When I was first diagnosed with PCOS eight years ago, it was an incredibly challenging diagnosis to navigate. My endocrinologist at the time offered metformin, and my gynecologist recommended birth control pills and spironolactone for the high androgen symptoms (hair growth in unwanted places and mood swings to name a few). While these medications offered a partial solution, it did not resolve all of my PCOS related symptoms.
PCOS stands for Polycystic Ovarian Syndrome. According to the Rotterdam Criteria, in order to meet the diagnosis of PCOS, one must present with two out of the following three criteria: hyperandrogenism (too much testosterone and related metabolites), oligomenorrhea (irregular menstruation), or polycystic ovaries.
When the medication was not enough to remedy all of my PCOS symptoms, I started digging further into the scientific literature, and I discovered that for many women struggling with this condition, insulin resistance is actually the underlying cause.
Insulin resistance is a mechanism that occurs when the cells in our body begin to resist or ignore the signal from the insulin hormone. Insulin’s main job is to bring glucose into our cells. When insulin resistance is present, glucose cannot enter our cells, and instead can lead to a host of other long-term consequences such as diabetes, non-alcoholic fatty liver disease, and infertility.
When I learned of insulin resistance and its role in PCOS, I decided to trial a low carbohydrate diet. Within 2 months of being on this low carbohydrate diet, I began to notice a significant difference in my PCOS related symptoms. Over the last 8 years, I have fine-tuned this diet and paired it with an exercise regimen that has truly been effective for women with insulin resistant PCOS.
Here are the main principles of this diet
#1: Eat organic when possible.
Eating organic ensures that you minimize the ingestion of pesticides and herbicides, many of which are now flagged as endocrine disrupting chemicals (EDCs). As the name implies, these EDCs can go on to disrupt our body’s natural hormones, which can be even more problematic in women with PCOS.
#2: Eat mostly plants, especially the cruciferous family of vegetables.
Plants offer a host of phytochemicals, antioxidants, and perhaps most importantly, fiber, which has been shown to reduce body mass index (BMI) in women with PCOS. Aim to get 6-9 cups of veggies per day. A green smoothie first thing in the morning is a great way to ensure that you are meeting your vegetable intake for the day!
While nearly all vegetables are superstars in their own right, the cruciferous family of vegetables (e.g., cauliflower, kale, and cabbage) are a true superfood for our hormones. That’s because these vegetables contain a compound called indole-3-carbinol, which has been shown to promote estrogen detoxification. Since women with PCOS have excess estrogen (in relation to progesterone), it is worth consuming this family of vegetables at least once daily.
#3: Consume high quality animal protein.
Aim for pasture-raised, grass-fed, and organic meats when possible. These meats have a much more nutrient dense profile and less environmental toxins (and therefore, less EDCs) compared to their conventional counterparts.
#4: Healthy fats.
Fats form the backbone of all hormones, and it is critical for reproductive health, ovulation, and menopausal health. The healthiest fats for hormone health include organic and unrefined oils such as avocado, coconut, and olive oil as well as nuts and seeds, avocados, and olives. Grass-fed sources of animal fats such as butter, ghee, lard, and tallow are also recommended in small quantities. Avoid vegetable oils such as canola, soybean, and corn since these fats are extremely inflammatory to the female body.
#5: Eliminate processed and refined carbohydrates and replace them with slow-burning carbohydrates.
Refined carbohydrates such as pastries, pasta, pizza, bread, sodas, juices, and refined sugar (I know, all the good stuff!) will convert into sugar very quickly, and in turn, create a large insulin spike in response. This excess insulin will then go on to signal the ovaries to release more testosterone, and lead to the high androgen symptoms that are commonly associated with PCOS. Instead of eating refined carbohydrates, I offer another solution, and that is to consume slow burning carbohydrates instead.
Slow burning carbohydrates include complex carbohydrates that take longer for your body to breakdown resulting in a reduced insulin spike. Examples of slow burning, or complex carbohydrates, include beans and legumes, whole grains such as quinoa and brown rice, root vegetables such as sweet potatoes and carrots, and nuts and seeds. Perhaps it’s easier to think of slow burning carbohydrates as foods that are readily available in nature.
#6: Reduce, and if possible, eliminate dairy and gluten from your diet.
Similar to refined carbohydrates, dairy can also elicit a strong insulin response. For women with PCOS, it’s best to avoid dairy (yes, all forms!) as much as possible to reduce the inflammatory cascade that is caused by high insulin spikes.
Most individuals now recognize the importance of avoiding gluten, especially in the presence of celiac disease. While the research behind gluten and PCOS is scarce, there are many scientifically sound reasons to avoid gluten, especially in those with a hormone imbalance.
- Most wheat crops in the U.S. are covered with pesticides that contain EDCs.
- Gluten and wheat-derived foods are high in refined carbohydrates, which will continue to create large insulin spikes when consumed.
- Gluten is also tied to systemic inflammation, which is a phenomenon known as non-celiac gluten sensitivity (NCGS). Therefore, this inflammatory process can likely worsen the already existing chronic low-grade inflammation that is present in PCOS.
The latest on insulin-resistant PCOS and exercise
After implementing these principles, I felt as though I completely transformed myself. The success that I experienced and later on, the success that my clients experienced, while validating this approach, was still anecdotal in nature. Now more and more research is confirming the importance of lifestyle changes in women with PCOS. In particular, a study conducted in 2015 found that an 8-week low-starch and low-dairy diet resulted in weight loss, improved insulin sensitivity, and reduced testosterone in women with PCOS. It’s very encouraging to see that the scientific literature is beginning to align with this anecdotal evidence.
Lastly, and perhaps equally as important, is implementing the right type of exercise into your daily routine. Two exercise regimens that have proven to be effective for insulin resistant PCOS include resistance, or strength training, and high intensity interval training (HIIT):
- A recent study in 2018 found that the very nature of resistance training, which is to activate and strengthen muscles, turns on a protein that is linked to improving insulin sensitivity.
- In 2016, a small pilot study discovered that women with PCOS who participated in progressive resistance training significantly increased lean body mass, while reducing waist circumference and HbA1c (a measure of blood sugar control) compared to women who did not exercise.
- Another 2015 pilot study showcased the benefits of both HIIT and strength training in PCOS women. The study found that both HIIT and strength training reduced body fat percentages while HIIT improved insulin resistance and strength training reduced Anti-Mullerian Hormone, which is usually elevated in women with PCOS.
When dealing with insulin resistant PCOS, it’s coming to terms with the diagnosis itself first, and then taking the first few steps towards changing your diet and lifestyle. While this list may seem intimidating at first, it’s implementing one small change at a time that over time leads to big achievements. Soon enough, you will be able to apply this framework to all aspects of your life, whether you are cooking at home, eating out with friends at a restaurant, visiting your aunt’s house for the holidays, or traveling!
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