If you missed part 1 where I talked about how PCOS develops, how to get diagnosed with PCOS, the different types of PCOS and how medications work you can read that post here. In this post, I’m going to share with you some lifestyle changes you can implement that don’t involve dieting and then in part three we’ll talk about supplements and medications as adjunctive tools as well. My hope is that these posts are informative, but they are certainly not prescriptive. Nutrition and medicine are highly individual – everyone has different genetics and biology, so it’s really important to work with your health care provider and dietitian to figure out what combination of treatment modalities will work best for you.
Everyone is at a different place emotionally, physically, mentally, financially, etc and therefore your care and treatment takes into consideration all of these things – that’s what makes it work for you. The optimal treatment approach for PCOS in multifactorial – lifestyle modifications, psychological treatment, supplements, and medications all play a role. I think the most important thing is that you as the patient and woman feel empowered in your decisions, that you feel well informed on the pros/cons of everything and that you know your treatment is 100% a personal decision and whatever works for you, works for you. You are not better or worse or doing things right or wrong for choosing or not choosing something to care for yourself.
Like we talked about in Part 1, the cause of PCOS isn’t totally known, but what we do know is that, along with genetics, environmental factors play a role – some of these factors we can control and some are out of our control. PCOS is a chronic inflammatory state, like many other diseases and conditions, and so decreasing inflammation in the body is a goal of treatment. The other goal is blood sugar regulation and improving insulin sensitivity. The word inflammation is quite trendy. Inflammation in normal amounts is a good thing, it’s how our bodies respond to infection and tissue damage and it’s crucial to the healing process. But when we have chronic, ongoing levels of inflammation we run into trouble. Decreasing inflammation is much more than cutting out sugar and eating an “anti-inflammatory diet” – there are many lifestyle factors (and factors out of our control) that contribute to inflammation.
I share these four components quite often because it’s a way to help take a look at and evaluate the modifiable areas of health. Although, we have to keep in mind that we will go through seasons of life that are rougher than others and so sometimes these areas will be less modifiable than other times in our life. And remember, there are environmental factors that we can’t control – like oppression, socioeconomic status, stigma, stuff in the air you breath etc and then non-environmental factors that are completely out of our control like genetics.
This could be several posts in and of itself, so I hope these tips will be helpful. With that said, if eating or not eating a particular food is causing you more psychological distress than the potential health benefits of that food, that food choice is no longer healthy. Stress is inflammatory, so that would be working against your body. I fully believe that with time, you can practice intuitive eating if you have PCOS, but it might look different than it does for someone without PCOS. Think about having two knobs, one for mind knowledge and one for body knowledge. In the presence of a medical diagnosis, you have to turn up the mind knowledge volume a bit more so you can best support your physical health. Also if you’re feeling new to IE or overwhelmed by the idea of IE, that is totally okay too.
It might not be the right time for you to implement the IE principles and instead, establishing a balanced, rhythmic eating pattern that supports your physical health along with your mental and emotional health will be the best place to start. Intuitive eating is a skill and it can take a lot of time, space and patience to develop that skill. No matter where you’re at with food, the goal with nutrition is to decrease inflammation and regulate blood sugar which in turn improves how your body utilizes insulin – the key player in the hormonal imbalances of PCOS. Some things to think about when nourishing your body in a way that supports your physical health include:
- Eat frequently – about every 3-4ish hours. Eating in a frequent, consistent way not only let’s your body know “hey, she’s giving us food on a consistent basis so we don’t need to compensate and slow down metabolism” it also helps regulate your blood sugar which means your cravings feel more manageable and steady and so does your energy.
- Eat enough – again, this helps your body’s metabolism and ensures your body is getting the fat and protein it needs for good hormonal function. Restricting calories only worsens the pathophysiology of PCOS and causes your body to release cortisol which contributes to more chronic inflammation. Dieting and restriction won’t help your body heal long term and they have the potential to be very harmful for your mental and emotional health. So all that to say, make sure you are nourishing your body with enough energy and macronutrients – if you’re not sure what that looks like or means, work with a knowledgable dietitian who can support you. If you email me, I’m happy to provide you with recommendations!
- Include all the macronutrients in meals (carbs, proteins and fats) and include a healthy fat and/or protein source at snacks – this again will help stabilize blood sugar and help manage your insulin levels.
- Eat omega 3 rich foods often such as walnuts, flaxseeds, chia seeds and salmon – these are great for fighting inflammation.
- Choose high fiber and unrefined carbohydrate sources (whole grains, fruits and starchy veggies etc) as much as possible – these sources of carbohydrates are broken down more slowly by the body and enter your blood stream at a slower rate which is helpful for insulin resistance. Through this, you’re giving your body manageable amounts of glucose to process over a longer period of time, keeping your blood sugar more stable and reducing the risk of your blood sugar getting too high or dropping too low. Now, this piece of knowledge doesn’t mean sugar or white flour is off limits – that wouldn’t be good for your emotional health and would likely set you up for a chaotic experience with those foods. Enjoy those foods! The idea is to still be flexible with food, but to be more intentional about including unrefined, fiber filled carbohydrates most of the time to help support your blood sugar and insulin levels. If you do choose refined carbohydrates, pair them with a fat and/or protein source to help regulate your blood sugar. There has never been a study to show that any one food is “bad” – remember there is a lot of nuance when it comes to nutrition and health.
- Eat as many colors as possible – all those colorful foods are filled with antioxidants and other anti-inflammatory compounds!
- Try to make half of your plate vegetables, most of the time. Again, this certainly isn’t hard and fast and there is so much flexibility and grey area here. You likely won’t eat a bunch of veggies at breakfast. But see if you can add tasty veggies (cooked in a way that makes them enjoyable like roasting or in a salad with avocado and yummy dressing) to most lunches and dinners.
Start slow with implementing these changes since sustainable changes do take time. This certainly isn’t a race!
I probably sound like a broken record by this point after writing about stress forever, but it really has a lot of influence on our physical health. Which is why just saying, “change your lifestyle!” can be really harmful. Change is stressful! So with everything you have going on, try to be as kind and compassionate to yourself as possible. Women with PCOS tend to experience anxiety and depression at higher rates than women without PCOS. It can take a toll on your emotional and mental health which can effect not only your physical health, but your sleep too. Safe people you can process with, asking for help and self compassion are some ways you can help manage stress. Mindfulness is also a great tool. Mindfulness use to sound like a “woo-woo” word to be, but then I realized that it just means, “the state of being conscious or aware of something.” A mindfulness practice helps decrease your stress hormone cortisol, which has been shown to be higher in women with PCOS. High levels of cortisol has several metabolic effects, including increased insulin.
There was a study released in 2012 that found yoga was highly beneficial in females with PCOS. The adolescent girls with PCOS in the study had various body shapes and sizes. For 12 weeks, half practiced yoga and half followed a traditional exercise routine. At the end of the study, yoga was found to be more effective than traditional exercise on many levels. And I think the coolest part is that these results were independent of the participants body size or weight and independent of any body changes during the 12 weeks of exercise intervention. Regardless, yoga was beneficial. I love this study. That doesn’t mean you have to jump right in to a regular yoga practice, start slow and do what feels good for you given your life circumstances. There are tons of yoga videos for free on YouTube ranging from 10 minutes to 60 minutes or more.
Other mindfulness practice ideas might mean deep breathing for 5 minutes in the morning, going on a stroll in the evening without music or your phone, doing a 10 minute guided meditation. Whatever it is, know you can start slow and there isn’t one way to do this.
Women who have PCOS actually experience more sleep disturbances than those without. Sleep issues are a contributing factor to insulin resistance so it can be a double edged sword. Sleep loss can also alter your appetite hormones ghrelin and leptin and increase your craving for carbs – when your body is tired it wants fast energy! So try not to be too hard on yourself if you haven’t gotten great sleep and your appetite and cravings feel off. Here is a great post with practical steps on how to improve your sleep. In addition to those tips, try to go to bed at the same time every night and sleep in a cool room. Your body temperature is naturally lower when you sleep so that helps support your body’s natural temperature regulation. Melatonin and magnesium are helpful supplements you could also try (always check with your doc first of course) to help you in falling and staying asleep.
Appropriate exercise is beneficial to our health. It’s worth noting that if you’re struggling with health issues where exercise is an underlying contributor, resting from exercise might be the healthiest thing for your body right now. For women with PCOS, exercise can help with ovulation and fertility, increase insulin sensitivity and improve metabolic markers totally independent of body weight. Everyone’s body is different, so what works for one women might not work for another woman. Choosing exercise that you truly enjoy and meets the unique needs of your physiology is important. Walking for 30-45 minutes most days of the week is great for improving insulin sensitivity. Perhaps you enjoy riding your bike or going to Zumba class. Or maybe you enjoy hiking or rock climbing. Maybe you like to vigorously clean your house (hey, somebody out there probably does!) All these things are exercise. If you enjoy higher intensity exercise and that feels good for your body, you can do that too. But do keep in mind that too frequent or long sessions of high intensity exercise can keep cortisol levels elevated which furthers the inflammatory process. I usually suggest no more than two, 30 minute high intensity exercise sessions per week. Choose movement that you enjoy – which could be yoga like we talked about above – and incorporate it into your life in a fun way most days of the week.
If you’ve made it thought this long post, cheers! Next week we’ll continue this series with talking about supplements and medications and some really cool research on the two.
Van Son J, NyklÃcek I, Pop VJ, Blonk MC, Erdtsieck RJ, Spooren PF, Toorians AW, Pouwer F. The effects of a mindfulness-based intervention on emotional distress, quality of life, and HbA(1c) in outpatients with diabetes (DiaMind): a randomized controlled trial. Diabetes Care. 2013;36(4):823-30
Fernandez, R. C., Moore, V. M., Van Ryswyk, E. M., Varcoe, T. J., Rodgers, R. J., March, W. A., … Davies, M. J. (2018). Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nature and Science of Sleep, 10, 45–64. http://doi.org/10.2147/NSS.S127475
Nidhi, R., Padmalatha, V., Nagarathna, R., & Amritanshu, R. (2012). Effect of holistic yoga program on anxiety symptoms in adolescent girls with polycystic ovarian syndrome: A randomized control trial. International Journal of Yoga, 5(2), 112–117. http://doi.org/10.4103/0973-6131.98223
(2009) Are polycystic ovaries associated with cardiovascular disease risk as polycystic ovary syndrome?, Gynecological Endocrinology, 22:6, 324-328, DOI: 10.1080/09513590600630447
Farrell, K., & Antoni, M. (2010). Insulin Resistance, Obesity, Inflammation, and Depression in Polycystic Ovary Syndrome: Biobehavioral Mechanisms and Interventions. Fertility and Sterility, 94(5), 1565–1574. http://doi.org/10.1016/j.fertnstert.2010.03.081
Salama, A. A., Amine, E. K., Salem, H. A. E., & Abd El Fattah, N. K. (2015). Anti-Inflammatory Dietary Combo in Overweight and Obese Women with Polycystic Ovary Syndrome. North American Journal of Medical Sciences, 7(7), 310–316. http://doi.org/10.4103/1947-2714.161246
Brinkworth GD, Buckley JD, Noakes M, Clifton PM, Wilson CJ. Long-term Effects of a Very Low-Carbohydrate Diet and a Low-Fat Diet on Mood and Cognitive Function. Arch Intern Med. 2009;169(20):1873–1880. doi:10.1001/archinternmed.2009.329
Tomiyama, A. J., Mann, T., Vinas, D., Hunger, J. M., DeJager, J., & Taylor, S. E. (2010). Low Calorie Dieting Increases Cortisol. Psychosomatic Medicine, 72(4), 357–364. http://doi.org/10.1097/PSY.0b013e3181d9523c
Mullington, J. M., Simpson, N. S., Meier-Ewert, H. K., & Haack, M. (2010). Sleep Loss and Inflammation. Best Practice & Research. Clinical Endocrinology & Metabolism, 24(5), 775–784. http://doi.org/10.1016/j.beem.2010.08.014
Hi Robyn! Thanks so much again for this series. Also thanks for including your research articles! I am a nerd so I enjoy referencing those sometimes. One question I had was whether you found anything in your research about avoiding dairy in PCOS? It seems to be the new thing out there, something to do with the fact that something in dairy increases testosterone production and should be avoided. Not sure if there is actually any research to back that up though and I love my milk, cheese and yogurt so would really hate to give it up unnecessarily! Thanks again!
This is great, thank you.
I thank you for this insightful article. Do you think my daughter could have PCOS? She is 14, and she reached menarche at age 13. Since then, she’s gotten five periods. It’s important to note that after a five month stretch without a cycle, her doctor recommended insotil without seeing her—just to try it out, and that regulated it quite a bit—she just had a 39 day cycle. She is lean with no signs of excess hair, but I am also a healthy weight, and I have PCOS. My gynecologist told me she might have it, just because it’s genetically linked. Any insight would be appreciated! You can email me back at [email protected]. Thank you so much!