Managing PCOS to achieve your health goals
Managing PCOS to achieve your health goals
August 12, 2021 by Allie Buxton and Lesley Seto
Polycystic ovarian syndrome (PCOS) is a common, yet underdiagnosed, condition with long-term health consequences. If you’ve been recently diagnosed with PCOS or are beginning to experience worsening symptoms, this article will give you an overview of PCOS, symptoms, and pathways, as well as treatment options to manage symptoms and achieve your health goals.
What is PCOS?
Polycystic ovarian syndrome (PCOS) is an endocrine disorder resulting from a disruption to the normal balance of hormones in the body. PCOS is the most common hormone disorder in women of reproductive age, affecting approximately 8-13% of women, and is a leading cause of infertility.
PCOS can exist across a spectrum and symptoms often vary from person to person. Some of the common symptoms include:
Absent, irregular, or unpredictable periods
New or excessive hair on the face or body
Thinning hair on the head
Skin issues (oily skin, acne, dark patches)
Weight gain or difficulty losing weight
Difficulties getting pregnant
Insulin resistance
Due to the variance of these symptoms, it can be difficult to obtain a diagnosis. The criteria for diagnosing PCOS are evolving, but women with this syndrome typically present with at least two of the following:
Irregular or absent ovulation
High androgen hormone levels
One or both ovaries are polycystic (have a covering that contains immature ova)
What causes PCOS?
A specific cause of PCOS isn’t clear—multiple pathways may lead to its development. Genetics, behaviour, lifestyle, and environment all likely play a role. Some examples of pathways include:
Insulin Resistance
Insulin resistance appears in up to two-thirds of people diagnosed with PCOS. Insulin is a hormone involved in processing sugar/glucose and acts as a signal for the body to produce testosterone (an androgen hormone). Insulin resistance is characterized by a reduction in the body's sensitivity to insulin. To process sugar, the body then needs to produce an excess of insulin, which in turn signals the production of additional testosterone, resulting in hormonal imbalances.
Inflammation
Chronic inflammation is emerging as a key contributor to the development of PCOS. Inflammation results from the body trying to rid itself of something the immune system interprets as a threat. This response may be caused by an autoimmune disorder, diet, stress, weight gain, excess alcohol consumption, or a sedentary lifestyle. Inflammation suppresses the insulin-signaling pathways in the body, making cells less responsive to insulin over time. As discussed above, this results in increased insulin and testosterone production in the body.
Gut Imbalances
Our gut microbiome—the multitude of microorganisms living in our gastrointestinal tract—is involved in a diverse set of roles in the body, some of which include regulating the immune system, managing inflammation, and balancing hormones. If the gut microbiome is imbalanced, it is unable to perform these functions optimally. Studies have shown that gut imbalances may contribute to symptoms of PCOS, but also that PCOS can exacerbate imbalances in the gut, further complicating symptom management.
Stress
Chronic stress is likely a major contributor to PCOS. When stressed or anxious, our bodies release cortisol (the primary stress hormone) to regulate physiological processes that allow us to respond to that stress. Extended exposure to cortisol can be harmful, so our bodies produce hormones that offer protection against it. However, these hormones also stimulate the production of androgens from the adrenal glands. It’s estimated that up to 30% of women with PCOS have adrenal androgen excess.
PCOS treatment
There is currently no cure for PCOS and so treatment plans focus on managing symptoms. Treatment goals for PCOS are dependent on the symptoms experienced, but generally include improving hormone imbalances, preventing complications, improving quality of life, and sometimes, improving fertility.
Common treatment plans include recommendations for weight loss, following specific diets (such as the keto diet), hormone therapy, and other medications to control blood sugar. For some pathways, these treatment plans may prove effective. Weight loss of more than 5% may improve ovarian function and fertility for overweight women with PCOS. And a ketogenic diet has been shown to support weight loss and is linked to an increase in insulin sensitivity. However, a ketogenic diet is difficult to sustain and there is evidence to suggest that long-term adherence to a low-carb diet could make PCOS symptoms worse for some women.
Many women experience frustrations treating PCOS as the options mentioned above may not be appropriate, preferred, or even successful in managing their symptoms. A successful treatment plan should address the root cause for that individual and include a combination of diet and lifestyle strategies, and medical intervention as necessary.
Key Nutrition Recommendations
PCOS is a lifelong condition and there is no straightforward pathway to managing it. What is successful for one person may not be successful for another. How PCOS is treated depends on the potential cause, symptoms, and goals of the individual. However, simple dietary changes have been shown to improve insulin resistance and metabolic and reproductive functions of the body. Some key nutrition recommendations for PCOS include:
Balance blood sugar
Insulin resistance is a common feature of PCOS. Learning how to balance your blood sugar can help restore your body's insulin sensitivity.
Timing of meals
Eat your highest caloric meal at breakfast and have a lighter dinner in the evening.
Eating every 4h based on hunger and satiety signals, snacking only if needed.
Quality is everything!
Choose good quality protein, fats, and slow carbs like starchy vegetables (potatoes, squash, parsnips, etc.) and healthful grains like buckwheat, millet, oats, and quinoa.
plant-based & anti-inflammatory
Plant-based & anti-inflammatory eating patterns, such as the Mediterranean diet, are supportive of managing PCOS. A plant-based eating plan ensures you get enough fruits, vegetables, and fibre to support a healthy gut and manage blood sugar, while the healthy fats and lean protein of the Mediterranean diet minimize inflammation.
Aim for 30g of fibre per day (every 1g increase in fibre can support 0.5lb weight loss)
Incorporate sources of omega-3 (salmon, sardines, and seeds like flax or chia)
Choose lean and plant-based proteins (chicken, white fish, seafood, beans & legumes)
Don’t Restrict
Restrictive eating can lead to a stress response in the body, increase insulin, and cravings for sugar/empty carbs. Further, over-restriction of foods often leads to binging cycles.
Use Supplements if needed
Supplements can support the body in replenishing nutrient insufficiencies, support healthy blood sugar, and reduce certain symptoms associated with PCOS. Working with a Registered Dietitian can help determine which supplements (and how much) may benefit you.
Berberine - supports blood sugar regulation, menstrual regularity, and weight loss
Inositol - improves blood sugar regulation, blood pressure, blood triglyceride levels, decreasing androgens
Vitamin D - a vitamin D deficiency can exacerbate symptoms of menstrual irregularity, insulin resistance, and obesity
Zinc - may help reduce acne, unwanted facial hair in PCOS (hirsutism), and female pattern hair loss
A personalized approach
I’m sure there are plenty of recommendations here that will help you get started! Working with a health care practitioner is usually the most effective way to manage symptoms and achieve your health goals. If you’re frustrated with your current symptom management plan or you don’t know where to start, give me a call. We’ll identify the root cause of your symptoms and develop a management plan that works for you!
Ready to start? Contact Lesley to book an appointment.