About one in 10 NZ women have PCOS, and may struggle with excess weight and acne. We reveal how what you eat can help.
If you've never heard of Polycystic Ovary Syndrome (PCOS) before, you could be forgiven for thinking it's a rare condition affecting very few people – but it's actually the most common hormonal disorder in the world for pre-menopausal women. It's estimated around 10% of women of child-bearing age are affected. Yet despite these staggering numbers, many of us still don't know a lot about the condition.
If you suffer from PCOS, or think you might, it may feel as if there's not much you can do about it, but there are lots of things which can help – and it starts with food.
Could I have PCOS?
Unfortunately, there is no one, single test used to diagnose PCOS. Instead, doctors look at ovary ultra-sound results, blood test results, and your symptoms before making a decision. Common PCOS symptoms include:
irregular or absent menstrual periods
hirsutism (excess hair growth on the face, chest and stomach)
alopecia (scalp hair-loss)
acanthosis nigricans (dark skin pigmentation, often found at the back of the neck and under the arms and breasts)
infertility or reduced fertility
obesity and difficulty losing weight
What is PCOS?
Put simply, PCOS is the result of a hormonal imbalance which prevents the ovaries from releasing an egg each month. This results in tiny, cyst-like formations on the ovaries. For most women, the underlying cause of this is insulin resistance.
A large proportion of PCOS sufferers will also experience symptoms such as weight-gain, acne, sub-fertility (difficulty falling pregnant) or infertility, excess hair growth on their body and face, and scalp hair-loss. Research also suggests those with PCOS have a higher risk of miscarriage, developing heart disease and diabetes.
Exactly why PCOS develops remains unknown, but it's thought to be a result of the interaction between genes and the environment. In countries such as New Zealand, where the incidence of diabetes and obesity are increasing, the incidence of PCOS is also higher.
How food can help
Although it's unlikely a poor diet alone causes PCOS, it can increase your chances of developing the condition if you are already genetically at risk.
What you eat can also affect your chances of developing insulin resistance and obesity, conditions which are strongly linked to PCOS, too. If you do have PCOS, eating the right foods can help to improve insulin resistance, potentially reducing your risk of developing long-term health problems linked with PCOS such as impaired glucose tolerance, type 2 diabetes and heart disease.
Eating healthily will also help you lose weight, which has been shown to help restore ovulation, increase fertility and improve many PCOS symptoms – even if you only lose a relatively small amount of your body weight (about 5-10%).
What should I be eating?
Despite the known benefits of lifestyle changes, research into the best type of eating plan for women with PCOS is lacking, with no studies having yet shown any significant benefits of one type of diet over another.
As insulin resistance is usually the underlying problem, however, an eating plan for PCOS should focus on lowering insulin levels and improving the body's sensitivity to insulin, while also helping with weight-loss.
Diet is a major contributor in managing your PCOS, but other lifestyle changes are also essential.
Exercise, for example, is proven to have a significant impact on the symptoms of PCOS, with a number of studies now showing the benefits of lifting weights for improving blood glucose and insulin levels. Aim to include resistance training (lifting weights) with moderately intensive aerobic activities such as walking, running and dancing, in 30-40 minute sessions, most days of the week.
Similarly, stress, inadequate levels of quality sleep and smoking have all been linked to insulin resistance. To make the most of your PCOS management programme, learn to manage stress levels, develop regular sleep patterns and put those cigarettes down – for good!
Medications for PCOS
While lifestyle changes should always be your first line of treatment for PCOS, you may also require medication. Common medications used to treat PCOS can include:
The oral contraceptive pill, which regulates menstruation and affects acne and excess hair growth
Metformin, to lower insulin levels
Spironolactone, cyproterone and flutamide, which block the action of male hormones and help with skin and hair problems
Clomiphene, to stimulate ovulation.
How to eat for PCOS
Swap processed grain foods found in white bread, puffed or flaked breakfast cereals, most cracker biscuits and many snack foods for higher fibre, low-GI versions including heavy, whole grain bread, oats, barley and cracked wheat.
Limit your intake of saturated fats. Choose lean cuts of meat, skinless poultry, eat more fish, and choose low-fat dairy products over their higher-fat counterparts.
Fill at least half your lunch or dinner plate with a variety of different coloured vegetables or salads, and include grilled tomato, mushroom, asparagus, capsicum and/or spinach in cooked breakfasts.
Prevent a large rise in blood glucose and insulin levels by switching three big meals a day for smaller, regular meals and snacks every three hours or so.
Swap in-between meal high-fat, high-sugar snacks for fruit, pottles of natural yoghurt with berries, small handfuls of raw nuts, or slices of whole grain fruit loaf.
A recent study found women with PCOS had a significantly lower base metabolic rate than women without PCOS, meaning they burn less energy, even at rest. This could explain why women with PCOS are more likely to be overweight and seem to find it harder to lose weight.
A pilot study on overweight and obese women with PCOS found implementing a six-month-long, self-directed, brisk walking programme resulted in psychological benefits, including improvements in body image perceptions.
A February 2008 study found replacing animal sources of protein with vegetable sources may reduce the risk of ovulatory infertility. The same authors also found small amounts of trans fats may increase the risk, too.
Insulin, a hormone produced by the pancreas, helps to regulate blood glucose levels. Insulin resistance means your insulin doesn't work effectively, so your body needs to produce increasing amounts of insulin to keep blood glucose levels under control. These high levels of insulin in the blood can cause many health problems, including PCOS. Being insulin resistant also increases your risk of developing other health problems, such as cardiovascular disease, type 2 diabetes and gestational diabetes.
Diet can make a real difference to PCOS. One HFG reader, 32-year-old Jane Norris, shares her story.
"Before I was diagnosed with PCOS, I had never considered myself 'unhealthy'. I had the occasional takeaway and fancied myself an 'exerciser' of sorts – I walked to the bus stop, after all! But then I began experiencing symptoms nobody could explain. I was constantly feeling tired, I started losing my hair and, over 12 months, I put on about 10 kilos – weight which wouldn't budge, even though I started eating more healthily and going to the gym.
I was then tested for insulin resistance. When the results came back, I was diagnosed with PCOS, put on medication and referred to a dietitian. Life hasn't been the same since.Before my diagnosis, I thought eating salad once a week was 'healthy.' So initially, the eating plan my dietitian created for me felt like a diet. But then I began to see results: I lost weight, my skin improved, my hair stopped falling out, and I had a lot more energy. I began to exercise, too. It's difficult to fit in with a busy job, but I still make sure I walk at least four times a week.
Three years after my diagnosis, my life is so different. My husband's life has changed, too. We decided to start trying for a baby a few months ago. I was prepared for a long wait but, incredibly, we conceived within a month! It was such a wonderful feeling. I had been working so hard for a healthy body and to increase my fertility levels that it really felt like a validation. Looking back, I'm amazed at how much I've changed. I used to think I had no control over my food habits, but now I know that I do. To all those women out there with PCOS, I recommend paying attention to your diet. If I can change, anyone can. You've only got one body. Look after it!"