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The Role of Intermittent Fasting in Managing PCOS: A Comprehensive Guide

Polycystic Ovary Syndrome (PCOS) is a complex hormonal endocrine disorder affecting about 10% of women of childbearing age in the United States, which amounts to approximately 5 million women. PCOS is characterised by hormonal imbalances, notably elevated levels of male hormones like testosterone, which can lead to irregular periods, infertility, acne, and excess facial and body hair. This condition is often accompanied by insulin resistance, inflammation, and toxic exposures. In this comprehensive guide, we will explore the benefits of intermittent fasting for women with PCOS and how it can be integrated into a holistic approach to manage this condition.


Understanding PCOS: The Root Causes


PCOS is a multifaceted condition with several influencing factors:


  • Insulin Resistance: One of the key factors believed to be at the root of PCOS is insulin resistance. When cells become resistant to insulin, blood sugar levels rise, prompting the body to produce even more insulin. Cells will also become so full of stored glycogen (sugar) that they cannot except anymore glucose. This excess insulin can lead to a cascade of hormonal imbalances, including elevated testosterone levels. Insulin resistance is a central concern in PCOS management, and addressing it is crucial.


  • Inflammation: Inflammation plays a significant role in PCOS, often exacerbated by dietary and environmental factors. Inflammatory foods and toxins can disrupt cell receptor sites, hinder proper cell function, and interfere with nutrient absorption and waste elimination. Three in five people will end up with an inflammatory based condition, so this is so prevalent in society.


  • Toxicity: Chronic exposure to toxins over time accumulates in the body, disrupting its optimal function. It is essential to assess and reduce exposure to unnecessary toxins to manage PCOS effectively.


Now, let's delve into the role of intermittent fasting in addressing these underlying factors and managing PCOS.


Intermittent Fasting: A Potential Game-Changer for PCOS


Intermittent fasting (IF) is gaining recognition as an effective strategy for managing PCOS. IF involves alternating between periods of fasting and eating within specific timeframes. Here are some key IF approaches that can benefit women with PCOS:


  • Intermittent Fasting (IF): IF typically involves fasting for 13-16 hours daily, allowing for a restricted eating window. The easiest way to start IF is to avoid eating 3hrs BEFORE bed and then 1-2hrs after you wake. This approach is an excellent starting point for those new to fasting and can be a part of a comprehensive PCOS management plan.


For a guided start to intermittent fasting download our free 28 Day Fasting eBook.

  • Autophagy Fasting: Autophagy is a natural cellular process that helps eliminate damaged cells and generate healthier ones. Fasting can stimulate autophagy, aiding in cellular detoxification and healing. These senescent cells will be removed, broken down and used for other processes. Autophagy fasting often involves approximately 17 hours of fasting and follows a high-fat, low-carb diet with limited protein (30g).


  • 24-Hour Fasting: Research has shown that 24-hour fasting can dramatically improve the ability of intestinal stem cells to regenerate, which is beneficial for improving the microbiome and hormone efficiency. With 70–80% of immune cells being present in the gut, this intricate interplay between the intestinal microbiota, the intestinal epithelial layer, and the local mucosal immune system. This significant connection cannot be ignored.



Insulin Resistance in PCOS.


Here are simple tips to reduce regular insulin spikes:


  • Intermittent Fasting (e.g. eat between 11am and 7pm)

  • Increase muscle mass – Arguably, the MOST IMPORTANT metric to improve insulin and glucose levels. Your skeletal muscles can absorb around 70% of your glucose from the blood circulation and is a MUST!

  • Try to consume around 1/3 of your carbohydrates within 1hr of exercise and more carbohydrate earlier on in the day.

  • Consume between 3 to 4 grams of sodium (7.5 - 10 grams of salt)

  • Eat 2 meals a day - avoid snacks!

  • Meal order:

- Eat your VEGETABLES FIRST

- PROTEIN + FAT

- CARBS / STARCHES LAST

  • Try lemon juice, vinegar or pickled (fermented) vegetables BEFORE a meal.

Pair that bread with vinegar or “amuse-bouche” with some kimchi!


How can lemon juice, vinegar or pickled (fermented) vegetables reduce blood glucose & insulin response by 50-60%?


“Naked” carbs can spike your blood glucose levels in a big way, but when we consume one of these acidic foods beforehand, it can actually help reduce the amount of carbohydrate you absorb as well as your body’s insulin response.


Lemon juice, and similar acidic foods, lower your glycemic response while increasing your gastric secretions and gastric emptying rate. Researchers believe that the reduction of the glycemic response is mainly due to the “interruption of starch hydrolysis by the acid-inhibition of salivary alpha-amylase.”



Gut Health and PCOS


Maintaining a healthy gut microbiome is vital for managing PCOS, as it influences hormone balance. Here are ways to support your gut health:


  • Incorporate probiotic and fermented foods like kimchi, sauerkraut, raw dairy, and yogurt into your diet.

  • Take a high-quality probiotic supplement, to enhance gut flora.

  • Consume prebiotic foods like flaxseeds, hemp seeds, chia seeds, bananas, berries, asparagus, and garlic.

  • Avoid gluten – this can lead to intestinal permeability (leaky gut syndrome).

  • Fasting can increase the numbers of butyrate producing bacteria, that can feed the cells that keep prevent the gut from leaking.


Inflammation, Diet, and PCOS


Inflammation is a significant concern in PCOS, influenced by dietary choices. Adopting an anti-inflammatory diet can help manage PCOS symptoms effectively.


Avoid or reduce the following inflammatory foods:

  • Seed oils (Rapeseed, Sunflower oil, Vegetable oil, Palm oil)

  • Grains

  • Refined Sugars

  • Heavily processed food

  • Anti-nutrient foods that contain:

- Phytic Acid

- Oxalic Acid

- Lectins

- Gluten

  • Preservatives

  • Colorants

  • Emulsifiers



Toxicity and PCOS


Assessing and minimising toxic exposure is the third crucial step in managing PCOS.


Chronic exposure to toxins can accumulate over time, impairing the body's optimal functioning. Here are steps to reduce toxic exposure:


  • Choose locally sourced or organic foods to minimise exposure to pesticides, herbicides, insecticides, and glyphosates.

  • Water can be a source of contamination with over 250 contaminants potentially found in water sources. Getting your water checked can be the first step before investing in reverse osmosis or carbon filtration.

  • Deodorant is a huge source of heavy metals so make sure you are opting for natural forms of deodorants.

  • Use non-toxic cleaning products, such a white vinegar, to maintain a healthy microbiome.

Plastics – Phthalate toxicity from plastics. These plastics are most prevalent in coffee cups, plastic takeaways and when you heat plastic.


The Role of Oestrogen and Androgens in PCOS


Elevated levels of oestrogen and androgens, such as testosterone, are common in women with PCOS, especially those who are overweight or obese. These imbalances can lead to adverse health outcomes, including PCOS-related symptoms and increased breast cancer risk. Research shows that breast cancer cells use more glucose than healthy cells. Second to this, breast cancer cells can impair the release of insulin from the pancreas and therefore actually leading to less insulin produced. This augments the issues of insulin resistance in PCOS further. Weight loss interventions have been shown to reduce estrogen levels among females with obesity.


Meal timing can also impact estrogen levels. Research indicates that eating a large portion of daily calories later in the day may augment oestrogen levels in women with PCOS. This emphasises the importance of shifting calorie intake earlier in the day to avoid further increases in oestrogen levels.


Effect on Androgens and Hyperandrogenism


Hyperandrogenism, characterised by high levels of androgens like testosterone, can lead to hirsutism, menstrual cycle disorders, and insulin resistance. Weight loss has been shown to decrease testosterone and androstenedione levels in women with PCOS and obesity. Studies exploring intermittent fasting's effects on androgens have provided promising results.


A 5:2 fasting approach, where individuals consume 500 kcal two days per week, led to decreased free androgen index (FAI) and total testosterone levels in premenopausal women with obesity. Another study implemented early time-restricted eating (TRE), where participants consumed all their calories between 8 am and 4 pm and fasted for the rest of the day. This approach significantly reduced FAI and total testosterone levels in young women with PCOS and obesity.


Intermittent Fasting, the Gut Microbiome, and Hormones


Recent studies have shown that changes in the gut microbiome can significantly affect reproductive hormones. Intermittent fasting has been shown to improve gut microbiome composition and diversity. Fasting periods can also reduce gut permeability, leading to decreased inflammation and improved overall health. These effects on the gut microbiome may contribute to the regulation of reproductive hormones.


Conclusion


Incorporating intermittent fasting into a holistic approach for managing PCOS offers promising results. It addresses insulin resistance, inflammation, and hormonal imbalances while promoting gut health. However, it's crucial to consult with healthcare professionals before starting any fasting regimen, as individual responses may vary.


While there is ongoing research in this field, intermittent fasting has shown potential in reducing androgen markers, improving menstrual regularity, and enhancing the quality of life for women with PCOS. As our understanding of the relationship between intermittent fasting and PCOS.


Reference:


- Li C., Xing C., Zhang J., Zhao H., Shi W., He B. Eight-hour time-restricted feeding improves endocrine and metabolic profiles in women with anovulatory polycystic ovary syndrome. J. Transl. Med. 2021;19:148. doi: 10.1186/s12967-021-02817-2.

- Jakubowicz D., Barnea M., Wainstein J., Froy O. Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome. Clin. Sci. 2013;125:423–432. doi: 10.1042/CS20130071.


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