Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects 8 to 20 percent of reproductive age women.
"PCOS is characterized by the release of excess androgens—male hormones such as testosterone—from the ovaries and is associated with insulin resistance," says Angela Grassi, M.S., R.D.N., L.D.N., author of The PCOS Workbook: Your Guide to Complete Physical and Emotional Health and founder of The PCOS Nutrition Center. "Tiny follicles, mistakenly called 'cysts,' can surround the ovaries, appearing on an ultrasound as a strand of pearls. The cysts are a result of hormonal imbalances, not the cause of them," Grassi says.
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"The most common symptoms of PCOS are irregular, or even completely absent, menstrual periods," says Hillary Wright, M.Ed., R.D., L.D.N., author of The PCOS Diet Plan.
Like many health conditions, what you eat—and what you don't eat—can impact how your body reacts to a disease or to its symptoms. The same is true for PCOS. A healthy diet can help reduce symptoms and manage insulin levels, and can go a long way to effectively treat PCOS.
PCOS Nutrition and Diet
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"Women with PCOS who are insulin resistant, as in the majority of cases, will experience weight gain in the abdominal area, difficulties losing weight, intense cravings for carbohydrates and hypoglycemic episodes," Grassi says.
These issues are tied to insulin resistance. "In insulin resistance, the body becomes numb to the action of the hormone insulin, whose job is to unlock cells to clear sugar, or glucose, out of the blood. This resistance to insulin triggers the pancreas to make more in an effort to regulate blood sugar levels, which, over time, can exhaust the pancreas, leading to diabetes," Wright notes. It can also cause an imbalance in some reproductive hormones, leading to infertility. Changing your diet can help control blood sugar levels and prevent insulin resistance from worsening.
Not all women with PCOS are overweight. But if you are overweight, losing weight can help ease symptoms. "If a woman with PCOS is overweight, losing as little as 5 to 10 percent of her weight can have a potent effect on her health and hormones, including fertility," Wright says.
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What Should You Eat if You Have PCOS?
In short, eat the same healthful foods recommended for everyone: fruits and vegetables, lean proteins, whole grains, and healthy fats. Limit processed sugars and refined carbohydrates, which can spike blood sugar levels. Eat saturated and trans fats in moderation. These fats can promote inflammation in the body.
"Diet and lifestyle changes are the primary treatment approaches to managing PCOS," Grassi says. This includes not only what you eat, but also exercise, sleep and managing stress. Medications and supplements might also help, she says, but there is no one-size-fits-all diet plan for PCOS. It is important to work with a dietitian who specializes in PCOS treatment.
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Vegetables are an important component of any healthful diet, but they have added benefits if you have PCOS.
"Besides being low in calories due to their natural water content, vegetables are loaded with fiber and phytonutrients, health-promoting compounds that act to neutralize inflammation and oxidation, both of which we think aggravate some of the health effects of PCOS," Wright says.
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Fruits, vegetables and whole grains are healthful carbohydrates to incorporate into your diet. Whole grains, like whole-wheat pasta, quinoa and barley, deliver a dose of fiber that can also help keep blood sugar levels from spiking. While limiting refined carbohydrates like white rice and pasta is recommended to help prevent PCOS symptoms, don't nix carbohydrates altogether, Grassi says.
"Many women with PCOS have found that if they cut out carbohydrates, or eat very minimal amounts, it only causes them to binge on them in the long run. This can actually make PCOS symptoms worse by increasing insulin levels," Grassi says.
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Meals and snacks should also contain healthy proteins like nuts, nut butters, beans, tofu, lean meat and fish. Pair protein with a healthy carbohydrate, such as fruits, vegetables or whole grains.
"Protein fills you up faster, keeps you feeling fuller longer and dampens down post-meal glucose spikes that can lead to crashes and cravings in the hours after you eat," Wright says.
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Don't fear fat if you have PCOS. Swap saturated and trans fats for poly- and monounsaturated fats like avocado, nuts, salmon, olive oil and nut butters. Fat is digested slowly, so it keeps you full longer. Omega-3 fatty acids also reduce inflammation in the body.
"Including anti-inflammatory foods in your diet can help lower inflammation and improve many PCOS symptoms," Grassi says.
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Eat more whole foods and fewer processed ones. "I'm a believer that the more whole foods you eat, the less processed food and sugar you'll want. Noticing how your body feels after eating whole foods, including a lot of fruits and vegetables, versus processed foods and sugar, can be a good reinforcer to stay on track with healthy eating," Wright says.
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Managing PCOS Long-Term
Unfortunately, PCOS does not go away. There is no cure, and treatment aims to reduce symptoms and prevent complications. The good news is that you can improve your health and symptoms by changing your diet, losing weight if you are overweight, managing your stress and exercising regularly.
Focus on one change at a time. By focusing solely on exercise, for example, it may improve your stress, which in turn could improve your diet. Or focus on changing your diet first and you may find you have more energy to exercise.