September has now been designated as PCOS (Polycystic Ovarian Syndrome) Awareness Month. PCOS is a condition that affects up to 10% of women of reproductive age
PCOS is a common but complex endocrine disorder affecting women of reproductive age. It involves multiple body systems, including the ovaries, adrenal glands, gut, and brain. There are three main criteria to diagnose PCOS:
- Infrequent ovulation or anovulation, also known as “ovulatory dysfunction”
- Elevated androgen levels as indicated by a blood test, also known as “hyperandrogenism”
- Cysts on ovaries as indicated by transvaginal ultrasound, also known as “polycystic ovarian morphology”
A woman must fulfill at least two of the three criteria to receive a diagnosis of PCOS.
The most common symptoms of PCOS include:
- Irregular or missing periods
- Blood sugar issues
- Weight gain or weight loss resistance
- Irregular menstrual cycles
- Missed periods
- Excessive or heavy menstrual bleeding
- Alopecia (balding)
- Mood disorders, including anxiety and depression
- Hirsutism (excessive body hair)
- Ovarian cysts
- Sleep disorders, including insomnia and sleep apnea
- Acanthosis nigricans (darkening of the skin in the armpits, back of the neck, or groin)
Women may experience many of these PCOS symptoms or as few as one or two as PCOS occurs on a spectrum.
The Causes Of PCOS
There are a variety of factors that cause hormone imbalances that eventually lead to a woman developing PCOS.
Insulin resistance is a condition in which cells in the muscle, fat, and liver do not respond appropriately to the hormone insulin. Insulin shuttles glucose from the blood into cells, allowing it to be used for energy production. When cells are unresponsive to insulin, glucose remains in the bloodstream resulting in hyperglycemia. Hyperglycemia results in chronic inflammation and a host of adverse downstream health effects. Approximately 50% of women with PCOS have varying degrees of insulin resistance. Insulin resistance can occur in overweight, normal weight, and lean women with PCOS
Inflammation is when the body’s immune system starts to attack its own muscles, joints, and tissues. Low-grade, chronic inflammation is thought to cause insulin resistance and hormone imbalances. Various dietary factors can contribute to chronic inflammation, so removing common dietary inflammatory triggers can significantly improve multiple aspects of PCOS.
Poor weight management and dramatic weight loss can trigger hormone imbalances, which then can lead to PCOS. This is due to the body’s natural instincts to shut down hormone production due to a perceived starvation. Being overweight and underweight are also thought to contribute to PCOS. Being overweight can cause inflammation, and being underweight can cause pituitary production to shut down. Both result in hormone imbalances that can lead to PCOS.
Over-training, much like dramatic weight loss and being underweight, may result in the body shutting down hormone production because of perceived starvation. However, how much exercise qualifies as too much is very individual.
Chronic stress can both trigger the onset of and exacerbate existing PCOS. The stress can be both physical, such as over-exercising and inflammation, or emotional, such as job dissatisfaction and emotional upheaval. This results in hormone imbalances within a woman’s body, producing more testosterone (male sex hormone) rather than estrogen and progesterone (female sex hormone).
Nutrition and a well formulated Paleo diet can address multiple underlying causes of PCOS, including blood sugar dysregulation, weight management, chronic inflammation, and hormonal imbalances. Following a Paleo lifestyle further encourages you to avoid pervasive environmental toxins linked to hormone disruption and improve your ability to manage stress.
A Paleo Lifestyle For PCOS
Eat Anti-Inflammatory Foods
An anti-inflammatory, Paleo diet is an excellent place for most women with PCOS to start when it comes to dietary management of PCOS.
A Paleo diet removes processed foods, refined carbohydrates and industrial seed oils, which are known to provoke chronic inflammation and blood sugar dysregulation, and may, in turn, exacerbate PCOS symptoms.
Focus on eating whole food-based, nutrient-dense carbohydrates such as roots vegetables, winter squash and whole fruit.
- Extra virgin olive oil
- Avocado oil
- Coconut oil
- Nuts and seeds
- Fatty cold-water fish
Include plenty of non-starchy vegetables in your diet. These foods contain fiber, regulating gut health and hormone elimination, and phytonutrients with anti-inflammatory and insulin-sensitizing properties.
The best anti-inflammatory foods are wild-caught salmon, bone broth, coconut oil, blueberries, green leafy vegetables, beets, bok choy, celery, broccoli, pineapple, walnuts, chia seeds, turmeric, and ginger
Optimizing protein helps to promote healthy blood sugar control, regulates insulin levels, and aids satiety and appetite control. A range of 20 to 25 percent of total calories from protein works well in women with PCOS. Focus on eating high quality, humanely raised protein including:
- Grass-fed beef
- Wild game
- Fatty cold-water fish
Incorporate Healing Foods, Nutrients, Herbs & Supplements
Various foods and nutrients can help correct underlying mechanisms involved in PCOS and improve PCOS symptoms.
Blood Sugar-Regulating Foods
Incorporating insulin-sensitizing foods may help manage insulin resistance. Dark blue and purple berries, such as blueberries and blackberries, are rich in phytonutrients called anthocyanins that support insulin sensitivity. Extra virgin olive oil also contains phytochemicals with insulin-sensitizing effects, while the acetic acid in balsamic vinegar improves muscle glucose uptake, reducing circulating blood sugar levels.
Fatty, Cold-Water Fish
Fatty, cold-water fish are rich in omega-3 fatty acids, which may improve blood sugar control and fat accumulation in women with PCOS. Wild-caught salmon, mackerel, anchovies, sardines, and herring/halibut are richest in omega-3 fatty acids and lowest in pollutants such as mercury.
Cruciferous vegetables such as broccoli, Brussels sprouts, cauliflower, kale, radishes, and rutabaga are rich in phytochemicals that support healthy hormone metabolism. Diindolylmethane, a phytochemical found in cruciferous vegetables, balances estrogen metabolism, promoting the production of “good” estrogens and minimizing the production of “bad” estrogens. Increasing cruciferous vegetable intake may be particularly beneficial for women with PCOS who have estrogen dominance.
Fermented Foods and Prebiotic Foods
Fermented foods contain probiotic microorganisms that may improve gut health, and support the metabolic pathways. Prebiotic fibers, found in foods such as artichokes, sunchokes, green banana flour, onions, and garlic, feed beneficial gut bacteria and may support the restoration of a healthy.
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Include foods rich in B12 and Folate, Calcium, Chromium, Iodine, Magnesium, Vitamin D, and Zinc. Many women with PCOS often have vitamin and mineral deficiencies that affect hormone regulation and/or insulin levels. Obtaining these vitamins and mineral from food sources is preferable but supplements are also an excellent option. B12 and folate work in tandem and supplements must be taken together in order for each to be effective.
The best sources for B12 are wild-caught salmon and grass-fed beef and grass-fed lamb along with raw cheddar cheese, raw swiss cheese, and full-fat grass-fed cottage cheese (if you tolerate dairy). The best sources for folate are asparagus, beets, broccoli, grass-fed calf’s liver, mustard greens, parsley, spinach, and turnip greens.
Whole food sources of calcium include basil, broccoli, collard greens, kale, kelp, oregano, spinach, and Swiss chard.
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Chromium can be found in apples, asparagus, bananas, broccoli, green beans, mushrooms, onions, and oysters. However, it is recommended that a person should take a chromium picolinate supplement since very little amounts are found in food.
Iodine is present in cod fish, pastured eggs, wild-caught salmon, scallops, shrimp, sea vegetables, and strawberries.
Foods rich in magnesium include almonds, avocados, bananas, dark chocolate, dark leafy greens (spinach, romaine lettuce, etc.), pumpkin seeds, and walnuts.
Sunshine is by far the best source of Vitamin D but dietary Vitamin D is present in cod liver oil, pastured eggs, Portobello mushrooms, wild-caught salmon, and wild-caught tuna.
Oysters, grass-fed beef, lobster, crab, shrimp, and pumpkin seeds are rich in zinc.
Herbs & Supplements
Organic cinnamon helps to reduce blood sugar and to regulate menstrual cycles in women with PCOS.
Turmeric helps to reduce inflammation.
Bay leaf helps to reduce blood sugar.
Peony and licorice root work in tandem with each other and help to reduce blood sugar and reduce testosterone levels.
Maca helps to balance estrogen and progesterone and is known as a fertility superfood.
Limit Exposure To Toxins
A Paleo lifestyle encourages you to remove as many environmental toxins from your daily life as possible. The most prevalent toxin is BPA, which is also an endocrine disruptor that negatively affects hormone balance. To avoid BPA exposure, use glass storage containers, canned goods that are BPA-free, and handle store receipts as little as possible as they are covered in BPA. In order to avoid exposure to other hormone disrupting toxins, use as many natural or organic home, personal care and beauty products as possible, such as makeup, deodorant, laundry detergent, lotions, soaps, etc.
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To minimize exposure to endocrine-disrupting pesticides, try to buy organic produce as much as your budget allows. You can refer to the EWG’s Dirty Dozen and Clean 15 lists to learn which fruits and vegetables you should prioritize purchasing organic. Use a filter for your drinking and cooking water because endocrine disruptors are common in tap water.
Move Your Body.
Moderate exercise is often recommended to help treat the symptoms of PCOS. The best form of exercise for women with PCOS is walking. However, jogging, swimming, biking, Pilates, and resistance training are all effective forms of moderate exercise. Simply moving your body regularly in ways you enjoy can help mitigate and balance many of the inflammatory markers exhibited by those with PCOS.
Participate In Restorative Therapies.
Yoga, meditation, hypnosis, guided visualization, biofeedback and aromatherapy have been shown to reduce PCOS symptoms since they decrease stress hormones as well as lower blood pressure. Of course, any activity that you find relaxing, such as gardening or reading, can be just as effective in reducing overall stress.
A Paleo lifestyle is truly a root-cause tool for addressing the underlying mechanisms and improving symptoms of PCOS. Bearing in mind that each case PCOS has its own individual and unique expression, it may require some self-experimentation to determine the optimal lifestyle approach that will alleviate your PCOS symptoms and improve your health. However, it is well worth the effort!