- Are you experiencing carbohydrate or sweet cravings? Even after you’ve just finished eating?
- Are you moving your body and have changed your nutrition, but still see no change in your weight?
- Do you have acne?
- Do you have more facial hair than what you would prefer, and have chin hairs that are just so darn stubborn?
- Do you experience irregular menstrual cycles?
- Are you always fatigued, even though you sleep well?
- Are you gaining weight and you do not even know how?
- Do you get an upset stomach?
- Do you feel like your mood is up and down?
These are signs of polycystic ovary syndrome (PCOS). A common condition that impacts about 10% of people assigned female at birth. Unfortunately, there are still many people who remain undiagnosed.
What is PCOS? Spoiler alert: it’s not just about cystic ovaries
PCOS is a complex multi-system, lifelong condition that involves the endocrine (hormones), reproductive, cardiometabolic, dermatologic (skin) and psychological systems of the body. It is generally characterised by insulin resistance and low-grade inflammation, but these can vary from one person to another [1].
People with PCOS experience a range of symptoms and what one person may experience may be very different to the next. Features may present as psychological (anxiety, depression, sleep and eating disorders and poor body image), reproductive (irregular menstrual cycles, infertility, endometrial cancer and pregnancy complications), dermatologic (hirsutism, acanthosis nigricans and acne) and metabolic (insulin resistance, metabolic syndrome, type 2 diabetes, gestational diabetes, high cholesterol, high blood pressure and increased risk of cardiovascular disease) [2-4].
There are 4 different types (phenotypes) of PCOS
There are four different types of PCOS, that are called phenotypes. Each phenotype presents slightly differently:
– Phenotype A: irregular ovulation, higher androgens, polycystic ovaries
– Phenotype B: irregular ovulation, higher androgens
– Phenotype C: higher androgens, polycystic ovaries
– Phenotype D: irregular ovulation and polycystic ovaries [5]
What food and drinks are best for a person with PCOS are dependent on their symptoms but also on your food preferences, medications, supplements taken, other conditions that may be experienced, relationship with food and culture (to name a few).
From my experience, most people with PCOS actually need to eat more NOT restrict what they are eating. This is a shocker for most people! So many are undernourishing themselves and restricting what they eat, due to wanting to influence their weight, shape or body or are just confused in terms of what to eat. Unfortunately, many people are just told to eat less and move more to achieve weight loss… like it was that easy or that everyone with PCOS needs to lose weight.
Another spoiler alert: not everyone with PCOS needs to lose weight
If this resonates with you I very much recommended working with a dietitian who takes a weight-neutral approach. This means we focus on holistic health and lifestyle change as a measure of health, rather than just weight. In some cases, working with a psychologist may also be beneficial.
Third spoiler alert: weight change does not equate to improved health
We now know that changes in metabolic, hormonal, fertility and psychological health occur independent of weight change. Weight should not be a focus to measure health. It would be better to observe lifestyle changes and their impact on body markers like insulin, fasting glucose, cholesterol or bowel health just to name a few.
How is PCOS diagnosed?
To be diagnosed with PCOS, a person needs to be experiencing 2 out of 3 of the following:
(1) Cystic ovaries on ultrasound (≥ 20 cysts on each ovary)
(2) High androgens either on a blood test (recommend free testosterone, total testosterone and free androgen index) or showing signs of it other than in the blood (e.g. acne, facial hair, weight gain around the stomach)
(3) Irregular cycles and ovulatory dysfunction defined as < 8 cycles per year or < 21 or > 35-day cycles in people who have had their period for more than 3 years and before perimenopause [6]
This means that you actually do not need to have cystic ovaries to have PCOS!
Why is nutrition important for PCOS?
Helps control blood sugar levels
One of the main drivers for PCOS is insulin resistance, with 75% of people with PCOS being resistant to insulin to some degree [7]. PCOS is also characterised by low, long-term inflammation across the body. What you eat and drink is important, as it influences how the body responds to carbohydrates, and how efficiently it takes glucose (the simplest form of carbohydrate our body uses for energy use) to the cells around the body. This is important for adequate energy and daily functioning. The GLUT4 protein (a transporter that takes glucose from insulin to fat and muscle cells) is the main celebrity when it comes to this. In PCOS, the GLUT4 protein is less efficient and less abundant compared to people without PCOS [8]. This is what contributes to changes in weight, feeling hungry even after eating, having carbohydrate or sweet cravings, being fatigued and feeling shaky at times due to low blood sugar levels.
Nutrition tip: pair complex carbohydrate foods like rolled oats, quinoa, grain breads or fruit and vegetables with proteins such as nut butter, dairy or lean meats and/or healthy fats like olive oil or yoghurt. This is a wonderful way to nourish your body well and reduce the risk of low or high blood sugar spikes.
Helps reduce inflammation
What you eat and drink influence the concentration of inflammatory markers in the body with PCOS, such as C-reactive protein (CRP) and cytokines interleukin 6 (IL-6), interleukin- 8 (IL-8) and tumour necrosis factor–α (TNF-α). Inflammatory markers are a healthy and needed way of life for our body to do the wonderful things it does to keep us healthy and alive. However, when the inflammation is long-term and slightly elevated, this impacts our health, and increases the risk of cardiovascular disease, abdominal weight gain, insulin resistance and dementia risk later on in life [9].
Nutrition tip: eating more antioxidants through seeds, grains, fruit and vegetables, eating more unsaturated fats and limited saturated fat such as avocado, olives, walnuts and fish in our body is one way to help reduce overall inflammation.
Helps optimise your gut health
The gut is the body’s immune barrier and is considered the ‘endocrine’ organ as it influences hormone changes like estrogen, androgen, insulin and more.
More than 50% of people with PCOS experience dysbiosis. This is when there are unfavourable changes to the concentration and diversity of the microorganisms in the gut, leading to bloating, gas, diarrhoea and/or constipation, stomach pain and/or gurgling. These are the symptoms of irritable bowel syndrome. People may also experience changes in the upper gastrointestinal tract that relate to small intestinal bacterial overgrowth. These can be signs of poor gut health and are important to consider, as the composition of the human gut is complex and is closely related to the metabolism of fat and glucose. So far, we do not know whether insulin resistance, inflammation and/or hormonal changes in the gut influence the onset of PCOS, or vice versa. Unfortunately, poor gut health is associated with higher inflammatory markers, insulin resistance and poorer cardiovascular health [10].
Talk to your GP if you are experiencing any of these symptoms to rule other possible conditions.
Nutrition tip: consult a dietitian to work up your gut through personalised nutrition recommendations and avoid removing whole foods or foods groups from your diet. If you remove whole food groups the body will stop making the enzymes required to digest those foods.
If you wish to talk to an evidence-based dietitian who specialises in PCOS to best understand your PCOS and what nutrition may be best for you, contact the Maven Centre and book in with Dr Stephanie Pirotta. She is an accredited practising dietitian and research fellow in the area of PCOS.
References
[1] Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF (2006) Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 91, 4237-4245.
[2] Teede H, Deeks A, Moran L (2010) Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Medicine 8, 41.
[3] Deeks AA, Gibson-Helm ME, Paul E, Teede HJ (2011) Is having polycystic ovary syndrome a predictor of poor psychological function including anxiety and depression? Hum Reprod 26, 1399-1407.
[4] Berni TR, Morgan CL, Rees DA (2021) Women With Polycystic Ovary Syndrome Have an Increased Risk of Major Cardiovascular Events: a Population Study. J Clin Endocrinol Metab 106, e3369-e3380.
[5] Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO (2016) The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 31, 2841-2855.
[6] Helena Teede, Chau Thien Tay, Joop Laven, Anuja Dokras, Lisa Moran, Terhi Piltonen, Michael Costello, Jacky Boivin, Leanne Redman, Jacqueline Boyle, Robert Norman, Aya Mousa, Joham A, on behalf of the International PCOS Network in collaboration with funding paco (2023) Monash University, Melbourne.
[7] Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ (2018) Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 110, 364-379.
[8] Di Lorenzo M, Cacciapuoti N, Lonardo MS, Nasti G, Gautiero C, Belfiore A, Guida B, Chiurazzi M (2023) Pathophysiology and Nutritional Approaches in Polycystic Ovary Syndrome (PCOS): A Comprehensive Review. Current Nutrition Reports 12, 527-544.
[9] Rudnicka E, Kunicki M, Suchta K, Machura P, Grymowicz M, Smolarczyk R (2020) Inflammatory Markers in Women with Polycystic Ovary Syndrome. Biomed Res Int 2020, 4092470.
[10] Sun Y, Gao S, Ye C, Zhao W (2023) Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications. Front Cell Infect Microbiol 13, 1142041.
