When I was 14 years old I was diagnosed with polycystic ovarian syndrome (PCOS), one of the most common endocrine disorders impacting 5% to 10% of women throughout the world. I had no idea what this condition was, how I got it, or what to do about.
PCOS: Beyond Birth Control Pills
I barely even knew how it impacted my body except that it supposedly was the cause for my irregular menstrual cycle, acne, and excess hair growth. I was instructed to take birth control pills for an indefinite amount of time and then my diagnosis was never discussed again.
Fifteen years later, I decided to get a second opinion! I had been hearing about all of the negative effects of using birth control long term, and I did not want to continue taking them if I did not “need” to. After visiting my gynecologist and primary care physician, I received a referral to a top reproductive endocrinologist. He ran a gamut of tests and confirmed the diagnosis of PCOS.
Diagnosis is confirmed if one has 2 of the 3 conditions:
1. Clinical and/or biochemical androgen excess
2. Ovulatory dysfunction
3. Polycystic ovaries
Lab tests that are typically assessed to help confirm PCOS include:
- Total testosterone- elevated
- Luteinizing hormone, follicle stimulating hormone: elevated
- Fasting glucose: elevated
- Fasting insulin: elevated
- CRP: elevated
- Triglycerides: elevated
- HDL-cholesterol: decreased
The endocrinologist told me, based on the workup, to stay on the birth control pill and again, end of story.
I decided to do a bit of research on the topic, just to make sure I was doing everything in my power to keep my body as healthy as possible despite the confirmed diagnosis. I have learned a lot about this condition over the past few years and am here to share the wealth!
So, the first question is, “Why should I care?” Why do lifestyle and nutrition practices make any bit of difference after the diagnosis of PCOS? Well, there are wide array of possible comorbidities and symptoms associated with PCOS including:
- Hirsutism (excess hair growth)
- Alopecia (balding)
- Acanthosis nigricans (dark, velvety patches in body folds and creases)
- Skin tags
- Menstrual and ovulatory irregularities
- Increased risk for metabolic syndrome, type 2 diabetes, cardiovascular disease, infertility, and complications during pregnancy
Diet And Lifestyle Changes – Part Of Treatment
With early diagnosis and intervention one can modify the natural history of PCOS. By adopting a healthy, low-glycemic diet, controlling blood sugar, and maintaining a healthy body weight, those with PCOS can greatly reduce their risk of developing the previous listed comorbidities.
No single therapy for PCOS exists and physicians typically tailor treatment based on the patient’s therapeutic goals and specific symptoms. Common medical treatment modalities include hormonal contraceptives (birth control pills) and metformin. In addition to these treatments, it is vital to modify diet and lifestyle.1
Studies show favorable metabolic effects in women with PCOS after adopting a moderately low carbohydrate diet (40% of total calories).2 Not only does this dietary strategy help improve the metabolic profile, but it also helps to decrease circulating testosterone levels.
Randomized, placebo-controlled clinical trials showed that the combination of medical intervention with lifestyle intervention is most effective for improving outcomes associated with PCOS.3
While there is no known “best” diet for the PCOS population, it is vital to address any metabolic or body weight concerns. Therefore, a Mediterranean style, low glycemic, low carbohydrate diet is certainly an effective strategy.4
This equates to plenty of colorful vegetables, a few servings of fresh fruit, legumes (beans, peas, lentils), nuts and seeds, anti-inflammatory oils or fats like avocado, olive, coconut, and grapeseed oil. Moderate intake of lean protein from poultry, eggs, fish, shellfish, dairy and even red meat, and limited portions of whole grains. Avoiding processed foods, fried foods, and added sugars is also an important concept of this diet.
The Meals May Look?
- 2 organic large whole eggs scrambled with sautéed in olive oil veggies (mushrooms, bell peppers, onions, etc), 2tbsp melted sharp shredded cheddar
- ½ cup (dry) cooked oatmeal with stevia, 2tbsp chopped almonds or pecans, sprinkle of cinnamon
- Smoothie with 1c frozen mixed berries, 1 c baby spinach or kale, ¼ avocado, 1 scoop unsweetened protein powder, 8-10oz water
- Homemade chili with chicken or turkey, beans, stewed tomatoes, and chopped veggies
- Tuna salad mixed with lite mayonnaise on a whole wheat “sandwich thin” with tomato, lettuce, mustard and sliced onion
- “Mix up” salad- different greens (arugula, romaine, mixed greens, etc.), sliced radishes, chopped cabbage, sautéed onions or peppers, beets, raw seeds or slivered almonds, top with protein(chicken or tuna or egg salad, beans or lentils, diced chicken, beef, pork, sautéed shrimp, etc.)
- 3-4 oz lean meat with ½ medium baked sweet potato or white potato with >1 cup of steamed broccoli
- 3-4 oz baked fish with ½ cup cooked quinoa or couscous (whole grain) with >1 cup of roasted asparagus
- 1 cup cooked spaghetti squash with ½ cup marinara with sautéed veggies and 3-4 oz meatballs or steamed shrimp
- ½ cup cottage cheese with ½ cup sliced peaches
- celery sticks with 1 tbsp unsweetened peanut or almond butter
- 1 oz of unsalted nuts or seeds
- 6 oz plain Greek yogurt
- 2 hard boiled eggs
- Carrot sticks dipped in salsa and ¼ c guacamole
Weight loss of 5-10% of total body weight if one is overweight or obese will also help to improve reproductive and metabolic parameters. Monitoring portions and total calories, estimated based on one’s specific needs, will produce desired weight loss.
Studies show that a higher protein (40% of total calories compared to 15% of total calories) can also assist in more weight loss for those with PCOS. In addition, incorporating regular physical activity, including 2-3 strength training sessions per week is helpful for those with stubborn weight loss.
There are nutritional supplements that can be helpful for specific concerns of individuals with PCOS including reducing testosterone, controlling blood sugar, reducing inflammation, improving the lipid profile, and improving fertility.
Overall, having the diagnosis of PCOS means that one should pay close attention to metabolic and hormonal parameters. By changing modifiable factors like food choices, portions, activity, and body weight, one may vastly reduce their risk of developing undesired comorbidities.
|↑1||Moran, Lisa J., Renato Pasquali, Helena J. Teede, Kathleen M. Hoeger, and Robert J. Norman. “Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome Society.” Fertility and sterility 92, no. 6 (2009): 1966-1982.|
|↑2||Gower, Barbara A., Paula C. Chandler‐Laney, Fernando Ovalle, Laura Lee Goree, Ricardo Azziz, Renee A. Desmond, Wesley M. Granger, Amy M. Goss, and G. Wright Bates. “Favourable metabolic effects of a eucaloric lower‐carbohydrate diet in women with PCOS.” Clinical endocrinology 79, no. 4 (2013): 550-557.|
|↑3||Hoeger, Kathleen, Kristen Davidson, Lynda Kochman, Tracy Cherry, Laurie Kopin, and David S. Guzick. “The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials.” The Journal of Clinical Endocrinology & Metabolism 93, no. 11 (2008): 4299-4306.|
|↑4||Marsh, Kate A., Katharine S. Steinbeck, Fiona S. Atkinson, Peter Petocz, and Jennie C. Brand-Miller. “Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome.” The American journal of clinical nutrition 92, no. 1 (2010): 83-92.|