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PCOS part 1: The diet

When it comes to diet and exercise, a lot of women with PCOS don’t know where to start. The condition can be worsened if you stress too much or have an underactive thyroid (hypothyroidism – a combination that is not at all uncommon).

What happens in the body when you have PCOS?

The ovaries produce eggs that are embedded in small follicles. The hormones oestrogen and progesterone ensure that a pair of ovarian follicles will grow until it is time to ovulate. The ovarian follicle ruptures and the egg rolls out. If you don’t ovulate, the ovarian follicle won’t rupture and the egg will remain in the ovary, where it will re-form after a while.

In some cases, one or both ovaries are filled with many small follicles that have not matured enough to ovulate. The ovaries in such cases are called polycystic ovaries. The high number of eggs present in the ovaries is due to high testosterone levels, which prevent the eggs from maturing.

PCOS symptoms:

✅ You probably have irregular periods or no periods at all

✅ You find it difficult to lose weight

✅ You have difficulty getting pregnant

✅ You have a lot of hair on your body – on your face, chest, stomach and thighs

✅ You have pimples/acne

You may have a number of these symptoms or just one of them. Symptoms can also vary throughout a woman’s life – I’ll talk more about that below.

Symptoms can also vary from one woman to another: some find it easy to get pregnant, others do not. Some have no skin problems, others have regular acne breakouts. Some women are overweight and others are not. Some women find it easy to gain weight but difficult to lose it – women without weight problems can find losing a couple of kilos extremely difficult.

What causes PCOS?

The cause of PCOS is debatable, and there are probably multiple causes rather than just one specific cause. Stress is a big factor, but so is exposure to too much oestrogen through, for example, cow’s milk, meat, water, plastic and high blood sugar levels due to a poor diet.

PCOS body type with low levels of subcutaneous fat
As I mentioned above, PCOS can be associated with being overweight, but it doesn’t have to be. However, women with PCOS who exercise a lot may suffer from chronic stress caused by too little food and too much exercise. This, in turn, also affects the thyroid gland, adrenal glands and ovaries. These three ‘share’ the same kind of communication channel with the brain, through the pituitary gland.

PCOS body type with high levels of subcutaneous fat
The reason for obesity is usually insulin from a poor diet that includes fast (starchy) carbohydrates – but also a lack of exercise. In this case, it is important to lower stress levels (cortisol) as well as insulin and oestrogen production.

Around half of the worlds women with PCOS are overweight.

Excess testosterone

If you have PCOS, your body produces a lot of testosterone. Testosterone is the male sex hormone that helps build muscle. Excess testosterone can also make you gain weight, and cause hair to grow on your chin, chest and legs. As I said, it’s easy for you to build muscle. If you have PCOS and do strength training, you may consider yourself to be very strong. It may be difficult for you to lose weight because testosterone can increase your appetite and make you crave fast carbohydrates and fat.

If you are overweight and want to decrease your testosterone level, losing a few kilos will help. This will cause ovulation to become more regular or to start again. Body hair may also decrease.

Get tested for other things

I have already mentioned that the thyroid, adrenal glands and ovaries communicate with the brain in the same way. That’s why it’s important to check your thyroid gland. Some people with PCOS also suffer from Hashimoto’s disease. But the best news is that PCOS can be reduced once you get your thyroid under control.

Vitamin D is important in managing PCOS as it plays a major role in our immune system and reduces inflammation.

You usually also lack B12 if you have PCOS.

Carbohydrates

Obesity is associated with the body’s inability to cope with elevated blood sugar levels (insulin resistance means that the body’s insulin cannot make the body’s cells absorb sugar from the blood; the result is far too much sugar in the bloodstream, which in turn increases the risk of diabetes). It is extremely important for anyone with PCOS to get their diet under control with all that entails. Your diet should contain protein, good sources of fat and not only the right kind of carbohydrates but also the right amount of carbohydrates (which is highly individual).

Women with high subcutaneous fat often struggle with cortisol-related problems (as a result of poor diet) including inflammation, anxiety and difficulty sleeping. Low carb diets can help but don’t always as low carb diets themselves can be stressful for the body.

Women with low body fat, on the other hand, may exhibit different behaviour: increased sugar cravings between meals, low energy during the day and too little sleep. These women cope poorly with low-carb diets.

Find the right amount of carbohydrates for you

This is probably the best thing you can do to manage PCOS. The more insulin resistant you are, the harder it is to lose weight.

The less body fat you have, the more careful you should be about reducing your carbohydrate intake.

Let’s take two women with PCOS, one with low subcutaneous fat and the other with high subcutaneous fat.

As both of them should have a reasonably low carbohydrate intake, there will be two completely different intakes anyway. Most of the time, people go to extremes when it comes to reducing foods, and they give some foods up completely (unnecessarily and without being able to handle it well!).

Some women tolerate more carbohydrates than others. If you’re the kind of person who has trouble sleeping at night, has small children, works and exercises – then you need more carbohydrates than someone who doesn’t have the same kind of lifestyle as you.

Always base your diet on your body’s signals: energy levels during the day and between meals, sleep, cravings, etc. Finding the right carbohydrate level for you is incredibly important!

So, what should we take into consideration and how can we find our ideal level?

WEEK 1

✅ Begin with 100 g of carbohydrates per day. Non-starchy vegetables such as spinach, broccoli, cauliflower, courgettes, etc. are not really carbohydrates but are very low carbohydrate vegetables and should be eaten in large quantities throughout the day.

✅ Start keeping a food diary and write down what you observe during your carbohydrate experiment. Daily questions you need to answer are: how is your energy level during the day and when exercising? Do you feel full? Do you crave sweet things? What time of day did you eat the carbs? Did you eat any before strength training? Or was it after?

✅ If you feel dissatisfied and hungry: increase the amount to 130 g in week 2. Continue with the food diary, observe and take notes.

✅ The questions you need to answer are the same, but add: does your stomach feel heavy after a meal containing carbohydrates? Do you experience food coma?

✅ Don’t forget to answer the questions about hunger – if you feel dissatisfied, irritated and hungry again after two hours – it means that this amount of carbohydrates is not right for you.

✅ Another example: you eat salmon with green salad. Add ½ a sweet potato. Start answering the questions after this meal. If you feel sleepy and tired, remove carbohydrates from your next meal. However, if you feel irritable and hungry, increase your protein intake and greens in your next meal, and include the sweet potato again. See what happens. If you are feeling as you did before despite the increase in protein, increase the amount of fat (olive oil, nuts, avocado, etc.) If you are feeling hungry and irritable again, it’s time to increase the amount of sweet potato.

✅ Try different types of carbohydrates from the list, including fruit.

I would just like to warn you not to expect immediate answers. It can take a few months of carbohydrate coaching to get it right.

Post-workout meals and PCOS

If you have insulin problems and exercise heavily, you may need more carbohydrates than your non-active friend with PCOS.

After a hard workout, we are extra insulin-sensitive and need to replenish our glycogen levels with fast carbohydrates (what’s known as the post-workout meal) – but sometimes it’s hard to get all the carbohydrates that are needed. My advice is to test things out again. You shouldn’t feel hungry or tired.

Your protein needs

Finding your carbohydrate intake is important, but so is finding your protein intake. It’s just as easy to overeat protein as carbohydrates.

Granted, tacos with lettuce leaves or a salad with feta are great when we’re lowering our carbohydrate intake and increasing our protein. But the problem with protein is that it also raises blood sugar. Your protein intake should make up about 30% of your daily intake.

The protein should come from lean meat such as chicken, turkey, fish, seafood, etc. If you are making an omelette or scrambled eggs, add a couple of egg whites to the mixture.

When it comes to fat, quality is more important than quantity.

✅ If you have insulin problems, it is important to be aware of how you combine foods. Especially if you combine starchy carbs and bad fats (think cinnamon rolls or pizza, which include wheat flour – a bad carbohydrate – and fatty cheese or sugar). If you’re smart, you’ll avoid such food at all costs! It is perfectly fine to eat it from time to time, but it should not be part of your everyday diet.

Environmental toxins

Environmental toxins and hormones in food can be a bigger problem for women with PCOS as their hormonal balance is impaired. What animals are fed (including any medication) and what they drink has a profound effect on us. Remember that organic meat comes from animals that have been exposed to the same environmental toxins and drunk the same water as non-organic animals.

A few words about stress

All kinds of stress will affect your PCOS. Stress affects blood sugar levels, leading to difficulties in losing weight and even thyroid problems. And too much exercise, too little sleep, internal stress when we worry about something or someone, excluding carbohydrates, resting too little between workouts, and skipping meals can all be sources of stress.

Quite often, stress management may be the only thing you need to do to keep getting results with your weight or at the gym. Strangely enough (believe it or not), the most difficult task for a coach is to convince women to relax about their diet, exercise and other aspects of their life.

If stress is present in your life, then workouts where you ‘pushed’ or ‘battled’ or ‘almost threw up at the end’ should be avoided at all costs.

Finally, remember – there is rarely just one cause that leads to/exacerbates PCOS. It could be that you have PCOS and you are going through the menopause (which adds a completely different set of hormonal issues), or you could have PCOS and Hashimoto’s disease. It’s dangerous to start blaming it on just one thing such as carbohydrates or gluten or lactose as many ‘experts’ do.

IF you have PCOS and eat large amounts of dairy in the form of cottage cheese, quark, milk, soured milk or yoghurt – it might be wise to reduce your intake (remember what I wrote about environmental toxins). If you are going to choose dairy products, choose organic varieties. And if you don’t have access to organic options, go for regular but low-fat options as the hormones are stored in the animal’s fat.

Updated January 18, 2022

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