PCOS, Nutrition, and Metabolism

Many people are interested in the factors that affect their metabolism, but don’t know what they can do to make a difference. One, major factor that influences the body’s metabolism is the endocrine system, and polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age ¹.

WHAT IS PCOS?

There is still a lot we don’t fully understand about PCOS, but it is currently diagnosed when a woman has at least 2 of the 3 following characteristics:

• irregular menses
• signs of excess androgens (i.e., particular hormones)
• polycystic ovaries ²

The most typical sign of excess androgens is more hair on the face or body, but this doesn’t always happen. Skipping menses or having them at irregular times is another common, apparent sign, but a diagnosis of polycystic ovaries requires an ultrasound. PCOS can have different effects for different people, so some women are more concerned with the effects of hormone imbalances, while others may find it more difficult to become pregnant.  Certain health risks are more likely for those with PCOS, which makes self-care particularly important.

NUTRITION & METABOLISM

In addition to altered levels of luteinizing hormone and higher levels of some androgens, women with PCOS are more likely to produce excess insulin and have greater insulin resistance³. Insulin resistance makes it harder for the body to use energy, and can cause high blood sugar. This is a problem in part because high blood sugar can damage blood vessels and lead to other health problems like diabetes.

Evidence is still too limited to provide many specific nutritional recommendations for those with PCOS. In general, eating patterns that are healthy for the average adult are also healthy for women with PCOS: those that are rich in fruits and vegetables, beans and whole grains, with only moderate amounts of saturated fat, meat, and added sugars. A few individual studies suggest some benefits from eating regular meals with relatively high protein (>20% of total calories, or roughly 25 grams per meal) and moderate carbohydrates (starches and sugars being about 45% of total calories)^4,5. Of course, the more that starches come from whole plant foods like beans, greens, fruit, and 100% whole grains, the better. Though this research is preliminary, it is encouraging that the same eating patterns benefit those with diabetes, and are what we follow here at Structure House.

 HEALTHY FATS

Another area where people with PCOS may be able to improve their symptoms through nutrition is by changing the types of fats they eat. Americans’ diets tend to be high in saturated fats but lower in the healthy, unsaturated fats that the body needs. Adequate consumption of omega-3 polyunsaturated fats is known to be beneficial for reducing inflammation and promoting overall health. Getting a better (i.e. higher) ratio of omega-3’s to saturated fats in the diet may also help improve insulin sensitivity in those with PCOS ⁶. Replacing foods like red meats and cheese with things like salmon, flax seeds, and walnuts is a good way to get there. In some cases, adding flax seed oil or fish oil supplements to your diet may help, but you should ask your doctor first.

PCOS, WEIGHT, & DIABETES

Scientists aren’t entirely sure why, but women with PCOS are more likely to be overweight ¹¹, which is an added risk factor for insulin resistance and diabetes ^{7, 8}. Fortunately, balanced  nutrition helps reduce the risk of many health problems, including those associated with PCOS.. We need more research on PCOS, but there are a few things we do know. The most well-supported approach to reducing the risk of type 2 diabetes is regular exercise and maintaining a healthy weight.⁹. For those with PCOS who are overweight, better managing their weight through balanced nutrition and regular movement is the best way to improve menstrual regularity and fertility ¹⁰, and is even more effective than medication in preventing type 2 diabetes in overweight individuals with high blood sugar ¹¹.

THE BIG PICTURE

In addition to other benefits, physical activity is great for you because it increases the ability of blood sugar (glucose) to enter the body’s cells, even without insulin. Moving more and eating lots of whole plant foods can especially help those with PCOS who want to lose excess weight. Focusing on eating at least 3 regular meals a day, and basing those meals around whole plant foods and lean protein is a good recipe for wellness. We also follow this advice here at Structure House, and many participants have witnessed its effectiveness firsthand. We can help treat many health conditions at once with balanced nutrition, and physical activity, and fortunately, PCOS is no different.

References:

1. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS). Hum Reprod 2012;27(1):14–24.
2. Fauser BC, Tarlatzis BC, Rebar RW, et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2012; 97(1):28–38.e25. https://dx.doi.org/10.1016/j.fertnstert.2011.1009.1024.
3. Trikudanathan S. Polycystic Ovarian Syndrome. Med Clin N Am 2015; 99:221–235. https://dx.doi.org/10.1016/j.mcna.2014.09.003.
4. Douglas CC, Gower BA, Darnell BE, Ovalle F, Oster RA, Azziz R. Role of diet in the treatment of polycystic ovary syndrome. Fertil Steril 2006; 85:679–688.
5. Mehrabani HH, Salehpour S, Amiri Z, Farahani SJ, Meyer BJ, Tahbaz F. Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study. J Am Coll Nutr 2012; 31:117–125.
6. Rafraf M, Mohammadi E, Asghari-Jafarabadi M, Farzadi L. Omega-3 fatty acids improve glucose metabolism without effects on obesity values and serum visfatin levels in women with polycystic ovary syndrome. J Am Coll Nutr 2012; 31:361–368.
7. Carmina E, Lobo RA. Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. Fertil Steril 2004; 82:661–665.
8. Carmina E, Bucchieri S, Esposito A. Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. J Clin Endocrinol Metab 2007; 92:2500–2505.
9. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346(6):393–403.
10. Usadi RS, Legro RS. Reproductive impact of polycystic ovary syndrome. Curr Opin Endocrinol Diabetes Obes 2012; 19(6):505–11.
11. Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Rev 2013; 14:25–109.