Many women with polycystic ovary syndrome (PCOS) tend to have a larger body size and may struggle with weight loss, but there is a smaller group with lean bodies who also have PCOS. Approximately 20% of women with PCOS maintain a normal or low body mass index (BMI) and may not exhibit common symptoms like irregular menstrual cycles or acne. This can often lead to these women being overlooked or undiagnosed.
PCOS is a complex condition with varying phenotypes, meaning the symptoms and their severity can differ regardless of a woman’s weight or body composition. Adding to the complexity, women from different ethnic backgrounds may exhibit different symptoms or phenotypes. For instance, East Asian women with PCOS and elevated testosterone levels are less likely to show physical signs of high testosterone, such as hair loss, acne, or facial hair.
Similarly, women with PCOS who do not experience weight gain may also display different symptoms. However, regardless of BMI, women with PCOS are more likely to have elevated insulin levels, insulin resistance, hormonal imbalances like increased testosterone, thickening of the uterine lining, and physical symptoms such as irregular periods, acanthosis nigricans (darkened skin creases), and facial hair growth.
Lean PCOS vs. PCOS
Most cases of PCOS are characterized by at least one of the following:
– Elevated androgen levels
– Irregular menstrual cycles or lack of ovulation
– Small cysts on one or both ovaries
Both lean and obese individuals with PCOS typically share similar metabolic profiles, including comparable levels of visceral adipose tissue (body fat), which plays a significant role in hormonal regulation and bodily processes.
Other common features of both lean and obese PCOS include low-grade inflammation and oxidative stress—an imbalance between free radicals and antioxidants in the body. However, there are distinctions between lean and obese PCOS, particularly in terms of body composition and hormonal profiles.
Insulin Resistance in Lean PCOS
Insulin resistance, where the body’s cells do not respond properly to insulin during glucose metabolism, can occur in both forms of PCOS. Even with lower levels of body fat, individuals with PCOS may still experience high blood insulin levels and insulin resistance.
However, the prevalence of insulin resistance is generally lower in individuals with lean PCOS. One study found that 83.3% of participants with lean PCOS experienced insulin resistance, compared to 93.1% of those with overweight or obese PCOS. Research in this area is ongoing, as it remains unclear whether insulin resistance affects individuals with lean PCOS to the same extent as those with overweight or obese PCOS.
Symptoms of Lean PCOS
Common symptoms of PCOS include:
– Irregular menstrual cycles
– Excessive hair growth on the face and other areas (hirsutism)
– Acne
– Thinning hair
– Skin tags
– Darkened skin patches, especially in areas like the groin, under the breasts, and along neck creases
People with lean PCOS are particularly prone to experiencing symptoms often associated with puberty, such as acne, irregular periods, and depression.
9 nutrition tips to help manage your lean PCOS
If weight loss isn’t the solution, how can you effectively manage lean PCOS? Maintaining a healthy weight is crucial, and if your body fat percentage is too low, you may not ovulate regularly. Healthy weight gain can actually be important to ensure regular and healthy ovulation and menstrual cycles.
1. Don’t Demonize Carbohydrates!
Many people believe that maintaining a healthy weight means reducing carbs, but this isn’t true. Carbohydrates are essential for maintaining stable blood sugar levels. Low blood sugar can lead to dizziness, fainting, blurred vision, shakiness, rapid heart rate, and intense hunger. Choosing the right kinds of carbs is important, especially if you are insulin-resistant. Opt for carbs rich in fiber, B vitamins, and whole grains, which also provide inositol—a key nutrient for women with PCOS. If you’re very active, carbohydrates become even more important to fuel your exercise routines. Consult Veera Health experts to develop a plan tailored to you.
2. Opt for Lower GI Foods
Low-GI (glycemic index) carbohydrates release sugar slowly into your bloodstream, helping your body’s insulin stores keep up. Some examples include:
– Basmati or brown rice instead of jasmine rice
– Multigrain, wholemeal, or sourdough bread instead of white bread
– Fresh fruits and vegetables
– Low-fat milk, unsweetened yogurt, and low-fat cheese
Spread your carbohydrate intake throughout the day and stick to recommended portion sizes.
3. Load Up on Vegetables
Fresh, whole fruits and vegetables are great sources of antioxidants, fiber, vitamins, and minerals—all crucial for managing PCOS.
4. Prioritize Protein
Organize your meals around lean protein sources, which help keep you full while stabilizing blood sugar levels. Choose lean cuts of meat, such as chicken breasts instead of thighs, pork loins instead of ham, and extra lean beef mince. Incorporating 1-2 meat-free days each week is also a great idea. Try plant-based protein-rich dishes like tofu stir-fries, kidney bean nachos, or lentil dhal. Legumes are especially beneficial for managing PCOS.
5. Incorporate Resistance Exercise
Research shows that women with lean PCOS who include resistance exercise in their routine have lower abdominal fat, higher lean muscle mass, and lower circulating testosterone levels. Resistance exercises include:
– Lifting weights, even using dumbbells during a morning walk
– Using resistance bands during floor workouts
– Bodyweight exercises like squats, push-ups, and planks
6. Make Breakfast Your Largest Meal of the Day
A study published in *Clinical Science* involved 60 lean women with PCOS, who were divided into two groups with different meal distributions. One group consumed a high-calorie breakfast (980 calories), a moderate lunch (640 calories), and a small dinner (190 calories). The other group ate a small breakfast (190 calories), a moderate lunch (640 calories), and a high-calorie dinner (980 calories). The women who had a larger breakfast experienced reductions in insulin, glucose, and testosterone levels, along with increased ovulation rates.
7. Take Vitamin D
Vitamin D, functioning as both a hormone and a vitamin, shows promise in aiding conception and reducing the risk of diabetes in women with PCOS. A review published in the *European Journal of Endocrinology* highlighted the role of vitamin D in female reproduction, including its positive effects on IVF outcomes and PCOS. The authors suggested that vitamin D supplementation might improve menstrual regularity and metabolic issues in women with PCOS.
Vitamin D deficiency is common among women with PCOS, with one study in the *European Journal of Endocrinology* reporting a 73% prevalence rate. Factors influencing vitamin D levels include poor dietary intake, sunscreen use, and geographic location, particularly in areas with less sunlight.
To determine if you need vitamin D supplementation, consult Veera Health nutritionists.
8. Don’t Forget Omega-3 Fats
Omega-3 fats may help improve insulin resistance and reduce hirsutism in lean women with PCOS. A study published in the *Journal of Obstetrics and Gynecology* involved 45 non-obese women with PCOS who took 1,500 milligrams of omega-3 fats daily for six months. The study found reductions in BMI and insulin levels, as well as improvements in LH, testosterone, and SHBG levels.
Avocados, nuts, and seeds are plant-based sources of omega-3 fats, while cold-water fish like salmon, tuna, and trout are excellent animal sources. Government guidelines recommend that Americans consume two servings of fish per week to meet the essential omega-3 fat requirements. Fish oil supplements can also help fulfill these needs.
9. Consider Inositol
Inositol is one of the most widely studied dietary supplements for women with PCOS. Both Myo-inositol (MYO) and D-Chiro-inositol (DCI) have been shown to improve various metabolic and reproductive aspects of PCOS, including cholesterol, insulin, and androgen levels. Additionally, MYO has been found to enhance fertility by improving egg quality and restoring menstrual regularity.
Learn more with Veera
At Veera Health, our nutritionists create personalized meal plans that evolve with each client’s needs and requirements. They focus on ingredients that enhance immunity, keeping you healthy and strong throughout the year. Each plan is carefully crafted to deliver the essential nutrients when you need them most. With Veera Health, your well-being is always in tune with the seasons.
