With the pandemic seemingly under control summer is in full swing, and that means the beaches are packed, the farmer’s markets are bustling, and many of us are enjoying long days in the sun. Summer is a magical time of year, but if there’s one health condition that can make you feel less-than-optimal during the warmer months, it’s PCOS. Thanks to weight gain and unwanted hair growth, PCOS can threaten to sabotage your summer. That’s why, this week, I want to dive into this increasingly common condition — and why the gut plays an integral role in minimizing the symptoms of PCOS.
What is PCOS?
PCOS has long been labeled a “reproductive disorder” since it’s characterized by an excess in androgen hormone levels, like testosterone. But in recent years, additional details about the mechanisms behind PCOS have come to light and just like we’ve had to rethink the cause of acid reflux (which we discussed in last week’s blog — What Your Doctor Never Told You About Acid Reflux) we’ve had to rethink PCOS. These days, we look at it as more of a metabolic condition, like diabetes or metabolic syndrome, instead of a purely reproductive disorder.
But let’s back up for a second — how do you know if you have PCOS in the first place? The common symptoms of PCOS are:
Irregular periods, or no periods at all
Lack of ovulation
Difficulty getting pregnant
Male-pattern hair growth (usually on the face, chest, or back)
Thinning hair or hair loss on the head
Acne or excessive oil production in the skin
Weight gain or weight loss resistance despite diet and exercise
These might seem like symptoms of reproductive health gone awry but the truth is the underlying causes of PCOS have everything to do with your body’s metabolism as well as hormonal imbalances.
For this blog, I sat down with my friend and women’s health dietitian Eleni Ottalagana, RDN, LD, who specializes in treating PCOS. As she explained it:
In other words, we need to start looking at PCOS as a full-body syndrome, not just localized to the ovaries.
How Do You Diagnose PCOS? The Two “Types” of PCOS
Diagnosing PCOS is more of an art than an exact science. Why? Because PCOS seems to be caused by a complex web of metabolic and hormone imbalances that can lead to very different symptoms. Typically, a diagnosis involves lab tests to check your hormone levels — including testosterone, FSH, and LH (often, patients with PCOS will have an excess of “male” hormones) — and an ultrasound to look for the presence of multiple cysts in the ovaries. A fasting blood sugar and insulin health evaluation is also recommended, because one of the main underlying causes of PCOS is insulin resistance. In fact, it’s estimated that at least 70 percent of women with PCOS are also insulin resistant.
The typical PCOS patient carries more weight around their midsection (a shape often described as an “apple” shape) and is overweight. People with PCOS are also more likely to struggle with anxiety or depression and binge eating. That said, there’s another “type” of PCOS patient that’s often overlooked.
Most women with PCOS struggle with their weight, but there’s also a group of women with PCOS who are extremely fit — typically athletes — and have higher than average stress levels. In this case, insulin resistance is still present, but it’s typically caused by stress — which can raise blood sugar and contribute to insulin resistance — instead of diet or lack of exercise. When treating PCOS, we must take both “types” of PCOS patients into account.
If you think you might have PCOS, based on the information above, then make sure to consult with your health provider, or seek out care with an integrative gynecologist, naturopath, or functional medicine-trained physician.
How Do You Treat PCOS? [Hint: Birth Control Isn’t the ONLY Solution]
If you get diagnosed with PCOS by a conventional doctor, you’ll likely leave with a prescription for the birth control pill, Spironolactone (a medication that can block excess androgens), or Metformin (a diabetes medication). And while these medications may be helpful for controlling symptoms of PCOS, they don’t truly address the root causes of PCOS, which is a combination of underlying imbalances in the body. These approaches also fail to consider the two “types” of PCOS, which benefit from different treatment approaches.
So, how do I approach PCOS? You won’t be surprised to hear that a big part of my PCOS treatment plan has to do with the gut. Why? Because the gut is intricately involved in hormone health, blood sugar balance, and reproductive health. For example, research has shown that gut microbiota imbalances (like loss of microbial diversity in the gut) can contribute to insulin resistance, excess androgen production, chronic inflammation, and metabolic syndrome. Studies have also directly linked PCOS to increased intestinal permeability and gut microbiome imbalances. For example, one study looked at 73 women with PCOS and found that compared to women without the condition, they had lower gut microbiome diversity and that this trend was related to an increase in androgens.
If we’re looking at PCOS as a full-body imbalance (not just a reproductive system issue), focusing on the gut — which is the foundation of overall health — is the ideal treatment approach.
The Best (and Worst!) Foods for PCOS
Oftentimes, PCOS is caused by a bunch of small lifestyle factors that are out of balance, so focusing on the gut — which influences blood sugar, inflammation, and hormone health — can be a great place to start. As Eleni said to me, “Women have different root causes of their PCOS, and we’re all genetically so different. You can’t just say ‘Do this!’ and guarantee a certain outcome.” So, what do you do instead? You must take all these different components and piece them together into an individualized approach to YOUR health.
If you have PCOS, cut out the following foods to start the healing process:
Foods to Avoid for PCOS
1. Non-Organic Produce
Reducing the overall burden on the body — especially on the liver’s detoxification system — is a key part of helping your metabolism and hormones function optimally — something I discuss in the HAPPY GUT® Detox Masterclass. If you emphasize eating organic whenever possible, it will help you avoid pesticides and that is essential to reducing PCOS. If it’s not in your budget to always buy organic, check out the Environmental Working Group’s list of the cleanest fruits and veggies you can buy.
Margaritas, Manhattan’s, Mojitos, wine and beer….these drinks are chock full of sugar and alcohol, both of which can lead to hormone disruption. Alcohol also leads to insulin resistance and weight gain in the middle of the abdomen, which spells trouble for any woman predisposed to PCOS. If you have PCOS, alcohol is one thing to limit as much as possible. If you do have the occasional drink, reach for a simple vodka soda or tequila on the rocks with lime to limit your sugar intake.
3. Hormone-Treated Meat and Dairy
If you’re already susceptible to a hormone imbalance, you don’t want to flood your body with more hormones. It just makes sense, doesn’t it? That is why I recommend that my patients with PCOS cut down on meat and dairy, choosing hormone-free, grass fed, free-range, and wild-caught organic meats whenever possible. Factory raised animals are often treated with antibiotics and hormones, which can end up in the meat or dairy products that you eat. As a dairy substitute, consider coconut yogurts and nut milks and kefirs.
4. Excess Fruit
Fruit is often praised as a health food, but if you have or suspect PCOS, you need to take a slightly more cautious approach to fruit since it can be high in a fruit sugar known as fructose. According to Eleni, “You can eat any fruit you want, but if you’re eating a higher sugar fruit — like a melon — always eat it with protein or fat.” This will help reduce the blood sugar spike and overall burden on the body. Studies have shown that starting a meal with vegetables reduces the sugar-impact of the meal. So, it’s best to save fruit for the end of the meal, when the absorption of its fruit sugar is going to be slowed down by the food already present in the stomach.
Instead of high-sugar fruit, enjoy lower sugar fruits as a snack or dessert, such as berries, green apples or grapefruit. Expert tip from Eleni: Try to avoid fruits and veggies packaged in plastic; these foods are very absorbent and can contain hormone-disrupting toxins that leech from the plastic, which can not only contribute to an inflammatory state of your body, but also increase your risk of autoimmune disease.
5. Low-Calorie Snack Foods
If you’re struggling with your weight and PCOS, you might be tempted to opt for “low-calorie” snacks and foods, like bars, crackers, “Skinny Pop” or other 100-calorie snack packs. And I get why! It seems like they would help you reduce your calorie intake and therefore your weight. But the problem is, as I’ve talked about before, calories out don’t equal calories in when it comes to your gut and overall health. Unfortunately, most of these foods are full of simple sugars and carbs, which can further sabotage your blood sugar balance — one of the underlying root causes of PCOS.
If you have PCOS, I recommend to keep snacking to a minimum and eat three healthy meals a day without skipping meals. This is true for both “types” of PCOS patients, but especially for the “skinny type.” If you do need a snack during the day, Eleni recommends something with plenty of protein and healthy fat, like a couple of pasture-raised, hard-boiled eggs or a handful of nuts, like walnuts or almonds.
When it comes to PCOS, what you should add to our diet is just as important as what you should eliminate. Below is a list of what I recommend eating if you want to help defend your body against PCOS.
Foods to Eat for PCOS
1. Cruciferous Veggies
Cruciferous vegetables contain a compound called 3,3′-Diindolylmethane (more commonly known as DIM), which can help with hormone regulation and the metabolism of hormones as well as toxins and chemicals from the environment. Eleni recommends enjoying cruciferous vegetables at least a few times a week,, but she also recommends taking a DIM as a supplement to get enough of this compound if you have PCOS to see an improvement in symptoms.
2. More Protein
Many women try to lose weight by cutting out meat or animal products; unfortunately, this can mean less protein, which is critical for building lean muscle mass and blood sugar balance. Make sure you’re eating at least 15 grams of protein at every meal, whether it be in the form of responsibly sourced, organic meats or legumes, eggs, or nuts and seeds. You can also take a cinnamon supplement, which can help reduce insulin resistance.
3. Omega-3 Fatty Acids
If you’re struggling with PCOS, weight loss resistance or weight gain, you might be tempted to cut down on your fat intake. But healthy fats are not only essential for blood sugar balance and satiation, but they’re also essential for fighting off chronic inflammation. I recommend eating 3 oz. of wild salmon twice per week, nuts and seeds regularly, and/or olive oil daily to get your daily dose of anti-inflammatory omega-3 fatty acids.
4. Fermented Foods
If you’re a frequent reader of my blog or follow me on social media, you know that I love fermented foods. Fermentation has a long list of benefits (read about them in this blog post) but the one that most applies to PCOS is an increase in gut microbiota diversity, which we learned earlier is lacking in PCOS patients. Try to eat at least one fermented food a day, and mix up your diet so you’re getting a wide range of fiber to feed those friendly bacteria in your gut! And if you want to turbocharge your results, then add in a high-potency probiotic, like HAPPY GUT® Restore.
5. Fermented Foods
If you look at nutrition and lifestyle tips for PCOS, you’ll see that most experts will tell you to cut out carbohydrates. Well, I’ve got great news! According to Eleni, you can still eat carbohydrates. But instead of processed simple carbs, she recommends focusing on carbs with a high resistant starch content. “These foods, which include cooked and chilled legumes, kiwi, and sunchokes, are great for PCOS because they have a better impact on blood sugar,” she says. Other great sources of resistant starch include oats, cooked and chilled potatoes, and cooked and chilled rice.
If you’re struggling with PCOS and you’ve only been given prescription drug options, Eleni and I both agree that you’ve only explored a fraction of the treatment options available to you. I’d never give you any kind of guarantee, but many women are able to reduce or even eliminate PCOS by making some key changes to their lifestyle! There’s hope. And, by the way, if you need further nutrition guidance, Eleni provides virtual nutrition consultations.
In summary, PCOS symptoms can make you feel frustrated, self-conscious, and reaching for cover-up, but remember that you’re not alone and that PCOS is the most common hormone disorder in the world. Follow the approaches detailed above to help you manage your PCOS in the long-term.