The role nutrition plays in PCOS (Polycystic Ovary Syndrome).
By Dr. Dylan Cutler, Ph.D. in Obstetrics & Gynecology, PCOS Fighter (IG @dr.dylancutler)
What is PCOS?
PCOS is short for polycystic ovary syndrome. PCOS is the most common hormonal condition in women impacting our reproductive, metabolic, and psychological well-being. Evidence shows PCOS affects up to 18% of women, as well as trans men and non-binary folks, worldwide (1).
What are the symptoms of PCOS?
Since PCOS is a heterogenous syndrome, symptoms can vary from person to person. The most common symptoms include irregular or absent cycles, acne, excess facial and/or body hair, hair loss from our head, unexplainable weight gain along with difficulty losing weight, skin tags, excessive sweating, insomnia, sleep apnea, and more.
How is PCOS diagnosed?
According to the most widely used diagnostic criteria, a diagnosis is made when any 2 of the following 3 criteria are present:
Hyperandrogenism (diagnosed by elevated blood androgens OR excess facial/body hair)
Irregular periods or no periods (likely meaning we are not ovulating)
Polycystic ovaries visible via ultrasound (not to be confused with ovarian cysts)
What are the long-term risks associated with PCOS?
If PCOS is unmanaged there is an increased risk of type 2 diabetes, heart disease, and endometrial cancer (2). In addition, people with PCOS are more likely to experience infertility, anxiety, depression, poor body image, low self-esteem, eating disorders, and a higher suicide rate (3,4).
Can nutrition support PCOS?
Lifestyle management is the recommended first-line approach for PCOS (5). Specifically, nutrition, physical activity, and stress management have been shown to improve reproductive, metabolic, and mental health (6,7).
Blood sugar and insulin regulation are key factors in PCOS management. Nutrition is one way we can manage blood sugar levels. Not only can blood sugar and insulin regulation help improve symptoms of PCOS, but this also helps to prevent type 2 diabetes.
Another factor often involved in PCOS is inflammation (8). Women with PCOS have been found to have increased levels of C-reactive protein, an inflammatory marker. Many diseases are associated with chronic inflammation, including type 2 diabetes and heart disease (9, 10).
Therefore, filling our plates with anti-inflammatory foods can help reduce our risks. Anti-inflammatory foods include turmeric, garlic, berries, leafy greens, nuts, avocado, broccoli, tomatoes, green tea, and dark chocolate (>75% cacao). In addition, reducing inflammatory foods can help reduce chronic inflammation (meat, dairy, many processed foods, fried foods, refined carbohydrates, and sugar-sweetened drinks/candies, etc.).
What about plant-based nutrition?
Research shows whole food, plant-based nutrition is associated with a lower prevalence of type 2 diabetes, metabolic syndrome risk factors, and death from all causes (11, 12, 13, 14, 15).
One reason that plant foods are effective is because they are great sources of fiber. Food high in fiber, like whole grains, fruits, vegetables, and legumes, has countless benefits, particularly for PCOS (16). Not only can fiber help combat insulin resistance, but fiber also can help improve cholesterol levels, support digestion, promote a healthy gut microbiome and reduce the risk of heart disease.
Another supportive factor of whole food, plant-based nutrition for PCOS is that it is low in saturated and trans fats. Both saturated and trans fats can increase the risk of heart disease and type 2 diabetes (17, 18, 19). Saturated fat may also increase inflammation, insulin resistance and hyperandrogenism in women with PCOS (20). Food high in saturated fats include animal products, such as meat and dairy, palm oil, and coconut oil, while trans fats are often found in vegetable shortening, partially hydrogenated oils, baked goods, and fried foods.
Finally, with disordered eating being so common in people with PCOS, plant-based nutrition offers many an escape from the caloric and macro-centric mind traps of diet culture. Research has shown it is not necessary to track caloric intake when consuming a whole food, plant-based diet, even when the desired outcome studied was weight loss (21). An unrestricted abundance of fruits, vegetables, legumes, whole grains, nuts, and seeds nourishes and satiates while supporting our quest for the healthiest, happiest body and mind.
Disclaimer: This is information, not medical advice. Please consult with your healthcare provider regarding PCOS diagnosis, management, and treatment.
Dr. Cutler’s Website: www.phruitfuldish.com
References:
March, WA, Moore, VM, Willson, KJ, et al. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod. 2010;25:544-51.
Månsson, Mattias, et al. "Women with polycystic ovary syndrome are often depressed or anxious—a case control study." Psychoneuroendocrinology 33.8 (2008): 1132-1138.
Veltman-Verhulst SM, Boivin J, Eijkemans MJ, Fauser BJ. Emotional distress is a common risk in women with polycystic ovary syndrome: a systematic review and metaanalysis of 28 studies. Hum Reprod Update. 2012;18:638-651.
Daniilidis A, Dinas K. Long term health consequences of polycystic ovarian syndrome: a review analysis. Hippokratia. 2009;13(2):90.
International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Monash University, Melbourne, Australia 2018.
Lin AW, Lujan ME. Comparison of dietary intake and physical activity between women with and without polycystic ovary syndrome: a review. Adv Nutr. 2014;5:486-496. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. Monash University, Melbourne, Australia 2018.
Stefanaki C, Bacopoulou F, Livadas S, et al. Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Stress. 2015;18:57-66.
González F. Inflammation in polycystic ovary syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids. 2012;77(4):300-5.
Kolb H, Mandrup-Poulsen T. The global diabetes epidemic as a consequence of lifestyle-induced low-grade inflammation. Diabetologia. 2010 Jan;53(1):10-20.
Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, Fadl YY, Fortmann SP, Hong Y, Myers GL, Rifai N, Smith SC Jr, Taubert K, Tracy RP, Vinicor F; Centers for Disease Control and Prevention; American Heart Association. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003 Jan 28;107(3):499-511.
Dinu M, Abbate R, Gensini GF, Casini A, Sofi F. Crit Rev Food Sci Nutr. 2017 Nov 22; 57(17):3640-3649.
McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. 2017;14(5):342-354. doi:10.11909/j.issn.1671-5411.2017.05.009
Tonstad S, Butler T, Yan R, Fraser GE. Diabetes Care. 2009 May;32(5):791-6.
Rizzo N S et al. Dia Care 2011;34:1225-1227.
Orlich MJ, Fraser GE. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings. Am J Clin Nutr. 2014;100 Suppl 1(1):353S-8S. doi:10.3945/ajcn.113.071233.
Cutler, D., Pride, S., & Cheung, A. (2019). Low intakes of dietary fiber and magnesium are associated with insulin resistance and hyperandrogenism in polycystic ovary syndrome: A cohort study. Food Science & Nutrition, 7(4), 1426-1437.
Wang L, Folsom AR, Zheng ZJ, Pankow JS, Eckfeldt JH, ARIC Study Investigators. Am J Clin Nutr. 2003 Jul; 78(1):91-8.
Iqbal MP. Trans fatty acids - A risk factor for cardiovascular disease. Pak J Med Sci. 2014;30(1):194-197. doi:10.12669/pjms.301.4525
Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD011737. DOI: 10.1002/14651858.CD011737.pub2. Accessed 27 March 2021.
González F, Considine RV, Abdelhadi OA, Acton AJ. Inflammation Triggered by Saturated Fat Ingestion Is Linked to Insulin Resistance and Hyperandrogenism in Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2020 Jun 1;105(6):e2152–67. doi: 10.1210/clinem/dgaa108. PMID: 32140727; PMCID: PMC7150616.
Turner-McGrievy GM, Davidson CR, Wingard EE, Wilcox S, Frongillo EA. Comparative effectiveness of plant-based diets for weight loss: A randomized controlled trial of five different diets. Nutrition. 2015 Feb; 31(2): 350-358