Polycystic ovarian syndrome (PCOS) is a frustrating hormonal disorder affecting roughly 10% of women. The name is misleading – many women with the syndrome have small cysts on the ovaries but some do not, and this feature is not required to make a diagnosis. PCOS is best explained as a syndrome of widespread hormonal imbalance. The most common signs? Irregular and infrequent menstruation, sporadic ovulation, difficulty losing weight, infertility, acne, and male pattern hair growth. Not all women with PCOS are overweight, some don’t have acne, and many have no trouble getting pregnant. In other words, there is tremendous variation in the experiences of women with PCOS.
To add to the confusion, some clinicians don’t really believe in PCOS or pursue it as a diagnosis. Women with the condition are simply told to lose weight, without a roadmap for how to do it when their bodies resist. PCOS should always be considered when a woman reports telltale symptoms because it is associated with serious, preventable consequences. PCOS increases the risk for endometrial cancer, heart disease, and type 2 diabetes as well as infertility and miscarriage. Weight loss and exercise are the best first line strategies for PCOS, but the devil is in the details.
Current research points to high insulin levels as the culprit behind a cascade of hormonal imbalances in PCOS. Insulin drives the production of androgens (“male” hormones), some of which convert to estrogen. These changes are responsible for increased acne and thickened skin, hair pattern changes, and menstrual irregularity. High insulin levels direct the deposit of fat, especially in the midsection of the body. Many other hormones, including pituitary LH and FSH, progesterone, prolactin, and even thyroid hormones can be altered with the condition.
Understanding insulin as Ground Zero in PCOS makes it easier to target dietary changes and begin the journey toward better health. Here are 3 diet secrets to learn and use.
1. Learn glycemic load.
Glycemic load is a number that helps you understand the sugar burden of eating a particular amount of a particular food. You may be familiar with the glycemic index, which represents how quickly a food spikes your blood glucose. Glycemic load goes a step further by considering not only how quickly blood glucose rises, but how much of a given food is being eaten. Favor foods with low glycemic load, a value of 10 or less. Look at a glycemic load food chart to get familiar with this strategy. I like the one by Harvard Health Publications, here. A word of warning: overdoing grains, even whole grains, puts a heavy sugar burden on your body. If you’re seeking a diet tailored to PCOS, choose one that is low in carbohydrates and high in fiber. Never eliminate carbohydrates completely. Lean proteins, fresh vegetables, and healthy fats and oils should be showcased in your chosen diet.
2. Eat your beans!
The legume family of plants is an ally for women with PCOS. Legumes contain inositols, compounds which may help to reduce insulin resistance. The high fiber content in beans can increase fullness and reduce overall caloric intake. Variety is key. Select unprocessed soy or edamame, kidney beans, lentils, garbanzos, and so on. Try herbal teas with alfalfa or licorice. Other foods with inositols include brown rice, carob, buckwheat, oats and barley. A word of warning: soy and gluten are relatively common dietary triggers, and are not well tolerated by some women with PCOS. Take the time to complete an elimination diet which eradicates these foods for 3 weeks if you’re not sure what their effects are on your body. Then reintroduce one trigger at a time and record any symptoms to be sure you can include these foods in your diet. A helpful handout on the elimination diet can be found here.
3. Get sensitive.
Eating foods and spices that enhance insulin sensitivity can become second nature. Include chromium-containing foods like broccoli and hibiscus flower tea. Get the essential fatty acid ALA into your diet – ground flaxseeds are a good everyday source. Cook with liberal amounts of cinnamon and experiment with fenugreek. Infuse your life with (a little) caffeine. A cup or two of coffee, black tea, or green tea may enhance insulin sensitivity. Eat up to an ounce and a half of dark chocolate every day. Don’t worry, chocolate does not cause acne. Erratic blood sugar and hormonal alterations are to blame.
The clinical benefits of these dietary changes are still being explored. Few experts would argue that these strategies are unhealthy, however. In fact, the typical U.S. diet is so different than this approach that many women would benefit from a PCOS diet plan whether or not they have the syndrome. Ready to make a change? Get individualized advice from a qualified professional. And be sure that your health team includes people who believe in PCOS, and who also believe in you.
April Ward, MSN, CNM is an integrative women’s health specialist in Skaneateles, NY. To learn more, call 315-200-2349.