PCOS - diet, supplementation. Everything you need to know!

Table of contents

1. What is PCOS?
2. Causes of PCOS
3. Polycystic ovary syndrome - symptoms
4. PCO and PCOS - Differences
5. Diagnosis of PCOS
6. Diet in PCOS
7. What are the glycemic index and glycemic load?
8. What to eat with PCOS
9. What should you avoid eating if you have PCOS?
10. PCOS - meal plan
11. Physical Activity and PCOS
12. PCOS supplements
13. Herbal Remedies with Potential Benefits for PCOS
14. PCOS - Summary

What is PCOS?

PCOS (Polycystic Ovary Syndrome) is a common endocrine disorder in women of reproductive age. It is marked by symptoms such as irregular menstrual cycles, hyperandrogenism (excess male hormones), and insulin resistance.

PCOS affects roughly 8 to 13% of women, mostly during their childbearing years. While PCOS is a chronic condition, many symptoms can be managed through lifestyle changes.

Regular physical activity, a balanced diet, and maintaining a healthy weight are essential for improving well-being and reducing symptoms.

Causes of PCOS

The exact causes of PCOS are not fully understood, but several factors may contribute to its development:

• genetic factors
• hormonal imbalances
• environmental and lifestyle factors
• metabolic factors
• neuroendocrine factors

Polycystic ovary syndrome - symptoms

Symptoms of PCOS include:

• irregular periods
• hyperandrogenism, such as hirsutism (male-pattern hair growth), acne, and androgenic alopecia
• metabolic symptoms like obesity and insulin resistance
• infertility
• psychological symptoms, including depression, anxiety, and low self-esteem

People with PCOS are also at higher risk for other health issues, such as:

• type 2 diabetes
• hypertension (high blood pressure)
• high cholesterol
• heart disease
• endometrial cancer (cancer of the uterine lining)

PCO and PCOS - Differences

The difference between PCO and PCOS is:

• PCO refers only to structural changes in the ovaries, where many small follicles are visible, but these changes may not be accompanied by other hormonal or metabolic symptoms.
• PCOS includes a broader range of symptoms, such as hormonal imbalances, irregular menstrual cycles, insulin resistance, and other clinical signs, following established diagnostic criteria.

Diagnosis of PCOS

PCOS in adult women can be diagnosed if at least two of the following are present*:

• Ovulation disorders
• Clinical and/or biochemical hyperandrogenism (excessive facial or body hair, male-pattern baldness, acne, or elevated blood testosterone levels)
• Presence of polycystic ovaries on ultrasound

*Other possible causes of these symptoms must be ruled out.

Diet in PCOS

In PCOS, special attention should be paid to four aspects:

• weight control or reduction
• lipid profile control
• carbohydrate metabolism control
• introduction of regular physical activity

Diet therapy in PCOS consists of following an anti-inflammatory diet. The Mediterranean diet and the DASH diet are suitable models due to their potential benefits in regulating insulin levels and improving PCOS symptoms.

The diet for people with polycystic ovary syndrome (PCOS) should be based on minimally processed foods with a low glycemic index (GI) and low glycemic load (GL). This approach helps stabilize blood glucose and insulin levels, which is crucial for women with PCOS, who often have insulin resistance. It is recommended to choose whole grain products, such as brown rice, groats, and whole grain bread, while eliminating white bread, sweets, and processed snacks from the diet.

It is beneficial to include vegetables, fruits, nuts, and seeds in your diet, as they provide fiber that supports metabolism, along with essential vitamins and minerals. Limiting animal fats in favor of vegetable fats - such as olive oil, avocado, or flaxseed oil - is recommended. Increasing protein intake is an important part of nutritional therapy for PCOS. Choose high-quality protein sources like fish, lean meat, dairy products, and legumes. Additionally, it is advisable to replace fried foods with boiled, stewed, or baked options.

This type of diet not only helps with weight management but can also relieve PCOS symptoms, improving overall health and quality of life.

However, it is important to remember that the PCOS diet should be individually tailored to the patient’s needs, especially in cases of insulin resistance, excess weight, or hormonal imbalances.

For those with excess weight, a weight-loss diet is recommended to reduce body fat, which can significantly improve PCOS symptoms, including insulin resistance and reproductive function.

What are the glycemic index and glycemic load?

The glycemic index (GI) measures how quickly and how much blood glucose levels rise after eating a particular food, on a scale from 1 to 100. Foods with a low glycemic index digest and absorb slowly, while those with a high GI digest quickly, which can cause fluctuations in insulin and glucose levels.

• High GI (>70) — examples include wheat bread, rice flakes, sweets, dates, beer, baked potatoes, French fries, chips, cooked carrots, and popcorn.
• Medium GI (56-69) — examples include oat and corn flakes, white bread, wholemeal bread, brown rice, raisins, boiled potatoes, sweetened juices and fruit drinks, pumpernickel, mango, banana, and watermelon.
• Low GI (<55) — examples include sourdough rye bread, apples, pears, blueberries, raspberries, blackcurrants, kiwis, onions, broccoli, zucchini, cauliflower, buckwheat, lentils, and soybeans.

The glycemic load (GL) is a more precise measure that complements the glycemic index by considering portion size. It accounts for both the amount of carbohydrates in a serving and the quality of those carbohydrates (including fiber content) in the portion consumed.

• Low glycemic load is below 10
• Medium glycemic load is 11–20
• High glycemic load is above 20

What to eat with PCOS:

• whole grains: wholemeal bread, buckwheat groats, whole grain pasta, brown rice
• fish and seafood: rich in omega-3 fatty acids, which help reduce inflammation
• plant proteins: tofu, beans, lentils, chickpeas
• lean meats: chicken, turkey, lean cuts of beef or pork
• nuts: walnuts, almonds, hazelnuts — good sources of healthy fats and protein
• healthy vegetable oils: olive oil, rapeseed (canola) oil, flaxseed oil
• eggs: nutrient-dense protein source
• fermented dairy: yogurt, kefir, buttermilk — good for gut health
• vegetables and fruits: especially low-GI options like blueberries, raspberries, blackberries, oranges, broccoli, cauliflower, and carrots

What should you avoid eating if you have PCOS?

It is recommended to limit primarily pro-inflammatory and high-GI foods, such as:

• cereal products made from wheat flour, including white bread, white rice, wheat pasta, and fine groats
• fatty meats and organ meats
• sweet confectionery
• fast food
• salty snacks
• sugar-sweetened beverages
• dried fruit and fruit in syrup
• deep-fried foods
• products high in salt
• alcohol and other stimulants

PCOS - meal plan

Breakfast - shakshuka with wholemeal bread

Ingredients:

• ½ can of chopped tomatoes
• 2 eggs
• 1 teaspoon olive oil
• ⅓ onion
• 2 slices of wholemeal bread
• your favorite herbs and spices

Preparation:
Heat the olive oil in a frying pan, then add the chopped onion and sauté until soft. Add the tomatoes and bring to a boil. Make two small wells in the sauce and crack in the eggs. Season to taste. Cover with a lid and cook on low heat until the eggs are set. Serve with wholemeal bread.

Second breakfast - chia pudding with strawberry mousse

Ingredients:

• 2 tablespoons chia seeds
• ¾ cup plant milk (e.g., almond milk)
• 1 teaspoon erythritol
• 150 g strawberries (fresh or frozen)
• 1 tablespoon almond flakes

Preparation:
In a bowl, mix chia seeds with plant milk and erythritol. Pour into a glass and let sit for about 15 minutes, then stir again. Refrigerate for at least 3 hours (preferably overnight). Blend the strawberries into a smooth mousse, pour over the pudding, and top with almond flakes.

Lunch - salmon with boiled broccoli and cauliflower purée

Ingredients:

• salmon fillet
• ⅓ head of broccoli
• ½ small cauliflower
• 1 teaspoon olive oil
• 1 teaspoon butter (optional, for the purée)
• salt and pepper to taste
• 1 teaspoon lemon juice
• fresh herbs (e.g., dill or parsley)

Preparation:
Rub the salmon with olive oil, lemon juice, salt, and pepper, then bake at 180°C (356°F) for 12-15 minutes. Separate the broccoli into florets and steam for 5-7 minutes. Boil the cauliflower in water for about 10 minutes, drain, and blend into a purée with salt, pepper, and a little butter. Serve the purée on a plate with the steamed broccoli and baked salmon, and garnish with fresh herbs.

Dinner - salad with arugula, grilled chicken, avocado, and pumpkin seeds

Ingredients:

• chicken breast fillet
• arugula
• semi-fat salad cheese
• ½ avocado
• 1 tablespoon pumpkin seeds
• 1 teaspoon olive oil
• lemon juice
• salt and pepper

Preparation:
Rub the chicken with olive oil, salt, pepper, and your favorite spices. Grill for 6-7 minutes on each side. Rinse the arugula and arrange it on a plate. Slice the avocado and add it to the salad along with the diced cheese. Sprinkle with roasted pumpkin seeds. Drizzle with olive oil and lemon juice, and season with salt and pepper. Top the salad with the sliced grilled chicken.

Physical Activity and PCOS

Regular, moderate physical activity is a crucial part of managing PCOS. A minimum of 150 minutes of moderate exercise per week is recommended. Consistent physical activity can improve insulin sensitivity, reduce hyperinsulinemia, and lower androgen levels.

Women with PCOS are also more likely to experience depression and anxiety, and regular exercise is linked to reduced symptoms of depression and improved overall mental well-being.

Aerobic exercises such as walking, yoga, running, cycling, or swimming, as well as strength training, can be especially beneficial. The key is consistency and choosing physical activities that are enjoyable and aligned with individual preferences.

PCOS supplements

Research suggests that certain supplements may help alleviate symptoms of PCOS. These include:

• Inositol - May improve glucose regulation, fertility, ovulation, and menstrual regularity. The most effective ratio of myo-inositol to D-chiro-inositol appears to be 40:1.
• NAC (N-acetylcysteine) - May enhance insulin sensitivity and reduce oxidative stress in women with PCOS.
• Vitamin D - May support better insulin sensitivity and help reduce inflammation.
• Omega-3 fatty acids - May help reduce inflammation, regulate androgen levels, and improve the lipid profile, which is often imbalanced in PCOS.
• Probiotics - Especially when combined with selenium, may reduce hyperandrogenism, inflammation, and oxidative stress.
• Magnesium - May aid in improving insulin resistance and support a healthier lipid profile.
• Antioxidants - Such as vitamin E and coenzyme Q10, can reduce oxidative stress and support overall metabolic health.

Herbal-remedies-with-potential-benefits-for-pcos">Herbal Remedies with Potential Benefits for PCOS:

• Curcumin - May contribute to a healthier lipid profile and help manage inflammation.
• Spearmint - May help reduce excess hair growth (hirsutism) and support hormonal balance.
• Fenugreek - May improve ovulatory function and help regulate hormone levels.

PCOS - Summary

Comprehensive lifestyle changes, including a well-balanced diet and regular physical activity, play a key role in managing PCOS. Combining these elements helps improve insulin sensitivity, regulate blood glucose levels, and reduce the risk of metabolic complications.

A diet with a low glycemic load can be effective in stabilizing glucose and insulin levels. Regular physical activity, including both aerobic and resistance training, further supports these benefits by lowering androgen levels and enhancing overall health.

This holistic approach not only helps relieve PCOS symptoms but also positively impacts quality of life.

Bibliography

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2. Mehrabani, H. H., Salehpour, S., Amiri, Z., Farahani, S. J., Meyer, B. J., Tahbaz, F. (2012). Beneficial effects of a high-protein, low-glycemic-load hypocaloric diet in overweight and obese women with polycystic ovary syndrome: a randomized controlled intervention study. Journal of the American College of Nutrition, 31(2), 117–125.
3. Shele, G., Genkil, J., Speelman, D. (2020). A Systematic Review of the Effects of Exercise on Hormones in Women with Polycystic Ovary Syndrome. Journal of functional morphology and kinesiology, 5(2), 35. https://doi.org/10.3390/jfmk5020035.
4. Melo, V., Silva, T., Silva, T., Freitas, J., Sacramento, J., Vazquez, M., Araujo, E. (2022). Omega-3 supplementation in the treatment of polycystic ovary syndrome (PCOS)–a review of clinical trials and cohort. Endocrine Regulations, 56(1), 66-79.
5. Menichini, D., Ughetti, C., Monari, F., Di Vinci, P. L., Neri, I., Facchinetti, F. (2022). Nutraceuticals and polycystic ovary syndrome: a systematic review of the literature. Gynecological Endocrinology, 38(8), 623-631.