Improving PCOS using Lifestyle Medicine
By looking at an individual’s root causes and using a whole-body, systems-based approach, it is possible to improve symptoms and restore health. In this blog post, we will discuss how to improve and possibly reverse PCOS symptoms by addressing the foundations of health.
Using food as medicine is paramount in the management of PCOS. The metabolic features intertwined with the syndrome (insulin resistance, dyslipidemia, and obesity) can be controlled and even reversed through diet alone in many cases. Focus on incorporating a variety of vegetables, as they are loaded with vitamins, minerals, phytonutrients, and fiber. Fruits are also great sources of nutrients and should be part of the diet with an emphasis on those with low sugar content like avocados, berries, grapefruit, lemons, limes, and papaya. Other foods to incorporate include nuts and seeds, healthy fats (olive oil, avocado, coconut oil), eggs, and high-quality fish and meat. Your aiming for whole, real foods and lots of plants! It’s imperative to limit highly-processed, inflammatory foods and refined sugar. Furthermore, some women may greatly benefit from eliminating gluten, dairy, and all grains. Finding the foods that work for your body is important since no one diet works for every single person. That is where working with a knowledgeable professional can help.
Exercise improves many health parameters associated with PCOS females. It can help with inflammation, belly fat, insulin sensitivity, and mood1. Seventy-five minutes per week of vigorous exercise (ex: jogging, aerobics, fast cycling) has been shown to significantly improve metabolic health in PCOS patients2. Resistance training is also beneficial in PCOS since it helps improve insulin sensitivity.
Modifying our habits and making healthier lifestyle choices is crucial to overall vitality and lasting health. There are many things that can fit in this category but we’ll focus on just a few here. It’s important to remember that small changes and consistency can lead to big results. It can be overwhelming to overhaul your whole routine or lifestyle, so pick one or two things to focus on at a time.
Sleep: sleep is paramount to feeling and functioning at our best. It’s a fundamental healthy lifestyle habit that can’t be ignored. When we sleep, the body is actually hard at work cleaning and repairing. Not only do we need a certain quantity (an average of 7-9 hours of sleep per night for most adults) but we also need quality sleep (passing through all stages of sleep a few times per night). To read more about the Power of Sleep and get tips on how to get a better night’s sleep, check out this blog post.
Reduce toxic burden: this was mentioned above when discussing EDCs but it is worth mentioning again. The role that environmental toxins, including EDCs, play in disease doesn’t get talked about enough. Research shows that environmental toxins are linked to a plethora of chronic diseases including asthma, obesity, metabolic syndrome, diabetes, endometriosis, autoimmune disease, and cancer. This blog discusses lifestyle modifications you can make to reduce your overall toxin exposure.
Social connections: as humans, we are meant to be in community and connection with others. It is actually vital to survival with research showing that a lack of social connection drastically increases the odds of mortality, even more so than obesity or physical inactivity3. Surround yourself with supportive people and make time to nurture the meaningful relationships in your life. Some ideas on how to connect with others include volunteering, joining a club, trying a new group activity, eating meals in communal spaces, introducing yourself to neighbors, and doing random acts of kindness4.
PCOS women may have exaggerated sympathetic nervous system (SNS) responses and HPA-axis abnormalities. Stress releases cortisol, which increases IR and visceral adiposity (belly fat)1. Regular modalities that lower the sympathetic response and regulate the HPA-axis should be implemented. This includes acupuncture, talk therapy, meditation, yoga, spending time in nature, and social connection. Read more about activating the parasympathetic nervous system here.
There are many supplements that can help with the underlying pathophysiology of PCOS and accompanying symptoms. Of course, supplements should be in addition to, not in place of, the nutritional and lifestyle modifications discussed above. Below we have discussed a few of the more well-known/studied supplements used in PCOS though there are many more that may be helpful.
Inositol, a sugar alcohol, is one of the most common nutraceuticals used in PCOS treatment. Randomized controlled studies of inositol supplementation in PCOS have shown recovery of reproductive abnormalities, decreased androgen levels, and improved insulin levels5. Two forms of inositol, myo-inositol (MI) and D-chiro-inositol (DCI), have synergistic activity when combined and should be administered at the physiological ratio of 40:1 (MI:DCI)6. Typical dosages range from 2-4 grams per day7.
- Omega-3 fatty acids
Omega-3 fatty acids (FAs) are beneficial for a wide variety of health conditions and are well-known for their anti-inflammatory properties. They have shown to improve insulin resistance, dyslipidemia, hyperandrogenism, and regulation of metabolic indicators in PCOS patients8. Typical doses of omega-3 FAs range from 1-4 grams per day and the most common adverse effects are gastrointestinal related (belching, nausea, diarrhea, heartburn).
Magnesium is involved in hundreds of cellular reactions in the body. It plays an important role in insulin metabolism, has a calming effect, and can be used for anxiety and sleep. It is typically taken at bedtime with average doses ranging from 200-600 mg.
- Vitamin D
The role of vitamin D in health and well-being cannot be emphasized enough. One study showed that 60-70% of PCOS patients were deficient in Vitamin D with serum 25(0H) D concentration levels less than 20 ng/ml9. It is advised to get vitamin D levels checked and supplement to an appropriate range (50-70 ng/ml for women with PCOS)1.
Zinc is involved in many processes in the body including follicle development and insulin metabolism. It’s also helpful for intestinal health, immune function, and has anti-inflammatory and antioxidant actions1. Studies have shown that women with PCOS and insulin resistance have lower zinc levels10. Typical doses range from 5-30 mg per day.
Some other supplements to consider include a high-quality multi-vitamin, probiotics, N-acetyl-L-cysteine (NAC), berberine, resveratrol, melatonin, adaptogens, and alpha-lipoic acid. It is advised to work with a functional medicine professional to create a personalized supplement regimen based off your individual PCOS picture.
Using nutrition and lifestyle modifications to reduce insulin resistance, inflammation, stress, and toxins can dramatically improve PCOS symptoms and increase quality of life. Having the guidance of a healthcare professional who’s knowledgeable in the etiology of PCOS and the multiple factors that contribute to its pathology can make all the difference.
Our pharmacists at PharmToTable specialize in functional medicine using a lifestyle-based approach and we also have health coaches on our team who can help you make changes towards improving your health. We’d be honored to help you on the journey of improving PCOS or other endocrine or metabolic condition. Book an appointment or schedule a free 15-minute discovery call today!
Written by Megan Morrison, PharmD
- McCulloch F. 8 steps to reverse your PCOS. Greenleaf Book Group Press; 2016.
- Greenwood EA, Noel MW, Kao CN, et al. Vigorous exercise is associated with superior metabolic profiles in polycystic ovary syndrome independent of total exercise expenditure. Fertil Steril. 2016;105(2):486-493. doi:10.1016/j.fertnstert.2015.10.020
- Yang YC, Boen C, Gerken K, Li T, Schorpp K, Harris KM. Social relationships and physiological determinants of longevity across the human life span. Proc Natl Acad Sci U S A. 2016;113(3):578-583. doi:10.1073/pnas.1511085112
- The importance of human connection. Canadian Mental Health Association, National. October 17, 2019. Accessed March 24, 2022. https://cmha.ca/the-importance-of-human-connection/#_ftn1
- Günalan E, Yaba A, Yılmaz B. The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A critical review. J Turk Ger Gynecol Assoc. 2018;19(4):220-232. doi:10.4274/jtgga.2018.0077
- Wojciechowska A, Osowski A, Jóźwik M, Górecki R, Rynkiewicz A, Wojtkiewicz J. Inositols’ Importance in the Improvement of the Endocrine-Metabolic Profile in PCOS. Int J Mol Sci. 2019;20(22):5787. Published 2019 Nov 18. doi:10.3390/ijms20225787
- Inositol. Natural Medicines Comprehensive Database. TRC Healthcare; Updated December 3, 2021. Accessed March 25, 2022. https://naturalmedicines.therapeuticresearch.com
- Salek M, Clark CCT, Taghizadeh M, Jafarnejad S. N-3 fatty acids as preventive and therapeutic agents in attenuating PCOS complications. EXCLI J. 2019;18:558-575. Published 2019 Jul 25. doi:10.17179/excli2019-1534
- Mishra S, Das AK, Das S. Hypovitaminosis D and Associated Cardiometabolic Risk in Women with PCOS. J Clin Diagn Res. 2016;10(5):BC01-BC4. doi:10.7860/JCDR/2016/19407.7771
- Kanafchian M, Mahjoub S, Esmaeilzadeh S, Rahsepar M, Mosapour A (2018) Status of serum selenium and zinc in patients with the polycystic ovary syndrome with and without insulin resistance. Middle East Fertil Soc J 23:241-245. https://doi.org/10.1016/j.mefs.2017.11.003