Episode 23 – Nutrition for PCOS

Key Topics Covered

In this episode we discuss what PCOS is, how it is diagnosed and the diets shown to best manage it.

Background

  • PCOS – Polycystic Ovarian Syndrome
  • PCOS affects 12-15% of women that are of reproductive age. However, up to 70% go undiagnosed.
  • Polycystic means “many cysts”. Individuals won’t always present with cysts.
  • To be diagnosed, individuals must present with at least 2 of the following:
    1. Lack of ovulation (irregular or no menstrual cycles)
    2. Excessive testosterone
    3. Cysts on ovaries
  • Other symptoms include:
    • Excessive hair growth – inc. facial
    • Hair loss
    • Skin changes – darkening or acne
    • Weight gain
    • Anxiety, depression, sleep apnea
    • Difficulty conceiving
    • Insulin resistance

Insulin Resistance

  • 85% Experience insulin resistance. On average women with PCOS are 35-40% less sensitive to insulin.
  • Those with higher body fat typically have more issues with insulin resistance.
  • Fortunately, the steps to manage PCOS involve the reduction of insulin resistance or its effects.

Managing PCOS

  1. Meeting core food group requirements – this is the foundation
  2. Weight management
    • When people decrease body fat, it has been proven that this improves insulin sensitivity.
    • In saying this, one study showed that people with PCOS had a BMR 14-40% lower than expected. Those with insulin resistance had the greatest drop in BMR.
  3. Anti-inflammatory diet
    • Eg. Meditterainian diet or Plant-based
    • Containing high amounts of fibre, omega-3, and antioxidants

Carbohydrates

  • Not everyone with PCOS is insulin resistant.
  • One small study showed that reducing carbohydrates assists in managing PCOS. However, it’s not the only option.
  • Decreasing carbs will help to manage insulin resistance.
  • Decreasing carbs will more often than not decrease calorie intake, thus helping weight management.
  • Challenges associated – adherence, quality of life, and micronutrient intake.

Dairy & Gluten Free

  • Typically based on the assumption that dairy & gluten cause “inflammation” to the body.
  • However, there’s no strong evidence to show that eliminating dairy or gluten from ones diet will improve PCOS.
  • There’s a small link between dairy and acne, so people could see benefits from that perspective.

Supplements

  • Inositol – Recommend 2-4g/day of Myo-inositol. Effective at 40:1 Myo to D-chiro inositol.
    • Myo-inositol improves egg quality and fertility.
    • D-chiro inositol increases insulin sensitivity.
    • On average, individuals with PCOS have a deficiency of Myo inositol in their ovaries.
  • Magnesium – Recommend 300mg/day before bed. Recommended to those interested or deficient.
    • Magnesium can improve insulin sensitivity.
    • Theoretically, this can improve sleep quality for those with insomnia.
    • If consuming the RDI for magnesium, an additional supplement likely won’t add any further benefits.
  • Omega-3 – Recommend 1000-3000mg of fish oil/day or microalgae supplement.
    • Can help reduce testosterone and improve the regularity of the menstrual cycle.
    • If an individual is already consuming a high amount (ie. consuming fatty fish 2-3x/week) this probably won’t benefit them.
  • Zinc – Recommend 50mg/ day. This is well above the upper limit recommended for women.
    • Helps with hair growth or hair loss.
    • It can also help with insulin resistance.
    • If consuming the RDI for zinc, an additional supplement likely won’t add any further benefits.
    • However, consuming too much zinc can cause zinc toxity and copper deficiency.
  • Chromium – Recommend 200micrograms chromium picolinate/ day.
    • Can improve insulin sensitivity.
  • Vitamin D
    • A larger percentage of people with PCOS are deficient in vitamin D.
    • It helps with insulin resistance.
    • It can help with mood and decrease depression.

Summary for management

  • People with PCOS can benefit from weight loss if they’re overweight. This is not always an easy task as PCOS often decreases BMR up to 40%.
  • Eat a Mediterranean-style diet, with high amounts of plant foods and omega-3.
  • Focusing on low GI carbohydrates (ie. wholegrains) and moderating carbohydrate intake.
  • Supplements recommended – Inositol and Omega-3.

Relevant Links/ Resources

Studies Mentioned

Useful Blog Posts