Holistic Treatment Approaches in PCOS
Diet + Lifestyle + Supplements
In my last blog post, I discussed what is PCOS, one of the most commonly diagnosed hormonal disorders in women, as well its presenting symptoms and long term implications for health and fertility. In this post, I would like to discuss some of the most basic but important ways to address this condition.
A low carb diet and regular exercise have a huge impact on managing PCOS symptoms. This is the first and most important step! Very often with a milder presentation of PCOS, natural approaches using diet changes and supplements may be sufficient treatment.
In 10 years of practice, I have met many a discouraged woman who came to me struggling with weight issues- because more often than not, women newly diagnosed with PCOS are told to lose weight without much further explanation or support. While PCOS is a weight-sensitive condition, meaning that even a 5 % reduction in baseline weight can improve many symptoms, to try and do this by restricting calories or extreme dieting would be counterproductive. Prolonged hunger can cause increased sugar cravings (and the increased likelihood of binge eating) and the fluctuations in blood sugar can also make you feel poorly, provoking headaches, fatigue, trouble concentrating and irritability.
Eating smaller meals, evenly paced through the day would be better to maintain a steady blood sugar and reduce sugar cravings. Additionally, your body requires a minimal caloric intake to maintain a healthy basal metabolic rate. Aim for 3 small meals with 1-2 servings of healthy snacks in between. Do not go more than 3-4 hours without consuming some calories, ideally with protein intake every time you eat.
What constitutes a low carb diet? Ideally, consuming less than 26% of carbohydrates as a percent of your daily macronutrients. For example, for an average 2,000 calorie diet, daily carb intake should be no more than 100-130 gms. Aim for a protein intake of 40-50% of your calories and 20-30 % healthy fats.
Role of proteins in your diet: Proteins are less likely to provoke insulin spikes compared to carbohydrates and starchy foods, thus keeping blood sugar levels more stable. Switching carb derived calories to protein sources, instead of eating fewer calories will also help to maintain muscle mass. This is particularly important with breakfast or your first meal of the day when insulin resistance tends to be the highest.
Role of fats vs carbs in your diet: Eating some healthy fats with your meal promote a feeling of satiety or fullness, allowing you to cut back on carbs more comfortably. When eating carbs, choose high fiber complex carbohydrates, such as beans, legumes, whole grains, and vegetables.
The role of a high fiber diet: soluble fiber slows the breakdown of carbs into sugar in the bloodstream, thus reducing insulin production. Insoluble fiber helps promote regular bowel movements, a very important factor in detoxing your digestive tract and avoiding water retention due to bloating and constipation.
Here’s a pro tip: Breakfast is one of the easiest meals to pack in a high protein meal with minimal carbs. Consider some of these options:
- Omelet with veggies or mushrooms and some cheese
- Cottage cheese or a non dairy yogurt topped with almond butter, chia seeds and berries seasoned avocado on a slice of multigrain toast
- Coconut milk smoothie with a scoop of nut butter and cacao nibs
- Almond milk smoothie with chocolate protein powder, spinach and frozen berries
- Even a boiled egg on the go with a sprinkle of salt and pepper!
Another key non-medical approach to treating PCOS is exercise. On a cellular level, during exercise, glucose is taken up by muscle to burn as fuel which can cause an immediate increase in insulin sensitivity. The more intense the exercise, the longer this effect will last. Any physical activity is beneficial but resistance training and aerobic exercise will give you a better impact. Aerobic exercise burns more calories and glucose than a low intensity activity such as walking or gardening. But resistance training or weight training also helps to build muscle which in turn is a better metabolizer of glucose.
The ideal way to incorporate exercise into your treatment plan for PCOS would be to alternate between low and high intensity exercise. Starting off with extreme or intense daily exercise can increase the risk of athletic injury. Hurting yourself exercising is a major de-motivator and can set you back in your goals. Also, pushing your body to challenging physical activity every day can eventually raise cortisol (stress hormone) levels which is not a good thing!
Chronically high stress levels can trigger inflammation in the body, raising both cortisol and insulin levels. Lowering stress with a daily meditation practice and yoga can help in this regard. But on a simpler and immensely satisfying level, many easy activities that bring you joy will also help lower stress! These could include spending time with loved ones, listening to music, doing a jigsaw puzzle, reading a good book or getting adequate sleep at night.
The role of botanical supplements, vitamins and minerals in PCOS is primarily targeted towards lowering insulin resistance. Often, lowering insulin resistance and circulating glucose levels in the body is enough to restore regular menstruation and ovulation without requiring prescription medications. There are also a few supplements that help block testosterone production but these tend to work less reliably.
Cinnamon has polyphenols which act as insulin sensitizers with antioxidant properties. As little as ½ tsp daily (1 gram) can help lower fasting insulin levels and decrease cholesterol as well, specifically LDL. Cinnamon is useful in prediabetes, PCOS and gestational diabetes. It can support regulation of menses and ovulation by lowering insulin resistance.
Berberine is a botanical supplement which works in a similar way to Metformin, the most commonly prescribed medication for diabetes and insulin resistance. It slows the breakdown of carbohydrates in the gut, helps the cells in our body break down sugar and lowers triglyceride levels. It also slows the production of glucose by the liver (called gluconeogenesis). Typical doses are 500 mg 2-3 times per day before meals. Of note, the side effects of Berberine are also quite similar to Metformin and mostly related to GI sensitivity such as bloating, diarrhea and indigestion. If trying this supplement, I advise my patients to start with just once a day dosing and slowly work their way up on the dosing as their digestion tolerates it.
Fenugreek seeds, also called ‘methi’ in ayurvedic medicine, is an insulin sensitizer but also helps to reduce ovarian cyst formation, thus helping PCOS in more than one way. It is also used post partum to boost breast milk production. An average dose would be 3-5 grams per day in divided doses.
Inositol is a naturally occurring carbohydrate that is found in our body as well as in certain fruits. It is part of the Vit B complex family and considered a phytonutrient. Many women with PCOS are deficient in inositol and supplementing it can help regulate ovulation. Inositol is typically sold as a blend of myoinositol and d-chiro inositol but you can also purchase these forms separately as single herb sources. Myoinositol helps restore ovulation by lowering insulin resistance (think ‘M’ for metabolism!) and D-chiro inositol decreases androgen hormone production.
Vitex, a herbal supplement also sold as chasteberry or chastetree vitex is well known for its use in menstrual issues. It’s benefit is not specific for PCOS but it can help with irregular periods, PMS and perimenopause symptoms. It is sold in both capsule and tincture forms, typically dosed at 500-1000 mg taken in the morning.
Other supplements include:
- Gymnema & bitter melon which have been part of ayurvedic treatment plans for PCOS by lowering insulin resistance, as does an essential mineral called chromium.
- Traditional Chinese and Japanese medicine (TCM and Kampo respectively) often incorporate a blend called shakuyaku-kanzo-to composed of white peony + licorice root to block testosterone and induce more regular periods.
- Also for testosterone blocking effect, naturopaths have long since used a herb called saw palmetto in their treatment approaches.
- Spearmint tea may help with some of the features of high testosterone including excessive hair growth- but only a few small studies have indicated any benefit, however mild.
- I tend to rely on these supplements less frequently but they may be found as a part of an over-the-counter PCOS supplement blend at your local health food store.
In my next post, I will explore some conventional medication therapies for PCOS.
Yours in good health,
Ashita Gupta, MD