Eat For You Dietitian

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Does this story sound familiar to you? You have received a diagnosis of PCOS, possibly finally giving you the answer you have been searching for, and then the advice you have been given is to ‘lose weight’. Is that it? I have spoken to many individuals who have repeatedly been given this same advice by different healthcare professionals. Is it that simple? Surely there must be more information? Read on here. 

Contents

1. What is PCOS? 
2. What hormones are involved? 
3. What health considerations are there? 
4. What to ask your GP? 
5. Anything other options? 
6. Dietary patterns for PCOS 
7. Stress, sleep, lifestyle 
8. Key Takeaways 

What is PCOS? 

PCOS or Polycystic Ovarian Syndrome is a complex endocrine or hormone condition impacting 1 in 10 women. Despite its name, it does not solely involve the ovaries. 

PCOS is diagnosed using the Rotterdam Criteria 

2 out of 3 of the below: 

• Irregular or absent periods 
• Evidence of ‘hyperandrogenism’, for example with excess facial or body hair. 
• Polycystic ovaries, usually identified using an ultrasound scan of your ovaries

What hormones are involved? 

Common symptoms associated can be excess hair on face and body, weight gain or difficulty with weight loss, acne, fatigue, irregular periods, and fertility issues. Signs and symptoms of PCOS are not limited to these as every person is different. 

PCOS is a hormone disorder, but what does this mean? It can be confusing to understand what all of our hormones are doing for us. 

1. Testosterone is known as the “male hormone,” the ovaries usually produce very small amounts, but in PCOS, they make more. This can be referred to as hyperandrogenism. This can contribute to acne, increased hair growth, and sometimes hair loss from the scalp. 
2. Oestrogen and progesterone  are hormones that are important for sexual and reproductive development. In PCOS these hormones can become imbalance. 
3. Follicular stimulating hormone (FSH) to luteinising hormone (LH) are hormones that are important to encourage ovulation. In PCOS there are altered levels, therefore it can mean your body isn’t ovulating or releasing an egg every month. 
4. Insulin is a hormone made by the pancreas which is needed to help us use glucose (sugar) from the food we eat to be used as energy. Insulin resistance is common in PCOS as your body can not recognise the amount of insulin already present in the blood, so will produce more than it needs. This can lead to hyperinsulinemia. 
5. Cortisol is often recognised as the stress hormone. Altered cortisol levels can be found in PCOS, however this may be due to other stresses in relation to the condition, as opposed to the pathways within PCOS itself. 

What health considerations are there? 

The primary health considerations that are related to PCOS include an increased risk of type 2 diabetes, and gestational diabetes in pregnancy. This is due to the often consistent high levels of insulin in the blood in individuals with PCOS as a result of insulin resistance. 

Secondly there is an increased risk of cardiovascular or heart disease, which is one of the biggest killers of women in the world. 

What to ask your GP? 

A 2017 study found that a third of almost 1400 women reported it taking over 2 years for a PCOS diagnosis. This does demonstrate that more awareness is required for healthcare professionals. Further guidelines on PCOS on the NHS website here. 

If you are concerned regarding your increased risk of type 2 diabetes and/or heart disease at any age you can speak to your GP about this.

There are key blood tests that can be requested for example HbA1c level which monitors the glucose (sugar) attached to your red blood cells that can give us an indication for the past 3 months. This blood test result can be used to diagnose type 2 diabetes. 

Full lipid profile focuses on looking at your cholesterol levels and further splitting into the different types of cholesterol in the blood which can highlight any concerns around your heart health. 

Anything other options? 

There is no one size fits all. There is no one diet superior to others. 

According to 2018 international guidelines for PCOS, dietary approaches recommended should be tailored according to the person’s food preferences and cultural norms. It also mentioned that we should avoid unnecessary restrictions. So can healthcare professionals stop recommending to cut out foods without justification. 

There are limited long-term studies assessing the success and sustainability of weight loss strategies (even in the general population <10% maintain clinically meaningful weight loss). 

Dietary patterns for PCOS 

A 2021 study has highlighted that the mediterranean diet may be preferred for individuals with PCOS as it focuses on lots of fruits and vegetables, omega 3 rich fish, lean animal proteins, wholegrains, beans and legumes and healthy fats (nuts/avocado/seeds). 

Often when we look towards making changes to our diet we focus on ‘what can’t I eat’ and we are focusing on the negative aspects. Instead can we focus on ‘what can I add to my diet’ to make a positive change. 

For example, choose an extra portion of fruits or vegetables to include per day. Or adding a handful of mixed nuts to your yoghurt snack. 

So we are looking away from the restrictive diet mindset and working towards including foods into our diet. 

Stress, sleep, lifestyle 

Alongside the food we eat, environmental factors can play a big part in PCOS. When you are stressed, your cortisol levels go up, it is thought to increase the levels of insulin and alter your oestrogen levels. 

Where possible finding effective stress management techniques and improving sleep patterns can have a positive impact. It may be useful to refer to Talking Therapies. 

Key Takeaways 

Current evidence has demonstrated that being in a bigger body impacts health and emotional wellbeing, increased risk of weight stigma, negative body image, low self-esteem and mental health concerns. This can be exacerbated with a person with PCOS who is also in a bigger body as often they are given the ‘lose weight’ advice only. Whereas a person in a smaller body with PCOS may be treated differently. 

I would highly recommend the PCOS for Professionals Online CPD course if you’re a Nutritionist, Dietitian or another allied healthcare professional interested in supporting people with PCOS in a compassionate way. I believe this has changed my clinical practice for the better. Link here.