How Nutrition Can Help With PCOS

With Rachel Brief, MS, RDN

Experts estimate that around 15% of women or people assigned female at birth have Polycystic Ovarian Syndrome (PCOS). PCOS is a hormonal imbalance that causes irregular periods, weight gain, insulin resistance, and fertility struggles. In fact, many health professionals believe PCOS to be the leading cause of infertility in women. While there is currently no cure for PCOS, targeted nutrition care has emerged as a way to ease the effect of PCOS symptoms. At Culina Health, we have many providers who specialize in the treatment of chronic conditions. Rachel Brief, MS, RDN, is a Registered Dietitian on our team who has deep experience understanding how nutrition can help with PCOS.

About Rachel Brief, MS, RDN specializing in PCOS

How did you come to specialize in PCOS?

After only a few months of counseling women in private practice, it became clear that many of them were struggling with similar symptoms—weight gain, insulin resistance, elevated triglycerides, infertility, and hormonal acne. In graduate school, PCOS education was nothing more than half a page in an Endocrine chapter. I quickly became fascinated with women’s health, and specifically managing PCOS.

What can a new patient with PCOS expect from working with you?

Personalized care. Personalization is the cornerstone of how I practice nutrition. Every patient that I see requires slightly different care and has individualized needs, so I spend a lot of time getting to know who’s in front of me and creating a bespoke nutrition guide that meets their unique goals. While people may be dealing with the same condition, they have different lived experiences and different preferences— from dietary preferences to cultural traditions to different daily routines. While there is certainly great research and evidence supporting best interventions for PCOS support, nutrition care is never one-size-fits-all.

 Working with a Registered Dietitian on PCOS

What makes PCOS so insidious as a chronic condition?

First and foremost, PCOS is a women’s health issue. The healthcare system tends to dismiss or misdiagnose women—or tell them their symptoms are actually anxiety, Irritable Bowel Syndrome (IBS), or to exercise more or lose weight. It makes women feel unheard, unseen, ignored and crazy when they’re just looking for help to feel their best. Often, patients suffer from many symptoms they don’t realize are connected.

Furthermore, women of color suffer from PCOS at higher rates, and disproportionately experience infertility, metabolic syndrome, and insulin sensitivity or insulin resistance. They’re not only dealing with the insidious dismissal of women’s health from the medical community—they’re also dealing with the institutional racism that continues to plague the healthcare space. Could you imagine if men had a condition that was the top cause of infertility, caused acne, stubborn obesity and irregular periods? PCOS affects 15% of women in the reproductive age but it’s probably higher since about 70% of cases are misdiagnosed or undetected. This is one reason why PCOS is called “a silent epidemic.” I love helping my patients identify and understand their root cause, understand symptom management, and finally have their concerns taken seriously.

What are the most common goals or challenges your patients with PCOS face?

Common goals many of my PCOS patients have are weight loss and to feel better in their body, addressing insulin resistance, and getting pregnant. 

The biggest challenge many of my patients face is managing expectations when it comes to results. Treating PCOS is all about slow and sustainable changes that someone can stick to throughout their entire life. Oftentimes, patients will start feeling better nearly instantly (better in their body, better bowel movements, decreased cravings). But sustainable, realistic and permanent changes in body composition, insulin levels, and lab work takes more than a handful of weeks. My advice is to stay consistent, stay curious in terms of what works for your body, and try to remain excited because if we’re working together (or if you’re receiving nutrition coaching or counseling elsewhere), you are in excellent hands and are sure to see results.

What is PCOS-related insulin resistance and how does it impact nutrition?

A main PCOS symptom is insulin resistance. When we eat carbs our body breaks them down into glucose. Glucose stimulates our body to release insulin from our pancreas. The job of insulin is to carry the glucose through the bloodstream into the cell, where our cells take it in for energy. Insulin resistance means the glucose can’t go into the cells. The cell is resistant to that insulin. So therefore there’s an increase of insulin and glucose in the bloodstream. That elevated insulin can do a few things:

• Excess glucose in the blood can be converted and stored as fat, leading to excess weight gain
• High insulin levels can stimulate androgen secretion which can lead to irregular periods, acne, extra facial and body hair, and hair loss.

Nutrition care is a proven way to treat insulin resistance, and an RD can create special meal plans and guides for you to slow the release of glucose into your bloodstream and keep your energy levels balanced.

Rachel’s words of wisdom for people with PCOS

What are three steps every person with PCOS should take to optimize their diet and ease symptoms?

1. Create your team to make sure you always have a network of support and care. Some folks I recommend working with include:
   • A registered dietitian, ideally a PCOS specialist, to help you personalize your nutrition approach to PCOS management and hormonal balance.
   • An endocrinologist or gynecologist that makes you feel seen and heard—this is because bi-annual lab-work is crucial to understanding what’s going on in your body, and whether medication may be appropriate for you. Ideally, this is a specialized physician who understands the female body, understands the range of symptoms that PCOS includes, and knows how to warmly support you.
   • A therapist, because mental health and managing stress is extremely important for symptom relief—and because a side effect of PCOS is mood imbalance. 
   • An exercise community (a trainer, a gym, an accountability buddy) that makes regular movement enjoyable and attainable for you.
2. Up your lean protein and fiber intake to promote satiety, balance your blood sugar, and help you stay fuller for longer. A diet rich in lean protein and dietary fiber, as well as healthy fat, helps my patients who want to address PCOS-related weight gain, or stay at a healthy weight, as well as those experiencing insulin resistance. Book a session with me to learn more about the properties of  fiber and protein in the PCOS diet. 😀
3. Optimize sleep, because getting a good, uninterrupted 7-8 hours is medicine and is the foundation for great health. From energy levels, to reduced stress to weight loss, and insulin resistance—there are so many benefits specific to PCOS support. BTW, night owls—there is research that we get our best sleep from 10pm to midnight so going to bed on the early side is ideal. 

What’s one myth or common misconception around PCOS and nutrition that you want to dispel?

There’s a misconception out there that every PCOS patient needs to avoid carbohydrates, full stop. While it’s important to manage carbohydrate intake, you certainly don’t need to cut them out of your diet altogether. I recommend opting for fiber-filled carbohydrates. Think berries, apples, kiwis, starchy vegetables like whole potatoes (with skin on!) legumes, and limiting refined carbohydrates such as white breads, white pastas, and baked goods..  

The added fiber in your carbs will help blunt that rush of sugar into your bloodstream, and instead give us small waves when it comes to our blood sugar curve which is ideal for people with PCOS. Versus the peaks and valleys which can result from high intake of those refined and processed carbohydrates.

What’s one thing you want someone suffering from PCOS to know?

First of all, know that you’re not alone. The symptoms of PCOS range and vary from patient to patient, and it can be years before a person is diagnosed and properly treated, so therefore PCOS can feel really lonely and isolating. But you don’t need to suffer, PCOS can be managed and well treated so that you can still live your happiest and healthiest life to the fullest.