This 3 part series on managing your PCOS is written by Megan Hallett a women’s health coach with special expertise in PCOS.

Polycystic Ovarian Syndrome (PCOS) is a metabolic endocrine condition defined by high levels of androgens, driven by various underlying causes such as insulin resistance, adrenal dysfunction and inflammation, to name a few.

This hormonal imbalance can result in failed attempts at maturing and releasing an egg, leading to follicles (or cysts, as they are more commonly called) can develop on the ovaries which can lead to irregular cycles, absent periods and sometimes further driving those levels of androgens.

The awkward imbalance of these sex hormones, stress hormones, insulin and in some cases, thyroid hormone, can result in acne, weight gain or stubborn weight, hair loss or dark hair growth (in places you don’t want it) and many wonderful things that every woman wants to experience day in and day out.

Common Symptoms of PCOS include:

• Hair loss
• Hair growth (typically around the jaw, chin or upper lip, on the arms, stomach, legs, underarms and lower back).
• Acne and/or oily skin
• Unexplained weight gain or holding onto stubborn weight
• Long and irregular cycles
• Absent periods
• Fertility problems
• Mood swings / poor mental health
• Low libido

If this sounds like you, it is highly recommended you visit your GP first (or zoom them, because you know…). They may run some blood tests and refer you on for an ultrasound and your diagnosis will be measured against the following Rotterdam criteria.

PCOS Diagnosing

1. Irregular periods/lack of ovulation
2. Clinical (physical symptoms) and biochemical (blood) signs of excessive androgens
3. Polycystic Ovaries

To officially qualify as part of this PCOS squad, you must have two of the three. You can have polycystic ovaries without having PCOS, just as you can have high androgens or those physical symptoms without PCOS. So what happens when you’ve been diagnosed with PCOS? Will there be ways of managing your PCOS?

You’ll most likely then be offered medication (hormonal birth control, metformin, spironolactone or in some cases, bio-identical hormones) to help manage the symptoms. Many are happy to have the helping hand of medication, whilst others chose to opt for a more natural route. Ultimately, this is your decision and only you can make it.

Frustratingly, PCOS cannot technically be cured. However, it can most definitely be managed, and symptoms can be as good as reversed if healthy practices, nutrition and lifestyle adjustments are consistent and well maintained. In this three-part series on managing your PCOS, let’s start with nutrition.

Managing your PCOS through nutrition

Stabilize Blood Sugar to manage PCOS

I find that almost everyone has heard about balancing blood sugar, for energy and keeping those hunger hormones at bay, but few know how to do it. Furthermore, keeping blood sugar stable can have a profound effect on sex hormones. For example, when blood sugar is chronically elevated and unstable, we release insulin. In PCOS, our bodies are a little dramatic and this process is elevated. When insulin is constantly released in high amounts, it reigns over testosterone, driving the enzyme that converts it into its more potent DHT (the hormone behind acne and hair growth). It lowers SHBG, meaning there are more free, unbound hormones running riot in the body. It can alter the oestrogen to progesterone ratio, leading to higher amounts of oestrogen, lowering progesterone, leaving our cycles a little confused.

Insulin can also impact our stress hormones, which in themselves just love to mess with our sex hormones. Long story short, unstable blood sugar impacts insulin, insulin impacts our sex hormones. In a body that is already home to hormonal imbalances and possible insulin resistance, managing blood sugar in order to manage your PCOS should be at the very top of your daily to-do list.

How to stabilize blood sugar

• Balancing those macronutrients:

Ensure that every single meal has a quality protein, fat, fibre and mindful carbohydrate source, in that order or priority. In my opinion, the carbohydrate source should never be the dominating food group on your plate as it is with so many western meals.

• Start the day with a blood sugar balancing smoothie:

Start the day off on a lovely blood sugar neutral, avoiding any peaks that lead to drops (the blood sugar roller-coaster) later in the day. Include high-quality protein powder, fat in the form of frozen avocado or a tablespoon of nut butter, two tablespoons of chia, flax or hempseeds for the fibre and a handful of leafy greens. Of course, add your liquid and any added extras such as cacao, ginger or cinnamon. Ideally, we want to keep fruit like bananas to a minimum or opt for ¼ cup of berries instead.

• Limit sugar:

Seriously. It’s the thing that no one wants to hear, but arguably has the biggest impact on symptoms and hormonal drivers. Start by swapping all your refined sources to unrefined options (dates, pure maple syrup, honey etc). Then, start to pull these back until your tastebuds have adjusted and use stevia or monk fruit sweetener instead. Always replace sugar with fat to keep blood sugar stable and prevent cravings.

• Limit processed flours and fast releasing carbohydrates:

These include bread, pasta, pastries and even white rice and grains for some people. During the processing of these foods, the fibre is often stripped which means the food will breakdown to glucose much more quickly in the blood. Start by swapping them for their whole counterparts including wholegrain or legume pasta and bread. Eventually, opt for whole grains such as quinoa, paleo bread or sweet potato toast instead.

• Incorporate other ways to manage blood sugar:

These include going for a walk around the block after meals, weight training, getting enough sleep, managing stress (more on this in part two) and incorporating apple cider vinegar and cinnamon into your meals.

• Gluten + Dairy:

These two pop up time and time again when we talk about PCOS as many believe that simply giving up these two will cure you of all your symptoms. That’s simply not true, it’s just not that easy. I do believe that giving up gluten is a good thing. Mostly because it is found in all those blood sugar spiking foods such as bread, cakes and pastries. However, there has been no research done linking gluten to PCOS, and the same goes with dairy. Many find that limiting gluten and dairy does help with symptoms including acne and hair growth, so experiment with what works for you. I recommend limiting, but not stressing about omitting completely, as the stress will cause more harm than the gluten and dairy ever will.

Support Your Liver and Gut Health to manage PCOS

Another aspect of managing your PCOS through nutrition is looking after your liver and gut health. The liver is our master organ of detoxification. Working in two phases to take toxins and hormones, chemically transforming them and packaging them up ready to leave the body via the gut. If somewhere along this process of detoxification and excretion things go wrong or the system is slightly sluggish, metabolised hormones and leak back out into the blood in a more potent, potentially havoc-causing form and build up. Furthermore, if we are not excreting the toxins and hormones through regular bowel movements. Or particular gut bacteria further alters the hormones, this can lead to a further imbalance of hormones and elevated symptoms, typically around oestrogen.

Keeping on top of both your liver and gut health is paramount for a healthy endocrine system and thus, management of your PCOS.

How to keep a healthy gut and liver

• Support phase one detoxification: Foods rich in b vitamins, including high-quality animal protein, organ meats and dark leafy green veggies. As well as colourful vegetables and particular herbal tea for the flavonoids. We want a full range of amino acids for this phase, so collagen found in bone broth or as a supplement can also be handy.
• Induce phase two detoxification: We want sulphur rich foods such as cruciferous veggies (broccoli, cauliflower, brussels sprouts) for this phase plus onions and garlic. Eggs for the choline, NAC (more on this when we look at supplements) and dandelion also support this phase.
• Keep beta-glucuronidase levels low to ensure successful excretion: This can pull those successfully packaged hormones apart and make them harmful. We do this by optimising health gut bacteria with a probiotic and probiotic-rich food as well as supporting kidney function.
•  Hydrate: The simplest element of the protocol yet one of the most important. Aim for 2-3 litres a day to support the detoxification pathways.
• Include foods to support optimal liver health: These include lemons (think hot lemon water), asparagus, beetroot, berries, dark leafy greens, cruciferous vegetables and foods rich in vitamin A, C, E and zinc.
• Support gut health: Again, consider those probiotic-rich foods and/or a probiotic supplement, but also prebiotic foods. Practice breathwork after your meals to stimulate the vagus nerve ( a mini massage for the gut) which promotes digestion. Eat without distractions and avoid drinking too much water before and water meals.

Key foods to include for PCOS Management

• High-Quality Protein Sources (Wild-caught salmon, tinned sardines/ mackerel in extra virgin olive oil, grass-fed, organic meat, pasture-raised eggs, soaked legumes, organic tofu or tempeh).
• Healthy Fat Sources (avocado, nut butter, extra virgin olive oil, eggs, oily fish, coconut oil, coconut butter, coconut yoghurt, coconut milk, nuts, seeds).
• Fibre (fruit and vegetables, quinoa, buckwheat, hemp seeds, chia seeds, flaxseed, pumpkin seeds, sunflower seeds, oats).
• Leafy greens (spinach, kale, romaine, rocket, cavolo nero, chard).
• Colourful veggies (courgette, peppers, beetroot, aubergine, tomatoes, cucumber, radish).
• Sweet potato, butternut squash and pumpkin.
• Berries (blackberries, blueberries, strawberries, raspberries).
• Cruciferous veg (broccoli, cauliflower, brussels sprouts, cabbage).
• Onions and garlic
• Eggs (pasture-raised, organic).
• Broccoli Sprouts
• Cinnamon
• ACV
• 100% dark chocolate (or high quality, high percentage)
• Spearmint tea, green tea, liquorice and peony tea (caution: high blood pressure), artichoke, dandelion and burdock tea.
• Keto/paleo bread and snacks (always check ingredients or make your own from almond flour, eggs, stevia etc).

Next in our 3 part “Managing your PCOS” series by Megan Hallett is around Lifestyle and Supplements.

Megan Hallett is a women’s health expert and nutrition coach and cookbook author. Megan specialises in women’s hormone health. Her work ranges from endocrine conditions such as PCOS and Hypothalamic Amenorrhea to addressing the root cause of symptoms including acne, PMS, hair loss, low mood and fatigue, to name a few.

Resources:
https://gpnotebook.com/simplepage.cfm?ID=x20120518100458251876
https://cks.nice.org.uk/topics/polycystic-ovary-syndrome/
https://emedicine.medscape.com/article/256806-treatment