Polycystic ovary syndrome (PCOS) is one of the MOST common endocrine disorders in women; it is estimated to affect up to 1 in 10 women1. Despite its high prevalence, misdiagnosis is common. In one study2 involving 210 women with PCOS, nearly 40% of the women had to see three or more healthcare professionals before finally getting their diagnosis. This same study found that at the time of diagnosis, 60% of women reported not being given or referred to information sources about PCOS, and another 20% felt they were given inadequate information. This means around 80% of women got this serious, scary diagnosis that could lead to significantly increased risks for metabolic disease, cancer, and infertility without being given the information they needed or wanted. Unfortunately, so many women with PCOS are left desperate for answers and must embark on a quest to figure out the best way to treat themselves.
So, let’s start at the beginning- what even is PCOS?
PCOS is a complex endocrine disorder thought to emerge from the interaction between a genetic predisposition and environmental factors. The great news is that even if you have a genetic predisposition for PCOS, you are not necessarily ‘doomed’. Think of the genes like a light switch, it is the environmental factors- like diet, stress, sleep, movement, etc.- that flip the switch.
Diagnosis is most commonly made based on something called the Rotterdam criteria which requires 2 out of the 3 features to be present:
- Hyperandrogenism (meaning symptoms of high testosterone, like hirsutism, acne, male-pattern hair loss, OR a blood test showing high testosterone)
- Ovulatory dysfunction (often presents as absent or irregular periods)
- Polycystic ovaries on ultrasound
Because of this, it is often possible to diagnose PCOS based on your history and physical exam alone without doing any other testing. If you have a history of the symptoms of high testosterone mentioned above PLUS a history of highly irregular or absent periods, the diagnosis can often be made right then and there. Other common symptoms or findings that point to a diagnosis are obesity, increased luteinizing hormone, infertility, depression, and anxiety.
The most important nutritional shifts for treating PCOS
Since up to 70% of women with PCOS have insulin resistance, managing blood sugar is one of the most important steps you can take to manage your PCOS. Stick with me for a bit of science here if you want to understand WHY this happens and why it is so important to address.
Every food you eat causes a release of insulin so that the newly available sugar can be transported into your cells. Carbohydrates cause the biggest release of insulin, followed by protein, and then fats which cause very little to no rise in insulin. Over time, when there are constant demands on insulin because of a diet causing big rises in blood sugar, insulin resistance can develop. Your body then tries to produce even more insulin to overcome the resistance leading to higher insulin levels, and women with PCOS often have genetic variations that make their ovaries more sensitive to these high insulin levels. So, in response to the increased insulin levels, the ovaries begin to secrete androgens (testosterone) which is responsible for the hyperandrogenism symptoms we see with PCOS, like hirsutism, thinning hair, and acne. Now that you understand the enormous role that insulin plays in PCOS, you can imagine why many women are prescribed metformin, a commonly used diabetes medication, to treat it.
Phew! Okay, now that the science is done, let’s get back to some tangible tips.
Even though carbs affect your blood sugar more than other macronutrients, this does not mean you should never eat carbs. A better idea is to avoid simple carbs and processed foods which often contain a lot of carbs without anything to balance them and try to avoid juices or other sweet drinks. Said another way, you never want to eat your carbs ‘naked’.
Fruit is a perfect example. When you eat an orange, it is packaged with fiber and protein, which slows the absorption, think of it like the ‘poison’ packaged with the ‘antidote’. It’s even better when the orange is eaten with something like a hardboiled egg or some nuts as a more complete snack. But if you say drink orange juice instead, you have now removed all of the components that slow absorption, the ‘antidote’, and have a massive sudden jump in your blood sugar that your body has to try to control with a big release of insulin.
So, to sum it up, be smart about your carbs, never eat them naked, & eat plenty of healthy fats as a good place to start.
The top 5 habit shifts that helped me to heal
Did I mention that I struggled with PCOS since I was a teen and have been able to heal naturally without being on any medications or birth control? Here are the top 5 shifts I made to make this dream a reality-
Getting my stress under control. Now, this is no easy task and I wish I could say all I had to do was spend 5 minutes every day journaling – and *poof*my stress was gone, but this is not so. For me, this process involved a much bigger shift in my life that included leaving my incredibly high-stress job, setting boundaries in many of my relationships, and learning to delegate and ask for help.
BUT stress management can definitely start on a much smaller scale. I don’t think there is a magic bullet for stress management- it depends on what is stressing you out & addressing the cause. If this isn’t possible, focus on adding in activities that bring you joy and feel calming to you, this may include walking, journaling, meditating, or seeing a counselor; what this does NOT include is hours of endless scrolling and t.v. Stress management is an intentional & active process, not distraction.
(Bonus tip- getting good sleep is essential for being able to handle stress).
Finally slaying my sugar monster. Getting off of the sugar-hamster wheel was NOT easy. After completing my first ‘Whole 30’ challenge many years ago, I had made a huge jump from mindless snacking on raw cookie dough throughout the day, to actually focusing on a whole foods diet and, of course, was feeling better. I stayed with a paleo/primal style of eating and thought I was really doing great, but just last year realized how reliant I still was on sugar and all of the fruit and dates and sugary ‘paleo’ snacks I was having. As a result, my energy would peak and tank throughout the day. I also realized I was eating so few fats & proteins. Adding a ton of healthy fats to my diet left me satiated and gave me more sustained energy, I was finally able to slay the sugar monster.
Intermittent fasting. Let me be clear- fasting is NOT about eating less food or being in a calorie deficit. Fasting is simply retiming your food which allows the gut time to heal and rest between digestion (leading to better energy), improves insulin sensitivity which we talked about earlier, and increases mitochondrial health. There’s a lot more geeky science that is beyond the scope of what I can discuss here but if you are at all curious, I definitely recommend exploring the concept of fasting further. Fasting has helped me immensely with managing my PCOS.
A word of caution, if you are a pre-menopausal woman, fasting should always be paired with your cycle. For example, aggressive fasting mid-cycle can actually prevent ovulation which is a big problem. I usually follow either a 14/10 schedule (meaning a 14 hour fast overnight and then a 10 hour ‘feeding window’) or 12/12 depending on how I’m feeling and where I’m at in my cycle. Always listen to your body; some days I break my overnight fast after just 10 hours because I’m hungry or that’s what my schedule allows for that day which is perfectly okay too.
Moving my body in a way that feels good to me. Resistance training is so important for PCOS- increasing muscle mass helps with insulin sensitization and blood sugar management. But I make sure to listen to my body and balance this with plenty of stretching, yoga, dancing, or whatever feels good to me that day and pairs with where I am in my cycle (if you’re noticing a theme, yes, pretty much everything you do as a pre-menopausal woman should be paired with your cycle)
Prioritizing sleep. The benefits of good quality sleep on hormones, mental health, and overall wellness cannot be overstated, so I work hard to set myself up for sleep success. Good sleep starts in the morning. I always make sure to get natural sunlight into my eyes as soon as possible in the morning and get plenty of sunlight throughout the day, which helps with my circadian rhythm. At night, I turn off all electronics my 8 pm, put my devices in my office to charge, and spend an hour winding down with my husband, stretching, reading, and sometimes doing breathwork. I always make sure to sleep in a completely dark room (or wear an eye mask).
So, there you have it, folks. If you are a woman interested in managing your PCOS naturally- I promise you there is hope! And please don’t get overwhelmed, commit to making one small shift at a time and soon it will all add up.
References
- Azziz, Ricardo. “Epidemiology, phenotype, and genetics of the polycystic ovary syndrome in adults”. UpToDate, Post TW (Ed), UpToDate, Waltham, MA. Accessed 18 April. 2022.
- Gibson-Helm, Melanie E et al. “Women’s experiences of polycystic ovary syndrome diagnosis.” Family Practice vol. 31,5 (2014): 545-9. doi:10.1093/fampra/cmu028
P.S. want 1:1 support on your PCOS journey from someone who’s been there? Book a sesh here.
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