Welcome back for part 2 series on PCOS. As I mentioned in my previous post, weight loss is very commonly prescribed to those who have PCOS and this diagnosis carries so much shame and frustration. I wanted to highlight some non-diet interventions to help manage PCOS and then discuss supplements.
Eating consistently.
Insulin resistance is a major challenge in PCOS. I discussed it in part 1 insulin and the analogy of insulin being a key to unlocking the cell door and carrying glucose from the bloodstream and unlocking the cell door to be used for energy. You may feel hungry all the time because the sugar (glucose) is not getting inside the cells where it can be used. Low-carb or keto style diets are often recommended for those with PCOS but your cells need glucose (sugar) and sugar or carb cravings are common in PCOS so you will feel it even more. The solution instead of cutting out carbs is to spread out your carb intake throughout the day and not eat a ton of carbs at one meal and none at the next meal.
I encourage people to eat three meals a day. You can add a snack as well if it will be a while before eating your next meal.
Pairing of carbs and types of carbs
I always recommend pairing your carbs with fat and protein foods. Fat and protein-rich foods take longer to digest which slows down absorption of glucose (sugar)and helps stabilize blood sugar levels. They also keep you full for longer. If you just eat chips or a banana, you will likely be hungry in a short amount of time, in a hour or less. Foods such as peanut butter which has fat/protein, and avocado which contain fat helps us feel satisfied and can be used to pair with a piece of bread, in a fruit smoothie, with a piece of fruit.
Carbohydrate sources that are rich in fiber (i.e. whole grains such as quinoa, beans, fruits, and starchy vegetables like potatoes) break down into sugar a little more slowly, meaning your blood sugar doesn’t spike. This is helpful for insulin resistance, because the body is getting smaller amounts of sugar (glucose) to process over a longer period of time, helping to keep blood sugars from spiking high than dropping low (think of a big roller coaster versus a smaller coaster that doesn’t have drops). High-fiber foods also contain antioxidants that can help lower inflammation1
It doesn’t mean you can’t have white bread or cupcakes ever! The goal is to include more high-fiber foods but it doesn’t mean you have to cut out sugar or refined grains such as white bread or white rice completely. If you cut out those foods completely, it can lead to wanting them more and you end up binging on them. If you are struggling with this, please reach to a dietitian such as me.
Omega-3 fats
Omega-3 fatty acids are important for everyone, especially for those with PCOS since it helps with inflammation. Omega-3 fatty acids are a group of polyunsaturated fatty acids consisting of alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). ALA is easier to get especially for vegan/vegetarian eaters, and the body converts a small amount to EPA and DHA but conversion is poor. We also tend to get enough of this type of omega-3. ALA food sources include nuts, seeds like chia seeds, oils, beans. EPA and DHA is found in fatty fish like salmon, tuna, mackerel, herring, trout and sardines. Other smaller sources of omega-3s can be found in grass fed dairy, beef, and pastured eggs. It’s recommended to aim to eat fish 2x/week. I would recommend a supplement as well as getting it from food sources.2
As a dietitian, I like to incorporate foods first and then look at what can be boosted through supplementation. Below are some supplements that have been found to be beneficial in studies to help those with PCOS.
Supplements
N-Acetylcysteine (NAC): This supplement is an antioxidant and has been shown to help protect insulin receptors and can aid with increasing insulin secretion and sensitivity as well as with high cholesterol and fatty liver. It can help improve fertility, reduce inflammation and oxidative stress.
Inositol: Inositol is a member of B-vitamins and can be found in grains, beans, fruits, and nuts. The supplement has been studied and shown to improve insulin sensitivity, menstrual regularity, and fertility. I like the brand Ovasitol, which is a combination of myo and d-chiro inositol that mimics the body’s own ratio. 3 Recommended dosage: 2-4 grams/day of myo-inositol with 50-100 mg/day of D-chiro inositol.
Berberine: This supplement can help improve insulin resistance and lower glucose similar to metformin. Berberine helps with lowering cholesterol, triglyceride levels, and reducing testosterone. It can help improve fertility, improve ovulation, and help with metabolic dysfunction-associated steatotic liver disease (MASLD), known formerly as fatty liver disease.
Omega-3 Fatty acids: Omega 3-fatty acids (EPA and DHA) can lower inflammation, lower triglycerides, increase insulin sensitivity, improve menstrual regularity, fertility, helps with MASLD formerly known as fatty liver disease, depression, heart health like lowering blood pressure. DHA helps with brain health.3,4
Amount: 250-500mg (2-5g) of EPA and DHA. There are no official recommendations for dosing, but most organizations suggest 250- 500 mg of EPA + DHA daily. 5 Nordic Naturals Ultimate Omega 2x is a great brand.
Supplementation should be individualized and I recommend reaching out to a dietitian or a medical practitioner who has training in PCOS management to help guide you.
If you’re needing guidance and looking to work with someone 1-on-1 to help manage your PCOS symptoms, learn more about my services and set up a free 15 minute call to see if we’d be a good fit to work together. I work with each client to find an approach to help you feel better with PCOS and support your relationship with food and your body.
References
1. Deledda, A., Annunziata, G., Tenore, G. C., Palmas, V., Manzin, A., & Velluzzi, F. (2021). Diet-Derived Antioxidants and Their Role in Inflammation, Obesity and Gut Microbiota Modulation. Antioxidants, 10(5), 708. https://doi.org/10.3390/antiox10050708
2. Novotny, Kristina, et al. “Omega-3 Fatty Acids.” PubMed, StatPearls Publishing, 2021, www.ncbi.nlm.nih.gov/books/NBK564314/.
3. Nordio,M., Bascinai, S., Camajani, E. “The 40:1 myo-inositol/D-chiro-inositol plasma ratio is able to restore ovulation in PCOS patients: comparison with other ratios” European Review 2019, https://www.europeanreview.org/wp/wp-content/uploads/5512-5521.pdf
4. Zhou, J. Effects of n-3 polyunsaturated fatty acid on metabolic status in women with polycystic ovary syndrome: a meta-analysis of randomized controlled trials. Journal of ovarian research, 2023;16(1), 54
5. Healthline: How Much Omega-3 Should You Take per Day?https://www.healthline.com/nutrition/how-much-omega-3
