I Have PCOS. How Should I Fuel?

Between five to 10 percent of women of childbearing age in the United States, or roughly 5 million, have polycystic ovarian syndrome (PCOS). That percentage makes it one of the most common hormonal endocrine disorders in women. The condition, which causes women to produce too many male hormones and not enough female hormones, can affect just about every system in the body if left unchecked, including irregular menstrual cycles, depression, weight gain, increased acne, and infertility.

The number-one prescription for PCOS? Working out. “Exercise is one of the best things a patient with PCOS can do,” says Dr. Kimberly Gecsi, OBGYN at UH MacDonald Women’s Hospital in Cleveland, Ohio. “In conjunction with a healthy diet and medications, it is a very important part of treating the disease.”

Yet it’s not so simple as telling someone with PCOS to go for a run. In fact, some women who turn to running and triathlon to deal with their PCOS find their symptoms get worse, not better. So what gives?

The answer may be in the way the athlete is fueling, says Sheila Leard, RDN, CSSD, CPT, and Board-Certified Specialist in Sports Dietetics. Seventy percent of women with PCOS also have insulin resistance, which is why a major dietary recommendation for those with PCOS is to avoid carbohydrate and sugar. This is at odds with the way most athletes are told to fuel while training and racing. Bars, gels, and chews are often high-carbohydrate sugar bombs–great for quick hits of energy in most people, but less than ideal for an insulin-resistant person, who can’t use glucose from the blood for energy. 

“If insulin resistance is an issue for an athlete with PCOS, then managing blood sugar is important,” says Leard. “High insulin levels can promote sugar cravings and overeating. Also, if a woman is overweight, leptin resistance can develop. This is the hormone that gives the feedback that we are full and satisfied. These hormone imbalances, combined with intense training, creates a double whammy for controlling appetite.”

But fear not–it’s possible for athletes with PCOS to manage carbohydrates and have enough fuel in the tank for training.  

Related: Why Men and Women Shouldn’t Follow the Same Strength Training Plan

Athletes with PCOS: How to Fuel

While training:

Think beyond the bars and gels.
Play around with real-food options, advises Leard: “Fueling a long workout doesn’t have to rely on gels and simple sugars. Try small potatoes, nut butter or homemade energy balls.” 

Drink up.
Hydrate the workout with a low-sugar electrolyte drink. Staying on top of hydration can reduce the chances of over-fueling during the workout. Keeping hydration levels topped off can also help reduce the intensity of cravings after the workout is completed.

Fasting? Not so fast.
For those who are trying to lose weight (or control their weight) caused by PCOS, fasting can seem like a logical option – after all, you avoid sugar and burn more calories, right? Not quite, says Leard, who discourages athletes with PCOS from under-fueling in the quest to lose weight. “Training fasted is not advised because it can increase cortisol, which can contribute to insulin resistance and make weight loss hard to achieve, especially belly fat. You need carbohydrate to train!”

Have a post-workout meal ready to go.
Before you head out the door for a long ride or run, have a healthy meal or snack waiting for you in the fridge. “Post workout fueling is twofold,” explains Leard. “One, it brings down cortisol and two, it prevents you from getting too hungry. Remember, managing blood sugar is paramount, so try to eat within the hour after a long (over 90 minutes) session or intense glycogen-depleting workout.”

Daily Diet:

Up your protein intake.
“In the daily diet, the first step is to include protein with meals,” says Leard. “This slows the rate of the insulin response.” According to a 2012 study published in the American Journal of Clinical Nutrition, replacing carbohydrates with high-quality proteins, such as fish, eggs, and nuts, reduced symptoms of PCOS. 

If you struggle to get in enough protein in your diet, try and make protein the focus of your meals and snacks instead of carbohydrate foods. Eating a high protein breakfast (an omelet for example) is a good way to start the day. 

Know your carbs.
It’s almost impossible to avoid carbohydrates altogether – but it is possible to choose your carbs wisely in your daily diet. “Be mindful of the types of carbohydrates that will cause insulin to rise quickly, such as low-fiber cereals, white bread, sticky rice, cookies and candy bars,” explains Leard. “Instead, seek out carbohydrates packaged naturally with fiber. Fiber creates a sense of fullness so that you are not hungry every two hours. Fiber is also extremely important for contributing to a healthy gut microbiome.”

For this one-two punch of carbs and fiber, Leard recommends selecting foods such as hardy ancient grains, sprouted breads, lentils, beans, vegetables, and whole fruit.

Still hungry? Eat fats.
If hunger continue to persist despite eating protein and higher fiber carbohydrates, then try increasing healthy fats such as avocadoes, nuts and seeds. However, if weight loss is a goal, be mindful of these calorie-dense foods. 

What about supplements?
In addition to affecting insulin levels, PCOS is associated with a range of nutrient deficiencies. Even with a healthy diet, some women may find they have low levels of certain nutrients. Leard recommends consulting with a medical professional to evaluate certain deficiencies associated with PCOS, including Vitamin D, magnesium, Vitamin B12, inositol, and iron.