In Part 1 of my PCOS series, I talked about getting a correct PCOS diagnosis, PCOS testing and my functional medicine perspective for treatment. Be sure to go back and read all of that information if you need the background. In this article, I’m going to give you some actionable steps around diet and lifestyle to support PCOS. 

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Let’s dive in!

PCOS Diet 

Food is medicine and food is incredibly foundational for hormonal balance and overall health. Every meal is an opportunity to nourish your body, provide your cells with deep nutrition, balance your hormones and care for yourself. Here are some of my top diet strategies for PCOS. 

1. Give up artificial sweeteners of any kind. They are known in studies to have biological effects on ovarian function, and they are a steroidogenic disruptor that decreases progesterone levels (which in turn makes estrogen more dominant which we darn sure don’t want). Basically, it affects your hormones in a very negative way. 
   

2. Avoid hormones in food. Here is what I mean: I recommend my patients avoid anything that has hormones in it or has a hormone-like effect. For example, some foods contain phytoestrogens called isoflavones – these are a group of chemicals found in plant foods including soy and flax seeds. This means, don’t eat soybeans, soy sauce, flax seeds, tofu, edamame, and flax seeds. In addition, for the first month or two, I recommend to avoid pumpkin, sunflower, poppy, sesame, whole grains such as rye, oats and barley, and bran such as wheat, oat, and rye and beans. 

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Also, you want to avoid any commercially raised meats and dairy… period. For some people these are okay but for you they are not because your hormones are hyper sensitive and not regulated. Your hormones are in a proverbial storm of chaos. Conventional animal products often contain growth hormone and antibiotics, which will work against your treatment plan. 

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3. Enjoy plant proteins. For now, I recommend following a mostly vegan diet where you primarily get your protein from plant foods. Use a pea or hemp protein powder, and add in spirulina, chlorophyll and chlorella. If you do choose to include some animal proteins, eat wild caught salmon and strictly organic PASTURED eggs only. I often recommend avoiding eggs initially as well. 
   

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For dairy alternatives, you can have almond milk unsweetened original, coconut mild unsweetened original, any kind of nut, oat, hemp, or other milk substitutes that are unsweetened. Also, regarding almond or coconut milk yogurt, choose the ones with the lowest carbs and please be careful to avoid those added sugars usually added to yogurt. 

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4. Include healthy plant-based fats. Enjoy avocado, olive oil, nuts, seeds such as hemp and chia, coconut oil (if you don’t have elevated cholesterol), avocado oil, and coconut milk. Make sure to have good fats with each meal or snack throughout the day. Trust that fat won’t make you fat and that your body needs these nutrient-rich foods to support hormone balance and fertility. 
   

5. Eat 9 cups of veggies a day… yes, 9 cups! I know you may be afraid to eat more food because weight gain might be one of the issues you are facing, but this PCOS diet is anti-inflammatory, low hormone, low-glycemic and rich in nutrients, which are all things that will help your body rebalance and heal. 
   

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Include a variety of colorful veggies each day. Don’t forget about purple cabbage, red beets, yellow squash, white cauliflower, green arugula and orange carrots! This handout (Phytonutrient Spectrum Foods) from the Institute for Functional Medicine is helpful for keeping track of veggies--just remember that in your case, you will need to make choices that are low on the glycemic index and are not starchy (fruits should be berries only in limited amounts and no potatoes).

“Food is medicine and food is incredibly foundational for hormonal balance and overall health. Every meal is an opportunity to nourish your body, provide your cells with deep nutrition, balance your hormones and care for yourself.”

6. Eat organic non-GMO food as much as possible. Foods that have been exposed to herbicides and pesticides particularly glyphosate (also foods that are genetically modified) are contributing factors to low aromatase activity in PCOS women. Glyphosate is an endocrine disruptor and has a connection to insulin resistance; it causes depletion of sulfate and in short impairs cellular glucose uptake and causes insulin resistance, which is a nightmare for someone with PCOS.
   

7. Include fermented foods. Studies have indicated that healthy bacteria in the gut correlated with improved symptoms in PCOS. You will want to eat lots of gut healthy foods such as fermented veggies such as raw sauerkraut, kimchi, and also fermented nut milk yogurts. Choose options low in carbs!  
   

8. Be careful of caffeine and alcohol. Some people hate this one! Truth is, caffeine and alcohol use exacerbates PCOS symptoms and issues and it often converts to sugar effecting insulin. Stop drinking any alcohol for a period of time, perhaps start with a month while adding in these other interventions. In my experience, this can make a big difference. 
   

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You’ll see the best results if you avoid caffeine, alcohol, gluten, and processed foods of any kind! Hate on me now, but it will make a difference and we can learn a lot about how your body is functioning at a core level. 

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You can do this!

PCOS Diet Resources

I am working on recipes for the PCOS diet, so be sure to check back here as I post them. Note: please confer with myself (Chyrl) or your functional medicine doctor or provider to understand what is driving your unique case of PCOS and what dietary choices are going to best serve you. While personalizing the diet is important, here are some books I love to help get you started. While they are not all perfect for the PCOS diet, each one of them has education and information that is essential for evolving to a diet that supports your journey to health.

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• Dr. Michael Greger’s series including How Not To Die, How Not To Die Cookbook, How Not To Diet, and How Not To Diet Cookbook all can be found on amazon here. 
• The Food Pharmacy
• The Primal Kitchen
• The Essential Vegan Keto 
• Keto-tarian

Yes, some of these are Keto or Primal/Paleo. I know you may have tried Keto and felt very yuck doing it, but I think the conventional animal products were contributing because of the hormones fed to them, not the paradigm of the Keto diet itself. In addition, many versions of a Keto diet fail to include enough nutrient-dense plant foods, especially vegetables as well as fermented plant foods. The premise behind this diet supports health on so many levels and you don’t have to be strict Keto… perhaps it’s more akin to Primal Plant Strong Keto-ish. Why Keto-ish? Because at the root of PCOS, there is abnormally elevated estrogen which is driven by insulin. Fortunately, the Keto diet, or variations of it, help to control insulin and therefore, stabilize your estrogen levels, bringing symptom relief I know you really, really want!

Let me know how it goes! And speaking of ways to reduce insulin and regulate hormones…

Intermittent Fasting For PCOS

In addition to the PCOS diet, as discussed above, there are other things you can do that are a springboard for healing and shifting towards optimal health.

“The premise behind this diet supports health on so many levels and you don’t have to be strict Keto… perhaps it’s more akin to Primal Plant Strong Keto-ish. Why Keto-ish? Because at the root of PCOS estrogen is driven by insulin.”

Many women who have PCOS are estrogen dominant and insulin resistant and probably in adrenal burnout. This is because women get androgens from the adrenal glands and this is potentially converted to estrogen, causing the facial hair and central weight gain. I am, in many cases, suspicious that in addition to all of this there can be an underlying thyroid issue. While stress management is key, and I’ll discuss that more below, intermittent fasting is another intervention to consider for PCOS. 

There are intense benefits to intermittent fasting. This is not about withholding calories or a low-calorie diet. This is a very healthy nutrient dense diet with periods of fasting that allows the body to reset itself and dispose of unhealthy cells (apoptosis). The body does incredible healing during times of fasting. Namely, it resets hormones. This is researched and there are many studies supporting it. 

I often suggest patients try intermittent fasting, either fast for 16 hours of every day or fast for 24 hours every other day. You don’t have to start this amount of fasting right away, instead, give your body the time to build up to this goal. Start out intermittent fasting one or two days a week and increase your fasting length over time.

During eating times eat regularly without restriction but following the dietary guidelines recommended to you by Chyrl or your functional medicine doctor or provider. You are not counting calories or fat grams or macronutrients; instead, you’re eating until you’re satisfied. This is important so that you don’t under eat and cause nutrient deficiencies that may further impact hormones.

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Here are the details you’ll need:

16 hour fasting: Eat breakfast and then at noon eat lunch. Then, fast till breakfast the next day. 

‍24 hour fasting: 

• Monday - eat your regular PCOS diet.
• Tuesday - eat breakfast and then eat lunch at noon. Fast from lunch Tuesday until lunch the following day (Wednesday). This is your first 24 hour fast!
• Wednesday - eat lunch and dinner.
• Thursday - eat your regular PCOS diet 
• Friday eat breakfast and then eat lunch at noon. Fast from lunch Friday until lunch the following day (Saturday). This is your second 24 hour fast!
• Saturday - eat lunch and dinner.
• Sunday – eat your regular PCOS diet.
  

PCOS Lifestyle Interventions

• Work on stress. You have no idea how huge this is. One study indicates that there is a higher incidence of stress in patients with PCOS and that this plays a critical role in the altered body composition. Your adrenals are the organs that produce cortisol and all androgens. Androgens are the root of PCOS and cortisol plays a role in whether or not your androgens support or deteriorate your health and vitality. Androgens can produce estrogen and male hormones where they are not supposed to be. The adrenals produce more of this when you are stressed. 
  

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Stress management means self-care. Begin to develop practices that help calm the biosystem. This is huge. This is not a joke. Begin to practice the art of extreme self-care. I recommend watching these TED talks on the importance of self-care. 

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Here are some strategies to begin incorporating:  

• Meditate
• Go for walks or hikes
• Take naps
• Get regular massage
• Practice yoga
• Take tai chi or qigong
  

It’s important to find what works for you and make it a non-negotiable part of your daily and weekly schedule.

• Sleep is critical. Get minimum of 8 hours of sleep per night. If you are not sleeping well or have issues going to sleep, staying asleep, etc. let me know so we can address this too. Sleep hygiene is an important part to any PCOS protocol.

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Other treatment suggestions:

In addition to what we’ve discussed in Parts 1 and 2 of this PCOS series, here are some other interventions to consider:

• Examinations and diagnostics such as pelvic exam, ultrasound and labs to guide the protocol. A list of recommended lab work is in Part 1.

• Supplements play a critical role in restoring balance and harmony in the body. While supplements aren’t meant to replace the important diet strategies that I’ve discussed here, they help to bridge the gap and accelerate results while you work on forming new diet and lifestyle habits. Supplements may include antioxidant supplementation, balancing of micronutrients, restoring nutrient deficiencies, strategies to address inflammation and the immune system, strategies to restore gut health, address adrenal and or thyroid issues, stress management, sleep support, and insulin sensitizing agents such as D-chiro-inositol and Myo-inositol.
  

• Progesterone or other hormone replacement therapy, depending on each individual’s root cause. This was also discussed in Part 1 of this article.
  

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The important thing to remember in all areas of chronic disease/illness is that it is never just one thing and there are no quick fixes. Do your research, advocate for yourself and find a functional medicine doctor or provider to be on your team and advocate for you as well. Through diet and lifestyle strategies we can work together to create a personalized protocol to not simply mask symptoms, but to restore the underlying imbalances that will ultimately restore your health. 

I hope all of this information has been helpful. If you are feeling overwhelmed, please reach out. I can help to simplify what is discussed here and help you hone in on the pieces that will support your unique PCOS case. I will support you in any way I can! 

“Through diet and lifestyle strategies we can work together to create a personalized protocol to not simply mask symptoms, but to restore the underlying imbalances and optimize your health.”

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Resources:

Bani Mohammad, M., & Majdi Seghinsara, A. (2017). Polycystic Ovary Syndrome (PCOS), Diagnostic Criteria, and AMH. Asian Pacific journal of cancer prevention: APJCP, 18(1), 17–21. https://doi.org/10.22034/APJCP.2017.18.1.17

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563096/

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Barrett, E. S., & Sobolewski, M. (2014). Polycystic ovary syndrome: do endocrine-disrupting chemicals play a role? Seminars in reproductive medicine, 32(3), 166–176. https://doi.org/10.1055/s-0034-1371088

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4086778/ 

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Basu, B. R., Chowdhury, O., & Saha, S. K. (2018). Possible Link Between Stress-related Factors and Altered Body Composition in Women with Polycystic Ovarian Syndrome. Journal of human reproductive sciences, 11(1), 10–18. https://doi.org/10.4103/jhrs.JHRS_78_17

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892097/

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Buliman, A., Tataranu, L. G., Paun, D. L., Mirica, A., & Dumitrache, C. (2016). Cushing's disease: a multidisciplinary overview of the clinical features, diagnosis, and treatment. Journal of medicine and life, 9(1), 12–18.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152600/ 

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Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A., & Willett, W. C. (2009). Caffeinated and alcoholic beverage intake in relation to ovulatory disorder infertility. Epidemiology (Cambridge, Mass.), 20(3), 374–381. https://doi.org/10.1097/EDE.0b013e31819d68cc

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3071680/ 

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Daka, B., Rosen, T., Jansson, P. A., Råstam, L., Larsson, C. A., & Lindblad, U. (2012). Inverse association between serum insulin and sex hormone-binding globulin in a population survey in Sweden. Endocrine connections, 2(1), 18–22. https://doi.org/10.1530/EC-12-0057

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680959/

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Dittrich, R., Kajaia, N., Cupisti, S., Hoffmann, I., Beckmann, M. W., & Mueller, A. (2009). Association of thyroid-stimulating hormone with insulin resistance and androgen parameters in women with PCOS. Reproductive biomedicine online, 19(3), 319–325. https://doi.org/10.1016/s1472-6483(10)60165-4

https://pubmed.ncbi.nlm.nih.gov/19778476/ 

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Fan, A.M. (2014). Chapter 64 – Biomarkers in toxicology, risk assessment and environmental chemical regulations. In Biomarkers in Toxicology (pp. 1057 – 1080). San Diego, CA. Academic Press. doi: https://doi.org/10.1016/B978-0-12-404630-6.600064-6 

https://www.sciencedirect.com/science/article/pii/B9780124046306000646?via%3Dihub 

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González F. (2012). Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids, 77(4), 300–305. https://doi.org/10.1016/j.steroids.2011.12.003

https://pubmed.ncbi.nlm.nih.gov/22178787/

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Guo, Y., Qi, Y., Yang, X., Zhao, L., Wen, S., Liu, Y., & Tang, L. (2016). Association between Polycystic Ovary Syndrome and Gut Microbiota. PloS one, 11(4), e0153196. https://doi.org/10.1371/journal.pone.0153196

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836746/ 

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Isabella, R., Raffone, E. CONCERN: Does ovary need D-chiro-inositol? J Ovarian Res 5, 14 (2012). https://doi.org/10.1186/1757-2215-5-14

https://ovarianresearch.biomedcentral.com/articles/10.1186/1757-2215-5-14 

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Longo, V. D., & Mattson, M. P. (2014). Fasting: molecular mechanisms and clinical applications. Cell metabolism, 19(2), 181–192. https://doi.org/10.1016/j.cmet.2013.12.008

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946160/ 

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Najem, F., Elmehdawi, R., & Swalem, A. (2008). Clinical and Biochemical Characteristics of Polycystic Ovary Syndrome in Benghazi- Libya; A Retrospective study. The Libyan journal of medicine, 3(2), 71–74. https://doi.org/10.4176/080122

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074283/

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Patel, S., Zhou, C., Rattan, S., & Flaws, J. A. (2015). Effects of Endocrine-Disrupting Chemicals on the Ovary. Biology of reproduction, 93(1), 20. https://doi.org/10.1095/biolreprod.115.130336

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6366440/ 

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Patterson, R. E., Laughlin, G. A., LaCroix, A. Z., Hartman, S. J., Natarajan, L., Senger, C. M., Martínez, M. E., Villaseñor, A., Sears, D. D., Marinac, C. R., & Gallo, L. C. (2015). Intermittent Fasting and Human Metabolic Health. Journal of the Academy of Nutrition and Dietetics, 115(8), 1203–1212. https://doi.org/10.1016/j.jand.2015.02.018

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516560/ 

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Perry, G. S., Patil, S. P., & Presley-Cantrell, L. R. (2013). Raising awareness of sleep as a healthy behavior. Preventing chronic disease, 10, E133. https://doi.org/10.5888/pcd10.130081

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741412/

Rosenfield, R. L., & Ehrmann, D. A. (2016). The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited. Endocrine reviews, 37(5), 467–520. https://doi.org/10.1210/er.2015-1104

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045492/ 

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Samsel, A., & Seneff, S. (2013). Glyphosate’s Suppression of Cytochrome P450 Enzymes and Amino Acid Biosynthesis by the Gut Microbiome: Pathways to Modern Diseases. Entropy, 15(12), 1416–1463. MDPI AG. Retrieved from http://dx.doi.org/10.3390/e15041416

https://www.mdpi.com/1099-4300/15/4/1416/htm#cite 

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Speiser P. W. (2015). Congenital Adrenal Hyperplasia. F1000Research, 4(F1000 Faculty Rev), 601. https://doi.org/10.12688/f1000research.6543.1

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544382/ 

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Swithers S. E. (2013). Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements. Trends in endocrinology and metabolism: TEM, 24(9), 431–441. https://doi.org/10.1016/j.tem.2013.05.005

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772345/ 

The Endocrine Society. (2019, March 23). Improved PCOS symptoms correlate with gut bacterial composition. ScienceDaily. Retrieved April 4, 2020 from www.sciencedaily.com/releases/2019/03/190323145201.htm

https://www.sciencedaily.com/releases/2019/03/190323145201.htm 

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Zhao, X., Jiang, Y., Xi, H., Chen, L., & Feng, X. (2020). Exploration of the Relationship Between Gut Microbiota and Polycystic Ovary Syndrome (PCOS): a Review. Geburtshilfe und Frauenheilkunde, 80(2), 161–171. https://doi.org/10.1055/a-1081-2036