PCOS is a metabolic disorder that affects 5 – 7.5% of all women. It is the number one cause of infertility and if left untreated, can increase risk of endometrial cancer. In addition, women with PCOS are at a greater risk for heart disease and diabetes. Until recently, diet was not thought of as an important adjunct in treatment. However, since the fairly recent discovery regarding the role insulin resistance plays many experts now believe that diet should be a part of the treatment plan. Although further research is needed, it is believed that diet can help reduce insulin resistance, which can not only help erratic menses, hirsutism and acne, but may decrease the risk of heart disease and diabetes as well. This article will discuss the role of diet in PCOS and give practical suggestions for meal planning.
Role of Insulin In PCOS

Exactly why and how PCOS develops is not quite clear, however most experts now agree that insulin plays a major role. Insulin is a powerful hormone that is released by the body’s pancreas in response to eating food - especially carbohydrates. It transports sugar out of the blood and into muscle, fat and liver cells, where it is converted to energy or stored as fat. Many women with PCOS have insulin resistance. This means that the process of getting the sugar out of the blood and into the cells is defective – the cells are “resistant” to insulin. The pancreas must secrete more and more insulin to get sugar out of the blood and into the cells. High levels of insulin or hyperinsulinemia, can wreak havoc in the body, causing any or all of the following conditions: polycystic ovaries, weight gain and/or difficulty losing weight, increased risk of heart disease by increasing LDL and triglycerides, decreasing HDL and increasing clotting factors. In addition, it can increase risk of diabetes by up to 40% by age 40.

The discovery of insulin’s role in PCOS has brought hopes for better treatment. Treatment is no longer just aimed at treating the individual concerns (ie. erratic menses, hirsutism, acne, etc.), but instead is now aimed at treating one of the underlying causes – insulin resistance. If insulin resistance is present, it is best treated with diet, exercise and weight loss if needed. Insulin sensitizing medications may be used as well. Most physicians prefer to start with diet and exercise and turn to drugs if needed. Keep in mind that not all women with PCOS have hyperinsulinemia, but the majority do.

Why Don't The Typical "Low-fat" Weight Loss Diets Work?

Approximately 50 – 60% of women with PCOS are obese. It has been shown that losing even 5% of body weight can lead to an improvement in skin, regularity of menstrual cycles and decreased insulin levels. However many women with PCOS experience difficulty losing weight, possibly due to high insulin levels promoting fat storage. The standard low fat high carbohydrate weight loss diet may not be the best approach for women with PCOS. High intakes of carbohydrates, especially refined carbohydrates (ie. sweets, white bread, white rice, etc.) will quickly turn to sugar and cause elevated levels of insulin. Since high levels of insulin can cause a multitude of problems for women with PCOS, a better diet would be a low glycemic index diet. This is a diet that includes foods or combinations of foods that do not cause a rapid rise in blood sugar. The low glycemic diet will be discussed more in detail later in this article.

How Many Carbohydrates Should You Eat A Day?

At this point in time, I am not aware of any studies that provide data as to the recommended level of carbohydrates for a woman with PCOS. Should you follow a Food Pyramid based diet (55% of calories from carbohydrates – but select mainly from whole grains), a diet which is 40% carbohydrates (ie. The Zone), or a very strict diet that allows only 20% of calories from carbohydrates (ie. Atkins or Protein Power)? In my experience, there is no one level that will work for all women. Dr. Walter Futterweit, clinical professor of the Division of Endocrinology of the Mount Sinai School of Medicine, has been working with women with PCOS for 25 years. He suggests that non-obese women with PCOS who get regular periods eat a balanced diet, moderate - not excessive intakes of carbohydrates (approximately 50% of calories), and select complex unrefined carbohydrates over refined carbohydrates. An obese insulin resistant woman should consume a diet that is 40 % carbohydrates or less, depending upon the degree of insulin resistance. These are only guidelines – the diet should be tailored to fit the individual person. I would suggest starting with a diet that is 40 % carbohydrates and work your way downward if need be. Some subjective indicators that the diet is “working” are: decreased cravings and increased energy levels. Some objective measures that the diet may be working are: weight loss, decreased insulin levels, regular periods. Clearly, this is an area that needs to be researched.

Hazards of Low Carbohydrate Diets That Are High In Saturated Fat

Several of the popular low carbohydrate diets contain as much as 60% of calories from fat, much of it saturated. I do not recommend these diets as saturated fat has been linked to heart disease. These diets could be especially dangerous for women with PCOS, as they already have an increased risk of heart disease. In addition, these diets are low in fiber, vitamins, minerals and disease fighting phytochemicals. Remember that this is not a temporary diet – it is one that you will need to follow long term! Therefore you will need to make it as healthy as possible.

Calculating Your Caloric Needs

Since the majority of women with PCOS are overweight, calories are very important. For weight control, remember – all calories, whether from fat, protein or carbohydrate, in excess of your body’s needs, will turn to fat. In order to lose weight, you must stay within your calorie goal.