A Practical Guide for PCOS: Exercise, Nutrition, and Lifestyle

What is the best diet and lifestyle approach to reduce the effects of polycystic ovary syndrome (PCOS)? What type of exercise is best?

Is it possible to maintain normal hormone levels, or do women with PCOS need to maintain a fairly strict diet and lifestyle plan throughout their lives?

PCOS affects 8-13% of women, leading to numerous symptoms that diet and lifestyle can help to correct.

In this blog post, I’ll outline what the most current research suggests for improving how to look, feel, and function better if you’re managing PCOS.

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How Doctors Diagnose PCOS

In women with PCOS, the ovaries produce excessive levels of androgens, the hormones that lead to male sex characteristics. As of yet, doctors don’t know the exact cause.

Women with PCOS may have abnormal levels of numerous sex hormones, including:

  • androstenedione
  • dehydroepiandrosterone (DHEA)
  • DHEA sulfate
  • free testosterone
  • luteinizing hormone (LH)
  • sex hormone-binding globulin
  • total testosterone

Healthcare practitioners use the Rotterdam criteria to diagnose women with PCOS. Two of the following three conditions must be present:

  1. Clinical or biochemical hyperandrogenism (high testosterone)
  2. Oligo- or anovulation (inconsistent or no ovulation)
  3. Polycystic ovaries (cysts on ovaries) on ultrasound

The Androgen Excess and POCS Society suggests that women with high testosterone and either oligomenorrhea or polycystic ovaries should be diagnosed with PCOS.

Obvious PCOS symptoms include:

  • infertility
  • irregular menstrual cycles
  • hirsutism (male-pattern hair growth)

As PCOS progresses, it leads to numerous other health problems.

PCOS, Metabolic Dysfunction, and Other Health Problems

Two physical characteristics most often indicate excessive androgen hormones in women: facial hair growth and excess weight in the midsection.

Weight gain around the midsection creates an “apple shape”  and is often the result of increased visceral fat. Visceral fat causes chronic, low-grade inflammation and significantly increases the risk of cardiovascular disease. 

Though the facial hair may become frustrating to deal with, the visceral fat could lead to life-threatening heart problems. Excess visceral fat also contributes to insulin resistance, which leads to even more visceral fat and total body fat.

Unchecked, insulin resistance leads to type II diabetes and metabolic syndrome.

Women with the disorder (PCOS) are more likely to develop obesity, type 2 diabetes, cardiovascular disease (CVD), non-alcoholic fatty liver disease (NAFLD), and have a greater risk of developing anxiety, depression, and mood disorders.

Shele G, et al.

Aside from the hormonal imbalance itself, women with PCOS are more likely to have mitochondrial dysfunction and defects in skeletal muscle insulin signaling. 

Mitochondria are the powerhouses of your cells, so if they don’t work right, you won’t be able to produce energy efficiently, burn fat effectively, or feel like exercising. 

If your muscle cells become insulin resistant, they won’t store dietary carbs as glucose, which increases blood sugar and triglycerides.

In short, PCOS can lead to several metabolic issues that ultimately make the symptoms worse. However, you don’t need to give in to the condition. You just need to manage it.

Based on the most current evidence, here’s how to do just that.

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PCOS and Exercise

Because of their higher testosterone levels, women with PCOS often build muscle easier. This deters many of them from sticking to a good strength training program.

However, strength training may be the most essential form of exercise for managing PCOS.

Muscle cells become insulin resistant with PCOS. Under normal circumstances, insulin triggers your muscle cells to store glucose, or blood sugar, as glycogen. Doing so helps lower circulating blood sugar and triglycerides.

Because your muscle cells don’t store carbohydrates appropriately, blood sugar remains elevated, causing:

  • a further increase in insulin
  • higher triglyceride levels
  • an increase in free radical production
  • increased fat storage around the liver, leading to non-alcoholic fatty liver disease

Resistance training can help reverse these issues. In addition, the most current evidence shows that progressive resistance training, but not aerobic exercise, helps to normalize testosterone and other androgenic hormones.

exercises that promote muscle growth, particularly of glycolytic, fast-twitch muscle fibers, may result in the utilization of T and lower levels in the blood…Aerobic exercise is unlikely to impact androgens, although closely monitored exercise and/or long-term incorporation of aerobic exercise may provide some benefit.

Shele G, et al.

Though aerobic exercise won’t improve sex hormone levels, it may help by improving fat utilization and inflammation levels, and improving mitochondrial function.

A small amount of research suggests yoga could also be helpful.

Based on the research, I would encourage women with PCOS to follow an exercise program that includes:

  • four strength and conditioning sessions per week with 30-40 minutes of resistance training and 20-30 minutes of aerobic exercise
  • one day of active recovery, meaning 30+ minutes of hiking, walking, biking, etc.
  • one optional day of a yoga session

As for the strength and conditioning work, VIGOR Everyday Athlete, one of my VIGOR Training programs, would be perfect.

PCOS and Nutrition

One of my guidelines for nutrition recommendations is, “Don’t lose muscle.” However, women with PCOS tend to have higher than average levels of muscle mass, or at least an easier ability to build and maintain it.

For that reason, I’m less inclined to stand behind a “1 gram per pound goal bodyweight” of protein recommendation. Shooting for .75-.8 gram per pound goal bodyweight is probably enough. 

That said, an energy-restricted diet seems to be the most effective way to lower weight and improve PCOS symptoms.

A calorie-restricted diet has been mainly used to achieve weight loss in PCOS patients with obesity, and several studies have confirmed the effects of symptomatic improvement along with weight loss.

Kim CH, Lee SH

Because PCOS leads to insulin resistance, a low-carb or ketogenic diet may be helpful, and avoiding processed carbs and sugar is an absolute must.

Some small studies over the past few years point to a ketogenic diet being quite effective for improving hormones and body fat levels in women with PCOS.

Based on the findings of a 2021 study, researchers stated: 

Our results showed that the ketogenic diet inducing therapeutic ketosis, improves the anthropometric and many biochemical parameters such as LH, FSH, SHBG, insulin sensitivity and HOMA index. In addition, it induces a reduction in androgenic production, whereas the contextual reduction of fat mass reduced the acyclic production of estrogens deriving from the aromatization in the adipose tissue of the androgenic excess, with an improvement of the LH/FSH ratio.

Cincinone RI, et al.

In addition to a ketogenic diet, vitamins, minerals, and other supplements may be helpful.

A 2018 review entitled, The effect of nutrient supplementation in the management of polycystic ovary syndrome-associated metabolic dysfunctions: A critical review, made a strong case for the following. You’d cover many of them by taking The Foundational Five.

Though it wasn’t on the list from the review above, research builds a strong case for berberine as well. The researchers of one study, comparing it to metformin, concluded:

Metformin has been used and will continue to be used in PCOS patients. It is the oldest and safest insulin sensitizer for women suffering from PCOS. However, long-term compliance with metformin could be troublesome for some PCOS patients. So, the present study explored two alternative drugs, berberine, and myoinositol. Berberine was associated with an improvement in various measures of insulin resistance that was well comparable to that of metformin. The notable risk factors for metabolic syndrome and cardiovascular disease are increased WC (waist circumference), WHR (waist-to-hip ratio), and a deranged lipid profile. Berberine improved all these parameters, and the data suggest that berberine may have a greater potential to reduce cardiovascular disease risk than metformin in patients with PCOS.

Mishra N, et al.

The authors of a review paper stated the following:

BBR (Berberine), as a multi-target, multi-path plant extract, can interfere with the development of PCOS and related pathological process from many aspects, with less adverse reactions than conventional drugs. It is mentioned in this review that BBR can alleviate IR (insulin resistance), reduce the level of serum androgen, alleviate abnormal lipid metabolism and chronic inflammation.

Zhang S, et al.

Other Lifestyle Factors

In addition to consistently following the exercise and nutrition described above, what else could help you manage PCOS?

This shouldn’t be a surprise, but your quantity and quality of sleep can be a major factor in PCOS management. Insufficient sleep makes you more insulin resistant, more likely to eat poorly, and less likely to exercise. Sleep debt also wreaks havoc on healthy hormone production.

Alcohol should be strictly limited, if not avoided entirely, at least in the early stages of PCOS management. In men, excessive drinking can cause low testosterone, but in women, it can increase it. Not good if you already have elevated testosterone.

Finally, avoid endocrine disruptors, which cause hormone imbalances. These include the Environmental Working Group’s Dirty Dozen, the worst hormone disruptors:

  1. BPA
  2. Dioxin
  3. Atrazine
  4. Phthalates
  5. Perchlorate
  6. Fire retardants
  7. Lead
  8. Arsenic
  9. Mercury
  10. Perfluorinated chemicals (PFCs)
  11. Organophosphate pesticides
  12. Glycol Ethers

Many personal care and cleaning products contain endocrine disruptors. In fact, this realization led my wife to start swapping out the products we used in our home for alternatives from Young Living.

We’ve All Got Issues

I’ve worked with many women in the past who feel like PCOS is an insurmountable burden. But then, I’ve worked with hundreds of other people who each have their individual, genetically-ordained health and fitness obstacles as well.

In reality, very few of us have bodies that work perfectly all of the time. Most of us deal with health challenges throughout our lives. We have a choice to use those challenges as excuses to live lives less than we’re capable of or to put on our big girl or big boy pants and make the most of the bodies we’re dealt with. I hope you’ll choose the latter.

Part of what makes health and fitness fun is that you never arrive. You just keep getting better each week.

If you take on a long-term perspective for managing PCOS, and understand that it’ll be a lifelong challenge, you can look, feel, and perform as well as women without it. The key, though, is that you need to consistently commit to the exercise, nutrition, and lifestyle choices above.

Alesi, Simon, et al. “Nutritional Supplements and Complementary Therapies in Polycystic Ovary Syndrome.” Advances in Nutrition (Bethesda, Md.), Nov. 2021, p. nmab141. PubMed, https://doi.org/10.1093/advances/nmab141.

Burgers, Janneke A., et al. “Oligoovulatory and Anovulatory Cycles in Women with Polycystic Ovary Syndrome (PCOS): What’s the Difference?” The Journal of Clinical Endocrinology & Metabolism, vol. 95, no. 12, Dec. 2010, pp. E485–89. Silverchair, https://doi.org/10.1210/jc.2009-2717.

Cincione, Raffaele Ivan, et al. “Effects of Mixed of a Ketogenic Diet in Overweight and Obese Women with Polycystic Ovary Syndrome.” International Journal of Environmental Research and Public Health, vol. 18, no. 23, Nov. 2021, p. 12490. PubMed Central, https://doi.org/10.3390/ijerph182312490.

Dirty Dozen Endocrine Disruptors | Environmental Working Group. https://www.ewg.org/consumer-guides/dirty-dozen-endocrine-disruptors. Accessed 12 Apr. 2022.

Günalan, Elif, et al. “The Effect of Nutrient Supplementation in the Management of Polycystic Ovary Syndrome-Associated Metabolic Dysfunctions: A Critical Review.” Journal of the Turkish German Gynecological Association, vol. 19, no. 4, Dec. 2018, pp. 220–32. PubMed Central, https://doi.org/10.4274/jtgga.2018.0077.

Kim, Chan-Hee, and Seon-Heui Lee. “Effectiveness of Lifestyle Modification in Polycystic Ovary Syndrome Patients with Obesity: A Systematic Review and Meta-Analysis.” Life, vol. 12, no. 2, Feb. 2022, p. 308. PubMed Central, https://doi.org/10.3390/life12020308.

Mishra, Neha, et al. “Study on the Effect of Berberine, Myoinositol, and Metformin in Women with Polycystic Ovary Syndrome: A Prospective Randomised Study.” Cureus, vol. 14, no. 1, p. e21781. PubMed Central, https://doi.org/10.7759/cureus.21781.

Paoli, Antonio, et al. “Effects of a Ketogenic Diet in Overweight Women with Polycystic Ovary Syndrome.” Journal of Translational Medicine, vol. 18, no. 1, Feb. 2020, p. 104. PubMed, https://doi.org/10.1186/s12967-020-02277-0.

Shele, Grei, et al. “A Systematic Review of the Effects of Exercise on Hormones in Women with Polycystic Ovary Syndrome.” Journal of Functional Morphology and Kinesiology, vol. 5, no. 2, May 2020, p. 35. PubMed Central, https://doi.org/10.3390/jfmk5020035.

Tefagh, Ghazale, et al. “Effect of Vitamin E Supplementation on Cardiometabolic Risk Factors, Inflammatory and Oxidative Markers and Hormonal Functions in PCOS (Polycystic Ovary Syndrome): A Systematic Review and Meta-Analysis.” Scientific Reports, vol. 12, no. 1, Apr. 2022, p. 5770. PubMed, https://doi.org/10.1038/s41598-022-09082-3.

Williams, Tracy, et al. “Diagnosis and Treatment of Polycystic Ovary Syndrome.” American Family Physician, vol. 94, no. 2, July 2016, pp. 106–13. Zhang, Si-Wei, et al. “Effect and Mechanism of Berberine against Polycystic Ovary Syndrome.” Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie, vol. 138, June 2021, p. 111468. PubMed, https://doi.org/10.1016/j.biopha.2021.111468.

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