microbiome by increasing the diversity of bacteria, which indicated a healthy gut microbiome. (1) In turn, the healthy gut microbiome can reduce insulin resistance. (1)
3) Limiting refined sugars and high-fat diets
Refined sugars have been linked to causing inflammation which in turn can cause androgen production and insulin resistance. (1) Refined sugar may also have a negative effect on the gut microbiome leading to oxidative stress. Oxidative stress is essential for an imbalance between free radicals (bad) and antioxidants (good). This can lead to many undesirable side effects including insulin resistance and hyperandrogenism. (1)
Examples of foods with refined sugars include foods with white flour in them, white bread, candy, breakfast cereals, and sweet desserts. Remember to keep balance in your diet and enjoy these foods occasionally!
4) Consuming adequate Omega-3's
Omega-3's are essential fatty acids that have a whole host of benefits including being anti-inflammatory and improving brain health. For those with PCOS, Omega 3's, AKA α-Linoleic acid, increases HDL (good cholesterol) and increases SHBG which will bind up free testosterone and decrease excess androgens. (1) It is recommended for women with PCOS to get 1-4 grams of Omega-3's per day!
Sources of Omega-3's:
- Wild-caught Salmon (1.7 g/ 6 oz)
-Tuna (1.4g/6 oz)
-Flaxseed oil (7.26 g/ TBSP)
-Ground Flax-seeds (2g/ TBSP)
-Chia seeds (5g/ TBSP)
-Walnuts (2.5 g/ oz)
Supplementation can be used as well! These include fish oil, krill oil, cod liver oil, and algae oil (vegetarian). (6)
Conclusion:
PCOS can be an incredibly difficult condition to manage. This is one of the most common underdiagnosed conditions in women as symptoms are easy to look over or get mistaken for something else. (7) Advocate for yourself and work with your trusted physician to take action and combat it, hope is there! Remember to manage that blood sugar with well-rounded meals with complex carbs, veggies, proteins, fats (especially Omega-3's!), and fruits that are high in fiber as well! Be aware of the negative effects refined sugars can have on PCOS and enjoy those foods on occasion.
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