On Apple Day, it seems only fitting to spotlight a popular apple-related health remedy that, over the years, has been touted as a miracle solution for everything from digestion to weight loss – apple cider vinegar. But today, let’s focus on whether it actually helps with PCOS symptoms, or is it just another health fad? Let’s separate fact from fiction and see what the research says.

What is apple cider vinegar?

Apple cider vinegar (ACV) is a type of vinegar made from fermented apple juice. It is produced through a two-step fermentation process:

• First, apples are crushed to extract their juice. Yeast is added to the apple juice, which converts the sugars into alcohol through a process called fermentation.
• In the second step, bacteria called Acetobacter convert the alcohol into acetic acid. This acetic acid gives vinegar its characteristic sour taste and strong smell.

Apple cider vinegar is available in both filtered and unfiltered forms. Unfiltered varieties contain the ‘mother’, which is a colony of bacteria and enzymes that form naturally during the fermentation process. This is considered the most nutritious part of unfiltered ACV, offering health benefits. But how do these benefit PCOS? Let’s dive into the potential advantages of ACV how it could support your PCOS health goals.

Improves insulin sensitivity

One of the hallmark challenges faced by many women with PCOS is insulin resistance. This condition makes it difficult for the body to effectively use insulin, leading to elevated blood sugar levels. Having too much insulin in your blood, can affect your reproductive hormones and can lead to a range of hormonal imbalances that create symptoms of PCOS, including irregular/no periods, weight gain, hair and skin concerns and fatigue.

There have been a number of studies that have shown that apple cider vinegar helps to improve insulin sensitivity. A systematic review of these studies found that ACV consumption (approx 15mls per day) resulted in a reduction of total glucose levels of those with type 2 diabetes. However, the studies weren’t carried out on people with PCOS (1,2).

Restores ovulation function

Although more research is needed, a (very) small study conducted in 2013 suggested that ACV might help restore ovulatory function in women with PCOS. The study involved seven women with PCOS who consumed 15g apple cider vinegar daily for 110 days. At the end of the study, four of the seven women experienced regular ovulation. While these results are promising, larger studies are needed to confirm these effects (3).

Supports digestive health

Digestive issues like bloating and constipation are often common among women with PCOS. ACV contains antioxidants, acetic acid and prebiotic fibres, specifically pectin, which may promote the growth of beneficial gut bacteria, prevent bloating, and contribute to better overall gut health.

Assists with weight loss

For women with PCOS, weight management can be particularly challenging. While ACV may help improve insulin sensitivity and reduce insulin resistance, leading to better blood sugar control, its role in weight loss is more indirect. By stabilizing blood sugar and preventing insulin spikes, ACV can help reduce cravings, prevent fat storage, and support overall metabolic health. However, it’s important to note that ACV is not a magic weight loss solution. Moreover, the studies that have shown weight loss from apple cider vinegar consumption didn’t involve people with PCOS, they were also very small scale and resulted in modest weight loss (4).

How to use apple cider vinegar

If you do choose to incorporate apple cider vinegar into your diet, here are some tips:

• Dilute it: Always dilute ACV in water before consuming to avoid damage to tooth enamel and irritation to the digestive tract. A typical dose is 1–2 tablespoons of vinegar in a large glass of water.

• Take it before meals: To maximize its blood sugar-regulating effects, it’s often recommended to drink diluted ACV before meals.

• Start small: Begin with small amounts and gradually increase to see how your body responds. Some people may find it harsh on their stomach, so starting with 1 teaspoon and working up to 1–2 tablespoons is a good approach.

Potential risks and considerations

While apple cider vinegar can have benefits, it’s important to be aware of its potential risks:

• Tooth enamel erosion: The acidity in vinegar can erode tooth enamel over time. To prevent this, dilute the vinegar and drink it through a straw.

• Digestive issues: ACV is very acidic and may cause stomach upset or heartburn in some people. If you have a sensitive stomach or a history of acid reflux, it may not be the best option.

• No magic cure: While ACV can support your overall health and may improve certain symptoms of PCOS, it should not be seen as a replacement for medical treatments or other lifestyle interventions like diet and exercise.

Key takeaways

So, is apple cider vinegar a fact or a fad for PCOS? The answer is mixed. It shows promise, especially when it comes to improving insulin sensitivity and regulating blood sugar levels. While early research is promising, more high quality studies are needed to confirm these effects in larger populations with PCOS. As with any natural remedy, it’s best to consult with your healthcare professional before taking apple cider vinegar.

If you’re looking for some personalised support and guidance to support managing your insulin resistance and improving your PCOS symptoms, book your FREE 20-minute Discovery Call here.

References

1. Hadi A, Pourmasoumi M, Ghaedi E, Sahebi M, Ghavami A, Najafgholizadeh A. The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials. Diabetes Res Clin Pract. 2019;156:107817.
2. Johnston, C. S., Kim, C. M., & Buller, A. J. (2004). Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care, 27(1), 281-282.
3. Akiko Ogata, Tatsuya Nagata, Tomoko Endo, & Tetsuro Ohta. (2013). Apple cider vinegar intake restores ovulatory function in women with polycystic ovary syndrome. Tōhoku Journal of Experimental Medicine, 230(3), 107-112.
4. Kondo, S., Tayama, K., Tsukamoto, Y., Ikeda, K., & Yamori, Y. (2009). Antihypertensive effects of acetic acid and vinegar on spontaneously hypertensive rats. Bioscience, Biotechnology, and Biochemistry, 63(12), 2040-2044.

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In PCOS, high levels of androgens and insulin can interfere with reproductive hormones that control ovulation and your menstrual cycle. As a result, you might often miss your period or have delayed or irregular periods.

This unpredictability can make it very frustrating when you’re trying to manage your PCOS symptoms, it can also be challenging if you’re trying to conceive.

The good news is that nutrition and lifestyle play a vital role in managing PCOS effectively, which is why the International Evidence-based Guideline for the assessment and management of PCOS recommends that nutrition & lifestyle treatment should be recommended to all women diagnosed with PCOS (1).

There is no such thing as the “best” diet for PCOS. However, there is a way of eating that can benefit you and your unique symptoms and concerns. Adapting your nutrition and incorporating regular movement into your lifestyle can help to correct hormone imbalances, improve insulin sensitivity, regulate periods and improve your fertility (if this is your goal!) when you have PCOS (2).

This blog article will explore proven ways to help you support regular ovulation and manage your PCOS symptoms through diet and lifestyle.

Low glycaemic index carbohydrates

Between 50-95% of women with PCOS will have insulin resistance. High insulin levels cause higher testosterone levels which further affect hormone balance and ovulation in PCOS. Eating foods that don’t spike insulin: moderate amounts of high fibre foods, paired with protein and fat foods, can help with ovulation.

All carbohydrate foods have an effect on your blood glucose levels. The glycaemic index (GI) refers to a ranking of carbohydrate foods from 1-100, and relates to how quickly these foods make your blood glucose levels rise after eating them.

Carbohydrates with a high GI rating, such as white bread, processed snacks and cereals, are refined and quickly broken down by your body. They cause a rapid rise in blood glucose, and to manage the sharp rise in blood sugar, your pancreas releases a large amount of insulin. Frequent consumption of high-GI foods results in more insulin being released more frequently, in larger amounts, which can disrupt ovulation (3).

After the initial spike, blood sugar levels often drop quickly (sometimes below normal levels), leading to what is known as a ‘blood sugar crash’. This can result in feelings of hunger, fatigue, and irritability, as your body craves more food to restore glucose levels (4).

Foods with a low GI rating are digested more slowly, leading to more gradual increases in blood sugar and insulin. Examples of low GI foods include high fibre carbohydrates such as brown rice, oats, quinoa, wholegrain bread and pulses. These foods demand much less insulin and cause less of a rise on your blood glucose levels.

Choosing good quality, low GI, high fibre foods at each meal, along with some protein and healthy fats, (which slow down the release of glucose), can regulate blood sugar levels and reduce insulin resistance. Including more fibre in your diet can also increase satiety and help to regulate your appetite.

Several studies have found that women with PCOS who followed a low-GI diet experienced significant improvements in insulin sensitivity and ovulation frequency (4). When following a low GI diet, ovulation occurred in 24.6% of women which was significantly higher than the 7.4% ovulation rate found in in women who consumed traditional diets (5).

The mediterranean dietary pattern

In addition to insulin resistance, the other part of the underlying mechanism driving the hormone imbalance in PCOS is due to inflammation. Women with PCOS have been shown to have higher levels of inflammatory markers such as increases in C-reactive protein (CRP), pro-inflammatory cytokines and chemokines, white blood cell count, oxidative stress, and various markers of endothelial inflammation. Higher levels of inflammation can cause excess androgen production as well as insulin resistance, which we know can disrupt the menstrual cycle (6).

The Mediterranean dietary pattern is a way of eating that focuses on fresh, seasonal fruits, vegetables, pulses, nuts, whole grains, fish, garlic, herbs, spices, and olive oil. It includes moderate amounts of high fat dairy, poultry, and eggs with red meat eaten less frequently. There’s a big focus on cooking, enjoying more meals at home, with minimal amounts of processed foods.

Ongoing studies strongly suggest that a Mediterranean way of eating can help reduce inflammation, and regulate ovulation in women with PCOS. If you’re trying to fall pregnant, this can be a great dietary pattern to follow as it promotes omega-3 fats (7). Omega-3 fatty acids, in particular, have been shown to improve insulin sensitivity and reduce androgen levels in women with PCOS, leading to better ovulatory function.

Moderate amounts of full fat dairy (1-2 serves per day) have also been shown to have a positive effect on ovulation. A study found that full-fat dairy products were shown to lower the risk of ovulatory infertility, with women having a 66% lower risk of ovulatory infertility, and a 27% lower risk of infertility (8).

The Mediterranean dietary pattern is also an overall ‘anti-inflammatory’ style of eating with lots of antioxidants from fruits, vegetables and high quality extra virgin olive oil, which helps to optimsie your egg health, as well as regulate ovulation.

Exercise for ovulation

Studies show that both regular aerobic and resistance exercises can significantly improve insulin sensitivity in women with PCOS. It also helps lower androgen levels by improving overall hormonal balance. This reduction in androgens can lead to more regular menstrual cycles and better chances of ovulation. It can also improve mood and your overall well-being.

A study comparing a group of women with PCOS following a low-calorie diet to a group who exercised for 30 minutes on a stationary bike three times a week found that the exercise group experienced more regular periods and ovulation than those in the diet group (9).

Some examples of aerobic exercise include: Activities like walking, running, cycling, or swimming. Resistance exercises include weightlifting or bodyweight exercise.

Don’t have 30 minutes? Even 10 minutes of moderate walking can help improve ovulation.

Try to gradually build up your activity level, allowing your body to adjust slowly, making it easier to incorporate regular movement into your daily routine over time.

PCOS supplements for ovulation

Many women with PCOS want to consider alternative treatments to medication. There is substantial research supporting the use of the following supplements for enhancing ovulation in women with PCOS, either on their own or in combination with prescribed medications. You can read more about these in my previous blog post here.

Key takeaways

Nutrition plays a vital role in regulating ovulation in women with PCOS by improving insulin sensitivity and balancing hormones. By focusing on diet quality and adopting a low GI, anti-inflammatory way of eating, you can optimise your menstrual cycle and your fertility. Regular movement and supplements can also offer additional support.

This blog post has presented some potential dietary pattern options that may help with managing your PCOS. These should be personalised to meet your unique needs and goals.

If you’re looking for more personalised support to make sustainable & realistic nutrition changes that will help you feel your best with PCOS, please feel free to contact me or book your FREE Discovery Call here.

References

1. Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations From the International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Hum Reprod (2018) 33(9):1602–18.
2. Shang Y. Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology. 202, Vol 12.
3. Chavarro, JE et al. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur J Clin Nutr. 2009;63(1):78-86.
4. Marsh, K. et al. (2010). The optimal diet for women with polycystic ovary syndrome? British Journal of Nutrition. 2005; 94(2):154-165.
5. Hernandez, TL et al. Effect of a low glycemic diet in patients with polycystic ovary syndrome and anovulation: a randomized controlled trial. Clinical and Experimental Obstetrics and Gynaecology. 2016; 43(4):555-559.
6. Salama, A et al. Anti-Inflammatory Dietary Combo in Overweight and Obese Women with Polycystic Ovary Syndrome. N Am J Med Sci. 2015 Jul; 7(7): 310–316.
7. Yang K, Zeng L, Bao T, Ge J, Chen X. Effectiveness of omega-3 fatty acid for polycystic ovary syndrome: A systematic review and meta-analysis. Reprod Biol Endocrinol. 2018;16(1):27.
8. Chavarro, JE et al. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol. 2007;110(5):1050-1058.
9. Palomba, S. et al. Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study Hum Reprod. 2008 Mar;23(3):642-50.

The post Nutrition & lifestyle changes to support ovulation in PCOS appeared first on The Endometriosis Dietitian.

Between 50-95% of women with PCOS have insulin resistance (1), which is believed to be the driving force for most of the signs and symptoms of the syndrome.

In this blog post I’m going to break down what insulin and insulin resistance are, explore the link between PCOS and insulin resistance, and provide you with some guidance on how to keep your insulin levels well-managed with diet and lifestyle.

What is insulin?

Insulin is a hormone that is produced by an organ in your body called the pancreas.

Carbohydrate rich foods such as bread, pasta, rice, potatoes, pulses, fruits, as well as foods such as soft drinks, fruit juice, pastries and cakes all break down into glucose and cause your blood glucose levels (often referred to as blood sugar levels) to rise.

Once this glucose enters your bloodstream, insulin is released to help the glucose move out of your blood into your body’s cells for energy. Like a lock and key mechanism, most of the cells in your body have special ‘locks’ or receptors for insulin. If you think of insulin as the key, and has attached itself into the ‘lock’ of the cell, it opens and allows glucose to flow into the cell.

What is insulin resistance?

If the ‘lock’ or receptor of the cell is defective in some way then the cell is said to be ‘insulin resistant’, and they block the uptake of insulin into the cells. Your pancreas then responds by releasing more insulin to try and fix this block to allow glucose to be transported. High insulin levels can contribute to various health issues, including type 2 diabetes and cardiovascular disease (2).

The link between PCOS and insulin resistance

As mentioned above, insulin resistance is found in 50-95% of women with PCOS, making it one of the most prevalent features and the driving force of the syndrome. Having too much insulin in your blood, can affect your reproductive hormones and can lead to a range of hormonal imbalances that create symptoms of PCOS.

Symptoms of insulin resistance and PCOS

• Irregular or no periods: High insulin levels stimulate the ovaries to produce more androgens (male hormones) such as testosterone. This excess testosterone can interfere with normal ovulation, leading to irregular periods or no periods at all, which can make it difficult to become pregnant (3).

• Increased appetite and weight gain: High insulin can stimulate your appetite, increase cravings, and can cause your body to store fat, particularly around your stomach. This creates a vicious cycle because increased body fat can worsen insulin resistance, and can increase symptoms of PCOS, including high cholesterol levels.

• Hair and skin concerns: High testosterone levels may cause physical signs such as excess facial or body hair, hair loss/thinning, increased sebum (oil) production, acne, skin tags, and dark patches on the skin (acanthosis nigricans).
• Fatigue: High levels of insulin and constantly fluctuating blood sugar levels can cause fatigue.

How do you know if you have insulin resistance?

If you’re experiencing any of the symptoms of insulin resistance, it’s important to speak with your doctor. Tests such as fasting plasma glucose and HbA1C only measure your blood sugar levels, they don’t measure how much insulin is in your blood. However, a fasting insulin blood test and an oral glucose tolerance test (OGTT) can help measure the amount of insulin in your blood.

How can diet manage insulin levels?

The good news is that making positive changes to your diet and lifestyle can successfully manage your insulin resistance and your PCOS symptoms.

Here are my top six steps to help you get started:

• Establish a regular eating pattern: To keep blood sugar levels stable, aim to eat every 3-4 hours. Avoid skipping meals or going for long periods without eating. This can increase your risk of overeating at your next meal and can cause your body to produce large amounts of insulin very quickly.
• Choose low GI foods. These types of foods you can control your blood glucose and reduce insulin resistance (4). You can read more about these in my previous blog post here.

• Practice regular movement. Daily movement makes your muscles more sensitive to insulin, which helps to control blood sugar levels.

• Maintain a healthy sleep cycle. Insufficient sleep can increase your stress hormones, causing low energy, low mood, and food cravings.

• Consider supplements. Research has shown some dietary supplements to be effective at improving insulin sensitivity. These depend on your individual requirements, and you can discuss these with your GP/dietitian.

• Seek support. Working in partnership with your GP/dietitian or other health professionals can ensure that you’re on the best PCOS management plan. You might also want to speak with your family, friends and support groups to help you feel more supported.

Key takeaways

Insulin resistance is common in women with PCOS. Managing insulin resistance is not just about alleviating the symptoms of PCOS, it’s also about preventing serious long-term health conditions such as type 2 diabetes and cardiovascular disease. By understanding the relationship between PCOS and insulin resistance, you can can better navigate your health journey, make informed decisions about your care, and reduce symptoms and your risk of long-term complications.

If you’re looking for some personalised support and guidance to support managing your insulin resistance and improving your PCOS symptoms, book your FREE 20-minute Discovery Call here.

References

1. D Mukherjee (2024). Polycystic Ovary Syndrome, Insulin Resistance, and Cardiovascular Disease: Ischemic Heart Disease.Current Cardiology Reports, 26, 483–495.
2. Moran, L. J., Misso, M. L., Wild, R. A., & Norman, R. J. (2010). Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Human Reproduction Update, 16(4), 347-363.
3. Farrell, M.S & Antoni, M (2010). Insulin Resistance, Obesity, Inflammation, and Depression in Polycystic Ovary Syndrome: Biobehavioral Mechanism and Interventions. Fertility & Sterility, 94(5), 1565–1574.
4. Marsh, K. A., Steinbeck, K. S., Atkinson, F. S., Petocz, P., & Brand-Miller, J. C. (2010). Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. The American Journal of Clinical Nutrition, 92(1), 83-92.

The post PCOS and insulin resistance: what’s the link? appeared first on The Endometriosis Dietitian.

The 2023 International Guideline for PCOS highlights the importance of dietary and lifestyle advice and guidance to be provided to all women with PCOS (1).

While there’s no cure for PCOS, making changes to your diet and lifestyle, with the guidance of a dietitian specialising in PCOS, can make a significant difference to your symptoms and overall health and wellbeing.

In this blog article, I’ll be exploring why seeing a PCOS dietitian can empower you with the right knowledge and tools to manage your PCOS symptoms, and help you to achieve your health goals in a sustainable way.

Managing insulin resistance

Most women with PCOS have insulin resistance. If you are insulin resistant, your body blocks glucose from going into your cells. This causes you to have high glucose and high insulin levels in your blood which can lead to increased appetite, fatigue and weight gain.

High levels of insulin can also effect reproductive hormones that control ovulation and cause your ovaries to start producing more testosterone. High testosterone levels can stop ovulation completely and can impact on your fertility, cause excessive hair growth and/or hair loss, and acne (2).

A dietitian can guide you to eat the right type and the right amount of carbohydrates to help you to control your blood sugar levels and improve insulin sensitivity, which is essential to improve your symptoms of PCOS.

Personalised nutrition guidance

PCOS affects everyone differently. A dietitian can provide a personalised approach with sustainable changes that are targeted to improve your individual symptoms, and your overall emotional and physical health.

A balanced approach

It can be challenging to manage symptoms of PCOS, and the physical symptoms can affect your emotional health. The pressure to lose weight can also lead to stress, anxiety, and a negative relationship with food and body image. Women with PCOS are already at a higher risk of disordered eating and low self esteem, and the added stress of weight loss can exacerbate these problems (3).

A dietitian can provide sustainable and compassionate care to support you to form a positive relationship with food and your body so that you can live well with PCOS, without dietary restrictions.

A holistic approach that includes balanced nutrition, mindful eating, regular movement, stress management, adequate sleep, and professional support is far more effective for managing PCOS than focusing solely on weight loss.

Gut health support

A study in 2010 found that 42% of women with PCOS also had irritable bowel syndrome (IBS) compared to the women without PCOS (4). The exact reasons why women with PCOS are more likely to have IBS are not fully understood. However, a dietitian will be able to help you to manage any gut symptoms such as constipation, diarrhoea, bloating, including IBS symptoms, and optimsie your overall gut health.

Energy support

Fatigue is a common symptom experienced in women with PCOS. Due to hormonal imbalances, it’s not uncommon for women with PCOS to have difficulties sleeping.

If you’re sleep-deprived, you might find it challenging to be active and follow a balanced diet. Lack of sleep can also lead to reduced immunity, increasing your stress hormones which can worsen insulin resistance and intensify your PCOS symptoms.

A dietitian can ensure that your diet is meeting your nutritional requirements while focusing on foods rich in fibre, high quality sources of protein, iron and B vitamins to help boost your energy levels.

Correct nutritional deficiencies

PCOS can lead to deficiencies in essential vitamins and minerals such as vitamin D, vitamin B12, zinc, calcium and folic acid.

A dietitian can help you to identify and treat these deficiencies through dietary changes and recommend appropriate nutritonal supplementation when necessary.

Optimise fertility

Due to the hormonal imbalances that occur with PCOS, your menstrual cycle is affected and you may have irregular or no periods at all. This can make it difficult to become pregnant.

A dietitian can support you to improve the quality of your diet, which includes anti-inflammatory, high fibre/low glycaemic index foods. Eating in this way will support your ovarian function, regulate your menstrual cycle, optimise egg development and improve your chances of falling pregnant.

Next steps

Living with PCOS can be challenging, but with the right kind of support and approach, you can manage your symptoms and improve your overall health and wellbeing. Remember, your health journey is unique, and it’s about finding what works best for you. By working closely with your PCOS dietitian you can develop a management plan that works for you, make informed choices, and take control of your PCOS.

If you’re looking for some personalised support to manage your PCOS, feel free to contact me to book your free 20-minute Discovery Call, or you can also email me here: laura@theendometriosisdietitian.com

References

1. Teede, H. J., et al. (2023). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 10, October 2023, Pages 2447–2469.
2. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: An update on mechanisms and implications. Endocr Rev. 2012;33(6):981–1030.
3. Dokras A, Stener-Victorin E, Yildiz B, et al. Androgen Excess-Polycystic Ovary Syndrome Society Position Statement on Depression, Anxiety, Quality of Life and Eating Disorders in Polycystic Ovary Syndrome. Fertility and Sterility 2018;In Press.
4. Mathur et al (2010). Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Accessed at: https://pubmed.ncbi.nlm.nih.gov/19697132/

The post Why you should work with a PCOS Dietitian appeared first on The Endometriosis Dietitian.

Summer holidays are the perfect time for you to relax and unwind from the daily routine. However, it can be a challenging time if you’re looking to improve your relationship with food.

When you have PCOS, going on holiday doesn’t have to be stressful, restrictive or boring.

It’s all about planning, deciding on ways that work best for you and finding your balance.

Here are my top tips to help support your PCOS while enjoying your food choices on holiday.

Tips to support your PCOS while enjoying your holiday

Eat regular meals

Continue with your usual way of eating and don’t skip meals. Ensure that you eat balanced meals throughout the day.

Balance your plate

Include all food groups and aim for a balance of lean proteins, healthy fats, wholegrains, and plenty of fruits and vegetables.

Eat mindfully

Be present and try to eat slowly. Focus on the sensory experience of eating – the flavours, textures, and smells of the food, which can help you to enjoy the meal more.

Listen to your body

Respect your hunger and fullness signals. Eat until you’re comfortably satisfied, not overly full.

Healthy snacks

Choose fruits, nuts, or yogurt to satisfy your hunger in between meals.

Stay hydrated

Often, thirst is mistaken for hunger. Try to drink plenty of water throughout the day.

Drink wisely

Avoid drinking alcohol on an empty stomach, alternative your drinks with non-alcoholic options to slow down your drinking and choose low sugar options.

Indulge mindfully

Allow yourself to enjoy your favourite holiday foods without guilt, over-restriction or excessive exercise.

Find an enjoyable activity

Incorporate movement into your holiday routine. Go for a walk, play a game with your family or friends, or dance to holiday music.

Practice self-care

Remember to be kind to yourself and allow yourself to enjoy all foods.

Get connected

Spend time with family members or friends who make you feel good. The holidays are about joy and connection.

If you’re looking for more personalised support, without restrictions, you can contact me to book your free 20-minute Discovery Call, or you can also email me here: laura@theendometriosisdietitian.com

The post Tips to manage your PCOS and relax on holiday appeared first on The Endometriosis Dietitian.

If you’ve been diagnosed with Polycystic Ovary Syndrome (PCOS), chances are you’ve heard the advice to lose weight.

While some weight loss can help alleviate some PCOS symptoms, focusing solely on weight loss can be misleading and can even cause more harm than good. Instead, holistic approaches to making health and lifestyle changes can provide more sustainable and effective results. In today’s blog, I’ll be exploring why diets don’t work, while providing some other ways to manage your PCOS symptoms and improve your overall health.

Why diets don’t work in PCOS

• The effects of the diet cycle: Dieting rarely leads to sustained weight loss for anyone, and for women with PCOS, losing weight is particularly difficult. Insulin resistance, impaired levels of appetite regulating hormones, and food cravings can make weight loss with PCOS challenging. Restrictive diets often lead to temporary weight loss followed by weight regain, known as yo-yo dieting. This cycle can worsen your insulin resistance and hormonal imbalances, making PCOS symptoms more severe over time.

• Mental impact: The pressure to lose weight can lead to stress, anxiety, and a negative relationship with food and body image. Women with PCOS are already at a higher risk of disordered eating, depression and anxiety, and the added stress of weight loss and can exacerbate these problems.

• Attention diversion: Focusing solely on weight can divert attention from other important health behaviours such as stress management, exercise and sleep hygiene, which are all important for managing PCOS.

Approaches to managing PCOS without dieting

A comprehensive, holistic approach considers all aspects of health and well-being, not just weight.The first step is making positive changes to your nutrition and lifestyle that address insulin resistance and hormone imbalances that occur in PCOS. By targeting these areas, you will see improvements in your PCOS symptoms, even if you don’t lose weight.⁠

Here are some key approaches to managing PCOS effectively:

Balanced nutrition

Rather than restrictive dieting, focus on a balanced diet rich in whole foods. Focus on low glycemic index (GI) foods, such as vegetables, fruits, wholegrain bread, wholemeal rice, beans, lentils, chickpeas with each meal, along with some lean protein and healthy fats. These help to manage blood sugar levels and reduce insulin resistance.

Eat mindfully & slowly

Avoid eating with distractions. Take time out, turn the TV and radio off, pop your phone on silent, sit at a table so you can concentrate on what you’re eating and savour every mouthful without interuptions. It takes 20 minutes for your brain to indicate that you’re full when eating. So, if you’re a fast eater you’re more likely to eat more than your body needs before you receive your brain’s fullness signals. A main meal should take 20-30 minutes to complete, so make sure you allow enough time for meals.

Regular physical activity

Engage in a form of regular movement that you enjoy, such as walking, swimming, or yoga. Regular exercise improves insulin sensitivity, reduces stress, and supports overall health.

Stress management

Chronic stress can worsen PCOS symptoms. Incorporate stress-reducing practices such as mindfulness, meditation, and deep breathing exercises into your daily routine. Stress management techniques can positively affect hormonal balance and overall well-being .

Adequate sleep

Good sleep hygiene is essential for hormonal regulation and overall health. Aim for 7-9 hours of quality sleep per night.

Professional support

Work with healthcare providers who understand PCOS, such as your GP, endocrinologist and dietitian. Personalised guidance can help you manage symptoms more effectively and support your health journey.

Conclusion

A holistic approach that includes balanced nutrition, mindful eating, regular movement, stress management, adequate sleep, and professional support is far more effective for managing PCOS than focusing solely on weight loss.

Remember, your health journey is unique, and sustainable, compassionate care is the key to living well with PCOS. Embrace a holistic approach to health, and discover the benefits of focusing on overall well-being rather than just the number on the scale.

If you’re looking for more personalised support, without restrictions, you can contact me to book your free 20-minute Discovery Call, or you can also email me here:

laura@theendometriosisdietitian.com

References

1. Teede, H. J., Deeks, A. A., & Moran, L. J. (2010). Polycystic ovary syndrome: A complex condition with psychological, reproductive, and metabolic manifestations that impacts on health across the lifespan. The Lancet Diabetes & Endocrinology, 4(8), 711-722.
2. Moran, L. J., & Norman, R. J. (2004). Understanding and managing disturbances in insulin metabolism in polycystic ovary syndrome (PCOS).Seminars in Reproductive Medicine, 22(3), 232-243.
3. Morgan, J. F., & Scholtz, A. (1993). “Prevalence of eating disorders in women with polycystic ovary syndrome.” Journal of Psychosomatic Obstetrics & Gynecology, 14(4), 259-265.
4. Deeks, A. A., Gibson-Helm, M. E., Paul, E., & Teede, H. J. (2011). Is having polycystic ovary syndrome a predictor of poor psychological function including anxiety and depression? Human Reproduction, 26(6), 1399-1407.
5. Brand-Miller, J., & Marsh, K. (2011). “The Low GI Diet for Beginners: The Essential Guide to Getting Started with the Low GI Diet.”Hachette Australia.
6. Teede, H. J., et al. (2023). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 10, October 2023, Pages 2447–2469.
7. Kausman, R. (2005). “If Not Dieting, Then What? A Proven Program for Healthy Weight Management.” Allen & Unwin Publishers.

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Working out what you should be eating can be confusing with the many myths and misconceptions that surround PCOS. So, in this blog post I’ll be debunking a common one I hear in my clinic.

Carbohydrates and PCOS

There’s a common misconception that avoiding carbohydrates entirely is the best strategy for managing PCOS. You might think you need to avoid carbs to control your insulin resistance and PCOS symptoms.

Let’s explore why completely avoiding carbohydrates isn’t the answer and how to make smarter carb choices to manage PCOS effectively.

Why avoiding carbs can be harmful

Overly restricting your intake of carbohydrates can lead to:

• Nutrient deficiencies: carbohydrates, especially wholegrains, are rich in essential vitamins, minerals, and fibre. Completely avoiding them can lead to nutrient deficiencies, which can make your PCOS symptoms worse.

• Dips in energy levels: carbohydrates provide a steady source of energy and can balance out your meals. Cutting them out can make your cravings worse and can make you feel tired.

• Changes in your gut health: Fibre from carbohydrate rich foods aids in digestion and helps maintain a healthy gut. Avoiding these foods can lead to digestive issues, such as constipation.

• An unsustainable way of eating: Completely avoiding carbohydrates is difficult to maintain long-term. Sustainable dietary changes are more effective in managing PCOS in the long run .

Insulin resistance and blood sugar control

A significant number of women with PCOS experience insulin resistance, meaning their bodies struggle to use insulin effectively, leading to elevated blood sugar levels.

What exactly is insulin resistance?

Whenever you eat, insulin is released (by your pancreas) into your blood. Insulin transports glucose from carbohydrates out of your blood into the muscles, liver, fat, and organ cells where it’s used as energy.

With insulin resistance, your body’s cells don’t respond properly to the insulin and they block the uptake of insulin into the cells. Your pancreas then responds by releasing more insulin to try and fix this block and allow glucose to be transported. This results in high levels of insulin in your blood which can lead to a range of hormonal imbalances that create the symptoms of PCOS. If excess glucose remains in your blood, the extra insulin moves it to be stored as fat and increases hunger, and this can often lead to food cravings for sugary foods.

But won’t eating carbohydrates make my insulin resistance worse?

All carbohydrate foods have an effect on your blood glucose levels, but it’s all about making sure you’re choosing the right type of carbohydrate, and the right amount for you, so that your level of insulin sensitivity is increased and your blood sugar levels are better controlled.

Low glycaemic index carbohydrates

Low glycaemic (low GI) carbohydrates demand much less insulin and cause less of a rise on your blood glucose levels.The glycaemic index is a ranking system for carbohydrates based on their immediate effect on blood glucose levels.

Choosing good quality, low GI, high fibre foods such as wholegrain bread, wholemeal rice and pasta, beans, lentils, chickpeas with each meal, along with some protein and healthy fats, (which slow down the release of glucose), will help you to:

• Reduce insulin resistance and help control your blood sugar levels.
• Regulate your menstrual cycle, reduce testosterone levels and improve your symptoms.
• Increase your sense of feeling full and satisfied after eating meals.
• Provide your body with fibre and many nutrients for optimum health and function.
• Optimise your sleep, mood, and energy.

How much carbohydrate can I eat?

The amount of carbohydrate foods varys from person to person and will depend on your individual symptoms, level of insulin resistance, nutritional requirements and health goals.

The key is finding a sustainable approach that is right for you and your unique needs.

Key takeaways

You don’t need to avoid carbohydrates if you have PCOS. Instead, focus on choosing low GI, high fibre carbohydrates that can increase your insulin sensitivity, and improve your PCOS symptoms. Remember, the goal is to nourish your body and maintain a healthy lifestyle that works for you and your individual needs.

If you’re looking for some personalised support and guidance about what nutrition choices are best for you, book your FREE 20-minute Discovery Call here.

References

1. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: An update on mechanisms and implications. Endocr Rev. 2012;33(6):981–1030.
2. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod Update. 2010;16(4):347–63.
3. British Dietetic Association (2022) Food Fact Sheet: Polycystic Ovary Syndrome.
4. Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A., & Willett, W. C. (2009). A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. European Journal of Clinical Nutrition, 63(1), 78-86.
5. Marsh, K. A., Steinbeck, K. S., Atkinson, F. S., Petocz, P., & Brand-Miller, J. C. (2010). Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. The American Journal of Clinical Nutrition, 92(1), 83-92.

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We often focus on how what we eat can impact PCOS but you might be wondering if you can drink alcohol when you have PCOS.

In this blog, I’ll be exploring the ins and outs of alcohol when you have PCOS, along with some steps you can take to manage your PCOS while still enjoying your favourite tipple.

Understanding PCOS

PCOS is a hormonal condition that affects women of reproductive age. Symptoms of PCOS can vary from person to person, but can include: irregular or no periods, oily skin or acne, having more facial or body hair than is usual for you, loss of hair on your head, weight gain, and difficulty getting pregnant. Symptoms of PCOS can be improved by making changes to your diet and lifestyle.

The effects of alcohol on PCOS

Now, let’s talk about alcohol. Like many of us, you might enjoy a nice glass of wine or a fun cocktail with friends at a BBQ or family gathering over the summer months, but it’s important to understand how alcohol can affect your PCOS symptoms.

Insulin resistance

Many women with PCOS struggle with insulin resistance. Insulin is a hormone that helps to manage blood sugar levels. If you are insulin resistant, your body doesn’t respond to insulin as efficiently as it should when blood sugar levels are at a certain level. This means that blood sugar levels stay high for longer than we’d expect after eating (1).

Alcohol, especially in excess, can worsen insulin resistance, making it harder for your body to regulate blood sugar, causing blood sugar levels to rise rapidly. Alcohol can also interfere with your liver’s ability to produce glucose, leading to blood sugar levels dipping too low (2).

This unstable cycle of peaks and troughs in blood sugar levels can worsen your PCOS symptoms. To prevent this from happening, be mindful of sugary mixed drinks, sweet wines and beer, and avoid drinking on an empty stomach.

Mental health

Depression and mood disorders are common in women with PCOS. Alcohol can affect or worsen symptoms of depression, including feelings of low mood and anxiety (3). Reducing your alcohol intake can help support your overall emotional well-being.

Sleep

Due to hormonal imbalances, it’s not uncommon for women with PCOS to have difficulties sleeping (4). Having an alcoholic drink might help you to fall asleep, however, alcohol can interfere with your sleep quality. Sleep disruptions and decreases in sleep quality are common after drinking, which can leave you feeling groggy and tired the next day. A cup of herbal tea, such as chamomile tea, or a warm milky drink before bed can be good alternatives.

Fertility

Research is mixed on whether or not alcohol affects fertility in women with PCOS. However, research has shown that women who drink five or more alcoholic drinks per week are more likely to experience fertility complications and it can take longer to conceive. Alcohol can affect ovulation and menstrual cycle regularity, as well as reproductive hormones, making it difficult to fall pregnant. Studies have found that there is “no safe dose” of alcohol regarding fertility The advice in the UK suggests avoiding alcohol if you’re actively trying to conceive (5, 6). This is to minimise the risk of alcohol being passed to the unborn baby.

Metformin and alcohol

Metformin is often prescribed to women with PCOS to manage their insulin resistance. If you’re taking this medication, it’s important to be aware of the risks associated with drinking alcohol and taking metformin.

Excessive alcohol intake while taking metformin can cause extremely low blood sugar levels (called hypoglycaemia) and a condition called lactic acidosis. Lactic acidosis is rare, but it can be serious. It occurs when there’s a build up of lactic acid which can damage your kidneys, lungs and heart. Due to these risks, the NHS (7,8) recommends drinking no more than 2 units of alcohol per day whilst taking metformin (see info on units below!).

So, do I need to stop drinking alcohol?

Not necessarily. If you have PCOS and enjoy having a drink, do so in moderation.

Tips for managing PCOS and alcohol

Here’s some tips below to help you drink safely.

Moderation is key

The NHS recommend women to limit their intake to 14 units of alcohol a week, spread across 3 days or more. But what does a unit of alcohol look like? Check out the image below (9) for more information.

Never drink on an empty stomach

Always try to eat before you start drinking. Have something to eat before you drink, to slow the absorption of alcohol into your bloodstream and minimise the effect on your blood sugar levels.

Stay hydrated

Always have a glass or bottle of water with you or a jug of water on the table as well to make sure you stay hydrated, especially during the summer months.

Smarter choices

Opt for drinks with lower sugar content to avoid spikes in blood sugar levels. Think vodka soda with a splash of lime or a mocktail instead of sugary cocktails.

Space out

A ‘spacer’ is a non-alcoholic drink that you take between alcoholic ones; you space them out. By doing this, you can slow down your drinking. You’ll be surprised how good and refreshing a spacer can be between alcoholic drinks.

Seek support

Let your friends and family know you are trying to cut down and that it’s important to you, so they can support you in the best way.

Key Takeaways

Alcohol can affect your PCOS symptoms. However, that doesn’t mean that you have to cut it out completely. You can still enjoy a drink if you have PCOS, but drink in moderation. Avoid drinking on an empty stomach, stay hydrated, opt for lower sugar options, and if you’re taking medication or looking to conceive, consult with a healthcare professional for further advice, if required.

References

1. Tannus, S., et al. (2017). Effect of alcohol consumption on insulin sensitivity and glycemic control in women with polycystic ovary syndrome: A systematic review and meta-analysis. Diabetes Metabolic Syndrome and Obesity, 10, 269-275.
2. Husted, S., & Thorbjarnardottir, T. (2015). Alcohol and endocrine disorders: Focus on polycystic ovary syndrome. Alcohol Research: Current Reviews, 37(2), 107-115.
3. Gémes, K., et al., Moderate alcohol consumption and depression – a longitudinal population-based study in Sweden. Acta Psychiatrica Scandinavica, 2019. 139(6): p. 526-535.
4. Cowan, S. M., & Hart, R. (2017). Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity. Human Reproduction Update, 23(2), 125-141.
5. Van Heertum, K., & Rossi, B. (2017). Alcohol and fertility: How much is too much? Fertility and Sterility, 108(3), 436-438.
6. Teede, H. J., et al. (2023). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, Volume 108, Issue 10, October 2023, Pages 2447–2469.
7. NHS (2022) Common questions about metformin, Available at: https://www.nhs.uk/medicines/metformin/common-questions-about-metformin (Accessed 01/07/24).
8. NHS (2021) Alcohol units. Available at: https://www.nhs.uk/live-well/alcohol-advice/calculating-alcohol-units/ (Accessed 01/07/24).
9. Drinkaware (2023) What is an alcohol unit? Available at: https://www.drinkaware.co.uk/facts/information-about-alcohol/alcoholic-drinks-and-units/what-is-an-alcohol-unit/ (Accessed 01/07/24).

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What is PCOS?

Polycystic Ovary Syndrome, or PCOS, is a hormonal condition that affects 1 in 10 reproductive-aged women.

Symptoms of PCOS can vary from person to person, but some common symptoms include absent/ irregular periods, excessive facial and body hair, acne, weight gain, and difficulties getting pregnant.

PCOS may be diagnosed if you have two or more of the following symptoms:

• Irregular or no periods.
• Signs or symptoms of high levels of androgens (e.g. acne/excess hair growth) or high androgen levels (shown in your blood test).
• Polycystic ovaries shown on an ultrasound scan.

There’s no cure for PCOS but symptoms can be improved by following a healthy balanced diet and making some lifestyle changes. There is also scientific research to show that some nutritional supplements can improve certain aspects of PCOS.

In this blog article I’ll provide a list of some effective and common supplements used among women with PCOS.

Disclaimer:

Please speak to your doctor, dietitian or healthcare professional before starting any supplement regime to ensure it is right for you and does not interact with any other medications or supplements that you are taking. 

Vitamin D

Vitamin D is a fat-soluble vitamin that is needed for the absorption of calcium. The main source of vitamin D is from exposure to UV sunlight and only a small amount of our daily vitamin D requirements is obtained from food sources. You can find small amounts of it in oily fish, red meat, egg yolks, and in fortified foods. In the UK, Vitamin D deficiency is common, and it is recommended that all adults take 10 micrograms of vitamin D in the winter months (1).

Lower levels of vitamin D have been shown in women with PCOS. Vitamin D affects reproduction, as it is involved in follicle egg maturation and development. Supplementation with vitamin D may improve ovulation and conception in women with PCOS (2). It has also been linked to improved insulin sensitivity and help to control blood glucose levels in women with PCOS (3). Therefore, if you have PCOS you might want to take a daily 10 microgram vitamin D supplement all year round.

Inositol

Inositol is a B-type vitamin and it’s found in fruits, pulses, grains and nuts and the body also makes it. There are two main forms of inositol: myo-inositol (MI) and D-Chiro inositol (DCI).

Both forms have a number of functions in the body, including influencing the action of insulin and controlling blood glucose levels. They have also been shown to affect reproduction and improve metabolic issues.

Research shows that women with PCOS may be at risk of inositol deficiency, and supplementation of MI and DCI have shown favourable results in improving nearly all aspects of PCOS including insulin sensitivity and improving blood glucose control (4).

A recent study has also found that inositol can help to promote ovulation, regulate menstrual cycles, and improve egg quality (5). Another study showed a decrease in triglycerides, testosterone, and blood pressure levels in women with PCOS (6).

The naturally occurring ratio of these two forms of inositol is 40:1, meaning for every 40mg of MI, there is 1mg of DCI. Therefore, it is suggested that supplements containing this ratio might be optimal for managing PCOS symptoms. Most studies showing beneficial effects have used a divided dose (taken twice a day) of between 2g to 4g per day.

Since it may lower blood glucose and insulin levels, please speak to your GP or health care professional if you plan to take this, particularly if you are already taking metformin.

Omega-3 fatty acids

EPA and DHA are long-chain omega-3 fatty acids. They assist in brain and eye development; cognitive function and they also have anti-inflammatory properties that benefit the immune system, improve insulin sensitivity and protect against heart disease. A diet rich in omega-3 fatty acids from foods such as oily fish, (salmon, mackerel, herring, trout and sardines), nuts and seeds is recommended for general health and wellbeing.

Omega- 3 fatty acids have been found to offer a range of health benefits to women with PCOS, including increased insulin sensitivity, lowered triglycerides and androgens, decreased inflammation, and improved symptoms of depression (7).

Including at least two servings of oily fish per week provides you with enough omega-3 fatty acids. If you don’t eat fish, a fish oil supplement or an algae omega-3 supplement (providing at least 200mg DHA per day) may be beneficial if you have PCOS.

Cinnamon

Cinnamon is a popular spice that has been used for thousands of years for its taste enhancement and potential medicinal benefits. It is derived from the dried inner bark of evergreen trees grown in South Asia (Ceylon cinnamon) and Southeast Asia (Chinese cinnamon).

It has been found to improve insulin function and insulin sensitivity in women with PCOS (8). Another trial involved women with PCOS taking cinnamon supplements (1.5g daily) for 6 months and showed promising results with improving menstrual cyclicity and may be an effective treatment option for some women with PCOS (9).

More research is required to determine the recommended dose to benefit women with PCOS. Most of the studies use amounts ranging from 1-6g daily. One teaspoon of ground cinnamon equals 3g and this can be easily sprinkled on foods such as cereal, oats, hot drinks or taken in capsule form.

As it may lower blood glucose and insulin levels, it’s important that you speak to your GP or healthcare professional if you’re planning to take this.

The bottom line

In summary, some nutritional supplements have shown promising results in improving PCOS. However, they’re not to be used as a substitute for a healthy balanced diet. Caution should also be taken when using any supplements, as they may lower blood sugar levels.

It is important that you speak to your GP or healthcare professional before starting or altering a dose of supplement.

Working alongside a Dietitian can help to improve PCOS symptoms.

If you’re looking for more personalised support to help you to manage your PCOS, please feel free to contact me.

References

1. NHS, (2020) Overview Vitamins and Minerals. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
2. Thomson, RL., Spedding, S., Buckley, JD. Vitamin D in the aetiology and management of polycystic ovary syndrome. Clinical endocrinology. 2012; 77 (3): 343-350.
3. Asemi, Z., ‘Calcium Plus Vitamin D Supplementation Affects Glucose Metabolism and Lipid Concentrations in Overweight and Obese Vitamin D Deficient Women with Polycystic Ovary Syndrome’. Clinical Nutrition 34, n0.4 (August 2015): 586-92.
4. Pizzo, A., Lagana, AS, Barbaro, L. Comparison between effects of myo-inositol and D-chiro-inositol on ovarian function and metabolic factors in women with PCOS. Gynecological endocrinology 2014 Mar; 30 (3): 205-8.
5. Dona, G., Sabbadin, C., Fiore, C., et al. Inositol administration reduces oxidative stress in erythrocytes of patients with polycystic ovary syndrome. European Journal of Endocrinology. 2012; 166 (4): 703-710.
6. Costantino, D., Minozzi, G., Minozzi, E., Guaraldi, C. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. European Review of Medical Pharmacological Sciences. 2009;13 (2): 105-110.
7. Oner, G., Muderris, II. Efficacy of omega-3 in the treatment of polycystic ovary syndrome. Journal of Obstetric Gynaecology. 2013; 33 (3): 289-291.
8. Wang JG., Anderson, RA., Graham, GM et al. The effect of cinnamon extract on insulin resistance parameters in polycystic ovary syndrome: a pilot study. Fertility and Sterility. 2007; 88 (1): 240-243.
9. Kort DH., Lobo, RA. Preliminary evidence that cinnamon improves menstrual cyclicity in women with polycystic ovary syndrome: a randomized controlled trial. American Journal of Obstetrics and Gynaecology. 2014 Nov; 211 (5): 487.e1-6.

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