In this article, we share the must-know information on PCOS nutrition therapy from our PCOS nutrition course for dietitians.

PCOS is the most common endocrine disorder amongst people with ovaries of reproductive age. There is an estimated global prevalence of 3-10% of the world’s population (1). Consequently, no matter where you work, you will likely encounter PCOS.

Learn more about PCOS, build your expertise, and access resources and PCOS diet pdfs with our PCOS nutrition course, created with support from Trista Chan, RD, MHSc of The Good Life Dietitian.

Importance to Dietitians

Firstly, people with PCOS face very unique challenges, such as:

• • Weight fluctuations

• • Fatigue

• • Increased risk of type-2 diabetes

• • Metabolic syndrome

• • Mood disorders, like depression and anxiety

• • Disordered eating, and commonly, binge eating disorder

Sadly, often patients with PCOS come to a dietitian, feeling beaten down by the healthcare system having endured years of weight stigma, weight discrimination, and lack of information and support. 

With this in mind, dietitians can help reduce the risk of developing some of these additional conditions.

PCOS Nutrition Therapy

Markedly, diet and lifestyle modification is the primary treatment approach for PCOS.

However, an international study on over 1300 people with PCOS found that only 25% were satisfied with the information that they received about lifestyle modifications (2).

Unquestionably, this speaks to the lack of support related to PCOS and the need for more dietitians to provide evidence-based nutrition recommendations and guidance. 

What is PCOS?

Basically, PCOS is defined as an endocrine disorder characterized by high levels of androgens (hormones like testosterone), irregular menstruation and or cysts around the ovaries (3). 

The exact cause is unknown, although research so far indicates that it is a mix of genetic and environmental factors (3). It is important to reassure clients that with PCOS that they are not to blame for this condition.

Above all, you can’t ‘move’ or ‘eat’ your way into PCOS. 

 

Diagnostic Criteria for PCOS

The diagnostic criteria for PCOS are called the Rotterdam Criteria (3). To be diagnosed with PCOS, someone must have two out of the three of the Rotterdam criteria, i.e. 

• Oligoovulation or Anovulation
• Biochemical or clinical signs of hyperandrogenism
• Polycystic ovaries

Consequently, PCOS can look different for every person. 

 

Signs and Symptoms of PCOS

The clinical signs and symptoms can be very distressing for individuals with PCOS, particularly if its taken them a long time to get a diagnosis, for example (3):

• Acne
• Hirsutism (excess hair growth)
• Alopecia
• Skin tags
• Dark patches of skin
• Subfertility

Insulin Resistance and PCOS

Insulin resistance is very common in PCOS (4), because of this, much of the treatment for PCOS is aimed at reducing overall insulin in the body.

We don’t know what causes insulin resistance in the first place and there is no specific research that tells us at this point. However, we do know that it might be linked to chronic inflammation, which is very often found in individuals with PCOS (4). 

The PCOS nutrition course, included in your DSC membership, summarizes evidence-based interventions for PCOS management including increasing low glycemic index and anti-inflammatory foods. 

 

Weight Challenges with PCOS

Weight will undoubtedly come up as you are working with clients who present with PCOS. Often, the first thing a physician will tell their patient is to “just lose weight” without receiving any follow-up information or support. 

Subsequently, many people with PCOS will take matters into their own hands and do tons of research, much of which is not necessarily evidence-based. Consequently, it’s essential for dietitians to be part of this conversation. 

Further, weight loss is even more challenging for individuals with PCOS, many factors contribute to weight, outside of intake or lifestyle, such as: 

• • Genetic predisposition to weight gain

• • Insulin Resistance and Hyperinsulinemia, which is independent of BMI (5)

• • People with PCOS may have a lower BMR compared to those without (6)

• • Extreme food cravings

So, it’s not as simple as “just losing weight”, and this can lead to intense frustration for people with PCOS. Anxiety and depression rates are high in people with PCOS (7). Likewise, one study on 455 women with PCOS found that 60% had binge eating disorders (8).

 

PCOS Medical Nutrition Therapy

Registered Dietitians play a central role in the interdisciplinary healthcare team for PCOS. 

A 2019 study on over 1000 women with PCOS found that the majority of women don’t follow any specific nutrition guidelines for PCOS management, while over half follow restrictive diets (11).

Plenty of individuals rely on the internet for diet advice and a small percentage follow diets provided by their medical doctor. 

This also highlights an opportunity for dietitians to be present when clients seek health information online. The more evidence-based practitioners who are sharing high-quality content on platforms like blogs, Instagram and other social media sites, the better. There’s still a need for this information.

 

Goals of PCOS Nutrition Therapy

The goals of medical nutrition therapy for PCOS, in order of importance and impact, are:

• Stabilizing blood sugars, which helps address insulin resistance commonly found in PCOS
• Reducing androgens like testosterone
• Reduce inflammation
• Symptom Management such as extreme cravings, acne, excess hair growth and fatigue

 

So, how exactly do we achieve these goals? 

The main interventions commonly used for PCOS nutrition therapy include:

• • Adjusting macronutrient distribution

• • Emphasizing low GI carbohydrates

• • Increasing omega-3

• • Emphasizing anti-inflammatory foods to address chronic inflammation

• • Increasing frequency of meals

• • Mindful eating, as sporadic eating and dieting behaviours are very common

• • Supplements to address insulin resistance and androgen levels, including:
    • • Inositol and N-Acetyl Cysteine (NAC for PCOS)

• • Supplements to correct any nutritional deficiencies

 

PCOS Nutrition Course

We dive into each of these in more detail in the DSC PCOS nutrition course. We include specific recommendations, including ideal macronutrient ranges, omega-3 and supplement dosages and more. You also get instant access to PCOS resources for dietitians including a summary sheet, chart note summary and supplement guide. As well as client-facing PCOS diet pdfs including: 

• • Hunger & Fullness Scale

• • Client Facing PCOS Fact Sheet

• • Low Glycemic Index Foods 

• • PCOS Anti-inflammatory Foods 

• • PCOS Snacking Guide 

• • Omega-3 Foods 

• • Food & Mood Diary

• • Mindful Eating Handout

 

Summary

To summarize, PCOS is an endocrine disorder that can cause a variety of distressing symptoms. Registered Dietitians play a central role in the interdisciplinary healthcare team. Dietary strategies can improve the quality of life of people living with PCOS and as diet and lifestyle modification is the primary treatment approach, it is important for RDs to feel confident with nutrition therapy for PCOS.

At DSC, we make it easier for dietitians and dietetic students to build expertise in topics including PCOS. Our PCOS nutrition course, ready-to-use client handouts, and community can help you feel more confident with nutrition counselling and medical nutrition therapy for PCOS.

Dietitian Success Center is THE professional development resource for dietitians and dietetic students. Our mission is to make it easier for dietitians and dietetic students to build expertise. We do this through evidence-based online nutrition courses, community and ready-to-use client handouts. Plus – we give you the tools to start and grow your dietitian private practice! 

 

References:

1. Wolf, W. M., Wattick, R. A., Kinkade, O. N., & Olfert, M. D. (2018). Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity. International journal of environmental research and public health, 15(11), 2589. https://doi.org/10.3390/ijerph15112589

2. Melanie Cree-Green, Worldwide Dissatisfaction With the Diagnostic Process and Initial Treatment of PCOS, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 2, 1 February 2017, Pages 375–378, https://doi.org/10.1210/jc.2016-3808

3. Tracy Williams, Rami Mortada, Samuel Porter. (2016, July 15). Diagnosis and treatment of polycystic ovary syndrome. AAFP American Academy of Family Physicians. https://www.aafp.org/afp/2016/0715/p106.html#abstract

4. Grassi A. (2020). PCOS: The Dietitian’s Guide. ISBN: 9780985116422

5. Marshall, J. C., & Dunaif, A. (2012). Should all women with PCOS be treated for insulin resistance?. Fertility and sterility, 97(1), 18–22. https://doi.org/10.1016/j.fertnstert.2011.11.036

6. Georgopoulos, N. A., Saltamavros, A. D., Vervita, V., Karkoulias, K., Adonakis, G., Decavalas, G., Kourounis, G., Markou, K. B., & Kyriazopoulou, V. (2009). Basal metabolic rate is decreased in women with polycystic ovary syndrome and biochemical hyperandrogenemia and is associated with insulin resistance. Fertility and Sterility, 92(1), 250–255. https://doi.org/10.1016/j.fertnstert.2008.04.067

7. Blay SL, Aguiar JV, Passos IC. Polycystic ovary syndrome and mental disorders: a systematic review and exploratory meta-analysis. Neuropsychiatr Dis Treat. 2016 Nov 8;12:2895-2903. doi: 10.2147/NDT.S91700. PMID: 27877043; PMCID: PMC5108561.

8. Jeanes YM, Reeves S, Gibson EL, Piggott C, May VA, Hart KH. Binge eating behaviours and food cravings in women with Polycystic Ovary Syndrome. Appetite. 2017 Feb 1;109:24-32. doi: 10.1016/j.appet.2016.11.010. Epub 2016 Nov 4. PMID: 27825940.

9. Venditti, E. M., Wing, R. R., Jakicic, J. M., Butler, B. A., & Marcus, M. D. (1996). Weight cycling, psychological health, and binge eating in obese women. Journal of Consulting and Clinical Psychology, 64(2), 400–405. https://doi.org/10.1037/0022-006X.64.2.400

10. A Trentham-Dietz, HB Nichols, JM Hampton, PA Newcomb, Weight change and risk of endometrial cancer, International Journal of Epidemiology, Volume 35, Issue 1, February 2006, Pages 151–158, https://doi.org/10.1093/ije/dyi226

11. Pirotta, Stephanie et al. “Disordered Eating Behaviours and Eating Disorders in Women in Australia with and without Polycystic Ovary Syndrome: A Cross-Sectional Study.” Journal of clinical medicine vol. 8,10 1682. 14 Oct. 2019, doi:10.3390/jcm8101682