Diet recommendations for Women with PCOS

Diet recommendations for Women with PCOS 

             PCOS is one of the most common causes of infertility in women, affecting six percent of premenopausal women and the majority of all women with irregular menstrual cycles. PCOS is a disorder of the endocrine system, which causes an imbalance of hormones secreted in a woman’s ovary needed to fully mature her follicles into eggs. The follicles may start to mature and build up fluid but no one follicle becomes large enough to be released for ovulation. Since no follicle becomes large enough and no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent.

              Furthermore, the remaining undeveloped cysts secrete male hormones called androgens, which also block follicular development, causing follicles to degenerate and make ovulation unlikely. The androgen produced by the cysts enters the bloodstream and alters the feedback the mechanism within the Hypothalamus-Pituitary-Ovarian axis that controls hormonal secretion in the body. The estrogen in the bloodstream can then increase in relation to other hormones, causing increased production of LH (luteinizing hormone) and testosterone and decreased levels of FSH (follicle stimulating hormone), thus preventing ovulation.

              Causes of PCOS are unknown, though one contributing factor seems to be an abnormal insulin and glucose (sugar) interaction. Insulin is a hormone that takes sugar from the bloodstream to the body’s cells for energy. When elevated, insulin increases the stress hormone cortisol. Cortisol competes with progesterone, which regulates normal ovulation cycles and pregnancy. Unfortunately, cortisol dominates over progesterone and negatively impacts ovulation. There are also insulin receptors in the ovaries, so excess insulin causes the ovaries to produce more testosterone and less estradiol. The body reacts by manufacturing more estrogen, which in turn suppresses the FSH needed to mature follicles and causes LH to dominate, ultimately curtailing ovulation.

              Eventually, some women with PCOS may become insulin resistant and their bodies no longer properly take the sugar from the bloodstream to their cells for energy. When this happens, the pancreas secretes more insulin into the blood to reduce sugar levels after meals. If the insulin no longer functions properly, high levels of sugar and insulin remain in the blood. Meanwhile, the cells in the body and brain become starved for glucose to make energy, leaving the woman feeling perpetually tired, hungry, depressed, and craving sugar.

Common symptoms of PCOS include: 

1.  Irregular, infrequent or absent periods
2.  Abnormal levels of insulin as well as insulin resistance
3.  Late or absent ovulation
4.  High prolactin hormone levels (hyperprolactinemia)
5.  Prolonged premenstrual syndrome (PMS) symptoms, such as bloating, pelvic pain, headaches, mood swings and/or depression
6.  Excessive weight gain
7.  Acne and/or oily skin
8.  Polycystic ovaries or enlarged ovaries containing more than 12 follicular cysts
9.  Excessive hair growth, appearing on the chin, upper lip, neck, sideburn area, chest, nipple area and the lower abdomen along the midline
10.  Darkening of the skin around the areas of the neck, arms, breasts, or thighs and is usually indicative of insulin resistance
11.  Skin tags, which are small pieces of excess skin around the armpit or neck area

To help eliminate PCOS, a balanced diet of protein, whole grains(preferably gluten-free), healthy fats, fiber, and low sugar is eaten every few hours is recommended to regulate blood sugar levels and manage insulin production and glucose metabolism. 

Foods to Include and Why

Protein: Consume equal amounts of protein to carbohydrates in each meal to balance sugar and insulin levels and sustain energy. Eat smaller meals or snacks, every 2-3 hours, to avoid spikes in blood sugar and insulin levels. 

• Organic beef, bison, chicken, turkey, always free of growth hormones, antibiotics, or added nitrates. 
•  Organic fish that is wild-caught, not farm-raised or with added coloring, and comes from clean water sources free from pesticides and chemicals. The most beneficial fish species are those that contain higher amounts of omega-3 fatty acids, which help boost the immune system and aid hormonal balance. These include salmon, herring, mackerel, sardines, trout, and tuna. Note: limit your tuna intake, as it is higher in harmful mercury levels than other fish. Please don’t eat bottom-feeding fish like catfish due to toxic levels as well. 
• Organic eggs, free of hormones and antibiotics. 

• Beans, a great vegetarian protein, including black, white, pinto, navy, garbanzo, lima, adzuki, lentils, etc. 
• Soy products (soybeans, tofu, soy protein powder, soy sauce, miso, tempeh, etc.) can increase estrogen production. Check with your doctor to determine whether or not soy is recommended for your condition. 
• Nuts and Seeds, including walnuts, almonds, brazil nuts, cashews, pumpkin seeds, chia seeds, sesame seeds, sunflower seeds, flax seeds, etc.

Complex Carbohydrates: Choose complex, whole grain or sprouted grain carbohydrates as they contain more protein and fiber, and break down gradually, keeping blood sugar and insulin levels more balanced after meals. 

• Millet, quinoa, brown rice, buckwheat, amaranth, kasha/buckwheat, oatmeal. Please avoid gluten grains like wheat, rye, and barley. 
• Gluten free whole grain or sprouted bread, which are easier to digest and better for the immune system.

Healthy Fats: Choose mostly monounsaturated oils that strike a balance between heavy saturated fats that clog arteries and polyunsaturated vegetable oils that are low fat but can cause an immune-damaging synthetic fat. 

•  Cold-pressed, unrefined extra virgin olive oil and sesame oil are best. Other good oils include oleic sunflower, oleic safflower, avocado, almond, apricot kernel, peanut, coconut, and canola. Fresh flax oil is especially helpful in regulating insulin levels. 
•  Other healthy fats include avocadoes, whole eggs, fish rich in omega-3 fatty acids, nuts, and seeds, and small amounts of cheese.

Fiber: Eating a high-fiber diet helps PCOS by slowing down the digestion of sugars in the body and avoiding a spike in insulin. Fiber also helps bind estrogens and inhibits their re-absorption, which ultimately reduces estrogen levels and aids in the reduction of elevated androgen levels. 

•  Great sources of fiber include broccoli, celery, whole grains, apples, and dark leafy greens. 
• Other foods that aid excretion of estrogens from the body include: peas and beans, red and purple berries, garlic, parsley, fennel, cabbage, cauliflower, nuts and seeds, carrots, rhubarb, and sage.

Low Glycemic (Low Sugar) Foods: Eat foods that break down slowly in the body and don’t cause a dramatic spike and then drop in insulin levels, like complex carbohydrates and low sugar foods. Note: For the best food choices, see the Glycemic Index chart attached. Aim for foods with a Glycemic Index (GI) of 55 or lower. This chart is just an example and there are others available that will contain additional foods.

• See Glycemic Index attached for the best food choices. Some low glycemic choices include: dark leafy greens and veggies like kale, broccoli, carrots, asparagus; organic lean meats and fish; whole-grain bread and complex carbs; beans and lentils; hummus; low sugar fruits like grapefruit and apples; and nuts and seeds. 
• Choose foods made with natural sweeteners, which are less processed than refined white or brown sugar and create fewer fluctuations in blood sugar. In moderation, use sugar alternatives like stevia, agave nectar, xylitol, barley malt, organic/raw unprocessed honey, blackstrap molasses, maple sugar, coconut palm sugar, or brown rice syrup. Cinnamon also helps reduce blood sugar levels. 
• Consume dairy products, like milk, cheese, yogurts, and butter limitedly, as they can affect hormone levels and increase inflammation. Always choose organic, unsweetened and low-fat varieties, free of any growth hormones or antibiotics. When eating yogurts, opt for plain, unflavored or unsweetened varieties, and flavor with fresh berries. Do not consume the commercially sweetened or flavored yogurts that only contain excess sugar and other additives. Other non-dairy alternatives include products made from almond milk, rice milk, cashew milk, and soy milk.

Foods to Avoid and Why

Refined Sugar: Highly processed and refined white or brown sugar breaks down rapidly in the body and causes a dramatic spike, and then drop in blood sugar and insulin levels. 

• Eliminate as much sugar in your diet as possible. When needed, consume limited amounts of natural sweeteners in place of refined, processed sugar. These include: stevia, agave nectar, xylitol, barley malt, organic/raw unprocessed honey, blackstrap molasses, maple sugar, coconut palm sugar, or brown rice syrup.

Refined or Simple Carbohydrates: Highly processed, simple carbohydrates break down rapidly in the body and cause a dramatic spike, and then drop in blood sugar and insulin levels. Note: For the best food choices, see the Glycemic Index chart attached. Aim for foods with a Glycemic Index (GI) of 55 or lower.

• Avoid refined carbohydrates like cakes, cookies, white bread/buns/pizza crusts, white rice, white pasta, potatoes, pretzels, sugary breakfast cereals, dried fruits or sugary fruits like raisins and watermelon, crackers, pancakes/waffles, plain bagels, or any highly processed food. 

Alcohol: All alcoholic beverages contain high amounts of sugar and some also contain high amounts of carbohydrates. Alcohol causes a major insulin spike and crash, disturbs sleep patterns, and negatively impacts hormone levels in the body.

• Avoid all alcoholic drinks, especially sugary mixed drinks, cocktails, beer, hard cider, and wine (white wine varieties in particular). If you must have a drink, opt for red wine, preferably organic since grapes are heavily sprayed with harmful pesticides.

Caffeine: Caffeine in coffee, tea, and soft drinks can increase levels of estradiol, a naturally occurring form of estrogen, during a woman’s menstrual cycle.

• Avoid all caffeinated drinks, including coffee, tea, sodas, and sports drinks. Many also contain high levels of added sugar, which will spike insulin levels. Instead, opt for decaffeinated, sugar-free, herbal and green teas. 

Sodas, Fruit Juices, Sweetened Beverages: These beverages all contain high amounts of added sugars and artificial ingredients, which spike insulin levels. 

• Avoid all sugary drinks and sodas, including sodas, fruit juices, sweetened teas or coffees, Gatorade or sports drinks, etc. Instead, opt for healthy, sugar-free drinks like carbonated flavored waters, coconut water, low-fat milk, herbal and green teas, or tomato juice

PCOS Diet and Foods at a Glance

 Every few hours, eat a balanced diet of protein, whole grains, healthy fats, fiber, and low sugar to regulate blood sugar levels, and manage insulin production and glucose metabolism. 

Include: 

• Equal Amounts of Protein to Carbohydrates in every meal: organic meats and fish, organic eggs, beans, nuts and seeds, soy (check with the doctor first). 
•  Complex Carbohydrates: millet, quinoa, spelled, brown rice, buckwheat, amaranth, kasha/buckwheat, oatmeal, gluten-free whole grain or sprouted bread. Best to avoid gluten if possible. Gluten grains are rye, barley, and wheat since these can cause inflammation. 
• Healthy Fats: cold-pressed, unrefined extra virgin olive oil and sesame oil are best. Other good oils include oleic sunflower, oleic safflower, avocado, almond, apricot kernel, peanut, coconut, and canola. Fresh flax oil is especially helpful in regulating insulin levels. Also consume avocadoes, whole eggs, fish rich in omega-3 fatty acids, nuts and seeds, and cheese. 
• Fiber: broccoli, celery, whole grains, apples, dark leafy greens, peas and beans, red and purple berries, garlic, parsley, fennel, cabbage, cauliflower, nuts and seeds, carrots, rhubarb, and sage. 
• Low Glycemic (Low Sugar) Foods: dark leafy greens and veggies like kale, broccoli, carrots, asparagus; organic lean meats and fish; whole-grain breads (preferably gluten-free) and complex carbs; beans and lentils; hummus; low sugar fruits like grapefruit, apples and lemon or lime in water; and nuts and seeds. 
• Natural Sweeteners (limitedly): stevia, agave nectar, xylitol, barley malt, organic/raw unprocessed honey, blackstrap molasses, maple sugar, coconut palm sugar, or brown rice syrup. Cinnamon also helps reduce blood sugar levels. 
• Dairy Products (limitedly): organic, unsweetened, and low-fat dairy products like milk, cheese, yogurt, butter, and non-dairy alternatives made from almond milk, rice milk, cashew milk, and soy milk. Avoid: 
• Refined Sugars: processed and refined white or brown sugars are worst. 
• Gluten grains like wheat, rye, and barley. 
• Refined or Simple Carbohydrates: cakes, cookies, white bread/buns/pizza crusts, white rice, white pasta, potatoes, pretzels, sugary breakfast cereals, dried fruits or sugary fruits like raisins and watermelon, crackers, pancakes/waffles, plain bagels, or any highly processed food. 
• Alcohol: sugary mixed drinks, cocktails, beer, hard cider, and wine (white wine varieties in particular). 
• Caffeine: coffee, tea, sodas, and sports drinks. 
• Sodas, Fruit Juices, Sweetened Beverages: sodas, fruit juices, sweetened teas or coffees, Gatorade or sports drinks, etc.