You’ve been to the doctor and got your tests done, it turns out you have the signs and symptoms of PCOS. What steps are you needing to take to address the underlying causes? Your doctor may want you to go onto Metformin, which is a common medicine recommended to women with PCOS, because it reduces blood sugar. However, while it can be useful in reducing blood sugar, it also comes with side effects like anaemia and vitamin B12 deficiency. There are lifestyle changes you can make that improve your blood sugar, insulin resistance and inflammation.
If you think blood sugar imbalances and inflammation are the root cause of your PCOS puzzle, here are some eating recommendations to find hormonal balance:
No one size fits all…but it can be simple
No diet or lifestyle recommendations suit everyone. You are the expert in YOUR own body and it’s wise to listen to it. Speak to a dietician, journal about what’s worked well for you in the past, and experiment with different macronutrient (percentage of calories from fats, proteins and carbs) guidelines. But, here are some rules of thumb to help you on your path. You’ll focus on two main areas – firstly, eating to balance your hormones and improve your blood sugar levels and, secondly, eating to reduce inflammation. Thirdly, target movement and stress reduction, which are both key elements to enhance and activate the two above.
Eating to balance hormones and improve your blood sugar
1. Eating to balance hormones and improve your blood sugar
Eat a whole foods diet, without refined carbohydrates or sugar. A study on mice, has found that a diet high in sugar and refined carbs causes metabolic dysfunction and inflammation. Observational studies of humans have shown similar results. In order to balance your hormones you have got to ditch the refined carbohydrates and sugary foods. These foods will spike your insulin levels, especially if you have an underlying insulin resistance. What it’ll look like, is mood and energy spikes and then dips like there is no tomorrow.
What’s the deal with carbs?
South Africans love the Banting diet, and a lot of people will tell you it’s crucial in balancing your blood sugar. The “keto” buzz word is also making its rounds. In my personal and observational experience, some nutrient dense, whole food, complex carbohydrates are important, especially for women. In a 2010 journal article, studying the effect of low GI diets (foods that have a lower and slower rise in blood sugar) on the management of PCOS, it was found that a low GI diet, in comparison to a conventional healthy diet, improves insulin resistance, cardiovascular risk and irregular menstrual patterns in women with PCOS who are overweight. A diet with a low to moderate intake of carbohydrates is the way to go with PCOS.
How many carbs should I be eating?
Remember, fruit and root vegetables are carbohydrates. An apple has 25g of carbs, and a sweet potato has 37g of carbs. These are good, low GI, nutrient dense carbohydrates. If you like working with macronutrients, allocate 20-40% of calorie intake from carbs. If you’re eating about 2000 calories per day, equivalent to the average amount of calories a moderately active women burns, this is about 100g-200g of carbs per day.
Bring on the protein
Protein is another essential macronutrient you’ll want to take note of. Starting your day with a high protein breakfast is one of the best things you can do for your hormones and regulating your blood sugar. The conventional breakfast is cereal, fruit and milk. Cereal and fruit are both carbohydrate heavy with no protein in sight. This, as my fiancé likes to say, , is rocket fuel breakfast. Your energy is like a shooting star for the first hour, which then crashes and you’re hungry by 10am. Rather substitute those breakfasts with some that are high in protein. Include whole eggs, healthy fats and unprocessed meats. Ditch the idea of breakfast. Eat last night’s curry/meat sauce/ Sunday roast. It’ll leave you feeling full for hours and there won’t be any energy or insulin spikes, or crashes.
Cereal and fruit are both carbohydrate heavy with no protein in sight. This, as my fiancé likes to say, , is rocket fuel breakfast.
How much protein should I be eating?
Again, if you like using macronutrient ratios, allocate 20-30% of calories from protein. If you’re eating about 2000 calories per day, equivalent to the average amount of calories a moderately active women burns, this is about 100g-150g of protein per day.
I’ve written an article about intermittent fasting. It can do a great job in balancing hormones and lowering blood sugar. Make sure you’re a good candidate before you try it. People with PCOS may have adrenal or thyroid problems, or are underweight. Fasting is not indicated if you fall in either of these categories, common to PCOS.
2. Eating to reduce inflammation
Processed foods, industrial seed oils like canola and sunflower oil, and refined sugars are in the spotlight for causing a chronic inflammatory response in the body. Whole and refined grains are related to inflammation, as shown in this study. One of the best things you can do when you have PCOS, is to take these foods out of your diet.
I’ve written an easy to follow article about anti-inflammatory foods here. PCOS and obesity are closely associated with low, chronic inflammation, and supporting your immune system with an anti-inflammatory diet can work wonders.
Let’s simplify it
Macronutrient counting isn’t essential. Base your meals around the following foods, and avoid others, and you’ll notice positive changes.
Foods you’ll love with PCOS
Here’s a list of foods that you can eat freely if you have PCOS:
- Eggs (all of it!)
- Cruciferous vegetables (broccoli, cauliflower, fennel, kale)
- Root vegetables (sweet potato, beetroot, carrots, butternut, squash)
- Your health oils: coconut, ghee, olive oil
- Fatty fish: salmon, mackerel, sardines
- Liver! I know, I don’t like it either. Freeze pieces of liver in your ice tray and sneak finely chopped pieces into a meat sauce. Tricks!
- Leafy greens and other non-starchy vegetables. Bring on the zucchini noodles!
- Nuts and seeds. See my favourite nut and seed breakfast recipe here.
- Berries and whole fruits (apples, plums, grapefruit, grapes)
Foods to limit with PCOS
- Processed meats (salami, hotdogs, some hams)
- Refined grains (crackers, bread, pastries, pasta)
- Fried foods (hot chips)
- Refined oils (canola, grapeseed, soyabean, vegetable oils)
- Dairy. You might be able to re-introduce this later if you have no negative side effects after an elimination period)
- Sugary foods and beverages
- Beans and lentils (they’re inflammatory)
- Foods with trans fats
3. Exercise matters
Exercise plays an important role in our hormone regulation as well as blood sugar control. Moderate cardio exercise like fast walking, jogging, swimming and cycling will increase your body’s sensitivity to insulin. Strength training helps to increase your metabolic rate, helping you burn fat for longer. For some women, a coach or physiotherapist, like myself, is helpful in tailoring an exercise and lifestyle protocol specifically designed for you.
The World Health Organisation recommends 150 minutes of moderate-intensity aerobic physical activity throughout the week and strength training should be done on 2 or more days a weeks. Strength training is one of the best secrets of exercise. It
4. Stress relief and mindfulness
We’ve spoken a lot about how diet and exercise is important for your PCOS transformation. But please don’t stress yourself out about it. This can do more harm than good. We know that stress can cause disruption or loss of menstruation in women. There are dozens of women who undereat and overtrain, and who are under a lot of physical and mental stress. They worry about their body image, causing emotional stress. Extreme diet, physical and mental stress can lead to “adrenal PCOS”. We don’t want that. My rule of thumb is the 80/ 20 rule. Stick to your good eating habits 80% of the time. But also have birthday cake on your birthday, and enjoy family celebrations.
Some other tips to ensure you’re not putting your body under too much stress:
- Your calorie intake isn’t too low
- You have easy exercise days and at least 1 rest day a week
- You’re getting at least 7-9 hours of sleep a night
- You are doing some yoga and/or meditation. Here’s an article I’ve written with Simple Steps to Starting your Meditation Practice.
- Pick a few “play” activities that you absolutely love doing and do one a day. This could be playing with your dog, your kid, having a bath or meeting up with a friend. What did you love doing when you were 8 years old? Do that.
- Start a gratitude diary. Write down 5 things you are grateful for every day before you go to bed. Be specific.
The bottom line
There isn’t one diet that fits all. But there are some good guidelines. I recommend focusing on eating a real-food diet, high in healthy fats and good quality protein while moderating your carb intake to match your activity levels. Exercise regularly, sleep well and practice stress reduction techniques.
Use food as your medicine, have an experimental mindset, listen to your body and enjoy the journey.