Dr. Courtenay Boer
Polycystic Ovary Syndrome (PCOS) Part 2: Nutritional and Lifestyle Approaches
In a previous article, I discussed the signs and symptoms, as well as root causes that are associated with Polycystic Ovary Syndrome (PCOS). Today, I’m going to share what the current research tells us about diet, exercise, and lifestyle in the treatment of PCOS. My philosophy is always to address nutrition and lifestyle as the foundations of any treatment plan, while adding in specific and targeted supplementation as needed. The key is in the name – herbal and nutritional supplementation is supplemental to lifestyle and nutrition.
There’s a great deal of complexity to PCOS: as a syndrome, the constellation of symptoms is quite variable and several different PCOS “phenoptypes” have been identified. This is why investigating the root cause is essential, and why every woman should be assessed to find the underlying pathology of her PCOS and treated accordingly. Broadly, treatment of PCOS should address insulin resistance and the subsequent hormonal imbalances that are common among women with PCOS.
Recall that insulin resistance occurs when the cells in our body become resistant to increased circulating blood levels of insulin, and fail to respond normally to insulin. In women with PCOS, high insulin levels lead to several hormone imbalances through various mechanisms, one of which is the stimulation of follicles in the ovaries to produce androgens (often called the “male hormones”). Important to note is that insulin resistance is not always correlated with increased weight – approximately 20-30% of women with PCOS are of average weight, while insulin resistance is still a part of the condition. With that in mind, let’s dive into treatment:
1. Nutritional approaches:
Since insulin resistance plays such an integral part in the pathophysiology of PCOS, one of the main goals is to stabilize blood sugar and insulin levels. This generally involves incorporating higher amounts of proteins and fats, while decreasing carbohydrate levels. Blood sugar levels after a meal tend to remain the most stable with a combination of fat, protein and fibre. A Stanford study found that substituting fats for carbohydrates reduces hyperinsulinemia (high insulin), specifically in women with PCOS. This is because fat has a very slow stimulation of insulin release in relation to both protein and carbohydrates. This was confirmed by a second study, which found that a lower-carbohydrate, ketogenic-style diet improved not only fasting insulin, but also free testosterone and the LH/FSH ratio in women with PCOS and obesity. Another important consideration is glycemic load, which is a measure of how quickly and how much a food will raise blood glucose levels after eating it. It has been shown that low-glycemic-load foods in combination with high protein foods can significantly increase insulin sensitivity and decrease inflammation.
What to avoid:
Sugar: this is perhaps an obvious one – if we want to stabilize blood sugar levels, it’s going to require reducing sugar intake. Especially important for women with PCOS, as diets high in sugar have been found to be associated with higher testosterone levels.
Processed foods and refined grains: similar to sugars, simple carbohydrates found in processed and refined foods tend to spike blood glucose and insulin, creating an imbalance.
Dairy: one of the most aggravating foods for PCOS is dairy. This is due to the branched-chain amino acids found in dairy products, which trigger the release of large amounts of insulin and can further exacerbate glucose and insulin dysregulation. It’s best to avoid dairy for this population.
What about intermittent fasting?
There’s a lot of buzz around intermittent fasting right now, and with good reason! Intermittent fasting (IF) is the practice of cyclical eating and fasting. While there is some debate over what these patterns look like, common IF practices involve daily 16-hour fasts (for example, from dinner until mid-morning the next day) or weekly fasts of 24 hours.
One recent study has shown insulin resistance (as well as LDL cholesterol, triglycerides, and blood pressure) improved after incorporating intermittent fasting. This was confirmed with a second study, in which participants followed a fasting-mimicking diet for 5 days per month over a period of 3 months. The study found improvements in the participants’ BMI, cholesterol, and fasting glucose levels.
Intermittent fasting is not for everyone. In some, it can exacerbate blood sugar fluctuations. Speak to your healthcare provider before implementing IF.
Exercise is an important part of a healthy lifestyle for anyone, and is especially important in the treatment for all women with PCOS. In obese women with anovulatory PCOS, a structured exercise training program of three 30-minute aerobic exercise sessions weekly along with dietary interventions was found to improve menstrual regularity and fertility. Additionally, vigorous exercise (such as that promoted through high intensity interval training (HIIT)) was found to be superior to moderate exercise (for example, brisk walking) for metabolic parameters in PCOS. The goals of exercise are to decrease waist circumference, as well as build lean body tissue. It’s been shown that a reduction in waist circumference can improve insulin sensitivity significantly, and that improving insulin sensitivity can restore menstrual function and fertility in obese women with PCOS.
What to incorporate:
Aim for high-intensity exercises that cause you to sweat, ideally for at least a total of 75 minutes per week.
Resistance training is equally important, with a goal of at least three 30-minute sessions per week.
If you are looking for a starting place, Fitness Blender is a free and accessible resource to start exercising at home.
3. Stress Management:
Chronic stress is associated with insulin resistance, due to the effect that our main stress hormone, cortisol, has on raising blood sugar levels. It’s therefore important to recognize our stress and the effects it has the body, and develop skills for managing that stress.
Tips to explore stress management:
Find a mindfulness practice that resonates with you, and start practicing it every day. Doing this for 5 minutes is a great place to start, with the goal of consistency. Some ideas are meditation, journaling, a yoga practice, deep breathing, or listening to music.
Get outside! Spend time in nature.
Seek to be in community with those you love.
Sleep is vital for our metabolism. In fact, one study found that after just one week of sleep deprivation (5 hours of sleep per night), insulin sensitivity was significantly reduced. A second study validated these findings, concluding that glucose metabolism was markedly altered with recurrent partial sleep restriction, and that this may be a risk factor for insulin resistance.
Goals for high-quality sleep:
Aim for 7-8 hours of good quality sleep per night.
Decrease screen time before bed, refrain from eating or working in bed, keep the bedroom dark, avoid stimulants too late in the day, develop a nightly routine and go to bed at the same time every night.
PCOS can be a challenging condition to manage, but incorporating these building blocks into your treatment will provide a strong foundation. If you are suffering from PCOS or suspect you may be, I recommend finding a health care practitioner to ensure a proper diagnosis and identification of the root cause. This allows you to find the best possible treatment plan to address your individual presentation and have your goals and needs met.
Stay tuned for Part 3 of my PCOS series - I’ll be exploring effective botanical and nutraceutical supplementation options for PCOS!