Here Alex O'Connor, a fertility acupuncture specialist, from Essex Fertility in her Explaining the Unexplained series talks about how we can take practical action to tackle PCOS.
At its root Polycystic Ovarian Syndrome (PCOS) is linked to insulin resistance. Increasing evidence suggests that a common underlying factor in PCOS is the maintenance of the correct levels of myo inositol into d-chiro inositol. These inositols are part of the B vitamin family and found in cell membranes; when these are disrupted, it can lead to insulin resistance which in turn can cause problems for fertility.
Studies have shown up to 80% of obese women with PCOS and 40% of lean women with PCOS show signs of hyperinsulinemia which can trigger symptoms such as sugar cravings, intense hunger, anxiety, finding it difficult to concentrate, lacking focus and fatigue. When insulin levels are erratic it has a knock on effect of disrupting menstrual hormones.
Tackling PCOS through diet
The good news is that any dietary changes that can improve insulin regulation can have a dramatic effect on PCOS, to the extent that it is possible to control symptoms of PCOS through diet and in doing so, restore ovulation and improve fertility. The basis of a good diet for someone with PCOS is to eat a natural, paleo style balanced diet, whole, real foods that you buy in a natural state and cook at home, avoiding processed foods and artificial sweeteners.
The most important thing when trying to tackle PCOS through diet is to cut out sugar. It isn't easy, but there are lots of resources out there to help. Magnesium and a vitamin B complex which includes Vitamin B6 may help to take the edge off the sugar cravings!
A healthy gut is vital for hormone regulation, we rely heavily on our gut microbiome to help us to assimilate the necessary hormonal components and to help us to eliminate excess hormones in order to maintain the correct hormone balance. As I write this, millions of people across the world are in lockdown at home, providing a perfect opportunity to take stock of our diet and lifestyle and to put changes into place for long term benefit.
Your diet needs to contain the following elements:
- Include lean fish, chicken and red meats if you can in your diet - choose free range if possible. Protein should be eaten with every meal, but not in large amounts. For your main meal, aim to have a portion of protein that is about the size of the palm of your hand.
- If you cook with any cuts of meat with bones, learn how to make a bone broth – you can then either have it as a broth or add it to other soups/casseroles to seriously increase the richness of micronutrients. Hundreds of recipes on the web, very easy to do.
- Try to get a bit of salmon into your diet if you can, or line-caught yellowfin tuna (thought to have a lower mercury content than regular tuna).
- It is really good to start the day with a hot breakfast with some healthy protein rather than starting the day with something carbohydrate based such as toast/cereal.
- Eggs are a fantastic breakfast, especially if you are working from home and have a bit more time! Get into the habit of cooking yourself a small omelette in the morning or have a poached egg with an avocado, a sprinkling of seeds and spoonful of kimchi on the side (optional!).
- Approximately half of your plate should be vegetables
- Fill your boots with non-starchy vegetables such as salads, cooked green leafy veg (spinach, kale, chard), cauliflower, carrots, green beans, broccoli, mushrooms, aubergine, celery, cucumbers, onions, avocado and tomatoes (those last two are particularly good to include if you can - get some tomato plants so you have a supply all summer long!).
- Try to use starchy vegetables in place of the more processed carbs, so have sweet potatoes, white potatoes, parsnips or butternut squash instead of pasta or bread.
- Low sugar fruits such as berries, grapefruit, apples, oranges, pears, pineapple are best.
- Some of the more sugary fruits such as mango, grapes and bananas are slightly less helpful but still useful if you need something sweet.
- Don’t forget dried fruits, dried apricots, figs and dates all make a healthy, nutritious snack. Try filling a date with a spoonful of nut butter for a delicious little snack.
Nuts, Seeds & Oils
- Nuts, seeds and oils are amazing for micronutrient content that really help us to support hormone health.
- Pick up a pot of seed sprinkles and keep them on the kitchen counter to scatter on your food - you won't notice them in small amounts but they will make a big difference.
- Put a bowl of nuts out - pecans, almonds, cashews, walnuts. You may think you don't like them, but if you leave them around where you can see them and eat one every now and then it is better than not eating them at all!
- Monounsaturated oils are surprisingly good for your hormone regulation system, oils like extra virgin olive oil, avocado oil and coconut oil. You can sprinkle oil lightly over steamed vegetables, or include a serving of nuts, seeds or avocado each day to make sure you take in enough. You can buy a mild coconut oil from Biona which doesn't taste of coconut and is amazing to cook with - for scrambled eggs, frying, roast potatoes etc)
- Green tea is particularly good for helping to regulate hormones.
- Spearmint tea is another very good tea for helping with excess androgen hormones.
- Liquorice tea can also help to gently regulate excess androgens in the system.
- All of the above teas can help recovery from polycystic ovaries - so if you can learn to like them, they will be very good for you. You may need to buy spearmint tea from a health shop or online, I am not sure they stock it in the supermarkets.
A Word about Gluten
There is also a strong link between PCOS and inflammation, so it is a good idea to try eliminating gluten from your diet – not through choosing heavily processed ‘gluten free’ foods, but by choosing not to eat foods that contain gluten! Gluten is found in wheat, spelt, rye and barley. Evidence suggests it is mildly inflammatory to anyone; it can create a situation where the gut wall becomes inflamed, leading to ‘leaky gut’ and increased immune reactions. If you want to know whether gluten is causing an increase in your baseline inflammation level, eliminate gluten for a month to see whether it improves how you feel. When/if you do reintroduce it, again, observe how you feel – you may find that you feel much better if you consume a much lower amount of foods containing gluten. Gluten has been shown to increase leptin resistance which in turn creates more hunger – so reducing gluten should also help you to control your hunger more easily.
In terms of supplements to take to support hormone regulation if you have PCOS, one of the most useful supplements seems to be myo-inositol. Inofolic is specifically designed to support hormone regulation to improve fertility for PCOS women.
Your doctor may prescribe Metformin to help regulate your insulin levels, but if not, check out Berberine as a natural alternative.
There are a wide range of other supplements that are often recommended for people with PCOS, but there are several different presentations of PCOS and not all supplements would be beneficial for everyone. The two mentioned here are both useful in terms of the insulin regulation issues that accompany PCOS.
Slowly does it
If you have a high BMI and are trying to lose weight to improve your fertility and decrease your PCOS symptoms, aim to lose weight very slowly over a long period of time rather than going for a rapid weight loss program. In most cases, losing 5% of your body weight should be enough to restart ovulation, but do it slowly. Rapid weight loss can trigger the body to shut down reproductive hormones which is not helpful if you are losing the weight to improve your fertility! Acupuncture and diet can help to get things going again, but it is better not to trigger that response in the first place by making sure your weight loss is slow and steady.
Acupuncture for PCOS
I would recommend you look for an acupuncturist who specialises in fertility acupuncture to work with you. A Fertility Acupuncture Specialist would be able to support you properly, adjusting their treatment and lifestyle advice according to your blood hormone profile to help you to restore a healthy, natural cycle and improve your fertility. The dietary changes discussed above would be beneficial to anyone with PCOS, but there are many different presentations of PCOS so it is definitely worth discussing your hormone levels with blood tests with your specialist to see what is really happening before diving too deeply into supplements - one size does not fit!
Read more about Alex and Essex Fertility here.