What to eat for PCOS? A functional dietitian’s advice

What to eat for PCOS

There’s a lot of advice out there for what you should eat with PCOS. We chatted with integrative dietitian Melissa Groves Azzaro, RDN, LD. She shares her philosophy on nutrition and how she helps women correct hormone imbalances and infertility from polycystic ovarian syndrome.

You’re the only dietitian on the Seacoast who specializes in PCOS. What made you interested in working with women with PCOS?

When I got started as a dietitian, I was working in another office with a colleague who specialized in gut health. So, she referred to weight loss clients to me. From a functional medicine perspective, I’d look at what they were eating and their exercise and think something’s just not adding up here. The scale wouldn’t budge or they’d even gain weight.

So, I started doing specialized testing and more digging. What I almost always found was that there would be a hormone imbalance—whether that was low thyroid, insulin resistance, high cortisol, or indicators of PCOS.

At the time, that condition was something I didn’t know much about. When I started my own practice, I felt women with PCOS were especially being underserved by conventional medicine. There’s so much that can be done with diet and lifestyle and success that can be had without medication.

Do you think most women with PCOS fully understand what to do to help reduce symptoms?

The awareness about PCOS is going up. I’m starting to see more women who were diagnosed in their late teens and early twenties. There just still aren’t a lot of resources on PCOS. Most of my clients are in their early 30s and are thinking they should start thinking about fertility. But some are in their late teens.

When clients come to me, no matter what hormone imbalance they have, they’re interested in knowing the steps they personally need to take to get the results they want.

A lot of women get told losing weight will help their PCOS. Is that true?

There are a lot of studies out there that show a 5 or 10% reduction in weight improves insulin resistance, testosterone levels, ovulation, and other markers associated with PCOS.

But my question to that is: is it really the weight loss itself that’s helping? Or, is it the behaviors that led to the weight loss? More than the number on the scale, the habits women adopt when they set weight loss goals can help PCOS. Suddenly, they’re eating more vegetables or foods with a lower glycemic index, working to reduce stress (which lowers inflammation), and exercising and walking.

Low-carb and Keto always seem to get recommended for PCOS weight loss. What is your perspective on using these diets as a guide for what to eat for PCOS?

Unfortunately, I hear women with PCOS tell me that they were told to lose weight and someone told them they should eat a super low-carb diet or Keto. And that works for a little while, but then your adrenals just get so stressed out. Adrenals are such a major component for so many women with PCOS. Yes, you’re losing weight at first. But it backfires.

Quick-fix diets work for some people some of the time. Whenever I hear a client say a certain diet worked for her in the past, I ask what she defines as success. Was it sustainable? Did she gain the weight back? Did she gain it back plus more? How long did it take? We see lots of tips but every case is PCOS is different. It’s an umbrella term, and it’s different for everyone. But we can get results without restrictive eating or cutting out foods.

How do you help women get the specific results they’re looking for?

In my practice, I use DUTCH testing to dig into what’s really going on with a woman’s hormones. I always suspect insulin resistance with PCOS until proven otherwise. Even lean women with PCOS have some insulin resistance.

The easiest way to check for this is to get a fasting blood glucose at the same time as fasting insulin. Then, you calculate the HOMA-IR (homeostatic model assessment for insulin) to see where they are on the insulin resistance spectrum. I look at inflammation and do full thyroid panel because thyroid issues and PCOS go hand-in-hand as well.

I also may grab some nutrient testing if there’s reason to suspect deficiency. Vitamin D is something I look at in most people. If someone’s been on metformin, I might look at B12 too. For women who are struggling with fertility issues, I might look at other nutrients, such as B12, folate, and calcium—and see what their overall antioxidant status is. With PCOS, what I’m looking for specifically is how much of their androgens are coming from their ovaries versus how much is coming from the adrenal glands in the form of DHEA.

Can you talk about why specific details on the production of androgens are important in understanding PCOS?

If testosterone is coming from the ovaries, the root issue is usually insulin resistance. When it’s the adrenal glands, it’s usually stress. This information is important for lifestyle. People always ask me, “What type of exercise should I do?” But, really, I need to see the status of their adrenal glands first. Then I can guide them on what types of things work best based on their personal results.

You’re an integrative dietitian. How does that differ from some other perspectives?

From an integrative and functional medicine standpoint, we consider all aspects of a person’s life. I don’t treat symptoms or use a blanket approach to what to eat for PCOS or any other hormone imbalance. I treat the person. My clients and I talk about things way beyond just food. We talk about sleep and digestion. The scope of what we discuss spans more than what’s on your plate.

When you think of working with a hospital dietitian, you think more about a prescribed eating plan. But you don’t want to cut out any foods. No food is evil; yet, you shouldn’t be eating some foods three meals a day either. But a little Parmesan cheese on your salad isn’t going to stop your goals or keep you from getting pregnant. Every day, I’m in the trenches with my clients. I see what works and what doesn’t.

You recently had a book published. Tell us how A Balanced Approach to PCOS takes the guesswork out of what to eat with PCOS.

We’re all so busy. I understand that. I am too. Even as a dietitian, I cannot spend time in the kitchen to eat healthy. So, in A Balanced Approach to PCOS, I came up with different ways to make 16 weeks of well-rounded, PCOS-centric meals really quickly. Overall, the advice women usually get on what to eat PCOS has them restricting their diets and cutting out certain foods or food groups. This can make them deficient in key nutrients, which leads to a cascade of other issues.

All of the meals in A Balanced Approach to PCOS have adequate protein, fat, and fiber in the form of vegetables and whole grains—so, a balanced-macro approach but without counting. The meals are under 30 minutes to make and require some vegetable chopping but minimal prep. I also created a section in the book for PCOS superfoods. These are foods that show a scientific benefit to one of the benefits of PCOS. For example, cinnamon balances blood sugar and turmeric lowers inflammation. In the book, we add these superfoods into meals for an enhanced benefit.

What levels of support do you offer and what kinds of successes are you finding with your clients?

There are a few ways to work together. I offer one-on-one coaching as a top-tier level of support for fertility and PCOS. They’re three months and all-inclusive. We test and talk. This means we communicate every day. Another option is PCOS small-group coaching with 5 or 6 women. It’s intimate and we use the same materials as the one-on-one coaching but not the same customization or test interpretation. I also have a PCOS self-study 6-week course called the PCOS Root Cause Roadmap. It gives women a really thorough understanding of PCOS and hormone imbalances, gut health, and so much more. The next round starts in October.

It’s incredible to see the results women get in all three levels of support. They’re losing weight, their periods are shorter, they’re ovulating, and they’re learning how to advocate for their healthcare needs—which is exactly what we want to see and what women need.

Melissa Groves Azzaro, RDN, LD
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