Polycystic ovary syndrome (PCOS) is the most common hormone-driven condition in women and those assigned female at birth, affecting up to a quarter of women of reproductive age. It is the number one cause of subfertility in that population group. PCOS is chronic, meaning there is no cure, but making diet and lifestyle changes can help to manage symptoms.

Editor’s Note: This article is adapted from The Plant-Based Dietitian’s Guide to Fertility, by Lisa Simon, RD. 

What Is PCOS?

PCOS is a complex chronic condition. Rather than PCOS being a syndrome caused by a disorder of the ovaries, it is actually an endocrine (hormone) system disorder that affects the function of the ovaries. It also causes general metabolic symptoms. 

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What Are the Signs and Symptoms of PCOS?

Higher circulating levels of androgens (sex hormones) is one of the main diagnostic criteria for PCOS and is thought to affect up to 80% of patients with the condition. This is why so many women with PCOS experience difficulties conceiving, as it causes disruptions to the menstrual cycle, resulting in many turning to fertility treatments to help them conceive. Other symptoms include weight gain, excess body hair, skin problems, hair loss, fatigue, depression, and insulin resistance.

Insulin Resistance and PCOS

Our bodies produce insulin, a hormone, to allow our fat and muscle cells to take up glucose from our bloodstream. It also allows our liver to store it. In insulin resistance, the hormone is less effective and we have to produce more and more insulin from our pancreas to encourage our cells to take up glucose. Initially this isn’t a problem, but over time, if it continues to happen, the cells in the pancreas that produce the insulin can wear out and fail to produce enough insulin to overcome the resistance. This then results in high blood glucose levels and ultimately the development of Type 2 diabetes. (Learn more about insulin resistance here.) The incidence of insulin resistance in the general population is around 10–25% but in women with PCOS it may be as high as 95%.

PCOS is a complex condition; we know it involves a combination of lifestyle and genetic factors, but the cause is not fully understood. While there is no cure for PCOS, making positive diet and lifestyle changes can help the body’s tissues use insulin more effectively and improve PCOS symptoms, because as insulin levels drop, so do androgen levels.

The Role of Advanced Glycation End-Products (AGEs)

Harmful compounds known as advanced glycation end-products are an important dietary factor when it comes to PCOS. On a basic level, AGEs are formed in the body when sugars attach to proteins. There are many routes for the entry of AGEs into our bodies: They are made internally but there are also outside sources, including diet, alcohol, and smoking. These compounds are a known risk factor for heart disease and stroke, as they can stiffen our arteries, but they are also associated with decreased male and female fertility.

We have receptors for AGEs throughout our body, including throughout the male and female reproductive tract. When AGEs attach to these receptors they can cause damage to cells and DNA, and cause inflammation. In men, they may cause damage to the DNA in sperm and reduce sperm quality, and in women they can accumulate around the ovaries and inside the uterus. This can lead to early ovarian aging and failure of the embryo to implant. Women with PCOS have been shown to have more than twice the average circulating level of AGEs.

Reducing dietary AGEs is vital for all women and men trying to conceive, but especially for women with PCOS. The highest dietary sources are cooked meat and animal products, as, although they are naturally present in raw animal foods, when they are heated, especially if they are cooked with dry heat, new AGEs are formed. If you are considering reducing the animal products in your diet, meat is the best place to start. It is worth noting that although plant foods are much lower in AGEs, there are certain foods that can contain significant amounts, and these include roasted nuts and toasted bread. My advice would always be to eat nuts in their whole, natural form as these are packed with fertility-friendly nutrients, and to avoid over-browning your toast.

The Importance of Fiber for Managing PCOS

Increasing fiber intake is an important part of dietary management of PCOS, as lower fiber intakes are associated with an increased risk of insulin resistance. Fiber slows down the absorption of glucose and can therefore help to regulate blood glucose levels. It can also aid weight management, with one reason being that some of the energy contained in high-fiber foods becomes a component of your poo rather than being absorbed. In the UK, adults’ average daily fiber intake is around 18 grams (in the U.S., it’s around 15 grams), much lower than the recommended 30 grams per day. It is important to highlight that the only foods that contain fiber are plant foods. There is no fiber in meat, fish, dairy, or eggs.

Benefits of Healthy Lifestyle Changes for PCOS

PCOS is chronic, meaning there is no cure. However, making positive diet and lifestyle changes can help manage the condition and significantly reduce symptoms.

As many women with PCOS are above what is considered the healthy weight range, interventions that help manage weight are vital. Losing as little as 5–10% of body weight has been shown to benefit reproductive and overall physical health, including the restoration of a normal menstrual cycle, achieving pregnancy, and a reduction in miscarriage rates. It can also reduce the risk of metabolic syndrome, which is common in women with PCOS.

The key is focusing on healthy lifestyle changes that will result in gradual, sustainable weight loss. The problem is there are lots of crash diets out there, promising to deliver rapid weight loss, and this can be very tempting. If women seek support and follow a weight loss program purely aimed at calorie restriction, although weight loss may initially happen, most of the weight is likely to be regained within one year. We know that, on the whole, “diets” do not work, as the basis of every weight-loss diet is restriction. Certain foods may be demonized, some meals may be replaced by shakes, and often calorie restriction is significant, leading to hunger, despondency and ultimately a return to previous eating habits. Many weight-loss diets also tend to focus on increasing animal protein and reducing carbohydrate foods, an approach that will exacerbate rather than help manage symptoms of PCOS and can even lead to disordered eating.

A predominantly whole-food, plant-based diet, on the other hand, is not a “diet” in the traditional sense but rather a dietary pattern that, although it minimizes or eliminates animal products, focuses on what you can add into your diet to make every meal colorful, tasty, and satisfying. Such foods contain key nutrients in terms of PCOS, including vitamin A and magnesium. Lower intakes of these micronutrients are associated with insulin resistance. A plant-based eating pattern focuses on including a huge variety of different grains, vegetables, fruits, nuts, seeds and legumes; after all, there are around 2,000 plant species in the world that are cultivated by humans for food. That is incredible, right? The choice is almost endless!

Excerpted with permission from Hammersmith Health Books from The Plant-Based Dietitian’s Guide to Fertility, a brand-new book in which Lisa Simon, RD, draws on her personal experiences with infertility and IVF, her expertise as a dietitian, and a wealth of scientific research to offer easy-to-understand guidance for optimizing fertility and achieving healthy pregnancy using a whole-food, plant-based diet and other lifestyle interventions. Learn more here.

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In a meta-study published in the March 2022 issue of Nutrition and Health, nutritionists at the University of Worcester in the U.K. conducted a statistical analysis of 27 interventional studies to assess how low-carb and high-protein diets might impact testosterone. They also looked at the impact that such diets might have on the stress hormone cortisol, because levels of the two hormones are closely linked, with higher cortisol indicating lower testosterone and vice versa.

A total of 309 healthy adult males participated in the 27 studies included in this meta-analysis.  

The specific focuses of the studies varied, but all measured participants’ testosterone and/or cortisol levels, and all assigned participants to low-carb and high-carb diets. In some studies, the low-carb groups ate high amounts of protein (defined here as 35 percent or more of total calories); in others, the low-carb groups ate moderate amounts of protein. 

In pooling the data, they identified a notable trend among participants assigned to high-protein, low-carb diets: Their testosterone levels decreased by about 17 percent on average. 

Additionally, they found that resting and post-exercise cortisol levels increased during the first three weeks on a low-carbohydrate diet. Beyond that period, resting cortisol rates returned to baseline, but post-exercise cortisol remained elevated. 

Joseph Whittaker, MSc, who led the study, says the findings fit within a still-developing picture of the effects of excessive protein consumption. “The long-term effects of very high-protein diets are largely unknown, but what data we have strongly suggests going above 35 percent protein leads to all sorts of nasty effects,” says Whittaker. “Our study adds low testosterone to this list.” 

“Bodybuilders and weightlifters are most at risk of excessive protein intakes, along with those on extreme weight-loss diets,” says Whittaker, noting that the average person consumes around 17 percent of calories from protein—a much lower proportion than the 35-percent amount examined in the study. 

Low-carbohydrate, high-protein diets have gained popularity in recent years because of their ability to promote weight loss. However, research suggests that these diets may have serious drawbacks in the long term, including an increased risk of chronic kidney disease, elevated cholesterol, and all-cause mortality. 

To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.

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Modern lifestyles contribute to unbalanced, excessive, or deficient levels of sex hormones in men and women. This may result in unpleasant outcomes—such as low sex drive or infertility—as well as to dangerous diseases, including cancer and heart disease. Here’s key information you need to make choices to help keep your sex hormones balanced.

While there are multiple male and female sex hormones, I’m going to concentrate on the best-known: estrogen and testosterone. You might not be aware that women produce and use testosterone, and men produce and use estrogen. The bodies of both sexes can convert testosterone into estrogen. So all sex hormones are important to you, whether you are male or female.

Balancing Strategy One: Carefully Consider Before Taking Supplementary Hormones

Some people have diagnosed medical conditions that may be treated with supplementary estrogen, testosterone, or other sex hormones. Before deciding whether to use hormones if you have one of these conditions, be sure you thoroughly understand the potential benefits and risks—and weigh these carefully—since sex hormones influence your entire body. Consider if there are alternative evidence-based treatments, as well as the benefits and risks of these. If you use oral contraceptives, be sure to understand possible side effects.

Millions of men and women seek supplementary hormones for vague purposes, such as weight loss, low energy, or a quest to regain lost youthfulness. In this case, the risks are likely to outweigh potential benefits. This is true regardless of whether you use compounded bioidentical hormones or those approved by the Food and Drug Administration (FDA).

The National Toxicology Program of the Department of Health & Human Services classifies estrogen as a known human carcinogen, associated with both uterine and breast cancer. Supplementary or excessive estrogen has also been linked to ovarian cancer, prostate cancer, dementia, and stroke.

The dangers of testosterone supplements are not as well understood, with studies finding different outcomes. The FDA requires labeling of prescription testosterone products for safety risks affecting the heart and mental health, as well as the potential for abuse. If you take these supplements, benefits, if any, may be small and fleeting. A medical journal editorial titled “Testosterone and Male Aging: Faltering Hope for Rejuvenation” states that “the sole unequivocal indication for testosterone treatment is as replacement therapy for men with … organic disorders of the reproductive system.”

Balancing Strategy Two: Avoid Endocrine Disruptors in the Environment

Endocrine-disrupting chemicals (EDCs) are capable of altering the production and/or function of many hormones. Interference with estrogen is the most-studied impact. EDCs may be found everywhere in modern environments, including pesticides, plastics, flame retardants, food, clothes, fragrances, pharmaceuticals, cooking and eating items, and personal care and cleaning products. Adverse effects of EDCs can be developmental, reproductive, neurological, and immune-related. Even tiny amounts can be harmful.

Common-sense strategies to minimize endocrine disruptors include consuming organic food; avoiding pesticides; using stainless steel, glass, or ceramic cookware and storage containers; staying away from air pollution whenever possible; washing new clothes before you wear them; and avoiding personal care, cosmetics, and cleaning products with added fragrance (other than plant oils) and chemicals with long names you can’t pronounce.

One of the most important ways to keep endocrine disruptors out of your body is to not eat animal foods. This is because most endocrine disruptors are fat soluble and accumulate in magnified amounts in animal fat. For example, the Institute of Medicine states that, for the EDCs’ dioxins, “consumption of animal fats is thought to be the primary pathway for human exposure. In humans, dioxins are metabolized slowly and accumulate in body fat over a lifetime.” This brings me to strategy three.

Balancing Strategy Three: Avoid Eating Animal Foods

All animal foods contain sex hormones that are often identical to the human versions. This is true even for animals raised without added hormones. All animals—including mammals, birds, and fish—need hormones for their own functioning. The hormones they produce become part of their tissues and secretions, which you consume if you eat meat, poultry, fish, eggs, or dairy.

Typically, the sex hormones you consume in the highest quantities vary with the type of animal food. Dairy and eggs contain the largest amounts of estrogen. For dairy, the soaring estrogen levels are tied to the fact that modern dairy cows are pregnant most of the year, and during pregnancy females become major estrogen producers. Testosterone exposure is strongly related to eating both milk and eggs (remember that your body may convert the testosterone to estrogen).

Hormones in animal foods are absorbed into your body. One study had adult men and children who had not yet reach puberty drink about 20 ounces of cow’s milk. Both the men and the children had elevated levels of estrogen and progesterone (another female hormone) in both their blood and their urine after consuming the milk. Testosterone secretion was suppressed in the men.

A series of studies considered the changes in diet in Japan after World War II. In the 50 years from 1947 to 1997, intake of milk, meat, and eggs increased 20-, 10-, and 7-fold, respectively. During that time, the death rate from breast cancer roughly doubled, and ovarian cancer deaths increased by a factor of four. The death rate from prostate cancer increased 25-fold. The researchers consider that the estrogen in dairy may have been responsible for these dramatic increases in reproductive cancer death.

All three strategies to balance your sex hormones are important. Avoiding animal foods may be the most powerful—and the most overlooked.

(Additional references)

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Hormones Are Chemical Messengers That Carry Information Through Your Body

Your body is an awesome machine composed of 100 trillion cells. Hormones are chemical messengers that flow through your blood, carrying information from one group of cells to another. This coordinated process keeps your body functioning.

Most people have heard of hormones like insulin, thyroid, estrogen, testosterone, human growth hormone, cortisol, and vitamin D. There are dozens of others with indispensable roles in maintaining health. Many are made by endocrine glands, such as the thyroid, whose only job is to produce and secrete hormones. Other organs, such as the stomach, intestines, heart, and skin, produce hormones, in addition to performing other critical biological functions.

The process of maintaining all your body’s vital functions within the range needed for survival is called homeostasis, and hormones play a major role in making sure these requirements are met—no easy feat.

How Hormones Work

Hormones circulate in your blood, but they don’t act on all cells. A hormone can target only cells that have a receptor that “fits” that particular hormone. This is often compared to a lock-and-key system: the receptor is the lock, and the hormone is the key. Some hormones have target receptors on most cells, while others act far more selectively. Once a hormone binds to its receptor, the targeted cell responds by taking action, making some change indicated by the hormone.

A Little is Good, but More Can Be Toxic Excess

A common misconception in understanding how your body functions is that if a little is good, more is better. More frequently the truth is that a little is good, and more is toxic excess.

Hormones illustrate this principle perfectly. Because hormones have such a profound influence on physical function, your body typically secretes them only in tiny amounts—often so tiny that special methods are needed to measure them. Even these small quantities are active only for a short time, and most are soon destroyed naturally by the body. A hormone may also be carried in the blood in an inactivated form or bound to another chemical that keeps it from reaching target receptors.

High levels of some hormones can have dire consequences. Additionally, hormones sometimes team up to regulate crucial body functions and maintain homeostasis. If the level of one hormone is off, others may get disrupted, and unhealthy effects then cascade.

Three Ways to Mess Up Your Hormones

Experts have concluded that more than half the people in Western societies develop a hormone-related disease at some point in their lives. These include diabetes (both type 1 and type 2), polycystic ovarian syndrome, osteoporosis, and hypothyroidism.

Your body is designed to precisely regulate the exact amounts of hormones and receptors it needs. However, hormone-related disease occurs for many reasons, and sometimes cannot be avoided. Prevention of these diseases may be possible if you avoid the three most common ways of messing up your hormones. Here they are, in reverse order of destructiveness.

1. Enjoying the worst of modern lifestyles.

Examples include staying indoors all day, sitting for hours at a stretch, not getting enough exercise or being inactive, sleeping too little or erratically, and frequently skipping meals. Contact with fragrances, herbicides, pesticides, and thousands of other manmade chemicals can disrupt your hormones as well.

2. Second guessing your body by supplementing with hormones that are not for clinical treatment of a diagnosed disease.

As you have learned, your body closely fine-tunes the hormones it produces and how it deploys them. Artificially high hormone levels as a result of supplementation can be profoundly dangerous. Use of hormones for general lifestyle goals such as “anti-aging,” building stronger muscles, losing weight, and enhancing sexuality can result in serious long-term consequences.

Supplementing with hormones should be a thoughtful decision made by a fully informed patient in partnership with a knowledgeable health team, and only after considering all options for treatment.

3. Eating animal foods.

All animal foods contain hormones (whether the animal was raised following organic practices or not). Animals, like humans, need hormones to maintain homeostasis and to reproduce, and animal hormones are often similar or identical to human hormones. In addition, your digestion and metabolism of animal foods can act to disrupt your own hormonal functioning in multiple direct and indirect ways.

Choosing to avoid these perils gives your body its best opportunity to maintain hormonal balance and healthy functioning.

(Read the second article in this series, 3 Strategies to Keep Your Sex Hormones Balanced.)

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