Guest blog by Claire Pettitt MSc RD PhD (c) – from CP Nutrition
Hi there! My name is Claire Pettitt and I am a UK Registered Dietitian and Nutritionist and I am passionate about supporting women with PCOS to understand their condition and what they can do to support themselves in managing their symptoms, to feel better and improve their relationship with food and their body.
I was diagnosed with PCOS when I was 16 and if you are anything like me, then when you first received your PCOS diagnosis you were told by your doctor to take the pill to regulate your period, go away and lose weight, and come back when you struggle to have kids (if that is what you want). Well, although that feels like a long time ago for me, unfortunately it doesn’t feel like too much has changed when it comes to PCOS management, but I strongly believe that those with PCOS deserve a more holistic approach when it comes to managing their condition.
As a syndrome, which is a collection of symptoms, PCOS presents differently in every individual and each person who experiences PCOS needs to be treated individually. The pathophysiology of PCOS is really complex and many of those with PCOS also experience insulin resistance and high levels of androgens (male hormones), both of which can stimulate increased production of the other, thus leading to a bit of a vicious cycle. High androgens are responsible for the symptoms like hirsutism, acne and male pattern hair loss, and both high androgens and insulin resistance can negatively impact ovulation, increasing risk of infertility as well as generally increasing risk of diabetes and cardiovascular disease.
For many of those diagnosed they may be offered medications and lifestyle modification advice to help control their symptoms. Medications include the oral contraceptive pill, insulin sensitisers (like Metformin) or anti-androgens (such as Spironolactone). However, first line advice according to the latest international guidelines is to use lifestyle modification (Teede et al 2018). Unfortunately for most women this means they are simply told to lose weight, avoid carbs or cut out sugar and are then sent on their way. This is not only unhelpful but can be harmful to some as they then embark on a journey of yoyo dieting and weight cycling. In fact, research suggests that at least 60% of those with PCOS are on some kind of diet, and that 60% of those with PCOS experience binge eating behaviours, and up to 35% have disordered eating (Jeanes, 2017, Lee, 2017, Karacan 2014). PCOS is also linked to mental health issues such as anxiety and depression with 45% experiencing anxiety and 34% depression.
Bearing in mind all these consequences of having PCOS, lifestyle management needs to be holistic and balanced in order to avoid leading to negative consequences typically seen in those following restrictive diets. Prioritising what you add into diet & lifestyle, rather than what you should restrict is often a more effective approach.
Although there is no one way of eating that is recommended for those with PCOS, there is evidence to support the following diet & lifestyle strategies:
- Eat regular meals and eat enough – skipping meals can lead to increased cravings and eating when you are overly hungry may lead to poor food choices or overeating, sometimes even bingeing.
- Include low GI carbohydrates – this helps to manage blood sugar control and reduce insulin resistance. Examples include whole grain bread, oats, muesli and other whole grains.
- Have balanced meals – Include protein and healthy fats with your high fibre carbs as this helps reduce the glycaemic load of the meal. Protein has also been seen to reduce androgen and insulin levels. Examples include lean meat, poultry, eggs, tofu, quorn, and nut butters.
- Eat plenty of fruits and vegetables – these are full of fibre as well as important micronutrients which act as antioxidants – these help reduce stress and inflammation which are both commonly seen in PCOS.
- Include omega-3 rich foods – oily fish, seaweed and algae are rich in DHA which helps with the chronic inflammation associated with PCOS.
- Regular movement may improve reproductive outcomes including ovulation and menstrual cycles as well as weight management, and insulin resistance. Aim for moderate physical activity, 3-5 times a week, but most importantly do something that you enjoy!
- Reduce stress – stress plays a huge role in the management and development of PCOS, and stress management is one of the key pillars of PCOS management. Consider things like yoga, meditation, and journaling to help manage your stress levels.
- Get adequate sleep – something that most of us struggle with these days is getting enough sleep, but poor sleep (both quality and quantity) is associated with poor blood sugar control, increased cortisol production (the body’s stress hormone) and it also interferes with appetite signalling which can lead to more cravings and overeating.
These strategies can help achieve a healthy and varied diet. Combining these with regular movement, prioritising rest and reducing stress will help in the management of PCOS and its symptoms.
To summarise, PCOS is a complex endocrine condition which also has metabolic, reproductive, and psychological consequences which can affect individuals with PCOS in different ways. People with PCOS need a personalised and holistic approach to managing their condition and restrictive diets are rarely the answer. Instead, the focus should be on what you can add into your diet, your lifestyle, and your self-care practices to ensure you are nourishing yourself in all possible ways in order to optimise your PCOS symptoms.
- BDA, 2016. Polycystic Ovary Syndrome – the fundamentals[online]. Available from: https://www.bda.uk.com/resource/polycystic-ovary-syndrome-the-fundamentals.html. Accessed 11 June 2021.
- BDA, 2019. Polycystic Ovary Syndrome (PCOS) and diet: Food Fact Sheet[online]. Available from: https://www.bda.uk.com/resource/polycystic-ovary-syndrome-pcos-diet.html. Accessed 10 September 2021.
- Farschi,H., Rane,A., Love,A., Kennedy,R.L., 2007. Diet and nutrition in polycystic ovary syndrome (PCOS): Pointers for nutritional management. Journal of obstetrics and gyncaecology. 27(8), 762-773.
- Helena J Teede, Marie L Misso, Michael F Costello, Anuja Dokras, Joop Laven, Lisa Moran, Terhi Piltonen, Robert J Norman, International PCOS Network, Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome, Human Reproduction, Volume 33, Issue 9, September 2018, Pages 1602–1618, https://doi.org/10.1093/humrep/dey256
- Harrison,C.L., Lombard,C.B., Moran,L.J., Teede,H.J., Exercise therapy in polycystic ovary syndrome: a systematic review. Human reproduction update, 17(2), 171-183.
- NHS, 2019. Diagnosis Polycystic ovary syndrome[online]. Available from: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/diagnosis/.Accessed 10 September 2021.
- Jeanes YM, Reeves S, Gibson EL, Piggott C, May VA, Hart KH. Binge eating behaviours and food cravings in women with Polycystic Ovary Syndrome. Appetite. 2017 Feb 1;109:24-32. doi: 10.1016/j.appet.2016.11.010. Epub 2016 Nov 4. PMID: 27825940.
- Lee I, Cooney LG, Saini S, Smith ME, Sammel MD, Allison KC, Dokras A. Increased risk of disordered eating in polycystic ovary syndrome. Fertil Steril. 2017 Mar;107(3):796-802. doi: 10.1016/j.fertnstert.2016.12.014. Epub 2017 Jan 16. PMID: 28104244.
- Karacan E, Caglar GS, Gürsoy AY, Yilmaz MB. Body satisfaction and eating attitudes among girls and young women with and without polycystic ovary syndrome. J Pediatr Adolesc Gynecol. 2014 Apr;27(2):72-7. doi: 10.1016/j.jpag.2013.08.003. PMID: 24602301.