Best Foods For PCOS

  • Dora Freitas Bachelor's degree, BSc Human Sciences, University College London, UK

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Introduction

Polycystic ovary/ovarian syndrome (PCOS) is a collection of symptoms affecting women of reproductive age due to hormonal imbalances. PCOS is defined by three main criteria: ovarian dysfunction, polycystic ovarian morphology, and hyperandrogenism (a condition characterized by high levels of androgens). If someone has two of these three criteria, then they are affected by PCOS. PCOS can lead to menstrual, dermatological (skin), reproductive, and psychological disorders. It is important to note that a crucial contributing factor to PCOS is diet. PCOS patients are already more at risk for metabolic syndrome and cardiovascular diseases, which increase with the consumption of fats and proteins. Diet regulation is therefore key to living with PCOS.1

In this article, we are going to guide you on how to get diagnosed with PCOS, the most frequent symptoms to look out for, and finally, what foods are best to eat if you are diagnosed with polycystic ovary/ovarian syndrome. 

What is PCOS?

PCOS is a condition characterized by abnormal hormone levels, notably elevated insulin levels. Insulin plays a pivotal role in regulating the body's sugar levels, but in the case of many women with PCOS, there is resistance to its action, leading to heightened insulin production. The surplus insulin contributes to the overproduction and heightened activity of hormones like testosterone. Increased testosterone levels will lead to symptoms such as excessive hair growth in areas where men typically grow hair. High levels of insulin will also cause weight gain, fertility issues, dermatological issues, irregular periods, and metabolic syndrome. Another common feature of PCOS is polycystic ovarian morphology, which is the presence of multiple small undeveloped eggs (follicles) that have not matured and have been released during the menstrual cycle.2 

How common is PCOS? 

PCOS is one of the most prevalent endocrine conditions affecting an estimated 8–13% of women of reproductive age.3 In the UK for example that represents about 1 woman out of 10 affected by PCOS.4 These numbers are already very high, but it is without counting that more than 70% of affected women still remain undiagnosed. 5 Despite its prevalence, PCOS has remained an enigma for many decades, with minimal advancements achieved in enhancing patients' well-being and symptom management.6 

The symptoms associated with PCOS

Signs and symptoms of PCOS usually arise during the late teens or early 20s. The symptoms can range from mild to severe, and not all affected women will necessarily exhibit all of them; for instance, some may only encounter menstrual issues, fertility challenges, or a combination of both.

The common symptoms of PCOS are listed here:

  • Menstrual irregularities (oligomenorrhea), absence of menstruation (amenorrhea) or heavy bleeding (menorrhagia)
  • Challenges in conceiving (due to irregular or absent ovulation)
  • Excessive hair growth, typically on the face, chest, back, or buttocks (known as hirsutism)
  • Skin discolouration (acanthosis nigricans)
  • Weight gain
  • Hair thinning and hair loss
  • Energy crashes and mood swings
  • Raised cholesterol
  • Chronic low-grade inflammation
  • Skin issues like excess oiliness or acne outbreaks1,4, 7

Associated metabolic disorders 

PCOS increases the chances of developing other health conditions. Women with PCOS are more at risk of developing type 2 diabetes. In fact, 50% of women with PCOS are diagnosed with diabetes before the age of 40.1 Type 2 diabetes occurs due to the metabolic disruptions present in PCOS, which increase abdominal fat and reduce insulin sensitivity. Additionally, there is an increased risk of high blood pressure and high cholesterol, which can contribute to heart disease and stroke, as well as the potential development of sleep apnoea. These conditions collectively fall under the umbrella of metabolic issues, including obesity, metabolic syndrome, insulin resistance, and type 2 diabetes. Finally, women who have amenorrhea or extremely irregular menstruation (occurring less than 3 or 4 times a year) are at an elevated risk for developing endometrial cancer (cancer of the womb lining). 

Mental health 

Alongside these physical health risks, people with PCOS may suffer from depression and anxiety, as certain PCOS symptoms can foster social stigmatization, potentially affecting their self-confidence and self-esteem.1,4

Risk factors of PCOS

Genetic factors

If a close family member is affected by PCOS, your likelihood of developing PCOS increases.1

Environmental factors 

Exposure to endocrine-disrupting chemicals has been associated with the rise in reproductive conditions, such as PCOS, especially if individuals are exposed during prenatal development when organ systems are developing. Reducing exposure to endocrine-disrupting chemicals can be beneficial for reproductive health. Products, such as plastic containers, detergents, flame retardants, food, toys, cosmetics, and pesticides, can contain these endocrine-disrupting chemicals. Therefore, taking steps to limit personal exposure to these substances is advisable to safeguard reproductive health. 1

The role of diet in managing PCOS 

Diet plays a major role in PCOS management as it is a contributing factor for PCOS. In fact, managing your diet will allow you to regulate your hormone levels, including those responsible for irregular periods and hirsutism. Diet management can also have a positive effect on weight loss, which can alleviate PCOS symptoms, promote regular ovulation, and lower cardiovascular risk. A balanced diet can help stabilise blood sugar levels, which helps reduce energy crashes and the risk of developing type 2 diabetes. Finally, Managing PCOS through diet can lead to better long-term health outcomes, reducing the risk of diabetes, heart disease, and other health conditions.1,4

Best foods for PCOS

Low-glycaemic index carbohydrates

We have seen that PCOS leads to a rise in insulin and blood sugar levels. It is, therefore, important to eat foods that will lower the levels of blood sugar. These foods are called low glycemic index (GI) foods. The Glycaemic Index assesses the speed at which the carbohydrates and sugars present in food are digested and enter the bloodstream. Foods that lead to a rapid and elevated increase in blood sugar levels are classified as having a high GI, while those resulting in a slower increase are considered to have a low GI. Eating low-GI food will lower not only blood sugar levels but also total testosterone.7

Dietary fibre helps to lower the GI. Fibre will also lower cholesterol levels and improve bowel health. Examples of high-fibre foods are brown rice, brown pasta, fruit and vegetables and potato skins. 

Examples of low GI-rated foods include: 

  • Grapes, berries, salad, pear, oranges, dried apricots, and non-starchy vegetables
  • Porridge, muesli
  • Pasta, noodles, basmati rice, sweet potatoes, and yams 
  • Milk and yoghurts 
  • Beans, chickpeas, lentils 
  • Multigrain and granary bread, chapattis 
  • Dark chocolate, nuts, seeds, and popcorn

People with PCOS should, therefore, prioritize eating these foods instead of high GI food such as white rice, white bread, watermelon, pumpkin, dates, and cakes. Foods such as full-cream milk might have a low GI, but they have a high fat content and, therefore, should be consumed in moderation.7

Omega-3 rich food

If you have PCOS, you should eat these omega-3-rich foods as they will help improve hormone balance, regulate period, improve insulin sensitivity, reduce inflammation, and support cardiovascular health:

  • Fish 
  • Fish oil8
  • Salmon 

α-linolenic acid

Dietary α-linolenic acid exhibited positive impacts on polycystic ovary syndrome by influencing the interplay between sex steroid hormones, gut microbiota, and inflammation. These are examples of oils that contain α-linolenic acid: 

  • Flaxseed 
  • Canola 
  • Soy 
  • Perilla
  • Walnut oils9

Ketogenic diet 

Studies have shown that another approach to lowering the GI of the diet is the ketogenic diet. This diet restricts the intake of carbohydrates in favour of plant-based fats. The ketogenic diet has several positive effects on women with PCOS. It improves their menstrual cycle, reduce blood sugar levels, body weight, and enhance their liver function.9 

Herbs supporting treatment

Certain herbs, spices and seeds are beneficial for those with PCOS. They will help reduce blood glucose and insulin resistance and lower androgen levels. Some herbs will also improve the growth of follicles and hormonal levels. Consuming these herbal infusions and their extracts will therefore be a valuable addition to your diet:9

  • Cumin (reduces oxidative stress)
  • Turmeric (helps reduce inflammation, alleviate insulin resistance, and regulate hormonal imbalances)
  • Cinnamon, Chamomile, Aloe vera, white mulberries, green tea (help regulate lipid and carbohydrate metabolism)
  • Green mint (revives follicular development)
  • Rosemary (lowers androgen levels)
  • Liquorice roots (reduces elevated levels of testosterone)
  • Flaxseed (adjust the balance of sex hormones in the bloodstream)
  • Nettle (anti-inflammation benefits) 

If PCOS is advanced, when metabolic syndrome occurs, it is advisable to explore the potential hepatoprotective (liver protective) benefits of these herbs and their extract: 

  • Artichoke extract 
  • Dandelion 
  • Milk thistle 
  • Black cumin 9

In conclusion, herbs and their components provide numerous opportunities for interventions that can aid in the management of PCOS at different stages of the condition. The choice of the most suitable combination can be customised based on the presence and severity of specific symptoms.9

Gut Health 

Recent research indicates that fostering a good gut health microbiome might be beneficial for PCOS symptoms. The research shows that gut bacteria may play a role in controlling insulin production, affecting androgen levels, and influencing the development of ovarian follicles. This opens a promising avenue for understanding the underlying mechanisms of PCOS.10 To improve your gut microbiome and, therefore, alleviate PCOS symptoms, it is recommended to consume a diet rich in fermentable fibres and plant polyphenols. This aligns with recommendations promoting the increased intake of whole-plant foods like fruits, vegetables, and whole-grain cereals.11

Supplementation

Often, women affected by PCOS are treated with metformin (this improves insulin sensitivity). However, chronic intake of this medicine is associated with deficiencies in thiamine. This is why it is recommended for a patient taking metformin to supplement their diet by taking thiamine (Vitamin B1). Thiamine, through its activation of transketolase, plays a role in inhibiting mechanisms that harm blood vessels, thereby reducing the risk of cardiovascular diseases.9

Conclusion

PCOS is a complex condition affecting a significant number of women of reproductive age, with many cases going undiagnosed. It is characterised by hormonal imbalances that lead to a range of symptoms affecting various aspects of a person's life. Diet plays a crucial role in PCOS management, as it can influence hormone levels, insulin sensitivity, and overall health.

To address PCOS effectively, individuals should consider dietary choices that promote hormone balance and reduce insulin resistance. Low-glycemic index (GI) carbohydrates, such as whole grains and certain fruits, can help stabilise blood sugar levels and lower testosterone levels. Omega-3-rich foods, like fatty fish and flaxseed, may aid in hormone regulation, reduce inflammation, and support heart health.

Herbal infusions and extracts, such as turmeric, cinnamon, and green tea, have demonstrated potential benefits in managing PCOS symptoms, including insulin resistance and hormonal imbalances. These can be valuable additions to one's diet.

Furthermore, fostering a healthy gut microbiome through the consumption of fermentable fibres and plant polyphenols may play a role in alleviating PCOS symptoms.

In managing PCOS, it's crucial to tailor dietary choices to individual symptoms and seek guidance from healthcare professionals or registered dietitians to create a personalised plan that addresses specific needs. Overall, a well-balanced diet can have a significant positive impact on PCOS management and long-term health outcomes.

References: 

  1. National Institute of Health. Polycystic Ovary/Ovarian Syndrome (PCOS) Underrecognized, Underdiagnosed, and Understudied [Internet]. National Institute of Health Office of Research on Women’s Health; 2019. Available from: https://orwh.od.nih.gov/sites/orwh/files/docs/PCOS_Booklet_508.pdf.
  2. Dewailly D, Lujan ME, Carmina E, Cedars MI, Laven J, Norman RJ, et al. Definition and significance of polycystic ovarian morphology: a task force report from the Androgen Excess and Polycystic Ovary Syndrome Society. Human Reproduction Update .2014 [cited 2023 Sep 14]; 20(3):334–52. Available from: https://academic.oup.com/humupd/article-lookup/doi/10.1093/humupd/dmt061.
  3. WHO. Polycystic ovary syndrome [Internet]. [cited 2023 Sep 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome.
  4. Polycystic ovary syndrome. nhs.uk [Internet]. 2017 [cited 2023 Sep 15]. Available from: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/.
  5. Rani R, Sharma P, Kumar R, Rai S, Hajam YA. Neurogenetic Perspective of Polycystic Ovary Syndrome: Protective Role of Exogenous Biomolecules. Frontiers in Science and Technology in India: An Overview. 2021 Mar 1:187.
  6. The Lancet Regional Health – Europe. Polycystic ovary syndrome: What more can be done for patients? The Lancet Regional Health - Europe. 2022 [cited 2023 Sep 14]; 21:100524. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2666776222002204.
  7. Dietary Advice for Polycystic Ovary Syndrome (PCOS). Dietetic Department George Eliot Hospital Warwick Hospital Nuneaton Warwick [Internet]. 2019; (1.1):8. Available from: https://www.swft.nhs.uk/application/files/8015/6586/5352/Dietary_Advice_for_Polycystic_Ovary_Syndrome_A4_2019.pdf.
  8. Office of Dietary Supplements - Omega-3 Fatty Acids [Internet]. [cited 2023 Sep 17]. Available from: https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/.
  9. Szczuko, M., Kikut, J., Szczuko, U., Szydłowska, I., Nawrocka-Rutkowska, J., Ziętek, M., Verbanac, D., & Saso, L. (2021). Nutrition Strategy and Life Style in Polycystic Ovary Syndrome—Narrative Review. Nutrients, 13(7), 2452. https://doi.org/10.3390/nu13072452
  10. Sun Y, Gao S, Ye C, Zhao W. Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications. Front Cell Infect Microbiol [Internet]. 2023 [cited 2023 Sep 14]; 13:1142041. Available from: https://www.frontiersin.org/articles/10.3389/fcimb.2023.1142041/ful
  11. Ferraris C, Elli M, Tagliabue A. Gut Microbiota for Health: How Can Diet Maintain A Healthy Gut Microbiota? Nutrients [Internet]. 2020 [cited 2023 Sep 14]; 12(11):3596. Available from: https://www.mdpi.com/2072-6643/12/11/3596.

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Dora Freitas

Bachelor's degree, BSc Human Sciences, University College London

Dora is a dedicated human scientist specializing in molecular cell biology and global health and development. Her academic journey at University College London and National University Singapore has ignited her passion for public health and the democratization of scientific knowledge. With experience in medical writing, data analysis, and laboratory work, she's committed to bridging the gap between science and the public.

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