• Caroline Spurr

How to Treat PCOS: An Overview of Issues Affecting Success

Updated: Nov 8

Lifestyle advice is more than just weight loss - it encompasses multiple health indicators and constitutes a holistic approach to health. As polycystic ovary syndrome (PCOS) is a complex condition with multiple health risks, it’s important to consider all aspects of well-being. Learn more about the different types of PCOS and why PCOS needs to be diagnosed & treated even if you are not concerned with fertility in our other blog posts.

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Not only do women with PCOS struggle to overcome barriers, but all women face numerous barriers to healthy lifestyle change. The available research shows all premenopausal women with or without PCOS are at a higher risk of dropout from nutrition & lifestyle interventions when compared to women of older age (Ee et al). Not to get on another soapbox of feminism and the unequal division of labour at home but women of reproductive age having higher dropout rates could be due to family responsibilities, poor partner support, low mood, lack of childcare for self-care or exercise, fatigue, and lack of time.


Despite knowing what may be healthy, many women still struggle to adopt the changes needed due to the roles and demands women face every day. This blog will outline the barriers women with PCOS may face and offer some strategies to overcome them.


Diets for PCOS + Weight Loss

A healthy diet (paired with regular physical activity) is beneficial for women with PCOS by helping them achieve and/or maintain a healthy weight, regulate hormones, improve metabolic factors (such as insulin resistance) and lead to improved body image. Even a 5-10% weight loss has been shown to improve health outcomes and PCOS symptoms.


Sticking to a diet is tough for anyone, but especially for women with PCOS. PCOS puts women at a metabolic disadvantage, requiring careful planning of macronutrients and foods to maximize satiety and prevent overeating.


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Impact of PCOS on Hunger, Cravings & Appetite

Women with PCOS face unique challenges with hunger and satiety, with some research showing alterations in hunger and satiety hormones, and reports of hunger sooner after eating compared to women without PCOS (Ee et al).


Meaning some women with PCOS have difficulty feeling satisfied and full after meals. However, the research studies that have initially shown these differences in women with PCOS have not been repeated since which means that this research may not be 100% applicable to women with PCOS.


Check out our blog on how to stop cravings sweets after supper!


PCOS Hormone Levels

The majority of women with PCOS have insulin resistance and subsequently, high levels of insulin (hyperinsulinemia) which may predispose women with PCOS to gain weight (Ee et al). High levels of androgens may also predispose women with PCOS to store fat in their abdomens which can exacerbate insulin resistance (Ee et al).


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PCOS & Metabolism

There is conflicting research showing women with PCOS may have altered metabolisms including lower metabolisms and metabolic inflexibility, meaning that the metabolism has a reduced ability to switch between burning fat for energy in fasting conditions from carbohydrates (Ee et al). The metabolic inflexibility in women with PCOS may be related to insulin resistance and hyperandrogenism in women with PCOS (Ee et al).


No one diet has proved superior to another for the purpose of weight loss, so it’s important to choose a diet that is both nutritionally complete and sustainable.

A sustainable diet is any diet that you can follow and enjoy for the rest of your life.



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PCOS & Disordered Eating

The estimated prevalence of disordered eating among women with PCOS varies between 1.33 to 3 times higher than those without PCOS (Pirotta et al). An unhealthy relationship with food can make it difficult for women with PCOS to stay consistent with nutrition and lifestyle changes. Plus when you factor in that many women with PCOS struggle with hunger and fullness cues, fatigue, cravings, and feel disconnected from their bodies - staying consistent with diets for PCOS or exercise.


While weight loss can improve PCOS symptoms, we also need to make sure that we are not worsening any potential negative relationship between food and mental health. Yes, weight loss can help improve the severity of PCOS symptoms but weight loss does not cure PCOS nor does it mean you are healthier! Read more about improving PCOS without weight loss here or how to boost confidence without weight loss here.



PCOS Nutrition: Antioxidants

Looking into the details of diet are antioxidants - powerful compounds in food that act to prevent oxidation leading to cell damage and potentially the development of diseases. Zaeemzadeh et al. compared the dietary consumption of some antioxidants of Iranian women with PCOS and metabolic syndrome to women with only PCOS. It was found that women with both PCOS and metabolic syndrome consumed fewer dietary antioxidants including selenium, zinc, chromium, carotenoids, and vitamin E.


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This is a key finding as antioxidants prevent cell damage and disease development, and some may help improve features of metabolic syndrome such as insulin resistance, metabolism of sugars and fats, and inflammation.


In this study, the two groups were matched for their BMI, physical activity, income, and education level, removing many confounders. This brings up the question - why are women with both PCOS and metabolic syndrome consuming a diet lower in antioxidants than women with only PCOS?


Metabolic syndrome brings a slew of health concerns to women, on top of their PCOS symptoms. Juggling so many health concerns like high fasting blood sugar, high blood pressure, high cholesterol, high triglycerides, overweight or obesity, and/or hormonal imbalances can make it confusing where to start on your health journey. Dietitians can help you prioritize and focus your strategy to improve your health, taking away the guesswork.


Zinc and PCOS
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Zinc is a nutrient to note, as it influences many systems in the body. Several studies have shown that women with PCOS have low serum levels of zinc. Zinc deficiency could be involved in the development of depression, fatigue, insulin resistance, poor immune system functioning, and poor growth of skin, hair, and nails - many of which are related to PCOS (Nasiadek et al).


Zinc plays a critical role in regulating a woman’s hormones while keeping inflammation, fats, and sugars in check. In deficiency, these become unbalanced, causing prerequisites to PCOS and other health conditions. It could be that a dietary deficiency of some of these important nutrients eventually leads to PCOS and metabolic syndrome since deficiency disrupts normal metabolic and endocrine functions.


If you want to read more about zinc and PCOS, check out our previous blog article here!


Best Foods for PCOS: Antioxidants

While these nutrients show promise for women with PCOS, hold off on running to the supplement store. A food-first approach is always more beneficial than mega-dosing with supplements!

Nutrients don’t work in isolation so there is value in getting them through food that has multiple other nutrients and compounds interrelated and interacting with each other.


The best food sources for each nutrient are as follows:

  • Selenium: Brazil nuts, seafood, and organ meats.

  • Zinc: meat, fish, seafood, and fortified cereals.

  • Chromium: present in small to medium amounts in many foods including meats, grain products, fruits, vegetables, nuts, spices, brewer’s yeast, beer, and wine - but amounts vary due to processing techniques.

  • Carotenoids: a compound found in plant foods that convert to vitamin A in the body and are found in foods like sweet potato, carrots, pumpkin, spinach, peppers, mangoes, cantaloupe, etc.

  • Vitamin E: nuts, seeds, whole grains, fortified cereals, leafy greens, and vegetable oils.


As these are just the highest sources, know that you will get smaller amounts of these nutrients from other foods too.


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PCOS and Exercise


Women with PCOS have a uniquely challenging health profile and challenges, thus the inclusion of exercise is important. The minimum amount of exercise for adults is 150 minutes per week at moderate intensity or 75 minutes of vigorous-intensity per week. For weight loss and weight maintenance efforts, this recommendation increases to 250 minutes per week of moderate-intensity or 150 minutes per week of vigorous-intensity.




While this may seem like a lot, consider the requirements per day:

  • ~20-36 minutes of moderate intensity daily or 4 hours of moderate intensity activity per week

  • ~11-20 minutes of vigorous intensity daily or 38 minutes of vigorous intensity activity twice per week

If you are more inclined to count steps and participate in walking, aim for at least 10,000 steps per day combined with normal-life activities and exercise. For example, exercise from work, doing household chores, and structured physical activity. Try to get 30 minutes of structured physical activity per day, or about 3000 steps.


As with diet, it’s important to choose a physical activity routine that is enjoyable as it will be more likely to be sustained and lead to lasting results. If you really hate running - don’t run - there are many other forms of exercise to choose from.


Sleep

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Obstructive sleep apnea (OSA) is more common in women with PCOS, leading to fatigue during the day if left undiagnosed and untreated. In fact, upwards of 35% of women with PCOS have OSA compared to 9-38% of the general population (Ee et al).


Particularly concerning, if a woman with PCOS wants to lose weight but is struggling with OSA, she may find weight loss difficult. It has been well documented that reduced duration of sleep is a risk factor for gaining extra weight (Hirostsu et al). In addition, lack of sleep can cause chronically elevated cortisol levels - our stress hormone - potentially preventing weight loss. Despite this association, the research in this area has not been clear.


Regardless, feeling fatigued during the day will make it difficult to successfully implement any change. It’s imperative that sleep hygiene be addressed as it forms one of the core pillars of health. Without good sleep, other efforts to improve health could be in vain.


Body Image + Depression + Psychosocial Dysfunction

The most common attributes of hyperandrogenism PCOS are facial hair, acne, and hair loss. Since these physical symptoms are more masculine qualities, it’s not hard to see why this is a significant challenge women with PCOS face.


Much research has found that reports of depression in women with PCOS are 44% compared to 17% of healthy women. As higher BMI and obesity are related to PCOS, it would seem intuitive to think these are related. Interestingly, this finding persisted despite BMI, meaning the depressive symptoms may not be weight-related (Dokras et al).


Another common occurrence in women with PCOS is psychosexual dysfunction. It has been reported in 13.3-62.5% of women with PCOS. While this may seem minor to some, a healthy sex drive is an important indicator of health. When struggling with poor body image, depression, anxiety, or psychosexual dysfunction, it becomes challenging to engage in health promotion activities like physical exercise or forming social and/or romantic relationships.


Clearly, this is another core pillar of health and should be addressed prior to diet, exercise, and weight loss efforts.



Change Your Habits: Behavioural Strategies

Various behavioural strategies could help individuals adopt healthier lifestyles. These include:

  • Goal setting

  • Self-monitoring

  • Stimulus control

  • Problem-solving

  • Assertiveness training

  • Slower eating

  • Reinforcing changes

  • Relapse prevention


Making small goals to propel you towards your larger goals is an important behavioural strategy. The Goal Setting Theory states that specific, difficult, yet achievable goals lead to better results than less descriptive goals. Goal setting is something that may be done individually with the help of an app. Although, a study found that Canadians (in Alberta and Ontario) set poor goals on their own and rarely tracked their progress using an app.


While behavioural strategies are possible for anyone to do independently, consider the success rate of those who employ these strategies alongside working with a health professional such as a registered dietitian. Jacobs et al. saw greater weight loss success in female patients working with dietitians to reduce calories, increase physical activity and employ self-management strategies compared to patients trying to lose weight without a dietitian.


Aware that barriers exist, registered dietitians work with you to develop a strategy that suits your individual situation, choosing the strategies to best suit your needs. PCOS isn’t simple and neither are you. You deserve practical, tailored advice to reach your health goals. Learn more about your tailored nutrition plan for PCOS by reaching out for a free discovery call!


Written by Caroline Spurr

Caroline is a co-dietitian with Edge Nutrition and she has 4 years of experience in women’s health, healthy relationships with food, weight management, and PCOS. Follow Edge Nutrition on Instagram & Facebook, or join our email list for more helpful tips.



References

  1. Ee, C., Pirotta,