Nutrition & PCOS: The challenges of clean eating

Polycystic ovary syndrome (PCOS) is a chronic condition, but symptoms can largely be managed through lifestyle adjustments including nutrition, movement, stress management, and sleep. If you have been diagnosed with PCOS, this is most likely not news to you! These factors go hand in hand with each other and balancing them all is no easy task. Being able to live in a way that supports PCOS requires additional resources that can be both costly and time consuming. For this particular article, we want to discuss how eating in a specific way that helps manage symptoms is a luxury not everyone has.

As mentioned, nutrition is an important component when it comes to PCOS.  Research has shown eating foods that help to stabilize blood sugar and lower inflammation has been proven to improve PCOS symptoms, but there is no “perfect diet” that fits all of our bodies and circumstances. 

It is likely that at some point, a medical provider, friend, or the internet has recommended adopting a specific way of eating including plant-based, keto, low-carb, gluten-free, dairy-free, or a combination of these diets. The evidence on these diets is mixed but PSA: eliminating entire food groups is not an approach that works for everyone (more on that later!). How you choose to nourish your body is entirely your decision and we aim to provide you with the proper education to make the best choice for yourself.

With that being said, sustaining your body in a manner that supports PCOS comes with its own set of challenges, especially if you have specific food sensitivities or allergies and are also on a budget. In this article we are going to take a closer look at those obstacles and review the following topics: 

• What is considered healthy? What is “clean eating”?
• What are the recommended diets for people with PCOS and what is the evidence behind them? How does “clean eating” fit into these diets?
• Is clean eating a privilege?
• How can you nourish your body in a way that is sustainable for your body, mind, and finances? 

Healthy vs. clean eating

What exactly does “healthy” mean?

Before we dive into the accessibility of healthy eating, what exactly is a “healthy” diet? 

To help answer this question, we will turn to the general MyPlate guidelines provided by the USDA. MyPlate was introduced in 2011 and gives recommendations for which food groups to include in a healthy diet and how many calories should be consumed. 

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As seen above, the five main food groups include fruits, vegetables, grains, protein, and dairy. MyPlate recommends making half your plate fruits and vegetables (focusing on whole fruits and a variety of vegetables), making half your grains whole grains, choosing a variety of protein sources, and consuming low-fat or fat-free dairy milk, yogurt or fortified soy alternatives. To determine your recommended caloric intake, you can get a personalized MyPlate Plan based on your age, sex, height, weight, and physical activity level by visiting the MyPlate website.

While these recommendations can serve as a guide, they are not always realistic. A study shows that following MyPlate guidelines with mostly fresh fruits and vegetables would cost a family of four approximately $1,249 a month (1) and as a result, it can be difficult for many individuals to comply with those guidelines. Especially those with dietary restrictions.

Furthermore, there is no “perfect diet” that universally works for all people. While following the MyPlate suggestions may work well for some individuals, others may find that a diet without dairy or higher in fat helps them feel their best. That’s why we are huge advocates for a personalized approach when it comes to your nutritional needs!

What is clean eating?

While its exact definition may mean something different depending on a person’s dietary beliefs, at its core, clean eating is a way of nourishing your body that improves and/or maintains your health and overall wellbeing. Basically, feed your body with a variety of foods as close as possible to their natural state and limit processed items (2). Although this seems pretty straightforward and most medical providers would favor this way of nourishment, it has become an umbrella term for many different styles of eating and can be taken too far. 

Variations of clean eating may include eliminating certain foods or food groups or placing extra emphasis on opting for organic, locally-sourced groceries. Based on the broad definition of clean eating, you do not need to do this in order to “eat clean,” despite what is typically shown in the media.  

When it comes to chronic conditions like PCOS, there are many opinions about what the best way to eat is - all of which can be framed as clean eating, which can be overwhelming and frustrating to weave through. While we do not believe that there is a one-size-fits-all way to eat for PCOS, there are several main dietary mindsets that research shows can be helpful for this hormone imbalance.

PCOS and clean eating: What the research says about specific diets

Dietary modifications are highly recommended to individuals with PCOS since food is an environmental factor most individuals can control. Even so, the jury is still out on which dietary modifications are the best for managing PCOS due to the complexity of the condition and how drastically different symptoms can manifest from person to person. 

It is also important to point out that when we say “diet,” we are referring to a way of eating rather than a way to lose weight quickly. Research has shown that size is not the best indicator of health and crash diets that limit calories are extremely likely to backfire over time (3). However, if weight loss is a goal for you, finding a sustainable and joyful way of eating and movement is key! If you find that pursuing any sort of structured way of eating triggers unhealthy thoughts and behaviors about food and your body, be sure to bring this up with someone you trust and consider seeking out a practitioner who can help you adopt a Health At Every Size (HAES) or intuitive eating mindset. 

With that in mind, here are a few ways of eating that have been most recommended to people with PCOS.

Low-carbohydrate 

There have been many studies conducted to examine the relationship between lowering carbohydrate intake and PCOS. There are several different ways you can follow a low-carb diet, but this type of eating typically limits carbohydrate intake and focuses more on protein and non-starchy vegetables (4).  Research has shown this diet can improve pregnancy rates, reduce miscarriages, and optimize ovulation function when conducted in a clinical setting (5). However, there is still uncertainty how long-term abiding by a diet that is significantly low in carbohydrates such as keto impacts the PCOS community, particularly those who do not struggle with insulin resistance.

Anti-inflammatory diet 

Within PCOS populations, current research suggests people who follow an anti-inflammatory diet for at least 3 months show significant improvements in cholesterol, blood pressure, and inflammatory markers. This overall style of eating focuses on whole foods, legumes, fatty fish, and fiber and limiting processed items like fried foods, processed meats, pastries, and processed oils (6). This way of eating is very similar to the Mediterranean Diet, which is a popular style of nourishment for people who live near the Mediterranean sea. 

The DASH Diet 

Next, there’s the DASH  (dietary approaches to stop hypertension) diet, which  is designed to be rich in fruits, vegetables, and whole grains while being low in cholesterol, saturated fats, and sweets (7). It is quite similar to an anti-inflammatory way of eating, but with a specific focus to manage hypertension.

Although there is evidence that shows the DASH Diet can improve insulin resistance and inflammatory markers, more current research on this style of eating is needed. Evidence suggests that within PCOS populations, people that follow the DASH diet showed significant improvements in insulin resistance and inflammatory markers (7). 

Gluten-free 

It is suggested that daily consumption of wheat and gluten products can worsen chronic inflammation and autoimmune diseases, which is why it is a diet of interest to people with inflammatory PCOS. While there is a chance that eliminating gluten intake could lessen inflammation,the evidence that gluten directly impacts PCOS is lacking and more research is needed for conclusive findings (8). 

If you suspect you have a gluten sensitivity, it can be helpful to get tested for Celiac disease and consider trying an elimination technique with the guidance of a healthcare provider to find the root cause of your triggers. 

Dairy-free 

Dairy has often been researched with its relation to acne and increased androgen production. People with PCOS may see increased androgen and insulin production and for these reasons, people often want to avoid dairy. However, dairy provides a lot of nutrients and is particularly important for maintaining strong bones and fighting off disease (9). 

Research shows that females specifically need a diet rich in calcium and vitamin D. It has been shown that people with PCOS also tend to have a deficiency in vitamin D which can increase insulin resistance and other symptoms associated with PCOS. We talk more about why vitamin D and calcium are important for PCOS here.

There has not been strong evidence that shows improved symptoms by removing dairy products. Of course, if you have a milk allergy or are lactose intolerant, you may need to avoid dairy altogether. Again, moderation is key and you do not have to be unnecessarily restrictive!

Plant-based 

A plant-based diet is often a suggestion for lessening or managing symptoms for many conditions, including PCOS. By no means is a plant-based approach a “cure-all,” but there is research suggesting it may be better than a low carbohydrate or low-calorie diet approach. The focus of a plant-based diet is to shift the plate more towards whole foods balanced with grains, fruits, vegetables, and plant derived proteins. It shares a few similarities and benefits with an anti-inflammatory style of eating, but with no animal products. 

Soy-free 

And here comes the soy debate! There has been a lot of misinformation surrounding soy ranging from cancer-causing to throwing hormones off balance. Soy has been researched in metabolic and thyroid disorders, but not much has been conducted with PCOS. With that being said, there is no research suggesting that soy will worsen or cause PCOS. Some research even suggests a diet rich in soy can prevent symptoms associated with menopause and heart disease (10). 

Still uncertain about soy? Try starting with non-processed soy sources like tofu, edamame, and miso. Other soy products are typically processed for dairy and meat alternatives, which can be avoided by obtaining alternative sources of protein and dairy. 

How does clean eating fit into this?

Here’s the thing about clean eating: it is all subjective and has no rules! Although the above styles of eating can all be considered clean eating based on its broad definition, it is important to remember that what maintains and improves your health is highly personal. 

Eating mostly whole foods is a great way to obtain a plethora of both micro and macronutrients that your body requires, which is why it is often recommended. It is a nonrestrictive approach that everyone can follow and adjust accordingly to their own body.

We also want to emphasize that structured eating does not equate to clean eating. You can follow certain dietary modifications and still be missing essential nutrients if your diet is not balanced with a range of quality foods. Clean eating simply helps you rethink your plate to ensure you are consuming nutrient dense foods and that looks different for everyone!

It’s a privilege to eat in a special way for PCOS

However you choose to nourish your body, eating in a way that supports PCOS is not easy! It is impossible to know which style of eating is best for you until you try a few different methods, but these alternative options are not always accessible for everyone. Whether it be cost or availability, there can be several obstacles when it comes to food choices and PCOS. On top of that, it takes time to learn about these different styles of eating and how to plan for them. 

The challenges of obtaining a balanced diet

Eating a balanced diet that incorporates a wide variety of quality macro and micronutrients has been shown to improve PCOS symptoms, but like we keep emphasizing, the quantity of each greatly depends on the individual. 

Although the USDA guidelines are just suggestions, research shows that the average American does not consume enough fruits and veggies (11).  When it comes to specific types of diets like the ones mentioned in the last section or clean eating in general, there are many obstacles that individuals may face. Below are a few areas of accessibility that can make the transition to a healthier lifestyle difficult.

Does it really cost more to be healthy?

This is a loaded question and one that has been long debated, but like with so many areas of wellness, it really depends! There are absolutely ways to maintain a diet of mostly whole foods on a lower budget, but it gets tricky if you have dietary restrictions or have been told to follow a certain diet.  

As we discussed earlier, there are common dietary modifications that are often suggested to people with PCOS including plant-based, dairy-free, and gluten-free. If you are someone who follows one (or more) of these modifications, you know how costly it can be to purchase alternative groceries, dine out, or just enjoy a cup of coffee. 

Additionally, if you look at food cost per calorie, healthy foods tend to cost more as well (12). A study conducted examining the affordability of MyPlate guidelines show that a diet of fresh fruits and vegetables is most expensive, thus supplementing with frozen or canned options could be a more feasible route (1).  

To put it simply, clean eating (whatever that may mean for you) takes effort, time, and money. Despite that, there are still ways to incorporate nutritious foods into your diet. Below are some ways you can make the most out of your grocery runs.

• Plan your meals ahead of time
• Shop seasonally and in bulk (you can always freeze whatever you don’t use!)
• Don’t neglect the canned aisle for nutrient dense foods (canned beans, corn, tomatoes are full of flavor)
• Sign up for store rewards
• Make use of leftovers
• Explore different grocery stores
• Consider growing low maintenance herbs like mint, basil, chives, and rosemary 

Geography, food deserts, and the importance of physical surroundings

In addition to cost, geography can also be a major factor to accessing whole foods. Also referred to as food deserts, this occurs when a supermarket is more than one mile away in an urban area and more than 10 miles away in a rural area for more than a third of the population (13). Based on this definition, approximately 23.5 million Americans live without food security. Although this distance is manageable with a car or even public transit, 2.1 million of people who are in these areas do not have a car or reliable public transportation (14). 

In addition to distance, fresh, quality produce may not be available and is often more expensive because getting food to these regions is costly. This especially impacts low-income families who spend upwards of a third of their income on groceries (1).

Having balanced meals is a major component to managing PCOS, but this is near impossible when your physical surroundings do not allow you to do so. Not having proper nutrition can also trigger and worsen symptoms and create a vicious cycle. Although this systemic issue is a long-term problem that requires long-term solution, there are resources available to help. Click here to learn more about how to access healthy foods. 

Time is a privilege too

Lastly, committing to clean eating takes time and planning. Grocery shopping, planning out meals, prepping food, and educating oneself on all the different diets out there is tedious work. Finding the foods that work for you ultimately requires time through trial and error and we recognize that not everyone has enough free moments outside of work, family, and general activities required for survival that makes eating a specific way attainable.

How to realistically prioritize nutrient-dense food 

If you are facing financial, geographic, and time barriers that make it more difficult to eat a certain way, learning about different diets for PCOS can understandably feel frustrating and impossible. However, there are a few things you can do to obtain a balanced diet:

• Focus on adding whole foods whether it be fresh, frozen, or canned 
• Consider purchasing conventional produce from the Clean Fifteen list when possible and limit non-organic Dirty Dozen purchases. Learn about why here.
• Limit processed meats and buy frozen sources of protein instead 
• Be on the lookout for farm stands for fresh, seasonal produce
• Hydration matters too! Drink enough water, ideally at least half your body weight in ounces per day

References

1. Mulik, K., & Haynes-Maslow, L. (2017). The Affordability of MyPlate: An Analysis of SNAP Benefits and the Actual Cost of Eating According to the Dietary Guidelines. Journal of nutrition education and behavior, 49(8), 623–631.e1. https://doi.org/10.1016/j.jneb.2017.06.005
2. Eileen Dutter, R. D. (2019, September 18). Clean eating: What does that mean? Mayo Clinic Health System. Retrieved June 1, 2022, from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/clean-eating-what-does-that-mean 
3. Strohacker, K., & McFarlin, B. K. (2010). Influence of obesity, physical inactivity, and weight cycling on chronic inflammation. Frontiers in bioscience (Elite edition), 2(1), 98–104. https://doi.org/10.2741/e70
4. Mayo Foundation for Medical Education and Research. (2020, November 18). Can a low-carb diet help you lose weight? Mayo Clinic. Retrieved June 1, 2022, from https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/low-carb-diet/art-20045831 
5. Shang Y, Zhou H, He R, Lu W. Dietary modifications for reproductive health in women with polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol. 2021. doi: 10.3389/fendo.2021.735954.
6. Grassi, A. (2021, October 21). The best diet for managing PCOS symptoms. Verywell Health. Retrieved June 1, 2022, from https://www.verywellhealth.com/what-is-the-best-diet-for-pcos-2616314 
7. Asemi Z, Esmaillzadeh A. DASH diet, insulin resistance, and serum hs-CRP in polycystic ovary syndrome: a randomized controlled clinical trial. Horm Metab Res. 2015;47(3):232-238. doi:10.1055/s-0034-1376990
8. Grassi, A. (2020, October 18). Learn why women with PCOS should try a gluten-free diet. Verywell Health. Retrieved June 1, 2022, from https://www.verywellhealth.com/gluten-and-pcos-is-there-a-connection-2616491#:~:text=There%20is%20no%20evidence%20that%20PCOS%20is%20affected%20by%20gluten%20consumption.&text=Reducing%20gluten%20consumption%20or%20avoiding,all%20women%20with%20the%20disease 
9. Grassi, A. (2022, January 31). It's fine to eat these foods if you have PCOS. Verywell Health. Retrieved June 1, 2022, from https://www.verywellhealth.com/the-biggest-pcos-food-myths-busted-2616311 
10. Grassi, A. (2020, October 18). These are the health benefits of soy for PCOS. Verywell Health. Retrieved June 1, 2022, from https://www.verywellhealth.com/health-benefits-of-soy-for-pcos-4076151 
11. Kimmons, J., Gillespie, C., Seymour, J., Serdula, M., & Blanck, H. M. (2009). Fruit and vegetable intake among adolescents and adults in the United States: percentage meeting individualized recommendations. Medscape journal of medicine, 11(1), 26.
12. Savoie-Roskos, M., Jorgensen, M. A., & Durward, C. (2021, April 13). Does healthy eating cost more? Utah State University. Retrieved June 1, 2022, from https://extension.usu.edu/nutrition/research/does-healthy-eating-cost-more 
13. U.S. Department of Agriculture. (2021, May 24). Food Access Research Atlas. USDA ERS . Retrieved June 1, 2022, from https://www.ers.usda.gov/data-products/food-access-research-atlas/documentation/ 
14.  Ney, J. (2022, January 25). Food deserts and inequality. Social Policy Data Lab. Retrieved June 1, 2022, from https://www.socialpolicylab.org/post/grow-your-blog-community 

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