Nutrition should be individualized to each unique case. This is particularly important for PCOS.
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The first step is to determine which PCOS subtype you are.
In general, there are 4 classifications of PCOS. This includes:
- Insulin resistance
- Inflammatory
- Post pill
- Environmental
- Here is a nice summary that reviews the different types of PCOS.
Why is this step important when it comes to nutrition? It allows us to tailor our diet even further.
Insulin resistance PCOS
In the case of insulin-resistant PCOS, we want to focus on food and treatment approaches that support a healthy blood sugar balance. This may include reviewing the glycemic index of foods and optimizing your macronutrient balance (i.e. ratios of fats, protein, and carbs on every plate). We may also explore food-based herbs that lower blood sugars like cinnamon, fenugreek, and fiber.
Inflammatory PCOS
In inflammatory PCOS, we may take it a step further and determine which foods are specifically inflammatory for your body. There are certain foods that are more or less associated with being inflammatory – but there’s no hard and fast rule. Strategic planning is key. We may also utilize functional tests like our food sensitivity blood test can help us narrow things down further. We also want to be mindful of our antioxidant intake and foods that support our microbiome; a key player in immune regulation.
Post pill PCOS
Comparatively, with Post Pill PCOS, we may choose to target the liver and hormones a little more closely. The focus is on foods that provide plenty of nutrients for the liver. We also include foods that support healthy hormone balance. The birth control pill has also been shown to influence the gut microbiome. Here’s a nice podcast episode that dives more into this. Along with liver and hormone support, if appropriate, we explore foods to support a healthy microbiome balance.
Environmental PCOS
Finally, in environmental PCOS, we’re exploring the quality and sources of your foods. This includes a review of things like intake of the “dirty dozen” vs “clean 15”. We also explore practices outside of nutrition, such as food storage practices. Or, look to genetic testing, to evaluate how your body is processing environmental toxins, and processing nutrients to better individualize.
As you can see, the approach needs to be targeted. And the first step is a proper assessment.
Is there anything I should avoid on a PCOS diet?
In my option, all PCOS patients should avoid processed foods. As a part of the “food processing” process, many of these foods contain advanced glycation end products (AGEs). These are reactive molecules that can be found in the blood. Elevated levels have been shown in patients with hyperglycemia, insulin resistance, diabetes, atherosclerosis, aging, and PCOS, They can cause cellular damage. (Garg, 2015)
Data shows that circulating AGES increases the expression of pro-inflammatory receptors on the ovaries, which can influence egg development and fertilization. It has also been shown to impact the chromosomal composition within the ovaries.
Dietary ages have been shown to influence insulin levels, inflammation, and hormonal and metabolic parameters. Low intake of AGES has been shown to improve metabolic and hormonal profiles and lower oxidative stress biomarkers.
If there is one thing all PCOS patients should limit or avoid in general, it’s processed foods.
What should I be eating on a PCOS diet?
There are three main things I focus on are
- Whole foods
- Antioxidant intake
- Macronutrient balance
Whole foods are exactly that, whole foods. Whole foods have lower levels of AGES. A nice rule of thumb is to shop in the outer grocery aisles, where the fresher ingredients are kept.
Food-based antioxidants (i.e. green leafy vegetables, berries, other colors veggies, etc.) are beneficial for all PCOS subtypes – there are rich in vitamins, minerals, and fiber. These keep our inflammation down, our blood sugar balanced, our liver support, and our microbiome happy.
Macronutrient balance – we need to make sure we’re fueling appropriately for your body. The most common theme I see in PCOS is under-fueling with proteins and fats, and over-fueling in carbs. We want to balance this out.