Healthy living

Food, eating & PCOS

The eating guidelines that assist with PCOS management are the same as recommended for the general population and for people with other metabolic conditions such as diabetes or high cholesterol.

Diet – what you eat – plays an important role in the management of PCOS. The most important focus of diet is weight management: first, preventing weight gain then, over time, losing some excess weight if you are overweight. This helps with the regulation of hormone levels, which in turn helps to improve symptoms such as acne, excess hair growth, cycle regularity, ovulation and fertility.

In the long term, a healthy diet aims not only to prevent weight gain, but also to reduce the risk of related health conditions such as type 2 diabetes and cardiovascular disease.^[2]

The importance of healthy food

Eating a healthy diet is more effective than exercise alone in achieving a healthy weight. For women with PCOS aiming to lose excess weight, reducing your overall intake of food (calories or energy) is recommended as the most successful approach, rather than following any specific diet. There is no one diet – for example, a high-protein diet or a low-fat diet – that has been shown to be more successful in weight management or weight loss for women with PCOS. Research shows that a diet that results in weight loss improves the signs and symptoms of PCOS.^[3]

The recommended way for women with PCOS to lose weight is to reduce overall food intake, so long as healthy food choices are made and the food is nutritionally balanced.^[4] Find an approach that works best for you, with the focus being a plan that you can continue with in the long term.

Seeking help that suits you

Support is available from your doctor or other health professionals, such as a dietitian, to help you find the best approach to suit your needs. The key to successful changes in your diet is to improve the quality of what you are eating and work towards nutritious food choices and correct portion sizes.

Small dietary changes that can be maintained in the long term can result in many health benefits, not just achieving or maintaining a healthy weight.

What and when to eat

It is recommended that women with PCOS eat regularly to help stabilise their insulin levels. It is suggested that they eat every three to four hours, which for most women means having three meals (breakfast, lunch and dinner) and a snack between each. Many women find it difficult to use appetite signals reliably, so a good start is to eat often but reduce the portion size.

Generally, meals and snacks need a balance of protein and high-fibre and/or low-glycaemic index (GI) carbohydrates, as well as plenty of vegetables and fruit.

The GI in carbohydrates is important because carbohydrates with a low GI produce lower glucose levels and insulin levels in the blood after they are eaten compared with carbohydrates with a high GI. For instance, rolled oats have a lower GI (51) than corn flakes (80).

The meal and snack suggestions below will help to guide you. For lunch and dinner, it is ideal for about half of the food you eat to be vegetables and salad.

Some helpful tips:

• eat regular meals including a wide variety of foods
• include plenty of vegetables and salad (at least 5 serves every day, which is equivalent to 2.5 cups of cooked vegetables)
• include some protein and a moderate amount of carbohydrate in each meal
• eat unrefined carbohydrates, such as wholegrain cereals, legumes and fruit, rather than refined carbohydrates (eg, white bread, white rice, soft drinks, lollies, biscuits) to make your meals and snacks more nutritious
• limit saturated fats, but instead use extra virgin olive oil, avocado, nuts and seeds, which are good sources of healthy fats
• aim to eat more fresh foods and limit use of processed packaged food
• be thoughtful of how much you eat and drink, not just what foods and drinks you choose.

Meal and snack suggestions

Breakfast

• ½ cup low-fat yoghurt, ½ cup berries and 2 dessertspoons seeds and nuts
• 1 slice wholegrain dense low-GI bread with
  • boiled/poached egg
  • ricotta/cottage/feta cheese with tomato and spinach
  • 100g canned fish, such as sardines/tuna, with salsa of chopped tomatoes, parsley/basil/dill +/- red onion and a teaspoon of olive oil
• Bircher muesli using yoghurt and grated apple but not the apple juice (option: omit rolled oats)
• Smoothie of 1 cup low-fat milk/almond milk/soy milk and ½ cup unsweetened yoghurt, ½ cup berries and 2 dessertspoons freshly ground seeds
• Slice of Frittata
• Scrambled eggs made with 2 eggs, freshly chopped herbs such as parsley/dill, crumbled feta cheese
• Omelette made with 2 eggs, feta/tasty cheese and chopped vegetables such as mushrooms, grated zucchini, onion and tomatoes
• Baked ricotta with cinnamon and berries
• Porridge made with 1/3 cup rolled oats, milk or milk substitute, ½ teaspoon cinnamon, 2 dessertspoons chopped nuts and seeds (choose from almond, walnuts, macadamia, sunflower seeds, sesame seeds, linseeds, pepitas)

Lunch

• Slice of Frittata
• Salad (equivalent to 2 cups of raw vegetables in quantity – such as lettuce, cucumber, tomato, sprouts and capsicum, or steamed vegetables, dressed with olive oil and lemon juice/vinegar) and canned fish or palm-sized portion of chicken/lean meat or cottage/ricotta cheese, or 2 boiled eggs
  • Add 2 dessertspoons pepitas and sesame seeds to promote a feeling of fullness
• Soup: chicken and vegetable or barley and lentil with a dollop of yoghurt; or cauliflower cannellini bean soup served with yoghurt or feta
• Tuna salad made with tinned tuna, 4-bean mix, fresh salad and chopped herbs

Dinner

• One-pot chicken and greens
• Stir-fried vegetables and chicken, lean meat or tofu
• Lean meat, chicken or fish served with salad or vegetables
  • The Australian Cancer Council recommends moderate amounts of unprocessed lean red meat, equal to 65–100g of cooked red meat, 3–4 times per week
• Sardines with tomato and green beans
• Rainbow meat loaf
• Roast dinner: try roasting vegetables that are less starchy, such as eggplant, zucchini, capsicum, red onion, and mushrooms, as well as some sweet potato
  • Leftover meat and roast vegetables can be eaten for lunch with a bunch of salad greens and balsamic dressing

Snacks

• Small handful of raw nuts
• Unsweetened yoghurt
• 1 apple or piece of stone fruit or kiwi fruit
• Boiled egg
• Tzatziki, baba ganoush or humous and vegetable sticks – carrots/cucumber/celery

Drinks

• Water
• Herbal tea like Spearmint tea
• Avoid soft drinks, fruit juice, flavoured milks and sports drinks as these contain added sugars and calories
• Alcohol: limit to no more than 1-2 standard drinks per day, and ensure regular alcohol-free days every week

Make it tasty

• Use fresh herbs for flavour; for example, a good handful of mint can be added to coleslaw, canned beans and fresh vegetables
• Roast vegetables with garlic, olive oil and rosemary
• Tasty dressings can include
  • olive oil, balsamic vinegar and a teaspoon of Dijon mustard
  • or check out the dressing on the red rice and aduki bean salad recipe for an Asian-inspired flavour
• Have different pestos on hand, for example, coriander and brazil-nut pesto on salmon fillet. Or make a salad of steamed vegetables, such as broccoli, asparagus, zucchini +/- potatoes, mix dill or coriander pesto with yoghurt and fresh lemon juice, and mix through. Serve with chicken or fish.

Watch the video below where dietitian Terrill Bruere talks about lifestyle and gives diet advice for the management of PCOS. Terrill explains that your weight isn’t a simple equation of energy in equals energy out. She talks through trigger points for emotional eating, explores the issues of dieting, and provides helpful and practical tips.

Physical activity & PCOS

Regular exercise seems to be most effective in improving insulin resistance, even without any noticeable change in weight or body fat measurement.^[1]

Improving insulin resistance is very important as this is the cause of many of the symptoms of PCOS.

Regular physical activity will help to:

• reduce androgens
• improve insulin resistance
• regulate menstrual cycles
• induce ovulation
• improve fertility
• increase energy levels
• improve self-esteem
• reduce anxiety and depression.

These improvements are achieved even when weight loss doesn’t occur.

What type of exercise should you do?

Research has shown any type of regular exercise is effective in improving PCOS symptoms.^[1] Whether it is moderate or vigorous aerobic exercise or resistance (using weights) exercise, women’s PCOS symptoms will improve.

A variety of exercise is good to maintain interest and motivation, but it isn’t essential to achieve the benefits. As long as you are moving and enjoying it, the type of exercise is not so important. Remember, physical activity includes walking, activity at work and household chores as well as sports and planned exercise.

The best thing to do is to aim to include some type of physical activity every day for 30 minutes, and build this up over time. This can also be broken up into smaller 10-15-minute sessions spread out over the day, and can include both structured exercise and incidental exercise.

Usually a mixture of exercise that builds both cardiac fitness and muscle strength is recommended.

How much exercise should I do?

Recommended guidelines^[1] for exercise include:

1. For women with PCOS who want to prevent weight gain and maintain health:

• Adults 18-63 years – do a minimum of 150 minutes a week of moderate intensity physical activity, or 75 minutes per week of vigorous activity or a combination of both and include muscle strengthening activities
• Adolescents (younger than 18) – do 60 minutes or more of moderate to vigorous activity per day, including those that strengthen muscle at least three times a week
• Activity can be performed in 10-minute episodes, or around 1000 steps, with the aim to do at least 30 minutes on most days
  

2. For women aiming to lose a moderate amount of weight (without dieting), prevent weight regain or achieve greater health benefits:

• A minimum of 250 minutes a week of moderate-intensity activity or 150 minutes a week of vigorous activity, or a combination of both
• Muscle-strengthening activity on two non-consecutive days of the week
• Overall, aim for around 30 minutes per day. Of this, 90 minutes per week should be aerobic activity (running, biking, fast walking etc) at a moderate to high intensity for the best clinical outcomes. Any form of exercise is fine

Some examples of moderate and high intensity exercise:

How do I start?

Start by looking at what you are doing already. Try using a pedometer to measure your steps each day. The National Heart Foundation recommends 10,000 steps a day for heart health. When you know your average daily steps, you can set goals to increase slowly to this level. If you already do this many steps, it could be you need a different type of exercise as well to increase your strength or cardiovascular fitness.

Research shows that women with PCOS can have a lower level of confidence when exercising. This might be due to issues such as poor body image, self-consciousness about excess weight, and negative past experiences.

Support is available if you are lacking the confidence to get started. It might be helpful to join an exercise group that you feel comfortable with to assist with motivation. Or, working with an exercise specialist can help you build your confidence to do regular exercise.

What do you like to do?

Do you like to walk alone or meet with a friend and walk with company? Do you like a class or an individual workout? Could you build a walk around the park into your usual coffee shop visit? Can you walk to work from a car park or a tram stop a bit farther away, or use the stairs rather the lift? What do you like to do in winter and what do you like to do in summer? Do you have an electronic system at home such as a Nintendo Wii system (or similar) that you could use to do a Zumba workout or dance program on a regular basis?

Finding a physical activity you like will help make it easier for you to include it as part of your daily and weekly routine. Alternating the type of exercise you do will also help with motivation.

It is important you try to make physical activity a key priority in your life as it will affect your long-term health.

What stops you exercising?

There are many barriers to exercise that can arise. Some people are self-conscious about their bodies and are reluctant to be seen exercising for this reason. Others are hesitant because they don’t have the right clothes to be comfortable. Some people have concerns about their ability to participate in exercise because of injuries.

If you don’t know where to start or feel you might be at risk of injury, consider seeing a physiotherapist or exercise physiologist for further advice and support.

Remember, you can change your activity plans any time you want to help stay motivated.

Other tips for healthy living

• Develop confidence in skills such as making healthy choices when shopping, cooking, eating socially or choosing take-away food. Find ways of managing these situations that suit both your lifestyle and your health.
• Reduce the size of your meals and snacks so that you are satisfied but not overfull when eating. The hormone changes with PCOS can make it more difficult to feel satisfied when eating. This means you become accustomed to eating more food than you need.
• Become aware of why you eat. Many people have forgotten how to eat when they are actually hungry and stop when they are just satisfied, rather than when they are too full. We eat for many reasons, such as grabbing meals when busy, bored or tired mid-afternoon, confusing thirst with hunger, or for more emotional reasons. This is normal occasionally, but if it is leading to weight gain over time then this is an important area to work on.
• Occasionally having foods with more fat, salt and sugar is normal, but be careful they are not an everyday part of life. They are high in energy, easy to overeat and don’t add much to your nutrition.
• Seek the advice of an Accredited Practising Dietitian (APD) if you need further help to identify which dietary approach is best for you.

Keep your goals in mind

Remember that progress is not always straightforward. Many things in our lives can stop our best efforts to be healthy, such as stress and emotional challenges. These can be hard to predict and can seem overwhelming at times. The important thing is to keep your eye on your goals and to keep going. Some days you will succeed in meeting your goals, and other days you will not do as well, but in the end, you will make progress.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at September 2019.