Nutrition for PCOS
A functional approach to nutrition for Polycystic Ovarian Syndrome (PCOS)
What is PCOS?
Polycystic Ovarian Syndrome (PCOS) is one of the most common hormone-related conditions affecting women of reproductive age. It’s called a syndrome because it’s not just one specific issue — rather, it’s a cluster of symptoms that tend to occur together.
According to the Rotterdam criteria (a commonly used diagnostic guide), a woman may be diagnosed with PCOS if she has at least two of the following three symptoms:
- High Androgen Levels (Hyperandrogenism): this means the body is producing higher-than-normal levels of “male” hormones like testosterone. It often shows up as:
- Persistent or severe acne
- Thinning hair on the scalp (androgenic alopecia)
- Excess hair growth in places like the face, chest, or back (known as hirsutism)
- Irregular Ovulation: this can mean long, irregular menstrual cycles or no periods at all. It also often means that ovulation (the release of an egg) isn’t happening regularly — which can make conception more difficult.
- Polycystic Ovaries: on an ultrasound, the ovaries may appear enlarged and contain many small follicles (often described as a “string of pearls”). These aren’t harmful cysts but immature follicles that haven’t developed properly due to hormonal imbalance.
Types of PCOS
There are several different types of PCOS that can be categorized based on the different symptoms present:
- Classic PCOS: all three symptoms are present
- Hyperandrogenic PCOS: hyperandrogenism and ovulatory dysfunction
- Ovulatory PCOS: presence of cysts on the ovaries and hyperandrogenism
- Non-hyperandrogenic PCOS: presence of cysts on the ovaries and ovulation is irregular
PCOS and Insulin Resistance
Women with PCOS are at higher risk for metabolic disorders like insulin resistance and diabetes. Why does this happen? We have to remember that PCOS is inherently tied to hormone levels. Hormones act as messengers to tell our organs and cells what to do. Insulin is also a hormone that helps lower blood sugar by telling cells to take up glucose for use or storage. When we are constantly spiking blood sugar and the pancreas is constantly pumping out insulin, our cells become “resistant” to insulin (meaning we need even more insulin present for them to do what they’re told). High levels of insulin can also tell the ovaries to produce more testosterone and impair ovulation (direct symptoms of PCOS), and have several other negative downstream impacts, as well. As a result, balancing blood sugar and improving insulin sensitivity are very important in the treatment of PCOS. The best way to do this? Diet and lifestyle!
Nutrition for PCOS
As with many hormone-related issues, nutrition can play a significant role in the management and even treatment of PCOS. The primary focus with diet and PCOS, is eating to control blood sugar to improve insulin sensitivity and support hormones. This includes:
- Limit refined carbohydrates and sugar. This does not mean cookies are not allowed, but there is evidence that following a diet low in refined carbohydrates (like white bread, white pasta/rice, sweets, etc.) can improve insulin sensitivity, lower testosterone levels, and support weight management. All of which are related to PCOS and hormone disruption. Instead we want to opt for whole and minimally processed grains and starchy vegetables instead (ex. brown rice, quinoa, potatoes, etc.). Additionally, check your packaged foods for unnecessary added sugar and high fructose corn syrup (I recommend this to pretty much everyone, not just individuals with PCOS).
- Plenty of fiber. As it relates to balancing blood sugar, fiber is a critical component to every meal and snack! The presence of fiber helps to slow the release of sugar into the bloodstream, which slows the glucose spike and helps with blood sugar control. Additionally, dietary fiber is the primary food for our good microbiota. When the microbes in our gut feed on and ferment dietary fibers, they release compounds called short-chain fatty acids (SCFAs), which have been found to reduce inflammation, regulate glucose balance, improve insulin sensitivity, and regulate hormones.
- Healthy fats and omega-3’s. Chronic low-grade inflammation is commonly present in women with PCOS. Getting that inflammation under control can help with hormone balance, insulin sensitivity, acne, and other symptoms. Not only are healthy fats very important for hormone balance, omega-3’s can have a big impact on reducing inflammation in the body. Ideally, we want our ratio of omega-3 to omega-6 intake to be 2:1 (most Americans following a Western diet have a ration closer to 16:1!).
- Balanced meals and snacks. Learning how to compose balanced meals and snacks with a good balance of protein, healthy fat, complex carbs, and fiber is very important for maintaining blood sugar balance and subsequently, for managing PCOS.
- Vitamin D. Vitamin D supplementation has been found to impact several of the symptoms associated with PCOS including insulin resistance, inflammation, testosterone levels, hirsutism, and chronic inflammation. Women with PCOS should have their vitamin D levels checked and may benefit from supplementing if levels are below the optimal range.
- Myo-Inositol. There is increasing evidence that supplementation with myo-inositol may improve insulin sensitivity, normalize androgens, improves blood sugar control, restore ovulation, and improve fertility in women with PCOS.
- Berberine. Berberine is an herb that is often used to control blood sugar balance and works similarly to the drug Metformin. There are several studies that suggest berberine may benefit women with PCOS with limited to no side effects.
About the Author
Morgan Goodstadt, MS, RD, CDN, LDN, IFNCP
Registered Dietitian, Master’s in Clinical Nutrition, Certified Integrative and Functional Nutritionist and Health Coach. Morgan combines her expertise in nutrition with evidenced-based functional medicine and experience in human behavior to help her clients improve their health, relationship with food, and overall wellbeing. Her philosophy aims to achieve balance in both the diet and other areas of life.
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