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Health and Wellness
Women with lean PCOS may struggle with irregular periods, insulin resistance, infertility, and other symptoms caused by elevated androgen (testosterone) levels such as excess facial hair and acne. In this article, we share diet and lifestyle tips to help keep symptoms of lean PCOS under control.

Many women with PCOS (Polycystic Ovary Syndrome) are overweight. However, it is possible to have PCOS and be a healthy weight or even underweight. This is known as lean PCOS.  Women with lean PCOS may struggle with irregular periods, blood sugar controlfertility problems, and other symptoms caused by elevated androgen (testosterone) levels such as excess facial hair and acne. 

Some strategies for handling these symptoms were discussed in our previous article About Lean PCOS: Symptoms and Supplements. This article will focus on diet and lifestyle tips to help keep these symptoms under control.

Meal planning for lean PCOS

Meal planning is essential for women with lean PCOS because it can help manage symptoms of lean PCOS. Here are some specifics to consider when planning what to eat.

Make breakfast the biggest meal of the day

A study shows that for women with lean PCOS, having the highest calorie meal at breakfast and the lowest calorie meal at dinner improves insulin resistance and ovulation and reduces testosterone levels.

Glycemic index 

The glycemic index, or GI, is a system of measuring how much a carbohydrate-containing food increases your blood sugar and insulin levels. Choosing lower GI foods may be beneficial for PCOS, especially to help manage insulin resistance.

Studies have shown improved insulin sensitivity and more regular menstrual cycles in women with PCOS who incorporate low glycemic index foods such as chickpeas and lentils into their meals in place of high glycemic index foods such as white rice and white flour bread.

The GI ranks foods on a scale from 1-100.  Foods that have a low GI, less than 55, promote a slower rise in blood sugar levels. Eating low GI foods also results in less insulin secretion by your body.

Glycemic load

Health experts recommend planning meals to include low GI foods, but encourage us to also consider the overall glycemic load, GL, of a meal to avoid sudden spikes in blood sugar.

Here’s the skinny on GL. Each food has a unique effect on blood sugar. GL considers both the number of carbohydrates in a food and the GI of the food. This measurement gives you a more precise estimate of the effect a food has on your blood sugar level. Simply put, to best use GL you’ll want to control portions of carbohydrate-rich foods, such as brown rice or a sweet potato. Then, be sure to pair them with foods containing protein and fat such as fish or chicken. Add a salad to complete your meal.

It makes sense for women with PCOS to use both GI and GL. Using both measurements is optimal for helping to manage insulin resistance. Some simple rules to follow are to know the GI of the foods you’re eating. Click here for a list. Also, choose whole grains, limit foods made with refined grains such as white rice or white bread, eat fruits and vegetables but limit fruit juice, and include beans and legumes. This PCOS Nutrition Center article explains how including protein-rich foods at each meal can help temper the rise of blood glucose.

Include healthful omega-3 fats, especially fatty fish

There are three main types of omega-3 fats: ALA (alpha-linolenic acid), found in canola oil, walnuts and flax seed oil, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid).  EPA and DHA are both found in fatty fish such as salmon, herring, sardines, tuna, trout, and mackerel. All are essential polyunsaturated fatty acids, but EPA and DHA are particularly beneficial for women with PCOS.

Some women with PCOS have a gene impairment leading to a reduced ability of D6D, delta-6 desaturase, to convert ALA into EPA and DHA. This gene impairment may also lead to insulin resistance and elevated blood lipid levels. It’s still recommended for women with PCOS to consume foods rich in ALA because they are essential fatty acids, may help reduce inflammation, are low in saturated fat, and foods such as flax seeds are also rich in fiber. It’s important, though, to also consume EPA and DHA omega-3 fats from fish.

Research has shown that including fatty fish more than twice per week may be beneficial for women with PCOS by helping manage symptoms. For recipes and more information to help you add fish to your weekly meals, consider reading The Pescetarian Plan, by Janis Jibrin, MS, RD.

Plate portions for PCOS

PCOS fitness expert Erika Volk recommends cooking with unsaturated fat such as olive oil and portioning food according to this simple plate method. In this method, you fill one half of your plate with low-starch veggies such as brussels sprouts or zucchini. Then, you fill one-quarter of your plate with protein-rich food such as fatty fish or chicken. Finally, you can include a handful of carbohydrate-dense foods such as oats, beans, fruit, or root vegetables.

Exercise for Lean PCOS

Although all types of exercise are beneficial for different reasons, women with lean PCOS can benefit from including strength training and high-intensity interval training as these exercises improve insulin resistance and decrease body fat percentage.

Strength training for PCOS

To get started, set some goals around the types of exercise and body parts that you plan to work. An excellent strength-training workout includes chest, back, shoulders, biceps, triceps, abdomen, hamstrings, and quadriceps. You can work out two to three non-consecutive days per week using weights, plate-loading machines or medicine balls. You can even use your own body weight or exercise bands.

Start with 3 sets of 10 repetitions (reps) for each body part. If you are using resistance, the weight should be challenging to move by the tenth rep. This plan will ensure that you strengthen your major muscle groups and challenge your muscles to help you decrease body fat percentage. If you need help getting started, consider enlisting the help of a personal trainer. And, as always, consult your healthcare professional before you begin.

High-intensity interval training, HIIT, for PCOS

According to the American College of Sports Medicine, HIIT cardiovascular workouts may include a one-minute high-intensity interval and a one-minute moderate-intensity interval. This is called a 1:1 interval since the intervals are the same length. The workout usually includes a short warm up and cool down period for a total of at least 32 minutes.

The intervals may vary and may be one, two, even up to eight minutes long.  The moderate-intensity interval length may vary as well, deviating from the 1:1 ratio. If you’re used to a steady intensity workout, start with just a few high-intensity intervals before you acclimate to the HIIT routine.

Lifestyle advice for managing lean PCOS

To eat healthfully with PCOS, pair low-glycemic carbohydrates (eg. whole grains, fruit, sweet potatoes) with protein-rich foods to help manage your glycemic load. Eat fatty fish at least twice per week, plenty of vegetables, and healthful fats such as nut butter, nuts, seeds, and olive oil.

Consider including HIIT cardiovascular workouts and strength-training exercise to improve insulin resistance and lower body fat percentage.

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