Everything You Need To Know About Nutrition For PCOS
By Cory Levin, MS, RDN
Did you know that Polycystic Ovary Syndrome (PCOS) is the most common endocrine problem for women worldwide and the leading cause of infertility in the United States? One out of every ten women of childbearing age has PCOS, and many still haven’t received an official diagnosis.
PCOS is a complex hormone disorder defined by a variety of different signs and symptoms. Frustratingly, the exact cause of PCOS is unknown: genes, inflammation, and insulin resistance are all factors that may play a role.
Clinical signs of androgen excess, such as facial hair, acne, and cysts on the ovaries, are all symptoms of this condition. It also may cause oligoovulation or anovulation, which means women with PCOS either ovulate irregularly or not at all. Because it is impossible to get pregnant naturally without ovulating, unfortunately many women with PCOS find that when they are ready to start their families, they are unsuccessful.
Although there is no proven “cure” for PCOS, symptoms can greatly improve and fertility can be restored with the proper diet and lifestyle changes.
Today, we’re going to talk through the core tenets when it comes to PCOS, nutrition, and fertility:
Blood Sugar Balance
We can’t even begin talking about nutrition for PCOS and fertility if we don’t start with blood sugar balance. Blood sugar, or glucose, is the main sugar found inside our blood that is raised in response to the consumption of carbohydrates. Our bodies depend on it for a variety of important functions and it can fluctuate wildly depending on what we eat.
Our pancreas is the organ responsible for keeping our blood sugar in check and it accomplishes this by releasing a hormone called insulin. Problems arise when the body has trouble responding to insulin effectively which leads to an excess of uncontrolled glucose floating around our bodies and more and more insulin being pumped out to deal with it. Eventually, our bodies start responding to sugars very differently. This is how insulin resistance comes about.
Although it doesn’t occur for every woman with the condition, insulin resistance is a key feature in PCOS. For mechanisms not entirely understood, an imbalance in blood sugar and thus insulin resistance causes our brain to send messages to our ovaries to pump out more testosterone.
An excess in these androgens, or male hormones, is what causes many unwanted PCOS symptoms of androgen excess including facial and chest hair growth, acne, hair loss on the head, and weight gain. In addition, our reproductive hormones respond to elevated androgens by halting ovulation, rendering us unable to get pregnant.
Along with androgen excess, poorly controlled blood sugar can also lead to chronic increases in cortisol, our stress hormone. When our cortisol is running rampant, it can contribute to symptoms like irregular ovulation and irregular or absent periods. In this sense, blood sugar is extremely important when we’re talking about trying to conceive with PCOS.
So how do we balance our blood sugar and improve our fertility? We start with prioritizing certain macro-nutrients like protein and fat while limiting carbohydrates. This may be the last thing you want to hear, but being more mindful of both the amount of carbohydrates we’re eating and what we’re eating them with is KEY to keeping our blood sugar stable on a consistent basis.
Out of all three of the macro-nutrients, carbohydrates affect our blood sugar the most and therefore are the ones we need to pay the MOST attention to. Carbohydrates are inside foods such as grains, fruits, starchy vegetables like corn and sweet potatoes, beans, and dairy.
One important thing to note here is that we’re not cutting out carbohydrates entirely (we need them for energy and other basic life-sustaining processes). Instead, we’re limiting the portion sizes and being mindful of what we’re pairing them with. For example, having a piece of fruit as a snack is perfectly healthy, but for better controlled blood sugar, cutting the fruit serving in half and adding some protein and fat (such as nut butter) is a much better idea.
When we are choosing carbohydrates, we always want to go for the “complex” ones! This means they include some fiber, such as brown rice instead of white rice. A higher fiber content will help your body pump the breaks on the blood sugar spike that might follow eating simple carbohydrates like white rice or white bread. When you have the choice, always go for the whole grain product!
Every woman with PCOS has her own unique “carbohydrate tolerance,” or an amount of carbohydrates that she can eat to help mitigate her symptoms and restore her fertility. Working with a Registered Dietitian who specializes in PCOS can help you figure out what your personal carbohydrate tolerance is in hopes of getting you on the path to pregnancy.
Unfortunately, women with PCOS have been found to be in a chronic state of low-grade inflammation, which contributes to and sustains symptoms for women with the condition. Compared to other women of the same weight, women with PCOS have higher levels of inflammatory markers such as C-reactive protein (CRP), oxidative stress, white blood cell count, and pro-inflammatory cytokines and chemokines. When trying to conceive, a body with chronic inflammation is not the ideal environment for your sex hormones to thrive and for a baby to be created; ditching pro-inflammatory foods and incorporating more anti-inflammatory nutrients into your diet can help mitigate PCOS symptoms and help you optimize your fertility.
Foods that contribute to inflammation are the following:
Processed meats (hot dogs, pepperoni, vegan meats)
Sugary drinks (soda, juice drinks, energy drinks, or really sugar-sweetened beverages of any kind)
Fried foods (especially out at restaurants and fast food- they use pro-inflammatory omega-6-rich oils to fry foods)
White bread, white pasta, and other refined flour foods
Processed snack foods (chips, cookies, pastries)
Too many carbohydrates
Here are some potent anti-inflammatory foods to stock up on:
Ginger: a powerful anti-inflammatory and prostaglandin reducer
Turmeric: contains curcumin, which is effective at reducing inflammation related to arthritis, diabetes and other diseases
Omega-3 fatty acids: DHA/EPA help reduce inflammation in the body
Foods high in DHA/EPA: fatty fish (salmon, tuna, herring, mackerel, sardines, anchovies), omega-3 enriched eggs
Vitamin D: shown to reduce pro-inflammatory cytokines that contribute to inflammation
Foods high in vitamin D: eggs (yolk) liver, salmon, tuna, milk, trout, sardines, oysters
Berries: contain antioxidants called anthocyanins that lower levels of certain inflammatory markers
Broccoli: rich in sulforaphane, an antioxidant that fights inflammation by reducing your levels of cytokines and NF-kB, which drive inflammation
Avocados: packed with potassium, magnesium, fiber and heart-healthy monounsaturated fats to reduce levels of inflammation in the body.
Peppers: Chili peppers contain sinapic acid and ferulic acid, which may reduce inflammation and lead to healthier aging. Bell peppers and chili peppers are also loaded with vitamin C and antioxidants that have powerful anti-inflammatory effects.
Extra-virgin olive oil: The effect of oleocanthal, an antioxidant found in olive oil, has been compared to anti-inflammatory drugs like ibuprofen. Keep in mind that anti-inflammatory benefits are much greater in extra virgin olive oil than in more refined olive oils.
Tomatoes: Tomatoes are high in vitamin C, potassium and lycopene, an antioxidant with impressive anti-inflammatory properties. Lycopene may be particularly beneficial for reducing pro-inflammatory compounds related to several types of cancer.
Nutrients for Egg Health
Unlike men who make new sperm every couple months, women are born with all the eggs we will ever have. Therefore, it’s of the utmost importance we are doing all we can to nourish the health of our eggs so that when we do ovulate, we can create a healthy embryo. For women with PCOS, higher levels of hormones like testosterone can actually negatively affect egg health leading to lower-quality eggs.
Make sure to include these nutrients in your diet:
CoQ10- an antioxidant that counteracts oxidative stress and improves ovarian response leading to better egg and embryo quality (Sources of CoQ10: cabbage, broccoli, oysters, liver)
Vitamins A and E- may help with the mitochondrial function of eggs, which is the energy source that helps with DNA replication (Sources of Vitamin A: salmon, sweet potato, kale, eggs; Sources of Vitamin E: almonds, sunflower seeds, spinach, broccoli)
Inositol- can help to regulate blood sugars and is also thought to increase insulin sensitivity of the ovary, which helps improve egg quality. Animal studies reported that Myo-inositol helped with blastocyst development and it appears especially useful for women with PCOS (Sources of Inositol: Beans, oranges, cabbage, bran)
Omega-3 fatty acids- help contribute to the outer layer of an egg (the cell membrane) and may influence egg maturation (Sources of Omega-3 fatty acids: Salmon, sardines, anchovies, herring)
B vitamins and Zinc- needed for cell division after fertilization (Sources of B vitamins: Poultry, pork, peanuts, quinoa; Sources of zinc: Oysters, pumpkin seeds, red meat, hummus)
Remember, it is entirely possible to get pregnant with PCOS, and making some key changes in your diet can put you on the path to regular ovulation, which will increase your chances of conceiving a happy, healthy baby.
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Cory Levin, MS, RDN is a Registered Dietitian and Women’s Health Expert. A fellow PCOS cyster herself, Cory dealt with severely irregular cycles her entire adult life until she began nourishing her body with the right nutrition, supplements, and exercise routine. In February of 2019, she conceived completely naturally. She is now getting ready to give birth to a very healthy little girl. Cory has spent over nine years studying nutritional science and received her Master’s degree in Nutritional Science. She spent time interning at Kaiser Permanente Los Angeles Medical Center where she gained in-depth clinical knowledge pertaining to prenatal and postpartum care. Afterwards, she opened up her own practice, The Women’s Dietitian, where she now works exclusively with women to help them conceive, balance their hormones, and put their PCOS into remission. You can find Cory on Instagram @thewomensdietitian.