Did you know that it takes an average of 2 years and 3 doctors for a woman to be diagnosed with Polycystic Ovary Syndrome (PCOS). 2 years. 3 doctors.
For many women, the painful journey to a PCOS diagnosis can take even longer, as this all-too-common condition continues to mystify healthcare professionals and researchers, leading to misdiagnosis and never-ending referrals to other specialists. PCOS is an elusive diagnosis for many doctors, but that’s not because it’s something they don’t often see. In fact, it’s the exact opposite:
PCOS is the most common endocrine disorder, the leading cause of infertility for women, and it’s thought to affect as many as 1 in 5 women of reproductive age.
We’re not going to dive into the astounding lack of knowledge on PCOS and why our incredibly talented healthcare systems struggle to diagnose and treat this condition, because that’s a much bigger conversation. But what we are going to talk about is how you can take back some of the control if you’re facing a PCOS diagnosis yourself. And it’s all through your diet.
Research has shown that diet plays a major role in the management of the symptoms of PCOS; particularly as it relates to weight management and the role of insulin production and resistance. So, we consulted Dr Harriet Holme, a Registered Nutritionist who spent over a decade as a pediatric doctor before transitioning into her current speciality in Nutrition Science, to find out more about PCOS and if there is such a thing as a PCOS diet.
What exactly is Polycystic Ovary Syndrome (PCOS)?
PCOS is a hormonal disorder that affects the proper functioning of a woman’s ovaries. The name comes from the fact that individuals with this condition will often have enlarged ovaries that present small cysts. Although we still do not know why some people get PCOS, it does appear to run in families. Approximately one in five women have the condition, but up to half of these individuals will not exhibit symptoms; which is partly why diagnosis can be difficult.
What are the symptoms of PCOS?
The most common set of symptoms include:
- Irregular or absent periods
- Excessive hair growth usually on the face, chest, back and buttocks; which is called ‘hirsutism’
- Weight gain
- Oily skin or acne
- Hair loss or general thinning of hair on the head
- Difficulty getting pregnant due to failure to ovulate or irregular ovulation
In what ways does diet affect PCOS?
Research has proven that there are two significant ways that diet affects PCOS and these are through weight and insulin management. Many women with PCOS also have insulin resistance so managing insulin levels within a PCOS diet is one of the first steps women can take to managing the condition. Following a diet that meets your core nutritional needs and helps maintain a healthy weight can also ease the symptoms associated with PCOS.
Let’s start with Insulin…
Insulin is an important hormone in our body, produced by the pancreas, and it has a key role in controlling our blood sugar levels. When we eat, food is broken down and absorbed, causing the amount of sugar in our blood to rise. The role of insulin is to signal to the muscles, fat and liver cells, to increase uptake of sugar from the bloodstream and store it. This reduces the blood sugar level and keeps it within a tight range.
People with Type 1 diabetes stop producing insulin altogether, and so have to replace it with insulin injections when they eat, to keep their blood sugar levels within range. Alternatively, people with Type 2 diabetes still produce insulin, but their cells become resistant to the signals from insulin, and so they need higher levels of insulin to respond. Type 2 diabetes is what’s usually associated with being overweight and some people with this condition can control their sugar levels with dietary-driven weight loss alone. However, others will still need to take medication which increases the sensitivity of their cells to insulin signals.
But why does Insulin matter in PCOS?
Women with PCOS seem to have insulin resistance regardless of their weight; however, the greater their weight, the greater the degree of insulin resistance and their risk of Type 2 diabetes. Diet is important in PCOS to ensure a healthy weight and to reduce the degree of insulin resistance. The good news is that even a modest weightloss of 5% of total body weight can reduce that risk.
So what does it mean for ovulation if you have PCOS?
Ovulation is dependent on a number of hormones which all rise and fall at different times within the menstrual cycle. A surge of the Luteinising Hormone (LH) is necessary for a mature ovum (egg) to be released at ovulation; and it’s this hormone (LH) that is detected by ovulation test kits.
In PCOS, insulin resistance leads to an increase in androgen hormones, which suppress Luteinising hormone (LH). However, as we know, LH is needed for ovulation. This means that many women with PCOS either ovulate infrequently, or not at all, leading to irregular periods and difficulty conceiving.
Once again, the good news is that short term calorie restriction resulting in weight loss, has been shown to reduce levels of the androgen hormones, which restores the normal LH surges and can also restore normalized ovulation cycles.
What should your diet look like with PCOS?
Your diet needs to be personalised to you, your body, and your exercise regimen. In general though, if you have PCOS, fat should make up less than 30% of your diet, lean protein should take up about 20%, and the remainder should be comprised of low-glycaemic index carbohydrates. The healthiest way to lose weight is to combine both a slight reduction in calories consumed and also increased exercise regimen to achieve an energy deficit (basically working to burn more calories than you consume in a day). Here are my top tips in this space:
- Understand the role of fats: A diet containing unsaturated fatty acids such as olive oil, avocados and nuts has been associated with decreased insulin resistance, but only when the total fat makes up less than one third of the diet. Trans fats have been associated with a failure to ovulate, and other general health concerns such as increased cancer risk, so I recommend to my clients to avoid these altogether.
2. Focus on mealtimes: Calorie intake should be distributed between several meals over the day with low intake from snacks. There has been research that found that people who ate irregularly were more likely to eat a higher fat, protein, cholesterol and salt diet. While those who ate along more regular mealtimes were more likely to have a more balanced diet, with higher carbohydrate and fibre levels, with more micronutrients. Additionally those who ate regularly were more likely to have a better glucose profile, with less insulin resistance, so I generally recommend eating regular meals as a benefit to women with PCOS.
3. How to approach short-term calorie restriction: When starting a calorie restriction diet, aim to eat about 200 kcal less than you need each day. After a couple of weeks, you can slowly increase this to 500 kcal less than you need each day. When undertaking calorie restriction diets it is best practice to consult a registered practitioner such as a dietician or nutritionist — and you definitely don’t want to be doing this if you’re currently pregnant or breastfeeding.
4. Be aware of carbohydrate cravings: Women with PCOS are more likely to have insulin and blood sugar levels that fluctuate more. This has been associated with a reactive low blood sugar after meals, leading to carbohydrate cravings, a frequently reported symptom for women with PCOS. But it’s still so important to follow the 30% fats, 20% lean protein, and 50% low-glycaemic carbohydrate balance to your diet, even when cravings hit.
5. Follow the basics of a healthy diet, because they are important! Aim to drink unsweetened drinks such as water where possible. Avoid trans fats, refined carbohydrates (for example white bread, white pasta, and sugary items) and aim for a diet full of fruit, vegetables, whole grains, lean protein, and unsaturated fat.
For more on this topic and healthy eating habits at all stages of your life, be sure to check out Dr. Harriet Holme @healthyeatingdr. And for nutritionally balanced meals to support you through preconception, pregnancy and postpartum, download the Baby2Body app today!