This blog post is co-authored by Mia Switzer
Are low carb diets effective for PCOS? Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders, estimated to affect approximately 5-20% of individuals worldwide. It is characterized by a combination of symptoms, including irregular menstrual periods, ovarian cysts, and elevated levels of androgens (male hormones). Additionally, managing PCOS requires most people to focus on regulating blood sugar levels, which is where carbohydrates play a crucial role. Carbs are the body’s preferred fuel source. However, consuming them excessively or in a way that isn’t optimal has the potential to worsen PCOS symptoms.
What are carbs?
Carbs, short for carbohydrates, make up one of the three primary macronutrients alongside proteins and fats. They’re organic compounds that supply energy to the body and are made up of carbon, hydrogen, and oxygen atoms. You can find carbs in grains, fruits, veggies, legumes, and dairy products. They’re a crucial energy source for the body, especially the brain and muscles. However, how you consume them and which type you consume can result in an imbalance of blood sugar levels. This imbalance could lead to worsened PCOS symptoms.
Types of carbs
There are 3 main types of carbs. These types are based on their chemical structure. The types are called simple carbs, complex carbs, and fiber.
Simple carbs
These are composed of one or two sugar molecules, known as monosaccharides (e.g., glucose and fructose) and disaccharides (e.g., sucrose and lactose). Simple carbs are typically found in foods such as table sugar, honey, and fruit juices. These carbs are digested and absorbed quickly by the body.
Complex carbs
These are made up of multiple sugar molecules joined together in a chain, known as polysaccharides. Examples of complex carbs include starch, found in foods like grains, legumes, and potatoes, and dietary fiber, which is found in fruits, vegetables, and whole grains. These carbs take longer to absorb and digest them, making them a more sustainable source of energy.
Fiber
Fiber is a type of carb that the body cannot fully digest or absorb. It passes through the digestive system relatively intact and provides various health benefits, such as promoting digestive health and helping to control blood sugar levels. Dietary sources of fiber include whole grains, fruits, vegetables, and legumes.
Seasonal carbs
Seasonal carbs, although not part of the three carb types, can refer to carbs that are naturally more abundant or commonly consumed during specific seasons or times of the year. Eating seasonally may provide various nutritional benefits since the produce is typically harvested at its peak ripeness and may offer better flavor and nutrient content.
Carbs vs. Net carbs
Carbs and net carbs are terms commonly used in the context of low-carb diets and food labeling. Here’s how they differ:
Carbs
Carbs are the total amount of carbs present in a food or meal. This includes all types of carbs, including sugars, starches, and dietary fiber.
Net Carbs
Net carbs are a calculation that represents the carbs that have a significant impact on blood sugar levels. To calculate net carbs, dietary fiber, and certain sugar alcohols are subtracted from the total carbs in a food. These are subtracted because they have minimal or no impact on blood sugar. The idea behind net carbs is that they provide a more accurate representation of the carbs that affect blood sugar levels and, therefore, have a greater impact on insulin response. Net carbs can be calculated using the following formula: Net Carbs = Total Carbs – Fiber – Sugar Alcohols. For people who are watching their carb intake, especially those with PCOS who monitor their blood sugar levels, understanding the difference between total and net carbs can be beneficial when reading food labels.
Glycemic index vs. Glycemic load
The glycemic index (GI) and glycemic load (GL) are both measures used to assess how quickly and significantly carb-containing foods affect blood sugar levels. However, they differ in their approach:
Glycemic index (GI)
The glycemic index is a numerical ranking system that measures how quickly a carb-containing food raises blood sugar levels compared to a reference food, typically pure glucose or white bread. The GI assigns a value to each food on a scale of 0 to 100. Foods with a high GI (70 or above) are rapidly digested and absorbed, leading to a quick spike in blood sugar levels. Foods with a low GI (55 or below) are digested and absorbed more slowly, resulting in a gradual and steady increase in blood sugar levels.
Glycemic load (GL)
The glycemic load considers a food’s glycemic index and the number of carbs in a typical serving. It provides a more practical measure of the overall impact of food on blood sugar levels. The GL is calculated by multiplying the GI of a food by the number of carbs in a serving and dividing it by 100. This calculation considers both the quality and quantity of carbs in a food. Foods with a low GL (10 or below) have a minimal impact on blood sugar levels, while foods with a high GL (20 or above) can cause a significant increase in blood sugar. In summary, the glycemic index measures the speed of a carb food’s impact on blood sugar, while the glycemic load considers both the speed and quantity of the carbs consumed. GI and GL can be useful tools for managing blood sugar levels in PCOS patients.
Is the low-carb diet the best for PCOS?
The low-carb diet is one of the dietary approaches that may benefit individuals with polycystic ovary syndrome (PCOS). For example, a study of fourteen women following a ketogenic Mediterranean diet for 12 weeks had promising results. They managed their weight better and saw significant decreases in glucose, insulin blood levels, triglycerides, total cholesterol, and hormones related to PCOS. Insulin resistance also improved, and estradiol and progesterone increased (1). However, another study found that despite weight management, fertility parameters, endocrine hormones, metabolic outcomes, and satiety hormones were not further improved on a low-carb diet compared to a standard diet in women with PCOS (2).
Overall, when it comes to making changes to your diet, it’s important to proceed with caution and consider your personal factors and preferences. For instance, a recent study found that women with PCOS face unique physical and psychological challenges, which can affect the success of any dietary changes they make (3). To ensure that you get personalized recommendations and support, it’s best to consult with a registered dietitian or healthcare professional who specializes in PCOS who understands these barriers. They can help you develop a well-balanced eating plan that meets your needs, considers your nutrient requirements, and can be sustained over the long term.
Why you SHOULD eat carbs with PCOS
With all of the messaging about cutting carbs if you have PCOS, I believe it is important to understand how carbs can benefit us. It is essential for individuals with PCOS and those who aim to maintain a balanced diet to consume an adequate amount of carbs. According to a study on PCOS nutritional management, it is recommended that individuals with PCOS opt for a diet that is high in fiber and low in simple sugars and refined carbs rather than completely cutting back on carbs altogether (4). The following are some of the advantages and vital roles that carbs play in the diet of individuals with PCOS:
Energy and Nutrient Source
Carbs are the primary source of energy for the body. They provide fuel for physical activity, brain function, and overall bodily functions. Including carbs in the diet ensures an adequate energy supply to support daily activities and maintain optimal health. Carb-rich foods also provide essential nutrients like fiber, vitamins, and minerals that are important for overall health and well-being.
Hormonal Support
Supporting hormones, particularly insulin, is a key aspect of managing PCOS. Insulin resistance, a common feature of PCOS, can be improved by including the right types and amounts of carbs in the diet. Complex carbs, such as whole grains, legumes, and vegetables, provide a steady release of glucose into the bloodstream, helping to regulate insulin levels and reduce insulin resistance over time.
There are also several diets that may be helpful in reducing insulin resistance, such as the Low Glycemic Index Diet, Mediterranean Diet, DASH Diet, Anti-Inflammatory Diet, and Nordic Diet. However, seeking advice from a registered dietitian or healthcare provider is important before attempting any diet.
Blood Sugar Regulation
While managing blood sugar levels is important in PCOS, completely eliminating carbs from the diet is unnecessary and not recommended for everyone. Choosing carbs with a low glycemic index (GI), which have a slower and more gradual impact on blood sugar levels, can help maintain stable blood sugar levels. This can prevent spikes or crashes in blood sugar, which can negatively affect energy levels, mood, and insulin response. When carbs are paired with other nutrients, especially fats, it can help slow down the absorption of glucose ensuring that your blood sugar levels are steady.
Gut Health and Digestion
Carbs, particularly those high in fiber, are crucial in maintaining good gut health and promoting proper digestion. Fiber-rich carbs help regulate bowel movements, prevent constipation, and support a healthy gut microbiome. This can benefit individuals with PCOS, as gut health is connected to overall hormonal balance and inflammation levels. It’s important to make informed choices about the types and quantities of carbs consumed. Opting for whole, unprocessed carb sources like whole grains, fruits, vegetables, and legumes provides more nutrients, fiber, and health benefits than refined and sugary carbs. Portion control and balance with other macronutrients, such as proteins and healthy fats, are also important considerations.
Considerations when eating carbs with PCOS
Recommended daily carb intake for individuals with PCOS
The recommended daily carb intake for those with PCOS varies depending on individual needs and goals. However, an early study found that lean women and average-weight women with PCOS tended to consume significantly less carbs like bread, cereals, rice, and pasta (5). Furthermore, a recommendation by Dr. Gerald Reaven, a renowned endocrinologist, suggested that those with insulin resistance consume 45% of carbs (6). It ultimately comes down to what works with your body based on recommendations by your personal healthcare professionals and how you feel while changing your carb intake.
Carb cravings with PCOS
Carb cravings can be a common symptom of PCOS, and fluctuations in blood sugar levels or hormonal changes may cause them. For example, a study on binge eating in individuals with PCOS states that intense carb cravings often follow insulin resistance and high insulin as a response to the body’s need to return blood sugar to normal levels. These cravings, in turn, often lead to binge eating and possible weight gain (7).
Cravings for sugary and processed foods can be difficult to resist, but it is important to make food choices that support overall health. Eating small, frequent meals throughout the day can help keep energy levels stable and prevent cravings from occurring. Additionally, including protein-rich foods at each meal can help balance blood sugar levels and reduce food cravings. Eating mindfully, getting enough sleep, and managing stress levels can also help reduce carb cravings.
Finding your carb tolerance
Finding your carb tolerance refers to determining the amount and types of carbs that your body can handle without causing negative effects on your blood sugar levels, insulin response, weight management, or overall health.
Here are some steps to help you assess your carb tolerance:
Consult a healthcare professional
You should consult with a registered dietitian or healthcare professional whenever you are making changes or monitoring your diet, especially those with PCOS. These professionals can provide individualized recommendations and help you find your optimal carb intake.
If you’d like to start receive a tailored approach, learn more here.
Monitor blood sugar levels
You can use a blood glucose monitor to test your blood sugar levels before and after meals with different amounts and types of carbs. This can help you identify how different carbs affect your blood sugar response and can easily be done at home.
Gradually adjust carb intake
Start with a moderate carb intake and gradually increase or decrease it while monitoring your body’s response. Observe how different amounts and sources of carbs affect your energy levels, mood, weight, and overall well-being.
Listen to your body
Be mindful of how your body reacts to different carbs. Notice any symptoms or signs of discomfort, such as bloating, fatigue, brain fog, or cravings. These can indicate whether certain carbs are well-tolerated by your body.
Everyone’s carb tolerance can vary, and finding the right balance requires self-awareness, experimentation, and individualized approaches. It’s important to prioritize whole, unprocessed foods and focus on the quality of carbs rather than solely relying on quantity.
Preparing a meal plan with the right balance of carbs for PCOS
When creating any PCOS-friendly meal, it is important to focus on minimally processed foods and strike a balance between carbs, protein, and healthy fats. I like to use the PCOS POWER PLATE method. It is a simple way to build your meals from anywhere. Start by filling your plate with a protein serving-plant or animal based. Next, you will add your fiber sources which can be fruits, vegetables, grains or starches. I suggest 2 cups of vegetables with each meal and if you’re having a starch you can keep that to one serving per meal. Lastly, let’s add some healthy fats like olive oil, avocados, nuts or seeds. By focusing on whole, nutrient-dense foods and incorporating various colors and flavors, you can create a PCOS-friendly meal plan that supports optimal health and helps manage PCOS symptoms.
Final thoughts
Managing PCOS requires the effective incorporation of carbs into your lifestyle. Every person with PCOS is different therefor, each person will have a different carbohydrate threshold. It is unlikely that you will need to eliminate or drastically restrict your carb intake. By making informed decisions on the type and quantity of carbs you consume, you can reduce insulin resistance and manage PCOS symptoms more efficiently.
References
- Paoli, A., Mancin, L., Giacona, M. C., Bianco, A., & Caprio, M. (2020). Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. Journal of Translational Medicine, 18(1), 104. https://doi.org/10.1186/s12967-020-02277-0
- Frary, J. M. C., Bjerre, K. P., Glintborg, D., & Ravn, P. (2016). The effect of dietary carbs in women with Polycystic Ovary Syndrome: A systematic review. Minerva Endocrinologica, 41(1), 57-69.
- Ee, C., Pirotta, S., Mousa, A., Moran, L., & Lim, S. (2021). Providing lifestyle advice to women with PCOS: An overview of practical issues affecting success. BMC Endocrine Disorders, 21, 234. https://doi.org/10.1186/s12902-021-00890-8
- Faghfoori, Z., Fazelian, S., Shadnoush, M., & Goodarzi, R. (2017). Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11(1), S429-S432. https://doi.org/10.1016/j.dsx.2017.03.030
- Wright, C. E., Zborowski, J. V., Talbott, E. O., McHugh-Pemu, K., & Youk, A. (2004). Dietary intake, physical activity, and obesity in women with polycystic ovary syndrome. International Journal of Obesity, 28, 1026-1032. https://doi.org/10.1038/sj.ijo.0802661
- Reaven, G. (2001). Syndrome x. Current Treatment Options in Cardiovascular Medicine, 3, 323-332. https://doi.org/10.1007/s11936-001-0094-6
- Krug, I., Giles, S., & Paganini C. (2019). Binge eating in patients with polycystic ovary syndrome: Prevalence, causes, and management strategies. Neuropsychiatric Disease and Treatment, 15, 1273-1285. https://doi.org/10.2147/NDT.S168944
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