The Connection between Diet and PCOS: How to Conquer PCOS Symptoms by Increasing Fiber and other Nutrients 

Most of us know at least one woman who has PCOS or “polycystic ovarian syndrome”. That’s because this life-altering condition is the most common hormonal disease in women of reproductive age---affecting 8-13% of women, is a leading cause of infertility, and the most prominent cause of what’s known as anovulatory infertility---an absence of ovulation which causes irregular periods.

 Though these numbers are astounding, the good news is we know a lot more about diagnosing, treating, and preventing PCOS than we did even a decade ago. Including the pivotal role diet and lifestyle play in prevention and disease management.

What exactly is PCOS?

PCOS, as the name suggests, is a condition in which a woman’s body produces high levels of androgen/male hormones such as DHEA-S and testosterone. This imbalance causes symptoms such as irregular periods, polycystic ovaries, acne, facial hair, and thinning scalp hair.

However, PCOS is primarily a metabolic issue associated with obesity (1 in 4 women with PCOS are obese), insulin resistance, and type 2 diabetes. 

Thus, its symptoms can also include things like blood sugar handling issues, weight gain, depression, anxiety, coronary heart disease, and other symptoms of blood sugar imbalance. 

Given this understanding, dietary management of PCOS is not only possible but can be highly effective.

What causes PCOS and who is at risk?

Medical science doesn’t have a definitive answer on the exact cause of PCOS. 

We do know that high androgen levels, weight, and family history can play a role...but we don’t know what causes those things. Nor do we know for sure if PCOS causes problems with weight and metabolic function, or if weight and metabolic function problems cause PCOS...a chicken-and-egg sort of scenario.

Women at greater risk of PCOS have a family history, symptoms of high androgen levels (missed periods, acne, facial hair), and struggle to maintain a healthy weight.

In functional medicine, we always seek to look at the “why” behind a condition. In this case: why does a person have high androgen levels to begin with? 

The answer: something’s causing dysfunction within the endocrine system, which could be rooted in a variety of things such as genetic mutations, nutrient deficiencies, poor diet, endocrine disruptors which lead to hormonal imbalance, gut health issues, thyroid dysfunction, toxic body burden, and/or others unique to the individual.

 Thus, if you suspect you have PCOS or already have a diagnosis, I’d encourage you to work with a functional medicine doctor to uncover and treat the root causes.

Dietary management of PCOS: the importance of fiber and other key nutrients

One of the most interesting things about the PCOS-weight-gain connection has to do with calories. Research has shown women with PCOS typically consume a similar amount of calories as women without PCOS, yet they tend to have a greater BMI…so what gives? 

Studies point to variations in nutrients levels and fiber consumption as possible causal factors.

For example, research has shown that optimizing levels of folic acid, vitamins D and C, cobalamin (vitamin B12), calcium, essential fatty acids, and anti-inflammatory foods can play a crucial role in effectively managing PCOS. Research has also shown that women with PCOS consume less fiber and magnesium than those without.

Why do PCOS sufferers require more of these key nutrients? 

Again, things like a woman’s diet, genetic variations, family history, and gut health—which is influenced by PCOS and imbalance androgen hormones—should be investigated as possible contributing factors.

The general recommendation for dietary management of PCOS is to follow a type 2 diabetes-style diet, aka low-carb, low-sugar, with an emphasis on the aforementioned nutrients.

Best sources of fiber and key nutrients for dietary management of PCOS

If you have PCOS, your best source of fiber is plenty of anti-inflammatory vegetables with moderate amounts of fruit, beans and legumes, nuts and seeds, and whole grains. 

How many servings? 

You can’t go wrong with 5-10 servings of vegetables per day with an emphasis on leafy greens, green veggies, and prebiotic-rich veggies which feed healthy gut bacteria such as leeks, asparagus, onions, chicory, garlic, mushrooms, soybeans (fermented and organic please, such as miso or tempeh) and Jerusalem artichokes.

In terms of fruit and whole grains, it depends on your blood sugar. However typically 2-3 servings of fresh fruit like berries, apples, or pears, and 1-2 servings of whole, gluten-free grains or starchy vegetables (with the skins on!) a day is a good bet, but when in doubt check with your doctor. Note: I recommend gluten-free grains since gluten consumption is associated with inflammation and a potential increased risk of insulin resistance and diabetes.

For beans and legumes, 1-2 servings and with nuts and seeds usually a handful (or two) a day will do the trick.

I’d also recommend including at least one serving a day of probiotic-rich cultured vegetables, kimchi, or sauerkraut to promote good gut health which, in turn, benefits your metabolism, weight, and insulin levels.

By following this advice, you’ll significantly increase the amount of fiber in your diet and get much more of those other key PCOS-fighting nutrients including the following: magnesium (from leafy greens and legumes), folic acid (leafy greens, whole grains), calcium (sesame seeds, broccoli and leafy greens), vitamin C (leafy greens, fruit, broccoli), vitamin D (mushrooms), and folic acid (leafy greens, whole grains, legumes). 

To increase your levels of anti-inflammatory essential fatty acids, B12, (and vitamin D!), you'll want to include 1-3 servings of fatty fish such as wild Alaska salmon, mackerel, sardines per week and (if you eat meat) choose grass-fed varieties, which research has shown are much higher in omega-3 fatty acids and antioxidants.

Finally, though it may go without saying, reducing or eliminating empty calories from high-sugar, high-carb, highly-processed, pro-inflammatory foods is equally important for blood sugar, weight, and inflammation management.

PCOS doesn’t have to ruin your life!

A PCOS diagnosis can be frightening—especially if you’re struggling with infertility. However, it does not have to ruin or control your life! 

Studies have shown that even a moderate reduction in weight, like 5-10% can restore fertility. And as you can see so many people can conquer their condition through diet and lifestyle.

I’d encourage you to learn as much as you can about this condition and seek out professional help to get to the root cause.