Figuring out how to manage polycystic ovary syndrome (PCOS) can feel like a maddening game of throwing darts while blindfolded. And maybe while using your non-dominant hand, too. PCOS is a hormonal disorder that can prompt a wide range of symptoms including irregular periods, excess facial hair, scalp hair loss, and acne, all of which may make it feel like your body isn’t, well, yours anymore.
If you have this condition, you may have heard that diet and exercise can help. But people tend to say that for a lot of health issues, even when it couldn’t be further from the truth. So, is this medical fact or fiction? Here, SELF explores the connection between PCOS, diet, and exercise.
What causes PCOS
Let’s walk through the science of PCOS a bit. Stay with us here, because it will help you understand any possible diet and exercise links.
One commonly accepted theory suggests that PCOS happens because the brain’s hypothalamus sends incorrect signals to the pituitary gland (a pea-sized organ that produces hormones), resulting in ovarian dysfunction that causes PCOS symptoms, Leanne Redman, Ph.D., director of the Reproductive Endocrinology and Women’s Health Research Program at Pennington Biomedical Research Center in Baton Rouge, Louisiana, tells SELF.
Typically, your ovaries are tasked with producing hormones such as estrogen, progesterone, and androgens (hormones that have historically been viewed as “male,” like testosterone). Ovarian dysfunction can throw these hormones out of whack, leading to PCOS symptoms. For instance, your ovaries might churn out excess androgens that rear their head through PCOS symptoms like acne, excess facial hair, scalp hair loss, and problems conceiving due to irregular or totally absent ovulation.
Experts aren’t sure of exactly how these excess androgens can affect ovulation. It could be that the buildup of these hormones inside ovarian follicles (small sacs that each hold an egg) keeps the follicles from maturing and eventually releasing eggs to be fertilized, John Nestler, M.D., a professor at Virginia Commonwealth University in Richmond, tells SELF.
Another prevalent theory holds that insulin resistance is at the root of PCOS. The relationship here is incredibly complex, but here’s the gist: If you’re insulin resistant, your cells don’t react properly to the insulin hormone your pancreas makes so you can absorb glucose (i.e., sugar from food), the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) explains. In that instance, your pancreas pumps out extra insulin. But if that’s still not enough to help your cells properly absorb glucose, high blood sugar levels lead to prediabetes, which then raises your risk of type 2 diabetes.
Where does PCOS come in? Insulin resistance can cause your ovaries to make too many androgens, according to the Mayo Clinic. Insulin resistance may also affect how the pituitary gland regulates your levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), both of which prepare those ovarian follicles for maturation. But data on this is conflicting, according to 2012 research on insulin resistance and PCOS in Endocrine Reviews.
So, how are diet and exercise supposed to help with these PCOS symptoms? If you're insulin resistant, then becoming more sensitive to insulin can lower the androgen levels that give rise to PCOS symptoms. “You can improve the insulin sensitivity and improve the syndrome,” Dr. Nestler says. The way you eat and exercise might help you do it.
The relationship between diet, insulin resistance, and PCOS
Maybe you’ve heard people say that trying this diet or swearing off those foods helped their PCOS symptoms. Don’t believe the claims that any particular food or food group worsens, causes, or cures PCOS, Lisa Moran, Ph.D., a dietitian and head of the Healthy Lifestyle Research Program at the Monash Centre for Health Research and Implementation in Melbourne, Australia, tells SELF.
No evidence suggests that you should cut out food groups to manage PCOS, says Moran, who served as chair of lifestyle research for a set of international evidence-based guidelines on the assessment and management of PCOS published in 2018. The exception is if you have PCOS and food intolerances, in which case, avoiding certain foods (under advisement from your doctor or registered dietitian) really might make you feel better overall even if it doesn’t directly impact your PCOS symptoms.
With that said, there is a wealth of evidence that eating what is commonly perceived to be a “healthy” diet may help improve PCOS symptoms by reducing insulin resistance. The evidence-based guidelines Moran worked on present what scientists have found on the subject so far.
These guidelines come from a partnership between the Centre for Research Excellence in Polycystic Ovary Syndrome (CREPCOS) in Australia, the European Society of Human Reproduction and Embryology (ESHRE), and American Society for Reproductive Medicine (ASRM). Teams of researchers from Australia, Europe, and the United States consulted with physicians and patients (and dug through data) in an attempt to improve health care, health outcomes, and quality of life for people with PCOS. When it comes to diet, these guidelines recommend going for balance, not a specific diet in particular.
According to the United States Department of Agriculture’s Dietary Guidelines, a balanced diet includes a variety of vegetables, fruits, legumes like beans and peas, grains (especially whole grains), fat-free or low-fat dairy products, oils, and proteins like lean meats, poultry, seafood, and eggs. The USDA also recommends limiting trans fats, saturated fats, added sugars, and excessive sodium.
A balanced diet is recommended for PCOS in part because eating this way may help you incorporate more foods low on the glycemic index (GI). In general, low GI foods take longer to digest and absorb, raising your blood sugar levels at a slower rate, according to the Mayo Clinic. Eating a lot of foods high on the glycemic index like white cereal and pasta forces the pancreas to work hard to produce extra insulin, which may exacerbate insulin resistance.
It’s no coincidence that a lot of low GI foods are high in fiber, as fiber requires more time to digest. Low GI, high-fiber foods include quinoa, rolled oats, barley, bulgur wheat, whole-grain bread, beans, and lentils. However, as the Mayo Clinic emphasizes, this is not about going on a low GI diet but instead eating more of these foods if you and your PCOS treatment team decide that makes sense for you.
Some experts believe eating this way may also help calm systemic inflammation that seems like it might be linked to PCOS. “Inflammation” is such a notorious buzzword that people often view it as inherently negative, but inflammation is actually a totally normal immune process that happens when your body is trying to protect you from an irritant or injury. The issue is when that inflammation becomes chronic, which may (among other issues) prompt the ovaries to produce too many androgens, according to the Mayo Clinic.
There’s no one “anti-inflammatory” diet, but a 2016 Fertility and Sterility review of diet, inflammation, and reproductive outcomes in people with PCOS suggests that choosing low GI carbs, cutting trans fat, and eating more plant-based sources of protein or fatty fish like salmon could help fight this kind of chronic low-grade inflammation. Still, it’s up to future research to confirm whether dietary changes can really improve PCOS symptoms.
All of this is well and good, but remember that you don’t need to cut out everything you love in order to have a balanced diet, and imposing a restrictive diet on yourself can make it much harder to have a healthy relationship with food, Moran says. What matters most is eating in a safe, sustainable way that’s healthy for you, which isn’t something anyone besides you and your PCOS treatment team can determine.
Exercise and insulin resistance
Working out can increase your cells’ response to insulin and allow them to more easily use glucose for energy, according to the American Diabetes Association (ADA).
There isn’t enough research to recommend specific types of activity for reducing PCOS symptoms, says Redman, who contributed to the evidence-based guidelines as an expert in PCOS and exercise physiology. Both the evidence-based guidelines and the American Heart Association say that adults can aim for a minimum of 150 minutes of moderate exercise each week. Think brisk walking, hiking, yoga, low-impact aerobics, recreational swimming, golf, and tennis. Or you can get 75 minutes of vigorous exercise, like running, mountain climbing, high-impact aerobics, high-intensity intervals, and intense swimming. Your third option is an equivalent combo of moderate and vigorous exercise. Muscle-strengthening activities should be part of whichever routine you choose (preferably twice a week on non-consecutive days).
Definitely talk to your doctor if your main goal is to exercise for better insulin sensitivity, or if you’re just not sure how much working out is best for your health.
What you need to know about weight management and PCOS
It might seem like the point of eating a balanced diet and exercising is to lose weight. It’s true that losing weight may help relieve certain PCOS symptoms, according to the Mayo Clinic, because weight loss can make you more insulin sensitive.
But it’s not valid to say that everyone with PCOS should consider trying to lose weight, Moran says. Not everyone with PCOS is overweight or obese, and even if someone is overweight or obese, it’s not as simple as drawing a line between their BMI and their health. Metabolic health varies from person to person, even among those with PCOS, according to a 2012 Fertility and Sterility review from the European Society of Human Reproduction and Embryology and the American Society of Reproductive Medicine, which summarized findings from hundreds of studies.
It’s also nowhere near guaranteed that eating well and exercising will always lead to weight loss. Stress, sleep, medications, and any other health conditions you have in addition to PCOS can all affect whether or not you’re able to lose weight easily. Plus, being able to afford (and access) healthy foods or make time for exercise also factors into this. In other words, circumstances you have little to no control over can impact your weight.
There’s also the fact that insulin resistance may make losing weight more difficult in the first place, Redman says. Some research points to a possible relationship between ghrelin (a hormone that helps to regulate appetite) and PCOS. The hormone has been linked to insulin, blood sugar, and ovarian function, according to a 2016 Endocrine Journal meta-analysis of ghrelin levels in PCOS. More research is needed to understand this connection, though.
Finally, even if losing weight would alleviate your PCOS symptoms, focusing too much on weight loss can be harmful if, for example, you have a history of disordered eating.
The biggest goal here is really to eat well and stay active for a variety of reasons, only one of which is PCOS management. If your doctor says that losing a certain amount of weight will really help with your PCOS, they should give you actionable tools to do that in a way that’s safe for you physically and mentally.
Bottom line: There’s no one-size-fits-all way to treat PCOS.
The options go far beyond diet and exercise, so you might need to mix and match. Your doctor may recommend hormonal birth control to regulate hormone levels (to alleviate androgen-related issues like acne) and menstrual cycles, according to the Mayo Clinic. They may also prescribe drugs like metformin to help your body become more sensitive to insulin or medications to stimulate ovulation if PCOS is making it difficult for you to get pregnant.
The point is that if you have PCOS, you also have options. See what your doctor thinks about how diet, exercise, and various medical treatments may impact your symptoms. Having the conversation may get you one step closer to landing on the best PCOS treatment regimen for your body and mind.
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