PMOS and Nutrition: Is There Actually a Best Diet?
If you've ever searched for what to eat with polyendocrine metabolic ovarian syndrome (PMOS), you've probably found plenty of conflicting advice.
Cut carbohydrates. Avoid sugar. Eat low GI. Lose weight. Follow a Mediterranean diet.
With so many different recommendations, it can be difficult to know what actually matters.
The good news is that nutrition can play an important role in managing PMOS. But the research doesn't suggest that everyone with PMOS needs to follow one specific diet.
And that makes sense, because PMOS doesn't look the same in everyone.
What is PMOS?
PMOS, formerly known as polycystic ovary syndrome (PCOS), is a hormonal and metabolic condition that can affect menstrual cycles, fertility, hormone levels and metabolic health.
People may experience symptoms such as irregular periods, acne, excess facial or body hair, hair thinning, fertility difficulties or changes in body weight. Insulin resistance is also common and can increase the risk of developing conditions such as type 2 diabetes over time.
Despite the condition's former name, having ovarian "cysts" isn't necessary for diagnosis.
PMOS can involve different combinations of irregular ovulation, higher androgen levels and changes to the appearance of the ovaries.
These differences are often described as PMOS phenotypes.
What are the different PMOS phenotypes?
There are four commonly recognised phenotypes:
Phenotype A: irregular ovulation, higher androgen levels and polycystic ovarian appearance.
Phenotype B: irregular ovulation and higher androgen levels.
Phenotype C: higher androgen levels and polycystic ovarian appearance, with regular ovulation.
Phenotype D: irregular ovulation and polycystic ovarian appearance, without higher androgen levels.
Your phenotype may help identify which areas of health need closer attention, but it doesn't determine which diet you should follow. Nutrition recommendations should also consider factors such as insulin resistance, metabolic health, body composition, symptoms and individual goals.
You don't need to remember all of those combinations.
The important point is that two people with PMOS can have quite different experiences of the condition.
Body weight, insulin resistance, symptoms and metabolic health can vary too. Someone can have PMOS in a smaller body and still experience insulin resistance, while someone else may have different metabolic concerns altogether.
That's one of the reasons a single "PMOS diet" isn't particularly helpful
Why does insulin resistance matter?
Insulin helps move glucose from our bloodstream into our cells so it can be used for energy.
When someone has insulin resistance, their cells don't respond to insulin as effectively. The body may then produce more insulin to compensate.
In PMOS, higher insulin levels can also interact with reproductive hormones and contribute to some of the hormonal symptoms of the condition.
Supporting insulin sensitivity and blood glucose management can therefore be an important part of nutrition care for many people with PMOS.
But this doesn't mean you need to stop eating carbohydrates.
So, is there a best diet for PMOS?
At the moment, research doesn't show that there is one diet that everyone with PMOS should follow.
Lower-carbohydrate, low-GI, Mediterranean-style and other dietary approaches have all been studied, and several have shown benefits.
For example, one study compared a Mediterranean-style, lower-carbohydrate diet with a low-fat diet in people with PMOS and a higher body weight. Both approaches improved a number of health measures, although the Mediterranean/lower-carbohydrate approach performed better in some areas.
Rather than telling us that carbohydrates are bad, this adds to a broader picture: there are different ways to build a healthy eating pattern for PMOS.
For some people, paying more attention to the amount of carbohydrate they eat may be helpful. For many, improving the quality of those carbohydrates is also a practical place to start.
That could mean including more wholegrains, oats, legumes, fruit and vegetables and other higher-fibre foods.
Mediterranean-style eating can also be a useful framework. It generally includes plenty of vegetables, fruit, wholegrains and legumes, alongside nuts, seeds, olive oil and fish.
Notice that this still includes carbohydrates.
The goal isn't necessarily to remove foods. It's to build an overall eating pattern that supports your health.
Does everyone with PMOS need to lose weight?
No.
For some people with PMOS and a higher body weight, weight loss may be an appropriate goal and can help improve insulin sensitivity and other aspects of metabolic health.
But having PMOS does not automatically mean you need to lose weight.
People with PMOS can have different body sizes and metabolic needs. For someone with lean PMOS, the focus may instead be on maintaining their weight, supporting insulin sensitivity, getting enough nutrients and improving overall dietary quality.
There can also be health benefits from improving nutrition and lifestyle habits even when body weight doesn't change.
What might eating for PMOS actually look like?
For many people, a good starting point isn't particularly extreme.
It might mean building meals around:
plenty of vegetables and fruit
wholegrains, legumes and other fibre-rich carbohydrates
a source of protein at meals
healthy fats from foods such as nuts, seeds, avocado, olive oil and fish
regular meals that work with your appetite and routine.
From there, nutrition can be adjusted depending on the individual.
Someone with significant insulin resistance may benefit from looking more closely at the amount, type and timing of carbohydrates they eat. Someone wanting to lose weight may need a different approach from someone with lean PMOS. Fertility goals, activity levels, blood results, food preferences and other health conditions can also influence what is appropriate.
And importantly, the way you eat needs to be realistic for your life.
Research into PMOS treatment shows that sticking with lifestyle changes can be challenging, with factors such as cost, access to healthcare, education and the demands of treatment all affecting people's ability to follow recommendations.
A nutrition plan that looks perfect on paper isn't particularly useful if you can't maintain it.
There isn't a perfect PMOS diet
Nutrition matters in PMOS, but that doesn't mean you need to find the perfect diet.
There are several evidence-informed ways of eating that can support metabolic health, and the right approach will depend on the person.
For some, that might involve more focus on carbohydrate quality or insulin resistance. For others, weight management may be relevant. And for others, the priority may simply be building a balanced eating pattern that supports their health without unnecessary restriction.
The goal isn't to eat perfectly. It's to find an approach that supports your health, your goals and your life.
Book a consultation today to get personalised nutrition advice tailored to your goals.
References:
Barrea, L., Frias-Toral, E., Verde, L., Ceriani, F., Cucalón, G., Garcia-Velasquez, E., Moretti, D., Savastano, S., Colao, A., & Muscogiuri, G. (2021). PCOS and nutritional approaches: Differences between lean and obese phenotype. Metabolism Open, 12, 100123. https://doi.org/10.1016/j.metop.2021.100123
Jiskoot, G., Dietz de Loos, A., Timman, R., Beerthuizen, A., Laven, J., & Busschbach, J. (2022). Changes in eating behavior through lifestyle treatment in women with polycystic ovary syndrome (PCOS): A randomized controlled trial. Journal of Eating Disorders, 10, 69. https://doi.org/10.1186/s40337-022-00593-y
Mei, S., Ding, J., Wang, K., Ni, Z., & Yu, J. (2022). Mediterranean diet combined with a low-carbohydrate dietary pattern in the treatment of overweight polycystic ovary syndrome patients. Frontiers in Nutrition, 9, 876620. https://doi.org/10.3389/Parker, M., Warren, A., Nair, S., & Barnard, M. (2020). Adherence to treatment for polycystic ovarian syndrome: A systematic review. PLoS ONE, 15(2), e0228586. https://doi.org/10.1371/journal.pone.0228586
Parker, M., Warren, A., Nair, S., & Barnard, M. (2020). Adherence to treatment for polycystic ovarian syndrome: A systematic review. PLoS ONE, 15(2), e0228586. https://doi.org/10.1371/journal.pone.0228586
Dietitians Australia. Polycystic ovary syndrome (PCOS). Dietitians Australia.
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