In PCOS, Preventing Chronic Disease Requires Multi-Pronged Approach

Grassi, who is the author of PCOS: The Dietitian’s Guide, said women with PCOS tend to be yo-yo dieters, suffer from intense cravings and have impaired levels of ghrelin and leptin. Hypoglycemia, a higher prevalence of eating disorders and increased anxiety, depression and bipolar disorder are also common.

Grassi, who has also written a cookbook for women with PCOS, said medical nutrition therapy should include long-term goals of reducing body weight if the person is overweight, maintaining the weight loss after weight reduction and engaging in 30 minutes or more of moderate intensity activity most days of the week.

Effective Eating Plans

Endocrinologists now have many more tools to improve fertility, resolve metabolic syndrome and reduce risk factors for type 2 diabetes and cardiovascular disease (CVD), according to Grassi. Eating plans that have shown favorable effects on weight loss and metabolic parameters in PCOS include modifying glycemic index and glycemic load and modifying carbohydrate intake.

One study involving 27 women with PCOS compared a high-protein diet (>40% protein and 30% fat) with a standard-protein diet (<15% protein and 30% fat) and found that the high-protein diet decreased weight, body fat, waist circumference and glucose levels.1

However, the controlled trial was only 6 months long and demonstrated no differences between the two diets in terms of lipids or hormones.

Another study looked at a low glycemic index diet vs. a conventional diet in 96 overweight or obese women with PCOS. The 12-month study demonstrated that the low glycemic index diet resulted in better menstrual regularity and better insulin sensitivity.2

Additionally, a study involving 48 women with PCOS showed that the DASH diet significantly reduced insulin and C-reactive protein levels as well as waist and hip circumference measurements.3

Grassi said overall helpful eating strategies include reducing carbohydrate intake, with an emphasis on low glycemic index carbohydrates, avoiding sugary and refined foods, and spreading intake of carbohydrates evenly throughout the day.  

Clinicians may also want to measure vitamin D levels, according to Grassi, since one study suggested that supplementing vitamin D and calcium for 3 months had the potential to significantly decrease testosterone and blood pressure in women with PCOS. Fish oil, which can improve triglycerides, risk for nonalcoholic fatty liver disease, fertility and depression, may also be considered.

Disease prevention is vital, Grassi said, and that requires an empathetic, supportive and encouraging approach. She also advocates focusing on healthy eating and exercise rather than weight loss.


  1. Sørensen LB et al. Am J Clin Nutr. 2012;95(1):39-48.
  2. Marsh KA et al. Am J Clin Nutr. 2010;92:83-92.
  3. Asemi Z et al. Horm Metab Res. 2014;47(8):565-570.
  4. Wright H, Grassi A. T20 – The Link Between PCOS, Prediabetes and Diabetes: Nutrition Strategies for Prevention. Presented at: AADE 2015; Aug. 5-8, 2015; New Orleans.