There is NO “PCOS diet”. Why? PCOS – Polycystic Ovarian Syndrome- does not have just one root cause! There are 4 main “types” of PCOS-and each needs its own nutrition & supplement approach in healing. There is not a “one size fits all” approach.
What is PCOS? PCOS is a condition that can affect a woman’s menstrual cycle, causing loss of, or abnormal cycles. It is diagnosed based off a symptom list of the Rotterdam criteria. In conventional medicine, it’s diagnosed when at least 2 of these symptoms are present: loss or abnormal of menstrual cycle, hyperandrogenism, or polycystic ovaries found on ultra sound.
Why is this troublesome? It puts people into a box they may not fit in! Truth is, polycystic ovaries are found naturally in women as follicles grow, and just losing your cycle doesn’t mean you have the androgen based, insulin resistance type of PCOS. Which is where you see the common “PCOS diets” lie- suggesting to eliminate carbs, fruits, etc. No bueno. The type of PCOS that you have, and your own symptoms, need an individualized approach. Not all people with PCOS have insulin resistance, and not all people with PCOS have high testosterone. PCOS is not one diagnosis with one set of labs and symptoms- as it is diagnosed based off the Rotterdam criteria, more symptoms, and more problems, can be present, and the diagnosis does not address the the root problem.
What are the 4 types of PCOS?
- Insulin Resistant PCOS: high fasting blood glucose & hgA1c can help diagnose this. In this case, monitoring and balancing blood sugar, using complex carbs vs simple, reducing added sugars, increasing fiber, and focusing on a higher fat, lower carb approach is best. Many women benefit from weight training & cortisol support- which plays a role in blood sugar balance. Supplements I commonly use with this type include: Myoinositol, Berberine, Magnesium, Chromium
- Post- Pill PCOS: loss of or abnormal cycles up to 1 year post stopping birth control is where this category sits. IN this case, ladies can have altered liver or gut health, nutrient deficiencies (that BC can deplete) and their hormones may be not regulating themselves again just yet- as BC surpasses your body’s production. I commonly see women with high testosterone in this case or low progesterone. Supplements commonly used: Multivitamin, Zinc, Magnesium, B6, Myoinositol, Vitex, N-acetyl-cysteine or Milk Thistle, Omega- 3’s
- Adrenal PCOS: adrenal dysfunction is often seen in this case, and this is where I classify Hypothalamic amenorrhea (which is commonly misdiagnosed as PCOS!). Too low of food, too high of workouts or cardio, chronic stress, and cortisol dysregulation are seen with this type. Tired & wired at night? Blood sugar swings? Waking up wide awake for hours at night? Adrenals needing love! Focus here is on stress reduction, ensuring enough energy availability, and balancing blood sugar. Common supplements for this type include: adaptogens, multivitamin, myoinositol, phophatidylserine, magnesium
- Inflammatory PCOS: in this case, inflammation may be from the diet (food intolerance or infection), environment (xenoestrogens), or chronic diseases such as Hashimoto’s or Rheumatoid arthritis. Joint/muscle pain? Headaches? Chronic bloating? Skin issues? Inflammation may be the issue. Common supplements for this type: Omega 3’s, Curcumin, Multivitamin, Berberine or antimicrobial in infection is present, N-acetyl-cysteine or milk thistle, ginger.
Though there are 4 main types of PCOS- don’t box yourself into either type. The best thing you can do is TEST, don’t GUESS. That’s where I use and recommend the Dutch Test (contact me if you need help!)- in which we can check your hormones, and if digestive issues are present, dive into digestive symptoms with possible testing. I ALWAYS suggest checking a comprehensive metabolic panel regardless, and the thyroid as PCOS and thyroid issues can go hand in hand (see more about the thyroid, Hypothyroidism and Hashimoto’s here). Common nutrition deficiencies must also be addressed, as a deficiency can be itself a root cause.
What is the DUTCH test? The DUTCH is a dried urine, in home hormone and cortisol test. This differs greatly than blood general lab tests for hormones, because it allows the metabolites and conversion pathways to be seen. For example, the DUTCH allows me to see if someone has a lagging COMT pathway, which is essential for Phase 1 to Phase 2 estrogen detoxifcation. Lag in the COMT pathway can lead to recirculating estrogen in the body, contributing to estrogen dominance (think heat flashes, weight gain, breast lumps, mood swings, bad PMS). The DUTCH complete checks for only hormone & hormone metabolites, while the DUTCH Plus includes cortisol testing. High or low cortisol can be a key contributing factor to adrenal PCOS, blood sugar imbalances, and too high or low can influence your metabolism and weight gain.
The results include:
• Analysis of 35 different hormones: estrogen, progesterone, testosterone, DHEA-S, and cortisol along with their metabolites, plus the cortisol awakening response (CAR)
• Graphical representation of results and embedded video tutorials to assist in the hormone assessment to share with your medical provider
• DUTCH OATs: Melatonin (6OHMS), 8-Hydroxy-2-deoxyguanosine (8-OHdG), and six organic acid tests (OATs) including markers for vitamin B12 (methylmalonate), vitamin B6 (xanthurenate), kynurenate, glutathione (pyroglutamate), dopamine (homovanillate), norepinephrine/epinephrine (vanilmandelate).
Whether your diagnosis is PCOS or just a menstrual cycle irregularity, always make sure to work with someone like me who can help you with YOUR root cause and plan YOUR set treatment. Don’t fall into the “grouped PCOS” coaching pitfalls. You aren’t PCOS- you HAVE a FORM of PCOS (;
Here’s to spreading the truth about the PCOS “diet”!
Lacey Dunn, MS, RD, LD, CPT