PCOS Diet article originally published 26 Aug 2016. Last updated 15 April 2021.
A few years ago, a close friend of mine was diagnosed with polycystic ovary syndrome. She came to me with questions because it seemed her doctor was recommending things that didn’t seem right to her. For example, her doctor recommended she begin a low-carbohydrate diet. She didn’t understand why and how this supported a PCOS diet. I responded, “Your doctor is absolutely right.”
Why you may ask? I’ll explain. But first, as I usually do, let’s start at the beginning and talk about what polycystic ovary syndrome and metabolic syndrome are, especially since they both can be kind of confusing.
Listen to Dr. Neal's Q&A on a PCOS diet on Episode 885 of the podcast Optimal Health Daily.
What Is Polycystic Ovary Syndrome?
I always like to break down these fancy medical terms into something meaningful. When we simplify these fancy words, it usually clues us in to what the the condition is all about.
Starting with the word “polycystic”: the term “poly” means “many.”
A cyst, in this sense, is referring to an abnormal growth in or on the body. And this growth is usually filled with some sort of fluid.
So the term “polycystic” means that a person has many of these cysts, or fluid filled growths, in or on their body. Because we’re talking about polycystic ovary syndrome, this means in theory, there are many cysts growing on their ovaries.
I say “in theory” because a woman may be diagnosed with polycystic ovary syndrome without cysts developing on her ovaries. Weird, right? Well, what doctors have discovered is that while some don’t always develop cysts on their ovaries, most women with this condition do share a common characteristic–most experience some hormonal imbalances–hormones like testosterone, estrogen, and progesterone are out of balance.
Why this happens to some women but not others isn’t really clear–doctors aren’t sure of the causes for this. What we do know is that these hormones are partly responsible for the regularity of menstrual cycles. Therefore, imbalances in these hormones can lead to symptoms like unpredictable menstrual cycles. But imbalances of these hormones can also cause acne, pain in the pelvic region of the body, abnormal body or facial hair growth, and here’s where it gets interesting… an increased risk for developing diabetes.
What the heck does diabetes have to do with polycystic ovary syndrome? Well, one of the other hormones that starts to get thrown out of balance is insulin.
Listen to Helen's thoughts on blood sugar and insulin on Episode 1023 of the podcast Optimal Health Daily.
The Insulin & Polycystic Ovary Syndrome Connection
Insulin helps sugar leave the bloodstream and get into the body’s cells. Remember, the bloodstream is just a transporter of stuff. We don’t want sugar to sit in the bloodstream for too long. Insulin helps this process by making our body’s cells more receptive to the sugar that’s floating around in the blood.
So insulin is good because it helps the sugar get to our cells where it can be used to provide our bodies with energy.
Insulin Resistance
What we’re learning is that women with polycystic ovary syndrome may be resistant to the effects of insulin. That means the sugar stays in the bloodstream and doesn’t get into the cells where it’s needed. Doctors can easily test for this by checking blood sugar levels. Higher-than-normal blood sugar levels means that the body is not responding to insulin properly.
That probably sounds a bit abstract so I am going to explain how this works:
You’re hungry so you eat a snack. Let’s say you eat a piece of toast. First, you will chew the toast. Even as you are chewing, your body starts to send some of the energy from that toast into your bloodstream. It happens that fast! This form of energy is actually the sugar (or glucose) in the toast. So, by just chewing your food, the body starts to break it down into a usable form of energy: sugar, or glucose (same thing).
Then those chewed bits of toast get swallowed and they eventually get pushed down and through the rest of your gut. As those bits of toast move through your stomach and intestines, it gets broken down further and further, all for the sake of turning that piece of toast into a usable form of energy: sugar (or glucose)!
But that sugar (or glucose) will not actually be used for energy just yet. Why not? Because the body needs that special hormone, insulin, first. Without insulin, that piece of toast with all the sugar that your body needs so badly in order to function will not be used as fuel for your muscles and your brain for energy.
So isn't a lot of insulin a good thing? Wouldn’t that mean that your body would be better at converting the toast you eat into energy for your body?
Unfortunately, no. If your body makes too much insulin, it means that something else is going on. It means that for some reason, your body is getting a signal that you’re not able to convert that piece of toast you just ate into usable energy. It just keeps pumping out more and more insulin. We call this insulin resistance. It basically means that your body is not using the insulin its making. But this is not a completely hopeless situation! There is still time to fix this!
Listen to Dr. Neal's thoughts on the best diets on Episode 625 of the podcast Optimal Health Daily.
Polycystic Ovary Syndrome and Metabolic Syndrome Connection
I want to start by saying that metabolic syndrome is not just specific to those that identify as female. Metabolic syndrome can affect anyone.
One of the signs of metabolic syndrome is having higher-than-normal blood sugar levels. After fasting for 8-12 hours, if you went to get your blood sugar checked, we’d say your values are normal if your blood sugar levels were between 76 and 99 milligrams per deciliter of blood. Blood sugar levels higher than 100 mg/dL would be considered too high. This is partly why some doctors call polycystic ovary syndrome a type of metabolic syndrome.
Insulin resistance is just one potential sign that someone has a condition called Metabolic Syndrome. A person is thought to have Metabolic Syndrome if they meet 3 of the following criteria:
- Having a large waist – the waist is the area around the belly button
- Having high triglycerides – this can be discovered with a simple blood test. It’s basically measuring the amount of fat that’s floating in the bloodstream
- Having high cholesterol
- High blood pressure
- High blood sugar (blood glucose) levels (which will probably mean high insulin levels, too)
If someone meets 3 of those criteria, then they would fit the profile for having Metabolic Syndrome. If there is no change in lifestyle, then type 2 diabetes is around the corner. But, again, having Metabolic Syndrome isn’t the end of the world! It can be REVERSED! (Diabetes cannot be reversed, but Metabolic Syndrome can!)
Reversing and Preventing Polycystic Ovary Syndrome and Metabolic Syndrome
What can someone do to feel their best even with a diagnosis of polycystic ovary syndrome or metabolic syndrome?
Luckily, many of the lifestyle tips I discuss on this blog and in the Optimal Health Daily podcast apply here.
Listen to Lucy's thoughts on five stress management techniques on Episode 737 of the podcast Optimal Health Daily.
Doctors often recommend some sort of:
- diet modification
- regular exercise
- possibly some weight loss
- stress management
When it comes to a PCOS diet, specifically, my friend was baffled at the thought of following a low-carbohydrate diet. But the reason a doctor might suggest this for polycystic ovary syndrome or metabolic syndrome is because the body is not responding to insulin as well. Again, this means that blood sugar levels are staying too high. By following a low-carbohydrate diet, you're decreasing the amount of sugar you're taking in with your meals. This is because the body easily converts carbohydrates to sugar. By decreasing your intake of carbohydrates, you may lower the amount of sugar floating around in your bloodstream.
But if a low-carbohydrate diet isn’t for you, researchers have also found that a Mediterranean-type diet that’s rich in fruits and vegetables, legumes, and other complex carbohydrates, and moderate in protein can also help with both polycystic ovary syndrome and metabolic syndrome.
When it comes to regular exercise, we’re learning that this may help the body respond to insulin more efficiently, which then helps lower blood sugar levels, too.
PCOS Diet: Summary
If we think about the criteria I just mentioned–larger waist, high cholesterol, high blood pressure–these can all be improved with a nutritious diet, regular physical activity, and adequate sleep.
Even if an individual with Metabolic Syndrome were to trim 100 calories from their diet each day, which would be like having half a can of soda instead of the full can, that may be enough to start bringing these numbers down. 100 fewer calories will lead to some minor weight loss, which may shrink the waist. Plus, even a small amount of weight loss can lead to BIG changes in blood pressure, blood levels of triglycerides, cholesterol, and blood sugar.
My recommendation to someone with polycystic ovary syndrome or metabolic syndrome would be to think about ways to remove anywhere from 100 calories to 500 calories per day (if feasible without putting yourself at risk for malnutrition) or to increase your activity to burn those extra calories. Don’t feel as though you need to deprive yourself… even if you start small, it can make a huge difference in the long run.
Listen to Dr. Neal's Q&A on a PCOS diet on Episode 885 of the podcast Optimal Health Daily.
