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How You Should be Fueling with PCOS

A sports dietitian breaks it down for athletes with polycystic ovarian syndrome.

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If you’re an athlete with polycystic ovarian syndrome, you’re not alone. Between 5 to 10 percent of women of childbearing age in the United States, or roughly 5 million women, have PCOS. That percentage makes it one of the most common hormonal endocrine disorders in women. The condition, which causes women to produce too many male hormones and not enough female hormones, can affect just about every system in the body if left unchecked, including irregular menstrual cycles, depression, weight gain, increased acne, and infertility. That can make fueling with PCOS tricky.

The number-one prescription for PCOS is working out. “Exercise is one of the best things a patient with PCOS can do,” says Dr. Kimberly Gecsi, OBGYN at UH MacDonald Women’s Hospital in Cleveland, Ohio. “In conjunction with a healthy diet and medications, it is a very important part of treating the disease.”

Yet it’s not so simple as telling someone with PCOS to go for a run. In fact, some women who turn to running to deal with their PCOS find their symptoms get worse, not better. So what gives?

The answer may be in the way the athlete is eating, says Sheila Leard, RD, CSSD, CPT, and Board-Certified Specialist in Sports Dietetics. Seventy percent of women with PCOS also have insulin resistance, which is why a major dietary recommendation for those with PCOS is to avoid carbohydrates and sugar. This is at odds with the way most athletes are told to fuel while training and racing. Bars, gels, and chews are often high-carbohydrate sugar bombs—great for quick hits of energy in most people, but less than ideal for an insulin-resistant person, who can’t use glucose from the blood for energy.

“If insulin resistance is an issue for an athlete with PCOS, then managing blood sugar is important,” says Leard. “High insulin levels can promote sugar cravings and overeating. Also, if a woman is overweight, leptin resistance can develop. This is the hormone that gives the feedback that we are full and satisfied. These hormone imbalances, combined with intense training, creates a double whammy for controlling appetite.”

But fear not—it’s possible for athletes fueling with PCOS to manage carbohydrates and have enough gas in the tank for training.

How to Fuel While Training

Think Beyond the Bars and Gels

Play around with real-food options, advises Leard: “Fueling a long workout doesn’t have to rely on gels and simple sugars. Try small potatoes, nut butters, or homemade energy balls.”

Drink Up

Hydrate the workout with a low-sugar electrolyte drink. Staying on top of hydration can reduce the chances of over-fueling during the workout. Keeping hydration levels topped off can also help reduce the intensity of cravings after the workout is completed.

Fasting? Not So Fast

For those who are trying to lose weight (or control their weight) caused by PCOS, fasting can seem like a logical option—after all, you avoid sugar and burn more calories, right? Not quite, says Leard, who discourages athletes with PCOS from under-fueling in the quest to lose weight. “Training fasted is not advised because it can increase cortisol, which can contribute to insulin resistance and make weight loss hard to achieve, especially belly fat. You need carbohydrates to train!”

Have a Post-Workout Meal Ready to Go

Before you head out the door for a long run, have a healthy meal or snack waiting for you in the fridge. “Post-workout fueling is twofold,” explains Leard. “One, it brings down cortisol, and two, it prevents you from getting too hungry. Remember, managing blood sugar is paramount, so try to eat within the hour after a long (over 90 minutes) session or intense glycogen-depleting workout.”

How to Fuel Your Daily Diet

Up Your Protein Intake

“In the daily diet, the first step is to include protein with meals,” says Leard. “This slows the rate of the insulin response.” According to a 2012 study published in the American Journal of Clinical Nutrition, replacing carbohydrates with high-quality proteins, such as fish, eggs, and nuts, reduced symptoms of PCOS.

If you struggle to get in enough protein in your diet, try and make protein the focus of your meals and snacks instead of carbohydrate foods. When you’re fueling with PCOS, eating a high protein breakfast (like an omelet) is a good way to start the day.

Know Your Carbs

It’s almost impossible to avoid carbohydrates altogether—but it is possible to choose your carbs wisely in your daily diet. “Be mindful of the types of carbohydrates that will cause insulin to rise quickly, such as low-fiber cereals, white bread, sticky rice, cookies and candy bars,” explains Leard. “Instead, seek out carbohydrates packaged naturally with fiber. Fiber creates a sense of fullness so that you are not hungry every two hours. Fiber is also extremely important for contributing to a healthy gut microbiome.”

For this one-two punch of carbs and fiber, Leard recommends selecting foods such as hardy ancient grains, sprouted breads, lentils, beans, vegetables, and whole fruit.

Still Hungry? Eat Fats

If hunger continue to persist despite eating protein and higher fiber carbohydrates, then try increasing healthy fats such as avocados, nuts, and seeds. However, if weight loss is a goal, be mindful of these calorie-dense foods.

What About Supplements?

In addition to affecting insulin levels, PCOS is associated with a range of nutrient deficiencies. Even with a healthy diet, some women may find they have low levels of certain nutrients. Leard recommends consulting with a medical professional to evaluate certain deficiencies associated with PCOS, including Vitamin D, magnesium, Vitamin B12, inositol, and iron.


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