What is The Best Diet for PCOS?
Intro
Many people who see me for holistic and integrative acne treatment are concerned that they might have PCOS. PCOS stands for Polycystic Ovarian Syndrome, and it’s a complex hormone-metabolic disruption that could lead to symptoms of cystic acne, head hair loss, facial hair growth, body hair growth, irregular menstrual bleeding/periods, fertility issues, and more. PCOS is seen in 15-20% of females, and science shows that those with PCOS may also experience metabolic syndrome, high blood pressure, cholesterol issues, blood sugar issues/diabetes, and more.
Conventional treatment for PCOS involves symptom management. When fertility is not the main concern for someone with PCOS, conventional treatment usually involves the use of long-term hormonal birth control. However, more people with PCOS are advocating more other options beyond hormonal birth control since this usual option does not address metabolic syndrome, high blood pressure, cholesterol issues, blood sugar issues/diabetes, etc.
More people with PCOS are also looking for other options since more people are understanding that hormonal birth control does not address the underlying causes affecting hormones that are playing a role in the development of PCOS. And, these concerns are why people with PCOS come to see me for holistic and integrative PCOS management.
As the scientific community learns more about PCOS, research shows that blood sugar issues appears to play a large role in the development of PCOS. And because of this, science has been looking at diet and exercise as possible options to address blood sugar issues in those with PCOS. As more literature comes out, it can be confusing for many people to understand what is the best diet for PCOS. So, let’s speak about them!
In this blog post, we will address 4 different eating patterns/diets and what science says about them and PCOS.
NOTE: THIS BLOG POST IS MEANT TO BE EDUCATIONAL ONLY, AND IS NOT MEANT TO DIAGNOSE, PREVENT, TREAT, OR CURE. PEOPLE SHOULD ALWAYS CONSULT THEIR TRUSTED LICENSED PROVIDER BEFORE TRYING ANY NEW TREATMENTS
Low-glycemic diet
Before we deep dive into the low-glycemic diet, and what it’s about. We need to make sure we understand the biology of blood sugar (aka blood glucose) maintenance in the body.
Insulin is a pancreatic hormone that is responsible for regulating and balancing blood sugar levels, and insulin will spike when we consume sugars and carbohydrates. The body naturally wants to bring down blood sugar levels, and will maintain those levels as best as it can by making insulin. However, when blood sugar levels continue to be high, and the body continues to pump out more and more insulin, the body can start to become resistant to insulin - leading to insulin resistance, and possible downstream pre-diabetes and diabetes.
Insulin is important when speaking about PCOS since insulin is thought to contribute to high testosterone seen in those with PCOS, leading to the symptoms of PCOS. This is because research says that high levels of insulin have been:
Thought to activate cells in the ovaries to over-produce testosterone,
And thought to prevent natural production of proteins that bind onto testosterone to reduce levels of free testosterone.
Okay, now let’s talk about glycemic index and the low-glycemic diet.
The Linus Pauling Institute (LPI) defines the glycemic index (GI) as “a measure of the blood glucose-raising potential of the carbohydrate content of a food.” And, the LPI states that “consumption of high-GI foods causes a sharp increase in [post-meal] blood glucose concentration that declines rapidly, whereas consumption of low-GI foods results in a lower blood glucose concentration that declines gradually.” So, focusing on low-glycemic foods may support more-steady blood sugar levels to support healthy insulin levels. And, the most well-known example of a low-glycemic diet is the DASH diet.
Now, what does science have to say about low-glycemic foods and PCOS?
Science shows that eating low-glycemic foods reduced symptoms of PCOS, especially improved menstrual regularity, compared to those eating a “conventional healthy diet.” Additionally, research says that eating low-glycemic foods combined with protein in a modified hypocaloric diet led to lower insulin levels and lower heart-specific inflammation in those with PCOS. Science also shows that a low-glycemic diet may reduce body weight in those with pre-diabetes and diabetes! Additionally, science shows that a combination of a low-glycemic diet with regular exercise for 12 weeks can increase insulin sensitivity, with regular exercise being 1 hour per day with a maximum heart rate of around 85% for at least 5 days per week
Anti-inflammatory diet
According to Harvard Health, an anti-inflammatory diet is a way of eating that uses foods and beverages to “reduce inflammation, and with it, chronic disease.” There is no specific regimen for an anti-inflammatory diet and is usually composed of eating non-processed foods, such as fruits, vegetables, nuts, seeds, whole grains, legumes, fish, and healthy oils. The most well-known anti-inflammatory diet is the Mediterranean Diet.
What does science have to say about the anti-inflammatory diet and PCOS?
A study completed in 2015 showed that non-pregnant, overweight, and obese adult females with PCOS who did an anti-inflammatory, hypocaloric diet with regular physical activity for 12 weeks led to:
Improvements in blood sugar, cholesterol, and inflammation levels;
improvements in hormones, period regularity, and fertility;
And moderate weight loss!
Since the definition of an anti-inflammatory diet is broad, researchers of this 2015 defined an anti-inflammatory diet as consuming legumes, fish, and low-fat dairy products in a “Mediterranean context” with 25% proteins, 25% fat, and 50% carbohydrates, with the diet also focusing on low-fat, low-saturated fat, and moderate-to-high fiber intake.
Ketogenic diet
The ketogenic diet is a diet that is “very low-carbohydrate and high-fat” that has become popular due to people reporting weight loss and more. The ketogenic diet has also become a popular topic of conversation in the PCOS community since many people with PCOS wonder if eating low carbohydrates and experiencing weight loss may improve symptoms of PCOS.
The ketogenic diet defined as having high fats, moderate proteins, and very low carbohydrates, and literature says that the ketogenic diet has “approximately 55% to 60% fat, 30% to 35% protein, and 5% to 10% carbohydrates” with “carbohydrates [amounting] up to 20 to 50 g per day”
So, what does science have to say about the ketogenic diet & PCOS?
Research from a 2020 study shows that 12 weeks of a hybrid ketogenic-Mediterranean diet in overweight females with PCOS led to:
Reductions in fasting blood sugar and insulin levels;
Improved markers for insulin resistance;
Reduction in testosterone;
And weight loss and reduction in body mass index!
Researchers of this study did indicate that severity of symptoms of high testosterone did not change after 12 weeks. And after reading this research article, I noticed that there were no metrics or data on menstrual period regularity.
Intermittent fasting
According to John Hopkins Medicine, intermittent fasting is an “eating plan that switches between fasting and eating on a regular schedule” that has been shown as a “way to manage your weight and prevent — or even reverse — some forms of disease.” Much like the ketogenic diet, intermittent fasting has also become a popular topic of conversation in the PCOS community.
So, what does science have to say about intermittent fasting and PCOS?
A 2021 study investigated the effects of time-restricted fasting in females with anovulatory PCOS for 5 weeks (the term “anovulatory” means that they had absent menstrual periods). In this study, subjects ate freely during an 8-hour period from 8 am to 4 pm and drank only water or calorie-free beverages during the 16-hour fasting period. So, subjects in this study were on a 16:8 intermittent fasting schedule.
And after doing this form of intermittent fasting for 5 weeks, researchers saw the significant improvements in fasting insulin, insulin resistance markers, testosterone and other androgen levels, and more. Researchers also saw that this form of intermittent fasting led to improvements in cycle regularities in 73% of subjects.
Summary & Takeaways
Okay, so you’ve gotten to the end. Now, what’s the best diet for PCOS? Well, before we speak about that let’s summarize what we’ve spoken about so far:
Low-glycemic diet: Science shows that eating low-glycemic foods reduced symptoms of PCOS, such as improved menstrual period regularity. The most well-known type of the low-glycemic diet is the DASH Diet.
Anti-inflammatory diet: Research says that an anti-inflammatory diet led to improvements in blood sugar, cholesterol, and inflammation levels; improvements in hormones, period regularity, and fertility; and moderate weight loss in non-pregnant, overweight, and obese adult females with PCOS. The most well-known type of the anti-inflammatory diet is the Mediterranean Diet.
Ketogenic diet: Science shows that a hybrid Ketogenic-Mediterranean Diet led to reductions in fasting blood sugar and insulin levels; improved markers for insulin resistance; reduction in testosterone; weight loss; and reduction in body mass index in overweight females with PCOS.
Intermittent fasting: Science shows that a 16:8 intermittent fasting schedule in females with anovulatory PCOS led to significant improvements in fasting insulin, insulin resistance markers, testosterone and other androgen levels, and more. Researchers also saw that this form of intermittent fasting led to improvements in menstrual period regularities in 73% of subjects.
So, what’s the best diet for PCOS?
A commonly-cited study reviewing dietary patterns and PCOS concluded that any form of dietary composition is helpful as long as it led to weight loss, since “weight loss improved the presentation of PCOS.” However, this begs a couple questions:
What does this mean for those with lean PCOS? People with lean PCOS have may not have to lose weight at all!
Which diet would be recommended by your provider?
The best answer is: The “best” diet depends on many factors!
Navigating diet and PCOS can be confusing and daunting to do on your own! There are many factors to consider when considering dietary and lifestyle changes since there are many pros, cons, and barriers for different recommendations. And, changing diet and lifestyle can be one of the hardest and most-invasive things that someone can do since it can impact many levels of their life.
Dietary recommendations from your provider will depend on:
What science has to say about the effectiveness of a specific diet and how that relates to your personal health;
How much of a change you are willing to make;
And what personal barriers are present that would make some dietary changes less of a viable option.
Let’s talk about the ketogenic diet for example: Even though the ketogenic diet has been shown to improve weight, it has not been shown to improve menstrual period regularity (despite science indicating that weight loss generally improves PCOS). Additionally, science shows that the ketogenic diet’s effects may not go past 12 months and that the ketogenic diet may not be a sustainable option due to its highly-restrictive nature (meaning that eating out can be difficult). So, depending on what a person's goals are, the ketogenic diet may or may not be recommended for them by their provider.
Takeaway: Don’t navigate PCOS on your own! The best diet for PCOS is personal, and dietary recommendations from a provider should take into account your individual clinical picture. Since PCOS is such a complex condition and more new science is coming out about diet and PCOS, work with a provider who knowledgable in nutrition and who will take time to see you and hear you, as this would be most-worthwhile.
Thanks so much for reading today! I hope you enjoyed this blog post and found it interesting & educational!
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