Diet and PCOS
As PCOS is associated with insulin resistance it is often suggested that a low carbohydrate approach is superior for women with PCOS. This is because insulin is secreted in response to carbohydrate breakdown and the resulting increase in blood sugar. However, insulin is also secreted in response to protein, which appears to be beneficial for PCOS. And some women with PCOS have improved their symptoms using high carbohydrate diets (B).
It turns out that the type of carbohydrate, and its effect on your blood sugar, is probably more important than the amount! Therefore I would suggest reducing carbohydrate intake but only from the ultra-processed, low fibre, high sugar foods that will spike your blood sugar. Try to get the majority of your carbohydrates from nutrient dense, high fibre foods such as starchy vegetables, wholegrains, beans, lentils, oats and fruits. There is research to suggest that those with insulin resistance may benefit from eating the bulk of their carbohydrate earlier in the day when they are more glucose sensitive.
A review of 8 high quality studies looking into PCOS and diet found that the most effective diet for improving hormonal balance was high in protein (A). Now this does not mean you should be reverting to an only protein diet and going full carnivore! They found that just a small drop in carbohydrates, below 45% of total food intake, a small drop in fat, below 35% of total food intake and an increase in protein was enough to see favourable hormonal changes. In a 2000 kcal per day diet that would look like a maximum of 225g of carbohydrate and a maximum of 78g of fat per day. This is great news! It means that by increasing protein in every meal and snack and displacing just a small amount of the carbohydrates and fat, you can start to see improvements. (Protein can be super filling too!).
Changes might look like:
- Swapping rice or pasta for beans, lentils or quinoa
- Having larger serves of white fish or chicken and slightly smaller serves of boiled potato and butter
- Decreasing cereal amount in favour of more yoghurt and fruit
- Cutting down on high fat, high sugar (junk) processed foods
Also adding high protein snacks such as:
- Yoghurt (goes with fruit)
- Cottage cheese (goes with fruit or spread on toast instead of jam or butter)
- Protein powders (a quick fix drink or add to a smoothie for density)
- Boiled eggs
There is a growing body of evidence that low grade chronic inflammation may be driving insulin resistance and increasing androgen production in women with PCOS (F). High blood glucose can be a trigger to pro-inflammatory markers in women with PCOS. With this in mind an anti-inflammatory diet that is low in sugar should help symptoms of PCOS. There are experts who recommend the most famous of all anti-inflammatory diets for PCOS, the Mediteraenean diet (G). Whatever you want to call it, eating less pro-inflammatory foods such as processed foods high in saturated fat, trans fats and sugar and more anti-inflammatory foods such as those high in fibre, healthy fats and micronutrients will help to reduce inflammation and is likely to improve PCOS management.
A Diet You Can Stick With?
The best diet is the one you can stick with! Research suggests that women with PCOS find it particularly challenging to stick with dietary and lifestyle changes but we also know that this is vital for success in managing symptoms (C). There may be a number of reasons that women with PCOS find it difficult to stick with a diet. As mentioned earlier women with PCOS are more susceptible to mood disorders, anxiety and depression which don’t often leave much mental capacity left for motivation and adherence to a diet. Women with PCOS tend to have altered appetite regulation leaving them less satiated and more hungry (D). This increased hunger leads to increased food intake and may be the reason why binge eating is higher in women with PCOS. It doesn’t help that women with PCOS may have been fed extreme diet information leading to highly restrictive diets (zero carb..cough..cough) which in themselves can be a trigger for disordered eating (E). Therefore finding a way to consistently eat healthy food whilst catering to your mental health, appetite, satiety levels and potential predispositions for disordered eating is the key to ultimate PCOS symptom management.
Many people believe you should be eating a low carbohydrate diet if you have PCOS but not necessarily. The type of carbohydrate is very important and you should avoid the ones that spike blood sugar but fibre and nutrient rich choices are actually really good for your health. Increasing protein might help you get a grip of appetite and better hormone balance whilst an anti-inflammatory diet avoiding processed junk is for the best. But ultimately, you have to find the healthiest way you can eat consistently FOR YOU!