PCOS Management: using food to fight inflammation by Gemma Wright
My name is Gemma Wright and I am an Accredited Practising Dietitian and founder of Lettuce Talk Nutrition. Lettuce Talk Nutrition is passionate about supporting, empowering and educating women with Polycystic Ovary Syndrome (PCOS) and other women’s health concerns, to create happier, healthier lives, in a sustainable way which is individualised to the person.
PCOS impacts 8-13% of women worldwide.(1) Symptoms vary between individuals and can include:
Irregular menstrual cycles and/or anovulatory cycles (when ovulation does not occur)
Excessive hair growth (hirsutism.)
Hair loss.
Unintentional weight gain or difficulty losing weight.
Mental health concerns, including anxiety, depression and body image concerns.
Oily hair and skin, including acne.
PCOS is associated with chronic low-grade inflammation which can negatively affect the symptoms of PCOS. Nutrition and lifestyle changes are considered first line management strategies for PCOS and diet may help reduce inflammation in the body.(1)
So, what is an anti-inflammatory diet?
Anti-inflammatory dietary pattern
An anti-inflammatory dietary pattern prioritises intake of whole foods such as fruit, vegetables, whole grains, plant-based proteins and healthy fats, including nuts, seeds and omega 3 fatty acids. It also focuses on reducing intakes of foods and drinks high in trans fats, saturated fats, sugar and alcohol. An example of a dietary pattern which is researched for its anti-inflammatory benefits, includes the Mediterranean diet.
So, why is an anti-inflammatory diet beneficial for those with PCOS?
Benefits of an anti-inflammatory diet in pcos management
PCOS is associated with chronic low-grade inflammation. Inflammation can worsen insulin resistance, a common driver of the hormonal imbalances experienced by those with PCOS, which can lead to blood glucose (sugar) imbalances and PCOS symptoms, such as acne.(3,4) By reducing inflammation in conjunction with other diet and lifestyle strategies, insulin sensitivity and PCOS symptoms may improve!
Anti-inflammatory dietary patterns, such as the Mediterranean diet, may also improve fertility outcomes, reduce the risk of developing conditions associated with PCOS, including cardiovascular-related health conditions, optimise gut health and may improve your mood.(2, 5, 6,7)
Now we know why an anti-inflammatory dietary pattern is beneficial for those with PCOS, what kind of foods should we be including to align with an anti-inflammatory dietary pattern?
Anti-inflammatory foods
Let’s take a look at some of my favourite inflammation fighting foods to include in your diet.
Fresh fruit & vegetables
No surprises here… Fruit and vegetables are packed with a range of anti-inflammatory compounds including antioxidants, dietary fibre and phytochemicals, all of which may reduce inflammation in the body.
It’s not only important to consume enough fruits and vegetables, but also a variety. Increasing both the volume and variety of fruits and vegetables chosen will help you meet your nutrient requirements, diversify the type and volume of anti-inflammatory compounds you consume and may benefit your gut health! Research has shown that those who include > 30 varieties of plant-based foods every week, have a more diverse gut microbiome, with gut health playing an important role in reducing inflammation.(8)
Aim for 3 colours of veggies on your plate at lunch and dinner, grate them into soups, sauces and smoothies and rotate the types of fruit you add to yoghurt, smoothies and salads.
Omega 3 rich fish
As a dietitian, I am often advocating for my clients to eat more omega 3 rich fish. Why? Omega 3 fatty acids have been shown to have strong anti-inflammatory benefits in the body.(9) I recommend including 2-3 serves of omega 3 rich fish each week, such as salmon, mackerel, anchovies, sardines and herring. Try grilled omega 3 rich fish with veggies, salmon and avocado on whole grain toast or bake omega 3 rich fish into a frittata.
If you are vegetarian or vegan, we recommend working with a dietitian to ensure your omega 3 needs are being met, particularly if actively trying to conceive.
Whole grains
Whole grains provide a rich source of dietary fibre and anti-inflammatory compounds, including antioxidants and polyphenols. Whole grains also tend to have a lower glycaemic index, to support blood glucose control, improve insulin sensitivity, may benefit gut health and as a result, may reduce inflammation.(6) Swap white bread for whole grain, seedy bread and add grains such as quinoa and frekkah to salads.
Plant-based proteins, including legumes
Increasing your intake of plant-based proteins, such as legumes, may help reduce inflammation, improve gut health and may also benefit your fertility. Research has shown that eating as little as 5% of your total energy / calorie intake from vegetable protein, in place of animal protein, was associated with a 50% reduced risk of ovulatory infertility.(10) Add legumes to mixed dishes such as sauces and casseroles, toss through salads and snack on roasted chickpeas.
Extra virgin olive oil
Extra virgin olive oil is a key component of the Mediterranean diet, which has been shown to have many anti-inflammatory health benefits. Extra virgin olive oil contains monounsaturated fats and anti-inflammatory compounds, including the phenolic compound oleocanthal, which may reduce inflammation in the body and may reduce risk of cardiovascular-related health conditions, which you are at a higher risk of developing when you have PCOS.(5, 11) I recommend using extra virgin olive oil as your primary oil of choice, in salad dressings, cooking and on toast.
Other anti-inflammatory foods
Other foods such as nuts, seeds, probiotic rich foods, such as kefir, herbs, spices and anti-inflammatory teas, such as green tea, may also exert anti-inflammatory impacts on the body.
Now we know what foods we should include more of, are there any we should limit?
Are there any foods I should limit to reduce inflammation?
To reduce inflammation in the body, we also want to focus on reducing our intake of highly processed foods high in added sugar and saturated and trans fats, such as baked goods, soft drinks, processed meats and refined grain products such as white bread and biscuits.(11) We also want to minimise our intake of alcohol. If you are actively trying to conceive or are pregnant, there is no safe level of alcohol to consume.
Try:
Replace white bread, for a seedy, dense whole grain bread.
Swap processed meats, such as ham and salami, for salmon in sandwiches.
Switch out soft drink for sparkling water with added lime, berries and mint.
Try whole grain, seedy crackers with hummus and tomato in place of sweet biscuits as a snack.
This is not to say that we can never have these foods. It is important to take a balanced approach to nutrition, so including these on occasion will not undo what you are doing the majority of a time.
Putting it all together
Following an anti-inflammatory dietary pattern may help support the management of your PCOS symptoms, optimise your fertility and may reduce the risk of developing a number of health conditions which are associated with inflammation, including type 2 diabetes and cardiovascular disease.
There are many steps involved in making these changes, so starting with 1-2 changes can make the change more manageable. For those of you who may be looking for more personalised, 1 on 1 support, Lettuce Talk Nutrition has a limited number of positions for new clients. Fill out our expressions of interest form here.
Gemma is an Accredited Practising Dietitian and founder of Lettuce Talk Nutrition. Gemma is passionate about women’s nutrition and uses a supportive, non-judgemental and holistic approach to nutrition and women’s health. She considers nutrition in combination with lifestyle factors, to find a plan which works for you, your unique needs and goals. Gemma operates an online clinic, supporting clients with polycystic ovary syndrome (PCOS), insulin resistance, endometriosis, gestational diabetes, fertility nutrition and irritable bowel syndrome.
Apply to work with Lettuce Talk Nutrition today: https://www.lettucetalknutrition.com/work-with-us.
Website: https://www.lettucetalknutrition.com/.
Instagram: https://www.instagram.com/lettuce_talk_nutrition/
Get in touch with Lettuce Talk Nutrition today: gemma@lettucetalknutrition.com
References
International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018: https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf
Alesi S, Villani A, Mantzioris E, Takele WW, Cowan S, Moran LJ, Mousa A. Anti-Inflammatory Diets in Fertility: An Evidence Review. Nutrients. 2022 Sep 21;14(19):3914. doi: 10.3390/nu14193914. PMID: 36235567; PMCID: PMC9570802.
Unluhizarci K, Karaca Z, Kelestimur F. Role of insulin and insulin resistance in androgen excess disorders. World J Diabetes. 2021 May 15;12(5):616-629. doi: 10.4239/wjd.v12.i5.616. PMID: 33995849; PMCID: PMC8107978.
Li X, Yang D, Pan P, Azziz R, Yang D, Cheng Y and Zhao X (2022) The Degree of Menstrual Disturbance Is Associated With the Severity of Insulin Resistance in PCOS. Front. Endocrinol. 13:873726. doi: 10.3389/fendo.2022.873726.
Guasch-Ferré, M, Willett, WC. The Mediterranean diet and health: a comprehensive overview. J Intern Med 2021; 290: 549–566.
Bagheri, S, Zolghadri, S & Stanek, A 2022, ‘Beneficial Effects of Anti-Inflammatory Diet in Modulating Gut Microbiota and Controlling Obesity’, Nutrients, vol. 14, no. 19, p. 3985, accessed from <http://dx.doi.org/10.3390/nu14193985>.
Jacka, F.N., O’Neil, A., Opie, R. et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med 15, 23 (2017). https://doi.org/10.1186/s12916-017-0791-y
McDonald D, Hyde E, Debelius JW, Morton JT, et al. American Gut Consortium; Knight R. American Gut: an Open Platform for Citizen Science Microbiome Research. mSystems. 2018 May 15;3(3):e00031-18. doi: 10.1128/mSystems.00031-18. PMID: 29795809; PMCID: PMC5954204.
Yang K, Zeng L, Bao T, Ge J. Effectiveness of Omega-3 fatty acid for polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol. 2018 Mar 27;16(1):27. doi: 10.1186/s12958-018-0346-x. PMID: 29580250; PMCID: PMC5870911.
Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Protein intake and ovulatory infertility. Am J Obstet Gynecol. 2008 Feb;198(2):210.e1-7. doi: 10.1016/j.ajog.2007.06.057. PMID: 18226626; PMCID: PMC3066040.
Bogani P, Galli C, Villa M, Visioli F. Postprandial anti-inflammatory and antioxidant effects of extra virgin olive oil. Atherosclerosis. 2007 Jan;190(1):181-6. doi: 10.1016/j.atherosclerosis.2006.01.011. Epub 2006 Feb 20. PMID: 16488419.
Tristan Asensi, M, Napoletano, A, Sofi, F & Dinu, M 2023, ‘Low-Grade Inflammation and Ultra-Processed Foods Consumption: A Review’, Nutrients, vol. 15, no. 6, p. 1546, accessed from <http://dx.doi.org/10.3390/nu15061546>.