Although all the underlying physiology in PCOS is not yet clearly understood, insulin resistance, or an inability of the body to efficiently utilize insulin, a hormone secreted by the pancreas, is clearly a major player.
After a meal, insulin’s job is to “unlock” muscle, fat and liver cells so that sugars can pass out of the blood and into the cells, where they are either burned as fuel or stored as an energy reserve. In insulin resistance, the cells are not as sensitive to the action of this hormone, causing the pancreas to up its insulin production in an attempt to keep blood sugars normal. This excess insulin in turn triggers an increased production of testosterone in the ovaries, which contributes to an upset of the hormonal balance needed to stimulate normal ovulation. These elevated testosterone levels are also to blame for the ovarian cysts, excess facial hair, acne, and male-pattern hair thinning seen in some women with PCOS, as well as the tendency for these women to store excess body fat in their abdomen, like men. Research shows this excess abdominal fat further aggravates insulin resistance and worsens the symptoms of PCOS.
For overweight women with PCOS, experts agree that weight loss is key, which naturally improves insulin resistance. As with anyone trying to lose weight, this involves both diet modification and exercise. Research shows that during exercise, and for several hours after, muscle cells are more sensitive to the action of insulin. Exercise should include at least 30 minutes of aerobic activity, like walking, cycling or swimming, most days of the week, and strengthening exercise two to three times per week, using free weights, weight machines or exercise bands. Yoga can also be extremely helpful for improving strength and flexibility, and as a mind-body technique for managing the stress of fertility treatment.
As with many people suffering from a chronic health problem, women with PCOS often feel so unwell and dissatisfied with their bodies that they just want to “take a pill” and have it go away. And you can’t really blame them. Many have spent years just trying to get a diagnosis, seeing countless doctors to have their symptoms treated, but never really getting to the root of the problem. Although insulin-sensitizing medications, such as Metformin or Actos, may be used, diet and lifestyle management is the primary treatment of PCOS. The diet to control PCOS is really very similar to what anyone who is interested in living a long healthy life should do.
While the ideal diet for PCOS is debatable, much of what has been written has focused on “low carb” diets. But it’s really an issue of what I call the “2 Q’s” – quality and quantity. Many nutritionists recommend modestly limiting the quantity of carbohydrate eaten at each meal or snack, particularly the processed type like added sugars and refined grains (like white flour). It’s mainly carbohydrates ““ from fruits, starchy vegetables (potatoes, sweet potatoes, yams, winter squash, corn, peas and legumes), milk, yogurt, grains, and “sweets” that influence insulin requirements after a meal, so limiting portions of “carbs” at meals and snacks (to about 45% of total calories as opposed to a typical “heart healthy” diet that’s about 55% carbohydrate) may help lower insulin levels. Replacing unhealthy saturated fats and trans fats with healthful monounsaturated fats like nuts and nut butters, fatty fish and olive and canola oils, is also beneficial for people with insulin resistance as it may help normalize insulin levels and improve blood cholesterol and triglyceride levels.
Choice of carbohydrate is key, with the best quality ones being those that haven’t been stripped of their dietary fiber through processing. Because fiber is not digestible, after eating our digestive enzymes need to “sift through” the fibers to extract the sugars and other nutrients, thereby slowing down the digestive process. This results in a more gradual release of “sugars” into the blood, and subsequently a more muted insulin response, lowering circulating levels of insulin. This in turn may help normalize ovarian hormones, which may help restore ovulation.
Pairing carbohydrates with lean proteins, like poultry, seafood, eggs, egg substitutes and reduced fat cheeses (made with part-skim milk), as well as a little “healthy fat,” like nuts, nut butters, seeds and olive or canola oil, may also help further “complicate” digestion and slow the release of sugars into the blood. It also helps to spread carbohydrates out over smaller meals and snacks so your pancreas is producing insulin in smaller doses throughout the day (see “Doling Out the Carbs”). As for sweets, no food is forbidden, it’s all about the quantity; a large slab of cake will trigger a more aggressive insulin response than a small piece eaten after a dinner that was light on other sources of carbohydrate.
Nutritionists agree that a diet for PCOS should be tailored to the individual. That’s best accomplished with the help of a registered dietitian experienced with PCOS. And though only women get PCOS, it suggests a family tendency for insulin resistance, which affects men as well.
Scheduling an appointment with a nutritionist is one of the first steps to take control of this disorder and help reduce your symptoms.
The Domar Center’s Director of Nutrition, Hillary Wright, MEd, RD, LDN has vast experience working with patients suffering from PCOS ~ and will help you to take control of the syndrome and without relying on medications.