Before discussing a PCOS diet, first let me explain what PCOS is
What Is PCOS?
PCOS (Polycystic Ovarian Syndrome) is a condition that can affect women of childbearing age in which their ovaries produce eggs, but do not release them (they do not ovulate). Instead the eggs stay in the ovaries, forming clusters of cysts. This clearly affects a woman’s fertility, but there are also other symptoms that can be distressing.
What Causes PCOS?
There is no known cause for PCOS. You do not ‘catch’ it, although there may be a genetic link as it can run in families.
At the root of PCOS is an inability to control blood sugar effectively. 40% of PCOS sufferers are insulin resistant. This means their cells are not responding to the hormone insulin, which helps stabilise blood sugar, properly. Blood sugar remains high and the body releases more and more insulin. So, the effect is similar to Type 2 diabetes.
Insulin resistance is associated with being overweight, although there is a bit of a chicken and egg situation going on. 75% of overweight PCOS sufferers are insulin resistant and insulin resistance makes PCOS worse . So which came first, the PCOS or the muffin top? No-one yet knows. One thing is clear, however, losing weight improves both insulin resistance and PCOS.
High insulin also stimulates the ovaries to produce testosterone and it is this ‘male’ hormone that accounts for some of the most tricky symptoms of PCOS – excess hair, acne and a more muscular physique. Stabilising blood sugar to reduce insulin resistance can also improve these symptoms.
How Do I know If I’ve Got PCOS?
Here are some clues you may have it :
- No periods or irregular periods
- Infertility
- Poor blood sugar control – dizziness or irritability if you don’t eat often
- Weight gain
- Craving for stimulants (sugar, caffeine, alcohol, chocolate)
- Excess hair along chin line, chest or stomach
- Acne
- Muscular physique – good at sport.
PCOS can run in families, so if you have a female blood relative who has been diagnosed with PCOS or who had difficulty getting pregnant but this was long enough ago for proper testing not to have been carried out, the likelihood that you have PCOS increases.
If you suspect PCOS, you should see your GP who will ask you to fill in a PCOS questionnaire similar to the one above. He/she may then suggest a scan of your ovaries, which will be regarded as positive if it reveals cysts.
What is the treatment for PCOS?
There is no cure for PCOS. However, it can be very effectively managed and symptoms reduced by adopting a PCOS DIET (see below) and exercise. Stress can be a major factor too, so learning to manage this better often reduces symptoms.
Medical Treatment for PCOS
Doctors often suggest the following:
- The Pill. This is for PCOS sufferers who do not want to get pregnant. The Pill masks the condition as the extra oestrogen/progesterone from the pill offsets some of the excess testosterone, so improving skin, weight and excess hair problems . The pill will also provide ‘false’ periods so making you feel that your PCOS has gone away. However, the moment you come off the pill, for example if you want to have a baby, your symptoms may return. Smokers are also advised not to take The Pill even to normalise PCOS symptoms.
- Metformin. This is drug used to increase insulin sensitivity and may also improve the action of another drug Clomifene (see below). Metformin has been shown to be helpful in weightloss which may also improve PCOS.
- Clomifene (Clomid). Often given with Metformin, this is the usual treatment for PCOS sufferers trying to get pregnant but not succeeding. It stimulates ovulation.
- Gonadatrophins – drugs to reduce testosterone
- Surgery. Laporoscopic Ovarian Drilling is a procedure in which the part of the ovary producing testosterone is lasered to reduce the release of testosterone.
Side Effects Of PCOS Medications
All drugs have side effects. Those given for PCOS are no exception.
The Pill
- Weight gain
- Depression
- Possible increased risk of developing some cancers, depending on which pill prescribed.
Metformin
- Nausea
- Vomiting
- Diarrhoea
Clomifene
- Bloating
- Breast tenderness
- Weight gain
- Mood swings
- Dizzyness and nausea
- Headaches.
(We are all individuals, but having been on Clomifene myself my experience was that I got symptoms 1 – 4 in spades.)
If you are desperate to get pregnant, you may be willing to put up with some or all of these symptoms. IVF drugs which may be the next step are often even more side effect-ridden. However, many doctors also advise diet and lifestyle changes not because they are health Nazis but because these can deliver some of the same PCOS improvements as medications without the downsides.
Some fertility clinics will not offer IVF treatment for PCOS sufferers if their BMI is not within a certain range, so it may be that you don’t have a choice but to adopt some form of PCOS diet. You can use this with or without medication to lose weight, improve insulin i and lessen your symptoms of PCOS..
THE PCOS DIET
The key to losing weight if you have PCOS is to keep your blood sugar as level as possible. This reduces fat storage, starts fat burning and may also lessen the sugar cravings that may be driving your weight gain.
This is not to say it will be easy. As a PCOS sufferer, you know that you put on weight more easily than your non PCOS friends. This is deeply unfair, but there we are. Do not give up. You can lose weight.
Here are the guidelines I give my PCOS clients who need to lose weight.
1. Plenty of Protein
This means eating some lean protein at every meal. One serving of protein is:
120g skinless chicken breast
120g salmon fillet
120g tofu./quorn
2 eggs
75g low fat cheese
100 low fat cottage cheese
50g full fat cheese
1 palmful of nuts/seeds
2 scoops of whey protein.
Why?
Protein helps stabilise blood sugar. Blood sugar that see-saws up and down can not only makes you feel cranky and lead to cravings and bingeing, it promotes fat storage and has an effect on hormone levels.
Protein is also important for proper function of the adrenal glands. As well as the ovaries, the adrenals produce testosterone and another hormone cortisol, which can further raises blood sugar and insulin, so further raising testosterone. So getting the adrenals to function properly is key to reducing testosterone levels and improving PCOS symptoms.
Another reason to boost protein is that the happy brain hormone serotonin is made from tryptophan which comes from the protein in some foods. Low serotonin is linked to feeling stressed and bingeing, both common among PCOSers.
2. Make Friends with Good Fat
You should eat some good fat at least 3 x week. One serving of good fat is contained in:
1 x salmon/trout steak
½ tin of sardines/salmon/mackerel
½ smoked mackerel filet
2 slices of smoked salmon.
½ avocado
1 palmful nuts/seeds
1 tablespoon olive/flax oil
Why?
‘Good’ fats are vital for proper blood sugar balance and linked to fat burning not storage. Deficiencies of ‘good’ fats can be a factor in hormone imbalances such as PCOS.
‘Good fats, aka Essential fats, are also known as EFAs or Omega 3, 6 and 9 fats. They are important for the functioning of every cell in our bodies, including those in our brains. A deficiency in good fats is associated with low level depression and anxiety which can promote comfort eating and weight gain
3. Eat Regularly.
The PCOS Diet is based around three good meals and one snack a day. You should try to evenly space these meals.
Your PCOS Diet food day looks like this
Breakfast 7 – 8.30am
Lunch 12 – 1
Snack 3 – 5pm
Dinner 6 – 8pm
Why?
Grazing on food does not allow the two blood sugar balance hormones – insulin and glucagon – a chance to work effectively. Instead, it’s important to have a period of fasting between meals.
4. Limit Your Starches.
The PCOS Diet limits starches such as bread, pasta and potatoes to 2 portions p/day. These need to be wholegrain, so avoid white bread, pasta, rice, couscous, noodles, pastry, cakes etc..
1 portion of PCOS friendly starch is:
1 teacup cooked volume of brown rice, quinoa, porridge, low sugar baked beans, red
kidney beans, lentils or chick peas
2 slices Ryvita, or 3 oatcakes.
1 thin slice rye or spelt bread
5. Reduce stimulants.
This means reducing or preferably avoiding completely normal tea/coffee, caffeinated soft drinks, energy drinks, sweets, chocolate, biscuits and cakes and alcoholic drinks. Instead, you can drink herbal teas and decaffeinated coffees, sparkling and still water.
Why?
Stimulants may trigger the release of stress hormone cortisol, so causing your blood sugar and insulin to rise and then triggering further testosterone production by the ovaries.
6. Reduce sugar.
We all know that sweets, chocolate and cakes are high in sugar, but so are fruit, dried fruit and fruit juices, as well as cordials. PCOS sufferers often really crave fruit, especially if they are trying to avoid chocolate or cake. The PCOS Diet allows you 1 serving of fruit p/day only.
1 serving is
1 apple/pear/orange/pear/half a grapefruit.
Other fruits such as nectarine, mango, grapes, pineapple are not permitted. Dried fruit of all kinds is not permitted. Fruit juices and cordials are not permitted.
You may drink flavoured water, sugar free fruit cordials, diet soft drinks, or best of all water.
Why?
While many trying to eat healthily cut out cakes etc. many do not realise how much sugar they are consuming in fruit and fruit juice. This can upset blood sugar balance and worsen PCOS.
7. Non root veggies are unlimited, so eat as much as you like!
You can eat as many non root veggies as you like. This means
Salads – e.g. lettuce, tomatoes, radishes, celery
Steamed veggies – e.g. broccoli, leek, cauliflower
Stir fry veggies – e.g. peppers, courgettes, bok choi
Roasted veggies – e.g. onions, aubergine, chicory
Sweet potato, carrot, swede, squash, turnip, beetroot – limit to 2 x week only.
Avoid: white potato,
Why?
This is not a high protein diet, it is a sensible, balanced, low starch one. Non root vegetables are packed full of nutrients so are great for general health. They also contain fibre and water which makes them filling and so are great for dieters.
Tips for Maximising Success
Exercise!
While you don’t want to go mad with exercise, as too much cardio can increase in stress hormone cortisol in the body which may boost your insulin levels, regular moderate cardio exercise will burn fat and improve blood sugar control. 40 mins brisk walking/cycling/swimming/aerobics 3 x a week, would be good.
A de-stressing form of exercise, such as yoga and tai chi would also be excellent as reducing your stress levels may reduce cortisol, so lowering insulin levels.
Insulin resistance is also associated with being overweight, although there is a bit of a
chicken and egg situation going on. 75% of overweight PCOS sufferers are insulin
resistant and insulin resistance makes PCOS worse . So which came first, the PCOS or
the muffin top? No-one yet knows. One thing is clear, however, losing weight improves
both insulin resistance and PCOS.
Insulin resistance is also associated with being overweight, although there is a bit of a
chicken and egg situation going on. 75% of overweight PCOS sufferers are insulin resistant and insulin resistance makes PCOS worse . So which came first, the PCOS or the muffin top? No-one yet knows. One thing is clear, however, losing weight improves both insulin resistance and PCOS.
Insulin resistance is also associated with being overweight, although there is a bit of a chicken and egg situation going on. 75% of overweight PCOS sufferers are insulin resistant and insulin resistance makes PCOS worse . So which came first, the PCOS or the muffin top? No-one yet knows. One thing is clear, however, losing weight improves both insulin resistance and PCOS.
Why?
Exercise burns calories, improves blood sugar regulation, reduces stress and lifts mood.
Be Prepared
Make a packed lunch, buy a flask and make soup, cook extra and keep ready-made meals in your fridge or freezer. If you are a tea or coffee drinker, carry herbal tea bags or a small bag of decaffeinated coffee. Alternatively, store them in your office drawer.
Why?
There is nothing worse than being starving and then finding there is nothing available that fits in with the food plan you’re trying to follow.
Get Enough Sleep
Most people need at least six hours of good quality sleep to feel good and function effectively. Scientific studies have shown that lack of sleep may be linked to depression and could actually cause weight gain.
Why?
Sleep deprivation may cause hormone changes that could lead to fat storage. Feeling tired could also stimulate cravings, leads to over-eating and is associated with low mood..
Establish a routine
My most successful clients get a routine going and stick to it. So they exercise the same time every day, or do a regular exercise class each week. They always pack their lunch the night before, or they even have the same breakfast every day.
Why?
A routine removes the possibility of being tempted to stray. It makes good habits automatic.
Consider Hypnosis.
Many people are a bit suspicious of hypnosis (they think they’ll be made to look silly). But clinical hypnosis is very different from stage or TV hypnosis. My clients have hypnosis weekly with me and also learn how to do it themselves at home.
Why?
Hypnosis is a highly effective form of relaxation that may reduce the level of stress hormone cortisol, so improving PCOS symptoms. Hypnosis can also be very helpful for weightloss, reducing cravings and increasing motivation to stick to your PCOS Diet.
FINAL WORD
The last thing I’d say is that as a former PCOS sufferer myself, who has gone on to have three children, I am proof that changing what you eat and getting your stress levels down can really turn around your PCOS. There is hope!
Author: Nutritionist/hypnotherapist Lowri Turner
