Introduction

PCOS, or Polycystic Ovary Syndrome, is a common hormonal disorder that can lead to a range of health issues, including infertility. The three main factors associated with PCOS are irregular ovulation, increased levels of male hormones, and cystic ovaries. These factors can cause problems like hirsutism (unwanted hair growth), acne, and hair loss. In fact, more than 70% of women with PCOS have polycystic ovaries. But here’s the good news: your diet can play a crucial role in managing PCOS. 

Let us dive into the connection between PCOS and diet, and explore how making simple changes to what you eat can make a big difference in your journey to better health.¹

What is PCOS?

PCOS, which stands for Polycystic Ovary Syndrome, is a condition where a woman’s ovaries produce too many male hormones. This can lead to the formation of small fluid-filled sacs called cysts in the ovaries. Not all women with PCOS have these cysts; some women without PCOS can have them too.

Ovulation is the release of a mature egg from the ovary for possible reproduction. But in PCOS, sometimes a woman’s body doesn’t produce enough hormones for ovulation to happen. This may cause the ovaries to develop into many small cysts. These cysts produce male hormones, leading to problems with the menstrual cycle and causing the symptoms of PCOS.²

Types of PCOS?

According to a consensus panel from the NIH (National Institutes of Health), PCOS can be classified into different types based on its phenotypic presentation. The proposed classification includes four phenotypes:

• Phenotype A (full-blown syndrome PCOS: HA+OD+PCO): This type of PCOS includes hyperandrogenism (excessive male hormone levels) either clinically or based on biochemical testing, ovulatory dysfunction (absent or irregular ovulation), and the presence of polycystic ovaries.

• Phenotype B (non-PCO PCOS: HA+OD): This type of PCOS involves hyperandrogenism and ovulatory dysfunction but without the presence of polycystic ovaries.

• Phenotype C (ovulatory PCOS: HA+PCO): This type of PCOS is characterized by hyperandrogenism and the presence of polycystic ovaries, while ovulatory function remains normal.

• Phenotype D (non-hyperandrogenic PCOS: OD+PCO): This type of PCOS is defined by ovulatory dysfunction and the presence of polycystic ovaries, without significant hyperandrogenism.

These different phenotypes help in better understanding and classifying the diverse manifestations of PCOS based on the combination of symptoms and characteristics exhibited by individuals.³

What foods should you eat?

When managing PCOS, it’s beneficial to include nutritious and delicious options in your diet. Here are some food choices from the Mediterranean diet that can help you maintain a healthy weight and manage PCOS symptoms:

• Include omega-3-rich fish, like salmon, by baking or broiling it.
• Olive oil may be used in place of butter or margarine.
• Opt for protein-rich legumes, such as beans, instead of meat.
• Add leafy greens (spinach, kale, lettuce, and so on), tomatoes, mushrooms, peppers, broccoli, cauliflower, snow peas, celery, and fennel to your meals.
• Choose whole grains like brown rice, barley, sorghum, and others. Whole-grain breads and pastas can help avoid blood sugar spikes.
• Enjoy whole fruits as a dessert option. The fibre in whole fruits aids in satiety, digestion, and slows down the absorption of sugars into the bloodstream.
• Stay hydrated by drinking plenty of water and opt for low- or no-sugar beverages.
• Make sure to prioritize hydration by drinking enough water and unsweetened coffee or tea. Instead of soda, consider seltzer with a touch of fruit juice for a refreshing alternative.

By incorporating these food choices into your diet, you can support your overall health and effectively manage PCOS symptoms.⁴

What foods should you avoid?

It is recommended for individuals with PCOS to avoid certain foods that can contribute to inflammation. Here are the foods to be avoided in PCOS:

• Fried foods: Fried foods like French fries, potato chips, corn chips, and fried chicken or fish should be avoided.
• Saturated fat: Saturated fats are found in items like butter or margarine.
• Red meat: Food made with red meat including hamburgers, roast beef, steaks, processed luncheon meat, and hot dogs should be avoided.
• Processed snacks: Processed snacks should be avoided in PCOS. These include cakes, cookies, candy, and pies.
• Sugary cereals: Cereals that contain excess sugars including instant oatmeal and granola.
• Sugary beverages: Beverages that contain a lot of sugar like sodas, sweetened teas, and sports drinks.
• Alcoholic beverages.
• Refined flour: This includes products made with refined flour like white bread, pizza crust, and pasta.
• White rice

By avoiding these foods, individuals with PCOS can help reduce inflammation and manage their condition more effectively.⁴

Tips for Following the PCOS Diet

To effectively manage PCOS, regular exercise, a healthy diet, and weight control are key. Here are tips to maintain a healthy PCOS-friendly diet:

• Opt for fresh and minimally processed foods: Include a variety of fresh fruits, vegetables, dairy/milk products, and lean protein sources like nuts and seeds.
• Choose whole grains: Incorporate whole grains into your meals, such as whole wheat products, barley, oatmeal, brown rice, and others.
• Stay hydrated with water: Water is the best choice for hydration. Consider adding a squeeze of lemon or lime, a sprig of mint, or try carbonated water for variety. Avoid high-sugar beverages like juices and soda.
• Eat smaller, frequent meals: Instead of three large meals, have smaller meals or snacks every three to five hours. Include a small amount of lean protein or vegetables in each snack.
• Avoid hydrogenated and trans fats: Check food labels for hydrogenated and trans fats, as consuming large amounts can increase the risk of heart disease.
• Focus on fibre: Aim for at least 25 grams of fibre daily from whole grains, fruits, and vegetables. 
• Limit sodium: Try to limit processed and restaurant meals and look for reduced sodium. Use other seasonings like lemon, garlic, herbs, and spices for taste.
• Prioritize soy protein: Include 25 grams of soy protein daily to improve metabolic and cardiovascular health. Good sources of soy protein include tofu, tempeh, edamame, soy nuts, and soy milk.

Remember, adapting your diet may seem overwhelming, but support is available to help manage your symptoms and develop a personalized treatment plan.⁵

Meal Plan For PCOS

Day 1:

Breakfast: 2 whole wheat parathas with ¼ avocado spread, 1 boiled egg or paneer, 2 slices of cucumber, 8 ounces of milk, or a calcium-fortified milk alternative.

Lunch: Vegetable oats upma with mixed vegetables, seasoned with spices, 1 small bowl of yoghurt and water.

Dinner: Palak paneer (spinach and cottage cheese curry) with 1 small bowl of brown rice or whole wheat roti, cucumber raita (yoghurt dip with cucumber and spices).

Day 2:

Breakfast: Vegetable poha (flattened rice) with peas, carrots, and onions, seasoned with spices, 1 orange, and water.

Lunch: Chickpea salad with mixed greens, tomatoes, cucumbers, and a tangy dressing, 1 small bowl of buttermilk.

Dinner: Whole wheat pasta with tomato and vegetable sauce, topped with grated paneer or tofu and water.

Day 3:

Breakfast: Vegetable dalia (broken wheat) with added carrots, peas, and spices, 1 small apple with 1 tablespoon of peanut butter.

Lunch: Mixed vegetable curry with whole wheat roti or brown rice, 1 small bowl of curd and water.

Dinner: Tofu tikka masala with a side of quinoa or brown rice, cucumber mint raita and water.

Day 4:

Breakfast: Moong dal cheela (pancake) made with ground moong dal and spices, served with mint chutney, 1 cup of whole strawberries, 8 ounces of milk or calcium-fortified milk alternative.

Lunch: Vegetable biryani made with brown rice, mixed vegetables, and aromatic spices, cucumber raita and water.

Dinner: Tofu stir-fry with colourful bell peppers and broccoli, served with quinoa or whole wheat noodles and water.

Day 5:

Breakfast: 2 idlis (steamed rice cakes) with ¼ avocado chutney, 1 boiled egg or paneer, 2 slices of cucumber, 8 ounces of milk or calcium-fortified milk alternative.

Lunch: Veggie wrap with whole wheat roti, hummus, mixed vegetables like lettuce, cucumbers, onions and water.

Dinner: Rajma masala (kidney bean curry) with brown rice or whole wheat roti, mixed vegetable salad and water.

It is recommended to stay hydrated by drinking an adequate amount of water throughout the day. It is also beneficial to reduce or eliminate the consumption of alcohol, sugary beverages, and processed foods. This meal plan is a suggested guideline for a PCOS diet and should not be taken as medical advice. 

To ensure your nutritional needs and dietary restrictions are met, it is recommended to seek guidance from a healthcare professional or registered dietitian to develop a personalized meal plan. This plan can be customized to align with your specific preferences and requirements, but it should emphasize the inclusion of whole foods, lean sources of protein, and a variety of fruits and vegetables. It is advisable to limit the intake of processed foods, sugar, and unhealthy fats.⁶ Before following any of the diets consult your doctor or nutritionist and proceed.

Tips to manage PCOS

Managing PCOS involves various strategies tailored to individual symptoms and goals. Following are some tips for managing PCOS:

Lifestyle modifications:

• Weight management: Aim to achieve a healthy weight through a balanced diet and regular exercise. Even modest weight loss can improve symptoms and insulin sensitivity.
• Regular physical activity: Engage in aerobic exercises and strength training to enhance insulin sensitivity and maintain overall health.
• Balanced diet: Consume a wide range of nutrient-rich foods, such as fresh produce, whole grains, lean meats, and healthy fats. 
• Stress management: Incorporate stress-reducing techniques like meditation, yoga, or engaging in hobbies to manage stress levels.

Medications:

• Menstrual irregularities: Medications can be prescribed to regulate the menstrual cycle and improve symptoms. Consult a healthcare professional for better outcomes.
• Androgen excess: Medications are available to address symptoms like hirsutism and acne caused by excess androgen. Topical treatments and laser hair removal may also be considered.
• Metabolic complications: Lifestyle changes including calorie restriction, exercise, and improving insulin sensitivity through metformin can help manage metabolic issues. In some cases, statins may be prescribed for dyslipidemia. Bariatric surgery might be an option for severe obesity and associated metabolic disorders.
• Infertility: For overweight or obese individuals aiming to conceive, weight loss through diet and exercise is crucial. Monitoring and adjusting medications may be necessary before pregnancy. Medications may be prescribed by a healthcare provider to help induce ovulation for fertility treatment.

Specialist referral:

• Severe symptoms or rapidly progressing virilization require referral to an endocrinologist or gynaecologist to exclude other causes.
• If first-line measures fail or symptoms are not adequately controlled, consider referral to an endocrinologist, gynaecologist, or reproductive medicine specialist.
• Patients struggling with comorbidities like severe obesity, diabetes mellitus (DM), obstructive sleep apnea (OSA), or depression may require further specialist referral.

Remember, it is important to consult with healthcare professionals experienced in PCOS management to develop a personalized treatment plan based on individual needs and circumstances.⁷

FAQs

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References

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3. Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Comparison of the different PCOS phenotypes based on clinical metabolic, and hormonal profile, and their response to clomiphene. Indian journal of endocrinology and metabolism. 2019 May;23(3):326. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683693/ 
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5. Skiadas, MD CC. Treating PCOS with Nutrition: 9 Tips for a Healthy Diet [Internet]. 2022 [cited 2023 May 19]. Available from: https://www.lancastergeneralhealth.org/health-hub-home/2022/october/treating-pcos-with-nutrition-9-tips-for-a-healthy-diet  
6. Polycystic ovarian syndrome (PCOS) nutrition information [Internet]. The Children’s Hospital of Philadelphia; 2023 [cited 2023 May 19]. Available from: https://www.chop.edu/health-resources/polycystic-ovarian-syndrome-pcos-nutrition-information  
7. Lua AC, How CH, King TF. Managing polycystic ovary syndrome in primary care. Singapore medical journal. 2018 Nov;59(11):567. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250763/