In the U.S. alone it is estimated that 6% to 12% (as many as 5 million) women of reproductive age suffer from Polycystic Ovary Syndrome (PCOS) according to the Centers For Disease Control. PCOS is a female fertility health disorder that impacts the body’s endocrine system. Typically, women with PCOS are overweight, and as a result of insulin resistance, struggle to lose weight, but there is an increasing number of women with PCOS for whom being overweight is not an issue.
Many women with PCOS regularly reach out to us for support. A large portion of these women do not fit what has become the stereotypical image of a woman with PCOS – overweight/obese with acne and facial hair. In fact, they are the opposite, they share that they are skinny or lean, not overweight, and some have no signs or symptoms at all (but many do), yet they have been diagnosed with PCOS. They are wondering why they don’t fit the typical profile of a woman with PCOS and how they can naturally heal themselves when most of the information on PCOS speaks to those who are overweight.
Why Does PCOS Happen?
Why PCOS happens is still somewhat of a mystery; this is especially true for lean women. PCOS could be a genetic condition, yet is believed to be a result of hormonal imbalance and the body’s inability to properly regulate insulin, which is made worse by poor diet, excess body fat, and an inactive lifestyle.
It is common to hear from a doctor that the chances of conceiving naturally with PCOS are slim to none. Medical solutions for women with PCOS wanting to conceive can include: hormone replacement therapy (most commonly oral contraceptives), blood sugar-regulating medications, IVF, egg donor, or adoption.
We want women with PCOS to know that these are not the only options! Many healthcare providers of all schools of thought now believe that dietary and lifestyle changes are foundational for all women with PCOS. Countless women with PCOS are successfully supporting their health, seeing dramatic changes to their health and getting pregnant by simply eating a PCOS-specific, nutrient-dense, whole food diet.
First, the Symptoms of PCOS…
Both lean and overweight women with PCOS can experience many of the same symptoms associated with PCOS, to varying degrees, which are:
- hormonal imbalance causing irregular menstrual cycles
- elevated levels of male hormones called androgens (testosterone), estrogen and luteinizing hormone (LH)
- low levels of follicle-stimulating hormone (FSH)
- heavy menstrual blood loss or absent periods
- cysts on one or both ovaries
- ovarian pain or enlarged ovaries
- severe acne
- male pattern facial and body hair growth (hirsutism)
- anxiety and depression
- weight gain and difficulty losing weight with no known cause (even if just slight gain)
- insulin resistance
More About Insulin…
Insulin is instrumental in helping glucose (blood sugar) travel to cells to give them energy. Whether eating a clean, whole food diet or eating a diet high in refined sugars and grains, processed foods, saturated fats, etc., insulin goes to work. It is when the unhealthy foods are indulged in too often, or are the basis of a diet (coupled with an inactive lifestyle), that the cells may become resistant to insulin. Resistance means that they don’t recognize insulin. Glucose is then forced to the liver where it is converted into body fat instead of being used as energy (excess adipose tissue, or fat, also contributes to estrogen dominance).
The organ that produces the hormone insulin and keeps blood sugar and salt levels balanced within the body is the pancreas. An imbalance of insulin and salt within the body, especially when the pancreas is not able to make enough insulin to meet the body’s needs, may lead to diabetes (a serious health condition).
Researchers from Prince Henry’s Institute of Medical Research, Australia, believe there is another cause for the development of insulin resistant PCOS, beyond poor diet and inactivity, – some women’s bodies have an excess of androgens (male hormones) (Diabetes/Metabolism Research and Reviews). Elevated androgen levels in women cause the ovaries to make more estrogen which, in turn, stops ovulation.
For women with lean PCOS, androgens levels may be low
If you are living with PCOS, ask your doctor to evaluate your body’s ability to regulate and control insulin, to know if insulin resistance is a concern for you. Even a lean woman’s body may not be able to produce and regulate insulin properly.
Whether lean or overweight, regardless if insulin resistance is a factor or not, it has been determined by science that PCOS impairs the body’s ability to properly process glucose and insulin-producing cells may not function properly. Another factor of concern is that the insulin-producing cells of women who were once overweight do not change after weight loss, they stay impaired.
So, while being lean may make conquering PCOS a bit easier, being lean does not mean insulin resistance is not a factor according to Dr. Sari Cohen in PCOSA Today Newsletter, September/October 2007. All of this being said, no matter which variation of PCOS you have, hormone levels, including insulin, can be managed through specific dietary changes, lifestyle changes, regular exercise, herbs, nutritional supplements, and natural therapies.
The Lean PCOS Diet and Lifestyle
It will, from the start, be easiest to implement and stick to lifestyle and diet changes if you make a routine! Sure, it’s great to have variety from day to day, but planning out meals, exercising around the same time each day and taking time for self-care and stress-reduction practices will help make this healthy lifestyle a habit.
The following steps will be beneficial for lean women with PCOS, who are not insulin resistant. Lean women with PCOS who struggle with insulin resistance would be best served by following our guide Learn to Eat a PCOS Fertility Diet. Here is a PCOS Fertility Diet Tip – Simple Food Choices to Stabilize Blood Sugar to help as well.
The PCOS Fertility Diet
The foundation of the PCOS Fertility Diet is really about going back to basic healthy, clean-eating principles. Clean eating means filling your plate with real, whole foods, eating a variety of fruits, vegetables, moderate amounts of lean (organic/grass-fed/free-range) animal products and seafood, legumes, nuts and seeds, healthy fats, and limited amounts of whole grains. Eating clean also means limiting processed foods, salt, added sugar, and saturated fats.
Diet Dos: Eat whole, fresh foods that are organic and non-GMO when possible, and:
- incorporate dark leafy greens, cruciferous and sea vegetables, a variety of vegetables daily – 5-6 servings a day
- cook with womb warming, anti-inflammatory herbs and spices – cinnamon, turmeric, cayenne, paprika, etc.
- balance your daily carbohydrate intake with an equal amount of lean protein (animal or vegetable; remember that beans, though high in protein, also contain carbohydrates)
- limit fruits to 1-3 servings per day, choose low glycemic-index fruits, and avoid fruit juice
- eat 5 smaller meals each day to keep blood sugar stable throughout the day
- incorporate fertility superfoods into your diet – Maca, Royal Jelly, quinoa, greens powders and wheatgrass are just a few
- eat fermented foods to boost gut health – a healthy gut helps the body assimilate nutrients
Diet Don’ts: Avoid eating processed, pre-packaged foods, as well as:
- processed carbohydrates (white flour – breads and pastries) and sugar
- soda and alcohol
- fried foods and any oil besides coconut and olive oils
- and limit gluten (inflammatory) and dairy (congesting)
The PCOS Lifestyle
Most of all, remain positive! Believe in your ability to kick this syndrome to the curb! Think about the exercises and self-care practices you enjoy and make them a part of your daily routine.
- Exercise even if you are lean – participate in moderate daily exercises like Fertility Yoga, light jogging and long walks, Pilates, leisurely bike riding and swimming are great too. The goal is to stay lean and if needing to put on weight, working to increase lean muscle mass rather than fat.A 2016 Brazilian study in the journal Medicine and Science In Sports and Exercise enlisted “45 sedentary women with PCOS and 52 without (non-PCOS), 18-37 yr of age, with body mass indexes (BMI) of 18-39.9 kg·m(-2) of all races and social status” to performed progressive resistance training three times a week for 4 months. The women with PCOS using resistance training saw a decrease in abdominal “visceral” fat (the fat that increases risk factors for insulin resistance), decrease in androgen levels, and improvements in irregular menstrual cycles and ovulation issues, as well as increased lean muscle mass.
- Acknowledge stress and learn ways to effectively manage it – work, family, fertility, body image, etc., can all cause stress. Some thoughts are to enlist a friend to go on a daily walk, learn the Emotional Freedom Technique (EFT) or Circle and Bloom. There are more short- and long-term stress reduction tips in our guide to Stress and Your Fertility.
- Avoid xenohormones – Xenohormones are environmental toxins known to contribute to endocrine system disruption and hormone imbalance. Examples of everyday ways we are exposed to xenohormones are plastics (avoid drinking water from plastic bottles and storing food in plastic), conventional cleaning products, personal and body care products, and non-organic foods.
- Cut out caffeine because caffeine increases estrogen levels.
PCOS Herbs & Nutritional Supplements
Supplements That Are Beneficial for PCOS… are complementary to the dietary and lifestyle changes you will be making with the goal to support the body in re-learning balance by promoting healthy hormonal balance, a healthy uterine lining, regular ovulation, improved estrogen metabolism and ultimately a healthy pregnancy if that is your wish. So, consider learning more about:
- vitamins and minerals like calcium and vitamin D
- herbs that promote hormonal balance and support regular ovulation like Vitex (Vitex agnus-castus) and Maca (Lepidium meyenii), Licorice root (Glycyrrhiza glabra) and White Peony (Paeonia lactiflora)
- nutritional supplements like DIM, essential fatty acids like Evening Primrose Oil and Cod Liver Oil, Saw Palmetto (Serenoa repens), and D-chiro inositol and Myo-Inositol
Your health begins with you! Your condition does not define who you are as a woman! If you chose health, you will achieve health!
- PCOS and Diabetes, Heart Disease, Stroke… (March 14, 2018). Centers for Disease Control. Retrieved from https://www.cdc.gov/diabetes/library/spotlights/pcos.html
- Cohen, S. (2007, September 1). Thin With PCOS: “How can I have PCOS if I’m not overweight?”. In PCOSA Today Newsletter. Retrieved from: https://pcos.com/thin-with-pcos-how-can-i-have-pcos-if-im-not-overweight/
- Corbould, A. (2008). Effects of androgens on insulin action in women: Is androgen excess a component of female metabolic syndrome? Diabetes/Metabolism Research and Reviews, 24(7), 520-532. doi:10.1002/dmrr.872 Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1002/dmrr.872
- Polycystic Ovary Syndrome (PCOS). (n.d.). Retrieved from: https://www.healthwise.net/ahni/Content/StdDocument.aspx?DOCHWID=tw9103
- Kirchengast, S., & Huber, J. (2001). Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Human Reproduction, 16(6), 1255-1260. doi:10.1093/humrep/16.6.1255 Retrieved from: https://academic.oup.com/humrep/article/16/6/1255/619529
- Milsom, S. (n.d.). Polycystic Ovary Syndrome. Retrieved from: https://www.fertilityassociates.co.nz/news-and-blog/pcos-symptoms-and-self-help/
- Nestler, J. E., & Jakubowicz, D. J. (1997). Lean Women With Polycystic Ovary Syndrome Respond to Insulin Reduction With Decreases in Ovarian P450c17 alpha Activity and Serum Androgens. The Journal of Clinical Endocrinology & Metabolism, 82(12), 4075-4079. doi:doi.org/10.1210/jcem.82.12.4431 Retrieved from: https://academic.oup.com/jcem/article/82/12/4075/2865999
- Slater, B. (n.d.). Skinny with PCOS. Retrieved from: https://www.ovarian-cysts-pcos.com/skinny-with-pcos.html
- The Lean PCOS Diet – PCOS Diet Tips. (2012, November 2). Retrieved from: http://www.pcosdietsupport.com/diet-tips/lean-pcos-diet/
- Kogure GS, Miranda-Furtado CL, Silva RC, Melo AS, Ferriani RA, De Sá MF, Dos Reis RM. (2016 Apr). Resistance Exercise Impacts Lean Muscle Mass in Women with Polycystic Ovary Syndrome. Med Sci Sports Exerc. 48(4):589-98. doi: 10.1249/MSS.0000000000000822. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26587847